Dependência, ciclo do capital e limites do fundo público no Brasil / Dependency, capital cycle and limits of the public fund in Brazil

Resumo: Este artigo visa identificar a participação e os limites do fundo público no ciclo do capital da economia dependente brasileira. Para isso, aborda as implicações do intercâmbio desigual, da transferência de valor e da superexploração da força de trabalho para a composição e direcionamento do fundo público no Brasil, utilizando-se da coleta e análise de dados acerca do sistema tributário brasileiro.

Abstract: This article aims to identify the participation and limits of the public fund in the capital cycle of the Brazilian dependent economy. To this end, it addresses the implications of unequal exchange, value transfer and overexploitation of the labor force for the composition and direction of public fund in Brazil, using the analysis of data about the Brazilian tax system.

Superexploração da força de trabalho: uma proposta metodológica de análise / Superexploitation of the labor force: a methodological proposal for analysis

Resumo: O presente ensaio propõe uma análise quantitativa da superexploração da força de trabalho, especialmente por meio de mecanismos que vinculem a intensificação da exploração da força de trabalho às transferências estruturais de valor da periferia ao centro. Nosso propósito é esboçar breves notas metodológicas que contribuam com os esforços incipientes de análise quantitativa da superexploração, avançando em relação a eles, sobretudo mediante o reconhecimento dos limites desses esforços.

Abstract: This essay proposes a quantitative analysis of the superexploitation of the labor force, especially through mechanisms that link the intensification of the exploitation of the labor force to structural transfers of value from the periphery to the center. Our purpose is to outline brief methodological notes that contribute to the incipient efforts of quantitative analysis of superexploitation, moving forward in relation to them, especially based on a recognition of the limits of these efforts.

Organización y división del trabajo: riesgos para trabajadores de servicios de salud en empresas venezolanas / Organization and division of labor: risks for health services workers in Venezuelan companies

Los modos de producción generan formas de organización y división del trabajo que puede ocasionar la aparición de riesgos psicosociales como la fatiga o el estrés laboral. El objetivo del presente estudio fue, evaluar los factores de riesgo psicosociales, la fatiga y el estrés laboral en profesionales integrantes de Servicios de Seguridad y Salud en el Trabajo, en cuatro empresas venezolanas en el 2020. Estudio de campo, descriptivo, de corte transversal. Participaron 39 trabajadores (muestra censal), 25,6% inspectores, 20,6% enfermeras y 20,6% personal médico. Se usó el cuestionario SUSESO/ISTAS21 versión breve, el cuestionario de Estrés Laboral OIT-OMS, el cuestionario de Síntomas Subjetivos de Fatiga y el cuestionario de Problemas Psicosomáticos. Resultados: Solo el 51% son del sexo masculino, promedio de edad de 35±8,7con antigüedad de 6±4,5años. Todos están bajo el tipo de contratación tercerizada (outsourcing). Resultó un trabajo de alta demanda, pero con alto control (trabajo activo). Niveles de riesgo medio (45%) vinculado al Apoyo Social y Calidad de liderazgo y nivel de riesgo alto (40%) en Compensaciones y Doble presencia. El trabajo es fatigante para el 30,7% y el estresor con mayor puntaje fue la Influencia del Líder. Concluyéndose que en estos servicios hay un número importante de profesionales femeninos, adultos jóvenes, con antigüedad laboral, expuestos a diferentes factores de riesgo psicosociales con importante influencia del líder, generadores de fatiga laboral. Recomendándose la revisión del tipo de contratación, la compensación dineraria, así como evaluaciones periódicas sobre el clima laboral(AU)

The modes of production generate forms of organization and division of labor that can cause the appearance of psychosocial risks such as fatigue or work stress. The objective of this study was to evaluate psychosocial risk factors, fatigue and work stress in professionals who are members of Occupational Health and Safety Services, in four Venezuelan companies in 2020. Descriptive, crosssectional field study. 39 workers (census sample) participated, 25.6% inspectors, 20.6% nurses and 20.6% medical personnel. The SUSESO/ISTAS21 short version questionnaire, the OIT-WHO Work Stress questionnaire, the Subjective Symptoms of Fatigue questionnaire and the Psychosomatic Problems questionnaire were used. Results: Only 51% were male, mean age 35 ± 8.7 with seniority age of 6 ± 4.5 years. All are under the outsourcing type of hiring. It turned out to be a high demand job, but with highly controlled (active work). Medium risk levels (45%) linked to Social Support and Leadership Quality, and high risk level (40%) in Compensations and Double presence. The work is tiring for 30.7% and the stressor with the highest score was the Influence of the Leader. It was concluded that in these services there are a significant number of female professionals, young adults, with seniority, exposed to different psychosocial risk factors with Important Leader Influence, generators of work fatigue. Recommending the review of the type of contract, the monetary compensation, as well as periodic evaluations of the work environment(AU)

Participación laboral durante la crisis económica por el COVID-19 en México: demandas de cuidado y recuperación diferencial entre hombres y mujeres

Introducción: la pandemia por COVID-19 no solo ha impactado en el campo de la salud, sino también ha llevado a una crisis profunda a nivel social y económico. Atender las demandas de este virus conllevó la paralización de las actividades económicas en casi todo el globo. México no fue la excepción y las medidas aplicadas en el país trajeron importantes consecuencias en la economía y el mercado laboral, con una fuerte reducción de la ocupación, así como salidas de la fuerza laboral. Este artículo busca comprender las diferencias observadas en este proceso desde un enfoque que prioriza las demandas de cuidados en los hogares como factor determinante del comportamiento dispar por sexo. Para esto se realizó un análisis cuantitativo a partir de los datos de la encuesta ECOVID-ML, mediante un modelo de regresión logística. De esa manera, se mostró la relevancia del efecto de las variables de cuidado para entender las diferencias en participación laboral entre hombres y mujeres y, además, se constató una menor reincorporación de las mujeres al mercado laboral, a pesar de que la recuperación se da en sectores feminizados.

