Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations.

BACKGROUND: Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). METHODS: We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. RESULTS: The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. DISCUSSION: PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Implementation of evidence-based nutritional management in primary health care settings: a systematic scoping review.

Scientific evidence is used to inform clinical nutritional guidelines in order to prevent diseases and promote health. However, little is known about the process of implementing evidence-based clinical nutritional guidelines in health services. This scoping review aims to map the steps in the implementation of evidence-based nutritional management within primary health care, as well as the facilitators and barriers to implementation. Electronic databases and the grey literature were searched for original studies on the implementation of evidence-based dietary recommendations and/or nutritional counselling in primary health care settings conducted by health practitioners. Studies were selected by independent reviewers. Extracted data were analysed and grouped into thematic categories and are presented in a narrative synthesis. In all, 26 studies were included. A review of the studies demonstrated four steps in the process of implementing evidence-based nutritional management in primary care: (1) acknowledging health needs in the catchment area and determining the characteristics of services and health professionals; (2) developing continuing education aimed at practitioners; (3) integrating nutritional management into interprofessional practice; and (4) adapting the interventions using a patient-centred care approach. The predominant facilitators were providers' pre-intervention training and the provision of support materials. Barriers included time constraints, a lack of resources and an incompatibility of the interventions with living conditions and patients' health needs.

Médicos e terceirização: percepções de trabalhadores e gestores sobre as transformações recentes no mercado de trabalho / Doctors and outsourcing: perceptions of workers and managers on recent transformations in the labor market / Médicos y tercerización: percepciones de trabajadores y directivos sobre los cambios recientes en el mercado laboral

Resumo O artigo examina as tendências recentes da forma de inserção dos médicos no mercado de trabalho à luz da regulação das relações trabalhistas na percepção de informantes-chave que atuam nos setores público e privado do sistema de saúde no estado de São Paulo. O estudo mostrou que, na percepção dos entrevistados, há uma tendência crescente de inserção de médicos como pessoa jurídica condicionada pela regulação das relações de trabalho e pela política de contratação dos estabelecimentos provedores de serviços de assistência à saúde. Em geral, a 'pejotização' de médicos foi associada à perda de autonomia desses profissionais em relação aos termos de contratação e às condições de realização do trabalho. O artigo conclui que a inserção 'pejotizada' de médicos se apresenta como parte do movimento mais geral de barateamento da força de trabalho associado à terceirização, e indica que há espaço para a exploração de políticas voltadas à gestão de trabalhadores que busquem atrair e fixar médicos no Sistema Único de Saúde.

Abstract The article examines recent trends in the way doctors enter the labor market in the light of the regulation of labor relations in the perception of key informants who work in the public and private sectors of the health system in the state of São Paulo, Brazil. The study showed that, in the perception of the interviewees, there is a growing trend of insertion of doctors as a legal entity conditioned by the regulation of labor relations and the contracting policy of establishments providing health care services. In general, the 'pejotização' (hiring free of labor rights/illegal hiring) of doctors was associated with the loss of autonomy of these professionals in relation to the terms of employment and the conditions for performing the work. The article concludes that the illegal hiring and insertion of doctors is presented as part of the more general movement of cheapening the workforce associated with outsourcing, and indicates that there is room for the exploitation of policies aimed at the management of workers who seek to attract and fix doctors in the Unified Health System.

Resumen El artículo examina las tendencias recientes acerca de como se dá la inserción de los médicos en el mercado de trabajo, a la luz de la regulación de las relaciones laborales, en la percepción de informantes clave que actúan en los sectores público y privado del sistema de salud del estado de São Paulo, Brasil. El estudio mostró que, en la percepción de los entrevistados, existe una tendencia creciente hacia la inclusión de los médicos como persona jurídica condicionada por la regulación de las relaciones laborales y por la política de contratación de los establecimientos que prestan servicios de asistencia a la salud. En general, la 'pejotización' de los médicos estuvo asociada a la pérdida de autonomía de estos profesionales en relación a los términos de contratación y a las condiciones de ejercicio del trabajo. El artículo concluye que la inserción 'pejotizada' de los médicos se presenta como parte del movimiento más general de abaratamiento de la mano de obra asociado a la tercerización, e indica que hay espacio para la exploración de políticas dirigidas a la gestión de trabajadores que busquen atraer y retener a los médicos en el Sistema Único de Salud.

