IgG Isotypes Targeting a Recombinant Chimeric Protein of Trypanosoma cruzi in Different Clinical Presentations of Chronic Chagas Disease.

Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi, which leads to a spectrum of clinical presentations that range from asymptomatic to severe cardiac involvement. The host immune response plays a pivotal role in disease progression. Ig isotypes may contribute to disease pathogenesis. Investigating these components can provide insights into the immunopathogenic mechanisms underlying CD. This cross-sectional study aims to establish a correlation between the Ig profile of individuals infected with T. cruzi with the clinical forms of chronic CD. Serum samples were collected from partner institutions in different states of Brazil. Individuals diagnosed with chronic CD were categorized based on the clinical form of the disease. The indirect ELISA method using the recombinant chimeric Molecular Biology Institute of Paraná membrane protein 8.4 as the antigen was used to determine the Ig profile, including total IgG, IgG1, IgG2, IgG3, and IgG4. Ninety-seven serum samples from patients classified as negative (NEG, n = 38), indeterminate (IND, n = 24), mild cardiac (MC, n = 20), and severe cardiac (SC, n = 15) forms were analyzed. IgG1 exhibited greater levels compared with the other isotypes, showing a significant difference between the MC and IND groups. IgG3 levels were greater in individuals from the MC group compared with the SC group. IgG1 and IgG3 isotypes can serve as biomarkers to evaluate the progression of CD because they exhibit variations across clinical groups. Additional longitudinal studies are necessary to explore the relationship between antibody kinetics and the development of tissue damage.

Spatial distribution of congenital syphilis in the state of Bahia, Brazil from 2009 to 2018.

Objective: To describe the temporal trend and spatial distribution of congenital syphilis (CS) cases in the state of Bahia, Brazil between 2009 and 2018. Method: Mixed ecological study conducted through the analysis of data obtained from the Notifiable Diseases Information System and the Live Birth Information System. Global Moran Index I was performed in order to analyze spatial autocorrelation of CS cases in the municipalities of Bahia and the Local Spatial Association Indicator (LISA) was used to identify the formation of spatial regimes in the GeoDA software. Results: 8,786 cases of CS were registered in the period. An increasing growth in CS incidence, with a 511% increase between 2009 and 2018. Spatial autocorrelation was observed between the municipalities (I Moran = 0.452; p < 0.001) and four clusters were identified. More frequently, mothers were aged 20-29 years (50.7%); had incomplete primary education (54.9%); were Black and multiracial (93.2%); received prenatal care (82.2%); 49.0% were diagnosed with syphilis during prenatal care; 68.8% were not adequately treated, and 81.1% of their partners were not treated. Conclusion: The results showed that CS consolidates as a serious public health problem in Bahia, with an incidence 8.4 times higher in the period than the WHO target of 0.5/1,000 live births, predominantly related to inadequate prenatal care and social vulnerability indicators: young mothers with low education levels, as well as individuals identified as Black and multiracial. Thus, programs aimed at women of childbearing age and pregnant women need to be intensified.

Epidemiological indicators of Chagas disease in the metropolitan region of Salvador, Bahia, Brazil.

BACKGROUND: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. METHODS: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. RESULTS: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. CONCLUSIONS: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.

Occupational stressors and work accidents among health workers.

OBJECTIVE: To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS: Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS: A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio's risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS: Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio's prevention in health.

[Social determinants of health: community features and nurse work in family health care]. / Determinantes sociais de saúde: características da comunidade e trabalho das enfermeiras na saúde da família.

The purpose of this study is to identify the Social Determinants of Health Care which emerge in nurses' statements as they characterize the community, analyzing its relation to the work carried out by them. It is an exploratory and descriptive study containing a qualitative analysis in the theoretical categories of the determinants. We used a semi-structured interview, recorded with the permission of the 65 nurses of the Family Health Care, members of the 3rd Regional Health Care Coordination of Rio Grande do Sul, Brazil. It has been shown the inter- and intra-relation in the health determinant factors, obtaining 104 citations for the anatomo-physiological features of the corresponding individuals/community to the proximal correspondents and in association, mainly, to the work carried out by the nurses. For intermediate determinants there were 27 citations and, for distals, 166, with predominant reference to the territorial localization of communities in rural areas and peripheries. The nurses have stated a narrow relation between the proximal features and the work carried out by them, as well as the connection with other determinants in the relation with the process of getting sick.

Risk perception in family health work: study with workers in Southern Brazil.

This analytical and qualitative study aimed to identify how workers in the Family Health Strategy perceive the risks they are exposed to at work. Thematic analysis and the reference framework of the work process were used to examine the contents of interviews with 48 subjects (community health agents, nurses, nursing auxiliaries and physicians). The workers noticed the following risks: physical and moral violence, typical work accident, emotional exhaustion, lack of problem-solving ability and occupational disease. The results predominantly show the connection with the object / subject of the work and the social environmental characteristics of the related communities. The study adds to the body of knowledge and can systemize collective and individual technological processes for occupational health risk management in primary health care.

