Training the next generation of community-engaged physicians: a mixed-methods evaluation of a novel course for medical service learning in the COVID-19 era.

BACKGROUND: Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact. METHODS: To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students' experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews. RESULTS: We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work. CONCLUSIONS: This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact. TRIAL REGISTRATION: N/A.

PUSK AND PULL FACTORS OF EMIGRATION AMONG PHYSICIAN IN NIGERIA.

Background: Physician emigration is increasing exponentially in developing countries. In Nigeria, with the last decade's unprecedented brain drain, it has gained the popular moniker 'japa syndrome'. Aim: This study aimed to determine push and pull factors affecting physician migration in Nigeria, to provide evidence-backed recommendations for physician retention policies. Materials/Methods: A cross-sectional study was conducted among attendees at the 2022 Abuja Cardiovascular Symposium hosted by Limi Multispecialty Hospital and the Nigerian Cardiac Society. Convenience and snowball sampling were used, and 295/400 responded to comprehensive self-administered questionnaires (73.7% response rate). Data was analysed using SPSS v.26. Results: Most participants (79.4%) were aged 20-39 years (Mean 35 years SD ±10.17); female (58.6%); married (58.4%) and had family size below six (73.6%). About 85.8% were employed, and 55.9% worked in private establishments. Solely basic medical degrees were possessed by 64.4%, and 63.7% earned N300,000-N399,999 (USD 396.82-USD 527.78) monthly. Top destinations were UK (50.5%), Canada (43.3%), and USA (37.9%), with low remuneration (71.2%), insecurity (62.7%), and difficult working environments (55.9%) most frequent push factors. Postgraduate-training frustrations (38.6%), and limited educational opportunities for oneself (37.6%), children (26.4%), or spouse (19.7%) were the least. High earning potential (76.6%), career growth opportunities (70.8%), and high-level equipment/technology (54.9%) were frequent pull factors. Conclusion: Physician emigration threatens Nigeria's health system and should be addressed multi-sectorally to boost physician remuneration and improve work environments and societal security. Additionally, innovative education and digital technology would encourage health workforce retention.

A precarização jurídica das relações de trabalho como fator de sofrimento das(os) trabalhadoras(es) no setor da saúde durante a pandemia de COVID-19 / The legal precariousness of work relations in the health sector during the COVID-19 pandemic, as a factor of worker suffering

Resumo O artigo analisou o processo de precarização das relações de trabalho no setor da saúde, demonstrando como essa situação gerou sofrimento dos trabalhadores. O texto buscou registrar como a adoção institucional das concepções econômicas neoliberais, de redução das políticas sociais de Estado, acopladas a um histórico de rejeição cultural aos direitos trabalhistas, proporcionou a atração dos mecanismos de precarização do trabalho, notadamente, a terceirização da mão de obra e da prestação de serviços. No segundo momento, o texto aponta as impropriedades jurídicas cometidas, apresentando as consequências da fragilização do vínculo jurídico nas condições de trabalho desses trabalhadores, principalmente no que se refere às jornadas de trabalho e a remuneração, destacando-se, também, o quanto a disseminação desses vínculos representou um fator de rebaixamento geral dos salários e direitos trabalhistas e previdenciários no setor. Foram apresentados, ainda, dados das pesquisas da Fiocruz sobre condições de trabalho durante a pandemia. Conclui mostrando a urgência de se resgatarem os institutos jurídicos trabalhistas que foram abandonados no percurso histórico estudado, para direcionar a novo rumo as políticas públicas na saúde.

Abstract The present article analyzed the process of precarious work relations in the health sector, demonstrating how this situation generated illness and suffering among workers. The text sought to register how the institutional adoption of neoliberal economic conceptions, of the reduction of State social policies, coupled with a history of cultural rejection of labor rights, provided the attraction of mechanisms of precarious work for the public sector, notably, the outsourcing of labor and the provision of services. In a second moment, the text points out the legal improprieties committed, presenting the consequences of the weakening of the legal bond in the working conditions of these workers, mainly regarding working hours and remuneration, also highlighting how much the dissemination of these links represented a factor of a general reduction in wages and labor and social security rights in the sector. Data from Fiocruz surveys on working conditions during the pandemic were also presented. The article concludes by showing the urgency of rescuing the legal labor institutes that were abandoned in the historical path studied in order to guide the public health policies in a new direction.

Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study.

BACKGROUND: Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. OBJECTIVE: We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. METHODS: Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. RESULTS: Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating." CONCLUSIONS: A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention.

Efeitos da pandemia de COVID-19 no trabalho em vigilância sanitária / Effects of the COVID-19 pandemic on health surveillance work

Resumo A pandemia de COVID-19 desafiou gestores e explicitou fragilidades dos sistemas de saúde. No Brasil, a pandemia surgiu em meio a dificuldades para o trabalho no SUS e na vigilância sanitária (VISA). O objetivo deste artigo é analisar os efeitos da COVID-19 sobre a organização, as condições de trabalho, a gestão e a atuação de VISA, conforme a percepção de gestores de capitais de três regiões do Brasil. É uma pesquisa exploratória, descritiva, com análise qualitativa. Utilizou-se o software Iramuteq no tratamento do corpus textual e a análise de classificação hierárquica descendente gerou quatro classes: características do trabalho de VISA na pandemia (39,9%), organização e condições de trabalho de VISA na pandemia (12,3%), efeitos da pandemia sobre o trabalho (34,4%) e proteção da saúde de trabalhadores e da população (13,4%). A VISA implantou trabalho remoto, ampliou turnos de trabalho e diversificou suas ações. Entretanto, enfrentou dificuldades de pessoal, infraestrutura e capacitação insuficiente. O estudo apontou as potencialidades das ações conjuntas para a VISA.

