o Staphylococcus aureus consiste em importante microrganismo no ambiente nosocomial, disseminado principalmente pelas mãos dos profissionais de saúde. É com essa compreensão acerca da temática, que nos propusemos realizar esta investigação. Objetivos: avaliar a prevalência de Staphylococcus aureus e de Staphylococcus aureus meticilina resistentes (MRSA) em profissionais das equipes médicas e de enfermagem de uma instituição de saúde de Goiânia-GO, e as interfaces com as infecções nosocomiais; e caracterizar o perfil fenotípico dos Staphylococcus aureus. Material e método: estudo realizado com as equipes médicas e de enfermagem, das unidades de terapia intensiva, clínica médica, clínica cirúrgica, gineco/obstétrica e centro cirúrgico de uma instituição de saúde de Goiânia-Goiás. Desenvolvido no período de agosto de 2005 a julho de 2006. Foi coletada a saliva de 268 profissionais, em 3 momentos distintos, o que resultou em 804 amostras analisadas. As amostras foram semeadas em ágar manitol e as colônias desenvolvidas contadas e submetidas à fenotipagem e teste de suscetibilidade aos antimicrobianos, determinado pelo método de difusão de disco. Os resultados foram submetidos à análise quantitativa, por meio de estatística descritiva, utilizando-se programa Epi-Info (versão 3.3.2-Center for Disease Control). Resultados: dos 268 profissionais da saúde que concordaram em participar da pesquisa, analisaram-se 804 amostras de saliva; dessas os Staphylococcus aureus foram isolados de 404 amostras, correspondendo a 227 profissionais colonizados. Identificou-se que 9,7% (26/268) dos profissionais da saúde investigados, eram portadores de MRSA. O fenótipo MLSB (macrolídeos, lincosaminas e estreptogaminas) foi detectado em 11,2% (46/409) dos Staphylococcus aureus. Destes, 8,7% resistentes à oxacilina. No tocante ao perfil dos profissionais da saúde colonizados por MRSA quanto à categoria profissional, destacou-se que 61,5% eram técnicos de enfermagem, 19,2% eram enfermeiros, 15,4% eram médicos e 3,8% auxiliares de enfermagem. Quanto ao local de trabalho dos profissionais da saúde acometidos por MRSA, identificou-se a UTI clínica (26,9%), seguida pela clínica médica (19,2%), pela UTI cirúrgica (15,4%), pela clínica cirúrgica (15,4%), pela clínica gineco/obstétrica (15,4%) e pelo centro cirúrgico (7,7%). A produção de lecitinase foi identificada em 48,5% dos Staphylococcus aureus isolados dos (130/268) profissionais da saúde que participaram das três coletas. Quanto à adesão dos profissionais da saúde aos equipamentos de proteção individual (EPI), durante a assistência direta ao cliente, verificou-se que 92,9% deles os utilizavam e 3,4% não os utilizavam sendo que de 3,7% não se teve o questionário recuperado. Dos que utilizavam EPI, a luva foi a mais usada por 93,7% dos profissionais, seguido pela máscara, (92,9%) e pelo jaleco (88,4%). Apesar de somente 3,4% não utilizarem os EPI, essa conduta é preocupante se considerar as suas justificativas: desinteresse, esquecimento, comprometimento do visual, entre outros. Em se tratando de MRSA, um único profissional é capaz de disseminar esse microrganismo tanto no local de trabalho como na comunidade em geral. Conclusão: a colonização de profissionais da saúde por Staphylococcus aureus meticilina resistentes é uma realidade, constituindo-se fonte potencial de infecção nosocomial grave podendo ter impacto na saúde dos clientes, dos familiares e do próprio profissional. Os resultados sinalizam a fragilidade da adesão dos profissionais de saúde às medidas preventivas. Dessa forma, recomenda-se a elaboração de estratégias específicas direcionadas a esses profissionais, acerca do MRSA, para que possam ser implementadas nas instituições de saúde, com vistas à adesão deles a tais medidas e, conseqüentemente, à diminuição dos índices de infecções hospitalares. Acredita-se que os resultados desta pesquisa levem a vislumbrar a construção de um banco de dados epidemiológicos sobre Staphylococcus aureus meticilina resistentes, na instituição, e que possam oferecer subsídios para um sistema de vigilância prospectiva populacional dessa bactéria, entre os profissionais de saúde da instituição referida / Staphylococcus aureus is an important microorganism in the nosocomial environment, mainly disseminated by the hands of health professionals. Based on this understanding about the theme, we decided to carry out this study. Objectives: assess the prevalence of Staphylococcus aureus and meticillin-resistant Staphylococcus aureus (MRSA) in medical and nursing team professionals from a health institution in Goiânia-GO, and the interfaces with nosocomial infections; and characterize the phenotypic profile of Staphylococcus aureus. Material and method: This study was carried out with the medical and nursing teams working at the intensive therapy, medical clinic, surgical clinic, gynecologic-obstetric units and surgical center of a health institution in Goiânia-Goiás. The research was carried out between August 2005 and July 2006. The saliva of 268 professionals was collected at 3 different moments, which resulted in 804 analyzed samples. The samples were seeded in mannitol agar and the colonies that developed were counted and submitted to phenotyping and antimicrobial susceptibility test, determined by the disk diffusion method. The results were submitted to quantitative analysis, through descriptive statistics, using Epi-Info software (version 3.3.2-Center for Disease Control). Results: Two hundred sixty-eight health professionals agreed to participate in the research, of whom 804 saliva samples were analyzed; in this group, Staphylococcus aureus were isolated from 404 samples, corresponding to 227 colonized professionals. The analysis identified that 9.7% (26/268) of the examined health professionals were carriers of MRSA. The