Desafios para o trabalho da disseminação científica em saúde pública em contexto de disseminação do coronavírus / Challenges for the scientific dissemination work in public health in the context of the coronavirus dissemination / Desafíos para el trabajo de la diseminación científica en salud pública en contexto de la diseminación del coronavirus

Durante a pandemia, em que o mundo se viu preocupado com a disseminação de um microrganismo, trabalhamos com a disseminação de pesquisas em saúde pública no Núcleo de Disseminação Científica do PMA/VPPCB/Fiocruz. Objetivamos neste artigo discutir como sentidos distintos do termo disseminação se relacionam e impactam a saúde pública e refletir sobre como o contexto da pandemia influenciou nosso processo de trabalho em disseminação científica. Como estratégia metodológica, adotamos o relato de experiência pela análise documental dos relatórios dos autores, comparando atividades e reflexões que ilustram o percurso de transição entre o trabalho realizado pelos profissionais em 2019 em contraste a 2020, diante do contexto da pandemia. Nesse período, foi necessário adaptar o trabalho para ser feito remotamente. As etapas da disseminação, como a produção e a circulação, modificaram-se para seguir protocolos de segurança e incluir as devidas contextualizações.

In pandemic times, when the whole world is concerned about a microorganism dissemination, we are working with the dissemination of public health researches at PMA/VPPCB/Fiocruz's Scientific Dissemination Nucleus. We aim to discuss how these different meanings of the term dissemination relate to and impact public health and to reflect on how the pandemic context has influenced the scientific dissemination work process. As a methodological strategy, we have adopted the experience report by using document analysis of the author's work reports, comparing activities and reflections which illustrate the transition between work performed by professionals in 2019 in contrast with 2020, in the context of the pandemic. In this period, it was necessary to readapt the work so that it could be done remotely. The dissemination steps, such as production and circulation, were modified to follow health protocols and to include the appropriate contextualization.

Durante la pandemia, en que el mundo está preocupado por la propagación de un microorganismo, estamos trabajando con la diseminación de la investigación en salud pública en el Núcleo de Disseminação Científica PMA / VPPCB / Fiocruz. Nuestro objetivo en este artículo es discutir cómo los distintos significados del término diseminación se relacionan e impactan en la salud pública y reflexionar sobre cómo el contexto de pandemia influenció en nuestro proceso de trabajo en diseminación científica. Como estrategia metodológica, se adoptó el relato de experiencia mediante el análisis documental de los informes de los autores, comparando actividades y reflexiones que ilustran el camino de transición entre el trabajo realizado por los profesionales en 2019 frente a 2020, en el contexto pandémico. Durante este período, fue necesario adaptar el trabajo para que se realizara de forma remota. Las etapas de diseminación, como producción y circulación, se han modificado para seguir protocolos de seguridad e incluir contextualizaciones adecuadas.

Mercado de trabalho e processos regulatórios - a Enfermagem no Brasil / Labor market and regulatory processes - Nursing in Brazil

Resumo O presente artigo faz uma análise do mercado de trabalho dos profissionais da Enfermagem, a partir dos dados obtidos através da Pesquisa Perfil da Enfermagem no Brasil (Cofen - Fiocruz), evidenciando que uma parcela significativa desses trabalhadores, a maioria auxiliares e técnicos de enfermagem, vivem em condições precárias de sobrevivência, com precarização, multiempregos e a insegurança no ambiente de trabalho cada vez mais frequentes, o que os impede de exercerem com dignidade suas atividades laborais. Analisa também o processo de regulação da Enfermagem, tendo como referencial a sociologia das profissões, a partir da criação do Sistema Conselho Federal/Conselhos Regionais de Enfermagem, na década de 1970, quando a categoria passa a ter autonomia da autorregulação, sendo que na atualidade, a profissão demonstra possuir um marco legal robusto e altamente regulador, considerando o quantitativo de resoluções emitidas pelo Cofen, que impactam sobre o exercício profissional. O artigo aponta como sendo essencial que o Estado desenvolva e aprimore as políticas de gestão do trabalho e de regulação, de modo a contribuir para a superação dos problemas enfrentados pela Enfermagem.

