Pistas genealógicas de um Consultório na Rua: criminalização e assimilação / Genealogical clues from a Street Clinic: criminalization and assimilation / Pistas genealógicas de un Consultorio em la Calle: criminalización y asimilación

Este artigo, por meio de aproximação genealógica, buscou investigar o que chamaremos de pistas genealó-gicas do equipamento Consultório na Rua em município de médio porte no Sul do Brasil. Para o percurso da pesquisa, junto a uma vivência em um Consultório na Rua, nesse município do país, foram realizados entrevistas e levantamentos de documentos. Na investigação foi possível encontrar pistas que apontam para uma produção de criminalização e assimilação histórica dos viventes da rua pelo Estado brasileiro, de maneira que esses pontos precisam ser discutidos e problematizados para que tais regimes de verdade não sejam norteadores das políticas públicas para tais pessoas.

This article, employing a genealogical approach, aimed to examine the genealogical traces of the Street Clinic equipment in a medium-sized city in Brazil's southern region. In order to follow the path of the research, along with an experience in a Street Clinic in a Brazilian city, interviews and document surveys were conducted. In the investigation, it was possible to find elements of the production of criminalization and historical assimilation by the Brazilian State that need to be discussed and problematized so that such regimes of truth are not guiding the production of health care for people experiencing homelessness.

Este artículo, a través de un abordaje genealógico, buscó investigar pistas genealógicas del Consultorio en la Calle en una ciudad de tamaño medio en el sur de Brasil. Para el transcurso de la investigación, junto con una experiencia en un Consultorio en la Calle en un municipio de tamaño medio en el sur de Brasil, se efectuaron entrevistas y encuestas documentales. En la investigación, fue posible encontrar pistas que apuntan a una producción de criminalización y asimilación histórica de las personas en situación de calle por parte del Estado brasileño, por lo que estos puntos necesitan ser discutidos y problematizados para que tales regímenes de verdad no guíen políticas públicas para dicha población.

Association between self-reported food intake and subjective sleep quality among truck drivers in a city in Southern Brazil.

Introduction: Sleep is an activity of great importance for maintaining the homeostasis of the human body and some components may interfere with the quality of sleep, including the pattern of food consumption. Truck drivers may constitute a population particularly sensitive to this association, since they are routinely exposed to situations that may interfere with food intake and sleep quality. Thus, this study investigated the association between self-reported food intake and sleep quality in truck drivers. Methods: This was a cross-sectional study, with drivers who traveled in a city in southern Brazil. Food intake was evaluated through the average of food intake over the last 30 days. Food intake was evaluated in two forms: division in food groups and evaluation only tryptophan-rich foods. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). In addition to the descriptive analysis, to identify possible associations between food intake and sleep quality, linear regression, crude and adjusted for confounding variables, were performed to obtain the Beta and Beta adjusted (Betaadj), respectively, and p-value. Results: A total of 352 truck drivers, mostly males, mean age 48.4 (±11.6) years, with a frequent consumption of meat, fruits, vegetables, sweets, and energy drinks participated in this study. The frequent consumption of dairy products (Betaadj: --0.614. p-value 0.004) and fruits (Betaadj: --0.342. p-value 0.034) was associated with lower PSQI score, while the consumption of energy drinks was associated with a higher PSQI score (Betaadj: 0.923. p-value <0.001). The frequency of consumption of tryptophan-rich foods was not associated with sleep quality. Conclusion: Fruits and dairy products are associated with better subjective sleep quality, while energy drinks are associated with worse sleep quality in truck drivers, whereas dietary tryptophan-rich foods intake was not associated with sleep quality.

Increased Consumption of Ultra-Processed Food Is Associated with Poor Mental Health in a Nationally Representative Sample of Adolescent Students in Brazil.

The objective of this study was to analyze the association between ultra-processed food (UPF) consumption and mental health symptoms in a nationally representative sample of the Brazilian adolescent student population. Cross-sectional analyses with data from the National School-Based Health Survey (PeNSE 2019) were performed. Self-reported information was obtained for the frequency of five mental health symptoms in the last month and the consumption of thirteen UPFs in the last 24 h. Generalized linear models adjusting for the main confounders were performed for each sex. Of the 94,767 adolescent students (52.4% girls) included, 8.1% of the boys and 27.2% of the girls reported "almost always" or "always" having at least four of the five mental health symptoms. In the fully adjusted models, compared to the boys who consumed ≤3 UPF, those consuming ≥6 UPF reported more frequent symptoms of poor mental health (ß-coefficient = 0.27 [0.03, 0.51]; p-for-trend = 0.005). A similar association was observed in girls (ß-coefficient = 0.31 [0.13, 0.50]; p-for-trend = 0.001). In conclusion, in this large sample of adolescent students from an entire country, the higher the consumption of UPF was, the higher the frequency of reported symptoms of poor mental health. These findings remained significant regardless of sociodemographic and lifestyle factors, self-perceived body image, and bullying victimization.