MLSB (macrolides, lincosamides and streptogamines) phenotype was detected in 11.2% (46/409) of the Staphylococcus aureus, 8.7% of which were oxacillin-resistant. With respect to the profile of health professionals colonized by MRSA in terms of professional category, 61.5% were nursing technicians, 19.2% were nurses, 15.4% were physicians and 3.8% nursing auxiliaries. As to the work place of health professionals affected by MRSA, the clinical ICU (26.9%) was identified, followed by the medical clinic (19.2%), surgical ICU (15.4%), surgical clinic (15.4%), gynecologic-obstetric clinic (15.4%) and surgical center (7.7%). Lecithinase production was identified in 48.5% of the Staphylococcus aureus isolated from (130/268) the health professionals who participated in the three sample collections. As to health professionals adherence to individual protection equipment (IPE), during direct client care, 92.9% used IPE and 3.4% did not, while questionnaires were not recovered for 3.7%. Among professionals who used IPE, gloves were the most used equipment by 93.7%, followed by masks (92.9%) and apron (88.4%). Although only 3.4% did not use the IPE, this behavior is preoccupying in view of their justifications: indifference, forgetting, impaired visual appearance, among others. In cases of MRSA, one single professional is capable of disseminating this microorganism in the workplace as well as in the community in general. Conclusion: the colonization of health professionals by meticillin-resistant Staphylococcus aureus is a reality, constituting a potential source of severe nosocomial infection that can impact the health of clients, relatives and professionals themselves. The results point towards health professionals? fragile adherence to prevention measures. Thus, the elaboration of specific strategies about MRSA is recommended, directed at these professionals, with a view to their implementation at health institution, health professionals? adherence to these measures and, consequently, decreased hospital infection rates. These research results can lead to the construction of an epidemiological database on meticillin-resistant Staphylococcus aureus at the institution, and can support a prospective populational surveillance system for this bacteria among health professionals at the study institution

O presente trabalho propôs a estudar as articulações entre saúde mental e trabalho, mais especificamente a dinâmica prazer-sofrimento bancário dos trabalhadores que ocupam cargo de gestores intermediários em um banco estatal, localizado no estado do Rio Grande do Sul, em agências diversas, de diferentes cidades. Fundamenta-se na importância de estudar as experiências relacionadas ao prazer e o sofrimento no trabalho, assim como, no significado do trabalho de gestão, além de interessar-se em investigar se gestores com tempos diferentes no cargo percebem de forma diferente o prazer e o sofrimento relacionado ao trabalho. Isto porque temos poucos estudos que visam aprofundar conhecimentos acerca destes gestores intermediários. Nossa pesquisa fundamenta-se nos pressupostos teóricos e metodológicos da Clínica em Psicodinâmica do Trabalho. O método qualitativo foi utilizado, realizando-se entrevistas individuais, semiestruturadas com gestores intermediários. Com relação as fontes de prazer e sofrimento no trabalho destes gestores intermediários, nossos estudos apontaram que as vivências de prazer podem ser relacionadas à satisfação em resolver os problemas dos clientes. No que diz respeito ao sofrimento, este foi relacionado a excessiva cobrança de metas, consideradas inatingíveis, intensificado pela existência de avaliações individuais, e estas, sendo objetivas, desconsideram esforço empregado para realizar uma tarefa, o que causa frustração. O volume de serviço excessivo também é mencionado como causador de desconforto, além do sofrimento ético, que coloca o trabalhador em um dilema moral, ao não saber se atende aos desígnios da empresa ou as necessidades dos clientes. Esses fatores que provocam sofrimento, muitas vezes, podem culminar no adoecimento do trabalhador. Os fatores identificados ora como fontes de sofrimento, ora como fontes de prazer, foram: o reconhecimento, a sensação de estabilidade e a quantofrenia. No que diz respeito as estratégias defensivas utilizadas pelos trabalhadores para manterem-se trabalhando, as possíveis de serem detectadas foram: a negação, a racionalização, repensar a escolha e não realizar a reflexão. Todas elas objetivam proteger a saúde mental do trabalhador contra a descompensação, porém não modificam a organização do trabalho. O eixo significado do trabalho de gestão nos mostrou que, os gestores entrevistados têm vigorosamente interiorizadas as diretrizes da organização, por conta disto, seu trabalho é essencialmente centrado na tarefa. Há casos mais raros, nos quais o sentido do trabalho está ligado aos valores relativos à construção de identidade, reconhecimento e relacionamento interpessoal, além daqueles de dupla racionalidade, entretanto, entendemos que a racionalidade instrumental ainda se sobrepõe. Portanto, não causa espanto o aparecimento de inúmeras vivências relacionadas ao sofrimento no trabalho, visto a satisfação estar mais intimamente relacionada ao caráter subjetivo daquele. Dentre os achados mais relevantes neste estudo, consideramos a relação entre uma maior adesão à cultura do management, com estratégias defensivas mais efetivas, permitindo aos trabalhadores continuar trabalhando. Por outro lado, a baixa adesão a estes novos modelos satura as defesas, ocasionando mais vivências de sofrimento e, mesmo o risco de adoecimento. / This work aims to study the links between mental health and work, more specifically the banking dynamics pleasure-suffering occupying position of middle managers in a state