Abstract The COVID-19 pandemic has challenged managers and exposed weaknesses in health systems. In Brazil, the pandemic emerged amid difficulties to work in the Brazilian Unified Health System (SUS) and in health surveillance (HS). The purpose of this article is to analyze the effects of COVID-19 on the organization, working conditions, management, and performance of HS, according to the perception of capital city managers from three regions of Brazil. This is an exploratory, descriptive research with qualitative analysis. The Iramuteq software was used in the treatment of the textual corpus and analysis of descending hierarchical classification, which generated four classes: characteristics of HS work during the pandemic (39.9%), HS organization and working conditions during the pandemic (12.3%), effects of the pandemic on work (34.4%), and the class of the health protection of workers and the population (13.4%). HS implemented remote work, expanded work shifts, and diversified its actions. However, it faced difficulties with personnel, infrastructure, and insufficient training. The present study also pointed out the potential for joint actions concerning HS.

Community Health Worker programmes' integration into national health systems: Scoping review.

BACKGROUND: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing. AIM: This review presents evidence on CHW programmes' integration into National Health Systems for improved health outcomes in SSA. SETTING: Sub-Saharan Africa. METHOD: Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form. RESULTS: A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region. CONCLUSION: Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region.Contribution: The study presents synthesized evidence on CHW programmes integration into national health systems in SSA.

Perfil do segurado submetido a reabilitação profissional oferecida pelo inss: uma análise de caso / Profile of the worker received vocational rehabilitation service of inss: a case analysis / Perfil del trabajador acogido al servicio de reinserción profesional del inss: análisis de un caso

Introdução: O Instituto Nacional do Seguro Social (INSS) é a autarquia federal legalmente incumbida de concretizar as políticas públicas da previdência social. A reabilitação profissional é um dos serviços oferecidos pelo INSS, e deve proporcionar meios para a (re)educação e (re)adaptação profissional e social do segurado incapacitado, com vistas a possibilitar o seu reingresso no mercado de trabalho e sua inclusão social no contexto em que vive. Percebe-se, assim, que a reabilitação profissional envolve conceitos de trabalho, de saúde e de educação. Objetivo: Este artigo tem por objetivo analisar o perfil básico do trabalhador acolhido no serviço de reabilitação profissional do INSS em Uberlândia/MG. Metodologia: Em termos metodológicos, trata-se de um estudo de caso, de natureza quantitativa. A unidade de análise são os segurados desligados no ano de 2017 e foram analisados dados secundários extraídos pelo INSS de processos físicos de acompanhamento dos reabilitandos. Descreveram-se o procedimento adotado pelo setor de reabilitação profissional do INSS e o perfil do segurado submetido a reabilitação profissional. Principais resultados: Concluiu-se que alguns aspectos da amostra contrariavam os prognósticos fornecidos pelo referencial teórico e que outros os confirmavam. Conclusão: O universo da amostra é semelhante ao dos estudos anteriores (composição etária, remuneração média, nível de escolaridade). Contudo, alguns resultados contrariam os indicados por eles, tais como quantidade de inelegíveis por possibilidade de retorno ao trabalho, quantidade de segurados desligados do programa sem passar por nenhum curso de capacitação ou treinamento profissional. Além disso, os resultados sugerem que a responsabilidade pelo sustento da família tem importância no sucesso da reabilitação profissional e que o fato de o segurado receber um benefício de valor superior prejudica o sucesso da reabilitação profissional. Contribuições teóricas e práticas: Ao final, foi possível contribuir com um bom diagnóstico da situação. Estas informações podem subsidiar a tomada de decisões administrativas.

Introduction: The National Social Security Institute (INSS) is the federal authority legally responsible to implement public policies of social welfare. The labour rehabilitation is one of the services offered by INSS, and should provide means for (re) education and (re) professional and social adaptation of the disabled workers, in order to enable their re-entry into the labour market and their inclusion the social context in which they live. We may affirm that labour rehabilitation involves concepts of work, health and education. Research´s goal: This article aims to analyze the basic profile of the worker received vocational rehabilitation service of INSS in Uberlândia/MG. Methods: In terms of methodology, it is a case study, quantitative oriented. The unit of analysis are workers switched off of the program in the year 2017 and secondary data were extracted by the INSS physical processes. The article describes the procedure adopted by INSS´ labour rehabilitation professionals and the profile of the workers who underwent the program. Main Outcomes: It was concluded that some aspects of the sample denied forecasts provided by theoretical studies and others confirmed them. Conclusion: The sample universe is similar to that of previous studies (age composition, average salary, education level). However, some results contradict those indicated, such as the number of ineligible persons due to the possibility of returning to work, the number of insured persons who were terminated from the program without undergoing any training or professional training courses. In addition, the results suggest that the responsibility for supporting the family is important for the success of professional rehabilitation and that the fact that the insured receives a benefit of higher value jeopardizes the success of professional rehabilitation. Theoretical and practical contribution: In the end, it was possible to generate a good diagnosis of the situation. This information can support administrative decision-making.

Introducción: El Instituto Nacional de Seguridad Social (INSS) es la autoridad federal legalmente responsable de la ejecución de las políticas públicas de asistencia social. La rehabilitación laboral es uno de los servicios ofrecidos por el INSS, y debe proporcionar medios para la (re)educación y (re)adaptación profesional y social de los trabajadores discapacitados, con el fin de permitir su reinserción en el mercado de trabajo y su inclusión el contexto social en el que viven. Podemos afirmar que la rehabilitación laboral implica conceptos de trabajo, salud y educación. Objetivo de la investigación: Este artículo tiene como objetivo analizar el perfil básico del trabajador que recibe el servicio de rehabilitación profesional del INSS en Uberlândia/MG. Metodología: En términos de metodología, se trata de un estudio de caso, de orientación cuantitativa. La unidad de análisis son los trabajadores desconectados del programa en el año 2017 y los datos secundarios fueron extraídos por los procesos físicos del INSS. El artículo describe el procedimiento adoptado por los profesionales de rehabilitación laboral del INSS y el perfil de los trabajadores que se sometieron al programa. Principales resultados: Se concluye que algunos aspectos de la muestra desmienten las previsiones aportadas por los estudios teóricos y otros las confirman. Conclusiones: El universo de la muestra es similar al de estudios anteriores (composición por edad, salario medio, nivel de estudios). Sin embargo, algunos resultados contradicen los indicados, como el número de personas no elegibles debido a la posibilidad de reincorporarse al trabajo, el número de asegurados que fueron dados de baja del programa sin realizar ningún curso de formación o capacitación profesional. Además, los resultados sugieren que la responsabilidad de mantener a la familia es importante para el éxito de la rehabilitación profesional y que el hecho de que el asegurado reciba una prestación de mayor valor pone en peligro el éxito de la rehabilitación profesional. Contribución teórica y práctica: Al final, fue posible generar un buen diagnóstico de la situación. Esta información puede servir de apoyo a la toma de decisiones administrativas.