[System of meanings about the purpose of family health work: a qualitative analysis]. / Sistema de significados sobre a finalidade do trabalho na saúde da familia: uma abordagem qualitativa.

This exploratory study was performed to understand the system of meanings about the purpose of the nursing and medical work performed by Family Health teams, in the cities of Rio Grande and Pelotas (Brazil). Data collection was performed by semi-directed individual interviews. The interviews of 82 participants were recorded, and analyzed. The nuclear meaning of the purpose, as an end transmuted into the product of collective work, was in agreement with the possibility of the community implementing changes and acquiring healthy individual and collective behaviors. This gives evidence of the component of ethics in the process, by means of categories such as solidarity and compassion. This led to a marker, in the text production, of the human condition in the construction of the work purpose. Through the analysis and critical discussion of the theme, this study contributes to the macro-dimension of developing competencies and adjustment to the health needs of society.

[Temporary workers' perceptions of occupational risks in the port of Rio Grande, Rio Grande do Sul State, Brazil]. / Percepção dos trabalhadores avulsos sobre os riscos ocupacionais no porto do Rio Grande, Rio Grande do Sul, Brasil.

This was a cross-sectional, descriptive, quantitative study in the port of Rio Grande, Rio Grande do Sul, Brazil, aimed at identifying occupational risk perceptions in a sample of 306 temporary dockworkers. Most temporary dockworkers (93.46%) acknowledged the existence of health risks on the job, independently of schooling (p = 0.44) and job activity (p = 0.47). Risks identified by temporary workers as a whole included falling of suspended objects (8.43 +/- 2.47), noise (8.06 +/- 2.32), and bad weather conditions (8.05 +/- 2.48). Risks that varied significantly between jobs were: noise (p = 0.00), lifting loads manually (p = 0.00), work tools (p = 0,00), insufficient number of work team members (p = 0.03), extra wages based on productivity (p = 0.00), work pace (p = 0.01), working on scaffolding and other high areas (p = 0.00), workers moving on top of cargo (p = 0.00), and ship's ladders and gangways (p = 0.00). The study corroborated that temporary dock work is unhealthy and hazardous, and that the risks affect workers according to the specific jobs they perform.

Fatores associados a acidentes com exposição a material biológico de trabalhadores da saúde da atenção básica e da média complexidade em cinco municípios baianos / Factors associated with occupational accidents involving exposure to biological material in primary care and medium complexity among workers in five municipalities in Bahia, Brazil

Resumo Introdução no trabalho em saúde podem ocorrer os acidentes de trabalho com exposição a material biológico, potencial fonte de infecção para doenças graves. Objetivo estimar os fatores associados aos acidentes com exposição a material biológico entre trabalhadores da saúde da atenção básica e da média complexidade. Método estudo transversal, exploratório, realizado com trabalhadores da atenção básica e da média complexidade em cinco municípios baianos. O processamento dos dados incluiu análises descritivas, uni e multivariadas. Resultados a incidência dos acidentes de trabalho com exposição a material biológico foi de 3,4%, atingindo a faixa etária entre 19 a 33 anos (RR: 2,06; IC 95%: 1,2 - 3,4), revelando ausência de prática regular de atividade de lazer (RR: 1,8; IC 95%:1,1-2,8), atuação na média complexidade (RR: 1,8; IC 95%: 1,2-2,8), exposição a agentes biológicos (RR: 3,7; IC 95%: 2,4 - 5,9) e trabalho de alta exigência (RR: 1,9; IC 95%: 1,1 - 3,3). Conclusão verifica-se ser necessária a priorização dos trabalhadores da saúde em ações de vigilância em ambientes de trabalho e programas voltados à prevenção dos acidentes como compromisso da área de saúde do trabalhador no Sistema Único de Saúde.

Abstract Background: i n health work, work accidents may occur with exposure to biological material, a potential source of infection for serious diseases. Objective To estimate the factors associated with occupational accidents with exposure to biological material among health workers in primary care and medium complexity. Method A cross-sectional and exploratory study was carried out with primary care and medium complexity workers in five municipalities in Bahia, Brazil. Data processing included descriptive, univariate, and multivariate analyses. Results The incidence of occupational accidents with exposure to biological material was 3.4%. The associated factors were age group of 19 to33 years (RR: 2.06; 95% CI: 1.2 - 3.4), absence of regular leisure activity (RR: 1.8; 95% CI: 1.1- 2.8), acting in medium complexity (RR: 1.8; 95% CI: 1.2-2.8), exposure to biological agents (RR: 3.7; 95% CI: 2.4 - 5, 9), and high-strain jobs (RR: 1.9; 95% CI: 1.1 - 3.3). Conclusion It is necessary to prioritize workers' health in actions to monitor work environments and programs aimed at preventing accidents as a commitment in occupational health, in the Unified Health System (SUS).

Epidemiological indicators of Chagas disease in the metropolitan region of Salvador, Bahia, Brazil

ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.

