Introdução: A prevalência de condições crônicas em todo o mundo vem apresentando significativo crescimento, todavia os serviços de saúde, ainda, encontram-se, majoritariamente, organizados para o atendimento de condições agudas de saúde. Na saúde suplementar essa lógica não é diferente e considerando que o mercado de saúde suplementar responde, atualmente, pelo atendimento de parcela expressiva da população brasileira torna-se relevante a compreensão da qualidade nesse cenário. Objetivo: Compreender a percepção acerca da qualidade de um serviço de saúde suplementar, perspectiva do usuário. Caminho metodológico: Estudo de abordagem qualitativa, cujo cenário foram os serviços próprios de saúde de uma empresa de autogestão. Os participantes foram usuários desse serviço, localizado em Brasília-DF. Os dados foram coletados após anuência do Comitê de Ética, por meio de entrevista associada à estratégia da observação, no período entre agosto e outubro de 2014. O corpus de dados foi apresentado em forma de narrativas e analisados segundo a análise de conteúdo. Achados: A partir das narrativas foram estabelecidas cinco categorias de análise que possibilitaram ampliar a compreensão, a saber: o vínculo como elemento de liga na qualidade do cuidado; a família como cimento do cuidado da condição crônica; a relação biopolítica do cuidado; a percepção da condição crônica; e a integralidade e continuidade do cuidado. As categorias foram discutidas à luz da sociologia do quotidiano, proposta por Maffesoli, possibilitando a compreensão da construção do imaginário de qualidade e do cuidado dos participantes. Para análise interpretativa dos dados foi utilizado o referencial da Trajetória da Doença Crônica, apresentada por Bury. Considerações finais: O estudo permitiu compreender o imaginário de qualidade compartilhado por usuários de um serviço de autogestão, que apresentam características próprias no consumo e acesso a serviços de saúde, em muito relacionadas à cultura organizacional compartilhada. Assim, a qualidade para o usuário de uma autogestão apresenta como elementos fundamentais o vínculo, a integralidade solidariedade orgânica. / Introduction: The prevalence of chronic conditions around the world has shown significant growth, however health services also are, mostly, organized for the care of acute health conditions. In the health insurance that logic is no different and considering the supplementary health market is now responsible for a significant portion of care of the population becomes relevant to understanding the quality in this scenario. Aim: To comprehend the perception of the quality of a supplementary health service user perspective. Methods: A qualitative study, whose scenario was the very health services in a self-management company. The participants were users of that service, located in Brasilia. Data were collected after approval of the Ethics Committee, through interviews associated with the observation strategy in the period between August and October 2014. The data corpus was presented as a narrative and analyzed according to content analysis. Findings: From the narratives were established five categories of analysis that enabled broaden the understanding, namely: the link as an alloying element in quality of care; the family as cement care of chronic conditions; biopolitics relationship of care; the perception of chronic condition; and the completeness and continuity of care. The categories were discussed in light of everyday sociology proposed by Maffesoli, enabling the understanding of the quality of imaginary construction and care of the participants. For interpretative analysis of the data it was used the reference of Trajectory of Chronic Disease, presented by Bury. Final considerations: The study permitted to comprehend the quality of imaginary shared by users of a self-management service, which has specific characteristics in consumption and access to health services, closely related to the shared organizational culture. Thus, the quality for the user of a self-management features as fundamental elements the bond, integrality and organic solidarity.