The COVID-19 pandemic not only has had an impact in public health field, but it has also lead to a profound social and economic crisis. Attending to the demands generated by the virus has meant an economic standstill almost everywhere in the world. Mexico wasn't the exception and the measures implemented in the country had important consequences in the economy and the labor market, carrying to a strong reduction of employment and withdrawals from the labor force. Thus, this article looks to understand the observed differences in this process, taking a point of view which prioritizes household care demands as a factor that can explain the dissimilar behaviour by gender. To follow this objective a quantitative analysis is performed using data from the ECOVID-ML, through a logistic regression model. This shows that the effect of the care variables is relevant in understanding differences in labor force participation between men and women, and also confirms the lower reincorporation into the labor market of women, even though recovery has concentrated on feminized sectors.

Efectos de la frecuencia de consumo de alimentos ultraprocesados y su asociación con los indicadores del estado nutricional de una población económicamente activa en México

RESUMEN El objetivo de este estudio fue determinar la relación entre consumo de alimentos ultraprocesados y los indicadores del estado de nutricional de una muestra de población económicamente activa en México. Se realizó un estudio transversal en individuos de ambos sexos (18 a 60 años, n=150). Para la obtención de datos antropométricos de la población y de composición corporal, se utilizó un equipo de bioimpedancia. Además, se aplicó un cuestionario de frecuencia de consumo de alimentos ultraprocesados (previamente validada) para la evaluación dietética. Los resultados de los indicadores de estado nutricional demostraron que el 80% de la población estudiada presentó obesidad y sobrepeso; el 88,7% tuvo un % de grasa alto; y el 75,3% presentó riesgo metabólico alto. Con respecto a la evaluación dietética, el grupo de alimentos de ultraprocesados con alto contenido de azúcares simples fue el de mayor consumo (47%, 10,4 veces por semana). Los resultados del análisis de correlación de Pearson, indicaron que existe una correlación negativa significativa entre la edad y el consumo en cuatro de cinco grupos de alimentos ultraprocesados. Finalmente, se encontró que la muestra presenta riesgos de salud importantes que pueden afectar su calidad de vida y productividad. Se deben implementar estrategias a corto plazo de mejora de hábitos de alimentación y estilo de vida saludables en este sector de la población tan importante.

ABSTRACT This work aimed to correlate ultra-processed product consumption and nutritional status in a sample of the Mexican labor force population. A cross-sectional study assessed subjects from both genders (18 to 60 years, n=150). Bioimpedance equipment was used to obtain anthropometric measurements and body composition parameters. Moreover, a previously validated frequency questionnaire of ultra-processed foods was used to obtain dietetic data. Results from the nutritional status evaluation indicated that 80% of the sample was obese or overweight; 88.7% had high total fat mass percentage, and 75.3% had high metabolic risk. Regarding the dietetic evaluation, ultra-processed products with high sugar content were the most consumed (47%, up to10.4 times per week). Furthermore, the Pearson correlation analysis results showed a significant negative correlation between age and consumption in four of the five ultra-processed product groups evaluated. Therefore, there is a need to implement internal strategies to diminish the consumption of ultra-processed products and improve healthy food choices and physical activity of the sample to avoid quality of life deterioration and reduce economic losses in this sector.

The Brazilian nursing workforce faced with the international trends: an analysis in the International Year of Nursing / A força de trabalho de enfermagem brasileira frente às tendências internacionais: uma análise no Ano Internacional da Enfermagem

Abstract The article analyzes the condition of the Brazilian Nursing workforce when confronted with international trends. Diagnoses in publications by international organizations marked the confrontation of international trends with the reality of Brazilian Nursing, based on secondary research data. The analysis allows asserting that the Brazilian Nursing workforce follows international trends, essentially, because the social and sexual division of work and the foundations of the origin of Nursing as a capitalist occupation are maintained. At the same time, the historical-structural assumption of female proletarianization is based on the following: the disparities between men and women in pay and access to prominent positions in the market; combined inequalities across nations and regions in the supply of the labor market, which stimulates immigration of professionals; exploitation of older professionals, in the context of restricted access to retirement and labor rights; and exposure to violence and harassment, associated with the potential for overload and work intensification, which result in workers contracting diseases. In summary, it is observed that the pillars of female proletarianization and professionalization of Nursing remain in today's differentiated forms of workforce exploitation, being configured depending on the intersections of gender, racial-ethnicity, and regional-nationality.