Projeto mais médicos e internações por condições sensíveis à atenção básica em distrito sanitário, Salvador (BA) / Mais médicos project and hospitalizations for conditions sensitive to primary care in a health district of Salvador / Proyecto más médicos y hospitalización para condiciones sensibles a la atención primaria en el distrito de salud, Salvador, BA, Brasil

A Atenção Básica em Saúde tem como principal proposta de reorientação do modelo assistencial a Estratégia de Saúde da Família. Contudo, um dos entraves para a sua resolubilidade se dá pela falta de médicos nas áreas de maior vulnerabilidade. Para atrair esses profissionais, foram instituídas políticas de provimento. Um indicador de qualidade da Atenção Primária em Saúde é a proporção de internações por condições sensíveis à Atenção Básica. O objetivo deste estudo foi descrever a tendência de internações por condições sensíveis à Atenção Básica em um distrito sanitário de Salvador (BA) antes e durante a atuação do Projeto Mais Médicos. Como metodologia, empregou-se estudo de tendência temporal realizado com os dados do Sistema de Informação Hospitalar e do Cadastro Nacional dos Estabelecimentos de Saúde para um distrito sanitário de Salvador (BA), entre 2010 e 2016. Foram calculadas as proporções de médicos pelos programas de provimento e a proporção de internações por condições sensíveis à Atenção Básica em Saúde em geral e para os vinte grandes grupos. Os resultados demonstraram que as internações por condições sensíveis à Atenção Básica variaram de 21,8% do total de internações hospitalares em 2010 para 8,2% em 2016, com redução após a instituição dos programas de provimento. Portanto, parece haver influências dos programas de provimento na redução das internações por condições sensíveis à Atenção Básica, recomendando-se a realização de outros estudos para a comprovação dessa hipótese.

Primary Health Care concerns itself with shifting the care model by employing the Family Health Strategy. One obstacle to this resolution is the lack of doctors in the most vulnerable regions. To attract these professionals, hiring policies have been instituted. One indicator of Primary Health Care quality is the proportion of hospitalizations for conditions sensitive to Primary Care. Given this context, this study describes the time trend of hospitalizations for conditions sensitive to Primary Care in a health district of Salvador, Bahia, Brazil, before and during the implementation of the Mais Médicos Project. Data were collected from the Hospital Information System and the National Registry of Health Establishments for the district, between 2010 and 2016. Proportion of physicians by the provision programs and the proportion of hospitalizations for conditions sensitive to Primary Care was calculated in general and for the 20 major groups. Results showed that hospitalizations for conditions sensitive to Primary Care ranged from 21.8% of total hospital admissions in 2010 to 8.2% in 2016, decreasing after implementation of the provision programs. These findings suggest that the provision programs influenced the reduction of hospitalizations for sensitive conditions to Primary Care, pointing to the need for further studies to prove this hypothesis.

La Atención Primaria de Salud tiene como principal propuesta reorientar el modelo asistencial de la Estrategia de Salud Familiar. Sin embargo, uno de los obstáculos para su resolución es la falta de médicos en las zonas de mayor vulnerabilidad. Para atraer a estos profesionales, se instituyeron políticas de contratación. Un indicador de la calidad de la Atención Primaria de Salud es la proporción de hospitalizaciones por condiciones sensibles a la Atención Primaria. El objetivo de este estudio fue describir la tendencia de internaciones por condiciones sensibles de la Atención Primaria en un Distrito de Salvador, BA (Brasil), antes y durante la ejecución del Proyecto Más Médicos. Se utilizó en la metodología el estudio de tendencia temporal realizado con datos del Sistema de Información Hospitalaria y del Registro Nacional de Establecimientos de Salud para un Distrito de Salvador, BA, entre 2010 y 2016. Se calcularon la proporción de médicos por los programas de provisión y la proporción de hospitalizaciones por padecimientos sensible a la atención básica de salud en general y para los veinte macrogrupos. Los resultados mostraron que las hospitalizaciones por condiciones sensibles en Atención Primaria oscilaron entre el 21,8% del total de ingresos hospitalarios en 2010 y el 8,2% en 2016, con una mayor disminución después de la institución de los programas de provisión. Se concluye que pudo haber una influencia de los programas de provisión en la reducción de hospitalizaciones por condiciones sensibles a Atención Primaria, lo que se recomienda realizar otros estudios para confirmar esta hipótesis.