Condições de trabalho e transtornos mentais comuns em agentes penitenciários do interior do estado de São Paulo, Brasil / Working conditions and common mental disorders in prison officers in the inland region of the state of São Paulo, Brazil

Resumo A profissão de agente de segurança penitenciária (ASP) se caracteriza pelo trabalho em situações de perigo, o que pode desencadear prejuízos à sua saúde mental. O objetivo desta investigação foi analisar as condições de trabalho associadas aos transtornos mentais comuns (TMC) em ASP. Trata-se de um estudo transversal, realizado com ASP de quatro unidades prisionais do interior do estado de São Paulo, de janeiro a agosto de 2019. Para mensurar a presença de TMC, utilizou-se o instrumento Self-Reporting Questionnaire (SRQ-20). A associação entre as variáveis foi verificada por meio de regressão de Poisson com variância robusta, ajustada por fatores de confusão para a estimação da razão de prevalência (RP) e intervalo de confiança (IC) de 95%. A população de análise foi constituída por 331 ASP, com frequência de TMC de 33,5%. A presença de TMC foi mais elevada entre os ASP com pior percepção sobre as condições de trabalho (RP: 1,13; IC95%: 1,03-1,24), que sofreram insultos (RP: 1,18; IC95%: 1,08-1,29), assédio moral (RP: 1,23; IC95%: 1,11-1,36) e assédio sexual (RP: 1,20; IC95%: 1,03-1,40), nos últimos 12 meses. O TMC apresentou associação com variáveis relacionadas ao trabalho, tais como piores condições do ambiente no interior do cárcere e ocorrência de violências psicológica e sexual.

Abstract The prison officer profession is characterized by working in risky situations, which can harm officers' mental health. This research aimed to analyze prison officers' working conditions associated with Common Mental Disorders (CMD). This cross-sectional study was conducted with prison officers in four penitentiary units in the inland region of the State of São Paulo, Brazil, from January to August 2019. The Self-Reporting Questionnaire (SRQ-20) tool was employed to quantify the presence of CMDs. Poisson regression verified the association between variables with robust variance and adjusted for confounding factors to estimate the prevalence ratio (PR) and 95% confidence interval (CI). The study population comprised 331 prison officers (ASP), with a 33.5% frequency of CMDs. CMDs were higher among prison officers with a worse perception of working conditions (PR: 1.13; 95%CI%: 1.03-1.24), who suffered insults (PR: 1.18; 95%CI: 1.08-1.29), psychological harassment (PR: 1.23; 95%CI: 1.11-1.36) and sexual harassment (PR: 1.20; 95%CI: 1.03-1.40) in the last 12 months. CMDs were associated with work-related variables, such as worse environmental conditions within the prison and psychological and sexual violence.

Working conditions and common mental disorders in prison officers in the inland region of the state of São Paulo, Brazil. / Condições de trabalho e transtornos mentais comuns em agentes penitenciários do interior do estado de São Paulo, Brasil.

The prison officer profession is characterized by working in risky situations, which can harm officers' mental health. This research aimed to analyze prison officers' working conditions associated with Common Mental Disorders (CMD). This cross-sectional study was conducted with prison officers in four penitentiary units in the inland region of the State of São Paulo, Brazil, from January to August 2019. The Self-Reporting Questionnaire (SRQ-20) tool was employed to quantify the presence of CMDs. Poisson regression verified the association between variables with robust variance and adjusted for confounding factors to estimate the prevalence ratio (PR) and 95% confidence interval (CI). The study population comprised 331 prison officers (ASP), with a 33.5% frequency of CMDs. CMDs were higher among prison officers with a worse perception of working conditions (PR: 1.13; 95%CI%: 1.03-1.24), who suffered insults (PR: 1.18; 95%CI: 1.08-1.29), psychological harassment (PR: 1.23; 95%CI: 1.11-1.36) and sexual harassment (PR: 1.20; 95%CI: 1.03-1.40) in the last 12 months. CMDs were associated with work-related variables, such as worse environmental conditions within the prison and psychological and sexual violence.

A profissão de agente de segurança penitenciária (ASP) se caracteriza pelo trabalho em situações de perigo, o que pode desencadear prejuízos à sua saúde mental. O objetivo desta investigação foi analisar as condições de trabalho associadas aos transtornos mentais comuns (TMC) em ASP. Trata-se de um estudo transversal, realizado com ASP de quatro unidades prisionais do interior do estado de São Paulo, de janeiro a agosto de 2019. Para mensurar a presença de TMC, utilizou-se o instrumento Self-Reporting Questionnaire (SRQ-20). A associação entre as variáveis foi verificada por meio de regressão de Poisson com variância robusta, ajustada por fatores de confusão para a estimação da razão de prevalência (RP) e intervalo de confiança (IC) de 95%. A população de análise foi constituída por 331 ASP, com frequência de TMC de 33,5%. A presença de TMC foi mais elevada entre os ASP com pior percepção sobre as condições de trabalho (RP: 1,13; IC95%: 1,03-1,24), que sofreram insultos (RP: 1,18; IC95%: 1,08-1,29), assédio moral (RP: 1,23; IC95%: 1,11-1,36) e assédio sexual (RP: 1,20; IC95%: 1,03-1,40), nos últimos 12 meses. O TMC apresentou associação com variáveis relacionadas ao trabalho, tais como piores condições do ambiente no interior do cárcere e ocorrência de violências psicológica e sexual.