Resumo O artigo analisa a condição da força de trabalho da enfermagem brasileira frente às tendências internacionais. Os diagnósticos de publicações de organizações internacionais balizaram a confrontação das tendências internacionais com a realidade da enfermagem brasileira, a partir de dados secundários de pesquisa. A análise permite afirmar que a força de trabalho da enfermagem brasileira segue as tendências internacionais, essencialmente, porque a divisão social e sexual do trabalho, alicerce da origem da enfermagem como ocupação capitalista, se mantém. Contemporaneamente, o pressuposto histórico-estrutural da proletarização feminina fundamenta: as disparidades salariais e de acesso a posições destacadas no mercado entre homens e mulheres; desigualdades combinadas entre nações e regiões na oferta do mercado de trabalho, o que estimula a imigração de profissionais; o aumento da exploração dos profissionais mais velhos, no contexto de restrição de acesso aos direitos de aposentadoria e trabalhistas; e a exposição à violência e ao assédio, associada ao potencial de desgaste da sobrecarga e intensificação do trabalho, que trazem como consequência o adoecimento dos trabalhadores. Em síntese, observa-se que os pilares da proletarização feminina e da profissionalização da enfermagem permanecem nas formas diferenciadas de exploração da força de trabalho atuais, sendo configuradas a depender das interseções de gênero, étnico-raciais e regionalidades-nacionalidades.

Analysis of death characteristics and disease burden of the labor force in Jingzhou , 2015-2018 / 公共卫生与预防医学

Objective To analyze the death characteristics and disease burden of the labor force in Jingzhou City from 2015 to 2018, and to provide a basis for formulating policies to protect the labor force population and propose effective prevention and control measures to reduce the death level and disease burden. Methods The death data of the labor force in Jingzhou City from 2015 to 2018 was collected and statistically analyzed. The death levels, causes of death, and disease burden of the labor force in different years, sexes, ages, and regions were analyzed. Results From 2015 to 2018, the death toll of the labor force accounted for 24.79% of total deaths in Jingzhou City, with a mortality rate of 219.61/100 000 and a standardized mortality rate of 192.17/100 000. There was no significant difference in the mortality rate in different years (P=0.34). The male and female mortality rates were 297.77/100 000 and 139.63/100 000, and the standardized mortality rates were 257.36/100 000 and 119.57/100 000, respectively. The male and female YLL rates were 9.55% and 4.47%, and the standardized YLL rates were 6.75% and 3.12%, respectively. The male mortality and YLL rates were higher than those of the female (P<0.01). The mortality and YLL rate of different age groups increased with age (P<0.01). The mortality rates of urban and rural population were 187.37/100 000 and 229.07/100 000, respectively, the standardized mortality rates were 141.87/100 000 and 208.58/100 000, respectively, the YLL rates were 5.90% and 7.37% respectively, and the standardized YLL rates were 4.13% and 5.20%, respectively. The mortality rate and YLL rate of rural population were higher than those of urban population (P<0.01). The first cause of death in the labor force population was malignant tumor, with the mortality and YLL rate being 87.19/100 000 and 2.90%, respectively. The second cause was injury, with the mortality and YLL rate of 42.60/100 000 and 1.56%, respectively. The leading cause of death was injury in the 15 and 25 years old groups, and malignant tumor in the 35, 45 and 55 years old groups. Lung cancer and liver cancer were the main types of lethal cancers. Transportation accidents and suicide were the main types of lethal injuries. Conclusion The disease burden of the rural labor force was heavy. It is important to strengthen health education for the rural labor force, especially male laborers over the age of 45, and to implement early cancer diagnosis and treatment and injury intervention programs to effectively improve the health of the labor population.

Desafios para o trabalho em saúde: um estudo comparado de Hospitais Universitários na Argélia, Brasil e França / Challenges for work in healthcare: comparative study on University Hospitals in Algeria, Brazil and France

Resumo O estudo compara os desafios no trabalho em serviços de emergência de hospitais universitários públicos na Argélia, Brasil e França. A descrição e a análise estão organizadas em três eixos: contexto e trajetória dos sistemas, hospitais e serviços de emergência, e os desafios enfrentados. Nos serviços foram feitas entrevistas, questionários, observação e "groupes de rencontre du travail"/GRT. Para o processo analítico utilizou-se técnicas do "participatory appraisal" complementadas com triangulação de fontes e dados. Os principais desafios referidos foram: déficit da força de trabalho; falta de leitos nos serviços de internação; déficit de infraestrutura e materiais; excesso de atividades cronofágicas; transição geracional; violência pelos usuários e familiares. Medidas de racionalização e contenção de gastos repercutem de modo mais intenso na Argélia e no Brasil onde há um baixo patamar de financiamento público. Nota-se que a gestão hospitalar não pode estar dissociada do planejamento da rede de atenção, tendo em vista as crescentes pressões do complexo produtivo, da transição demográfica e epidemiológica. A médio prazo, medidas que possam atenuar atividades cronofágicas, o deficit de materiais e a violência devem ser consideradas na melhoria do trabalho em emergências.

Abstract This study compares the challenges for work in emergency services of publicuniversity hospitals in Algeria, Brazil and France. The description and analysis are organized in three topics: context and trajectory of the health systems; hospitals and emergency services; and the challenges that are faced. The research carried out interviews, surveys, observation and "groupes de rencontre du travail" / GRT. The data analysis was done using participatory appraisal techniques associated to triangulation of sources and data. The main challenges found were: workforce deficit; lack of hospitals beds in inpatient units; deficit of infrastructure and materials; excess of "chronophagic activities"; generational transition; and violence by patients and families.Despite their particularities, the countries coincide regarding the challenges. Measures to rationalize and restrain spending have a greater impact on Algeria and Brazil due to the low level of public funding, but they also occur in France. The hospital management cannot be dissociated from healthcare system planningconsidering the increasing pressures of the demographic and epidemiological transition. In medium term, measures that may mitigate "chronophagic activities", materials deficit and the violence should be considered to improve work in emergencies.

