Lockdown or participatory health surveillance? Lessons from the Covid-19

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Lockdown ou vigilância participativa em saúde? Lições da Covid-19

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[decentralization Of Workers' Health Surveillance In The City Of Campinas, São Paulo State, Brazil: A Process Evaluation].

This study evaluates the decentralization of workers' health surveillance to district teams in Campinas, São Paulo State, Brazil, from 1990 to 2006. The history and context of this process were retrieved from documents at the Municipal Health Department in order to establish evaluation criteria and define facilitating factors and obstacles in guideline implementation, as well as to measure the gap between guidelines and reality. The evaluation used qualitative techniques with stakeholders' focus groups. The results showed that decentralization was defined according to the prevailing political options and according to the principles of the Unified National Health System (SUS). Facilitating factors included the increase in technical capability and integration among the teams, and obstacles included excessively centralized planning with limited participation, insufficient resources, and lack of clarity between the services concerning roles and responsibilities. The discussion of these results with health system administrators, social actors, and participating health professionals has contributed to the analysis and organization of transformative measures in regional public practices in workers' health surveillance.27759-6

Workers Health service delivery by primary care units in the Brazilian Unified Health System: a case-study in Campinas, São Paulo, Brazil

ABSTRACT OBJECTIVE: The purpose of this study was to analyze the implementation of workers' health and epidemiological surveillance services at the primary healthcare units (UBS) of the Brazilian Unified Health System (SUS) in Campinas, São Paulo, Brazil. METHOD: Qualitative and quantitative methods were combined to yield a parallax approach to the research object. Work-related injuries and diseases recorded in 2006 were selected to investigate whether UBS conducted surveillance actions and if preventive and protective changes had occurred in work processes and environment. Professionals in charge of workers' health surveillance in the units were interviewed. RESULTS: The study showed that healthcare and disease notification were successfully implemented, mainly those with the purpose of reporting work injuries. Nevertheless, poor recognition was given to the causal links of workrelated diseases; they were dealt bureaucratically, and their epidemiologic relevance for decision taking was neglected. Informal workers did not receive specific attention. Administration of local health units still demands specific protocols to establish their role in integrating information systems to workers' health surveillance in primary care level. CONCLUSION: Decentralization of workers' health service was only partially implemented in the primary healthcare units in Campinas.RESUMO OBJETIVO: avaliar o processo de implantação das ações de vigilância em saúde do trabalhador nas Unidades Básicas de Saúde (UBS) do SUS, em Campinas, SP. Métodos: foram usados métodos qualitativos e quantitativos para produzir uma aproximação sob diferentes aspectos do objeto em estudo. Os acidentes e as doenças relacionados ao trabalho registrados em 2006 foram eleitos para verificar se as UBS conduziram ações de vigilância e se ocorreram mudanças preventivas e protetoras no processo de trabalho e no ambiente. Realizamos entrevistas com os profissionais responsáveis pela vigilância em saúde do trabalhador das unidades. RESULTADOS: as ações de atenção à saúde e a notificação foram implantadas com êxito principalmente para acidentes de trabalho. Todavia, o vínculo das doenças relacionadas com o trabalho foi menos reconhecido. Os acidentes e as doenças receberam uma abordagem burocrática, negligenciando a relevância epidemiológica para a tomada de decisão. Trabalhadores do mercado informal não receberam ações específicas. A gestão dos sistemas locais de saúde ainda necessita de regras específicas para estabelecer seu papel na integração dos sistemas de informação com a vigilância da saúde do trabalhador na atenção primária. CONCLUSÃO: o presente estudo apontou que a descentralização da vigilância da saúde do trabalhador para a atenção primária foi parcialmente efetivada em Campinas.21622

Esgotamento profissional, qualidade e intenções entre enfermeiros de saúde da família