bank, located in the state of Rio Grande do Sul, in different agencies, different cities. It is based on the importance of studying the experiences related to pleasure and suffering at work, as well as the significance of management work, as well as interest in investigating whether managers with different times in office perceive differently the pleasure and suffering work-related. This is because few studies have aimed to deepen knowledge about these middle managers. Our research is based on the theoretical and methodological assumptions of the Clinic for work psychodynamics. The qualitative method was used, carrying out semistructured individual interviews with middle managers. With regard to pleasure and pain sources in the work of these middle managers, our studies indicated that the experiences of pleasure can be related to satisfaction in solving customer problems. With regard to suffering, this was related to overcharging goals, considered unattainable, intensified by the existence of individual assessments, and these are objective, disregard effort employed to perform a task, which causes frustration. The excessive volume of service is also mentioned as causing discomfort, beyond the ethical suffering, that puts the worker in a moral dilemma, not knowing whether to meet the company designs, or customer needs. These factors that cause suffering, can often culminate in worker illness. The factors identified either as sources of suffering, either as sources of pleasure, were: recognition, sense of stability and quantofrenia. With regard to defensive strategies used by workers to keep yourself working, possible to detect been denial, rationalization, rethink the choice not to bring about reflection. We design all of them as defense strategies and health, aimed at protecting the mental health of the worker against decompensation, but do not change the organization of work. The axis meaning the management work has shown us that the managers interviewed, has strongly internalized the guidelines of the organization, because of this, his work is mainly focused on the task. There are rare cases in which the meaning of work is linked to values relating to the construction of identity, recognition and interpersonal skills in addition to those of dual rationality, however we understand that the instrumental rationality still overlaps. So do not astonishes the appearance of numerous experiences related to suffering at work, as the satisfaction be more closely related to the subjective nature of that. Among the most important findings in this study, we consider the relationship between greater adherence to the management culture with more effective defensive strategies allowing workers to continue working. On the other hand, the low adherence to these new models, saturate the defenses, causing more experiences of suffering, and even the risk of illness.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-11-06T18:13:59Z No. of bitstreams: 1 Michelle Leiko Uemura.pdf: 1905572 bytes, checksum: 3f6485a1c200299a9216b36e406b1da3 (MD5) / Made available in DSpace on 2017-11-06T18:14:00Z (GMT). No. of bitstreams: 1 Michelle Leiko Uemura.pdf: 1905572 bytes, checksum: 3f6485a1c200299a9216b36e406b1da3 (MD5) Previous issue date: 2017-09-18 / Universidade Católica de Santos - Católica de Santos / According to the Ministry of Health, respiratory problems represent the second cause of morbidity in the distribution of diseases in Brazil. Studies on the association of air pollutants with morbidity and mortality outcomes from respiratory diseases began in the 1990s. Within professional kitchens, the pollutants emitted by food products mainly result from the heating and cooking process. In addition, the combustion of liquefied petroleum gas (LPG) and the smoke emitted during the cooking process may contain a number of hazardous pollutants due to the incomplete combustion of the organic compounds in the food material. This study aims to evaluate respiratory risk in commercial restaurant workers in the city of Santos exposed to pollutants, temperature and humidity released during cooking. The present study is cross-sectional, with random sampling for convenience and standardized definitions. Data collection was carried out in ten commercial Buffet restaurants, inside their kitchens and in the hall. The collection of particulate matter (PM2.5), nitrogen dioxide (NO2), temperature and humidity were performed in duplicate. We also used the European Community Respiratory Health Survey (ECRHS) questionnaire for symptoms suggestive of respiratory compromise validated in Brazil and was the pulmonary function test (Spirometry) in the workers. The descriptive analysis, correlation analysis and Mann-Whitney U-test were performed to make the results. The univariate and multiple logistic regression model was used to evaluate risk factors for the loss of lung function of exposed workers. The significance level was 5%. Statistical Package for Social Science (SPSS) for Windows, version 13.0 (SPSS Inc., Chicago, United States) was used for the statistical analysis. It was verified that NO2, PM2.5 and Temperature are above values recommended by the National Environment Council (CONAMA) and São Paulo State Environmental Company (CETESB), both in the kitchen and in the salon, which are higher in the kitchen when compared to the salon (p<0.05), as well as the Humidity that is higher in greater proportions in the hall when compared to (p<0.05). Regarding the respiratory findings among all the evaluated levels PM2,5 and NO2 are jointly important risk factors for decreased FEV1 (PM2.5 above the 1st Quartile OR 2.98, 95% CI 1.15 - 7.71 and NO2 Above the 1st Quartile OR 3.49, 95% CI 1.25 - 9.89). In view of the above, respiratory diseases present a chronic effect on the exposure to air