Bakgrund   Antalet patienter på akutmottagningar ökar globalt och patientsäkerhet rapporteras vara ett problemområde i hela världen. Miljön på akutmottagningen kännetecknas av hög arbetsbelastning, få resurser och lite tid. Detta kan uppfattas som rörig och oförutsägbar för patienten, vilket kan innebära utmaningar i mötet mellan de två parterna. Ett gott bemötande främjar egenmakt och ökar självkänslan vilket är avgörande för hälsa och välbefinnande medan ett bristande bemötande kan innebära konsekvenser för patienten. Syfte Syftet var att belysa vuxna patienters upplevelser av bemötandet på somatisk akutmottagning. Metod En icke-systematisk litteraturöversikt med 15 vetenskapliga originalartiklar med kvalitativ, kvantitativ eller mixad metoddesign. Artiklarna samlades in via databaserna PubMed och CINAHL och har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Integrerad dataanalys användes för att sammanställa resultatet. Resultat Resultatet presenterades med två huvudkategorier: positiva upplevelser av bemötande och negativa upplevelser av bemötande. De positiva upplevelserna bestod av att bli informerad och vara delaktig, att bli respekterad och lyssnad på samt att bli behandlad som en egen person. De negativa upplevelserna bestod av upplevelser som att inte bli tagen på allvar, att känna sig bortglömd, att känna kontrollförlust och att uppleva bristande kommunikation. Slutsats Upplevelsen av bemötande påverkades av den vård som hälso- och sjukvårdspersonalen bedrev. De som blev bemötta utifrån ett personcentrerat förhållningssätt hade positiva upplevelser som att vården bedrevs utifrån den individuella personens resurser och behov samtidigt som de blev respekterade och lyssnade på. Vård som inte utgick från patientens behov och berättelse fick patienterna att känna sig bortglömda och att de inte blev tagna på allvar, samtidigt som en del upplevde maktlöshet, kontrollförlust och en känsla av sårbarhet. Denna föreliggande litteraturöversikt bidrar med kunskap och förståelse för hur patienterna upplever bemötandet på akutmottagningen. / Background The number of patients in emergency departments has increased globally and patient safety problems is reported worldwide. The emergency department is characterized by a high workload, few resources and little time, which can be perceived as chaotic and unpredictable. This can lead to challenges in the meeting between the two parties. Good care promotes empowerment and increases self-esteem, which is crucial for health and well-being, while poor care can have consequences for the patient.   Aim The aim of this study was to illuminate adult patients’ experiences of care at the emergency department.  Method A non-systematic literature review with 15 original scientific articles with a qualitative, quantitative or mixed method design was conducted. The articles were collected via the databases PubMed and CINAHL and have been quality checked based on Sophiahemmet University´s assessment tool for scientific classification and quality. Integrated data analysis was used to compile the results. Results The results were presented with two main categories: positive experiences of care and negative experiences of care. The positive experiences consisted of being informed and participating, being respected, and listened to, and being treated as an individual. The negative experiences consisted of not being taken seriously, feeling forgotten, loss of control and lack of communication. Conclusions The experience of care was influenced by the care provided by the health care staff. Those who were treated with a person-centered approach had positive experiences such as care based on the individual person's needs while being respected and listened to. Care that was not based on the patient's needs made them feel forgotten and not taken seriously, while some experienced powerlessness, lack of control and a sense of vulnerability. This literature review contributes knowledge of how patients experience the care at the emergency department.