Objetivo: analisar como enfermeiros de saúde da família avaliam qualidade do cuidado; verificar se têm intenção de deixar o trabalho atual e a enfermagem; estimar prevalência de esgotamento profissional e correlacionar variáveis. Método: estudo transversal e correlacional com 198 enfermeiros. Foi utilizado o Maslach Burnout Inventory, questões para caracterizar os enfermeiros, para avaliar percepção sobre a qualidade do cuidado e de recursos materiais e humanos e para verificar intenções de deixar o trabalho atual e a enfermagem. Resultados: a maioria dos enfermeiros avalia a qualidade do cuidado como boa, 28,0% apresenta exaustão emocional, há intenção de deixar o trabalho atual e a enfermagem. Conclusão: enfermeiros de saúde da família vivenciam esgotamento profissional que apresenta correlação com diminuição da qualidade do cuidado e com aumento das intenções de deixar o trabalho atual e a enfermagem.Objective: to analyze how family health nurses assess quality of care; check if they have any intention of leaving their current job and nursing; estimate prevalence of professional exhaustion; and correlate these variables. Method: cross-sectional and correlational study with 198 nurses. The Maslach Burnout Inventory was applied, as it has questions for characterizing nurses, assessing perception on quality of care and of material and human resources, and verifying intention of leaving current work and nursing. Results: most nurses assess quality of care as good, 28.0% present emotional exhaustion, there is intention of leaving current work and nursing. Conclusions: family health nurses experience professional exhaustion, which in turn presents correlation with decreased quality of care and increased intentions of leaving current work and nursing.Objetivo: analizar como enfermeros de salud de la familia evalúan la calidad del cuidado; verificar si tienen intención de dejar el trabajo actual y la enfermería; estimar la prevalencia de agotamiento profesional y correlacionar variables. Método: estudio transversal y correlacional con 198 enfermeros. Se utilizó el Maslach Burnout Inventory, cuestiones para caracterizar a los enfermeros, para evaluar percepción sobre la calidad del cuidado y de recursos materiales y humanos, así como para verificar intenciones de dejar el trabajo actual y la enfermería. Resultados: la mayoría de los enfermeros evalúa la calidad del cuidado como buena, el 28,0% presenta agotamiento emocional, con intención de dejar el trabajo actual y la enfermería. Conclusión: enfermeros de salud de la familia experimentan agotamiento profesional que presenta correlación con disminución de la calidad del cuidado y con aumento de las intenciones de dejar el trabajo actual y la enfermería

Self-reported musculoskeletal symptoms among nursing personnel

The aim of this cross-sectional study was to evaluate musculoskeletal symptoms among female members of the nursing personnel. The sample consisted of 105 female nursing aides and technicians who were working at a university hospital with highly dependent patients. The questionnaire was composed of items on demographic and job-factor information and the symptom section was a modification of the "Nordic Musculoskeletal Questionnaire". In this study, 93% of the health workers reported at least one musculoskeletal symptom in the previous 12 months. The highest prevalence of musculoskeletal disorders was in the following anatomical areas: low back (59%), shoulders (40%), knees (33.3%) and neck (28.6%). As a result of musculoskeletal pain, 29.5% of the respondents reported missing work and 47.6% reported having had an appointment to see a physician in the previous 12 months. Limited experience on the job and in the present unit were also observed among those who had more frequent complaints of pain in the knees (p=0.0272) and low back pain (p=0.0332), respectively. However, hand/wrist pain occurred more often among the participants with the higher numbers of weekly worked hours (OR=3.72:1.26Este trabalho teve por objetivo avaliar sintomas músculo-esqueléticos em trabalhadoras de enfermagem. Os sujeitos compreenderam 105 auxiliares e técnicos de enfermagem que trabalhavam em unidades de internação de um hospital que atende pacientes com alto grau de dependência física. Utilizou-se um questionário contendo dados demográficos e ocupacionais e queixas osteomusculares, dentro de uma abordagem ergonômica, adaptado do Nordic Musculoskeletal Questionnaire. Das participantes, 93% referiram algum tipo de sintoma osteomuscular nos últimos 12 meses. As mais elevadas prevalências desses sintomas, segundo as áreas anatômicas, foram: região lombar (59%), ombros (40%), joelhos (33,3%) e região cervical (28,6%). Verificou-se também que, das respondentes, 29,5% faltaram ao trabalho e 47,6% consultaram um médico nos últimos 12 meses devido aos mesmos sintomas. Observou-se também menor tempo de trabalho na área de enfermagem e na unidade atual entre as trabalhadoras com ocorrência maior de dor nos joelhos (p=0,0272) e dor lombar (p=0,0332), respectivamente. No entanto, a dor em punhos/mãos mostrou-se mais freqüente entre as participantes com maior número de horas semanais trabalhadas (OR=3,72Este trabajo tuvo por objetivo evaluar síntomas músculo-esqueléticos en trabajadoras de enfermería. Los sujetos fueron 105 auxiliares y técnicas de enfermería que trabajaban en unidades de hospitalización de una institución hospitalaria de pacientes con alto grado de dependencia física. Se utilizó un cuestionario conteniendo datos demográficos y ocupacionales y quejas osteomusculares dentro de un abordaje ergonómico, adaptado del "Nordic Musculoskeletal Questionnaire". De las participantes, 93% refirieron algún tipo de síntoma osteomuscular en los últimos 12 meses. Las más elevadas prevalencias de esos síntomas según las áreas anatómicas fueron: región lumbar (59%), hombros (40%), rodillas (33,3%) y región cervical (28,6%). Se verificó también que de las entrevistadas, 29,5% faltó al trabajo y 47,6% consultó un médico en los últimos 12 meses debido a los mismos síntomas. Se observó también menor tiempo de trabajo en el área de enfermería y en la unidad actual entre las trabajadoras con mayor ocurrencia de dolor en las rodillas (p=0,0272) y dolor lumbar (p=0,0332), respectivamente. No obstante, el dolor en puños/manos se mostró más frecuente entre las participantes con mayor número de horas semanales trabajadas (OR=3,7