Tendências da força de trabalho de cirurgiões-dentistas no Brasil, no período de 2007 a 2014: estudo de séries temporais com dados do Cadastro Nacional de Estabelecimentos de Saúde / Tendencias en la fuerza laboral de dentistas en Brasil nel periodo del 2007 al 2014: estudio de series temporales con datos del Registro Nacional de Servicios de Salud / Trends in the dental surgeon workforce in Brazil 2007-2014: a time series study using data from the National Registry of Health Services

Objetivo: analisar as tendências da força de trabalho de cirurgiões-dentistas no Brasil, no período de 2007 a 2014. Métodos: estudo de séries temporais com dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e da Fundação Instituto Brasileiro de Geografia e Estatística (IBGE); regressões lineares generalizadas de Prais-Winstein foram utilizadas para estimar as tendências temporais e calcular a variação percentual anual da força de trabalho de cirurgiões-dentistas no período estudado. Resultados: houve crescimento do número de cirurgiões-dentistas atuando como clínicos gerais e especialistas, em média 12,7% e 17,3% ao ano, respectivamente; a expansão da força de trabalho de clínico geral (0,5%) e de especialista (11,6%) foi menor no setor público, em relação ao setor privado (24,5% e 30,3%, respectivamente). Conclusão: o número de cirurgiões-dentistas é elevado, embora estejam desigualmente distribuídos em ambos setores de atuação, o que pode implicar barreiras no acesso aos cuidados odontológicos no Brasil.

Objetivo: fue analisar las tendencias de la fuerza laboral de dentistas en Brasil, entre 2007 y 2014. Métodos: estudios de Series Temporales con datos nacionales del Registro Nacional de Establecimientos de Salud y del Instituto Nacional de Geografía y Estadística fueron analizados; regresiones lineares generalizadas de Prais-Winstein fueron utilizadas para estimar las tendencias en el tiempo y calcular el cambio porcentual anual de la fuerza de trabajo de los dentistas durante el período. Resultados: el número de dentistas que actúa como generalistas y especialistas creció al año en promedio de 12,7% y 17,3%, secuencialmente; la expansión de la mano de obra de dentistas generalistas (0,5%) y especialistas (11,6%) fue menor en sector público e comparado con el privado (24,5% e 30,3%, respectivamente). Conclusión: el numero de dentistas en Brasil es elevado, entretanto, están desigualmente distribuidos, lo que puede implicar barreras en el acesso a los cuidados odontológicos en Brasil.

Objective: the objective was to analyze trends in the dental surgeon workforce in Brazil between 2007 and 2014. Methods: this is a time series study using data from the Brazilian National Register of Health Establishments and the Brazilian National Institute of Geography and Statistics. Prais-Winsten generalized linear regression was used to estimate time trends and to calculate the annual percent change in the dental surgeon workforce over the period. Results: the number of dental surgeons working as general practitioners and as specialists grew on average by 12.7% and 17.3% per annum, respectively; dental surgeon workforce expansion in relation to general practitioners (0.5%) and specialists (11.6%) was lower in the public sector, compared to the private sector (24.5% and 30.3%, respectively). Conclusion: the number of dental surgeons in Brazil is high, although they are not equally distributed between both sectors. This may imply barriers to dental care access in Brazil.

Trend on mortalities in all-cause and chronic non-communicable diseases among the labor force population in China, 2007-2016 / 中华流行病学杂志

Objective To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016.Methods Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates,age-standardized mortality rates and component ratios of NCDs,among the Chinese labor force population,during 2007 to 2016.Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases,maternal and infant diseases,nutritional deficiency diseases;NCDs;injuries) were analyzed.Age-standardized mortality of cancer,COPD,cardiovascular and cerebrovascular diseases were also analyzed by gender.Age-standardized mortality was calculated based on the Year 2010 Population Census of China.Joinpoint regression model was used to obtain annual percentage change and 95％CI was set for assessing the trend.Results In 2016,the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population,but decreased by-2.8％ (95％CI:-3.8％--1.7％) annually from 2007 to 2016.The gap between different gender and regions gradually narrowed.The proportion of deaths caused by NCDs increased annually by 0.8％ (95％CI:0.7％-0.9％).The age-standardized mortality rate of NCDs appeared as 171.89/100 000,among the Chinese labor force population in 2016,showing a downward trend by-2.4％ (95％CI:-3.3％--1.4％).However,in females,there appeared the greatest decrease,with an average annual change of-3.3％ (95％CI:-4.0％--2.5％).Diseases as cancer,COPD,cardiovascular and cerebrovascular diseases all showed downward trends in the whole country,with an average range of-2.0％ (95％CI:-2.6％--1.3％),-8.0％ (95％CI:-8.9％--7.1％),-1.5％ (95％CI:-2.9％--0.1％),-2.3％ (95％CI:-2.8％--1.8％)in a ten-year period,respectively.Conclusion All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016.However,the constituent ratios appeared increasing,year by year.Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.

