As startups no contexto da organização capitalista financeira e as subjetividades empreendedoras / Startups in the context of financial capitalist organization and entrepreneurial subjectivities / Startups en el contexto de la organización capitalista financiera y subjetividades emprendedoras

As startups são empresas que apresentam modelos de negócios marcados pela inovação, rapidez, flexibilidade e alta capacidade de adaptação aos mercados. Atuando em diferentes setores socioeconômicos, elas prometem criar e transformar produtos e serviços. A emergência e disseminação dessas empresas ocorrem em um momento histórico de mudanças iniciadas a partir de 1970 e marcadas pelas crises geradas com o esgotamento do paradigma da sociedade urbano industrial. No Brasil, o número desse modelo de negócio apresentou uma expansão expressiva, alcançando a marca de 13.374 nos últimos cinco anos. Atento a esse cenário, o objetivo desta pesquisa consistiu em compreender como sujeitos, grupos e instituições atribuem sentidos à experiência de trabalho nas chamadas startups. Na parte teórica, as condições sociais e econômicas que possibilitaram a emergência e disseminação das startups são analisadas em uma perspectiva crítica. A parte empírica, por sua vez, apresenta depoimentos de empreendedores relatando o contexto geral de atuação nas startups. Ao final deste artigo, conclui-se que há uma instrumentalização capitalística de componentes subjetivos específicos selecionados e colocados em circulação para fortalecer o modo de produção capitalista financeirizado.(AU)

Startups are companies that have business models characterized by innovation, speed, flexibility, and a high capacity to adapt to markets. Operating in different socioeconomic sectors, they promise to create and transform products and services. The emergence and dissemination of these companies occur at a historical moment of changes that began from 1970 and are marked by the crises generated by the exhaustion of the paradigm of industrial urban society. In Brazil, the number of businesses in this model showed a significant expansion, reaching 13,374 companies in the last five years. Attentive to this scenario, the objective of this research was to understand how subjects, groups, and institutions attribute meanings to the work experience in so-called startups. In the theoretical part, the social and economic conditions that enabled the emergence and dissemination of startups are analyzed in a critical perspective. The empirical part presents entrepreneurs reporting the general context of action in startups. At the end of this article, it is concluded that there is a capitalistic instrumentalization of specific subjective components that are selected and put into circulation to strengthen the financed capitalist production.(AU)

Las startups son empresas que tienen modelos de negocio marcados por la innovación, la velocidad, la flexibilidad y una alta capacidad de adaptación a los mercados. Desde diferentes sectores socioeconómicos, las startups prometen crear y transformar productos y servicios. La aparición y difusión de estas empresas se produce en un momento histórico de cambios que comenzó a partir de 1970 y que está marcado por crisis generadas por el agotamiento del paradigma de la sociedad urbana industrial. En Brasil, estas empresas se expandieron significativamente alcanzando la marca de 13.374 empresas en los últimos cinco años. En este escenario, el objetivo de esta investigación fue entender cómo los sujetos, grupos e instituciones atribuyen significados a la experiencia laboral en las startups. En la parte teórica, se analizan las condiciones sociales y económicas que permitieron el surgimiento y la difusión de las startups en una perspectiva crítica. La parte empírica presenta testimonios de emprendedores que informan sobre el trabajo en startups. La investigación concluye que hay una instrumentalización capitalista de componentes subjetivos específicos que se seleccionan y ponen en circulación para fortalecer el modo de producción capitalista financiero.(AU)

O SUS no horizonte trabalhista: a tradição corporativa de direitos e a privatização da saúde / SUS in the labor sphere: the corporatist tradition of rights and the privatization of healthcare

Resumo Este artigo investiga as implicações do comportamento corporativo sindical para a construção do Sistema Único de Saúde (SUS) no Brasil. Tendo em vista a luta sindical por assistência à saúde, analisamos o dinamismo do mercado de planos de saúde a partir das negociações coletivas de trabalho. Ao documentar esse vínculo, problematizamos o corporativismo como um fenômeno político que, ao se reatualizar no tempo, conforma um momento da tradição de lutas do trabalho que fragiliza a base de apoio social ao SUS, afetando a correlação de forças políticas em torno da superação do hibridismo público e privado de interesses presente no mercado de planos de saúde. Tendo em vista esse cenário, dialogamos com as teses da saúde coletiva, apontando que a centralidade do sindicalismo brasileiro para a realização dos propósitos públicos e universais da Reforma Sanitária ainda carece de pleno reconhecimento nos estudos da área. Como conclusão, apontamos que a aproximação política entre sanitaristas e sindicalistas é condição fundamental para a ampliação das lutas e da legitimação pública do SUS, para o qual será necessário superar o sentido corporativo do acesso à saúde.