Introdução: As instituições de saúde trabalham, incansavelmente, em prol da melhoria da qualidade dos serviços prestados e a enfermagem, como integrante desses serviços, busca, constantemente, programas que acarretem melhores resultados assistenciais e com isso a segurança do paciente. Dentre esses programas destaca-se o Magnet Recognition Program, desenvolvido pela American Nurses Credentialing Center- ANCC, o qual visa acreditar os estabelecimentos de saúde com excelência na prática de enfermagem. Objetivo: Analisar a produção científica acerca do processo de implementação do Magnet Recognition Program, publicada no período de junho de 2004 a junho de 2014. Metodologia: Trata-se de uma revisão integrativa de literatura, cuja coleta de dados foi realizada de julho a agosto de 2014, no portal de dados BVS que contempla as bases de dados BDENF, LILACS e MEDLINE e na base de dados CINHAL. A amostra constituiu-se de 16 artigos. Resultados: Os resultados evidenciaram que grande parte dos estudos eram oriundos de revistas de enfermagem, no idioma inglês. Quanto ao delineamento do estudo, verificamos que 11 deles eram constituídos por relatos de experiência e cinco compreendiam pesquisas de abordagem qualitativa, com nível de evidência VI. A análise dos estudos possibilitou compreender com maior clareza o processo de implementação do Magnet Recognition Program constituído por seis etapas, a saber: aplicação, avaliação, visita local, premiação, manutenção e redesignação. Os estudos demonstraram que a etapa de aplicação consistia no processo de submissão da instituição à candidatura frente a ANCC. A etapa de avaliação constituiu-se na análise, pelos avaliadores da ANCC, da documentação escrita apresentada pela organização candidata. Após a aprovação, uma visita ao local era agendada. Na ocasião da visita à instituição a ser acreditada eram identificadas a presença das 14 Forças do Magnetismo na organização. Uma vez aprovado, a certificação Magnet era concedida, constituindo a fase de premiação. Decorrido esse processo, havia o início da fase de manutenção da cultura Magnet, para que a redesignação acontecesse após quatro anos. Como facilitador de todo o processo, os estudos evidenciaram a utilização de consultores, a visita a uma organização anteriormente credenciada, a utilização de um profissional experiente para a elaboração do relatório, o envolvimento de todos os profissionais entendendo o Magnet como uma meta organizacional e o apoio do corpo diretivo, a fim de que os recursos financeiros e estruturais fossem providenciados. Os estudos evidenciaram, ainda, aspectos importantes relacionados aos componentes do Magnet Recognition Program os quais versavam principalmente sobre a governança compartilhada, prática profissional exemplar e estrutura de empowerment fundamentais para as organizações. Conclusão: Este estudo propiciou o conhecimento das etapas para a implementação do Magnet e, desse modo, acreditamos que esse resultado possa contribuir com outras organizações que estão pleiteando essa certificação, fornecendo subsídios para o alcance de seus credenciamentos. No entanto, frente aos níveis de evidência dos artigos, torna-se imperativo a realização de estudos com rigor metodológico mais elevados. / Introduction: Health care organizations vigorously work for the improvement of service quality and nursing, as part of these services, always seeking for assistance programs that involve better results and consequently the patient safety. Among these programs, the Magnet Recognition Program, developed by the American Nurses Credentialing Center-ANCC, aims to accredit health facilities with excellence in nursing practice. Objective: To analyze the scientific production on the implementation process of the Magnet Recognition Program, published from June 2004 to June 2014. Methodology: This is an integrative literature review. Data collection was carried out from July to August 2014, through BVS data portal that includes the BDENF, MEDLINE, LILACS and CINHAL databases. The sample consisted of 16 articles. Results: The results showed that most of the studies were from nursing journals in the English language. Regarding design of the study, we found that 11 of them were based on case reports and five researches comprised a qualitative approach, with evidence level VI. The analysis of the studies allowed us to clearly understand the implementation process of the Magnet Recognition Program consisting of six stages, as follows: implementation, evaluation, site visit, awards, maintenance and reassignment. Studies have shown that the application stage consisted of submitting to the institution the process to be elected by the ANCC. The evaluation stage consisted of analysis by the evaluators of the ANCC related to writing documentation presented by the applicant organization. After approval, a visit to the place was scheduled. On the occasion of the visit to the institution to be accredited, it was identified the presence of 14 Magnetism Forces in the organization. Once approved, the Magnet certification was granted, constituting the awards stage. After this process, the culture Magnet maintenance stage was started so that the reassignment could be performed after four years. As a facilitator item