Pediatric care in Brazil's Unified Health System: reflections on the role of pediatricians in Family Healthcare Strategy

This essay seeks to contribute to the elucidation of the potential activities of pediatricians in the Family Healthcare Strategy. The origins, types of care and inherent implications to the process of change in the Healthcare Model that are being implemented in the Brazilian Unified Health System (SUS) since the Basic Operational Norms were instituted in 1996 are duly presented.     

Identity's configuration of nurses of a mobile emergency care service

This study considers the configuration of the identity of nurses working in a Mobile Emergency Care Service, based on the model of Dubar. This is a qualitative study, in which data were collected mainly through interviews, with nurses and other team members, and analyzed according to the technique of content analysis. About the identity of the nurse, the results point to a different subject, experienced, lonely, closer to the welfare activities, in search of training and recognition, wrapped in complex labor relations. Due the limitations of research and the issues that emerged in the research process, suggestions for future research are aligned at the end of the article.     

Family coping: caring for the elderly in home care

This paper focuses on the nature and significance of family caregiving problems when providing assistance to chronically ill or frail older adults. It includes theoretical frameworks that provide explanations of related research about family coping problems, a guide for assessment of family caregiving problems, and a summary of current findings relative to home care agency planning and health care policy. The Family Caregiver Assessment Guide for use in home care agencies is included in the appendix to the paper.     

The Family Health Strategy and healthcare for the elderly: experiences in three Brazilian cities

This study focuses on healthcare for the elderly under the Family Health Strategy in three municipalities (counties) in the State of Rio de Janeiro, Brazil, specifically analyzing the organization of the healthcare network and the knowledge of six health teams, using interviews and focus groups. The study emphasized the central role of work by community health agents, the prioritization of program activities as compared to management of problems in the community covered by the strategy, a work overload in the health teams, disorganization of the healthcare networks, and lack of systemic approaches based on the basic contents of Geriatrics and Gerontology. The article concludes that there is a need for a healthcare network for the elderly consisting of hierarchically organized services and levels of care that provide support for the healthcare teams' work. The teams could also benefit from continuing education programs. The undergraduate medical curriculum should also include more course content in geriatrics and gerontology.     

Family care of the elderly: the role of public policy

There is little evidence to support the belief--and many policy initiatives flowing from it--that families are less willing or able to provide home care to elderly relatives. Informal care-giving remains at a high level; institutionalization rates have changed little over the past 30 years. But some demographic trends affecting both the elderly and families may change this picture in the future. Proposals for providing cash grants or tax allowances do not get to the heart of the matter.     

上海医疗系统发展战略

在理想状态下,每个国家都有一个最适合的医疗融资和递送系统.我们认为对于每个国家并非只存在单一的理想模式.然而在医疗系统的设计和改革中依然存在许多共同的问题,并且有很多教训值得大家吸取.     

Management of waste generated in home care by the Family Health Strategy

This study aimed to analyze the management of waste generated by home care. Data were collected through observation of care provided by professionals and users and/or caregivers. Data were recorded on a checklist developed according to the recommendations of RDC 306. The following wastes were generated: syringes (38.1%), needles (36.5%), adhesive plasters (31.7%), gauze (31.7%) and lancets (28.5%). The residues of group A were not segregated in all opportunities and group E were segregated 100% and 10.5% by professionals and users, respectively. It is concluded that, given the inadequacies found, wide collective discussion is required for the proposal of public policies that address the specific waste management of home health services, aiming to provide safety to workers, community and the environment.     

Health care restructuring, work environment, and health of nurses

BACKGROUND: In the last 15 years, the health care system has undergone significant restructuring. The study's objective was to examine the psychosocial work environment and the health of nurses after major restructuring in comparison with two reference populations. METHODS: This cross-sectional study involved 2,006 nurses from 16 health centers. A questionnaire measured current work characteristics: psychological demands, decision latitude, and social support at work from Karasek's Job Content Questionnaire, organizational changes, and health effects. Prevalence ratios and binomial regression were used to examine the associations between current work characteristics, changes and psychological distress (PSI). RESULTS: There was a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994. These adverse factors were also more prevalent among nurses than among Québec working women and they were independently associated with psychological distress. CONCLUSION: Workplace interventions should be based on elements identified by many nurses as being problematic.     