Abstract This article investigates the implications of union corporate behavior for the construction of the Brazilian National Health System (SUS) in Brazil. In view of the union struggle for health care, we analyzed the dynamics of the health insurance market based on collective labor negotiations. By documenting this link, we characterize corporatism as a political phenomenon which, over time, shapes the tradition of labor struggles in a way that weakens the social support base for SUS, by affecting the capacity of political forces to act collectively to overcome the hybridity of public and private interests present in the health insurance market. Against this backdrop, we dialogue with collective health theses, pointing out that studies in this area still fail to fully recognize the centrality of Brazilian unions in the realization of the public and universal aims of the Public Health Reform movement. In conclusion, we suggest that political alignment between health workers and union members is a crucial condition for advancing the struggles and public legitimacy of SUS, something that will be necessary to overcome sectoral fragmentation in health access.

COVID-19 real-world data for the US and lessons to reopen business.

This Pearl article recounts the story of a US corporation, Lennar, the nation's leading homebuilder, an essential function in the US (not allowed to lock down), when faced with the coronavirus disease 2019 (COVID-19) pandemic at the end of February 2020. The culture of the company, which allowed it to proceed safely, is one of cohesion, trust, teamwork, and respect for fellow humans. Theirs is a culture in which the safety, wellness, and health of the associates (employees) and the communities they serve is the number one priority. All associates wear a name badge with first name only, and all name badges share the same family name, Lennar. At Lennar, individual success means nothing, and collective success means everything. This is the story of how Lennar took control of the COVID-19 pandemic, metamorphosed itself into an even stronger organization, better suited to deal with COVID-19, and more importantly, optimally suited for the 21st century. The lessons learned not only were instrumental to Lennar but could also apply to any company eager to reopen their business.

The Corporate Practice of Medicine: Ethical Implications of Orthopaedic Surgery Practice Ownership by Non-Physicians.

There has been an upsurge in the number of practices owned by non-physicians. With orthopaedic surgery as the next frontier in this market, orthopaedists need to consider the ethical consequences of such acquisitions. The history and trends of practice ownership are reviewed alongside how laws shifted to reflect a changing health-care climate. The 4 tenets of bioethics (beneficence, nonmaleficence, autonomy, and justice) are explored with regard to practice acquisition by non-physician entities. Although non-physician-owned corporations and private equity firms provide liquidity to the health-care sector, there are ethical concerns that may ultimately impact patient care. Orthopaedic surgeons must be cautious when engaging in acquisitions with non-physician-owned entities, as the goals of each party may not align. This may yield situations that infringe on the basic principles of bioethics for both physician and patient.

Novo olhar ao board interlocking: evidências a partir das redes sociais corporativas / Nueva mirada al board interlocking: evidencias a partir de las redes sociales corporativas / A new look at board interlocking: evidence from corporate social networks

Resumo Este estudo teve por objetivo avaliar as estruturas de interligações pelos membros do conselho de administração (CA) com expertise política e financeira de empresas listadas na B3. A amostra foi composta por 2.474 observações no período de 2010 a 2015. Por meio da Teoria da Agência, sugere-se que o board interlocking (BI) pela expertise financeira pode auxiliar o monitoramento corporativo e servir como mitigador dos conflitos da agência. Por outro lado, o BI pela expertise política pode maximizar o comportamento oportunista. Na visão da Teoria da Dependência de Recursos, o BI pela expertise financeira pode auxiliar as empresas na captação de recursos financeiros, enquanto o BI pela expertise política pode maximizar os resultados mediante contratos mais lucrativos e vantagens oferecidas pelos políticos. Conclui-se que a sistematização do BI pelos diferentes tipos de expertise pode ser utilizada em futuras pesquisas para explicar as estratégias, as decisões e os fenômenos corporativos, bem como para avaliar as causas e os efeitos de tais estruturas na gestão das organizações.