Desastre socioambiental de Mariana: implicações nas condições de saúde da população atingida e no processo de trabalho dos serviços de saúde / Mariana socio-environmental disaster: implications for the health conditions of the affected population and the work process of health services

O desastre socioambiental, ocorrido em Mariana, em consequência do rompimento da barragem de Fundão da mineradora Samarco, devastou as comunidades de Bento Rodrigues e de Paracatu de Baixo provocando perdas e danos que podem se desdobrar ao longo do tempo, produzindo efeitos profundos na saúde, no meio ambiente, bem como no contexto de vida e trabalho. Com isso, busca-se analisar o processo saúde-doença e o processo de trabalho nos serviços de saúde destinados à população atingida pelo desastre socioambiental em Mariana. Trata-se de um estudo de caso conduzido pela abordagem qualitativa, descritiva e exploratória, cujo cenário é Mariana, onde se encontram as comunidades diretamente atingidas pelo rompimento da barragem de rejeito de mineração. As fontes de evidências utilizadas foram documentos de domínio público e entrevistas com profissionais de saúde e gestores. Foram escolhidas intencionalmente a Unidade de Saúde de Bento Rodrigues e o dispositivo Conviver, por atenderem exclusivamente as famílias vítimas do desastre. Participaram da pesquisa onze profissionais de saúde e três gestores. Os dados foram analisados por meio da estratégia de proposições teóricas à luz da teoria de Determinação Social do Processo Saúde-Doença. Os resultados revelaram as implicações do desastre nas condições sociais, econômicas, culturais e sobretudo na saúde da população atingida, com consequências relacionadas aos agravos respiratórios e os ocasionados por veiculação hídrica ou contato com a lama toxica de rejeito, e os casos depressivos e demais transtornos psicossociais que intensificaram o sofrimento crônico da população. Já as implicações do desastre no processo de trabalho nos serviços de atendimento exclusivo aos atingidos, evidenciam uma (re)organização do sistema de saúde, o qual enfrentou dificuldades estruturais tanto na fase emergencial quanto de recuperação pós-desastre. Destaca-se que embora os instrumentos do processo de trabalho utilizados pelos profissionais de saúde e gestores, são capazes de acolher, estimular práticas mais integradas e que transcendem a intervenção apenas nos corpos biológicos, ainda assim não são capazes de suprir as necessidades mediadas de saúde dos atingidos, não promovendo respostas às necessidades políticas, sociais e econômicas no que tange à reparação, à indenização e os direitos da população atingida.

The socio-environmental disaster that occurred in Mariana, because of the collapse of the Samarco mining company's Fundão dam, devastated the communities of Bento Rodrigues and Paracatu de Baixo, causing losses and damages that can unfold over time, producing profound effects on health, in the environment, as well as in the context of life and work. With this, we seek to analyze the health-disease process and the work process in health services intended for the population affected by the socio-environmental disaster in Mariana. This is a case study conducted using a qualitative, descriptive and exploratory approach, whose setting is Mariana, where the communities directly affected by the collapse of the mining tailings dam are located. The sources of evidence used were public domain documents and interviews with health professionals and managers. The Bento Rodrigues Health Unit and the Conviver device were intentionally chosen, as they exclusively serve families who were victims of the disaster. Eleven health professionals and three managers participated in the research. The data were analyzed using the strategy of theoretical propositions in light of the theory of Social Determination of the HealthDisease Process. The results revealed the implications of the disaster on social, economic, cultural conditions and above all on the health of the affected population, with consequences related to respiratory problems and those caused by water transport or contact with toxic waste sludge, and depressive cases and other disorders, psychosocial problems that intensified the chronic suffering of the population. The implications of the disaster on the work process in services providing exclusive care to those affected highlight a (re) organization of the health system, which faced structural difficulties in both the emergency and postdisaster recovery phases. It is noteworthy that although the work process instruments used by health professionals and managers are capable of welcoming and stimulating more integrated practices, that transcend intervention only in biological bodies, they are still not capable of meeting mediated health needs of those affected, failing to promote responses to political, social and economic needs in terms of reparation, compensation and the rights of the affected population.

Propostas para a área de gestão do trabalho e educação na saúde para o fortalecimento do SUS / Proposals for the work management and education in the healthcare field to strengthen Brazilian National Health System

Resumo Este documento propositivo foi delineado no âmbito do 13º Congresso Brasileiro de Saúde Coletiva, realizado em novembro de 2022. O evento congregou 6,8 mil pessoas imbuídas de esperança pela eleição de um governo progressista e democrático, além de um espírito de articulação, integração e de defesa de direitos. O documento foi escrito com o objetivo de contribuir para a formulação de soluções para problemas enfrentados pela sociedade brasileira, apresentando propostas à comissão de transição do governo federal que são caras à área de gestão do trabalho e educação na saúde e caminham na direção de um Sistema Único de Saúde forte e igualitário.

Abstract This propositional document was outlined within the scope of the 13th Brazilian Congress on Collective Health, held in November 2022. The event brought together 6,800 people imbued with hope for the election of a progressive and democratic government, as well as a spirit of articulation, integration, and defense of rights. The document was designed with the objective of contributing to formulating necessary solutions for problems faced by the Brazilian society, presenting proposals to the federal government's transition commission that are dear to the work management and education in the healthcare field and move towards a strong and egalitarian Brazilian National Health System.