Abstract The present article analyzes the job market of nursing professionals, based on data obtained through the survey "Nursing Profile in Brazil" (Cofen - Fiocruz), showing that a significant portion of these workers, mostly nursing aides and technicians, live in increasingly precarious conditions of survival, with low wages, multi-employment and insecurity in the work environment, which prevents them from performing their work activities with dignity. It also analyzes the Nursing regulation process, having as reference the sociology of professions, from the creation of the Federal Nursing Council/Regional Nursing Councils System, in the 1970s, when the category started to have self-regulation autonomy, and currently, the profession shows a robust and highly regulatory legal milestone, considering the number of resolutions issued by Cofen, which have an impact on professional practice. The article points out that it is essential for the government to develop and improve job management and regulation policies, in order to contribute to overcome the problems faced by nursing professionals.

Assessing community health workers' conditions for delivering care to patients in low-income communities.

In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.

Labor market and regulatory processes - Nursing in Brazil. / Mercado de trabalho e processos regulatórios ­ a Enfermagem no Brasil.

The present article analyzes the job market of nursing professionals, based on data obtained through the survey "Nursing Profile in Brazil" (Cofen - Fiocruz), showing that a significant portion of these workers, mostly nursing aides and technicians, live in increasingly precarious conditions of survival, with low wages, multi-employment and insecurity in the work environment, which prevents them from performing their work activities with dignity. It also analyzes the Nursing regulation process, having as reference the sociology of professions, from the creation of the Federal Nursing Council/Regional Nursing Councils System, in the 1970s, when the category started to have self-regulation autonomy, and currently, the profession shows a robust and highly regulatory legal milestone, considering the number of resolutions issued by Cofen, which have an impact on professional practice. The article points out that it is essential for the government to develop and improve job management and regulation policies, in order to contribute to overcome the problems faced by nursing professionals.

O presente artigo faz uma análise do mercado de trabalho dos profissionais da Enfermagem, a partir dos dados obtidos através da Pesquisa Perfil da Enfermagem no Brasil (Cofen - Fiocruz), evidenciando que uma parcela significativa desses trabalhadores, a maioria auxiliares e técnicos de enfermagem, vivem em condições precárias de sobrevivência, com precarização, multiempregos e a insegurança no ambiente de trabalho cada vez mais frequentes, o que os impede de exercerem com dignidade suas atividades laborais. Analisa também o processo de regulação da Enfermagem, tendo como referencial a sociologia das profissões, a partir da criação do Sistema Conselho Federal/Conselhos Regionais de Enfermagem, na década de 1970, quando a categoria passa a ter autonomia da autorregulação, sendo que na atualidade, a profissão demonstra possuir um marco legal robusto e altamente regulador, considerando o quantitativo de resoluções emitidas pelo Cofen, que impactam sobre o exercício profissional. O artigo aponta como sendo essencial que o Estado desenvolva e aprimore as políticas de gestão do trabalho e de regulação, de modo a contribuir para a superação dos problemas enfrentados pela Enfermagem.

Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas.

Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.

Risk factors for arbovirus infections in a low-income community of Rio de Janeiro, Brazil, 2015-2016.

BACKGROUND: Dengue epidemics have occurred in the city of Rio de Janeiro (Brazil) since 1986. In the year 2015, Zika and chikungunya viruses were introduced in the city, causing sequential and simultaneous epidemics. Poor socioeconomic conditions have been suggested as contributing factors of arboviral infection. OBJECTIVE: To describe the spatial distribution of human cases of symptomatic arboviral infections and to identify risk factors for infection in a poor community of Rio de Janeiro in the years 2015 and 2016. METHODS: We built thematic maps of incidence rates for 78 micro-areas in the Manguinhos neighborhood. The micro-areas congregate about 600 inhabitants. Simple and multiple multilevel logistic regression models were used to evaluate the association between the incidence of arboviral diseases and socio-demographic factors at both the individual and micro-area levels. RESULTS: From 2015 to 2016, 370 human cases of arbovirus infection were reported in the Manguinhos community: 123 in 2015 and 247 in 2016. There was a significant difference in the risk of arbovirus diseases among different micro-areas, but this was not explained by water and sanitation indicators. The cumulative incidence rate was 849/100,000 in two years. The incidence was greater in those individuals with familiar vulnerability (1,156/100,000 vs. 794/100,000). The multilevel adjusted model showed that the odds of acquiring an arbovirus infection was 55% greater in those with familiar vulnerability. CONCLUSION: Arbovirus infections cause a high burden of disease in Brazilian urban centers. Our results suggest that even in poor neighborhoods, there is a high spatial variability in the risk of acquiring an arbovirus infection. The conditions that favor vector proliferation and infection by arboviruses are complex and involve both individual and environmental characteristics that vary from place to place. To reduce the burden of arboviral diseases, continued public health policies and basic services should be provided to the communities at risk that consider specific local needs.