of the whole process, the studies showed the use of consultants, the visit to a previously accredited organization, the employment of an experienced professional to prepare the report, the involvement of all professionals understanding the Magnet program as an organizational goal and the support of the governing staff, in order that the financial and structural resources can be provided. The studies also showed important aspects related to the components of the Magnet Recognition Program which were mainly about the shared governance, professional exemplary practice and fundamental empowerment structure for the organizations. Conclusion: This study allowed to identify the steps to implement the Magnet program and the results can contribute to other organizations that are seeking for this certification, providing subsidies to reach their accreditation. However, when comparing the levels of evidence of the analyzed studies, it was observed the need to use a higher methodological rigor for further studies.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-14T15:24:46Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação de Maristela - completo (4).pdf: 1666360 bytes, checksum: 6326d5af06a488722ac05a5564cac305 (MD5) / Made available in DSpace on 2017-07-14T15:24:46Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação de Maristela - completo (4).pdf: 1666360 bytes, checksum: 6326d5af06a488722ac05a5564cac305 (MD5) Previous issue date: 2016-03-31 / PPGES / Esta pesquisa teve como objetivo analisar a eficiência das especialidades médicas na média complexidade em seis Policlínicas na cidade do Recife-PE. Estudo de abordagem quantitativa, descritiva, tendo como objeto os custos das consultas ofertadas/programadas e executadas no ano de 2014. Avaliou-se o desempenho de cada unidade quanto à produtividade profissional por especialidade médica e a eficiência microeconômica pelo valor monetário das consultas ofertadas e programadas e não realizadas. Os dados primários foram obtidos em entrevista com os gestores locais e os secundários de relatórios dos sistemas de informações SIA/SUS, CNES e outros municipais. Utilizou-se para análise estatística descritiva: frequências absolutas, relativas e médias de consultas programadas, realizadas e aprovadas e valores monetários por especialidade médica e por unidade. Os resultados estão apresentados em tabelas e figuras. As unidades não atingiram o valor monetário estimado segundo a capacidade ofertada e obtiveram índice de desempenho que variou de 47% (mínimo) a 67% (máximo), classificando os serviços em pouco eficientes ou ineficientes quanto à produção. Identificou que a programação orçamentária das unidades está aquém da capacidade produtiva dos profissionais e que a avaliação da eficiência não integra as atividades da auditoria municipal de saúde. Faz-se necessário sua incorporação desse tipo de auditoria para que se possa informar ao gestor sobre a produtividade e eficiência a fim de contribuir para o planejamento e reorganização das redes municipais, visando à melhoria do desempenho e da qualidade dos serviços. / The aim of this research was to analyze the efficiency of the median complexity in six Polyclinics in the city of Recife-PE using information from specialized medical consultations. This was a descriptive study with a quantitative approach and as tracers the programmed and performed consultations in 2014. The performance of each unit was evaluated regarding the professional´s productivity in his/her medical specialty and the microeconomic efficiency through the difference in the monetary value of programmed but unperformed programmed consultations. Primary data were obtained from interviews with local managers in order to confirm secondary data collected from information systems reports at SUS – Brazil's Public Health System: outpatients clinics (SIA), The National Register for Health Facilities (CNES), the Budget Programming File (FPO) and others municipal systems. The absolute and the relative frequencies, the annual mean programmed, performed and approved consultations, in addition to the monetary values paid by SUS were used for the descriptive analysis per medical specialty and per unit. The results are presented in tables and figures. The units did not reach the expected monetary value according to the offered capacity and few medical specialties fulfilled the number of programmed consultations. The performance index ranged from 47% (minimum) to 67% (maximum). It was identified that the Budget Programming for the units was lower than the productive capacity of the professionals involved and that routine evaluation of efficiency is not an activity undertaken by the municipal health audits. It is necessary to incorporate this type of audit so as to inform the health authorities, in order to plan and reorganize municipal networks, aiming to improve the quality and performance of the services. In order to monitor this activity we have proposed a measure based on the compliance of the consultations goals and a classification system for the units as being efficient, slightly efficient or inefficient, according to the percentage scores obtained, so as to stimulate both professionals and managers to achieve their best performances.