O trabalho em saúde pode ser considerado "tecnologia leve"? / Can health work be considered as "soft technologies"?

Resumo Neste ensaio trazemos uma discussão sobre o conceito de tecnologia leve aplicado ao trabalho em saúde, como proposto por Emerson Merhy. Objetivamos problematizar a ideia de tecnologia leve e, para isso, estabelecemos duas linhas de análise. Na primeira, há um diálogo com Antonio Negri, Michael Hardt e Maurízio Lazzarato na reflexão sobre a dimensão produtiva do trabalho vivo, como trabalho imaterial e produção de valor no campo da saúde. Na segunda, orientados por Michel Foucault, analisamos a dimensão ética de um trabalho que tem na imprevisibilidade do encontro, da experiência e do acontecimento a produção de um saber. Concluímos apontando que o trabalho em saúde se trata de uma tecnologia que produz relações de cuidado e, assim, solicita a criação de modos de cuidar, trabalhar e gerir com os cotidianos da saúde pela metamorfose de um êthos.

Abstract In this essay we discuss the concept of soft technology applied to health work proposed by Emerson Merhy. We aimed to discuss the idea of soft technology and, to that end, we established two analytical paths. The first one dialogues with Antonio Negri, Michael Hardt, and Maurízio Lazzarato in thinking about the productive dimension of living labour, such as immaterial labour and value production in the healthcare field. In the second, driven by Michel Foucault, we analyze the ethical dimension of a work that has the production of a knowledge in the unpredictability of the encounter, the experience, and the event. We conclude by pointing out that healthcare work is a technology that produces care relationships and, thus, calls for the creation of ways of caring, working, and managing daily health by the metamorphosis of an ethos.

[The Pan American Health Organization's Virtual Campus for Public Health as a technical cooperation strategyO Campus Virtual de Saúde Pública da Organização Pan-Americana de Saúde como estratégia de cooperação técnica]. / El Campus Virtual de Salud Pública de la Organización Panamericana de la Salud como estrategia de cooperación técnica.

The Virtual Campus for Public Health (VCPH) is the educational platform of the Pan American Health Organization, conceived as a tool for technical cooperation.The objectives of this article are to: characterize the training offered at the VCPH, identifying its virtual courses; characterize course participants; describe technological updating processes and the advances made in terms of accessibility; and identify the VCPH's relationship with the main lines of cooperation of the Pan American Health Organization.The VCPH has developed 210 tutored courses and 226 self-learning courses since 2007, related to the Organization's policies. Heterogeneous use of the campus was observed in the different areas of cooperation. The number of self-learning courses conducted during the pandemic surpassed the total figure accumulated in previous years.Participants are mainly from Latin America; 67.5% are women between 26 and 45 years of age; 57.1% have a university education, mainly in nursing or medicine; half of them work in hospitals and 35.8% at the first level of care.More than 90% of the participants had a favorable opinion of the topics addressed, the learning resources offered, and the characteristics of the virtual classroom. Among difficulties, they indicated little available time and poor internet access; among advantages, they emphasized independent schedules and access to various sources of information. The available assessment tools are not sufficient to determine the impact of VCPH educational programs.The challenges are to deepen the accessibility and quality of education offered, strengthen links with areas of cooperation, and improve course evaluations and knowledge about VCPH users.

O Campus Virtual de Saúde Pública é a plataforma educacional da Organização Pan-Americana da Saúde, concebida como uma ferramenta de cooperação técnica.Os objetivos deste artigo são caracterizar os treinamentos oferecidos pelo Campus Virtual de Saúde Pública, identificando as propostas de cursos virtuais; caracterizar os participantes desses cursos; descrever os processos de atualização tecnológica e seu progresso em termos de acessibilidade; e identificar sua relação com as principais linhas de cooperação da Organização Pan-Americana da Saúde.Desde 2007, o Campus Virtual de Saúde Pública desenvolveu 210 cursos com orientação e 226 cursos de autoaprendizagem relacionados às políticas da Organização. Houve um uso heterogêneo do campus em relação aos diferentes temas de cooperação. O número de cursos de autoaprendizagem realizados durante a pandemia excedeu o número total acumulado nos anos anteriores.Os participantes são oriundos principalmente da América Latina. No total, 67,5% são mulheres, com idade entre 26 e 45 anos, e 57,1% têm formação universitária, principalmente em enfermagem ou medicina. Metade trabalha em hospitais e 35,8% na atenção primária.Mais de 90% dos participantes fizeram uma avaliação favorável dos tópicos abordados, recursos de conhecimento e características da sala de aula virtual. Como dificuldades, destacam-se a pouca disponibilidade de tempo e o acesso limitado à Internet. As vantagens incluem a autonomia de horários e o acesso a várias fontes de informação. As ferramentas de avaliação disponíveis não são suficientes para reconhecer o impacto dos programas educacionais.Os desafios são aprofundar a acessibilidade e a qualidade das propostas educacionais, fortalecer sua relação com os temas de cooperação e melhorar a avaliação dos cursos e o conhecimento dos usuários.

Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden.

This article focuses on the role of lay health promoters in the Lindängen initiative, a community-based participatory research (CBPR) programme for health promotion that started 2016 in a low-income neighbourhood in the outskirts of Malmö, southern Sweden. The programme aimed to support equitable health and develop an innovative model for community health promotion. The purpose of this article is to describe the role of the lay health promoters in the initiative and discuss the challenges of their position mediating between residents of the neighbourhood and the established institutions, using interviews, meeting notes and focus groups sessions with the health promoters and local stakeholders. Lay health promoters' role and function developed in a collaborative process of networking with local stakeholders and citizens in local meeting places. Their work was based on their credibility in their role, in combination with the use of a CBPR model that was open to innovation, with a strong focus on actively engaging members of the community. This allowed the lay health promoters to take political and social stances towards various issues, and to start to concretely address the social determinants of health in the community, as well as express recommendations to policymakers. Based on these experiences, the lay health promoters gained clearer insights into the institutional and structural conditions that impact their community. The position they had in the process of the programme resulted in empowerment and a new local association for health promotion; LindängenKraft (LindängenPower) driven by the health promotors and community members.

Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?

BACKGROUND AND AIMS: Medicaid is a public health insurance program in the United States that serves low-income individuals. Medicaid beneficiaries have elevated risk of opioid use disorder (OUD), yet face barriers to receiving medications for OUD (MOUD). To inform efforts to increase MOUD receipt among Medicaid beneficiaries, this study: (1) estimated Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and (2) estimated the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. DESIGN, SETTING AND PARTICIPANTS: Retrospective study of North Carolina, USA licensed physicians, physician assistants and nurse practitioners. Licensure data from 2018 were merged with 2019 US Drug Enforcement Administration (DEA) data to identify clinicians who received the DEA waiver required to prescribe buprenorphine (n = 1714). Medicaid claims data were used to characterize clinician engagement in OUD care delivery. MEASUREMENTS: Outcomes were indicators of any Medicaid professional claims and any Medicaid prescription claims for buprenorphine and/or naltrexone. Predictors included clinician characteristics (e.g. gender and race) and characteristics of clinicians' practice location (e.g. area opioid overdose death rate). FINDINGS: Most waivered clinicians delivered services to Medicaid beneficiaries, ranging from 67.0% of behavioral health clinicians to 82.9% of specialist physicians. Among waivered clinicians with Medicaid professional claims, prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians. The probability of prescribing MOUD to Medicaid beneficiaries was higher among waivered clinicians identifying as male compared with female (8.5 percentage points, P = 0.004) or black compared with white (9.9 percentage points, P = 0.007), older clinicians (0.5 percentage point increase per year, P < 0.001) and clinicians in counties with a higher opioid overdose death rate (5.0 percentage point increase per additional death per 10 000 residents, P = 0.010). CONCLUSIONS: Among clinicians in North Carolina, USA who are authorized to prescribe buprenorphine, 67-83% (depending on type of specialist) deliver services to Medicaid beneficiaries, but only 30-52% of those prescribe medications for opioid use disorder (OUD) to Medicaid beneficiaries. Engagement in OUD care delivery to Medicaid beneficiaries varies by clinician demographic and area characteristics.

Health systems strengthening through policy-level integration of community health worker programs into national health systems for improved health outcomes - scorecard metrics validation: A bifactor structural equation model approach.

Background: Subsequent to the demonstrated potential of community health workers (CHWs) in strengthening health systems to improve health outcomes, recent literature has defined context and guidelines for integrating CHW programs into mainstream health systems. However, quantitative measures for assessing the extent of CHW program integration into national health systems need to be developed. The purpose of this study was to validate a newly developed scale, Community Health Worker Program Integration Scorecard Metrics (CHWP-ISM), for assessing the degree of integration of CHW programs into national health systems in Sub-Saharan Africa (SSA). Methods: Data obtained through a pilot study involving a purposively selected sample of 41 participants selected from populations involved in CHW programs work in selected countries of SSA formed the basis of a 31-item bifactor model. Data were collected between June and December 2019. By applying a latent variable approach implemented with structural equation modeling, data analysis was mainly done using the R statistical environment, applying factor analysis procedures. Results: Dimensionality, construct validity, and the CHWP-ISM scale's internal consistency were assessed. Confirmatory factor analysis of the CHW-ISM bifactor model supported a co-occurring CHW integration general factor and six unique domain-specific factors. Both the comparative fit index (CFI) and Tucker-Lewis Index (TLI) fit indices were above 0.9, while the root mean square of the residuals (RMSR) was 0.02. Cronbach's alpha (α), Guttman 6 (Lambda 6), and Omega total (ωt) were above 0.8, indicating good scale reliability. Conclusion: Statistical significance of the bifactor model suggests that CHW integration has to be examined using factors that reflect a single common underlying integration construct, as well as factors that reflect unique variances for the identified six subject-specific domains. The validated CHWP-ISM could be useful to inform policy advisers, health systems, donors, non-governmental organizations, and other CHW program stakeholders with guidance on how to quantitatively assess the integration status of different components of CHW programs into respective critical functions of the health system. Improved integration could increase CHW program functionality, which could in turn strengthen the healthcare systems to improve health outcomes in the region.

More than chores: The invisible health work of family caregivers in rural New Brunswick, Canada.

Most home care for people living with chronic illness or disability is provided by informal, or unpaid, family members. Family caregivers in rural New Brunswick engage in essential work to maintain the home as a site of care. Renovations, property maintenance, and the administrative work involved in accessing medical equipment and managing staff are examples of the types of invisible labour involved in interacting with a complex care environment. Conversations with 13 family caregivers across a small rural Canadian province suggest that even when resources are 'available', place-based factors involved in caring at home in a rural setting make it difficult for carers to use these resources and accessing them becomes another form of work itself. Similar to Wiles et al.'s (2018) findings in their study of end-of-life family care in Aotearoa, New Zealand, carers in rural New Brunswick spoke of their activities as part of an ongoing process of interaction with the care recipient and care environment. Carers with fewer financial and material resources experienced higher burdens of invisible work. The paper sheds light on the types of labour involved in 'knowing, doing, and negotiating' care at home and re-categorizes these activities as 'health work' as a means of informing home care policy. The paper finds that family caregivers are aware of their invisible work, characterize it as essential health work, and seek recognition for their complex contribution to the formal health system.