pollutants and meteorological factors, affecting commercial kitchen workers, as evidenced by the importance of public policies aimed at maintaining pollutant levels in concentrations that do not affect workers' health. / Segundo o Ministério da Saúde os problemas respiratórios representam a segunda causa de morbidade na distribuição de doenças no Brasil. Estudos de associação de poluentes atmosféricos com desfechos de morbidade e mortalidade por doenças respiratórias começaram a partir da década de 1990. Dentro de cozinhas profissionais, os poluentes emitidos pelos alimentos resultam principalmente do aquecimento e processo de cocção dos mesmos. Além disso, a combustão do gás liquefeito de petróleo (GLP) e a fumaça emitida durante o processo de cocção podem conter uma série de poluentes perigosos devido à combustão incompleta dos componentes carbônicos no material alimentar. Este estudo tem por objetivo avaliar o risco respiratório em trabalhadores de restaurantes comerciais na cidade de Santos expostos a poluentes, temperatura e umidade liberados durante a cocção dos alimentos. O presente estudo é transversal, sendo os dados obtidos com amostragem aleatória por conveniência e definições padronizadas. A coleta de dados foi realizada em dez restaurantes comerciais tipo Buffet, dentro de suas cozinhas e no salão, sendo a coleta do material particulado (PM2,5), dióxido de nitrogênio (NO2), temperatura e umidade realizadas em duplicata. Foi utilizado o European Community Respiratory Health Survey (ECRHS) questionário investigativo para sintomas sugestivos de comprometimentos respiratórios validado no Brasil e foi a prova de função pulmonar (Espirometria) nos trabalhadores. Para confecção dos resultados foi realizada a análise descritiva, análise de correlação e teste U de Mann-Whitney. Para avaliação fatores de risco para a perda de função pulmonar dos trabalhadores expostos foi utilizado o modelo de regressão logística univariada e múltipla, sendo o nível de significância utilizado 5%. Para as análises estatísticas foi utilizado o programa StatisticalPackage for Social Science (SPSS) para Windows, versão 13.0 (SPSS Inc., Chicago, Estados Unidos). Verificou-se que o NO2, o PM2,5 e a temperatura encontram-se acima dos valores recomendados pelo Conselho Nacional do Meio Ambiente (CONAMA) e Companhia Ambiental do Estado de São Paulo (CETESB) tanto na cozinha como no salão, esses mais elevados na cozinha quando comparado ao salão (p<0,05) bem como a umidade que se encontra elevada em maiores proporções no salão quando comparada a cozinha (p<0,05). No que se refere aos achados respiratórios, entre todos os níveis avaliados, PM2,5 e NO2 são fatores de risco conjuntamente importantes para FEV1 diminuído (PM2,5 acima do 1o Quartil OR 2,98, IC95% 1,15 - 7,71 e NO2 acima do 1o Quartil OR 3,49, IC95% 1,25 - 9,89). Diante do exposto, verifica-se que as afecções respiratórias apresentam efeito crônico à exposição aos poluentes do ar e aos fatores meteorológicos, afetando os trabalhadores de cozinhas comerciais, com isso evidencia-se a importância das políticas públicas voltadas para manutenção dos níveis de poluentes em concentrações que não afetem a saúde dos trabalhadores.

O trabalho assume um papel cada vez mais central na vida das pessoas, assim, é previsível que modelos modernos de tecnologias de gestão se ocupem também da qualidade de vida no trabalho (QVT) e dos fatores que incorporam a satisfação do indivíduo em sua atividade laboral e na humanização das situações relacionadas ao trabalho humano. Alguns estudiosos aventam a possibilidade do estresse contínuo no ambiente de trabalho acarretar prejuízos à integridade física, psicológica e ao convívio social e familiar dos profissionais. Assim à medida que o trabalho evolui e se torna mais dependente da técnica, ocorre um maior desgaste físico, psíquico e mental nos trabalhadores, isto acontece em função das exigências impostas pelas ocupações de ocupacionais e aumenta de forma assustadora o número de acidentes e doenças ocupacionais. Desta forma, a prática da odontologia predispõe seus profissionais a desenvolverem, sobretudo doenças do sistema osteomuscular, levando a incapacitação para o trabalho se não forem adotados princípios de ergonomia aplicados ao serviço. De maneira geral, no ambiente profissional há uma série de estímulos que podem contribuir significativamente para o surgimento de um conjunto de sintomas que são classicamente associados ao estresse laboral ou ocupacional. O objetivo do presente estudo consistiu em investigar os possíveis sintomas que acometem os cirurgiões dentistas da rede pública e da rede privada do município de Bauru/SP e sua relação com a atividade laboral, por meio do questionário Nórdico de Sintomas Osteomusculares (QNSO), avaliando também a presença da perda muscular manual utilizando um dinamômetro e assim investigar o impacto que esses possíveis fatores de risco causam na qualidade de vida desses cirurgiões dentistas utilizando o questionário QWLQ-Bref (Quality of Working Life Questionnaire Questionário de Qualidade de Vida no Trabalho). Do total de 1066 cirurgiões dentistas regularmente inscritos no Conselho Regional de Odontologia de Bauru (CROSP), apenas 128 (100,00%) participaram desta pesquisa, onde 64 cirurgiões dentistas pertencem à rede pública e 64 cirurgiões dentistas pertencem à rede privada. Tendo em vista a relevância sobre o tema Sintomas de LER/DORT, assim como os resultados também mostram que ao comparar a rede pública com a rede privada pôde-se perceber que na rede privada é maior é a frequência dos relatos de queixa de dor, desconforto ou dormência. / Work plays an increasingly central role in people\'s lives, so it is expected that modern models of management technologies will also focus on quality of life at work (QWL) and factors that