[self-reported Musculoskeletal Symptoms Among Nursing Personnel].

The aim of this cross-sectional study was to evaluate musculoskeletal symptoms among female members of the nursing personnel. The sample consisted of 105 female nursing aides and technicians who were working at a university hospital with highly dependent patients. The questionnaire was composed of items on demographic and job-factor information and the symptom section was a modification of the Nordic Musculoskeletal Questionnaire. In this study, 93% of the health workers reported at least one musculoskeletal symptom in the previous 12 months. The highest prevalence of musculoskeletal disorders was in the following anatomical areas: low back (59%), shoulders (40%), knees (33.3%) and neck (28.6%). As a result of musculoskeletal pain, 29.5% of the respondents reported missing work and 47.6% reported having had an appointment to see a physician in the previous 12 months. Limited experience on the job and in the present unit were also observed among those who had more frequent complaints of pain in the knees (p=0.0272) and low back pain (p=0.0332), respectively. However, hand/wrist pain occurred more often among the participants with the higher numbers of weekly worked hours (OR=3.72:1.26<OR<11.12; p=0.0141).11608-1

Food consumption and working conditions in manual sugarcane harvesting in São Paulo state

ObjectiveTo describe the working conditions and aspects related with food consumption amongst manual workers in sugar-cane crops intending to contribute to developing public policies towards workers’ health surveillance and delivering comprehensive services. MethodDirect observation at the work field in upstate São Paulo and a semi-structured questionnaire were conducted with a group of forty sugar-cane migrant workers who came from Ceará state to work as hand harvesters in São Paulo state, over 15 days during the 2007/2008 crop season. Socio-demographic data, water consumption, food consumption and cultural habits, hydro-electrolyte reposition, work pauses, body pains and duration of working days were registered. ResultWorkers ingested 5 to 10 liters of water/day and the dilution of electrolytes replacement was below the adequate recommendations. Food consumptions during the crop season did not ensure food and nutritional security. Food consumption was monotonous, conserved and consumed at inadequate temperature, and incompatible with cultural habits, implying reduction and wastage of food. Workers reported pains and cramps during the work day. Pauses for resting were insufficient. Payment by results, the working process and payment practices were taken as determinants of a wide range of precarious conditions to which these workers were subjected. The hand harvesting of sugar-cane is extenuating and the payment by results may be a grievance for health as it implies reducing the work resting pauses. Food consumption and adequate hydration could minimize the working wear and pains during the job.ObjetivoDescrever as condições de trabalho e aspectos relacionados à alimentação do trabalhador no corte manual de cana para contribuir para desenvolver políticas públicas de vigilância e atenção integral em Saúde do Trabalhador. MétodoForam utilizados a observação direta do trabalho no campo em colheita no estado de São Paulo e aplicado questionário semi-estruturado a um grupo de 40 cortadores manuais de cana migrantes procedentes do estado do Ceará, durante 15 dias da safra 2007/2008. Aspectos sócio-demográficos, consumo de água, reposição eletrolítica, alimentação e aspectos culturais, pausas, dores e a jornada de trabalho foram registrados. ResultadoOs trabalhadores ingerem de 5 a 10 litros de água/dia e a diluição dos repositores eletrolíticos foi inferior à adequada. A alimentação durante a safra não garantia a segurança alimentar e nutricional. A alimentação foi monótona, conservada e consumida em temperatura inadequada, e incompatível com os hábitos culturais, gerando desperdício e redução do consumo alimentar. Os trabalhadores relataram dores e câimbras no decorrer da jornada. As pausas para descanso foram insuficientes. O pagamento pela quantidade de produção, o processo de trabalho e as práticas de pagamento foram considerados determinantes da situação de precariedade ampla a que estes trabalhadores estavam submetidos. O trabalho no corte manual de cana é extenuante e o pagamento por produção pode ser um agravante para a saúde, pois implica na redução das pausas para descanso. A alimentação e hidratação corretas poderiam minimizar o desgaste e as dores durante o trabalho.Universidade Federal de AlfenasUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Saúde PúblicaUniversidade Estadual de Campinas Faculdade de Ciências MédicasUNIFESPSciEL