Mapping the implementation of evidence-based nutritional management in primary health care settings: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to systematically map and categorize the wide variety of interventions and programs that might be classified under the umbrella term "evidence-based nutritional management in primary healthcare". The development of this scoping review will provide a better understanding of how evidence-based nutritional management has been implemented by healthcare professionals in primary health care settings, especially of barriers and facilitators to implementing evidence-based nutritional management. Therefore, three research questions were chosen to guide the scoping review.

Parâmetros para dimensionamento de médicos na Estratégia de Saúde da Família / Parameters for staffing physicians in the Family Health Strategy

O planejamento adequado da força de trabalho é imprescindível a bons resultados que se deseja alcançar nos sistemas de saúde. Na atenção primária, o dimensionamento de médicos baseia-se, tradicionalmente, na razão de profissionais por população (ex.: médico/habitante; médico/paciente) ou relação entre produção e capacidade instalada. Contudo, os métodos de planejamento precisam estar baseados em evidências e utilizar dados precisos sobre as necessidades de saúde e recursos humanos. Objetivo geral: analisar a carga de trabalho do médico em unidades de saúde da família no Brasil. Método: Estudo de natureza exploratório-descritiva, de campo, com abordagem quantitativa. Foram selecionadas 27 unidades de saúde da família (USF), em 12 municípios brasileiros, avaliadas com desempenho ótimo, pelo Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ciclo 1 (PMAQ-AB), do Departamento de Atenção Básica do Ministério da Saúde (DAB-MS). Foram observados 47 médicos presentes nas USF, a cada 10 minutos, durante a jornada típica de trabalho. Para identificação das intervenções/atividades realizadas foi utilizado um instrumento de medida de carga de trabalho elaborado e validado por especialistas. A análise dos dados foi realizada por região geográfica, estratos do PMAQ e turnos do dia. Além disso, os parâmetros obtidos neste estudo foram aplicados no método WISN (Workload Indicators of Staffing Need) para dimensionar o quantitativo de médicos de uma unidade. Resultados: Foram realizadas 8544 observações distribuídas entre intervenções, atividades associadas, atividades pessoais, tempo de espera e ausência, o que configurou uma amostra representativa nacional. As intervenções diretas mais frequentes foram consulta (62,95%) e atendimento a demanda espontânea (21,97%). As intervenções documentação (34,89%), troca de informações sobre os cuidados de saúde (24,69%) e apoio ao estudante (21,84%) foram as intervenções indiretas de maior percentual. O tempo médio de consulta foi de 15 minutos. Os médicos estão ausentes 54,05% do tempo de sua jornada de trabalho. Conclusão: Os dados possibilitaram uma análise nacional das atividades desenvolvidas pelo médico na ESF, bem como a distribuição na jornada de trabalho. O comportamento foi semelhante em todo o país, chamando atenção para o percentual de ausências do profissional estudado. Os resultados podem, então, subsidiar discussões sobre o processo de trabalho do médico e o planejamento de recursos humanos na atenção primária em saúde

Proper planning of the workforce is imperative to the good outcomes that health systems want to achieve. In primary care, staffing physician is traditionally based on the ratio of professionals by population (eg, physician/inhabitants, physician/patient) or in the relationship between production and installed capacity. However, planning methods need to be evidence-based and use accurate data on health needs and human resources. Objective: to analyze the workload of the physician in family health units in Brazil. Method: Study exploratory-descriptive, with a field work and quantitative approach. Twenty-seven family health units (USF) were selected in twelve Brazilian municipalities evaluated with optimal performance by the National Program for Improvement of Access and Quality of Primary Care cycle 1 (PMAQ-AB) of the Department of Primary Care of the Ministry of Health (DAB-MS), configured as a national representative sample. We observed 47 physicians present at the USF, every 10 minutes during the typical working day. To identify the interventions/activities performed, a workload measurement instrument was elaborated and validated by specialists. Data analysis was performed by geographic region, PMAQ strata and day shifts. In addition, the parameters obtained in this study were applied in the Workload Indicators of Staffing Need (WISN) method, to size the quantity of physicians of a unit. Results: There were 8544 observations distributed among interventions, associated activities, personal activities, waiting time and absence. The most frequent direct interventions were consultation (62.95%) and meeting spontaneous demand (21.97%). The indirect interventions with the highest percentage were documentation (34.89%), information exchange on health care (24.69%) and student support (21.84%). The mean time of consultation was 15 minutes. The doctors are absent 54.05% of the time of their work day. Conclusion: The data made possible a national analysis of the activities developed by the doctors in the USF, as well as the distribution in the working day. The behavior was similar across the country, drawing attention to the percentage of absences of the professional studied. The results can then subsidize discussions about the physician's work process and the planning of human resources in primary health care

