Arcabouço teórico-metodológico, funções e efeitos do apoio institucional à saúde no contexto do Sistema Único de Saúde / Theoretical-methodological framework, functions, and effects of institutional support in health within the Brazilian National Health System (SUS)

Resumo Os arranjos de apoio institucional têm se destacado como um modo inovador de gestão. Este artigo objetivou sumarizar e analisar o arcabouço teórico-metodológico e os efeitos do apoio institucional no contexto do Sistema Único de Saúde (SUS) e sintetizar os conceitos, as funções e as habilidades do apoiador institucional. Uma revisão de escopo foi empreendida em diferentes bases científicas, resultando em 89 publicações, cuja análise indicou que os conceitos e métodos de apoio se ancoram no Método Paideia, que intenciona a democratização da gestão. Os apoiadores institucionais, com esse objetivo, atuam como articuladores dos diversos jeitos de gerir a micropolítica dos espaços coletivos, fornecendo suporte para o movimento de ampliação da descentralização do poder e para a geração de autonomia. Os efeitos de sua aplicação expressam processos de democratização institucional, que se traduzem como dilatação da autonomia dos sujeitos nos processos decisórios, da reflexão crítica e compreensão dos processos instituídos. Esses efeitos também expressam novos modos de produzir saúde, que buscam romper com as práticas de saúde repetitivas, cristalizadas e cronificadas. As evidências publicadas não nos permitiram refletir a respeito dos limites macro e microinstitucionais concretamente encontrados na implementação do apoio, colocando-nos o desafio de adentrarmos cientificamente nas práticas de socialização de recursos de poder operadas pela função apoio.

Abstract Institutional support arrangements have stood out as an innovative mode of management. This study aimed to summarize and analyze the theoretical-methodological framework and the effects of institutional support within the Unified Health System (SUS) and synthesize the concepts, functions, and skills of the institutional supporter. A scoping review was undertaken on several scientific bases, retrieving 89 publications, the analysis of which indicated that the concepts and supporting methods are anchored in the Paideia Method, which aims to democratize management. Institutional supporters, with this objective, articulate different ways of managing the micropolitics of collective spaces, supporting the movement to expand the decentralization of power and generate autonomy. The effects of its application express processes of institutional democratization, which expand the autonomy of subjects in decision-making processes, offer critical reflection and understanding of the established processes, and new ways of producing health to break with repetitive, crystallized, and chronic health practices. The published evidence prohibits us to reflect on the macro- and micro-institutional limits concretely found in the implementation of support, posing the challenge of scientifically entering the practices of socialization of power resources operated by the support function.

A saúde do trabalhador offshore: uma análise sanitarista sobre a realidade das negociações coletivas do trabalho em alto-mar / The health of the offshore worker: a sanitarian analysis of the reality of collective negotiations on the high seas

Considerando como tema central a saúde do trabalhador, o objetivo do presente estudo foi analisar a realidade das negociações coletivas do trabalho em alto-mar, avaliando como hipótese a fragilidade no controle do poder público sobre o processo produtivo como limite da efetividade de uma realidade em prol da saúde e segurança dos trabalhadores e trabalhadoras desse setor. Para isso, foram pontuados os seguintes objetivos específicos: a) apresentar distintas concepções e valorações do trabalho humano através das perspectivas sanitarista, ocupacional e previdenciária; b) apontar como a saúde do trabalhador offshore se organiza e vem sendo estruturada; c) elencar quais são os principais atores, práticas, possibilidades e obstáculos na consolidação do controle público na garantia de direitos do trabalhador offshore; d) pautar limites e possibilidades contidos nas negociações (acordos e convenções) no âmbito de acidentes e adoecimentos decorrentes da relação laboral da categoria; e e) analisar aspectos do acidente ocorrido no dia 11 de fevereiro de 2015 na unidade estacionária de produção, armazenamento e transferência de óleo e exportação de gás da empresa BW Offshore denominada Cidade de São Mateus (FPSO CDSM), que na ocasião era afretada pela Petrobras. Assim sendo, o leitor poderá observar detalhes a respeito do mercado de petróleo e gás, tais como sua importância no contexto econômico nacional, a inserção massiva da terceirização nas relações de trabalho e prestação de serviços dessa cadeia produtiva, além das representações sindicais desse universo laborativo em específico. Será possível, ainda, compreender as diferentes concepções de saúde do trabalhador, que revelam as abordagens e os interesses diversos no campo teórico-prático quando o assunto é a saúde e a segurança no ambiente laborativo, além de se familiarizar com aspectos garantidores ou vulnerabilizantes de direitos frente às negociações coletivas entre os representantes sindicais dos trabalhadores offshore da empresa BW Offshore. Por fim, será possível observar uma análise e tentativa de compreensão mais ampla do acidente supracitado, sob a ótica do déficit de controle público sobre os processos produtivos empresariais e, por consequência, da manutenção da inobservância do Estado em mediar essas relações. (AU)