A gestão do trabalho e o contexto da flexibilização no Sistema Único de Saúde / Labour management and increased flexibility within the Unified Health System

A precarização do trabalho é discutida entre as três esferas de governo, e políticas foram desenvolvidas para a busca de soluções. O objetivo deste estudo foi analisar como as políticas de gestão do trabalho no SUS têm enfrentado essa situação, adotando como método a análise documental das produções do CONASS e CONASEMS á luz da agenda do Ministério da Saúde. Conclui-se que há consenso entre eles em relação ao conceito de trabalho precário e que a flexibilização dos vínculos é necessária em determinadas situações, respeitando as normas administrativas. A condução das políticas ocorreu de forma participativa, pactuada, colegiada. Há um momento político favorável e evolutivo para a construção de consensos. Foram conquistados avanços com possibilidades de resolução da problemática em questão.

Following discussions between the three governmental spheres about the degradation of labour, policies have been developed to provide solutions. The purpose of this study was to analyse SUS Labour Management policies in relation to this situation. Documents produced by the CONASS and CONSASEMS were reviewed in light of the Ministry of Health agenda. It is concluded that there consensus regarding the concept of precarious labour and that more flexible employment relations are required in certain situations, without infringing any administrative regulations. The policies were developed collegially, with general participation and agreement, and taking advantage of the favorable political and progressive climate for achieving consensus. Steps forward have been made, offering the possibility of resolving the issues as stake.

[Use of clinical guidelines and the results in primary healthcare for hypertension]. / Utilização de diretrizes clínicas e resultados na atenção básica à hipertensão arterial.

This study aimed to identify strategies to implement clinical guidelines for hypertension in a primary healthcare unit, focusing on the effects of the Family Health Program (FHP) and government Pharmaceutical Home Delivery Program (PHDP) on adherence to guidelines by health professionals and the results of care. The data were obtained from a registry of 5,499 hypertensive patients, stratified according to registration in the FHP and PHDP. The random selection procedure resulted in samples of 150 patient charts in three strata and one stratum (without the FHP or PHDP) with only 22 patient charts. Descriptive statistics and linear regression models were obtained, incorporating the structural information from the sample design (sample strata and weight). Based on information recorded on the patient charts, adherence to clinical guidelines was extremely low. A positive effect had been expected from the FHP and PHDP in terms of adherence to clinical guidelines and results of care. A trend towards a positive effect was observed for the PHDP and a slightly favorable performance for the FHP for adherence to clinical guidelines.

Utilização de diretrizes clínicas e resultados na atenção básica à hipertensão arterial / Use of clinical guidelines and the results in primary healthcare for hypertension

Este estudo objetivou identificar estratégias facilitadoras da implantação de diretrizes clínicas de hipertensão arterial em uma unidade de atenção básica, focalizando os efeitos do Programa Saúde da Família (PSF) e do Programa Remédio em Casa na adesão dos profissionais e nos resultados assistenciais. Partiu-se de um cadastro com 5.499 pacientes hipertensos, estratificados segundo inscrição no PSF e no Programa Remédio em Casa. O procedimento de seleção aleatória adotado resultou em amostras de 150 prontuários em três estratos e um estrato (sem PSF e sem PRC) com somente 22 prontuários. Estatísticas descritivas e modelos de regressão linear foram obtidos, incorporando-se as informações estruturais do desenho da amostra utilizado (estratos e peso amostrais). A adesão às diretrizes clínicas, segundo registros nos prontuários, foi muito baixa. Esperava-se um efeito positivo das estratégias PSF e Programa Remédio em Casa na adesão às diretrizes clínicas e resultados assistenciais. Observou-se a tendência de um efeito positivo do Programa Remédio em Casa nos resultados assistenciais e um desempenho levemente favorável do PSF na adesão às diretrizes clínicas.