Resumen El estudio tiene como objetivo evaluar las estructuras de interconexiones entre los miembros del Consejo de Administración (CA) con experiencia política y financiera de empresas que cotizan en la B3. La muestra se compuso de 2.474 observaciones en el período 2010-2015. Por medio de la Teoría de la Agencia, se sugiere que el board interlocking (BI) por la experiencia financiera puede auxiliar al monitoreo corporativo y servir como mitigador de los conflictos de la agencia. Por otro lado, el BI por la experiencia política puede maximizar el comportamiento oportunista. En la visión de la Teoría de la Dependencia de Recursos, el BI por la experiencia financiera puede auxiliar a las empresas en la captación de recursos financieros, mientras que el BI por la experiencia política puede maximizar los resultados mediante contratos más lucrativos y ventajas ofrecidas por los políticos. Se concluye que la sistematización del BI por las diferentes experiencias puede ser utilizada en las investigaciones futuras para explicar las estrategias, decisiones y fenómenos corporativos, así como para evaluar las causas y los efectos de tales estructuras en la gestión de las organizaciones.

Absract The study aims to evaluate the interconnection structures by members of the Board of Directors with political and financial expertise of companies listed in the Brazilian stock market B3. The sample consisted of 2,474 observations in the period from 2010 to 2015. It is suggested by the Agency Theory that board interlocking (BI) for financial expertise can help in corporate monitoring and mitigates the agency's conflicts. On the other hand, BI by political expertise can maximize opportunistic behavior. In the view of Resource Dependency Theory, BI for financial expertise can assist companies in attracting financial resources, while BI for policy expertise can maximize results through more lucrative contracts and advantages offered by policymakers. It is concluded that the systematization of BI by different expertise can be used in future research to explain corporate strategies, decisions, and phenomena, as well as to evaluate the causes and effects of such structures in the management of organizations.

O empreendedorismo de negócios entre enfermeiros / Business entrepreneurship among nurses / El emprendimiento de negocios entre enfermeros

Objetivo: caracterizar o empreendedorismo de negócios entre enfermeiros. Método: estudo de caso com abordagem quantitativa, apoiado nos conceitos de Schumpeter. Os dados foram coletados em um município mineiro, em 2015, por meio da aplicação de um questionário validado e entrevistas semiestruturadas com 10 enfermeiros empreendedores. O tratamento dos dados foi realizado por meio da análise de conteúdo, modalidade temático-categorial e os dados relacionados ao perfil e características comportamentais com auxílio do software STATA versão 12.0. Aprovado por Comitê de Ética em Pesquisa. Resultados: verificou-se que a maioria dos enfermeiros possuem empreendimentos registrados, de alta lucratividade e voltados para a assistência domiciliar. As características comportamentais: busca de informações, planejamento e monitoramento sistemático e persuasão e rede de contatos precisam ser potencializadas. Conclusão: o empreendedorismo de negócios entre os enfermeiros estudados conformou-se como uma oportunidade profissional vislumbrada a partir da necessidade de lucratividade e satisfação pessoal, o que os obrigou a deslocarem-se dos nichos tradicionais de trabalho.

Objective: to characterize business entrepreneurship among nurses. Method: in this quantitative case study, framed conceptually by Schumpeter, data were collected in 2015, by validated questionnaire and semi-structured interview, from ten business entrepreneur nurses in a municipality in Minas Gerais. The data were analyzed by thematic category content analysis, while data on profile and behavioral characteristics were analyzed using STATA (version 12.0). The study was approved by the research ethics committee. Results: most of the nurses were found to have highly profitable registered businesses providing home care. The following behavioral characteristics need to be leveraged: information search, planning and systematic monitoring, and contact persuasion and network. Conclusion:business entrepreneurship among the nurses studied constituted a professional opportunity envisaged in response to the need for profit and personal satisfaction, which forced them to move away from their traditional professional niches.