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents.

Purpose: The aim of the current study was twofold: first, to determine the prevalence of anxiety-induced sleep disturbances among Argentine adolescents according to sex, and second, to identify the association between these sleep disturbances and lifestyle behaviors in this population. Methods: This is a cross-sectional study with data from the Global School-based Student Health Survey (GSHS) in Argentina (2018). A total of 32,393 adolescents (aged 12-17 years; 53.4% girls) were included in the final analysis. Anxiety-induced sleep disturbances were assessed with the question "During the past 12 months, how often have you been so worried about something that you could not sleep at night?" Results: The prevalence of anxiety-induced sleep disturbances was higher in girls (17.4%) than in boys (7.9%) (p < 0.001). In boys, results indicated that those who used marijuana (cannabis) (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.08-1.98), used amphetamine or methamphetamine (OR = 2.19, 95% CI 1.28-3.77), walked or biked to or from school (OR = 1.53, 95% CI 1.19-1.96), and spent 3 h or more in sedentary behaviors (OR = 1.35, 95% CI 1.05-1.74) were more likely to report anxiety-induced sleep disturbances. In girls, those who ate from a fast-food restaurant (OR = 1.24, 95% CI 1.05-1.47), consumed alcoholic beverages (OR = 1.45, 95% CI 1.19-1.75), smoked cigarettes (OR = 2.09, 95%CI 1.05-4.14), consumed any tobacco product (OR = 1.47, 95% CI 1.19-1.82), used amphetamine or methamphetamine (OR = 2.08, 95% CI 1.33-3.26), and those who spent 3 h or more in sedentary behaviors (OR = 1.32, 95% CI 1.11-1.57) were more likely to report frequent anxiety-induced sleep disturbances. Conclusion: In conclusion, considerable sex differences were observed with respect to the prevalence of anxiety-related sleep disturbances and associated lifestyle aspects.

Schoolteachers with voice handicap are twice as likely to report depressive symptoms.

This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.

[Occupational factors and physical activity among public school teachers: a prospective cohort study]. / Fatores ocupacionais e atividade física em professores da educação básica da rede pública: uma coorte prospectiva.

The association between self-reported changes in working conditions and the incidence of recommended levels of leisure-time physical activity (LTPA) among middle and high school teachers of the public school network was analyzed. It is a prospective cohort in which 298 teachers from the public middle and high school network in Londrina, State of Paraná, were monitored for 24 months. The incidence of recommended LTPA levels (≥150 minutes/week) was the study outcome. The analysis included adjusted Poisson regression models, using those who had the worst working conditions in the baseline, and remained unchanged in the follow-up, as a reference group. The incidence of recommended levels of LTPA was 23.2%, being higher among those who maintained a good balance between their personal and professional lives (RR=3.50; 95%CI=1.26-9.72), frequently became exhausted at work (RR=2.47; 95%CI=1.10-5.56), infrequently became exhausted at work (RR=2.42; 95%CI=1.09-5.36), rarely became exhausted at work (RR=2.78; 95%CI=1.30-5.95), rarely began to work too hard (RR=2.69; 95%CI=1.24-5.87) and those who rarely needed to work too much (RR=3.25; 95%CI=1.46-7.26). These results indicate the importance of improving working conditions in the promotion of AFTL.

Analisou-se a associação entre mudanças autorreferidas nas condições de trabalho e a incidência de níveis recomendados de atividade física no tempo livre (AFTL) em professores da educação básica da rede pública. Trata-se de uma coorte prospectiva em que 298 professores da educação básica da rede pública de Londrina, Paraná, foram seguidos por 24 meses. A incidência de níveis recomendados de AFTL (≥150 minutos/semana) foi o desfecho do estudo. A análise incluiu modelos de regressão de Poisson ajustados, sempre tendo como grupo referência aqueles que tinham a pior condição de trabalho na linha de base e assim permaneceram no seguimento. A incidência de níveis recomendados de AFTL foi de 23,2%, sendo maior naqueles que se mantiveram com bom equilíbrio entre vida pessoal e profissional (RR=3,50; IC95%=1,26-9,72), passaram a ficar frequentemente desgastados no trabalho (RR=2,47; IC95%=1,10-5,56), passaram a ficar raramente desgastados no trabalho (RR=2,42; IC95%=1,09-5,36), mantiveram-se raramente desgastados no trabalho (RR=2,78; IC95%=1,30-5,95), passaram a raramente trabalhar demais (RR=2,69; IC95%=1,24-5,87) e mantiveram-se raramente trabalhando demais (RR=3,25; IC=1,46-7,26). Estes resultados indicam a importância da melhoria das condições de trabalho na promoção da AFTL.