Trend on mortalities in all-cause and chronic non-communicable diseases among the labor force population in China, 2007-2016 / 中华流行病学杂志

Objective To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016.Methods Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates,age-standardized mortality rates and component ratios of NCDs,among the Chinese labor force population,during 2007 to 2016.Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases,maternal and infant diseases,nutritional deficiency diseases;NCDs;injuries) were analyzed.Age-standardized mortality of cancer,COPD,cardiovascular and cerebrovascular diseases were also analyzed by gender.Age-standardized mortality was calculated based on the Year 2010 Population Census of China.Joinpoint regression model was used to obtain annual percentage change and 95％CI was set for assessing the trend.Results In 2016,the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population,but decreased by-2.8％ (95％CI:-3.8％--1.7％) annually from 2007 to 2016.The gap between different gender and regions gradually narrowed.The proportion of deaths caused by NCDs increased annually by 0.8％ (95％CI:0.7％-0.9％).The age-standardized mortality rate of NCDs appeared as 171.89/100 000,among the Chinese labor force population in 2016,showing a downward trend by-2.4％ (95％CI:-3.3％--1.4％).However,in females,there appeared the greatest decrease,with an average annual change of-3.3％ (95％CI:-4.0％--2.5％).Diseases as cancer,COPD,cardiovascular and cerebrovascular diseases all showed downward trends in the whole country,with an average range of-2.0％ (95％CI:-2.6％--1.3％),-8.0％ (95％CI:-8.9％--7.1％),-1.5％ (95％CI:-2.9％--0.1％),-2.3％ (95％CI:-2.8％--1.8％)in a ten-year period,respectively.Conclusion All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016.However,the constituent ratios appeared increasing,year by year.Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.

Trabalho e educação na saúde: análise da produção científica brasileira entre 2011 e 2014 / Work and Education in Health: analysis of the Brazilian scientific production between 2011 and 2014

RESUMO O estudo aqui relatado teve como objetivo atualizar a análise da produção científica sobre trabalho e educação na saúde no Brasil para o período 2011 a 2014. Trata-se de um estudo de síntese com um total de 757 artigos analisados. A categoria 'Formação-Capacitação' manteve a liderança do número de publicações (51,9%), seguida de 'Profissionais de Saúde' (42,4%). Houve redução do percentual de publicações sobre mercado de trabalho, política de recursos humanos e administração de recursos humanos. Os últimos investimentos na formação e capacitação dos trabalhadores podem contribuir para a produção de novos trabalhos baseados no cotidiano dos serviços, sendo necessário avançar no detalhamento da produção científica.

ABSTRACT The study here reported aimed to update the analysis of scientific production on work and education in health in Brazil for the period 2011 to 2014. This is a synthesis study that analyzed 757 papers. The category 'Training-Qualification' responded for the majority of publications (51.9%), followed by 'Health Professionals' category (42.4%). There has been a reduction in the percentage of publications on labor market, human resources policy and human resources administration. Current investments in training and qualification of workers can contribute to the production of new researches based on everyday services, being necessary to further the scientific production detailing as well.

O cotidiano da prática do enfermeiro de rede básica de saúde: reflexões/ações sobre a informação para a tomada de decisão / The daily practice of the nurse of basic health network: reflections / actions on information for decision making

O presente estudo encontra-se inserido no Núcleo de Estudos e Pesquisa em Gestão e Trabalho em Saúde - NUPGES/CNPq, na Linha de Pesquisa: O cuidado em seu contexto sócio cultural. Apresenta como objetivos: Descrever os aspectos da atuação do enfermeiro de rede básica de saúde que oportunizem à tomada de decisões; Analisar a prática do enfermeiro de rede básica frente à ação-reflexão-ação sobre a utilização da informação em seu cotidiano de trabalho, como um instrumento para tomada de decisões; Discutir implicações da reflexividade sobre a prática do enfermeiro frente a informação em seu cotidiano de trabalho, no que tange a tomada de decisões. Trata-se de um estudo de abordagem qualitativa, do tipo estudo de caso, tendo como participantes doze enfermeiros de rede básica de saúde do município de Niterói/RJ. Como referencial teórico, utilizaram-se as ideias de Donald Schön ao assegurar que é a reflexividade constante sobre a própria prática, quem dará subsídios para encontrar respostas aos impasses que surgem no cotidiano do exercício profissional. Os dados foram analisados através da análise temática indutiva que descreve a indução como um procedimento que consiste de fatos singulares que remonta a uma proposição genérica, tendo sua aplicabilidade a proposições particulares semelhantes. Após da construção do corpus originaram três categorias: Aspectos que oportunizam a atuação do enfermeiro de rede básica para tomada de decisões - A racionalidade técnica como paradigma; as informações no cotidiano da prática do enfermeiro de rede básica e sua tomada de decisão - A racionalidade prática como paradigma; e a reflexividade crítica sobre a prática do enfermeiro de atenção básica frente à informação para tomada de decisão. Confirma-se a Tese de que: A prática do enfermeiro de rede básica de saúde da Fundação Municipal de Saúde do município de Niterói, no que concerne a utilização da informação para a tomada de decisão, ocorre com movimentos reflexivos que visam efetivar a qualidade do seu cotidiano de trabalho, a partir das competências adquiridas e desenvolvidas na prática, indicando a necessidade de formação permanente. O estudo evidenciou a natureza do processo de tomada de decisão subsidiado pelas informações, tendo como referência a experiência e a percepção inter-relacionadas com as características laborais locais, apresentando modelos distintos de decisão em diferentes momentos de atuação da prática profissional