Raciocínio clínico: percepções e práticas de estudantes de medicina / Clinical reasoning: perceptions and practices of medical students

Resumo: Introdução: Em tempos de ameaças constantes ao financiamento destinado à manutenção do Sistema Único de Saúde (SUS), faz-se necessário debruçar o olhar sobre a prática médica, sobretudo no que tange ao alto custo que o emprego desnecessário de exames complementares ocasiona à saúde pública. Objetivo: Este estudo teve como objetivo analisar as percepções sobre o raciocínio clínico (RC) e as respectivas práticas entre estudantes de Medicina (EM) de uma universidade pública do Nordeste brasileiro. Métodos: Trata-se de pesquisa qualitativa realizada com 12 EM. A coleta de dados ocorreu por meio de entrevistas semiestruturadas com gravação de áudio. A análise de dados foi realizada por meio da técnica de análise de conteúdo, modalidade análise temática. Resultados: A maioria dos EM compreendeu o RC como sinônimo de raciocínio diagnóstico, pois os discentes o praticavam como uma junção da utilização de dados da anamnese, do exame físico e de exames complementares, e realizavam raciocínio terapêutico como base em aspectos como diagnóstico do paciente, sintomatologia, comorbidades, alergia e adesão terapêutica. Além disso, os EM demonstraram conhecimento teórico-conceitual superficial sobre o tema. Conclusão: As percepções e práticas dos EM sobre o RC revelaram aspectos relevantes do contexto prático do internado na referida universidade, os quais podem subsidiar novas discussões e oportunizar a realização de outras pesquisas sobre o tema.

Abstract: Introduction: In times of constant correction of funding for the maintenance of the Sistema Único de Saúde (SUS), it is necessary to focus on medical practice, especially with regard to the high cost that the unnecessary use of complementary tests causes to public health. Objective: To analyze perceptions and practices in clinical reasoning (CR) of medical students at a public university in northeastern Brazil. Methods: Qualitative research, conducted with 12 medical students (MS). Data was collected through semi-structured interviews with audio recording. Data analysis was performed using the method of thematic content analysis. Results: Most MS understood clinical reasoning as a synonym for diagnostic reasoning, and CR practice as a combination of anamnesis data, physical exam and complementary exams. They perform therapeutic reasoning based on aspects such as patient diagnosis, symptoms, comorbidities, allergies and therapeutic compliance; and demonstrated superficial theoretical-conceptual knowledge of the topic. Conclusion: The perceptions and practices of MS on CR revealed relevant aspects of the practical context of the internship at the university. The study, therefore, supports new discussions and opportunities for new research on the topic.

Occupational stressors and work accidents among health workers / Estressores ocupacionais e acidentes de trabalho entre trabalhadores da saúde

ABSTRACT OBJECTIVE To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio's risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio's prevention in health.

RESUMO OBJETIVO Testar associação entre estressores ocupacionais e acidentes de trabalho por exposição a material biológico (ATbio) em trabalhadores da saúde, considerando a análise isolada e combinada das dimensões de dois modelos, o modelo demanda-controle (MDC) e o modelo de desequilíbrio esforço-recompensa (ERI). MÉTODOS Estudo de corte transversal em amostra representativa de trabalhadores de nível superior, técnico, médio, incluindo agentes de saúde de unidades da atenção básica e média complexidade em cinco cidades da Bahia. Selecionou-se amostragem aleatória, estratificada por área geográfica, nível de complexidade do serviço e ocupação. A variável desfecho foi ATbio; a exposição principal foram os estressores ocupacionais, avaliados pelo MDC e ERI. As incidências e os riscos relativos foram estimados em função do caráter agudo, de curta duração, do desfecho de interesse. Testaram-se associações entre ATbio e as dimensões do MDC e ERI isolados e combinados. RESULTADOS Participaram do estudo 3.084 trabalhadores. A incidência global de ATbio foi de 3,4% e mostrou-se associada a alta demanda psicológica, alto esforço e alto comprometimento com o trabalho, com ajuste por sexo, idade, escolaridade e turno de trabalho. Trabalho de alta exigência e situação de desequilíbrio entre esforços e recompensas estavam associados aos ATbio. Com a combinação dos modelos, observou-se incremento da medida de associação com o desfecho. As associações significantes e de maior magnitude foram observadas nos modelos combinados completos. O risco de ATbio foi 5,23 vezes maior entre os expostos em ambos os modelos completos em comparação com a ausência de exposição nos dois modelos. CONCLUSÕES Estressores ocupacionais mostraram-se associados aos ATbio. Observaram-se vantagens no uso dos modelos combinados. A abordagem de diferentes dimensões psicossociais ampliou a capacidade de identificação de grupos expostos, oferecendo base sólida para intervenções de prevenção dos ATbio em saúde.