Fatores ocupacionais e atividade física em professores da educação básica da rede pública: uma coorte prospectiva / Occupational factors and physical activity among public school teachers: a prospective cohort study

Resumo Analisou-se a associação entre mudanças autorreferidas nas condições de trabalho e a incidência de níveis recomendados de atividade física no tempo livre (AFTL) em professores da educação básica da rede pública. Trata-se de uma coorte prospectiva em que 298 professores da educação básica da rede pública de Londrina, Paraná, foram seguidos por 24 meses. A incidência de níveis recomendados de AFTL (≥150 minutos/semana) foi o desfecho do estudo. A análise incluiu modelos de regressão de Poisson ajustados, sempre tendo como grupo referência aqueles que tinham a pior condição de trabalho na linha de base e assim permaneceram no seguimento. A incidência de níveis recomendados de AFTL foi de 23,2%, sendo maior naqueles que se mantiveram com bom equilíbrio entre vida pessoal e profissional (RR=3,50; IC95%=1,26-9,72), passaram a ficar frequentemente desgastados no trabalho (RR=2,47; IC95%=1,10-5,56), passaram a ficar raramente desgastados no trabalho (RR=2,42; IC95%=1,09-5,36), mantiveram-se raramente desgastados no trabalho (RR=2,78; IC95%=1,30-5,95), passaram a raramente trabalhar demais (RR=2,69; IC95%=1,24-5,87) e mantiveram-se raramente trabalhando demais (RR=3,25; IC=1,46-7,26). Estes resultados indicam a importância da melhoria das condições de trabalho na promoção da AFTL.

Abstract The association between self-reported changes in working conditions and the incidence of recommended levels of leisure-time physical activity (LTPA) among middle and high school teachers of the public school network was analyzed. It is a prospective cohort in which 298 teachers from the public middle and high school network in Londrina, State of Paraná, were monitored for 24 months. The incidence of recommended LTPA levels (≥150 minutes/week) was the study outcome. The analysis included adjusted Poisson regression models, using those who had the worst working conditions in the baseline, and remained unchanged in the follow-up, as a reference group. The incidence of recommended levels of LTPA was 23.2%, being higher among those who maintained a good balance between their personal and professional lives (RR=3.50; 95%CI=1.26-9.72), frequently became exhausted at work (RR=2.47; 95%CI=1.10-5.56), infrequently became exhausted at work (RR=2.42; 95%CI=1.09-5.36), rarely became exhausted at work (RR=2.78; 95%CI=1.30-5.95), rarely began to work too hard (RR=2.69; 95%CI=1.24-5.87) and those who rarely needed to work too much (RR=3.25; 95%CI=1.46-7.26). These results indicate the importance of improving working conditions in the promotion of AFTL.

Chronic musculoskeletal pain and occupational aspects among Brazilian teachers.

Objectives. This study aimed to determine the association between working conditions and chronic musculoskeletal pain (CMP) in regions of the body in teachers. Methods. A cross-sectional study was performed with 958 teachers from Brazil. Outcomes were chronic pain in the upper limbs, lower back and lower limbs. Independent variables were characteristics and perceptions about the work. Poisson regression models were adjusted by socio-demographic, lifestyle and co-morbidity variables. Results. After adjustments, strong associations were observed between a negative perception regarding writing on the board and pain in the upper limbs (prevalence ratio [PR] = 4.65; 95% confidence interval [CI] [2.02, 10.70]) and lower back pain (PR = 2.10; 95% CI [1.06, 4.15]) and between a negative perception of standing duration and pain in the lower limbs (PR = 3.98; 95% CI [1.54, 10.26]). Additionally, the number of workplaces, number of students and conditions for carrying teaching material were associated with pain in the upper limbs. Time in the profession and a negative perception of work-life balance were associated with pain in the lower limbs. Conclusions. Different work conditions were associated with CMP in different body regions. Policies to improve teachers' working conditions, such as providing furniture that meets teachers' ergonomic needs, are needed to reduce CMP.

Consórcio Público de Saúde no processo de regionalização: análise sob o enfoque da ação coletiva / Public Health Consortium in the regionalization process: analysis from the perspective of collective action

Resumo A regionalização é um dos grandes desafios enfrentados desde a municipalização da saúde no Brasil e, uma vez consolidada, possibilita a estruturação de uma escala regional potencializadora dos territórios. Dentre os arranjos organizativos para a regionalização, está posicionado o Consórcio Público de Saúde (CPS), que deve tratar não apenas da soma de individualidades, mas de uma ação coletiva. Este estudo objetiva analisar a percepção dos gestores de saúde no âmbito municipal da Região de Saúde do Médio Paranapanema do Norte do Paraná acerca do papel do CPS no processo de regionalização. A pesquisa teve abordagem qualitativa, de caráter exploratório, que utilizou entrevistas e grupos focais para coleta de dados, os quais foram submetidos ao método de análise do discurso. Os resultados apresentam tanto as condições que limitam a ação coletiva quanto as condições que a favorecem. Com isso, são desveladas algumas limitações na atuação do consórcio, destacando o confundimento acerca de seu papel e os conflitos de interesses que surgem a partir dessa atuação, além de seu caráter colaborativo e apoiador, o que o posiciona como um espaço para exercitar a cooperação. Com isso, as iniciativas de ação consorciada demonstram o empoderamento dos gestores, resultando no fortalecimento da regionalização.