The present study is located within the Nucleus of Studies and Research in Management and Work in Health - NUPGES / CNPq, in the Research Line: Care in its socio-cultural context. It presents as objectives: To describe the aspects of the actions of the nurse of basic health network that opportune to the decision making; To analyze the practice of basic network nurses in relation to action-reflection-action on the use of information in their daily work, as an instrument for decision-making; To discuss the implications of reflexivity on the nurses' practice regarding the information in their daily work, regarding decision making. This is a qualitative study, as case study type, involving twelve nurses from the basic health network of the city of Niterói / RJ. As a theoretical reference, the ideas of Donald Schön were used to assure that it is the constant reflexivity about the practice itself, who will give subsidies to find answers to the impasses that appear in the daily routine of the professional practice. The data were analyzed through the thematic inductive analysis that describes the induction as a procedure that consists of singular facts that goes back to a generic proposition, having its applicability to similar particular propositions. After the construction of the corpus, three categories emerged: Aspects that provide the basic network nurse for decision making - Technical rationality as a paradigm; the information in the daily practice of the basic network nurse and its decision making - Practical rationality as a paradigm; And critical reflexivity about the nurse's practice of basic attention to information for decision-making. It is confirmed that: The practice of the nurse of the basic health network of the Municipal Health Foundation of the city of Niterói, regarding the use of information for decision making, occurs with reflexive movements that aim at effecting the quality of their daily work, from the skills acquired and developed in practice, indicating the need for ongoing formation. The study evidenced the nature of the information-based decision-making process, based on experience and perception related to local labor characteristics, presenting different models of decision-making in different moments of professional practice

El presente estudio se localiza dentro del Núcleo de Estudios e Investigación en Gestión y Trabajo en Salud ­ NUPGES/CNPQ, en la línea de investigación: El cuidado en su contexto socio cultural. Presenta como objetivos: Describir los aspectos de actuación del enfermero de la red básica que brinde oportunidad a la toma de decisiones; Analizar la práctica del enfermero de la red básica frente a la acción-reflexión-acción sobre la utilización de la información en su cotidiano de trabajo, como un instrumento para tomar decisiones; Discutir las implicaciones de la reflexividad sobre la práctica del enfermero frente a la información en su cotidiano de trabajo en lo que respecta a la toma de decisiones. Se trata de un estudio de abordaje cualitativo, tipo estudio de caso, teniendo como participantes doce enfermeros de la red básica de salud del municipio de Niterói/RJ. Como referencial teórico se utilizaron las ideas de Donald Schön, que asegura la reflexividad constante sobre la propia práctica y dará subsidios para encontrar respuestas a los impases que surgen en el cotidiano del ejercicio profesional. Los datos fueron analizados a través del análisis temático inductivo que describe a la inducción como un procedimiento que consiste de hechos singulares y que se remonta a una proposición genérica teniendo en su aplicabilidad proposiciones particulares semejantes. Después de la construcción del cuerpo del trabajo, se originaron tres categorías: Aspectos que dan oportunidad a la actuación del enfermero de la red básica para tomar decisiones - La racionalidad técnica como paradigma; las informaciones en el cotidiano de la práctica del enfermero de la red básica y la toma de decisión - La racionalidad práctica como paradigma; y la reflexividad crítica sobre la práctica del enfermero de la atención básica frente a la información para tomar decisiones; Se confirma la tesis de que: la práctica del enfermero de la red básica de salud de la Fundación Municipal de Salud del municipio de Niterói, en lo que respecta a la utilización de la información para la toma de decisión, acurre con movimientos reflexivos que visan a efectivizar la calidad de su cotidiano de trabajo, a partir de las competencias adquiridas y desarrolladas en la práctica, indicando la necesidad de formación permanente. El estudio evidenció que la naturaleza del proceso de toma de decisión es subsidiada por las informaciones, teniendo como referencia la experiencia y la percepción interrelacionadas con las características laborales locales, presentando modelos diferentes de decisión en diferentes momentos de actuación de la práctica profesional

Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030 / 中华预防医学杂志

Objective@#To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030.@*Methods@#We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost.@*Results@#If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively).@*Conclusion@#Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

Association of job burnout with subjective well-being and health status among employees from 29 provinces in China / 中华劳动卫生职业病杂志

Objective@#To investigate the influence of job burnout on subjective well-being and health status among employees in China.@*Methods@#The data from the 2014 China Labor-force Dynamic Survey were used to analyze the association of job burnout with subjective well-being and health status among 7289 employees aged 18-64 years from 29 provinces in China.Some items from the Maslach Burnout Inventory-General Survey were used to investigate job burnout; subjective well-being assessment included life happiness and degree of satisfaction with living condition; the questions for self-evaluation of health status were used to analyze health status.@*Results@#Of all employees,30.5% had low subjective well-being and 4.7% had poor health status based on self-evaluation. The logistic regression analysis showed that emotional exhaustion(two items), reduced sense of personal accomplishment,and cynicism were risk factors for low subjective well-being(OR=1.07,1.11,1.10,and 1.06,P<0.001),and emotional exhaustion(two items)was a risk factor for poor health status (OR=1.10 and 1.07,P<0.001).Reduced sense of personal accomplishment and cynicism had no significant influence on health status(P>0.05).@*Conclusion@#Emotional exhaustion is a major influencing factor for health status,and reducing job burnout may be an effective method for improving subjective well-being and health status.