Autoavaliação negativa da saúde em trabalhadoras de enfermagem da atenção básica / Poor self-assessment of the health of primary health care nursing workers / Autoevaluación negativa de la salud en trabajadoras de enfermería de la atención básica

Resumo O objetivo deste estudo é avaliar os fatores associados à autoavaliação negativa da saúde entre trabalhadoras de enfermagem. Realizou-se estudo transversal exploratório, com amostra probabilística de 451 trabalhadoras de enfermagem da Atenção Básica à Saúde. Foi aplicado questionário com informações sociodemográficas, de hábitos de vida, ocupacionais, aspectos psicossociais e satisfação no trabalho e morbidade das trabalhadoras. A autoavaliação da saúde foi aferida por meio da questão "De modo geral, em comparação às pessoas da sua idade, como você considera o seu próprio estado de saúde?". Os dados foram analisados por meio do modelo de regressão logística em blocos. Identificou-se prevalência de 15,8% de autoavaliação negativa da saúde. Os fatores associados foram: incompatibilidade das atividades desenvolvidas com o cargo, média e alta sobrecarga doméstica, situação de trabalho ativo (alto controle, alta demanda), avaliação ruim da qualidade de vida e transtornos mentais comuns. Os achados corroboram a relação entre processo saúde-doença e condições de vida e trabalho e indicam a necessidade de políticas públicas de prevenção e promoção da saúde das trabalhadoras de enfermagem. Essas politicas, ao constituir situações favoráveis de trabalho, podem ser muito relevantes para a qualidade da assistência prestada aos usuários do Sistema Único de Saúde.

Abstract The goal of this study is to assess the elements associated with the negative self-assessment of health among nursing workers. We performed a cross-sectional exploratory study, with a probability sample composed of 451 Primary Health Care nursing workers. We applied a questionnaire with sociodemographic data, as well as data on life habits, occupations, psychosocial aspects and satisfaction at work and morbidity of the workers. The self-assessment of health was measured through the question "Overall, in comparison with other people your age, how would you consider your own health status?" The data was analyzed using the model of logistic regression in blocks. We identified a prevalence of 15.8% of negative health self-assessments. The factors associated to it were: incompatibility of the activities developed with the position, medium and high housework overload, active work situation (high control, high demand), poor assessment of the quality of life, and common mental disorders. The findings confirm the relationship between the health-disease process and the life and working conditions, and point to a need for public policies of prevention and promotion of the health of nursing workers. By constituting favorable work situations, these policies may be highly relevant for the quality of the care provided to the users of the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym).

Resumen El objetivo de este estudio es evaluar los factores asociados a la autoevaluación negativa de la salud entre trabajadoras de enfermería. Se realizó un estudio transversal exploratorio, a partir de una muestra probabilística de 451 trabajadoras de enfermería de la Atención Básica de la Salud. Se aplicó un cuestionario con información sociodemográfica, de hábitos de vida, laborales, aspectos psicosociales y satisfacción en el trabajo, y morbilidad de las trabajadoras. La autoevaluación de la salud fue realizada a través de la pregunta "¿De manera general, en comparación a las personas de su edad, cómo considera usted su propio estado de salud?". Los datos se analizaron por medio del modelo de regresión logística en bloques. Se identificó que la autoevaluación negativa de la salud prevalece con un 15,8%. Los factores asociados fueron: incompatibilidad de las actividades desarrolladas en relación al cargo, media y alta sobrecarga doméstica, situación de trabajo activo (alto control, alta demanda), mala evaluación de la calidad de vida y trastornos mentales comunes. Los resultados corroboran la relación entre el proceso salud-enfermedad y las condiciones de vida y trabajo, e indican la necesidad de políticas públicas de prevención y promoción de la salud de las trabajadoras de enfermería. Estas políticas, al constituir situaciones favorables de trabajo, pueden ser muy importantes para la calidad de la asistencia brindada a los usuarios del Sistema Único de Salud.

The prevalence of musculoskeletal diseases among casual dock workers.

This study identified the prevalence of work-related musculoskeletal disorders among casual dockworkers. This is a retrospective and quantitative study, the data sources of which included the medical files of dockworkers from 2000 to 2009. Data were collected in a medical service for dockworkers using a previously developed form; descriptive quantitative analysis was performed. Ethical aspects were complied with. A total of 15.8% of the diagnoses identified among male workers referred to musculoskeletal disorders. Individuals older than 52 years of age and with more than 21 years working in the field predominated. The most frequent musculoskeletal diseases included low back pain (38.8%), tendinitis (19.7%), and neck pain (12.5%). These diseases can be prevented through health interventions, confirming the importance of developing clinical support in nursing in order to improve the quality of life of dockworkers.

Notificações de agravos à saúde dos trabalhadores na área de abrangência de um município de médio porte da Bahia / Notifications of health risks to workers health coverage area of a medium-sized municipality in the State of Bahia / Notificaciones de las enfermedades de los trabajadores en la área de cobertura de una ciudad de medio porte en el Estado de Bahia

O trabalho é importante determinante no processo de saúde/doença na população. O objetivo do estudo foi caracterizar o perfil dos casos de Agravos Relacionados ao Trabalho (ART) notificados na área de abrangência do Cerest de Itaberaba, Bahia. Estudo descritivo, incluindo os casos de agravos ocupacionais registrados no Sistema de Informação de Agravos de Notificação, no período de 2007 a 2012. Os resultados mostram que, no período investigado, foram notificados 539 casos de ART, sendo 68,1% registrados pelo Cerest e quase a totalidade dos casos foram de LER/Dort e de acidentes de trabalho (92,3%). Os trabalhadores mais acometidos foram as mulheres (60,3%), com faixa etária entre 20-39 anos (62,6%), com nível de escolaridade até o ensino médio (93,7%), empregado registrado ou servidor público (70%) e que ocupavam funções relacionadas à produção de bens e serviços e comércio (62,4%). Concluiu-se que há subnotificação desses casos, fato que evidencia a importância da realização de ações de vigilância em saúde do trabalhador, para prevenção, principalmente dos acidentes de trabalho e de LER/Dort, e entre os trabalhadores com características sociais e ocupações mais acometidas.

