Modelo multidimensional para o controle da dengue: uma proposta com base na reprodução social e situações de riscos / Multidimensional model for dengue control: a proposal based on social reproduction and risk situations

O objetivo do artigo consiste em apresentar e discutir um modelo compreensivo/explicativo, de caráter ecossistêmico, sobre o processo de transmissão da dengue nos níveis de micro e macrocontexto, a partir da identificação das situações de riscos envolvidas. Considerou-se a dengue como doença infecciosa viral de transmissão vetorial que traz, na sua dinâmica de transmissão, elementos das dimensões biológicas, de conduta, ecológicas, políticas e econômicas, o que a caracteriza como um problema complexo e exige um enfoque sistêmico para seu controle. Assim, para a construção da modelagem, utilizaram-se o enfoque teórico da reprodução social de Juan Samaja e seus condicionantes de macro e microcontexto, e o enfoque operativo ecossistêmico, que buscou responder à pergunta condutora desta construção: quais são as situações de risco para transmissão da dengue, considerando as diversas dimensões da "reprodução social da saúde" no nível local? A visão ampliada das inter-relações entre as diversas situações de risco envolvidas na determinação multidimensional da dengue poderá servir como eixo direcionador para uma gestão integrada das ações do programa de controle da doença, articuladas entre os diversos setores envolvidos.

This paper aims to present and discuss a comprehensive / explanatory model, of ecosystem approach, on the process of transmission of dengue in the levels of micro and macro context, from the identification of the risks involved. Dengue was considered a viral infectious disease of vectorial transmission that carries on its transmission dynamics, elements of the biological, behavioral, ecological, political and economic dimensions, that make it a complex problem and require a systemic approach to its control. Thus, for the construction of modeling, we used the theoretical framework of social reproduction of Juan Samaja and its conditions of macro and micro-context, and the operating ecosystem approach, which sought to answer the question driving this construction: what are the risk situations for the transmission of dengue, considering the different dimensions of "social reproduction of health" at the local level? The enlarged view of the interrelationships among the various risk situations involved in determining multidimensional dengue could guide the integrated management of actions of a disease control program, coordinated by the several sectors involved.

Situación organizacional de los Grupos de Control de Vectores en Ciudad de La Habana / Organizational situation of Vector Control Groups in the City of Havana

Se desarrolló una investigación operativa en octubre de 2006, que en breve tiempo aportó información útil para la toma de decisiones en el trabajo de erradicación del mosquito Aedes aegypti. Caracterizar la situación organizacional existente en los Grupos de Control de Vectores de la provincia Ciudad de La Habana, la llamada Campaña e identificar aquellos factores que obstaculizaban el trabajo. Métodos Se realizó un estudio descriptivo y transversal. Se trabajó con una muestra intencional que incluyó 278 trabajadores de diferentes categorías ocupacionales y procedentes de 15 áreas de salud, seleccionadas a partir de una estratificación de la provincia por criterio cualitativo. Se estudiaron también 57 directivos. Se exploraron las variables tiempo en la actividad y otras relacionadas con el propósito de la organización, estructura organizativa, capacitación, relaciones entre trabajadores y con los superiores en rango (jefes), dentro y fuera del sector; mecanismos de apoyo, uso y formas de reconocimiento, condiciones de trabajo y recursos. Además, se evaluó el clima organizacional a partir de 16 criterios en las dimensiones: Liderazgo, Motivación, Reciprocidad y Participación. Se emplearon técnicas cuantitativas y cualitativas: encuesta, entrevista a profundidad y grupo focal, y se trianguló la información obtenida. Resultados Los principales resultados estuvieron en la inadecuada selección del personal y poco tiempo en la actividad, insuficiente integración de los operarios al trabajo del Equipo Básico de Salud no inherente a la estructura organizativa, inadecuadas normas de trabajo que propiciaban conductas fraudulentas, insuficiencias en los mecanismos de apoyo, de estimulación y reconocimiento que generaban desmotivación en los trabajadores; estilos de dirección que dificultaban la comunicación y las relaciones interpersonales y métodos de dirección poco participativos. Conclusiones Se localizan numerosos y ...

An operational research was made in October, 1996 that quickly offered useful information for decision-making on the work carried out to eradicate Aedes aegypti. Objectives To characterize the organizational situation of Vector Control Groups in the City of Havana province and identify those factors that hinder its work. Methods A descriptive cross-sectional study that uses an intentional sample of 278 workers of various occupational categories from 15 health areas that have been previously selected on the basis of stratification by qualitative criteria. Fifty seven directors were also included. Variables such as length of time performing this activity and others related to the objective of the organization; organizational structure, training, relationship between workers and higher rank staff (heads) within and outside the sector, supporting mechanisms, use and ways of acknowledgement, working conditions and resources were examined. Additionally, the organizational environment based on 16 criteria in dimensions, i.e., leadership, motivation, reciprocity and participation. Quantitative and qualitative techniques were used like survey, in-depth interview, and focal groups. Obtained information was triangled. Results The main results were the poor selection of the staff and short length of time in the activity; low integration of workers to the Basic Health Team non-inherent to the organizational structure, inappropriate working standards that facilitate fraud, deficiencies found in the supporting, stimulation and acknowledgement mechanisms, thus discouraging workers, management methods that make it difficult to communicate each others, and inter-personal relations; management methods with low participation. Conclusions Many diverse organizational problems were found. They unfavorably influence the working environment, and consequently restrict the work dynamics of the studied group.