Objetivo: caracterizar el emprendimiento de negocios entre enfermeros. Método: estudio de caso con enfoque cuantitativo, apoyado en los conceptos de Schumpeter. Los datos fueron recolectados en un municipio de Minas Gerais, en 2015, por medio de la aplicación de un cuestionario validado y entrevistas semiestructuradas junto a diez enfermeros emprendedores. El análisis de los datos fue realizado por medio del análisis de contenido, modalidad temático-categorial y los datos relacionados al perfil y características conductuales utilizando el software STATA versión 12.0. Aprobado por el Comité de Ética en Investigación. Resultados: se verificó que la mayoría de los enfermeros poseen emprendimientos registrados, de alta rentabilidad y volcados a la atención domiciliaria. Las características conductuales: búsqueda de información, planificación y monitoreo sistemático y persuasión y red de contactos necesitan ser potenciadas. Conclusión: el emprendimiento de negocios entre los enfermeros estudiados se conformó como una oportunidad profesional vislumbrada a partir de la necesidad de rentabilidad y satisfacción personal, lo que los obligó a desplazarse de los nichos tradicionales de trabajo.

A Defensoria Pública e Cuidados em uma Relação de Cuidado: Um Estudo de Caso / The Public Defender in a Care Relationship: a Case Study / La Defensa Pública en una Relación de Cuidado: un Estudio de Caso

Resumo A Defensoria Pública ocupa lugar em processos judiciais de destituição do poder familiar atuando majoritariamente em favor dos pais de famílias pobres. O psicólogo na Defensoria que atua em processos judiciais é chamado de assistente técnico. O objetivo do presente artigo é discutir concepções pertinentes à atuação do psicólogo na Defensoria a partir do lugar processual do assistente técnico, especialmente compreendido dentro das políticas públicas que trabalham com famílias necessitadas nos termos da lei. Para tanto, foi feito um estudo de caso com pesquisa documental qualitativa em busca das ações radicais possíveis. Os dados e as ações foram pensados à luz das teorias winnicottianas do desenvolvimento e do conceito de juízes anexos, de Foucault. O discurso dominante na Psicologia mantém a lógica de legislações anteriores ao Estatuto da Criança e do Adolescente, em que se culpabiliza a família pobre em processos de destituição do poder familiar. O assistente técnico figurou como importante ator para a inserção, no sistema de justiça, da compreensão de que um bebê não é um bebê sozinho, mas será sempre acompanhado de seus principais cuidadores, pessoas de quem ele depende e que são sujeitos que pretendem desfrutar de uma sociedade livre. A prática comunitária produziu o efeito de criar soluções para a situação que gerou sofrimento aos membros de uma família. Concluímos que teorias que associam pobreza e incapacidade de cuidar dos filhos funcionam de modo similar aos códigos minoristas anteriores ao Estatuto da Criança e do Adolescente...(AU)

Abstract The Public Defender takes place in lawsuits of destitution of the family power acting largely in favor of the parents of poor families. The psychologist at Public Defender that acts in legal proceedings is called technical assistant. The purpose of this article is to discuss pertinent concepts to the psychologist’s activities in Public Defender from the procedural place of the technical assistant, especially understood within the public policies that work with needy families in accordance with law. To that end, we made a case study with qualitative documental research searching for possible radical actions. The data and actions were thought in the light of Winnicott’s development theories and the concept of attachments judges, by Foucault. The dominant discourse in psychology maintains the logic of previous legislation to the Statute of Children and Adolescents, in which blames the poor family in the family power dismissal processes. The technical assistant figured as an important actor for the inclusion, in the justice system, of the understanding that a baby is not a baby alone, but will always be accompanied by their primary caregivers, people he depends and which are subject wishing to enjoy a free society. The community practice had the effect of creating solutions to the situation that caused suffering to family members. We conclude that theories linking poverty and inability to take care of the children, they work in a similar way as minorists codes previous to Child and Adolescent Statute....(AU)

Resumen La Defensa Pública tiene lugar en la destitución del poder familiar actuando en gran medida a favor de los padres de familias pobres. El psicólogo de la Defensa Pública que actúa en los procedimientos legales se llama asistente técnico. El propósito de este artículo es discutir los conceptos pertinentes para la accíon del psicólogo en la Defensa Pública desde el lugar de asistente técnico, entendido sobre todo dentro de las políticas públicas que trabajan con las familias necesitadas de conformidad com la ley. A tal efecto, se realizó un estudio de caso con la investigación cualitativa documental en busca de posibles acciones radicales. Los datos y las acciones fueron diseñados a la luz de las teorías de desarrollo de Winnicott y el concepto de los jueces adjuntos, de Foucault. El discurso dominante en psicología mantiene la lógica de la legislación anterior en el Estatuto de los Niños y Adolescentes, en el que culpa a la familia pobre en los procesos de despido de alimentación de la familia. El asistente técnico hay figurado como un actor importante para la inclusión, en el sistema de justicia, de la comprensión que un bebé no es un bebé solo, pero siempre estará acompañado por sus cuidadores primarios, la gente que depende y que están deseando sujetos a disfrutar una sociedad libre. La práctica comunitaria produjo el efecto de crear soluciones a la situación que causó sufrimiento a los familiares. Llegamos a la conclusión de que las teorías que vinculan la pobreza y la incapacidad para cuidar de los niños trabajan de una manera similar a los códigos anteriores minoritas el Estatuto de los Niños y Adolescentes....(AU)