Work is such an important determinant to the health/disease process for population. The objective of this study was to characterize the profile of cases of the Work Related Diseases reported in the coverage area of Cerest de Itaberaba, Bahia. A descriptive study, including cases of occupational diseases registered in the Information System for Notifiable Diseases from 2007 to 2012. The results show that 539 cases were reported in that period, 68.1% of the cases were registered by Cerest and almost all of the cases were WRULMSDs accidents (92.3%). The most injured workers were women (60.3%), aged between 20-39 years (62.6%), with level of education through high school (93.7%), registered employee or public servant (70%) and who held functions related to the production of goods and services and trade (62.4%). In conclusion, there was underreporting of such cases, what highlights the importance of conducting surveillance activities for occupational health, for the prevention, particularly, of accidents at work and WRULMSDs amongst workers who fit the social characteristics and occupations most affected.

El trabajo es un factor determinante en el proceso salud/enfermedad en la población. El objetivo del estudio fue caracterizar el perfil de los casos de Enfermedades Relacionadas con el Trabajo (ERT) notificados en el área de cobertura del Cerest en Itaberaba, Bahia. Estudio descriptivo incluyendo los casos de accidentes de trabajo registrados en lo Sistema de Información de Agravios de Notificación (Sinan), entre 2007 y 2012. Los resultados muestran que, en el período investigado, fueron notificados 539 casos de ERT, siendo 68,1% notificados por el Cerest y casi todos fueron de LER/Dort y accidentes de trabajo (92,3%). Los trabajadores más afectados fueron las mujeres (60,3%), con edades entre 20-39 años (62,6%), con el nivel de educación secundaria (93,7%), empleado registrado o servidor público (70%) y que ocupaban funciones relacionados con la producción de bienes y servicios y el comercio (62,4%). Concluyóse que ha subnotificación de estos casos, lo que destaca la importancia de la realización de acciones de vigilancia en la salud del trabajador, para la prevención, principalmente, de accidentes de trabajo y de las LER/Dort, y entre los trabajadores con características sociales y ocupaciones más afectadas.

The prevalence of musculoskeletal diseases among casual dock workers / Prevalência de doenças musculoesqueléticas entre trabalhadores portuários avulsos / Prevalecía de enfermedades musculoesqueléticos entre trabajadores portuarios apulsos

This study identified the prevalence of work-related musculoskeletal disorders among casual dockworkers. This is a retrospective and quantitative study, the data sources of which included the medical files of dockworkers from 2000 to 2009. Data were collected in a medical service for dockworkers using a previously developed form; descriptive quantitative analysis was performed. Ethical aspects were complied with. A total of 15.8% of the diagnoses identified among male workers referred to musculoskeletal disorders. Individuals older than 52 years of age and with more than 21 years working in the field predominated. The most frequent musculoskeletal diseases included low back pain (38.8%), tendinitis (19.7%), and neck pain (12.5%). These diseases can be prevented through health interventions, confirming the importance of developing clinical support in nursing in order to improve the quality of life of dockworkers.

O objetivo deste estudo foi identificar a prevalência de doenças musculoesqueléticas relacionadas ao trabalho, entre trabalhadores portuários avulsos. É estudo quantitativo, retrospectivo. A fonte de dados constituiu-se de fichas de atendimento médico dos trabalhadores portuários avulsos, no período de 2000 a 2009. A coleta de dados foi realizada em um serviço de medicina do trabalho portuário, a partir de formulário pré-determinado. Procedeu-se à análise quantitativa descritiva. Aspectos éticos foram respeitados. Identificaram-se 15,8% de diagnósticos de doenças osteomusculares, entre trabalhadores do sexo masculino. Predominaram indivíduos com mais de 52 anos de idade e com tempo de atuação laboral superior a 21 anos. As doenças osteomusculares prevalentes foram lombalgias (38,8%), tendinites (19,7%) e cervicalgias (12,5%), que podem ser prevenidas por meio de ações interventoras em saúde, ratificando a importante construção de subsídios clínicos em enfermagem para a qualidade do trabalho portuário.