Uso de drogas psicotrópicas por estudantes: prevalência e fatores sociais associados

OBJECTIVE: To determine the prevalence of the heavy use of drugs among elementary and high school students in a sample of public and private schools, and to identify associated demographic, psychological, cultural and social factors. METHODS: This report describes a cross-sectional study using an intention-type sampling technique that compared public schools in central and peripheral areas and private schools. An anonymous self-administered questionnaire was applied. The sample consisted of 2,287 elementary and high school students in the city of Campinas in 1998. Heavy use of drugs was defined as the use of drugs on 20 or more days during the 30 days preceding the survey (WHO, 1981). For the statistical analysis, polytomic logistic regression analysis (logit model) was utilized to identify factors that influenced this manner of using drugs. RESULTS: Heavy use of legal and illegal drugs was found as follows: alcohol (11.9%), tobacco (11.7%), marijuana (4.4%), solvents (1.8%), cocaine (1.4%), medications (1.1%) and ecstasy (0.7%). The heavy use of drugs was greatest among students at the city-center public school who had daytime jobs and studied in the evenings. These students were in the A and B socioeconomic classes and had had little religious education during childhood. CONCLUSIONS: Greater availability of cash and specific socialization patterns were identified as factors associated with the heavy use of drugs among students.OBJETIVO: Determinar a prevalência do uso pesado de drogas por estudantes de primeiro e segundo graus em uma amostra de escolas públicas e particulares, e identificar fatores demográficos, psicológicos e socioculturais associados. MÉTODOS: Trata-se de um estudo transversal com uma técnica de amostragem do tipo intencional comparando-se escolas públicas de áreas periféricas e centrais e escolas particulares. Foi utilizado um questionário anônimo de autopreenchimento. A amostra foi constituída por 2.287 estudantes de primeiro e segundo graus da cidade de Campinas, SP, no ano de 1998. Considerou-se uso pesado, o uso de drogas em 20 dias ou mais nos 30 dias que antecederam a pesquisa. Para análise estatística, utilizou-se a análise de regressão logística politômica - modelo logito, visando identificar fatores que influenciem este modo de usar drogas. RESULTADOS: O uso pesado de drogas lícitas e ilícitas foi de: álcool (11,9%), tabaco (11,7%), maconha (4,4%), solventes (1,8%), cocaína (1,4%), medicamentos (1,1%), ecstasy (0,7%). O uso pesado foi maior entre os estudantes da escola pública central, do período noturno, que trabalhavam, pertencentes aos níveis socioeconômicos A e B, e cuja educação religiosa na infância foi pouco intensa. CONCLUSÕES: Maior disponibilidade de dinheiro e padrões específicos de socialização foram identificados como fatores associados ao uso pesado de drogas em estudantes

[religion And Drug Use By Adolescents].

Many international studies show that religion is an important dimension modulating the use of alcohol and drugs by adolescents. to determine which religious variables are associated to frequent or heavy use of alcohol, tobacco and drugs among adolescents in intermediate and high schools in Campinas, Brazil. A cross-sectional study using a self-report anonymous questionnaire was administered to 2,287 students from a convenience sample of seven schools: five from central areas (two public and three private schools) and two public schools from the outskirts of the city, in 1998. The study analyzes data regarding the use of alcohol, tobacco, medicines, solvents, marijuana, cocaine and ecstasy. The religious variables included in the regression analysis were: religious affiliation, church attendance, self-assessed religiousness, and religious education in childhood. For the substances, nicotine, alcohol, marijuana, cocaine, ecstasy and abuse of medicines a logistic regression analysis for dicotomic answer was applied. The heavy use of at least one drug during the last month was more frequent among students that did not have a religious education during childhood. The use in the last month of cocaine, ecstasy and (abuse of) medicines was more frequent among those students that had no religion (cocaine and medicines) and that did not have a religious education during childhood (ecstasy and medicines). this study is consistent with previous investigations demonstrating a strong influence of religious variables over the use of drugs among adolescents. Interesting, it was found that no or weaker religious education during childhood was markedly associated with significant more use of drugs during adolescence.2682-9