Quimioterapia hipertérmica intraperitoneal transoperatória: o que a enfermagem precisa saber / Intraoperative hyperthermic intraperitoneal chemotherapy: what nurses should know / Quimioterapia intraperitoneal hipertérmica transoperatória: qué necesita saber la enfermería

Objetivo: apresentar o estado do conhecimento científico sobre quimioterapia hipertérmica intraperitoneal transoperatória no tratamento da carcinomatose peritoneal e os cuidados de enfermagem pós-operatórios para pacientes submetidos a essa terapia. Métodos: apresentam-se aspectos técnicos da quimioterapia hipertérmica intraperitoneal transoperatória, suas complicações potenciais e cuidados de enfermagem pós-operatórios envolvidos. Resultados: destaca-se a importância dos cuidados de enfermagem, quais sejam: monitorar sinais vitais, perfusão periférica, débito cardíaco e pressão venosa central; avaliar dor; encorajar tosse e realização de exercícios de respiração profunda; registrar drenagem de ferida operatória e drenos; investigar ruídos intestinais; medir volume residual gástrico; promover mudanças de decúbito; avaliar resultados laboratoriais de exames sanguíneos; instituir balanço hídrico e; aferir peso corporal. Conclusão: a quimioterapia hipertérmica intraperitoneal transoperatória é terapia promissora no tratamento de pacientes com carcinomatose peritoneal. Entretanto, para ser bem-sucedida, a prestação de cuidados de enfermagem é fundamental.

Objective: to present the current state of scientific knowledge about intraoperative hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis, and postoperative nursing care for patients undergoing this therapy. Methods: the study describes technical aspects of intraoperative hyperthermic intraperitoneal chemotherapy, the potential complications and post-operative nursing care involved. Results: emphasis was placed on the importance of nursing care, viz.: monitoring of vital signs, peripheral perfusion, cardiac output, and central venous pressure; pain assessment; encouraging coughing and deep breathing exercises; recording drainage of surgical wound and drains; investigating bowel sounds; measuring gastric residual volume; ensuring change of decubitus; evaluating laboratory blood test results; establishing water balance; and measuring body weight. Conclusion: intraoperative hyperthermic intraperitoneal chemotherapy has been shown to be a promising therapy in treatment of patients with peritoneal carcinomatosis. However, to be successful, the nursing care provided is fundamental.

Objetivo: presentar el estado del conocimiento científico sobre quimioterapia intraperitoneal hipertérmica transoperatoria en el tratamiento de la carcinomatosis peritoneal y los cuidados de enfermería posoperatorios para pacientes sometidos a ella. Métodos: se presentan aspectos técnicos de la quimioterapia intraperitoneal hipertérmica transoperatoria, sus complicaciones potenciales y cuidados de enfermería posoperatorios involucrados. Resultados: se destaca la importancia de los cuidados de enfermería: monitorear señales vitales, perfusión periférica, débito cardíaco, presión venosa central; evaluar dolor; estimular la tos y realización de ejercicios de respiración profunda; registrar drenaje de herida operatoria y drenes; investigar ruidos intestinales; medir volumen residual gástrico; promover cambios de decúbito; evaluar resultados de análisis de sangre en laboratorio; establecer balance hídrico; verificar peso corporal. Conclusión: la quimioterapia intraperitoneal hipertérmica transoperatoria es terapia prometedora en el tratamiento de pacientes con carcinomatosis peritoneal. Sin embargo, para ser exitosa, la prestación de cuidados de enfermería es fundamental.