Este estudio tuvo como objetivo identificar la prevalecía de enfermedades osteomusculares relacionadas al trabajo entre trabajadores portuarios sin registro. Estudio cuantitativo, retrospectivo. La fuente de datos las tablas de atención medica de los trabajadores portuarios sin registro en el período de 2000 a 2009. La colecta de datos fue realizada en un Servicio de Medicina del Trabajo Portuario a partir de un formulario predeterminado. Se procedió en el análisis cuantitativo descriptivo de los datos. Los aspectos éticos fueran respetados. Se identificó 15,8% diagnósticos de enfermedades osteomusculares, entre trabajadores del sexo masculino. Predominaran individuos con más de 52 años de edad y con tiempo de actuación laboral superior a 21 años. Las principales enfermedades fueran de lumbalgia (38,8%), tendinitis (19,7%) y cervicalgía (12,5%). Las enfermedades osteomusculares mas prevalentes fueran las lumbalgías, tendinitis y cervicalgías, las cuales pueden prevenirse por medio de acciones interventoras y evaluativas en salud, ratificando la importancia de construir subsidios clínicos en enfermería que colaboren para la cualidad de vida del trabajador portuario.

Prevenção de agravos e promoção da saúde: um estudo com trabalhadores portuários / Injury prevention and health promotion: a study among dock workers / Prevención de enfermedades y promoción de la salud: un estudio con trabajadores portuarios

Estudo quantitativo, transversal e descritivo, realizado no porto do Rio Grande, Rio Grande do Sul, Brasil. Objetivou identificar o conhecimento e participação nos serviços portuários locais especializados, em amostra com 306 trabalhadores portuários avulsos. No grupo geral dos trabalhadores, a maioria identificou a existência do Programa de Prevenção de Riscos Ambientais (67,32 por cento), do Serviço Especializado em Segurança e Saúde no Trabalho Portuário (93,46 por cento) e da Comissão de Prevenção de Acidentes no Trabalho Portuário (97,38 por cento). Quanto à participação dos trabalhadores nos serviços citados, estratificada por categoria profissional, salienta-se, no primeiro, a colaboração, implantação, execução e respeito às orientações (p=0,001); junto ao segundo e terceiro, a participação na eleição dos representantes (p=0,001). Evidencia-se que conhecer tais serviços e deles participar relaciona-se com a atividade desenvolvida pelos trabalhadores. As evidências apontadas contribuem para uma pactuação entre suportes educacionais e ambientais, para a gestão de riscos e a promoção da saúde dos trabalhadores portuários.

The objective of this exploratory, transversal and quantitative study carried out in the port of Rio Grande, Rio Grande do Sul, Brazil is to identify the knowledge and participation of dock workers about specialized port services, involving a sample of 306 workers. In general group of dock workers, the majority identified the existence of an Environmental Risk Prevention Program (67.32 percent), from the Specialized Service in Health Safety for dock workers (93.46 percent) and from the dock workers Accident Prevention Commission (97.38 percent). Worker participation in the services cited, stratified by professional categories, were highlighted in the first place to collaboration, implantation, execution, and respect for orientation (p=0.001). With respect to the second and third tasks, participation in representation election (p=0.001) was highlighted. This study has shown that knowing these services and participating in them is related to worker-developed activity. The evidence presented contributes to form a pact between educational and environmental supporters for dock worker risk management and health promotion.

Estudio cuantitativo, transversal y descriptivo, realizado en el puerto de Rio Grande, en la ciudad de Río Grande do Sul, Brasil. El objetivo fue identificar el conocimiento y participación de trabajadores al respecto de los servicios portuarios especializados, siendo utilizada una muestra con 306 individuos. En el grupo general de los trabajadores participantes del estudio, la mayoría identificó la existencia del Programa de Prevención de Riesgos Ambientales (67,32 por ciento), del Servicio Especializado en Seguridad y Salud en el Trabajo Portuario (93,46 por ciento) y de la Comisión de Prevención de Accidentes en el Trabajo Portuario (97,38 por ciento). Sobre la participación de los trabajadores en los servicios citados, estratificada por categoría profesional, se destaca en relación al primero, la colaboración, implantación, ejecución y respeto a las orientaciones (p=0,001), y con relación al segundo y tercer servicios, la participación en la elección de los representantes (p=0,001). Se evidencia que conocer estos servicios y participar se relaciona con la actividad desarrollada por los trabajadores. Tales evidencias contribuyen para un acuerdo entre el apoyo educativo y ambiental para la gestión de riesgos y la promoción de la salud de los trabajadores portuarios.

Percepção da equipe de enfermagem no acompanhamento do processo detrabalho no Programa Saúde da Família / Nursing team perception in the accompanying of the work process in the Family Health program

Objetivo. Descrever as percepções da equipe de enfermagem com respeito à importância, ações e propósitos do acompanhamento realizado no processo de trabalho no programa de Saúde da Família (SF). Metodologia. Estudo descritivo qualitativo no participaram 185 pessoas da equipe de enfermagem que laboram em 12 municípios que possuem unidades de SF inscritos à Terceira Coordenação Regional de Saúde de Rio Grande do Sul, Brasil. Fizeram-se entrevistas semi-estruturadas que foram gravadas, cuja informação foi posteriormente analisada com o software NVivo 7.0. Resultados. Destacam-se as ações de investigação das necessidades em saúde. A assistência, a administração e os procedimentos curativos têm um fluxo normativo trabalhista. A finalidade do acompanhamento é a criação de um vínculo entre enfermeiros e agentes comunitários de saúde, o qual facilita o alcance das metas da estratégia de saúde familiar e que também permite a organização do trabalho nas unidades. Conclusão. O acompanhamento ao pessoal de enfermagem que trabalham em SF é um processo contínuo que deve ser apoiado pela comunidade.