Considering workers' health as a central theme, the objective of this study was to analyze the reality of collective negotiations on the high seas work, considering as a hypothesis the fragility in the control of the public power over the productive process as a limit of the effectiveness of a reality in favor of the health and safety of workers in this sector. For this, the following specific objectives were scored: a) To present different conceptions and valuations of human work through the sanitarian, occupational and social security perspectives; b) To point out how the health of the offshore worker is organized and has been structured; c) List the main actors, practices, possibilities and obstacles in consolidating public control in guaranteeing the rights of offshore workers; d) To guide limits and possibilities contained in the negotiations (agreements and conventions) in the context of accidents and illnesses resulting from the employment relationship of the category; e) Analyzing aspects of the accident that occurred on February 11, 2015, at the stationary production, storage, and oil and gas export unit of the company BW Offshore, known as Cidade de São Mateus (FPSO CDSM), which was chartered by Petrobras. Thus, the reader will be able to observe details about the oil and gas market, such as its importance in the national economic context, the massive insertion of outsourcing in labor relations and provision of services to this production chain, in addition to the union representations of this specific labor universe. It will be possible to understand the different conceptions of workers' health, which reveal the diverse interests and approaches in the theoretical and practical field regarding health and safety in the workplace. Additionally, the reader will be able to become acquainted with aspects that guarantee or undermine rights vulnerable during collective negotiations between the union representatives of offshore workers at BW Offshore. It will be also possible to observe an analysis and attempt at a broader understanding of the aforementioned accident, understood from the perspective of the deficit of public control over the business production processes, and consequently the maintenance of the State's non-observance in mediating these relations. (AU)

Políticas desenvolvimentistas e mulheres quebradeiras de coco babaçu: capturas contemporâneas / Developmentalist policies and babassu coconut-breaking women: contemporary catches / Políticas desarrollistas y las mujeres que rompen coco babaçu: capturas contemporáneas

Este estudo propõe analisar as relações e os processos de subjetivação de mulheres quebradeiras de coco babaçu decorrentes das intervenções de políticas desenvolvimentistas em seus territórios de vida e reverberações no Movimento Interestadual de Quebradeiras de Coco Babaçu (MIQCB). Sob a perspectiva ético-estético-política da Cartografia, acompanhamos as narrativas das histórias de vida de 24 mulheres, suas atividades cotidianas e eventos do MIQCB, também analisamos os documentos das políticas. Entendemos que, ao passo que tais políticas de desenvolvimento rural contribuem para a melhoria das condições de vida, em termos materiais e simbólicos, elas também produzem ressonâncias relacionadas ao modo de subjetivação do tipo "empresário de si", que agenciam seus modos de viver, de produzir e de se relacionar consigo e com os outros na lógica capitalista neoliberal. A resistência às capturas neoliberais também estão presentes ao ampliarem as mobilizações coletivas do próprio movimento, articulando com outros na produção de um "comum".(AU)

This study proposes to analyze the relations and the processes of subjectivation of babassu coconut-breaker women arising from developmental policy interventions in their territories of life and reverberations in the Babassu Coconut-breaker Interstate Movement (MIQCB). From the ethical-aesthetic-political perspective of Cartography, we followed the narratives of the life stories of 24 women, their daily activities and promoted events by MIQCB, we also analyzed the policy documents. We understand that while these policies of rural development contribute to improve the living conditions, in material and symbolic terms, they also produce resonances related to the "self-entrepreneur" mode of subjectivation, which has been handling their ways of living, producing, and relating to themselves and others in the neoliberal capitalist logic. Resistance to neoliberal captures is also present as they expand the collective mobilizations of the movement itself, articulating with others, in the production of a "common."(AU)