Health Applications for Corporate Health Management.

INTRODUCTION: Many corporate organizations around the world are looking at new ways to improve the health and well-being of their employees. Many have begun to use m-health approaches and unique applications (apps) to provide assistance. In Germany, both m-health and occupational health management (OHM) are growing quickly. Therefore, we hypothesized that the combination-apps usage in OHM-is growing as well. We studied the usage of health apps in large corporations for health management of employed individuals. METHODS: To understand the environment in Germany, a two-part study was conducted. First, an extensive literature search was done and second, interviews were conducted with 12 of the 20 biggest companies' health management representatives. RESULTS: Using key search terms, 5,445 peer-reviewed journal articles traced with German databases and on PubMed were reviewed. Interestingly and somewhat surprising to the authors, none of them covered our specific topic. Interviews were conducted with 60% of the companies indicated. Only 3 out of 12 companies use apps. Four companies are piloting apps. With one exception, apps cover well-known areas such as food coaching, physical motion, smoking cessation, stress prevention, and other health-related subjects. One app used sensors in work clothing to prevent unhealthy motion. With a few exceptions, there has been no evaluation of the utility and utilization of apps. DISCUSSION: Current app usage in corporate health management in Germany is surprisingly low. Apps need to be better evaluated. Main obstacles-which could be resolved in the future-are legal restrictions (especially on data security), the lack of company-owned smart phones, misfit of apps and corporate health strategy, a lack of app evaluation, and high app prices.

Food and beverage product reformulation as a corporate political strategy.

Product reformulation- the process of altering a food or beverage product's recipe or composition to improve the product's health profile - is a prominent response to the obesity and noncommunicable disease epidemics in the U.S. To date, reformulation in the U.S. has been largely voluntary and initiated by actors within the food and beverage industry. Similar voluntary efforts by the tobacco and alcohol industry have been considered to be a mechanism of corporate political strategy to shape public health policies and decisions to suit commercial needs. We propose a taxonomy of food and beverage industry corporate political strategies that builds on the existing literature. We then analyzed the industry's responses to a 2014 U.S. government consultation on product reformulation, run as part of the process to define the 2015 Dietary Guidelines for Americans. We qualitatively coded the industry's responses for predominant narratives and framings around reformulation using a purposely-designed coding framework, and compared the results to the taxonomy. The food and beverage industry in the United States used a highly similar narrative around voluntary product reformulation in their consultation responses: that reformulation is "part of the solution" to obesity and NCDs, even though their products or industry are not large contributors to the problem, and that progress has been made despite reformulation posing significant technical challenges. This narrative and the frames used in the submissions illustrate the four categories of the taxonomy: participation in the policy process, influencing the framing of the nutrition policy debate, creating partnerships, and influencing the interpretation of evidence. These strategic uses of reformulation align with previous research on food and beverage corporate political strategy.

Perfil e percepções dos feirantes em relação ao trabalho e segurança alimentar e nutricional nas feiras livres / Profile and Perceptions of Marketers Regarding of Work and Food and Nutritional Security of the Free Fairs