This study aimed to identify strategies to implement clinical guidelines for hypertension in a primary healthcare unit, focusing on the effects of the Family Health Program (FHP) and government Pharmaceutical Home Delivery Program (PHDP) on adherence to guidelines by health professionals and the results of care. The data were obtained from a registry of 5,499 hypertensive patients, stratified according to registration in the FHP and PHDP. The random selection procedure resulted in samples of 150 patient charts in three strata and one stratum (without the FHP or PHDP) with only 22 patient charts. Descriptive statistics and linear regression models were obtained, incorporating the structural information from the sample design (sample strata and weight). Based on information recorded on the patient charts, adherence to clinical guidelines was extremely low. A positive effect had been expected from the FHP and PHDP in terms of adherence to clinical guidelines and results of care. A trend towards a positive effect was observed for the PHDP and a slightly favorable performance for the FHP for adherence to clinical guidelines.

A gestão do trabalho e o contexto da flexibilização no Sistema Único de Saúde / Work management and flexibility in the context of the National Health System

A Reforma Sanitária, devido à reorientação do modelo de assistência, impulsionou a ampliação do número de estabelecimentos de saúde e da força de trabalho, especialmente no nível da Atenção Básica em Saúde tornando, junto com a descentralização, os municípios nos maiores gestores do SUS. Por outro lado, a Reforma do Estado ocorrida especialmente na década de 1990 representou aimplantação de um modelo para administração pública que impulsionou a adoção de formas contratuais baseadas na flexibilização. Estes dois contextos, juntos, repercutiram na facilitação da expansão da força de trabalho, porém conduzindo a um quadro elevadode precarização dos vínculos devido à forma como foi conduzida a flexibilização. A Gestão do Trabalho no SUS, oriunda da incorporação de conceitos das Ciências da Economia e da Sociologia do Trabalho, possui como objetivo elaborar, implantar eimplementar políticas para a área, tendo como modelo de gestão ideal aquele baseado na flexibilização, na descentralização e na negociação. Atualmente o contexto da Gestãodo Trabalho envolve 2,5 milhões de empregos na esfera pública, com uma força de trabalho majoritariamente pertencente ao nível municipal, com diferenças importantes entre as regiões brasileiras, e em torno de 30 por cento desta está inserida através de formascontratuais consideradas precárias. Este estudo teve como objetivo analisar como as políticas de Gestão do Trabalho no SUS têm enfrentado esta grave situação, adotando como método a análise documental de publicações do Ministério da Saúde, CONASS e do CONASEMS e entrevistas aos representantes dos Núcleos de Políticas de Recursos Humanos em Saúde do CONASS e de Gestão do Trabalho e Educação na Saúde do CONASEMS. Através deste estudo pode-se concluir que há consenso entre o Ministérioda Saúde, o CONASS e o CONASEMS em relação ao conceito de trabalho precário e que...

Due to re-orientation of the model of assistance, the Healthy Care Reform impelled the expansion in numbers of health establishments and of work, chiefly in level of Primary Care in Health, turning the municipal district, together with the decentralization to be the greatest manager of SUS. On the other hand, the Reform of State occurred especially in the decade of 1990 represented the deployment of a model for public administration thatspurred the adoption of contractual forms based on the flexibilization. Both contexts together reflected in the facilitation of the workforce expansion, leading, however, to a high framework of precarious contractual forms, due to the forms of how the flexibilitywas conducted. The Labor Management in Health in SUS, derived from incorporation of concepts of Sciences of Economics and Sociology Labor, has as objective to elaborate, to implant and implement politics for the area, having as model of ideal management that one based on flexibility, decentralization and negotiation. Currently the context of Labor Management involves 2.5 million jobs in the public sphere, with aworkforce mostly belonging to the municipal level, with important differences among Brazilian regions, and about 30% of that is inserted through contractual forms considered as precarious. This study had as objective to analyse the way in which thepolitics of the Labor Management in Health in SUS have faced this serious situation, adopting as method the documentary analysis of publications of Health Department, CONASS and CONASEMS and interviews with the representatives of Cores of HumanResources Politics in the Health of CONASS and Management of Labor and Education in Health of CONASEMS. By this study, we can conclude there is consensus among the Department of management Labours in Health, CONASS e CONASEMS, in relation tothe concept of precarious work and that, concerning to flexibility of contractual forms, this one is necessary...