家庭关怀及社会支持对社区老年人社会隔离的影响

目的了解社区老年人社会隔离的现状,明确家庭关怀及社会支持因素对其产生的影响,为采取应对措施提供理论依据。方法于2017年12月-2018年8月采用社会网络量表(LSNS-6)、家庭关怀度问卷(APGAR)、社会支持评定量表(SSRS)对唐山市6所社区1 526例老年人(≥60岁)进行问卷评测。结果社区老年人社会网络总均分为(16.16±5.447)分,其中发生社会隔离者占24.3%;多因素分析结果显示,患有慢病(OR=2.477,95%CI:1.948～3.057)、居住在3层楼房以上(OR=2.475,95%CI:1.747～3.505)是社会隔离的危险因素,家庭关怀度高(OR=0.644,95%CI:0.588～0.706)、社会支持度高(OR=0.806,95%CI:0.779～0.833)是社会隔离的保护因素;分层回归分析显示家庭关怀及社会支持能够独立解释30.1%的社会隔离。结论唐山市社区老年人社会隔离发生率远高于北京市水平,加强家庭及社会支持可降低社会隔离的发生。     

Perspectives of physical therapy participation in the Family Health Program for elderly care

The premise of this paper was to introduce the concept of elderly physical therapy care in the Family Health Program. Inspired by the impact attributable to the socio-demographic changes, the increase of an elderly population and for the consolidation of a national health policy inspired by civil rights principles, the authors present an initiative for physical therapy practice aimed at the elderly. The successful integration of physical therapy in the Family Health Program conducted in the city of S?o Carlos, S?o Paulo State, has shown that the idea is likely to achieve great results and qualified participation.     

Theoretical review of the work process in health care used to analyze work in the Family Health Program in Brazil

This literature review focused on the work process in health care, particularly issues linked to the Family Health Program. Since 1994, the Program has rapidly expanded health coverage for the Brazilian population, and as a result the Program's work force has also increased. The Program thus requires attention, allocation of responsibilities, and contributions of various types by stakeholders and institutions. The work occurs in the services sector, within a neoliberal scenario. Work in health care shares some characteristics with other occupations in the services sector, such as bureaucratization, the influence of capitalist division of labor, and difficulties in teamwork, in addition to little regard for the subjectivity of health system clients and workers. The study particularly focuses on work conditions of family health teams in Brazil, including strategies for revitalizing health care work and coping with alienating conditions in the work process. Finally, the study reiterates the dialectic condition of the work process in health care under the Family Health Program, with its possibilities for success, conceived and functioning in the midst of contradictions and difficulties.     

Burnout and work environments of public health nurses involved in mental health care

Aims: (1) To examine whether prevalence of burnout is higher among community psychiatric nurses working under recently introduced job specific work systems than among public health nurses (PHNs) engaged in other public health services. (2) To identify work environment factors potentially contributing to burnout.     

家庭无酬照料劳动供给对中老年人健康的影响

伴随人口老龄化的加剧与三孩政策的放开,照料需求也不断增长。在有酬照料服务供给相对不足且质量欠佳,女性越来越多地进入劳动力市场的背景下,由中老年群体提供家庭照料成为了理性的选择。本文利用CHARLS数据库,构建面板数据固定效应模型,探究了家庭无酬照料劳动供给对中老年群体健康的影响。结果表明,提供家庭照料劳动对中老年群体的身体健康不存在显著性影响,但对其精神健康存在显著的负面冲击。提供家庭照料劳动对女性中老年人与农村中老年人精神健康的负面影响更强。中介效应分析表明,家庭照料劳动通过增加家庭总支出与减少花费在主要工作上的工作时间两种渠道对精神健康产生影响。文章最后从关注弱势群体精神健康、增加公共照料服务供给等角度提出了政策建议。     

老年居家卫生服务机构医护人员结构研究

目的:为了设置更科学、更合理的老年居家卫生服务机构医生和护士的配比。方法:通过前期广泛问卷调查以及运用排队论建立老年居家卫生服务机构的模型。结果:计算得出每1000人社区需要2个医生和3个护士。结论:该模型可以推广以用于设置其他社区的老年人居家卫生服务机构的人员配比。     

The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese).     

Characteristics of wet work in nurses

Background objectives: Nursing is known for its high prevalence of hand dermatitis, mainly caused by the intense exposure to wet work in nursing activities. We aimed to study the characteristics of wet work exposure in nursing. Method: Trained observers monitored the duration and frequency of different wet work activities in 45 randomly chosen nurses from different wards during a morning shift, using a method of continuous observation based on labour-observation techniques. Results: Wet work in intensive care units accounted for 24% of the overall morning shift duration, with a frequency of 49 incidents. This was 16% in dialysis wards, with a frequency of 30 incidents, and 9% on regular wards, with a frequency of 39 incidents. The wet work activities had short mean duration cycles. The mean duration of occlusion by gloves was 3.1 min on regular wards and 6.7 min in intensive care units. Discussion: The characteristics of wet work in nurses differed substantially, depending on the ward. According to the German regulation TRGS 531, our observations classify nursing as a wet work occupation, due to the frequency of wet work rather than its duration. The mean duration of occlusion in our observations was short, which makes an occlusion-induced irritating effect doubtful. Reduction in wet work exposure in nursing on regular wards could focus on the reduction of the frequency of hand-washing and patient-washing. We suggest increasing the use of gloves for patient washing. Although this will increase exposure to occlusion from gloves, it may reduce the frequency of exposure to water and soap by about a quarter.