As feiras livres de Juiz de Fora procuram fomentar a participação dos feirantes e dos pequenos produtores no abastecimento e na oferta de produtos de alta qualidade. O objetivo deste trabalho foi descrever o perfil socioeconômico e demográfico dos feirantes e suas percepções sobre o trabalho e sobre as condições de segurança alimentar e nutricional nas feiras da cidade de Juiz de Fora (MG). Trata-se de um estudo com delineamento transversal, descritivo e quantitativo. Foram realizadas entrevistas com 100 feirantes das 15 feiras da cidade, existentes no período do estudo, utilizando um questionário elaborado para a pesquisa. Os dados foram descritos por meio da distribuição de frequências absolutas e relativas utilizando o programa Excel, processados e analisados por meio do programa Epi Info 7.2.1.0. Utilizou-se o teste de Qui-quadrado para avaliar a associação entre as variáveis (p<0,05). O perfil dos feirantes é representado por homens (64%, n=64) de meia idade, casados (57%, n=57), com escolaridade até o ensino fundamental (37%, n=37) ou médio (48%, n=48) e que atuam nas feiras há mais de uma década (59%, n=59). As feiras têm caráter familiar e são, por vezes, os únicos meios para obtenção do sustento (64%, n=64) dos feirantes. Dentre os problemas enfrentados, o mais citado foi a falta de segurança (32%, n=32). Apesar do relato de preocupação com a higiene (75%, n=75), foram presenciadas condições distantes da garantia de segurança alimentar. São necessárias ações educativas aos feirantes e apoio governamental para melhoria das condições de trabalho dos feirantes e para a garantia da segurança alimentar e nutricional.

The free fairs of Juiz de Fora seek to foster the participation of small producers in the supply and in the offering of high quality products. The aim of this study was to describe the socioeconomic and demographic profile of the marketers and their perceptions about the work and about the food and nutritional security conditions at the fairs of the city of Juiz de Fora (MG). This is a study with a cross-sectional delineation, descriptive and quantitative. Interviews were conducted with 100 marketers from the 15 free fairs, existing in the study period, using a questionnaire developed for the research. The data were described by means of the distribution of absolute and relative frequencies using the Excel program, processed and analyzed through the program Epi Info 7.2.1.0. The Chi-square test was used to evaluate the association between the variables (p <0.05). The profile of the marketers is represented by men (64%, n = 64) of middle age, married (57%, n = 57), with schooling until middle school (37%, n = 37) or medium (48% n = 48) and working in fairs for over a decade (59%, n = 59). The free fairs have a family character and are sometimes the only means to obtain livelihoods (64%, n = 64) from the marketers. Among the problems faced, the most cited was lack of security (32%, n = 32). Despite the reports of concern about hygiene (75%, n = 75), conditions far removed from food security were observed. Educational actions are required to the marketers and government support to improve the work conditions of the marketers and to guarantee food and nutritional security.

'Manage and mitigate punitive regulatory measures, enhance the corporate image, influence public policy': industry efforts to shape understanding of tobacco-attributable deforestation.

BACKGROUND: Deforestation due to tobacco farming began to raise concerns in the mid 1970s. Over the next 40 years, tobacco growing increased significantly and shifted markedly to low- and middle-income countries. The percentage of deforestation caused by tobacco farming reached 4 % globally by the early 2000s, although substantially higher in countries such as China (18 %), Zimbabwe (20 %), Malawi (26 %) and Bangladesh (>30 %). Transnational tobacco companies (TTCs) have argued that tobacco-attributable deforestation is not a serious problem, and that the industry has addressed the issue through corporate social responsibility (CSR) initiatives. METHODS: After reviewing the existing scholarly literature on tobacco and deforestation, we analysed industry sources of public information to understand how the industry framed deforestation, its key causes, and policy responses. To analyse industry strategies between the 1970s and early 2000s to shape understanding of deforestation caused by tobacco farming and curing, the Truth Tobacco Documents Library was systematically searched. The above sources were compiled and triangulated, thematically and chronologically, to derive a narrative of how the industry has framed the problem of, and solutions to, tobacco-attributable deforestation. RESULTS: The industry sought to undermine responses to tobacco-attributable deforestation by emphasising the economic benefits of production in LMICs, blaming alternative causes, and claiming successful forestation efforts. To support these tactics, the industry lobbied at the national and international levels, commissioned research, and colluded through front groups. There was a lack of effective action to address tobacco-attributable deforestation, and indeed an escalation of the problem, during this period. CONCLUSIONS: The findings suggest the need for independent data on the varied environmental impacts of the tobacco industry, awareness of how the industry seeks to work with environmental researchers and groups to further its interests, and increased scrutiny of tobacco industry efforts to influence environmental policy.

Implementation of a clinical practice guideline for schizophrenia in a specialist mental health center: an observational study.