Estratégias de enfrentamento em acidentes de trabalho com exposição ao material biológico / Coping strategies for workplace accidents involving exposure to biological material / Estrategias de enfrentamiento en accidentes de trabajo con exposición al material biológico

Diferentes trabalhadores estão sujeitos a acidentes com material biológico, que geram não apenas agravos físicos, mas, sobretudo, psicológicos. O coping ocupacional é a tentativa individual de adaptação às situações estressantes no ambiente de trabalho. O estudo analisou as estratégias de enfrentamento utilizadas pelos trabalhadores da área da saúde que se acidentam com material biológico. Adotou como método o estudo descritivo, com abordagem qualitativa, realizado por meio de entrevistas semiestruturadas com dez trabalhadores da área da saúde que trabalham em hospitais e sofreram acidente com exposição a material biológico recentemente, selecionados a partir da estratégia de bola de neve. As entrevistas foram gravadas, transcritas e organizadas, e, para análise do conteúdo, foram utilizadas as etapas da técnica propostas por Bardin. Os resultados mostraram que a estratégia de enfrentamento mais representativa para os trabalhadores pesquisados foi o controle por meio da busca de mudança de atitudes em relação às rotinas de trabalho e do aperfeiçoamento técnico. A metodologia utilizada proporcionou a identificação, ainda, de outras estratégias, caso da autoculpabilização e a da interação social. Aponta para a importância da formação integrada e continuada no espaço de trabalho como forma de prevenção e de condução dos acidentes de trabalho.(AU)

Diverse workers are subject to accidents involving biological material, which cause not only physical injury but, above all, psychological damage. Occupational coping is the individual's attempt to adapt to stressful situations in the workplace. The study analyzed the coping strategies of health professionals who suffered accidents involving biological material. It adopted a descriptive method, with a qualitative approach, carried out by using semi-structured interviews with ten health professionals working in hospitals and who had recently suffered accidents involving exposure to biological material, selected with a snowball sampling strategy. The interviews were recorded, transcribed, and organized, and for the analysis of the content, the technique of content analysis proposed by Bardin was used. The results showed that the most common coping strategy for the workers surveyed was control by seeking a change of attitudes regarding work routines and technical improvements. The methodology also identified other strategies, such as self-blaming and social interaction. These findings point to the importance of integrated and continuous workplace training as a way to prevent and manage workplace accidents.(AU)

Los trabajadores están sujetos a accidentes con material biológico, los cuales ocasionan no solo agravios físicos, sino también psicológicos. El coping ocupacional es el intento individual de adaptación a las situaciones estresantes en el ambiente de trabajo. Este estudio tuvo como objetivo analizar las estrategias de enfrentamiento utilizadas por los trabajadores del área de la salud que sufrieron accidentes con material biológico. El método que se utilizó fue el estudio descriptivo, de naturaleza cualitativa, a partir de la aplicación de entrevistas semiestructuradas a diez trabajadores del área de la salud en hospitales y que sufrieron accidentes con materiales biológicos recientemente, seleccionados por la estrategia de bola de nieve. Las entrevistas fueron grabadas, transcritas y organizadas, y para el análisis del contenido se utilizaron las etapas de la técnica propuestas por Bardin. Los resultados mostraron que el control fue la estrategia de enfrentamiento más utilizada mediante la búsqueda de cambio de actitud con relación a las rutinas de trabajo y al perfeccionamiento técnico. La metodología permitió identificar otras estrategias, como la autoculpabilización y la interacción social. Cabe destacar la importancia de la formación integrada y continua en el espacio de trabajo como medio de prevención y de manejo a accidentes de trabajo.(AU)

Estrategias y herramientas de capacitación en seguridad y salud en el trabajo, en el sector construcción / Strategies and Tools for Occupational Health and Safety Training in the Construction Sector / Estratégias e ferramentas para treinamento em segurança e saúde ocupacional no setor de construção

Introducción: En los últimos años, el sector de la construcción en Colombia se ha ubicado en el cuarto lugar entre los sectores económicos con mayor accidentalidad. Las cifras indican que de los 1233 accidentes laborales en el país, 156 pertenecían a este sector. La capacitación en seguridad y salud en el trabajo desempeña un papel funda-mental para reducir los índices de accidentalidad. Objetivo: Mencionar algunas estrategias y herramientas digitales actualizadas para la capacitación en seguridad y salud en el trabajo en el sector de la construcción. Método: Revisión teórico-descriptiva de tipo documental. Algunas bases de datos consultadas fueron: Medline, ScienceDirect, Scopus, SciELO, Proquest y Pubmed. Como criterio de selección se incluyeron artículos en inglés y español a partir del 2015 y algunos anteriores como referentes históricos. De más de 80 trabajos consultados, 53 cumplieron con los criterios de inclusión; además, se validó cada descriptor en ciencias de la salud (Decs). Conclusiones: Existen diferentes estrategias y herramientas que podrían usarse para la capacitación en riesgos laborales, que van desde las actividades lúdicas, pasando por herramientas digitales, hasta estrategias de participación activa del trabajador que permitan una mayor concientización y apropiación del conocimiento en materia de seguridad, que incentiven la aplicación de prácticas seguras, teniendo en cuenta su contexto crítico de accidentalidad

Introduction: In recent years, the construction sector in Colombia, has ranked fourth among the economic sectors with the highest accident rates in the country, figures indicate that of the 1233 occupational accidents in Colombia, 156 belong to the construction sector. Occupational health and safety training plays a fundamental role in reducing accident rates. Objective: To mention some updated strategies and digital tools for training in occupational safety and health in the construction sector. Method: Theoretical and descriptive documentary review. Some databases consulted were Medline, ScienceDirect, Scopus, SciELO, Proquest and Pubmed. As a selection criterion, articles in English and Spanish from 2015 and some previous ones were included as historical references. Of more than 60 papers consulted, 53 met the inclusion criteria, in addition, each Descriptor in Health Sciences (DeCS) was validated. Conclusions: There are different strategies and tools that could be used for training in occupational hazards, ranging from playful activities, digital tools and strategies of active worker participation that allow greater awareness and appropriation of knowledge on safety, encouraging the application of safe practices taking into account their critical context of accident rate.