Abstract Regionalization is one of the great challenges faced since the municipalization of health in Brazil and, once consolidated, it enables the structuring of a regional scale that enhances territories. Among the organizational arrangements for regionalization, the Public Health Consortium (PHC) is positioned, which must deal not only with the sum of individualities, but with collective action. This study aims to analyze the perception of health managers at the municipal level in the Middle Paranapanema Health Region of Northern Paraná, Brazil, regarding the role of the PHC in the regionalization process. The research had a qualitative, exploratory approach, which used interviews and focus groups for data collection, which were submitted to the method of discourse analysis. The results present both the conditions that limit collective action and the conditions that favor it. With this, some limitations in the consortium's performance are unveiled, highlighting the confusion about its role and the conflicts of interest that arise from this performance, in addition to its collaborative and supportive character, which positions it as a space to exercise cooperation. With that, the joint action initiatives demonstrate the empowerment of managers, resulting in the strengthening of regionalization.

Reflexões sobre as diretrizes dos Núcleos de Apoio à Saúde da Família acerca do profissional fisioterapeuta / Reflections on Family Health Support Center guidelines about the physiotherapist professional

No âmbito do Sistema Único de Saúde (SUS), ainda não existe uma política pública de saúde consolidada sobre o papel da Fisioterapia, em particular na Atenção Básica (AB). O perfil epidemiológico e a transição demográfica brasileira levam a fisioterapia a rever sua práxis profissional e adequar suas ações para a AB, visando a maior integralidade e resolubilidade dos problemas de saúde da população neste nível de atenção. Os Núcleos de Apoio à Saúde da Família (NASF) criados em 2008 são a maior oportunidade de inserção do Fisioterapeuta na AB. O objetivo deste trabalho foi realizar uma reflexão crítica do capítulo direcionado a Fisioterapeutas nas diretrizes do NASF, de 2009. O texto apresenta-se confuso sobre a atuação deste profissional na AB, e ainda direciona muito suas práticas à reabilitação. Considera o Fisioterapeuta como profissional de reabilitação para atuar com idosos/deficientes, o que é um contrassenso ao que se preconiza como ações para a atenção primária em saúde, tanto pela restrição às ações de reabilitação, quanto por colocar apenas duas condições de saúde como aptas à atuação da fisioterapia. O documento traz direcionamentos para atuação do fisioterapeuta apenas para idosos e deficientes, não considerando todos os problemas de saúde que a população está exposta. A apresentação do conteúdo destinado a fisioterapeutas difere da apresentação de outros profissionais da saúde que também atuam no NASF, tendo estes direcionamentos mais específicos. Conclui-se que a referida diretriz não fortalece a atual demanda da população sobre as práticas do Fisioterapeuta na AB, tampouco auxilia na quebra de paradigma do fisioterapeuta como profissional exclusivo da reabilitação. São necessárias novas políticas públicas de saúde voltadas para o trabalho do fisioterapeuta na AB para que esse profissional possa ampliar suas ações neste nível de atenção.

Within the scope of the Unified Health System (SUS), there is still no consolidated public health policy on the role of Physical Therapy, particularly in Basic Care (AB). The epidemiological profile and the Brazilian demographic transition lead physiotherapy to review its professional practice and adjust its actions to the AB, aiming for greater comprehensiveness and resolubility of the population's health problems at this level of attention. The Family Health Support Centers (NASF) created in 2008 are the greatest opportunity for the insertion of the Physiotherapist in the AB. The objective of this work was to carry out a critical reflection on the chapter directed to Physiotherapists in the NASF 2009 guidelines . The text is confusing about the performance of this professional in the AB, and still directs its practices to rehabilitation too much. It considers the Physiotherapist as a rehabilitation professional to work with the elderly / disabled, which is a contradiction to what is advocated as actions for primary health care, both by restricting rehabilitation actions, and by placing only two health conditions as suitable to physiotherapy. The document brings directives for the Physiotherapist only for the elderly and disabled, not considering all the health problems that the population is exposed to. The presentation of the content intended for Physiotherapists differs from the presentation of other health professionals who also work at NASF, as they have more specific directives. It was concluded that this guideline does not strengthen the current demand of the population on the practices of the Physiotherapist in the AB, nor does it help with breaking the paradigm of the Physiotherapist as a professional exclusive to rehabilitation. New public health policies aimed at the work of the Physical Therapist in AB are necessary so that this professional can expand his actions to this level of attention.

Cross-sectional and longitudinal relationships between psychological violence and teacher burnout.