Evaluation of a Novel Hybrid Viable Bioprosthetic Mesh in a Model of Mesh Infection.

BACKGROUND: The reported incidence of mesh infection in contaminated operative fields is as high as 30% regardless of material used. Our laboratory previously showed that augmenting acellular bioprosthetic mesh with allogeneic mesenchymal stem cells (MSC) enhances resistance to bacterial colonization in vivo and preserves mesh integrity. This study's aim was to determine whether augmentation of non-crosslinked porcine dermis (Strattice) with commercially available, cryopreserved, viable MSC-containing human placental tissue (Stravix) similarly improves infection resistance after inoculation with Escherichia coli (E. coli) using an established mesh infection model. METHODS: Stravix was thawed per manufacturer's instructions and 2 samples were tested for cell viability using a Live/Dead Cell assay at the time of surgery. Rats (N = 20) were implanted subcutaneously with 1 piece of Strattice and 1 piece of hybrid mesh (Strattice + Stravix sutured at the corners). Rats were inoculated with either sterile saline or 106 colony-forming units of E. coli before wound closure (n = 10 per group). At 4 weeks, explants underwent microbiologic and histologic analyses. RESULTS: In E. coli-inoculated animals, severe or complete mesh degradation concurrent with abscess formation was observed in 100% (10/10) hybrid meshes and 90% (9/10) Strattice meshes. Histologic evaluation determined that meshes inoculated with E. coli exhibited severe acute inflammation, which correlated with bacterial recovery (P < 0.001). Viability assays performed at the time of surgery failed to verify the presence of numerous live cells in Stravix. CONCLUSIONS: Stravix cryopreserved MSC-containing human umbilical tissue does not improve infection resistance of a bioprosthetic mesh in vivo in rats after inoculation with E. coli.

Bone Marrow-Derived Mesenchymal Stem Cells Enhance Bacterial Clearance and Preserve Bioprosthetic Integrity in a Model of Mesh Infection.

BACKGROUND: The reported incidence of mesh infection in contaminated operative fields is as high as 30% regardless of the material used. Recently, mesenchymal stem cells (MSCs) have been shown to possess favorable immunomodulatory properties and improve tissue incorporation when seeded onto bioprosthetics. The aim of this study was to evaluate whether seeding noncrosslinked bovine pericardium (Veritas Collagen Matrix) with allogeneic bone marrow-derived MSCs improves infection resistance in vivo after inoculation with Escherichia coli (E. coli). METHODS: Rat bone marrow-derived MSCs at passage 3 were seeded onto bovine pericardium and cultured for 7 days before implantation. Additional rats (n = 24) were implanted subcutaneously with MSC-seeded or unseeded mesh and inoculated with 7 × 10(5) colony-forming units of E. coli or saline before wound closure (group 1, unseeded mesh/saline; group 2, unseeded mesh/E. coli; group 3, MSC-seeded mesh/E. coli; 8 rats per group). Meshes were explanted at 4 weeks and underwent microbiologic and histologic analyses. RESULTS: MSC-seeded meshes inoculated with E. coli demonstrated superior bacterial clearance and preservation of mesh integrity compared with E. coli-inoculated unseeded meshes (87.5% versus 0% clearance; p = 0.001). Complete mesh degradation concurrent with abscess formation was observed in 100% of rats in the unseeded/E. coli group, which is in contrast to 12.5% of rats in the MSC-seeded/E. coli group. Histologic evaluation determined that remodeling characteristics of E. coli-inoculated MSC-seeded meshes were similar to those of uninfected meshes 4 weeks after implantation. CONCLUSIONS: Augmenting a bioprosthetic material with stem cells seems to markedly enhance resistance to bacterial infection in vivo and preserve mesh integrity.

Long-term epigenetic alterations in a rat model of Gulf War Illness.