The goal of this dissertation is to examine the utility of screening for common mental disorders in primary care in low and middle income countries. Screening for common mental disorders in primary care is often considered as an important step in addressing the mental health treatment gap in low and middle income countries. Nevertheless, there is insufficient evidence to support routine mental health screening in primary care in these countries. Even in high income countries, there is a lack of consensus on the effectiveness of routine mental health screening in primary care, especially screening for depression. Challenges to screening include the high rates of false positive diagnosis, poor evidence on outcomes for people identified by screening, and potential harms due to screening. The specific aims of this dissertation are to: 1) synthesize evidence from low and middle income countries on the current practices of screening for common mental disorders in primary care and the use of screening instruments; 2) understand the significance of a positive screen for common mental disorder in primary care, specifically the distribution and the stability of ICD-10 diagnosis for screened positive patients, their clinical course over a period of one year, and the factors associated with the clinical course; 3) examine the factors associated with antidepressant prescriptions for patients screened positive for common mental disorders in primary care and evaluate the appropriateness of antidepressant prescriptions following screening. Based on our review of literature, evidence to support routine screening for common mental disorders in primary care in low and middle-income countries is inadequate. We highlight concerns about the fidelity with which screening is implemented, especially the flawed use of screening instruments. Introducing depression screening and physician notification in these settings seldom results in improved access to care or appropriate care. The majority of patients identified by screening in primary care have contextual, and probably non-pathological psychological distress (see page iii, for definition of key terms) which is often temporary and self-limiting. Patients with persistent distress symptoms identified by repeated screening, and those with moderate to severe depression may benefit from screening in the presence of evidence based stepped care interventions that are easily accessible and acceptable. Although, the long term effects of these interventions and the sustainability of such primary care based programs in low and middle income countries are uncertain. Our analysis of data from a cluster randomized control trial in India confirmed that a significant proportion of patients screened positive for common mental disorders in primary care has psychological distress that is temporary and self-limiting. However, a smaller, albeit important share of patients also experienced psychological distress that persisted throughout one-year follow-up. Persistent distress was predicted by psychosocial and economic disadvantage. Thus, psychosocial support systems and structural interventions have a larger role to play in addressing psychological distress. We found poor diagnostic stability for ICD-10 based diagnoses, and the most stable and prevalent diagnosis was mixed anxiety and depressive disorder. Further, we found that antidepressants are widely prescribed following screening especially for women and older adults. While many patients with moderate to severe depression could benefit from antidepressants, it is problematic that a significant proportion of patients with less severe disorders also received anti-depressant prescription despite the availability of non-pharmacological treatment options. In summary, there is a lack of empirical evidence to support routine screening for common mental disorders in primary care in low and middle income countries as an effective strategy to identify those in need of treatment; instead screening could lead to over diagnosis and inappropriate antidepressant prescriptions. To address psychological distress in primary care and the unmet need for treatment in low and middle income countries, there is an urgent need to focus on locally driven and culturally relevant approaches to case finding and intervention.

