ABSTRACT
Objetivo: Analisar a construção de um projeto de intervenção com os gestores municipais de saúde e suas equipes, a partir de um problema relevante para eles. Método: Utilizou-se a ferramenta de gestão do PES, proposta por Carlos Matus, com os momentos: explicativo, normativo, estratégico e tático-operacional. Participaram 32 trabalhadores da Atenção Primária a Saúde. A coleta de dados foi realizada durante 12 encontros quinzenais nos meses de dezembro de 2017 a maio de 2018. Resultados e Discussão: Priorizados pelos participantes o problema: falta de organização do processo de trabalho na Atenção Primária a Saúde; os descritores: Descritor 1: 90% dos servidores municipais não têm capacitação para trabalhar na atenção primária à saúde; nó crítico1: não existe um espaço coletivo de discussão de problemas e ações; intervenção: criação de um espaço em cada equipe da APS para discussão dos problemas por meio da Educação Permanente em Saúde; e Descritor 2: não aplicação/elaboração de protocolos que orientem os serviços, sobretudo na unidade; nó crítico 2: não existência de protocolos na atenção primária à saúde; intervenção: disponibilizar recursos para os profissionais se apropriarem dos conceitos e práticas para construção de protocolos. Considerações Finais: Gestores e equipes construíram o planejamento utilizando a ferramenta do PES com momentos de divergências de ideias, porém, houve fortalecimento do vínculo, tanto no processo de trabalho, como na convivência e na construção de intervenções.
Objective: To analyze the construction of an intervention project with the municipal health managers and their teams, based on a problem relevant to them. Method: The PES management tool, proposed by Carlos Matus, was used during explanatory, normative, strategic and tactical-operational moments. A total of 32 Primary Health Care workers participated. The data collection was carried out during 12 meetings in the months of December 2017 to May 2018. Results and Discussion: Prioritized by the participants the issue: lack of organization of the work process in primary health care; the descriptors: Descriptor 1: 90% of municipal employees do not have the qualification to work in primary health care; Critical node 1: there is no collective space for discussion of problems and actions; Intervention: creation of a space in each PHC team to discuss health problems through Permanent Education in Health and Descriptor 2: non-application/ elaboration of protocols that guide the services, especially in the unit; Critical node 2: lack of protocols in primary health care; Intervention: Provide resources for professionals to appropriate the concepts and practices for protocol construction. Final Considerations: Managers and teams built the planning using the PES tool with moments of divergence of ideas, however, there was a strengthening of the bond, both in the work process and in coexistence and in the construction of interventions.
Subject(s)
Strategic Planning , Health , PlanningABSTRACT
BACKGROUND: There are 20 million living US armed forces veterans; however, the organ donation attitudes of veterans have not been examined. METHODS: Over a 17-month period, a convenience sample of 1517 veterans in New England completed a survey to assess attitudes about organ, tissue, and vascularized composite allograft (VCA) donation. RESULTS: Most veterans (96%) supported the donation of organs and tissue for transplantation, and 59% were registered as an organ and tissue donor. Being younger (adjusted odds ratio [aOR]: 0.960.970.98; P = 0.01), female (aOR: 1.061.462.03; P = 0.02), non-Hispanic white (aOR: 1.302.073.30; P = 0.01), Hispanic (aOR: 1.282.434.61; P = 0.01), and having more trust that the transplant process is fair and equal (aOR: 1.191.401.65; P = 0.01) were predictive of donor registration. Also, most veterans were willing to donate their face (57%), hands/arms (81%), legs (81%), penis (men: 61%), and uterus (women: 76%) at time of death; donation willingness was higher for upper and lower limbs than for face or genitourinary organs (P < 0.001). Those unwilling to donate VCA organs expressed concerns about identity loss, psychological discomfort of self and others, body integrity, funeral presentation, and religious beliefs. Most (54%) felt that VCA donation should require permission of legal next-of-kin at the time of one's death, even if the decedent was a registered donor. CONCLUSIONS: There is a high level of support for organ, tissue, and VCA transplantation and donation among veterans, despite limited educational campaigns targeting this population. There is high potential among veterans to further increase donor registry enrollment and raise awareness about VCA benefits for severely injured service members.
Subject(s)
Health Knowledge, Attitudes, Practice , Organ Transplantation , Tissue Donors/psychology , Tissue Transplantation , Veterans/psychology , Altruism , Attitude to Death , Female , Humans , Male , Middle Aged , New England , Religion and Medicine , Surveys and Questionnaires , Vascularized Composite AllotransplantationABSTRACT
Wild crop relatives are an important source of genetic diversity for crop improvement. Diversity estimates are generally lacking for many wild crop relatives. The objective of the present study was to analyze how genetic diversity is distributed within and among populations of the wild rice species Oryza glumaepatula in Costa Rica. We also evaluated the likelihood of gene flow between wild and commercial rice species because the latter is commonly sympatric with wild rice populations. Introgression may change wild species by incorporating alleles from domesticated species, increasing the risk of losing original variation. Specimens from all known O. glumaepatula populations in Costa Rica were analyzed with 444 AFLP markers to characterize genetic diversity and structure. We also compared genetic diversity estimates between O. glumaepatula specimens and O. sativa commercial rice. Our results showed that O. glumaepatula populations in Costa Rica have moderately high levels of genetic diversity, comparable to those found in South American populations. Despite the restricted distribution of this species in Costa Rica, populations are fairly large, reducing the effects of drift on genetic diversity. We found a dismissible but significant structure (θ = 0.02 ± 0.001) among populations. A Bayesian structure analysis suggested that some individuals share a significant proportion of their genomes with O. sativa. These results suggest that gene flow from cultivated O. sativa populations may have occurred in the recent past. These results expose an important biohazard: recurrent hybridization may reduce the genetic diversity of this wild rice species. Introgression may transfer commercial traits into O. glumaepatula, which in turn could alter genetic diversity and increase the likelihood of local extinction. These results have important implications for in situ conservation strategies of the only wild populations of O. glumaepatula in Costa Rica.