BACKGROUND: In mental health settings, implementation of and adherence to clinical practice guidelines (CPGs) is low. Strategies are needed to overcome barriers and facilitate successful implementation of CPGs into standard care. The goals of this study were to develop a framework for the implementation of a CPG for schizophrenia for hospitalized service users in a mental health care facility, and to monitor adherence to the guideline. METHODS: An eight-step framework was developed based on project management principles: 1) the Appraisal Guideline for Research and Evaluation (AGREE) tool was used to rate and select a CPG; 2) an algorithm was created from the guideline; 3) a gap analysis identified clinical services and processes not conforming with the CPG recommendations; 4) a governance structure was created; 5) a modified Delphi process determined key outcome and process adherence metrics; 6) a project charter was developed; 7) clinical informatics ensured that systems and tools were in place to support the CPG; and 8) therapeutic services were realigned to match the requirements of the CPG within specified fiscal constraints. Percent adherence to the identified process adherence metrics was calculated before (March 2014) and for 12 months after implementation (April 2014-March 2015). RESULTS: The National Institute of Health and Care Excellence guideline scored highest on AGREE and was used to develop the algorithm. Cognitive behavior therapy for psychosis (CBT-P), art therapy and carer assessments were identified as gaps in care. Clinical global impression - Schizophrenia score was identified as the primary service user outcome variable and antipsychotic polypharmacy, metabolic monitoring, CBT-P referral and supported employment/vocational services referral as the primary process adherence measures. Adherence to guidance for metabolic monitoring (March 2014, 76.7 %; March 2015, 81.6 %), CBT-P referral (March 2014, 6.5 %; March 2015, 11.4 %) and vocational rehabilitation referral (March 2014, 36.6 %; March 2015, 49.1 %) were increased after CPG implementation. There was an initial increase in adherence to antipsychotic monotherapy (March 2014, 53.4 %; November 2014, 62.7 %), which decreased back toward baseline (March 2015, 55.1 %). CONCLUSIONS: The eight-step framework was used to implement a CPG process, though further quality improvements initiatives may be needed to improve adherence.

Sinonasal Malignancies of Anterior Skull Base: Histology-driven Treatment Strategies.

The advances in endoscopy have revolutionized the management of sinonasal and skull base lesions. Many complex cancers that traditionally required open approaches are now amenable to purely endoscopic endonasal resection, providing less invasive surgery with lower morbidity but with comparable oncologic outcomes in terms of survival rates. This article discusses the current evidence for the multimodal management of sinonasal and anterior skull base cancers focusing on the different treatment protocols driven by histologic subtypes.

Complication Avoidance in Endoscopic Skull Base Surgery.

Endoscopic endonasal approaches to the skull base pathology have developed and evolved dramatically over the past 2 decades, particularly with collaboration between neurosurgery and otolaryngology physicians. These advances have increased significantly the use of such approaches beyond just resection of pituitary adenomas, including a variety of skull base pathologies. As the field has evolved, so has our understanding of the complications accompanying endoscopic skull base surgery, as well as techniques to both avoid and manage these complications. These are discussed here.

Corporate governance and proactive environmental management in Novo Hamburgo and neighbouring cities, Brazil / Governança corporativa e manejo ambiental pró-ativo em Novo Hamburgo e cidades vizinhas, Brasil

This study compiled data on environmental auditing and voluntary certification of environment-friendly businesses of the Commercial and Industrial Association of Novo Hamburgo, Campo Bom and Estância Velha and analysed them according to classical environmental management principles: sustainable development and corporate governance. It assessed the level of application of the concepts of corporate governance to everyday business in companies and organisations and estimated how the interconnection and vertical permeability of these concepts might help to make bureaucratic environmental management systemic, proactive and evaluative, changes that may add great value to the operations evaluated. Results showed that, when analysing only audited items not directly defined in legislation, no significant changes were identified. The inclusion of more advanced indices may promote the transition from bureaucratic management, which meets regulated environmental standards only satisfactorily, into proactive and systemic environmental management, which adds value to companies and helps to perpetuate them. Audited and analysed data did not reveal actions that depend on the internal redistribution of power and the interconnection or verticality of attitudes that may materialize concepts of corporate governance.