incorporate the satisfaction of the individual in his work activity And the humanization of situations related to human work. Some scholars point out the possibility of continuous stress in the work environment causing damages to the physical and psychological integrity and to the social and familiar life of the professionals. Thus, as the work evolves and becomes more dependent on the technique, there is a greater physical, mental and mental exhaustion in the workers, this happens in function of the exigencies imposed by occupations of occupational and increases in a frightening way the number of accidents and occupational diseases. In this way, the practice of dentistry predisposes its professionals to develop, especially diseases of the musculoskeletal system, leading to incapacitation for work if principles of ergonomics applied to the service are not adopted. In general, in the professional environment there are a number of stimuli that may contribute significantly to the appearance of a set of symptoms that are classically associated with occupational or occupational stress. The objective of the present study was to investigate the possible symptoms that affect the dental surgeons of the public network and the private network of the city of Bauru / SP and its relation with the work activity, through the Nordic Questionnaire of Osteomuscular Symptoms (QNSO), evaluating Also the presence of manual muscle loss using a dynamometer and thus investigate the impact that these possible risk factors cause in the quality of life of these dental surgeons using the QWLQ-Bref questionnaire (Quality of Working Life Questionnaire). Of the total of 1,066 dentists regularly enrolled in the Regional Council of Dentistry of Bauru (CROSP), only 128 (100.00%) participated in this research, where 64 dental surgeons belong to the public network and 64 dental surgeons belong to the private network. Considering the relevance of the topic \"Symptoms of RSI / DORT\", as well as the results also show that when comparing the public network with the private network it was possible to perceive that in the private network it is greater is the frequency of the complaints reports of Pain, discomfort or numbness.

Between 1980 and 2000, mortality rates of children under the age of five and maternal mortality ratios declined across sub-Saharan Africa. During the same period, Kenya's mortality rates continued to rise until 2005 when the Kenyan Ministry of Health (MOH) introduced the Kenya Essential Package for Health (KEPH) in an effort to reverse its declining health indicators. The KEPH defined six service delivery levels which included the new community level, also known as level one. The Ministry of Health's plan for delivering services at the community level, known as the Community Health Strategy (CHS), called for the creation of Community Health Workers (CHWs) which the MOH hoped would produce the expected outcomes of the CHS. CHWs would be trained volunteers that were both members of the community they would serve, and selected by their community. Their training would allow them to recognize health problems, provide basic first aid, refer patients with serious problems to health facilities, conduct surveys, maintain records, provide education, and distribute supplies. In 2010, the Division of Community Health Services released an evaluation of the relevance, efficiency, and sustainability of the community health strategy. Their results showed that CHWs could produce many of the CHS's expected outcomes. In 2013, researchers from the Boston University School of Public Health and Moi University resolved to conduct a cross-sectional study for the Kenyan Ministry of Public Health and Sanitation to assess the effectiveness of the CHWs in Kajiado County. The county faced numerous health challenges and an overburdened health system. Data collection was completed over a seven-day period in June of 2013 by fourteen teams. Data was collected from 12 communities located in the areas of Rombo, Entonet, and Central Divisions of the Loitokitok sub-county within Kajiado County in rural South Kenya. Six of the selected communities had CHWs mobilized and were the intervention communities. Six communities had no registered CHWs and served as the controls. Eligibility to participate in the study was limited to permanent members of randomly selected households that housed at least one child less than five years of age and no active CHWs. Mothers of children less than five years of age were the preferred respondents. The primary and secondary outcomes were selected to address as many of the CHS's expected outcomes as possible. In an effort to compensate for the study's cross-sectional design, results were analyzed by stratifying them by each community's proximity to a hospital, the time since the CHW's last visit, and the respondent's knowledge of their CHW's name. Data was collected from 316 households, half of which were from intervention communities, and was entered into CSPro 5.0 before being exported to EpiInfo 7.1.1 for analysis. Analysis of the results suggests that the Community Health Strategy has been largely ineffective at producing its expected outcomes in Kajiado County as communities with active community health workers typically did not fare significantly better than non-CHW communities. The CHS was not entirely unsuccessful however, as mothers in CHW communities were significantly more likely to give birth at a health facility (PR: 1.41; CI: 1.15-1.72) than in non-CHW communities. Results also indicated that a community's proximity to a hospital could be a confounder in the relationship between a community's CHW status and health outcomes. The success of CHWs may have been masked by their tendency to visit households with worse health indicators more frequently.