Gulf War Illness (GWI) is a chronic, multisymptom illness that affects 25% of the 700,000 US veterans deployed to the Persian Gulf during the 1990-1991 Gulf War. Central nervous system impairments are among the most common symptoms reported, including memory dysfunction and depression. After 25 years, the diagnosis remains elusive, useful treatments are lacking, and the cause is poorly understood, although exposures to pyridostigmine bromide (PB) and pesticides are consistently identified to be among the strongest risk factors. Epigenetic changes including altered microRNA (miRNA) expression and DNA methylation play an important role in learning, memory, and emotion regulation and have been implicated in various neurological disorders. In this study, we used an established rat model of GWI to determine whether 1) chronic alterations in miRNA expression and global DNA methylation and DNA hydroxymethylation are mechanisms involved in the pathobiology of GWI, and 2) plasma exosome small RNAs may serve as potential noninvasive biomarkers of this debilitating disease. One year after a 28-day exposure regimen of PB, DEET (N,N-diethyl-3-methylbenzamide), permethrin, and mild stress, expression of 84 mature miRNAs and global 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) content were analyzed in the brains of GWI rats and vehicle controls by PCR array and enzyme-linked immunosorbent assay, respectively. Plasma exosome RNA next-generation sequencing analysis was performed in pooled samples to discover potential noninvasive biomarkers. We found that combined exposure to low doses of GW-related chemicals and mild stress caused epigenetic modifications in the brain that persisted one year after exposure, including increased expression of miR-124-3p and miR-29b-3p in the hippocampus and regional alterations in global 5mC and 5hmC content. GW-relevant exposures also induced the differential expression of two piwi-interacting RNAs (piRNAs) in circulation (piR-007899 and piR-019162). Results from this study implicate a role for epigenetic alterations in GWI. Evaluation of the diagnostic potential of plasma exosome RNAs in veterans with GWI is warranted.

Tumor-to-tumor metastases in Cowden's disease: an autopsy case report and review of the literature.

Tumor-to-tumor metastasis is a rare phenomenon, but it has been suggested to be more frequent in patients with hereditary cancer syndrome. We report an autopsy case of tumor-to-tumor metastasis in a 75-year-old male. At 6 months before his death, the patient complained of hoarseness and dysphagia, and clinical whole-body examinations revealed advanced lung adenocarcinoma (T4N2M1b, Stage IV), multiple skin verrucas, gastrointestinal polyposis, goiters, and cerebellar dysplastic gangliocytoma (Lhermitte-Duclos disease), while PTEN gene mutation was detected in his serum. An mTOR inhibitor had been used to treat his lung adenocarcinoma, but he developed aspiration pneumonia and died of respiratory failure. Autopsy revealed that the lung adenocarcinoma had metastasized to cavernous hemangiomas of the right atrial appendage and liver, to cerebellar dysplastic gangliocytoma and to multiple organs such as the liver, kidney, adrenal glands and spine. This is the first reported case of Cowden's disease with multiple tumor-to-tumor metastases.

An experimental comparison of the effects of bacterial colonization on biologic and synthetic meshes.

PURPOSE: Biologic meshes are being used with increasing frequency to repair contaminated abdominal wall defects despite high long-term recurrence and infection rates associated with their use. Recent clinical reports describing the success of lightweight, macroporous synthetic meshes in contaminated ventral hernia repairs have led some surgeons to challenge the belief that synthetics are contraindicated in contaminated fields. We aimed to determine whether a frequently used biologic mesh (Strattice(TM)) is more resistant to bacterial colonization than macroporous synthetic mesh (Parietex(TM) Progrip(TM)) after inoculation with two common pathogens. METHODS: Rats (n = 48) were implanted subcutaneously with Strattice(TM) or Progrip(TM). Meshes were inoculated with sterile saline or a suspension containing 10(6) colony-forming units of Staphylococcus aureus or Escherichia coli prior to wound closure (n = 8 per subgroup). Meshes were explanted at 4 weeks and underwent microbiologic and histologic analyses. RESULTS: Progrip(TM) demonstrated superior bacterial clearance compared to Strattice(TM) (E. coli, 88 vs. 17% clearance, p = 0.03; S. aureus, 75 vs. 50%, p = 0.61; combined bacterial strains, 81 vs. 36%, p = 0.02; respectively). In the Strattice(TM) group, severely degraded meshes were observed in 100% of animals inoculated with E. coli (but 0% inoculated with S. aureus). In contrast, all Progrip(TM) meshes remained intact regardless of inoculum. Scores for neovascularization were higher in the synthetic group irrespective of contamination (p < 0.05). CONCLUSIONS: Biologic meshes may not be more resistant to bacterial colonization than reduced-weight synthetics, and their resistance may differ in response to different pathogens. The routine use of biologics in contaminated ventral hernia repair should be questioned, particularly in the presence of E. coli.