Este estudio tiene como objetivo analizar los procesos de subjetivación de las mujeres que rompen coco babaçu que surgen de las intervenciones de las políticas de desarrollo en sus territorios de vida y las reverberaciones en el Movimiento Interestadual de las Mujeres que Rompen Coco Babaçu (MIQCB). Desde la perspectiva ético-estético-política de la Cartografía, seguimos las narraciones de las historias de vida de 24 mujeres, sus actividades diarias y eventos del MIQCB, y también analizamos los documentos de las políticas. Si bien estas políticas han contribuido a mejorar las condiciones de vida de las mujeres, en términos materiales y simbólicos, también han producido resonancias del modo de subjetivación "autoempresarial", que ha agenciado sus formas de vivir, producir y relacionarse consigo mismas y con los demás en la lógica capitalista neoliberal. La resistencia a las capturas neoliberales también está presente cuando amplían las movilizaciones colectivas del propio movimiento, articulándose con otros en la producción de un "común".(AU)

20 anos da comissão consultiva em avaliação psicológica: desafios da ADI 3481 / 20 years of the advisory committee on psychological assessment: challenges of ADI 3481 / 20 años de la comisión consultiva en evaluación psicológica: desafíos de la ADI 3481

A Comissão Consultiva em Avaliação Psicológica (CCAP) do Conselho Federal de Psicologia (CFP), em seu 20º aniversário, vem discutir os possíveis efeitos, ainda efetivamente desconhecidos, da Ação Direta de Inconstitucionalidade (ADI) 3481, instruída no Supremo Tribunal Federal (STF), a qual desestruturou o modo como os testes psicológicos eram comercializados no Brasil. A livre comercialização de testes psicológicos coloca em risco a segurança de avaliações psicológicas e cabe à categoria profissional pensar estratégias de enfrentamento desses riscos. Neste artigo, são discutidos possíveis efeitos da ADI 3481 para a categoria profissional da psicologia, bem como para a sociedade em geral, e são também elencadas possíveis estratégias de enfrentamento desses riscos, sem desconsiderar aspectos éticos relacionados a eles. Dessa forma, busca-se neste manuscrito, além da problematização dos efeitos derivados da ADI 3481, pensar soluções ou alternativas que venham a redirecionar a trajetória da área da avaliação psicológica no Brasil. Com isso, abre-se um espaço de discussão e encaminhamentos que a categoria profissional precisará tomar nos próximos anos.(AU)

The Advisory Commission for Psychological Assessment of the Federal Council of Psychology discusses, on its 20th anniversary, the possible and still effectively unknown effects of the Direct Action of Unconstitutionality (DAU) 3481, following the Supreme Federal Court, which interrupted how psychological tests were marketed in Brazil. The free trade of psychological tests puts the safety of psychological assessments at risk, and this professional category must think of strategies to face these risks. This study discusses the possible effects of DAU 3481 for professional psychology and for society in general, listing possible strategies for coping with these risks without disregarding its ethical aspects. Thus, this study seeks to problematize the effects derived from DAU 3481 and think of solutions or alternatives that may redirect the trajectory of the field of psychological assessment in Brazil, thus opening a space for discussion and referrals professional psychology will require in the coming years.(AU)

La Comisión Consultiva en Evaluación Psicológica (CCEP) del Consejo Federal de Psicología (CFP), en su 20.º aniversario, propone discutir los posibles efectos aún efectivamente desconocidos de la Acción Directa de Inconstitucionalidad (ADI) 3481, determinada por el Supremo Tribunal Federal (STF), por la cual trastornó la forma de comercializar las pruebas psicológicas en Brasil. La comercialización sin restricciones de las pruebas psicológicas pone en riesgo la seguridad de las evaluaciones psicológicas, y le corresponde a la categoría profesional pensar estrategias para enfrentar estos riesgos. En este artículo se discuten los posibles efectos de la ADI 3481 para la categoría profesional de la Psicología, así como para la sociedad en general, pero también se enumeran posibles estrategias para el enfrentamiento de estos riesgos, sin descuidar los aspectos éticos relacionados con ellos. Así, este manuscrito busca, además de problematizar los efectos derivados de la ADI 3481, pensar en soluciones o alternativas que puedan reconducir la trayectoria del campo de la evaluación psicológica en Brasil. Esto abre un espacio de discusión y derivaciones que la categoría profesional deberá tomar en los próximos años.(AU)

Gender, Race/Ethnicity, and Unionization in Direct Care Occupations.