INTRODUCTION: Community health workers are a growing and developing portion of the healthcare workforce. They have proven successes in decreasing healthcare inequities for many common chronic medical conditions, such as asthma, and have secured support at the Department of Health and Human Services. One common medical condition for which community health workers have not yet been explored as a resource is pediatric Attention Deficit Hyperactivity Disorder. We sought to investigate what the literature showed on community health workers' involvement in ADHD treatments thus far, and to specifically investigate which ADHD behavioral parent training program could best be adapted to a pilot study where community health workers were the intervention delivery agents. METHODS: We performed a systematic review of the literature on evidence based behavioral parent training programs for children with ADHD. Parent training interventions were compared for ease of application to a community health worker home-visit model. Program ability to successfully reduce child behavior problems and improve parenting practices was analyzed. RESULTS: 8 full text articles were analyzed in depth and grouped by intervention type. 1 article was a sports-based intervention for fathers, 1 was meant to improve attendance rates, 1 was a combined child-targeted and parent-targeted Behavioral Parent Training (BPT) therapy, 2 were based on the "New Forest Parenting Package", and 3 were based on Barkley's 1997 manualized BPT. DISCUSSION: Evidence exists for the ability of community health workers to deliver a behavioral therapy to families of children with ADHD, specifically behavioral parent training. Barkley's manualized BPT had the best combination in our study of positive outcomes for families and ease of adaptability to in-home delivery. We recommend a pilot study be conducted using a modified version of Barkley's BPT and have community health workers as the delivery agents to begin to see what role community health workers can play in the treatment of pediatric ADHD.

Thesis on the topic Satisfaction of health and social workers with financial rewards deals with the the subjective perception of satisfaction with the possibilities of financial compensation. The aim of of this paper is to describe the health and social care services by extension the South Bohemian Region and to map out the possibilities funding these services and not least theoretically identify the main motivational factors at work and care for employees. For processing the research part of the thesis was used quantitative research strategy, data capture been performed via interviewing methods, through a standardized questionnaire Job Satisfaction Survey, which was translated into the Czech language as a Průzkum spokojenosti se zaměstnáním M. Fraňkem. The research showed that both professions are dissatisfied with their financial rewards, but the overall rate of job satisfaction was in the range of ambivalence.

O presente trabalho propôs a estudar as articulações entre saúde mental e trabalho, mais especificamente a dinâmica prazer-sofrimento bancário dos trabalhadores que ocupam cargo de gestores intermediários em um banco estatal, localizado no estado do Rio Grande do Sul, em agências diversas, de diferentes cidades. Fundamenta-se na importância de estudar as experiências relacionadas ao prazer e o sofrimento no trabalho, assim como, no significado do trabalho de gestão, além de interessar-se em investigar se gestores com tempos diferentes no cargo percebem de forma diferente o prazer e o sofrimento relacionado ao trabalho. Isto porque temos poucos estudos que visam aprofundar conhecimentos acerca destes gestores intermediários. Nossa pesquisa fundamenta-se nos pressupostos teóricos e metodológicos da Clínica em Psicodinâmica do Trabalho. O método qualitativo foi utilizado, realizando-se entrevistas individuais, semiestruturadas com gestores intermediários. Com relação as fontes de prazer e sofrimento no trabalho destes gestores intermediários, nossos estudos apontaram que as vivências de prazer podem ser relacionadas à satisfação em resolver os problemas dos clientes. No que diz respeito ao sofrimento, este foi relacionado a excessiva cobrança de metas, consideradas inatingíveis, intensificado pela existência de avaliações individuais, e estas, sendo objetivas, desconsideram esforço empregado para realizar uma tarefa, o que causa frustração. O volume de serviço excessivo também é mencionado como causador de desconforto, além do sofrimento ético, que coloca o trabalhador em um dilema moral, ao não saber se atende aos desígnios da empresa ou as necessidades dos clientes. Esses fatores que provocam sofrimento, muitas vezes, podem culminar no adoecimento do trabalhador. Os fatores identificados ora como fontes de sofrimento, ora como fontes de prazer, foram: o reconhecimento, a sensação de estabilidade e a quantofrenia. No que diz respeito as estratégias defensivas utilizadas pelos trabalhadores para manterem-se trabalhando, as possíveis de serem detectadas foram: a negação, a racionalização, repensar a escolha e não realizar a reflexão. Todas elas objetivam proteger a saúde mental do trabalhador contra a descompensação, porém não modificam a organização do trabalho. O eixo significado do trabalho de gestão nos mostrou que, os gestores entrevistados têm vigorosamente interiorizadas as diretrizes da organização, por conta disto, seu trabalho é essencialmente centrado na tarefa. Há casos mais raros, nos quais o sentido do trabalho está ligado aos valores relativos à construção de identidade, reconhecimento e relacionamento interpessoal, além daqueles de dupla racionalidade, entretanto, entendemos que a racionalidade instrumental ainda se sobrepõe. Portanto, não causa espanto o aparecimento de inúmeras vivências relacionadas ao sofrimento no trabalho, visto a satisfação estar mais intimamente relacionada ao caráter subjetivo daquele. Dentre os achados mais relevantes neste estudo, consideramos a relação entre uma maior adesão à cultura do management, com estratégias defensivas mais efetivas, permitindo aos trabalhadores continuar trabalhando. Por outro lado, a baixa adesão a estes novos modelos satura as defesas, ocasionando mais vivências de sofrimento e, mesmo o risco de adoecimento. / This work aims to study the links between mental health and work, more specifically the banking dynamics pleasure-suffering occupying position of middle managers in a state bank, located in the state of Rio Grande do Sul, in different agencies, different cities. It is based on the importance of studying the experiences related to pleasure and suffering