OBJECTIVE: This study aimed to identify cross-sectional and longitudinal relationships between psychological violence (PV) and burnout after two years of follow-up. METHODS: This is a longitudinal study involving 430 public school teachers from a city in southern Brazil. PV was defined as insults by students, humiliation or embarrassment by colleagues or superiors or threats by any member of the school. Burnout was measured using the emotional exhaustion (EE) and depersonalization (DP) subscales of the Maslach Burnout Inventory-Human Services Survey. Analyses were performed using structural equation models in R. RESULTS: Younger age (ß = - .167) and poor/fair relationship with students (ß = .275) had a direct effect on PV. Temporary employment (ß = - .111) and poor/fair perception of the number of students in the classroom (ß = .124) had a direct effect on EE. Cross-sectionally, PV showed a direct effect at both T0 and T1 on EE (T0: ß = .435; T1: ß = .334) and on DP (T0: ß = .332; T1: ß = .325). Longitudinally, PV at T0 did not have a significant direct effect on burnout at T1. However, indirect effects of PV on EE (ß = .459) and DP (ß = .428) at T1 were observed. CONCLUSIONS: The effect of PV on burnout occurs in a short period of time. However, the long-term effect should be considered because there is a cumulative burden of exposure to violence over time.

The association of continuous-use medications and sleep parameters in a sample of working adults.

PURPOSE: Although polypharmacy is linked to health outcomes in the elderly, the use of multiple medications is increasing in middle-aged adults. This study analyzed whether or not the increased number of continuous-use medications (C-UM) is associated with objective and subjective sleep parameters in a working population. METHODS: Cross-sectional study with schoolteachers from public schools in Londrina, Brazil. The participants were classified according to the self-reported number of C-UM. Sleep data were obtained with actigraphy and a concomitant sleep diary for 7 days. The analyses were adjusted for socio-demographic, lifestyle, and morbidity variables. RESULTS: A total of 17% of the participants were classified as using ≥3C-UM. In fully adjusted analyses, the use of ≥3C-UM was associated with lower actigraphic sleep duration (<6 h) (odds ratio [OR] = 2.51; 95% confidence interval [CI] = 1.01,6.21), higher actigraphic sleep onset latency (SOL) (OR = 2.65; 95%CI = 1.00,7.02), and with a higher number of awakenings during sleep measured by actigraphy (OR = 3.30; 95%CI = 1.32,8.28). The use of ≥3 C-UM was also associated with higher SOL (OR = 3.76; 95%CI = 1.36,10.5) and lower sleep efficiency (OR = 11.6; 95%CI = 2.92,46.1), as measured with the sleep diary. A 1-unit increment in the number of continuous-use medications was associated with higher self-reported SOL and lower subjective sleep efficiency. CONCLUSION: The continuous use of ≥3 medications is associated with worse objective and subjective parameters of sleep duration and quality in schoolteachers.

Job strain is prospectively associated with a lower frequency of fruit consumption in schoolteachers.

OBJECTIVE: The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers. DESIGN: This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders. SETTING: The setting consisted of elementary and secondary schools located in a large city in southern Brazil. PARTICIPANTS: The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]). RESULTS: A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = -0·066; 95 % CI -0·115, -0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work. CONCLUSION: Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.

Work-related rumination and worry at bedtime are associated with worse sleep indicators in schoolteachers: a study based on actigraphy and sleep diaries.

OBJECTIVE/BACKGROUND: Work-related rumination and worry are indicators of occupational stress which can impact sleep when they occur close to bedtime. This study examined the relationship between these repetitive thoughts before sleep with objective and subjective sleep parameters. METHODS: A microlongitudinal study was carried out with schoolteachers who answered questions on rumination and worry before sleep, wore a wrist actigraph, and completed a sleep diary for 5 to 7 consecutive days. Analysis used mixed-effects repeated measures linear models adjusted for sociodemographic, lifestyle, and health status. RESULTS: Among the 134 schoolteachers studied, 64.9% were women and were aged 41.9 ± 9.5 years. In the fully adjusted analysis, actigraphy indicated that a wake-up time <6:30 a.m. was associated with both rumination (relative risk (RR) = 1.67; 95% confidence interval (CI) = 1.21-2.31) and worry (RR = 2.44; 95%CI = 1.63-3.64). Moreover, actigraphy-measured nighttime sleep duration <7 h (RR = 1.23; 95%CI = 1.03-1.47) and self-reported sleep latency >15 min (RR = 1.43; 95%CI = 1.02-2.02) were associated with work-related worry. CONCLUSIONS: The occurrence of work-related repetitive thoughts before sleep, particularly worry about next-day issues, is associated with an increased risk of impaired objective and subjective sleep indicators. These findings suggest that these cognitive processes related to work should be addressed in strategies aimed at preventing and treating sleep disturbances and their individual and occupational consequences.

Recurrence of Violence Against Teachers: Two-Year Follow-Up Study.