Objectives. The goal of this study was to measure unionization in the direct care workforce and the relationship between unionization and earnings, looking closely at differences across race/ethnicity and gender. Methods. Using data from the Current Population Survey from 2010 to 2020, we first used logit analyses to predict the probability of unionization among direct care workers across race/ethnicity and gender. We then measured the relationship between unionization and weekly earnings. Results. We found that male (12%) and Black (14%) direct care workers were most likely to be unionized, followed by Hispanic and other direct care workers of color. Unionized direct care workers earn wages that are about 7.8% higher than nonunionized workers, but unionized workers of color earn lower rewards for unionization compared with White direct care workers. Conclusions. Unions are a mechanism for improving job quality in direct care work, and protecting workers' rights to unionize and participate in collective bargaining equitably may be a way to stabilize and grow the direct care workforce. (Am J Public Health. 2022;112(11):1676-1684. https://doi.org/10.2105/AJPH.2022.307022).

A bibliometric analysis of Health Promotion International content regarding unions, unionization and collective agreements.

A recent article brought together the health benefits of unionization and working under collective agreements. It was noted how Canadian health promotion texts, reports and statements made no mention of unionization and working under collective agreements as promoting health. This was seen as a significant omission and reasons for this were considered. In this article this analysis is extended to consider how contributors to the flagship health promotion journal Health Promotion International (HPI) conceptualize unions, unionization and working under collective agreements as promoting health. Of 2443 articles published in HPI since its inception, 87 or 3.6% make mention of unions, unionization, collective agreements or collective bargaining, with most saying little about their promoting health. Instead, 20 make cursory references to unions or merely see them as providing support and engagement opportunities for individuals. Forty-five depict unions or union members as involved in a health promotion programme or activity carried out by the authors or by government agencies. Only 33 articles explicitly mention unions, unionization or collective agreements as potentially health promoting, representing 1.3% of total HPI content since 1986. We conclude that the health promoting possibilities of unionization and working under collective agreements is a neglected area amongst HPI contributors. Reasons for this are explored and an Organisation for Economic Cooperation and Development report on the importance of collective bargaining is drawn upon to identify areas for health promotion research and action.

The health effects of wage setting institutions: How collective bargaining improves health but not because it reduces inequality.

Do wage-setting institutions, such as collective bargaining, improve health and, if so, is this because they reduce income inequality? Wage-setting institutions are often assumed to improve health because they increase earnings and reduce inequality and yet, while individual-level studies suggest higher earnings improve well being, the direct effects of these institutions on mortality remains unclear. This paper explores both the relationship between wage-setting institutions and mortality rates whether income inequality mediates this relationship. Using 50 years of data from 22 high-income countries (n ~ 825), I find mortality rates are lower in countries with collective bargaining compared to places with little or no wage protection. While wage-setting institutions may reduce economic inequality, these institutions do not appear to improve health because they reduce inequality. Instead, collective bargaining improves health, in part, because they increase average wage growth. The political and economic drivers of inequality may not, then, be correlated with health outcomes, and, as a result, health scholars need to develop more nuanced theories of the political economy of health that are separate from but in dialogue with the political economy of inequality.

Volunteers as members of the stroke rehabilitation team: a qualitative case study.

OBJECTIVES: Clinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers' place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement. DESIGN: A qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada. PARTICIPANTS: 28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed. RESULTS: While there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments. CONCLUSIONS: An interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.

What Should Physicians Consider Prior to Unionizing?

Physicians considering unionization face many practical, emotional, and moral obstacles. Even some who feel that a collective bargaining unit is necessary remain concerned that patient care could suffer if physicians unionize. This article discusses unionized physicians' moral obligations to patient populations and health care systems' share in this responsibility. It argues that unionization can be done ethically as long as union actions are focused on improving patient care.

Language effects on bargaining.

Language is critical to coordination in groups. Though, how language affects coordination in groups is not well understood. We prime distributive and integrative language in a bargaining experiment to better understand the links between group outcomes and communication. We accomplish this by priming interests or positions language in randomized groups. We find that priming positions as opposed to interests language leads to agreements where controllers, subjects with unilateral authority over the group outcome, receive a larger share of the benefits but where the total benefits to the group are unaffected. In contrast to common justifications for the use of integrative language in bargaining, our experimental approach revealed no significant differences between priming interests and positions language in regards to increasing joint outcomes for the groups. Across treatments, we find subjects that use gain frames and make reference to visuals aids during bargaining experience larger gains for the group, while loss frames and pro-self language experience larger gains for the individual through side payments. This finding suggests a bargainer's dilemma: whether to employ language that claims a larger share of group's assets or employ language to increase joint gains.