at work, as well as the significance of management work, as well as interest in investigating whether managers with different times in office perceive differently the pleasure and suffering work-related. This is because few studies have aimed to deepen knowledge about these middle managers. Our research is based on the theoretical and methodological assumptions of the Clinic for work psychodynamics. The qualitative method was used, carrying out semistructured individual interviews with middle managers. With regard to pleasure and pain sources in the work of these middle managers, our studies indicated that the experiences of pleasure can be related to satisfaction in solving customer problems. With regard to suffering, this was related to overcharging goals, considered unattainable, intensified by the existence of individual assessments, and these are objective, disregard effort employed to perform a task, which causes frustration. The excessive volume of service is also mentioned as causing discomfort, beyond the ethical suffering, that puts the worker in a moral dilemma, not knowing whether to meet the company designs, or customer needs. These factors that cause suffering, can often culminate in worker illness. The factors identified either as sources of suffering, either as sources of pleasure, were: recognition, sense of stability and quantofrenia. With regard to defensive strategies used by workers to keep yourself working, possible to detect been denial, rationalization, rethink the choice not to bring about reflection. We design all of them as defense strategies and health, aimed at protecting the mental health of the worker against decompensation, but do not change the organization of work. The axis meaning the management work has shown us that the managers interviewed, has strongly internalized the guidelines of the organization, because of this, his work is mainly focused on the task. There are rare cases in which the meaning of work is linked to values relating to the construction of identity, recognition and interpersonal skills in addition to those of dual rationality, however we understand that the instrumental rationality still overlaps. So do not astonishes the appearance of numerous experiences related to suffering at work, as the satisfaction be more closely related to the subjective nature of that. Among the most important findings in this study, we consider the relationship between greater adherence to the management culture with more effective defensive strategies allowing workers to continue working. On the other hand, the low adherence to these new models, saturate the defenses, causing more experiences of suffering, and even the risk of illness.

The diploma thesis is divided into a theoretical and a practical part. The first part describes the current state of the issue of informed consent in a general context and related topics. To obtain the data, I used the qualitative research, the method of questioning, and the data collection technique of a semi-structures interview. The research sample group consisted of 11 patients and two doctors. The objective of the thesis was to identify and describe the differences between the theory and the practice of informed consent in the hospital, and to find out whether there has been any shift in the mistakes and errors associated with informed consent as stated by Haškovcová (2007). The research results have shown that the interviewed patients are not familiar with the concept of informed consent. The knowledge of the informed consent concept was more accurate by doctors as presumed. On the issue of viewed benefits of informed consent, it is clear from respondents? answers that informed consent is viewed primarily as doctors? legal protection against any complaints or lawsuits made by the patients in the performance of their profession by making the patient familiar with any complications that may occur during the performance. This benefit is perceived by both patients and doctors. Doctors see its benefit also as the protection of patients. Another benefit viewed by doctors is the written informed consent form. Six of the interviewed patients stated that informed consent was submitted to them to sign by the nurse/male nurse without proper instructions. Furthermore, doctors? answers show that the timing of instructions depends on the nature of the surgery, whether it is planned or acute. However, some patients said that they were not even instructed with the sufficient time after giving informed consent even when related to a planned procedure. The most stated form was the combination of written and oral instructions, so the patient was first instructed orally and then he was also handed a detailed description of the particular procedure in the written form. There was no uniformity about the question of the amount of submitted information among the interviewed patients as well as doctors ? some of them prefer just basic information, some of them want to know all the information. One of the interviewed doctors favored just the adequate informed consent and saw the detailed informed consent as problematic, another doctor preferred introduction of all the details, although in the written form, mainly because of legal protection. In terms of quality of the provided information, it is clear from the statements of the patients that two most important facts for them are that the performance is in their benefit and the duration of hospitalization. All patients have agreed on the fact that it is very good that they are informed about the procedure which will be performed on them. However, they were not united regarding the issue of participation in the decision ? two patients stated that not even the properly informed patient should participate in the decision about their treatment. Only one doctor expressed his stance to the patient?s participation in the decision stating that he tries to persuade his patients that his proposed solution is the optimal. The standard for the patients is to ask questions when they are concerned about something or interested in it. However, the statements showed that they do not always get the answer they are satisfied with. When the patients stated that they do not ask their doctors about anything, their reasons were enough information, lack of staff and a feeling of unwillingness on the part of doctors. If the patients did not receive enough information from the medical staff, they looked for it in other sources of information. This thesis points to the broader psychosocial context of informed consent, so its results may help during the training of staff in the assisting professions.

