ABSTRACT
RESUMO Esta pesquisa teve como objetivo prospectar as condições de trabalho das equipes de socorro do Serviço de Atendimento Móvel de Urgência (Samu-192) fluvial das áreas ribeirinhas e costeiras da região do Alto-Solimões, a partir da análise sistêmica das atividades no serviço de embarcações popularmente chamadas de 'ambulanchas' durante os picos da Covid-19 no estado do Amazonas, quando o sistema de saúde funcionou sob o estresse provocado pela pandemia. Os dados foram obtidos a partir de um desenho transversal exploratório, baseado em dados qualitativos coletados por meio de entrevistas e observação do funcionamento normal do sistema antes da pandemia. A partir daí modelos de dois cenários foram elaborados mostrando o funcionamento do serviço de ambulanchas ao lidar com a pandemia de Covid-19 e o impacto nas condições de trabalho das equipes de socorro interprofissionais de socorro. Entrevistas remotas com trabalhadores das ambulanchas após a pandemia indicaram que a prospecção das condições de trabalho a partir das instâncias dos modelos corresponderam ao funcionamento real do sistema durante a pandemia de Covid-19.
ABSTRACT This research aimed to prospect the working conditions of the rescue teams of the Mobile Emergency Care Service (SAMU-192) at the fluvial areas of the Alto Solimoes region, trough the systemic analysis of the activities of the water ambulances service popularly called 'ambulanchas' during the peaks of COVID-19 in the state of Amazonas, when the health system functioned under stress caused by the pandemic. Data were obtained from an exploratory cross-sectional design, based on qualitative data collected through interviews and observation of the normal functioning of the system before the pandemic. From there, models of two scenarios were developed showing the functioning of the water ambulances service when coping with the COVID-19 pandemic and the impact on the working conditions of the interprofessional rescue teams. Remote interviews with workers after the pandemic indicated that the prospection of working conditions from the instances of the models corresponded to the real functioning of the system during the COVID-19 pandemic.
ABSTRACT
BACKGROUND: As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy. METHODS: This paper explores the case of the health system's collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic. RESULTS: Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance. CONCLUSIONS: Through a systems analysis approach, this study describes the implicit strategy of "living with Covid-19", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Delivery of Health Care , Brazil/epidemiology , Government Programs , Pandemics/prevention & controlABSTRACT
By the time the present study was completed, Brazil had been the second epicenter of COVID-19. In addition, the actions taken to respond to the pandemic in Brazil were the subject of extensive debate, since some diverged from recommendations from health authorities and scientists. Since then, the resulting political and social turmoil showed conflicting strategies to tackle the pandemic in Brazil, with visible consequences in the numbers of casualties, but also with effects on the resilience of the overall health system. Thus, this article explores the actions taken in Brazil to cope with the pandemic from a systems analysis perspective. The structure of the domain was analyzed using Work Domain Analysis, and the activated functions were analyzed using the Functional Resonance Analysis Method, identifying the variability resulting from the conflicting strategies carried out and the consequences to the capacity of the Brazilian health system to respond resiliently to the pandemic. Results of the study show that functions that overlapped the operation of the overall system were introduced, causing the health system to operate under conflicting objectives, in which functions were created to restrict the outcomes of each other during the entire COVID-19 crisis.
ABSTRACT
RESUMO O estudo avaliou o desempenho resiliente quanto à continuidade da atenção e ao cuidado longitudinal, às Doenças Crônicas Não Transmissíveis (hipertensão arterial sistêmica e Diabetes Mellitus) pelas unidades de atenção básica à saúde de uma região vulnerável do município do Rio de Janeiro, durante a pandemia da Covid-19. Trata-se de um estudo transversal, de métodos mistos, de abordagem quantitativa e qualitativa. Apesar de a interrupção total ou parcial potencialmente expor os usuários a complicações agudas e crônicas, o estudo aponta que as estratégias desenvolvidas pelo primeiro nível de atenção das unidades básicas de saúde do município foram efetivas para a redução de internações por essas enfermidades, demonstrando um desempenho resiliente.
ABSTRACT The study evaluated the resilient performance in terms of continuity of care and longitudinal care for Noncommunicable Chronic Diseases (systemic arterial hypertension and Diabetes Mellitus) by primary health care units in a vulnerable region of the city of Rio de Janeiro, during the COVID-19 pandemic. It is a cross-sectional mixed methods study, with a quantitative and qualitative approach. Despite the total or partial interruption potentially exposing users to acute and chronic complications, the study points out that the strategies developed by the first level of care of the basic health units in the municipality were effective in reducing hospitalizations for those diseases, demonstrating a resilient performance.
ABSTRACT
Melipona mondury Smith 1863 is an important stingless bee species pollinator and honey/pollen producer, but threatened by fragmentation of habitats throughout its range. This article presents the identification and partial characterization of nesting substrates, bionomic including population features of M. mondury by comparing data between nest architecture of natural beehive and boxes colonies. Nineteen colonies (13 in boxes and six in beehives) were analyzed with regards to substrate nesting, nest characteristics (e.g. length and width of the combs, height and diameter of the pollen and honey jar) and bee population. The average volume and diameter of the trunks cavities used for nesting of M.mondury were18.4 L and 15.8 cm; the average number of combs was 9.26; the average diameter and height of the honey pots were 2.81 cm and 3.29 cm, and the average volume of honey stored was 15.85 mL; the average height and diameter of pollen pots was 3.21 cm and 2.93 cm, respectively, while the average mass of pollen deposited was equal to 12.56 g. The population ranged from 3537 to 10281 individuals between colonies. The results suggest that the conservation of M. mondury should involve reforestation with native species from Atlantic Forest, and the dimensions of boxes should be based on the average size of the nests in the natural environment in order to support strategies of conservation and sustainable management of this species.
Melipona mondury Smith 1863 é uma espécie de abelha sem ferrão, importante polinizadora, produtora de mel e de pólen, mas ameaçada pela fragmentação dos habitats ao longo de sua área de ocorrência. Este artigo apresenta a identificação e a caracterização parcial dos substratos de nidificação e as características bionômicas, incluindo as populacionais, de M. mondury, comparando os dados de arquitetura do ninho entre colônias de cortiço e caixas rústicas. Dezenove colônias (13 em caixas rústicas e seis em cortiços) foram analisadas em relação aos substratos de nidificação, características do ninho (e.g.: comprimento e largura dos favos de cria, altura e diâmetro dos potes de pólen e mel) e população das abelhas. Foram encontrados volume e diâmetro médios da cavidade dos troncos nidificados por M. mondury, de 18,4 L e 15,8 cm; número médio de favos de cria de 9,26; diâmetro e altura médios dos potes de mel de 2,81 cm e 3,29 cm, sendo o volume médio de mel armazenado de 15,85 mL; altura e diâmetro médios dos potes de pólen de 3,21 cm e 2,93 cm, enquanto a massa média de pólen depositado foi de 12,56 g. A população variou de 3 537 a 10 281 indivíduos entre as colônias. Os resultados sugerem que a conservação de M. mondury deve envolver o reflorestamento com espécies nativas da Mata Atlântica; e as dimensões das caixas racionais foram definidas com base no tamanho médio dos ninhos no ambiente natural, para subsidiar estratégias conservacionistas e de manejo racional.