The objective of this study was to analyze whether the experience of violence by teachers in the school environment increases the risk of teachers suffering violence again within a 2-year period. This longitudinal study included 430 primary and secondary public school teachers from a city in the south of Brazil, with data collected at two time points: T1 (2012-2013) and T2 (2014-2015). The data were obtained via face-to-face interviews and the completion of a questionnaire. The forms of violence investigated included reports of insults from students, humiliation or embarrassment by colleagues or superiors, and threats and physical violence from any member of the school occurring in the 12 months prior to the study. McNemar's test and the Poisson regression with robust error variance were used in the analyses, and the relative risk (RR) and 95% confidence interval (95% CI) were calculated. After 2 years, there was a reduction in violence reported by the teachers from 65.4% (T1) to 56.9% (T2) (p = .003). Teachers who suffered a certain form of violence had three times the risk of suffering that type of violence again. Those who reported three or four forms of violence at T1 had an RR of 2.23 of suffering any form of violence at T2 (95% CI [1.70, 2.93]) compared with those who did not report violence at T1. Psychological violence at T1 was not associated with physical violence at T2, nor was physical violence at T1 associated with psychological violence at T2. Despite the reduction in violence against teachers reported at T2, some forms of violence remained stable after 2 years. Suffering more forms of violence increases the risk of suffering any future violence.

Da gestação à laqueadura: cartografia de uma mãe órfã vivenciada em um Consultório na Rua / De la gestación a la ligadura de trompas: cartografía de una madre huérfana vivida en un consultorio en la calle / From pregnancy to sterilization: a cartography of an orphan mother experienced in a Clinic at the Street

Este artigo buscou mapear os afetos em cenas que ocorreram em uma vivência em um Consultório na Rua (CnaR) por meio da realização de uma cartografia. Os territórios mapeados, junto com a intercessão da obra "Sandman" de Neil Gaiman, que foi utilizada como dispositivo cognitivo de discussão da fantasia-realidade, evidenciaram modos de viver que desafiam os métodos tradicionais de produzir cuidado, enquanto tornaram visíveis capturas micropolíticas que levaram à produção de controle e enquadramento. Diante disso, foi perceptível no CnaR uma potência de produção de outros modos de cuidado ao mesmo tempo que as capturas micropolíticas para controle do vivente da rua agem agressivamente maquinando a produção da necessidade de esterilizações e desmaternizações com o sequestro de bebês pelo Estado. (AU)

El objetivo de este artículo fue mapear los afectos en escenas ocurridas en una experiencia en un consultorio en la calle (en portugués, Consultório na Rua - CnaR) por medio de la realización de una cartografía. Los territorios mapeados, juntamente con la intercesión de la obra Sandman de Neil Gaiman utilizada como dispositivo cognitivo de discusión de la fantasía-realidad, pusieron en evidencia modos de vivir que desafían los métodos tradicionales de producir cuidado, puesto que dieron visibilidad a capturas micropolíticas que llevaron a la producción de control y encuadre. Ante esto, fue perceptible en el CnaR una potencia de producción de otros modos de cuidado, al mismo tiempo que las capturas micropolíticas para control de la persona que vive en la calle actúan agresivamente maquinando la producción de la necesidad de esterilizaciones y desmaternizaciones juntamente con el secuestro de bebés por parte del Estado. (AU)

This article aimed to map the affections in scenes that occurred in an experience in a Clinic at the Street (CnaR) through the realization of a cartography. Mapped territories, with the intercession of Neil Gaiman's Sandman used as a cognitive device for the discussion of reality-fantasy, have highlighted ways of life that challenge traditional methods of care production, while making visible micropolitical captures that led to production of control and framing. Therefore, it was noticeable in the CnaR a potency of production of new ways of care, but at the same time, there are micropolitical captures for the control of street dwellers, conspiring aggressively to produce needs of sterilization and de-motherhood as well as the kidnapping of babies by the State. (AU)

A arte do palhaço na educação médica / The art of clowning in medical education

Resumo: Introdução: Em todo o mundo, a arte tem sido utilizada como recurso pedagógico no curso médico. No Brasil, vários grupos de "palhaçoterapia" - projetos que envolvem a atuação de estudantes como palhaços-doutores - foram criados visando promover uma humanização do cuidado nos hospitais. A partir daí, vários estudos começaram a identificar impactos da participação nesses projetos na formação médica. Este estudo investiga a percepção do profissional formado acerca da influência da experiência como palhaço-doutor na sua prática médica. Objetivo: Este estudo tem como objetivo analisar, na graduação de Medicina, a formação na arte do palhaço como estratégia para contribuir para o desenvolvimento de competências na prática médica. Método: Trata-se de uma pesquisa exploratória e descritiva com abordagem qualitativa, por meio de entrevista semiestruturada com 15 participantes, que foram escolhidos pela técnica da bola de neve. O universo da pesquisa consiste em médicos que participaram de projetos de palhaçoterapia durante a graduação, em Recife, Pernambuco. As informações coletadas foram organizadas com o auxílio do software MAXQDA e submetidas à análise textual discursiva proposta por Moraes, que segue três passos de forma cíclica: a desmontagem dos textos em unidades de significado, o estabelecimento de relações e a captação do emergente. Resultado: A partir da análise das transcrições das entrevistas, emergiram diversas categorias de competências relatadas pelos participantes. No processo de construção de um novo significado com base nesses achados, foi necessário selecionar os que tinham relação com o que estava proposto nas Diretrizes Curriculares Nacionais (DCN) de Medicina de 2014. As habilidades percebidas foram agrupadas nas seguintes categorias: sensibilização, ressignificação, lidar com o erro e relação com o paciente. Conclusão: Esta pesquisa procurou explorar o fenômeno translacional, por meio do qual se investigaram quais ensinamentos, na visão de profissionais da medicina, foram apreendidos para sua prática a partir da aprendizagem e do exercício da arte do palhaço. Quando se realizou essa comparação com as DCN, foi possível encontrar interseções entre o que se espera desenvolver durante a formação médica e algumas das competências desenvolvidas com ajuda da arte do palhaço.