The purpose of the study was to explore the inter-rater reliability of the Multi-Dimensional Outcome Measure (MDOM) in the following areas: overall reliability, differences in reliability between samples, differences in reliability between scales, and increasing reliability over time. The study was to assist mental health professionals by clarifying the technical properties of an evaluation tool which could be used to document program outcomes for policy makers and to develop more effective treatment methodologies. The MDOM was administered to two groups, a mentally and emotionally disturbed sample of thirty-five Subjects from an inpatient facility and a normal sample of thirty-three community college Subjects. The MDOM was given in back-to-back interviews by two interviewers alternating in first interviewer, second interviewer roles. The data indicated acceptable inter-rater reliability for the Multi-Dimensional Outcome Measure. For anyone sample, all twelve scales showed acceptable reliability according to the criterion of a .75 product moment correlation coefficient. However, four scales did not meet the .75 level: Productivity I (.55), Productivity II (.74), Interpersonal Isolation--Family (.71) when administered to the inpatient sample, and Drug Abuse (.74) when administered to the community college sample. Assessment of the differences in reliability between samples showed higher reliability for the community college sample than for the inpatient sample with the exception of the Drug Abuse scale. Exploration of the differences in reliability between scales showed some scales contained items which were more relevant for the college student than for the inpatient. Other scales included items which were ambiguous or worded in an awkward manner which may have contributed to their lower reliability. Reliability could be increased as a result of the increased skill and clarification of questionable items. Scales which demonstrated unacceptable reliability the first weeks of the study indicated an acceptable level the last week. The data suggested that interviewers should be trained to insure acceptable reliability. The MDOM was seen to be suitable for monitoring the functioning of a community based sample; however, consideration should be given to the inherent limitations before administering the instrument to an inpatient sample.

Evaluative research in the field of mental health is carried out pursuant to several goals. One is to study a very particular intervention on a very particular client (or client population) in a controlled way with the aim to test a theory of intervention. This form of research requires basically an experimental research design. It also requires rigorously defined and measured intervention and a good control for factors other than intervention. The requirements for this form of research are stringent and the number of such projects reported is, therefore, rare. The present study was done as a pilot study for the Elahan Center for Mental Health and Family Living (formerly Clark County Mental Health) in Vancouver, Washington. This agency has recently undergone much change. About eighteen months ago there was a change of Directors. At about the same time, though unrelated, the agency was involved in a public scandal around the drug program. As a result of much inter-agency strife and the change in administration, few employes from the old staff remain. The new administration is dedicatedly behaviorist in therapeutic orientation, as are some of the therapists. Use of para-professionals in professional capacities is high and most of tile para-professionals follow the behavioristic bent of the administration.

The COVID-19 pandemic prompted a widespread shift to teletherapy, a historically underutilized yet potent modality that can help increase access to mental health treatment. While numerous studies have investigated the adaptation to teletherapy from the perspective of therapists, there remains a paucity of research on client perspectives. To address this gap, the present study examined the teletherapy process and outcome from the perspective of 2,118 clients who shifted to teletherapy during the pandemic with the same therapist they had been seeing in-person pre-pandemic. Specifically, this study investigated client-perceived changes, concerns, disclosure patterns, benefits, drawbacks, and treatment preferences in teletherapy. Findings revealed that the majority of clients reported teletherapy to be as engaging, effective, and valuable as in-person therapy, with therapeutic boundaries remaining intact. However, several factors, including positive regard, privacy concerns, and technological distractions, significantly influenced clients’ treatment engagement, effectiveness, and future treatment preferences. In addition, clients experiencing elevated distress reported teletherapy as less engaging and effective than in-person treatment. Implications for therapists and clients to optimize teletherapy, as well as directions for future research, are discussed.