Introdução: Nos últimos anos, o setor de construção na Colômbia ocupou o quarto lugar entre os setores econômicos com maior índice de acidentes. Os números indicam que dos 1233 acidentes de trabalho ocorridos no país, 156 ocorreram neste setor. O treinamento em segurança e saúde ocupa-cional tem um papel fundamental na redução das taxas de acidentes. Objetivo: Mencionar algumas estratégias e ferramentas digitais atualizadas para o treinamento em segurança e saúde ocupacional no setor de construção. Método: Revisão teórico-descritiva de tipo documental. Alguns bancos de dados consultados foram: Medline, ScienceDirect, Scopus, SciELO, Proquest e Pubmed. Os critérios de seleção incluíram artigos em inglês e espanhol a partir de 2015 e alguns artigos anteriores como referentes históricas. Dos mais de 80 artigos consultados, 53 preenchiam os critérios de inclusão; além disso, foi validada cada pala-vra-chave nos descritores em ciências da saúde (Decs). Conclusões: Existem diferentes estratégias e ferramentas que poderiam ser utilizadas para o treina-mento sobre riscos ocupacionais, desde atividades lúdicas, passando por ferramentas digitais, até es-tratégias de participação ativa dos trabalhadores que permitem maior conscientização e apropriação de conhecimentos sobre segurança, que incentivam a aplicação de práticas seguras, levando em conta seu contexto critico de acidentes

El Campus Virtual de Salud Pública de la Organización Panamericana de la Salud como estrategia de cooperación técnica / The Pan American Health Organization's Virtual Campus for Public Health as a technical cooperation strategy / O Campus Virtual de Saúde Pública da Organização Pan-Americana de Saúde como estratégia de cooperação técnica

RESUMEN El Campus Virtual de Salud Pública es la plataforma educativa de la Organización Panamericana de la Salud, concebida como herramienta para la cooperación técnica. Los objetivos de este artículo son caracterizar la oferta de formación del Campus Virtual de Salud Pública identificando las propuestas de cursos virtuales; caracterizar a los participantes de los cursos; describir los procesos de actualización tecnológica y sus avances en términos de accesibilidad; e identificar su relación con las principales líneas de cooperación de la Organización Panamericana de la Salud. El Campus Virtual de Salud Pública ha desarrollado 210 cursos con tutoría y 226 de autoaprendizaje desde 2007, relacionados con las políticas de la Organización. Se verificó un uso heterogéneo del campus en las distintas temáticas de la cooperación. La cantidad de cursos autoadministrados realizados durante la pandemia superó la cifra total acumulada en años previos. Los participantes provienen principalmente de Latinoamérica. Un 67,5% son mujeres, con edades entre 26 y 45 años. Un 57,1% posee educación universitaria, principalmente en enfermería o medicina. La mitad trabaja en hospitales y un 35,8% en el primer nivel. Más de un 90% de los participantes evaluaron favorablemente los temas abordados, recursos de conocimiento y características del aula virtual. Como dificultades, señalan escasa disponibilidad de tiempo y bajo acceso a internet. Como ventajas, destacan autonomía de horarios y acceso a diversas fuentes de información. Las herramientas de evaluación disponibles no son suficientes para reconocer el impacto de los programas educativos. Se plantean los desafíos de profundizar en la accesibilidad y calidad de las propuestas educativas, fortalecer la relación con los temas de cooperación y mejorar la evaluación de los cursos y el conocimiento sobre los usuarios.

ABSTRACT The Virtual Campus for Public Health (VCPH) is the educational platform of the Pan American Health Organization, conceived as a tool for technical cooperation. The objectives of this article are to: characterize the training offered at the VCPH, identifying its virtual courses; characterize course participants; describe technological updating processes and the advances made in terms of accessibility; and identify the VCPH's relationship with the main lines of cooperation of the Pan American Health Organization. The VCPH has developed 210 tutored courses and 226 self-learning courses since 2007, related to the Organization's policies. Heterogeneous use of the campus was observed in the different areas of cooperation. The number of self-learning courses conducted during the pandemic surpassed the total figure accumulated in previous years. Participants are mainly from Latin America; 67.5% are women between 26 and 45 years of age; 57.1% have a university education, mainly in nursing or medicine; half of them work in hospitals and 35.8% at the first level of care. More than 90% of the participants had a favorable opinion of the topics addressed, the learning resources offered, and the characteristics of the virtual classroom. Among difficulties, they indicated little available time and poor internet access; among advantages, they emphasized independent schedules and access to various sources of information. The available assessment tools are not sufficient to determine the impact of VCPH educational programs. The challenges are to deepen the accessibility and quality of education offered, strengthen links with areas of cooperation, and improve course evaluations and knowledge about VCPH users.

RESUMO O Campus Virtual de Saúde Pública é a plataforma educacional da Organização Pan-Americana da Saúde, concebida como uma ferramenta de cooperação técnica. Os objetivos deste artigo são caracterizar os treinamentos oferecidos pelo Campus Virtual de Saúde Pública, identificando as propostas de cursos virtuais; caracterizar os participantes desses cursos; descrever os processos de atualização tecnológica e seu progresso em termos de acessibilidade; e identificar sua relação com as principais linhas de cooperação da Organização Pan-Americana da Saúde. Desde 2007, o Campus Virtual de Saúde Pública desenvolveu 210 cursos com orientação e 226 cursos de autoaprendizagem relacionados às políticas da Organização. Houve um uso heterogêneo do campus em relação aos diferentes temas de cooperação. O número de cursos de autoaprendizagem realizados durante a pandemia excedeu o número total acumulado nos anos anteriores. Os participantes são oriundos principalmente da América Latina. No total, 67,5% são mulheres, com idade entre 26 e 45 anos, e 57,1% têm formação universitária, principalmente em enfermagem ou medicina. Metade trabalha em hospitais e 35,8% na atenção primária. Mais de 90% dos participantes fizeram uma avaliação favorável dos tópicos abordados, recursos de conhecimento e características da sala de aula virtual. Como dificuldades, destacam-se a pouca disponibilidade de tempo e o acesso limitado à Internet. As vantagens incluem a autonomia de horários e o acesso a várias fontes de informação. As ferramentas de avaliação disponíveis não são suficientes para reconhecer o impacto dos programas educacionais. Os desafios são aprofundar a acessibilidade e a qualidade das propostas educacionais, fortalecer sua relação com os temas de cooperação e melhorar a avaliação dos cursos e o conhecimento dos usuários.