A influência da estratégia saúde da família sobre indicadores de saúde em municípios do Rio de Janeiro, Brasil / La influencia de la estrategia de la salud de la familia de los indicadores de la salud en los municipios de Rio de Janeiro, Brasil / The influence of family health strategy on health indicators in the municipalities of Rio de Janeiro, Brazil

Este estudo objetiva analisar o comportamento de indicadores de saúde segundo implantação da Saúde da Família nos municípios do Rio de Janeiro, Nova Iguaçu e Duque de Caxias. Trata-se de estudo ecológico de séries temporais de variáveis selecionadas no período de 1998 a 2010. Os dados foram coletados nos endereços eletrônicos do DATASUS e do Departamento de Atenção Básica, posteriormente exportados e tabulados em planilha eletrônica e analisados através de estatística inferencial com cálculo de coeficiente de Pearson (r) e teste t ao nível de significância de 5% (?=0,05). Constataram-se fortes correlações negativas com significância estatística entre evolução da saúde da família e: número de óbitos por doenças infectoparasitárias no Rio de Janeiro e em Duque de Caxias; frequência de internações infantis por diarréia no Rio de Janeiro e em Nova Iguaçu; e frequência de internações por diabetes mellitus no Rio de Janeiro. Depreende-se que a estratégia de saúde da família exerceu influência no comportamento dos indicadores de saúde dos municípios estudados, no entanto, pesquisas subseqüentes serão necessárias para investigar mais profundamente influência da saúde da família em municípios com grande densidade demográfica.

This study examines the behavior of health indicators deployment of Family Health in the cities of Rio de Janeiro, Nova Iguaçu and Duque de Caxias. This is ecological study of time series of selected variables in the period 1998 to 2010. Data were collected at the websites of DATASUS and Department of Primary Care and later exported into a spreadsheet, tabulated and analyzed using inferential statistics with calculation of Pearson coefficient (r) and t test at a significance level of 5% (α = 0.05). There was a strong negative correlation with statistical significance between the evolution of family health and: number of deaths from infectious and parasitic diseases in Rio de Janeiro and Duque de Caxias; frequency of hospitalized children with diarrhea in Rio de Janeiro and Nova Iguaçu; and frequency of hospitalization for diabetes mellitus in Rio de Janeiro. It is concluded that the strategy of family health influence the behavior of health indicators for the cities studied, however, further research will be needed to investigate further the impact of family health in cities with high population density.

Este estudio tiene como objetivo analizar el comportamiento de los indicadores de salud en el segundo despliegue de Salud de la Familia en las ciudades de Río de Janeiro, Nova Iguaçu y Duque de Caxias. Este estudio ecológico de series temporales de las variables seleccionadas en el período comprendido entre 1998 y 2010. Los datos fueron recolectados en los sitios web de DATASUS y el Departamento de Atención Primaria y posteriormente sean exportados a una hoja de cálculo y tabulados y analizados mediante estadística inferencial con el cálculo del coeficiente de Pearson (r) y la prueba t con un nivel de significancia del 5% (α = 0,05). Hubo una fuerte correlación negativa con significación estadística entre la evolución de la salud de la familia: número de muertes por enfermedades infecciosas y parasitarias en Río de Janeiro y Duque de Caxias, la frecuencia de los niños hospitalizados con diarrea en Río de Janeiro y Nueva Delhi, y con frecuencia de ingresos para la diabetes en Río de Janeiro. Al parecer, la estrategia de salud de la familia influyen en el comportamiento de los indicadores de salud de las ciudades estudiadas, sin embargo, investigaciones posteriores será necesario seguir investigando la influencia de la salud de la familia en las ciudades con alta densidad de población.