Objetivo. Describir las percepciones del equipo de enfermería con respecto a la importancia, acciones y propósitos del acompañamiento realizado en el proceso de trabajo en Salud de la Familia (SF). Metodología. Estudio descriptivo cualitativo en el que participaron 185 personas del equipo de enfermería que laboran en 12 municipios que poseen unidades de SF adscritos a la Tercera Coordinación Regional de Salud de Rio Grande do Sul, Brasil. Se hicieron entrevistas semiestructuradas que fueron grabadas, cuya información fue posteriormente analizada con el software Nvivo 7.0. Resultados. Se destacan las acciones de investigación de las necesidades en salud. La asistencia, la administración y los procedimientos curativos tienen un flujo normativo laboral. La finalidad del acompañamiento es la creación de un vínculo entre enfermeros y agentes comunitarios de salud, el cual facilita el alcance de las metas de la Estrategia de SF y, también, facilita la organización del trabajo en las unidades. Conclusión. El acompañamiento al personal de enfermería que trabaja en SF es un proceso continuo que debe ser apoyado por la comunidad.

Objective. To describe the nursing team perceptions regarding the importance, actions and purposes of accompanying the work process in the Family Health program (FH). Methodology. Descriptive study, where 185 people from nursing teams that work in 12 cities that have FH units subscribed to the Third Regional Health Coordination of Rio Grande do sul, Brazil, participated. Semi-structured interviews were recorded; collected data was analyzed using the NVivo 7.0 software. Results. Research actions of the health necessities are highlighted. Attendance, management, and healing procedures have workflow regulations. The purpose of accompanying is the creation of links between sick people and health communitarian agents, which facilitate reaching the goals of the family health strategy and also allow work organization in the units. Conclusion. Accompanying for the nursing personnel who work in the FH is a continuous process that should be supported by the community.

Processo de trabalho da Estratégia Saúde da Família: a concepção de gestão que permeia o agir em saúde / Work process of the Family Health Strategy: a design management that permeates health action

Este estudo, de caráter explicativo e transversal, e natureza predominantemente qualitativa, tem o objetivo de analisar o processo de trabalho dos gestores municipais da Estratégia Saúde da Família (ESF), a fim de apreender a concepção de gestão que permeia seu agir em saúde. Os dados foram coletados através de entrevista semiestruturada gravada, junto aos gestores da ESF pertencentes a 12 municípios da Terceira Coordenadoria Regional de Saúde do Rio Grande do Sul (3ªCRS/RS), totalizando 15 sujeitos. A análise temática congregou uma abordagem dialética, seguindo os passos de pré-análise, exploração e tratamento do material e interpretação dos resultados. Os resultados foram organizados em três subtemas elucidativos das ações desenvolvidas pelos gestores investigados: 1) Ações de organização/funcionamento da Saúde da Família; 2) Ações de formação/educação permanente ou continuada; 3) Ações de monitoramento e avaliação. Apreendem-se do processo de trabalho duas concepções de gestão, sendo a primeira relacionada à gestão clássica/tradicional e a segunda relativa aos preceitos da cogestão. À guisa de conclusão, depreende-se que o processo de trabalho dos gestores da ESF na 3ªCRS/RS apresenta fortalezas e fragilidades, relacionadas à concepção de gestão que estrutura seu trabalho. Assim, sugere-se a revisão de algumas práticas, de modo que a cogestão seja a concepção preferencial utilizada para a administração da Saúde da Família.

This work, which has explanatory cross-sectional nature and is largely qualitative, aims to analyze the work process of municipal managers of the Family Health Strategy (FHS) in order to grasp the concept of management that permeates their health actions. Data were collected through semistructured interviews taped, with the managers of the FHS belonging to 12 municipalities of the Terceira Coordenadoria Regional de Saúde do Rio Grande do Sul (3ªCRS/RS), totaling 15 subjects. The thematic analysis brought together a dialectical approach, following the footsteps of pre-analysis, exploitation and processing of material and interpretation of results. The results were organized into three sub-themes elucidating the actions developed by the managers under consideration: 1) Action for organization / operation of Family Health; 2) Actions for training and continuing education; 3) Actions for monitoring and evaluation. Two management concepts arise from the work process, the first being related to the management classic / traditional and the second on the precepts of co-management. In conclusion, it appears that the working process of the managers at the 3rd ESF CRS / RS has strengths and weaknesses related to design management structures that work. Thus, it is suggested to revise some practices, so that the co-management is the preferred design used for the administration of Family Health.