Sofrimento laboral e estratégias de defesa referidas por técnicas de enfermagem de maternidades públicas / Distress at work and defensive strategies reported by nursing technicians at public maternity hospitals / El sufrimiento laboral y las estrategias de defensa mencionadas por las técnicas en enfermería de maternidades públicas

Objetivo: analisar as vivências de sofrimento e as estratégias de defesa referidas por técnicas de enfermagem em maternidades públicas. Método: pesquisa qualitativa, exploratória e descritiva, com 11 técnicas de enfermagem de maternidades públicas do Rio de Janeiro. Os dados foram coletados em maio de 2019, por meio de entrevistas semiestruturadas, submetidos à análise de conteúdo temática e discutidos à luz da Psicodinâmica do Trabalho. Resultados: os relatos apontam para condições laborais geradoras de desgaste e sofrimento, que repercutem na saúde das participantes. Diante disso, elas elaboram estratégias defensivas individuais, como isolamento emocional, soluções criativas, espiritualidade, religiosidade e momentos de lazer. Na perspectiva coletiva, recorrem a períodos de conversa e ao apoio mútuo no turno laboral. Conclusão: as estratégias defensivas referidas são relevantes para lidar com o sofrimento e atender às demandas do trabalho, mas parecem não evitar o adoecimento nem promover mudanças no contexto laboral das maternidades.

Objective: to examine experiences of distress and related defensive strategies reported by nursing technicians at public maternity hospitals. Method: in this exploratory, qualitative, descriptive study of 11 nursing technicians from public maternity hospitals in Rio de Janeiro, data were collected in May 2019 by semi-structured interviews, subjected to thematic content analysis, and discussed in the light of the Psychodynamics of Work. Results: the reports point to wearing and distressing working conditions, which affected participants' health. In response, they developed individual defensive strategies, such as emotional isolation, creative solutions, spirituality, religiosity, and moments of leisure. Collectively, they resort to periods of conversation and mutual support during shifts. Conclusion: the defensive strategies reported are important in coping with suffering and meeting work demands, but they do not seem to prevent illness nor promote changes in the maternity hospital work environment.

Objetivo: analizar las experiencias de sufrimiento y las estrategias de defensa mencionadas por técnicas de enfermería en maternidades públicas. Método: investigación cualitativa, exploratoria y descriptiva, junto a 11 técnicas de enfermería de maternidades públicas de Rio de Janeiro. Los datos se recopilaron en mayo de 2019, por medio de entrevistas semiestructuradas. Luego se sometieron a un análisis de contenido temático y se discutieron a la luz de la Psicodinámica del Trabajo. Resultados: los relatos apuntan hacia condiciones laborales que generan desgaste y sufrimiento y que afectan la salud de las participantes. Por tanto, desarrollan estrategias defensivas individuales como: aislamiento emocional, soluciones creativas, espiritualidad, religiosidad y momentos de ocio. Desde una perspectiva colectiva, recurren a las conversaciones y al apoyo mutuo durante la jornada laboral. Conclusión: las estrategias defensivas mencionadas son relevantes para enfrentar el sufrimiento y satisfacer las demandas del trabajo, pero no parecen prevenir enfermedades ni promover cambios en el contexto laboral de las maternidades.

Produção de corpos generificados em um bloco cirúrgico: uma análise pelo trabalho como atividade / Production of bodies generated in a surgical ward: an analysis by work as an activity / Producción de cuerpos generados en uma unidad quirúrgica: una análisis por trabajo como actividad

Neste artigo, analisamos o trabalho em saúde em um bloco cirúrgico a partir do referencialteóricoda Clínica da Atividade, atentando para a especificidade da performatividade do gênero por entre esta experiência. Para tanto, produzimos um percurso transverso do ponto devista do método, operando por entre Clínica da Atividade e pistas do Método Cartográfico, realizando, ainda, articulações com a proposta praxiográfica. As análises apontam que, apesar das fortes prescrições que compõem o trabalho em um bloco cirúrgico, ostrabalhadores e trabalhadoras problematizam as normas de trabalho e de gênero nas situações laborais, produzindo estilizações. É na atividade que as normas de trabalho, e também de gênero, são colocadas em questão abrindo brechas e críticas a modelos regulatórios, e também violentos, que ancoram, por vezes, as práticas em saúde. A partir dessa pesquisa, apontamos a importância de produzir estudos relativos à produção do gênero em meio aos processos operativos do trabalho. (AU)

In this article, we analyzed the health work in surgical ward based on the theoretical references of the Clinic of Activity, taking into account specificity of gender performativity among this experience. For this purpose, we produced a transversal path from the point of view of the method, operating methodologically between the Clinic of Activity and clues from the Cartographic Method, also performing articulations with the praxiographic. The analyzes point out that, despite the strong prescriptions that make up the work in surgical ward, the workers problematize labor and gender norms in work situations, producing stylizations. It's in the activity that work norms, as well as gender, they are called into question, opening loopholes and criticisms of regulatory models, and also violent, that sometimes anchor health practices. This research indicates the importance of further studies towards the production involving gender and labor processes. (AU)

En este artículo analizamos el trabajo em salud en una Unidad Quirúrgica de un Hospitala partir de los referentes teóricos de la Clínica de Actividad, prestando atención a la especificidad del performatividad de género em esta experiencia.Para eso, producimos un recorrido transversal desde el punto de vista del método, operando entre la Clínica de Actividad y las pistas del Método Cartográfico, realizando también articulaciones com la propuesta praxiográfica. Los análisis muestran que, a pesar de lãs fuertes prescripciones que conforman el trabajo en una unidad quirúrgica, los trabajadores y trabajadoras problematizan las normas laborales y de género em lãs situaciones laborales, produciendo estilizaciones. Es em la actividad donde se cuestionan las normas laborales, así como el género, abriendo lagunas y críticas a modelos regulatorios, y también violentos, que en ocasiones anclanlas prácticas de salud. A partir de esta investigación, señalamos la importancia de producir estudios relacionados com la producción de género em medio de los procesos operativos del trabajo. (AU)