Agentes comunitários de saúde: a visão dos usuários do psf da região de saúde de Juiz de Fora / Community health workers: perception of users from the Juiz de Fora family health program

Neste artigo buscou-se obter uma visão geral da percepção dos usuários sobre o trabalho do agente comunitário desaúde nas comunidades em que atua, contemplando aspectos da sua inserção, assim como foi avaliada em que nívelas atividades dos agentes são percebidas e incorporadas na prática de saúde da população. Para tal, elaborou-se um questionário contendo questões abertas e fechadas que foi respondido por 330 usuários. De forma específica, evidencia que os usuários percebem que a assistência melhorou após a entrada do agente, sem negligenciar os aspectos e características que devam ser modificados e observados no perfil desse trabalhador e no próprio serviço de saúde.

In this article we assessed the perception of users of the family health program about the work implemented by the community health agent. The agents insertion, and the degree to which their actions are perceived by the population and incorporated into their health practices were also assessed. A questionnaire, composed of open and closed questions, was answered by 330 users. Care was seen tohave improved after the entry of the health agents, althoughsome features amenable to improvement and concerningthe agents profile and the health system were identified.

A formação do enfermeiro para atuação na atenção básica: uma análise segundo as diretrizes do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) / The nursing education for performancein the primary care: an analysis according to the guidelines of the “Reorientation National Program of Health Professional Formation (Pró-Saúde)

O processo de institucionalização do Sistema Único de Saúde (SUS) já duravinte anos e uma das medidas de organização e implementação é o fortalecimento da Atenção Básica, via Estratégia de Saúde da Família, procurando atender à população de acordo com as realidades locais. Nesse contexto, a partir de 1996, a Lei de Diretrizes e Bases da Educação Nacional e as Diretrizes Curriculares dos cursos de Educação Superior modificam a qualificação do profissional de saúde com vistas ao processo de trabalho no SUS. Esta pesquisa teve como objetivo analisar a formação do enfermeiro na perspectiva do trabalho na Saúde da Família no município do Rio de Janeiro. Foi realizado estudo de caso múltiplo em duas instituições de ensino superior que possuem curso de graduação em enfermagem, utilizando uma abordagem quali-quantitativa de natureza descritivo-exploratória. O instrumento de coleta de dados foi um survey aplicado por meio de questionário aosalunos dos últimos períodos das instituições escolhidas. O eixo norteador da construção do questionário foram as diretrizes do Programa Nacional deReorientação da Formação Profissional em Saúde (Pró-Saúde), escolhido por ser um programa que visa à indução de medidas de transformação do ensino de saúde no Brasil, com ênfase na Atenção Básica. Os dados obtidos foram processados e tabulados através do software R versão 2.10.0 e receberam tratamento estatístico. Os resultados apontam para um grupo de alunos de graduação em enfermagem com perfil predominantemente feminino e jovem, que reside com os pais e não contribui financeiramente com a manutenção da casa. Em relação à organização das atividades curriculares, há o predomínio da abordagem do processo saúdedoençae da saúde como um processo multideterminado, valorizando ações depromoção, prevenção, recuperação e perspectiva de vigilância da saúde...

A formação do enfermeiro para atuação na Atenção Básica: uma análise segundo as diretrizes do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) / The training of nurses to work in Primary Care: an analysis according to the guidelines of the National Program for Reorientation of Vocational Training in Health (Pró-Saúde)