Abstract: Introduction: Art has been used as a teaching resource in medical education around the world. In Brazil, several "clown therapy" groups - a common name for projects in which students perform as "clown doctors" in hospitals - have been created with the aim of helping to humanize hospital care. Several studies have identified the impacts on medical training, as perceived by the participants of such projects. This study investigates how trained professionals view the influence of their previous experiences as clown doctors on actual medical practice. Objective: To analyze clown training in medical school as a strategy to contribute to the development of medical practice skills. Method: This is an exploratory and descriptive study with a qualitative approach. Semi-structured interviews were conducted with 15 participants, who were chosen using the snowball technique. The sample consists of doctors who participated in clown therapy projects during their undergraduate training, in Recife, Pernambuco. The collected information was organized with the MAXQDA software and underwent discursive content analysis as proposed by Moraes, which follows a three-step cycle: the deconstruction of text into units of meaning, the establishment of relationships, and the capture of the emerging knowledge. Result: Analysis of the interview transcripts generated several categories of competencies reported by the participants. In the process of constructing new meaning based on these findings, it was necessary to select those that were related to the proposals of the 2014 National Curriculum Guidelines (DCNs) for medicine. The perceived skills were grouped into the following categories: awareness, resignification, dealing with error and physician-patient relationship. Conclusion: This research sought to explore the translational phenomenon, investigating which competencies, in the eyes of medical professionals, were learned from practicing the art of clowning. By drawing comparisons with the National Curriculum Guidelines (DCNs), intersections were found between expected development during medical training and some of the skills developed with the help of the art of clowning.

Physiotherapy practices in primary health care / Práticas fisioterapêuticas para a produção do cuidado na atenção primária à saúde

Abstract Introduction: Physiotherapy was included in primary health care (PHC) in order to expand access and provide comprehensive care to the population. Objective: To understand the routine and tools used by physiotherapists in primary health care and analyze the determining factors in providing care in a municipality where every basic health unit (BHU) has a physiotherapist. Methods: This is a qualitative study of nineteen physiotherapists conducted in a city of Southern Brazil, using a semistructured interview and a methodological framework for discourse analysis. Results: The main tools routinely used in the physiotherapy service are individual appointments, home visits and group work. Physiotherapy practices are influenced by public health, municipal management and BHU policies, physiotherapy profile in addition to the characteristics of the coverage area and the population being treated. Introducing health promotion measures and implementing relational technologies are the main challenges for physiotherapists, and many of these professionals already recognize their importance in promoting comprehensive care. Conclusion: Physio-therapy practices and the tools used are in line with the Primary Care Family Health Support Center (NASF-AB) model of action recommended by public policies and have been effective for many health conditions. Knowing the routine of PHC physiotherapy services may help professional training and service management, with a view to producing physiotherapy care aimed at the principle of comprehensiveness and consolidating the role of physiotherapists at this level of care.

Resumo Introdução: A fisioterapia foi inserida no contexto da atenção primária à saúde (APS) como forma de ampliar o acesso da população e proporcionar a integralidade do atendimento à saúde das pessoas. Objetivo: Compreender a rotina e as ferramentas utilizadas por fisioterapeutas na atenção primária à saúde e analisar seus determinantes para a produção do cuidado em um município que possui fisioterapeutas em todas as unidades básicas de saúde. Métodos: Realizou-se pesquisa qualitativa em uma cidade do sul do Brasil, com 19 fisioterapeutas, através de entrevista semiestruturada e referencial metodológico de análise do discurso. Resultados: As principais ferramentas utilizadas na rotina do serviço de fisioterapia no contexto estudado são: atendimentos individuais, visitas domiciliares e trabalho em grupos. As práticas fisioterapêuticas são influenciadas por políticas públicas de saúde, gestão municipal e da unidade de serviço, perfil dos fisioterapeutas e características do território e da população assistida. Realizar ações de promoção em saúde e implementar tecnologias relacionais são desafios para o fisioterapeuta, mas muitos profissionais já reconhecem essas práticas para promover o cuidado integral. Conclusão: As ações fisioterapêuticas realizadas e ferramentas utilizadas estão em consonância com o modelo de atuação do Núcleo Ampliado de Saúde da Família e Atenção Básica preconizado pelas políticas públicas e têm sido resolutivas para muitas condições de saúde. Conhecer a rotina de serviços de fisioterapia na APS pode subsidiar discussões no âmbito da formação profissional e de gestão de serviços, com vistas à produção do cuidado fisioterapêutico pautado no princípio da integralidade e a consolidar a atuação do fisioterapeuta neste nível de atenção.