No campo da Saúde Pública, a avaliação de serviços é área de extrema relevância, pois viabiliza diretrizes e opções para o processo de planejamento e possibilita um controle técnico e social dos serviços e programas prestados à sociedade. Contudo, ainda é escassa a produção científica publicada voltada a satisfação dos usuários em relação aos serviços de atenção primária à saúde, em especial aquelas para a Saúde da Família. A estratégia de Saúde da Família, viabilizada pelo Ministério da Saúde, em curso no país a cerca de uma década, tem sido objeto de avaliação pelo próprio Ministério que vem indicando a necessidade de estudos locais e que possam se voltar para analisar a relação dos serviços com os seus usuários. Assim, o objetivo geral desta pesquisa é avaliar a aceitabilidade dos usuários em relação à oferta e prestação de assistência pelas equipes de Saúde da Família de Ribeirão Preto-SPBrasil. Trata-se de uma pesquisa de caráter exploratório-descritivo centrando-se numa abordagem quanti-qualitativa. A população do estudo foi constituída por 171 usuários cadastrados nos quatros Núcleos de Saúde da Família que cobrem a área básica de um serviço de referência secundário da zona oeste do município. Os dados empíricos foram coletados nos domicílios por meio de entrevista semi-estruturada. Utilizamos como dimensões analíticas: infra-estrutura, acessibilidade, relação equipe-usuário, resolutividade e, incluímos ainda um item de sugestões. A análise dos dados é discutida simultaneamente, sendo que para a análise dos dados quantitativos recorremos ao auxílio do software SPSS e os qualitativos, utilizamos a análise temática, sendo identificados três temas: Acesso e acessibilidade nos Núcleos de Saúde da Família; Humanização da assistência na Saúde da Família ? os detalhes que fazem a diferença na produção do cuidado em saúde; A busca por qualidade da atenção. Identificamos uma avaliação em geral com alto percentual de satisfação, contudo, ao aprofundarmos nas narrativas, percebemos uma contradição, evidenciada pela insatisfação dos usuários em relação a alguns indicadores. Os usuários apontam como um dos pontos de grande satisfação relações inter-pessoais atenciosas e afetivas, demonstrando a grande valorização das tecnologias leves nas relações entre os trabalhadores e usuários e um dos aspectos diferenciais na atenção à saúde. Já as insatisfações predominaram quanto a ambiência, tempo alto na sala de espera, e principalmente, obstáculos em relação a acessibilidade organizacional, prejudicando a longitudinalidade e a continuidade da atenção à saúde. A maioria das sugestões dos usuários foi relacionado à melhoria da acessibilidade organizacional, favorecendo inclusive a dispensação de medicação e realização de procedimentos na própria unidade de saúde. Estudos de avaliações de satisfação dos usuários permitem a esses oportunidades de expressão nas quais podem monitorar e controlar as atividades dos serviços públicos de saúde, fortalecendo sua participação nos processos de planejamento e exercendo o controle social. / In Public Health, service assessment is extremely relevant, as it provides guidelines and options for the planning process and allows for technical and social control of services and programs delivered to society. However, the lack of scientific production about user satisfaction in primary health care services is still scarce, especially with respect to Family Health. The Family Health Strategy, made possible by the Brazilian Ministry of Health and in course for approximately one decade, has been assessed by the Ministry itself, which has appointed the need for local studies, which can analyze the relation between services and their users. Thus, this study aims to assess users? acceptability of the care offered and delivered by Family Health teams in Ribeirão Preto-SP-Brazil. We carried out an exploratory-descriptive study, based on a quantitative-qualitative approach. The study population consisted of 171 users, registered at the four Family Health Units that cover the basic area of a secondary service in the West of the city. Empirical data were collected at users? homes through a semistructured interview. We used the following analytic dimensions: infrastructure, accessibility, team-user relation and problem-solving capacity, and we also included an item for suggestions. Data analysis was discussed simultaneously. For quantitative data analysis, we used SPSS software and, for qualitative data, thematic analysis. Three themes were identified: Access and accessibility in Family Health Units; Care humanization in Family Health ? the details making the difference in health care production; The search for care quality. We identified a high satisfaction level in the general assessment. However, when we looked deeper into the narratives, we perceived a contradiction, evidenced by users? dissatisfaction with some indicators. Users indicated considerate and affective interpersonal relations as one point of great satisfaction, demonstrating the high valuation of soft technologies in relations between workers and users and one of the aspects that differentiate health care. Dissatisfaction predominated in terms of environment, long time spent in the waiting room and, mainly, obstacles related to organizational accessibility, impairing care longitudinality and continuity. Most user suggestions were related to improving organizational accessibility and even favored medication distribution and the realization of procedures at the health unit. Studies about the assessment of users? satisfaction grant them opportunities to express themselves, through which they can monitor and control public health service activities, strengthening their participation in planning processes and exercising social control.