The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes.

BACKGROUND: The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself. PURPOSE: This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides' job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts. METHODOLOGY: We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH. RESULTS: Findings show that the factors influencing nursing aides' satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers' satisfaction. CONCLUSION: Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts. PRACTICE IMPLICATIONS: Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.

Quantifying Physical Demands in the National Basketball Association-Challenges Around Developing Best-Practice Models for Athlete Care and Performance.

The National Basketball Association (NBA) has an extremely demanding competition schedule, requiring its athletes to compete in 82 regular-season games over a 6-mo period (∼3.4 games/wk). Despite the demanding schedule and high value of athletes, there is little public information on the specific game and training demands required to compete in the NBA. Although provisions in the NBA collective-bargaining agreement allow for research designed to improve player health and broaden medical knowledge, such information is sparse in the available literature. In relation to the physical demands of the NBA, the current lack of information likely results from multiple factors including limited understanding of (basketball-related) emerging technologies, impact of specific league rules, and steps taken to protect players in the age of Big Data. This article explores current limitations in describing specific game/training demands in the NBA and provides perspectives on how some of these challenges may be overcome. The authors propose that future collaborations between league entities, NBA clubs, commercial partners, and outside research institutions will enhance understanding of the physical demands in the NBA (and other health- and performance-related areas). More detailed understanding of physical demands (games, practices, and travel) and other health-related areas can augment player-centered decision making, leading to enhanced player care, increased availability, and improved physical performance.

An Exploratory, Descriptive Study of Nurse Leaders' Personal and Work Experiences During Union Negotiations and Strike Events.

OBJECTIVE: This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives. BACKGROUND: Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities. METHODS: This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members. RESULTS: The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff. CONCLUSION: This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

Right-to-Work-for-Less: How Janus v. AFSCME Threatens Public Health.

In February 2018, the Supreme Court heard oral arguments in Janus v. AFSCME, a case poised to make right-to-work (or, as some call it, right-to-work-for-less) the law in the public sector. At issue is the constitutionality of requiring non-union members, who benefit from collective bargaining, to pay fees that support contract negotiations on the terms and conditions of their employment. We argue that a win for Janus would threaten public health by eroding organized labor's power to improve working conditions. Furthermore, we critique the dubious legal theory underpinning Janus's case and describe the moneyed political interests backing his legal representation. Finally, we chart a path forward for labor organizing in a post- Janus world, drawing inspiration from the winter 2018 educators' strike in West Virginia. Regardless of how Janus itself is decided, the issues raised in this article remain crucial because the ongoing weakening of unions by legislative and judicial means undermines workers' health and exacerbates inequities.

What is the Value of a National Football League Draft Pick? An Analysis Based on Changes Made in the Collective Bargaining Agreement.

Kraeutler, MJ, Carver, TJ, Belk, JW, and McCarty, EC. What is the value of a National Football League draft pick? An analysis based on changes made in the collective bargaining agreement. J Strength Cond Res 32(6): 1656-1661, 2018-The purpose of this study was to analyze and compare the value of players drafted in early rounds of the National Football League (NFL) Draft since the new collective bargaining agreement began in 2011. The NFL's player statistics database and database of player contract details were searched for players drafted in the first 3 rounds of the 2011 to 2013 NFL Drafts. Performance outcomes specific to each position were divided by each player's salary to calculate a value statistic. Various demographics, NFL Combine results, and total number of games missed because of injury were also recorded for each player. These statistics were compared within each position between players selected in the first round of the NFL Draft (group A) vs. those drafted in the second or third round (group B). A total of 147 players were included (group A 35, group B 112). Overall, players in group A were significantly taller (p ≤ 0.01) and heavier (p = 0.037) than players in group B. Group B demonstrated significantly greater value statistics than group A for quarterbacks (p = 0.028), wide receivers (p ≤ 0.001), defensive tackles (p = 0.019), and cornerbacks (p ≤ 0.001). No significant differences were found between groups with regard to number of games missed because of injury. Players drafted in the second or third rounds of the NFL Draft often carry more value than those drafted in the first round. NFL teams may wish to more frequently trade down in the Draft rather than trading up.