Health workforce and hospital network in the 9th health region of Paraná / Força de trabalho em saúde e rede hospitalar na 9ª região de saúde do paraná / Fuerza de trabajo en salud y red hospitalariaen la 9ª región de salud de paraná

RESUMO A rede hospitalar e a força de trabalho em saúde se distribuem de maneira desigual no territorio nacional, refletindo o modelo de atenção hegemônico e a organização a partir da oferta de serviços. O estudo teve por objetivo analisar a rede hospitalar e a composição e distribuição da força de trabalho em saúde dos hospitais da 9ª Região de Saúde do Paraná. Pesquisa descritiva, quantitativa que teve como fonte de dados o Cadastro Nacional de Estabelecimentos de Saúde. A estatística descritiva revelou que 84,62% dos hospitais são privados; 61,54% de pequeno porte; existem 2.307 ocupações cadastradas e destas 57,91% são de nível superior; 69,27% dos vínculos de trabalho são precários e 23,50% dos trabalhadores apresentavam mais que um vínculo empregatício. Identificou-se, ainda, menor jornada de trabalho semanal e maior precarização entre as ocupações de nível superior. Conclui-se pela necessidade de maior participação do Estado na regulação das instituições públicas e privadas, sobretudo na gestão do trabalho, e no planejamento da distribuição da força de trabalho em saúde.

RESUMEN La red hospitalaria y la fuerza del trabajo en salud se distribuyen de forma desigual en el país, lo que refleja el modelo de atención hegemónico y la organización a partir de la oferta de servicios. El objetivo del estudio fue analizar la red hospitalaria y la composición y distribución de la fuerza de trabajo en salud de los hospitales de la 9ªRegión de Salud de Paraná-Brasil. Investigación descriptiva, cuantitativa que tuvo como fuente de datos el Registro Nacional de Establecimientos de Salud. La estadística descriptiva mostró que 84,62% de los hospitales son privados; 61.54% pequeño porte; hay 2.307 ocupaciones registradas y de estas 57,91% son de nivel superior; 69.27% de los vínculos laborales son precarios y 23,50% de los trabajadores tenían más de un empleo. También fueron identificadas menos horas de trabajo semanal y más relaciones precarias entre las ocupaciones de nivel superior. Los resultados confirmaron la necesidad de una mayor participación del Estado en la regulación de las instituciones públicas y privadas, sobre todo en la gestión del trabajo, y la planificación de la distribución de la fuerza de trabajo en salud.

ABSTRACT The hospital network and health workforce are distributed unevenly in the country, reflecting the hegemonic model of attention and organization as from the services offer. The study aimed to analyze the hospital network and its composition and distribution of health workforce of the 9th Health Region hospitals of Paraná. Descriptive, quantitative research had as data source the National Register of Health Facilities. The statistics showed that 84.62% of hospitals are private; 61.54% are small; there are 2,307 registered occupations and, of these, 57.91% are educated level; 69.27% of the working relations are precarious and out of them, 23.50% of workers had more than one job. It was also identified shorter week working hours and higher precariousness among the educated level occupations. The results confirmed the need for greater participation of the state in the regulation of public and private institutions, particularly in work management, and planning the distribution of the health workforce.

Outsourcing and "dismantling" of steady jobs at hospitals / La tercerización y el "desmonte" del empleo estable en hospitales / A terceirização e o "desmonte" do emprego estável em hospitais

Abstract OBJECTIVE To relate hospitals' organizational structure as the core of a web of outsourced services and flexible employment bonds among healthcare professionals in the context of finance capitalism, analyzing work arrangements based mainly on the type of employment bond. METHOD Qualitative research through ethnography, interviews, data analysis, and case studies. The case studies were concentrated in 3 hospitals located in the São Paulo metropolitan region under different management types: public administration; outsourced administration via a healthcare social organization (HSO); and private administration. RESULTS This study highlights a trend in outsourcing, dismantling of steady jobs, and shaping working relations asymmetrically in terms of healthcare professions. CONCLUSION These aspects are characteristic of contemporary capitalism and post-Fordist work organization. In this context, the state under sponsorship cripples the very existence of an effective human resources policy, creating a favorable environment for outsourcing and flexibility of employment bonds among healthcare workers.

Resumen OBJETIVO Relacionar la estructura organizativa de los hospitales como núcleo de una red de servicios subcontratados y la flexibilización de vínculos contractuales de los profesionales sanitarios en el marco del capitalismo financierizado, analizando los regímenes laborales condicionados centralmente por el vínculo de empleo. MÉTODO Investigación cualitativa mediante etnografía, realización de entrevistas, análisis de datos y utilización de estudio de caso. Los estudios de caso se concentran en tres hospitales ubicados en la Región Metropolitana de São Paulo con gestiones distintas: administración pública; administración tercerizada para Organización Social de Salud (OSS); y administración privada. RESULTADOS Destacamos la tendencia de la tercerización, del desmonte del empleo estable y la conformación de relaciones laborales asimétricas para las profesiones sanitarias. CONCLUSIÓN Dichos aspectos son característicos del período del capitalismo contemporáneo y la organización post-fordista del trabajo. En ese marco, la subfinanciación del Estado inviabiliza una política de recursos humanos efectiva, configurando el ambiente propicio para las tercerizaciones y la flexibilidad del vínculo de empleo para los trabajadores de la salud.