Introdução: A avaliação da assistência prestada é uma das condições básicas para promover a qualidade dos serviços de saúde. Obter dados a respeito do bem estar segundo a perspectiva da mulher permite corrigir inadequações e melhorar a qualidade da assistência ao parto. Objetivo da pesquisa: Esta pesquisa teve o objetivo de adaptar culturalmente e validar as propriedades psicométricas da Escala de Bienestar Materno em Situación de Parto (BMSP 2) para a língua portuguesa (Brasil).Metodologia: Trata-se de um estudo do tipo metodológico aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo, sob o parecer nº 170.412. A adaptação cultural desta Escala, que foi produzida por enfermeiras obstétricas chilenas, foi feita conforme recomendações da literatura científica pertinente: tradução da BMSP2 para a língua portuguesa; retrotradução para língua de origem do instrumento; avaliação por um comitê de juízes; pré-teste da versão adaptada e aplicação da versão final em português. Os dados foram coletados no período de dezembro de 2012 a março de 2013 em um Hospital-Escola, situado na Zona Norte do Município de São Paulo. Participaram do estudo, 500 mulheres que receberam assistência ao parto normal na Instituição. A validade de face e conteúdo foi avaliada pelo comitê de juízes; para a validade de constructo foi realizada a análise fatorial; a validade de constructo convergente foi avaliada através do Teste de Correlação de Pearson entre a BMSP 2 e o domínio satisfação com a vida da Escala de Bem Estar Subjetivo; a validade de constructo divergente foi avaliada por meio de teste para comparação de grupos distintos. A confiabilidade foi avaliada pela consistência interna de seus itens (Alfa de Cronbach). O nível de significância adotado foi de 0,05. Resultados: A maioria das participantes do estudo vivia com o parceiro, possuía idade de 26,7 anos em média, era da cor branca, tinha entre nove e 11 anos de estudo e era do lar. Em relação às características obstétricas, 36,2% era multigesta, 28% estava na segunda gestação e 35,8% era primigesta, com idade gestacional entre 39 e 39 semanas e 6 dias (33,8%). Na avaliação das propriedades psicométricas, a análise fatorial apresentou um agrupamento diferente do encontrado pelos autores da versão original do instrumento, demonstrando a necessidade de desenvolver novos estudos objetivando propor nova distribuição fatorial para a versão brasileira desta escala. A validade de constructo convergente apresentou correlação positiva com o domínio satisfação com a vida da EBES. Na validade de constructo divergente foi obtida uma relação significante com algumas características sociodemográficas e clinico obstétricas. Com relação à confiabilidade, foi obtido um valor adequado para a consistência interna da versão adaptada da BMSP 2 (Alfa de Cronbach 0,93). Conclusão: A versão adaptada para o português da BMSP 2 mostrou-se válida e confiável na amostra estudada. Novos estudos necessitam ser realizados para testar essas propriedades em outros grupos de pacientes brasileiras. / Introduction: To evaluate the effects of health care on women`s wellness during childbirth is possible with the use of scales based on women`s perception of care. To establish the quality of these assessments is required by using a valid and cultural scale to make possible to achieve the desired improvements on outcomes of midwifery care. Objectives: The aims of this study were to translate the Chilean scale Mother`s Wellness during Childbirth to Brazilian Portuguese and to evaluate its reliability and validity. Method: This quantitative study followed five steps of cultural adaptation of the scales: translation of the scale to Brazilian Portuguese; back-translation to Spanish; assessment by a judge´s committee, scale pre-test and the application of the final version of the scale. The data were collected from December, 2012 to March, 2013 in a Brazilian University Hospital. A total of 500 women who had childbirth in this institution participated in this study. The face validity and content validity was assessed by an expert´s committee; the factor analysis was performed using the construct validity, the convergent validity was tested using the Pearson´s Correlation Test between Mother`s Wellness during Childbirth and Subjective Welfare Scale; and the divergent validity test was used to compare different groups. The reliability of the scale`s final version was assessed through internal consistency of its items using Cronbach\'s Alpha.The significance level was 0.05. Results: Women aged 26.7, were white, had a partner, had nine to 11 years of study and were housewives. Most women were multiparous, with gestational age between 39 weeks and 39 weeks and six days. The factorial analysis of scale showed a cluster difference in relation to the original scale indicating the need to explore better new distribution factors for the portuguese version of the scale. The convergent construct validity was positively correlated with life satisfaction domain of Subjective Welfare Scale and the divergent construct validity had a significant relationship with sociodemographic obstetric characteristics. The reliability of the Portuguese version of Mother`s Wellness during Childbirth was adequate for internal consistency observed with Cronbach\'s alpha value (0.93). Conclusion: Portuguese version of Mother`s Wellness during Childbirth is valid and reliable for this studied sample.