INTRODUÇÃO: O processo de institucionalização do Sistema Único de Saúde (SUS) já dura vinte anos e uma das medidas de organização e imple mentação é o fortalecimento da Atenção Básica, via Estratégia de Saúde da Família, procurando atender à população de acordo com as realidades locais. Nesse contexto, a partir de 1996, a Lei de Diretrizes e Bases da Educação Nacional e as Diretrizes Curriculares dos cursos de Educação Superior modificam a qualificação do profissional de saúde com vistas ao processo de trabalho no SUS. OBJETIVO: Esta pesquisa teve como objetivo analisar a formação do enfermeiro na perspectiva do trabalho na Saúde da Família no município do Rio de Janeiro. MATERIAL E MÉTODO: Foi realizado estudo de caso múltiplo em duas instituições de ensino superior que possuem curso de graduação em enfermagem, utilizando uma abordagem quali-quantitativa de natureza descritivo-exploratória. O instrumento de coleta de dados foi um survey aplicado por meio de questionário aos alunos dos últimos períodos das instituições escolhidas. O eixo norteador da construção do questionário foram as diretrizes do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde), escolhido por ser um programa que visa à indução de medidas de transformação do ensino de saúde no Brasil, com ênfase na Atenção Básica. Os dados obtidos foram processados e tabulados através do software R versão 2.10.0 e receberam tratamento estatístico. RESULTADOS: Os resultados apontam para um grupo de alunos de graduação em enfermagem com perfil predominantemente feminino e jovem, que reside com os pais e não contribui financeiramente com a manutenção da casa.Em relação à organização das atividades curriculares, há o predomínio da abordagem do processo saúde doença e da saúde como um processo multideterminado, valorizando ações de promoção, prevenção, recuperação e perspectiva de vigilância da saúde. Em relação aos campos de prática, as diferenças observadas nas duas instituições estudadas estão relacionadas à precocidade e predominância da inserção dos alunos nos campos. Em ambas as instituições, prevalece a expectativa profissional dos alunos em buscar aprimoramento profissional após concluírem a graduação. CONCLUSÃO: Assim sendo, foi possível verificar que a continuidade e o fortalecimento do incentivo às instituições para a adesão ao programa aproximará cada vez mais a formação do enfermeiro ao modelo de atenção proposto pelo SUS, repercutindo desta forma na qualidade do atendimento prestado aos usuários do sistema de saúde brasileiro.

INTRODUCTION: The institutionalization of the Brazilian Unified Health System (SUS) has been going on for twenty years and one of the organization and implementation measure is the strengthening of Primary Care, through "Family health strategy", which aims to serve the population according to the local context. Since 1996, there have been changes in the Brazilian Educational Law and in the Curriculum Guidelines of the higher education programmes regarding the qualification of health professionals with a view to the SUS work practice model. OBJECTIVE: This study aimed to analyze nursing education in the context of the Family Health practice in Rio de Janeiro. MATERIAL AND METHOD: A multiple case study was carried out in two institutions of higher education that have graduate programmes in nursing, and a quali-quantitative descriptive ­ exporatory approach was used. The data was collected through a survey applied to the students in the last years of the selected institutions. The framework of the questionnaire were based in the guidelines of the "Reorientation National Program of Health Professional Formation (Pró-Saúde)". This was chosen as its objective is to induce changes in the health education in Brazil, with emphasis on Primary Health Care. The data were processed and tabulated by the software version 2.10.0 and also a statistical analysis was made. RESULTS: The results showed that the graduate students in nursing are predominately female and young, who live with their parents and do not contribute financially to the maintenance of their home. Regarding academic activity, there is a predominance of multiple determinants of health-disease process, with an approach to health as a multi-determined process, emphasizing health promotion, prevention, recovery and prospects for health monitoring. The differences between selected institutions in the fields of practice are related to how early and predominant the students are placed in these fields. In both institutions, it is very high the expectation of the students to seek professional development after their graduation. CONCLUSÃO: Therefore, it was possible to demonstrate that the continuity and strengthening of the incentive for institutions to join the program could contribute to get close the nursing education to the health care model proposed by the SUS, thus impacting favorably the quality of care given to the Brazilian health system users.

O uso do tabaco entre os universitários de enfermagem da Universidade do estado do Rio de Janeiro (UERJ) / The use of tobacco among undergraduate students of nursing at Universidade do estado do Rio de Janeiro

O estudo refere-se ao hábito de fumar entre alunos de Graduação em Enfermagem da Universidade do Estado do Rio de Janeiro e tem como objetivos identificar os fatores que estimulam o uso de tabaco e verificar a sua incidência entre esses alunos. Trata-se de estudo descritivo quantitativo que investigou 213 estudantes do 1º ao 9º período, de abril a dezembro de 2004, mediante aplicação de um questionário. Os resultados demonstraram que 42

dos alunos experimentou o fumo alguma vez na vida, porém, a maioria desses (73

) não continuou o uso. Dos que continuaram (26

), 65

iniciou entre 16 e 20 anos de idade, e 53

desenvolveu o hábito por curiosidade e desejo de fumar (AU)