Resumo OBJETIVO Relacionar a estrutura organizativa dos hospitais como núcleo de uma rede de serviços subcontratados e a flexibilização dos vínculos contratuais dos profissionais de saúde no contexto de capitalismo financeirizado, analisando os regimes de trabalho condicionados centralmente pelo vínculo empregatício. MÉTODO Pesquisa qualitativa através de etnografia, realização de entrevistas, análise de dados e utilização de estudo de caso. Os estudos de caso concentram-se em três hospitais localizados Região Metropolitana de São Paulo com gestões distintas: administração pública; administração terceirizada para Organização Social de Saúde (OSS); e administração privada. RESULTADOS Destacamos a tendência da terceirização, do desmonte do emprego estável e a conformação de relações trabalhistas assimétricas para as profissões em saúde. CONCLUSÃO Esses aspectos são característicos do período do capitalismo contemporâneo e da organização pós-fordista do trabalho. Nesse contexto, o subfinanciamento do Estado inviabiliza uma política de recursos humanos efetiva, configurando o ambiente propício para as terceirizações e flexibilidade do vínculo empregatício para os trabalhadores de saúde.

Mercado de trabalho em enfermagem no âmbito do SUS: uma abordagem a partir da pesquisa Perfil da Enfermagem no Brasil / Labor market in nursing in the SUS: an approach from the research Nursing Profile in Brazil

O presente artigo aborda algumas dimensões estruturais do mercado de trabalho da enfermagem, focalizando a importância desse segmento na organização e no desenvolvimento das atividades no âmbito do Sistema Único de Saúde. Utilizou-se os dados provenientes da pesquisa* Perfil da Enfermagem no Brasil realizada pela Fundação Oswaldo Cruz em convênio com o Conselho Federal de Enfermagem (2015) e outras fontes secundárias disponíveis. Trata-se de um estudo transversal, abrangendo todos os enfermeiros, técnicos e auxiliares inscritos no Sistema Cofen/Conselhos Regionais no ano de 2013, possuindo, portanto, abrangência nacional. As dimensões analisadas referem-se: a) à inserção nos setores público, privado e filantrópico; b) a vínculos trabalhistas; c) a jornadas de trabalho; c) à renda mensal, entre outras que conformam a dinâmica do mercado de trabalho. O texto conclui que o setor público é o grande empregador da enfermagem; que esses profissionais têm jornadas extensas, acima de 40 horas semanais; no entanto, têm rendas mensais baixas etc. Como contribuição ao entendimento dessa realidade, este artigo procura descrever a situação atual e a natureza do trabalho da enfermagem estabelecendo inter-relações causais entre essas dimensões.(AU)

This article discusses some structural dimensions of the nursing labor market, focusing on the importance of this segment in the organization and development of activities under the SUS. We used data from the research Nursing Profile in Brazil conducted by Oswaldo Cruz Foundation in partnership with the Federal Council of Nursing (Cofen) (2015) and other secondary sources. This is a cross-sectional study, covering all nurses, technicians and auxiliaries enrolled in the Cofen /Corens (Regional Council of Nursing) System in 2013, having thus nationwide coverage. The analyzed dimensions refer to: a) the inclusion in the public, private and philanthropic sectors; b) labor relationships; c) working hours; c) monthly income, among others that make up the dynamics of the labor market. The text concludes that the public sector is the major employer of nursing; these professionals have long hours, over 40 hours per week; however, they have low monthly incomes, etc. As a contribution to the understanding of this fact, this article aims to describe the current situation and the nature of nursing work, establishing causal interrelationships between these dimensions.(AU)

Gestão do trabalho nos hospitais da 9ª região de saúde do Paraná / Work management in hospitals of Paraná's 9th health region

Objetivou-se analisar a gestão do trabalho em 12 hospitais da 9ª Região de Saúde do Paraná. Estudo exploratório, por meio de entrevista semiestruturada com 116 profissionais: 52,59% de nível superior; 56,43% ingressaram por processo seletivo; 19,82% possuem mais de um vínculo; 21,43% com vínculos desprotegidos; 19,29% participam de atividades de educação permanente; nenhum hospital possui Plano de Carreira, Cargos e Salários. Conclui-se ser fundamental o Estado exercer seu papel de regulador, fiscalizador e controlador dos serviços de saúde, independentemente da titularidade de quem os execute, necessidades que podem interferir em melhores condições de trabalho, com impacto na qualidade da assistência.

We aimed to analyze work management in 12 hospitals of Paraná's 9th Health Region. Exploratory study, conducted through semi-structured interview with 116 professionals: 52,59% of higher education; 56,43% enrolled through a selective process; 19,82% have more than one bond; 21,43% precarious bonds; 19,29% participate in ongoing activities of continuing education; no institution has a career plan formally instituted. We conclude that it is essential that the State to exercise its role as regulator, supervising and controlling health services, regardless of the ownership of those who perform them, needs that may interfere with better working conditions, impacting the quality of care.

Sistematização do conhecimento sobre as metodologias empregadas para o dimensionamento da força de trabalho em saúde / Systematization of the knowledge on methodologies for health workforce staffing

A força de trabalho em saúde representa um fator de grande importância nos sistemas de saúde, sendo imprescindível à promoção e ao avanço da área, relacionada quantitativa e qualitativamente aos resultados alcançados. Esta revisão sistemática visa à identificação na literatura de metodologias que, empregadas, resultem em dimensionamento eficaz da força de trabalho em saúde. Os resultados indicam a necessidade de complementação da avaliação, sendo indispensável a identificação de metodologias que resultem em dimensionamento mais eficaz da força de trabalho em saúde para subsidiar decisões gerenciais no sistema de saúde.

The health workforce is a key factor in health systems and is essential to the promotion and advancement of the area, related quantitative and qualitative results achieved. This systematic review aims to identify, in the literature, methodologies that result in effective health workforce staffing. The results indicate the need to complement the assessment, in order to identify methodologies that result in more effective health workforce staffing and provide support to management decisions in the health system.