Analisaram-se os serviços laboratoriais com o objetivo de caracterizar o perfil dos laboratórios de microbiologia que realizam exames para hospitais com dez ou mais leitos de UTI e hospitais da rede sentinela, com ênfase na funcionalidade, recursos humanos e métodos de trabalho.. Estudo transversal analisou dados secundários de um levantamento realizado em 464 laboratórios de microbiologia de todos os hospitais com pelo menos dez leitos de UTI de quinze unidades federadas selecionadas. Os dados foram coletados entre abril de 2002 a dezembro de 2005. A análise descritiva foi realizada por distribuição de freqüências. As variáveis selecionadas compuseram um conjunto para descrever três dimensões dos laboratórios: organização geral (administrativa, informação e comunicação, qualidade e gestão de risco), estrutura (formação e atualização profissionais; condições físicas gerais; equipamentos, materiais de consumo e de referência) e métodos de trabalho em todas as fases do processo analítico (pré, inter e pós). Os resultados encontrados indicaram principalmente que: uma minoria dos laboratórios possui administração profissionalizada e conhece os custos dos exames; pequena adesão aos aspectos do sistema da qualidade e de biossegurança; pequeno grau de institucionalização dos laboratórios com a atualização dos seus profissionais e apenas um terço de um subconjunto dos laboratórios possuía pós-graduação na área de bacteriologia; existência de quadro potencial para ocorrência de erros na fase préanalítica do processo; há laboratórios dos hospitais com pelo menos dez leitos de UTI e os da rede sentinela que não isolam microorganismos de importância clínica e cometem erros graves no antibiograma por não seguirem recomendações técnicas atualizadas; a participação na comissão de controle de infecção hospitalar é inadequada / Laboratory services were analyzed with the objective of characterizing the profile of microbiology laboratories which perform exams for hospitals with ten or more beds of intensive care and hospitals of the sentinel network, with emphasis in functionality, human resources and method of work. Data from a survey carried out in 464 microbiology laboratories of all hospitals with ten or more beds of intensive care of fifteen selected Brazilian states were analyzed. Data were collected from April 2002 to December 2005. Descriptive analyses were done using frequency distributions. The variables were selected to describe three dimensions of the laboratories: general organization (administrative, information and communication, quality and risk management), structure (professional formation and modernization, general physical conditions, equipment, supplies and references) and methods of work in all phases of the analytical process (pre-, inter- and post-). The main results indicate that: the minority of the laboratories has professional administration and know the costs of the exams; low adherence to the aspects of the quality system; low level of institutionalization of the laboratories with the modernization of their professionals and only one third of a subset of laboratories had post-graduated professionals in the area of bacteriology; existence of a potential for occurrence of errors in the pre-analytical phase of the process; there are laboratories with ten or more beds of intensive care and hospitals of the sentinel network which do not isolate microorganisms of clinical importance and make serious mistakes in the antibiogram due to lack of adherence to the current technical recommendations; the participation in the nosocomial infection control committee is inadequate