O presente estudo é uma compilação dos dados resultantes das ações de auditoria ambiental da certificação ambiental voluntária empresa amiga do meio ambiente da Associação Comercial e Industrial de Novo Hamburgo, Campo Bom e Estância Velha, os quais são analisados, considerando as premissas mais clássicas da gestão ambiental, quais sejam, o desenvolvimento sustentável e governança corporativa. O objetivo é avaliar o nível de aplicação das concepções de governança corporativa no cotidiano das empresas, empreendimentos ou organizações e verificar o quanto a permeabilidade e imbricação vertical destes conceitos poderia auxiliar na transformação da gestão ambiental burocrática numa ação de gestão ambiental sistêmica, proativa e valorativa, trazendo maior valor agregado para as operações avaliadas. Os resultados demonstram que quando são analisados itens auditados que não estejam diretamente relacionados com legislação e sanções aplicáveis, não ficam claros os possíveis indicativos de melhorias de gestão e processos. A inclusão de indicadores mais avançados significaria a passagem de uma gestão ambiental burocrática, que atende apenas satisfatoriamente normas regulamentadas a uma gestão ambiental sistêmica e proativa, que possa trazer maior valor agregado e perenização aos empreendimentos. Todas as ações que depende mais de redistribuição interna de poder e imbricação vertical ou permeabilidade de atitudes que materializem concepções de governança corporativa não são identificadas pelos dados auditados e analisados.

Educação em fisioterapia: análise crítica desde a prática profissional / Education in physiotherapy: a critical analysis from a professional practice perspective

Este estudo trata da Educação em Fisioterapia e busca reconhecer e problematizar os aspectos que estruturam a relação educação - prática profissional, para identificar elementos orientadores para uma educação que promova a construção de consciência crítica. Entende-se que a educação profissional é, em termos gerais, o processo de preparação para a prática profissional, com o qual se configura uma lógica de predomínio da organização dos serviços assistenciais no processo educativo; em consequência, cabe perguntar como tal organização influencia a formulação da Educação em Fisioterapia. Destaca-se o fato de que os processos de formulação curricular e desenho das disciplinas - tanto para a formação em disciplinas da saúde em geral, como na Fisioterapia em particular - não consideram uma aproximação explícita aos sistemas e à organização dos serviços, como aspecto estruturante da própria prática profissional ao tempo que a referência das necessidades em saúde, como orientadora na definição de conteúdos curriculares, é fraca e com frequência desvirtuada, na medida em que ela reflete os próprios limites de compreensão da realidade, que com frequência negam as críticas e inclusive o desenvolvimento de outras formas de interpretação, mantendo os marcos hegemônicos do conhecimento muitas vezes influenciados pelos interesses e lógicas dos serviços que, frequentemente, acabam modelando tais necessidades. Neste sentido, é frequente que a avaliação dos processos de educação seja desenvolvida desde uma lógica autocentrada e instrumental do próprio processo educativo, que não permite a aproximação a marcos analíticos que deem conta da relação prática profissional - educação, na qual a estrutura de organização da primeira tem um papel definitivo sobre a segunda, fazendo com que o impacto da própria educação se dê em campos limitados, no sentido de animar transformações de fundo, tanto no desenvolvimento da disciplina como na prática em si. Metodologicamente,...

This study addresses Education in Physiotherapy and aims to recognize and problematize the aspects that structure the education - professional practice relationship, in order to identify guiding elements for an education that promotes the development of critical consciousness. Professional education is understood as, in broad terms, the preparation process for professional practice, with which is established the logic of predominance of healthcare services organization in the educational process; consequently, one question that should be asked is how such organization affects the conception of Education in Physiotherapy. Attention is drawn to the fact that the processes of curriculum formulation and discipline design - both for the study of health disciplines in general and Physiotherapy in particular - do not take into consideration an explicit approach to systems and service organization, as a structural aspect of the professional practice itself; moreover, the approach to health needs, as a guidance in the formulation of curriculum contents, is weak and often misrepresented, since such approach reproduces the own limits of understanding reality, and frequently denies not only criticism but even the development of other forms of interpretation, maintaining the hegemonic frameworks of knowledge often influenced by the services interests and logics, and which finally shape the needs. In this sense, the evaluation of the education processes are often developed from a self-centered and instrumental perspective of the educational process itself, which does not allow the approach to analytical frameworks that give full account of the professional practice - education relationship, in which the former organization structure plays a key role on the latter; this means that the impact of education itself takes place in limited fields, regarding background changings, both in discipline development and practice itself. Methodologically, this study aims at...