O presente trabalho propôs a estudar as articulações entre saúde mental e trabalho, mais especificamente a dinâmica prazer-sofrimento bancário dos trabalhadores que ocupam cargo de gestores intermediários em um banco estatal, localizado no estado do Rio Grande do Sul, em agências diversas, de diferentes cidades. Fundamenta-se na importância de estudar as experiências relacionadas ao prazer e o sofrimento no trabalho, assim como, no significado do trabalho de gestão, além de interessar-se em investigar se gestores com tempos diferentes no cargo percebem de forma diferente o prazer e o sofrimento relacionado ao trabalho. Isto porque temos poucos estudos que visam aprofundar conhecimentos acerca destes gestores intermediários. Nossa pesquisa fundamenta-se nos pressupostos teóricos e metodológicos da Clínica em Psicodinâmica do Trabalho. O método qualitativo foi utilizado, realizando-se entrevistas individuais, semiestruturadas com gestores intermediários. Com relação as fontes de prazer e sofrimento no trabalho destes gestores intermediários, nossos estudos apontaram que as vivências de prazer podem ser relacionadas à satisfação em resolver os problemas dos clientes. No que diz respeito ao sofrimento, este foi relacionado a excessiva cobrança de metas, consideradas inatingíveis, intensificado pela existência de avaliações individuais, e estas, sendo objetivas, desconsideram esforço empregado para realizar uma tarefa, o que causa frustração. O volume de serviço excessivo também é mencionado como causador de desconforto, além do sofrimento ético, que coloca o trabalhador em um dilema moral, ao não saber se atende aos desígnios da empresa ou as necessidades dos clientes. Esses fatores que provocam sofrimento, muitas vezes, podem culminar no adoecimento do trabalhador. Os fatores identificados ora como fontes de sofrimento, ora como fontes de prazer, foram: o reconhecimento, a sensação de estabilidade e a quantofrenia. No que diz respeito as estratégias defensivas utilizadas pelos trabalhadores para manterem-se trabalhando, as possíveis de serem detectadas foram: a negação, a racionalização, repensar a escolha e não realizar a reflexão. Todas elas objetivam proteger a saúde mental do trabalhador contra a descompensação, porém não modificam a organização do trabalho. O eixo significado do trabalho de gestão nos mostrou que, os gestores entrevistados têm vigorosamente interiorizadas as diretrizes da organização, por conta disto, seu trabalho é essencialmente centrado na tarefa. Há casos mais raros, nos quais o sentido do trabalho está ligado aos valores relativos à construção de identidade, reconhecimento e relacionamento interpessoal, além daqueles de dupla racionalidade, entretanto, entendemos que a racionalidade instrumental ainda se sobrepõe. Portanto, não causa espanto o aparecimento de inúmeras vivências relacionadas ao sofrimento no trabalho, visto a satisfação estar mais intimamente relacionada ao caráter subjetivo daquele. Dentre os achados mais relevantes neste estudo, consideramos a relação entre uma maior adesão à cultura do management, com estratégias defensivas mais efetivas, permitindo aos trabalhadores continuar trabalhando. Por outro lado, a baixa adesão a estes novos modelos satura as defesas, ocasionando mais vivências de sofrimento e, mesmo o risco de adoecimento. / This work aims to study the links between mental health and work, more specifically the banking dynamics pleasure-suffering occupying position of middle managers in a state bank, located in the state of Rio Grande do Sul, in different agencies, different cities. It is based on the importance of studying the experiences related to pleasure and suffering at work, as well as the significance of management work, as well as interest in investigating whether managers with different times in office perceive differently the pleasure and suffering work-related. This is because few studies have aimed to deepen knowledge about these middle managers. Our research is based on the theoretical and methodological assumptions of the Clinic for work psychodynamics. The qualitative method was used, carrying out semistructured individual interviews with middle managers. With regard to pleasure and pain sources in the work of these middle managers, our studies indicated that the experiences of pleasure can be related to satisfaction in solving customer problems. With regard to suffering, this was related to overcharging goals, considered unattainable, intensified by the existence of individual assessments, and these are objective, disregard effort employed to perform a task, which causes frustration. The excessive volume of service is also mentioned as causing discomfort, beyond the ethical suffering, that puts the worker in a moral dilemma, not knowing whether to meet the company designs, or customer needs. These factors that cause suffering, can often culminate in worker illness. The factors identified either as sources of suffering, either as sources of pleasure, were: recognition, sense of stability and quantofrenia. With regard to defensive strategies used by workers to keep yourself working, possible to detect been denial, rationalization, rethink the choice not to bring about reflection. We design all of them as defense strategies and health, aimed at protecting the mental health of the worker against decompensation, but do not change the organization of work. The axis meaning the management work has shown us that the managers interviewed, has strongly internalized the guidelines of the organization, because of this, his work is mainly focused on the task. There are rare cases in which the meaning of work is linked to values relating to the construction of identity, recognition and interpersonal skills in addition to those of dual rationality, however we understand that the instrumental rationality still overlaps. So do not astonishes the appearance of numerous experiences related to suffering at work, as the satisfaction be more closely related to the subjective nature of that. Among the most important findings in this study, we consider the relationship between greater adherence to the management culture with more effective defensive strategies allowing workers to continue working. On the other hand, the low adherence to these new models, saturate the defenses, causing more experiences of suffering, and even the risk of illness.