Bakgrund  Sedan sjukdomens uppkomst har 40,1 miljoner människor mist sitt liv till följd av HIV; en kronisk virusinfektion som i obehandlat tillstånd kan vara livshotande. Adekvat behandling kan leda till ett normalt liv med omätbara virusnivåer, god vård och god behandling är således livsviktigt. Att belysa hur personer med HIV upplever vårdmöten med vårdpersonal är väsentligt för att erhålla kunskap om hur vårdpersonal skall förhålla sig i mötet. Vårdmöten av hög kvalitet med ett personcentrerat förhållningssätt kan leda till ökad medicinsk följsamhet, ett ökat välbefinnande och ökad livskvalitet för personer med HIV.  Syfte  Syftet var att belysa hur patienter med HIV upplever möten med vårdpersonal inom vården.  Metod  En icke-systematisk litteraturöversikt genomfördes baserad på 16 vetenskapliga originalartiklar av både kvantitativ och kvalitativ ansats. Data inhämtades från databaserna PubMed och CINAHL. Artiklarna kvalitetsgranskades  Resultat  Resultatet sammanställdes i fyra huvudkategorier: Upplevelser av stigmatisering och diskriminering, upplevelser av kommunikation, upplevelser av relationen mellan patient och vårdpersonal samt upplevelser av bemötande. Upplevelser av respekt och tillit visades vara det mest centrala för att uppnå en relation med vårdpersonal samt för att uppleva en god kommunikation och ett gott bemötande. Fördomar, förutfattade meningar och diskriminerande handlingar visade sig utgöra ett hinder för detta.  Slutsats  Denna litteraturöversikt visade att patientupplevelser av vårdmöten var komplexa. Upplevelser som skildrades i resultatet visade att patienter som kände sig sedda som personer utöver sin sjukdom, blev behandlade med respekt eller kände tillit till personalen upplevde vårdmöten som positiva. Resultatet visade även upplevelser som utgjorde hinder för ett positivt vårdmöte. Ökad förståelse om patienters upplevelser kan ge värdefulla insikter gällande hur vårdpersonalen genom ett professionellt och personcentrerat förhållningssätt kan bidra till upplevelser av positiva vårdmöten. / Background  HIV is a chronic viral infection that can be life-threatening if not treated. Since the emerge of the disease 40,1 million people have deceased. Thus, adequate treatment is vital. Illustrating patient experiences of encounters with healthcare professionals is important to gain knowledge about actions and attitudes that contribute to positive experiences. Encounters of high quality, with a person-centered approach can lead to increased medical compliance, wellbeing and a greater life quality for people with HIV.  Aim  The aim of this literature review was to illustrate how patients with HIV experience encounters with health care professionals within health care settings.  Method  A non-systematic literature review was carried out, with data collected from 16 original scientific articles of both quantitative and qualitative approaches. The data was obtained from the databases PubMed and CINAHL. The articles were quality-reviewed based on Sophiahemmet University's assessment basis for scientific classification. The results from the articles were categorized, collated, and analyzed using an integrated data analysis.  Results  The results were compiled into four main categories: Experiences of stigmatization and discrimination, experiences of communication, experiences of the relationship between patient and health care professionals and experiences of treatment. Experiences of respect and trust were shown to be the most central in encounters to achieve a relationship with healthcare professionals with communication and treatment of good quality. Prejudice, preconceptions, and discriminatory actions proved to be obstacles of positive experiences.  Conclusions  This literature review showed that patient experiences of healthcare encounters were complex. Experiences in the results suggested that patients who felt seen as individuals beyond their illness, were treated with respect and trusted health care professionals had positive experiences. Improved understanding of patients' experiences can provide valuable insights of how healthcare professionals, through a professional and person-centered approach, can contribute to positive experiences of healthcare encounters.

Objective: Research on the association of empathy and burnout within professional health care workers has shown that the work is posing a risk for burnout. Empathy and compassion abilities are essential to understand others and when working with caring for others. Research from social neuroscience and psychology has forwarded findings indicating the risk of a negative side of empathy – empathic distress being associated with ill health such as burnout. Contrary, compassion has been shown to be associated with health benefits. Research integrating knowledge from social neuroscience and psychology is needed to inform evidence-based health promotion in the workplace arena. Aim: The aim is to investigate if empathic distress among professional health care workers is associated with burnout, and if compassion has a buffering effect on burnout. Design: A cross-sectional, within-group survey study is employed, using a quantitative explorative approach. 105 participants identified as professional health care workers was included. The bio-psychosocial model was used as a theoretical analysing tool. Results: Results showed a significant positive association between empathic distress and client-related burnout. Compassion was found to be negatively associated with client-related burnout, however, not significant. Multiple regression analysis showed no significant effect of empathic distress, compassion or theory of mind to predict burnout. Conclusion: Empathic distress was found to be significantly associated with client-related burnout. The study integrated social neuroscience and psychology theories, which can inform health promotion programs within social workplace settings especially for a vulnerable group in risk of burnout such as professional health care workers.

Bakgrund: Diabetes typ 2 är en kronisk folkhälsosjukdom som beror på att upptaget av insulin i kroppsvävnaden är nedsatt. Diabetes typ 2 kan medföra många komplikationer, både akuta och sena. Det finns många faktorer som ökar risken för sjukdomen, bland annat livsstilsfaktorer. Fysisk inaktivitet och ohälsosam mat är exempel på livsstilsfaktorer som ökar risken för att bli drabbad av sjukdomen. Syfte: Syftet med denna litteraturöversikt var att beskriva patienters upplevelse av livsstilsförändringar vid diabetes typ 2. Metod: Litteraturöversikt där tio vetenskapliga artiklar analyserats från databaserna PubMed och Cinahl Complet, med utgångspunkt från Fribergs analysmodell. Resultat: Resultatet presenteras i fem teman: Att bli diagnostiserad med diabetes typ 2, vårdpersonalens bemötande och betydelse för livsstilsförändringar, förändrade kostvanor, motivationens betydelse för att genomföra livsstilsförändring samt känslor vid livsstilsförändringar. Dessa teman presenteras i resultat delen. Sammanfattning: Många patienter är i behov av stöd och motivation för att kunna genomgå livsstilsförändringar. Vårdpersonal behöver en ökad kunskap kring hur de ska kunna arbeta motivationsfrämjande och personcentrerat för att stödja patienter som behöver genomgå livsstilsförändringar vid diabetes typ 2. / Background: Diabetes type 2 is a chronic public health disease caused by the low absorption of insulin in the body tissue. Diabetes type 2 can bring many complications, both acute and late complications. There are many factors that increase the risk of the disease, for instance lifestyle factors. Physical inactivity and unhealthy food are examples of lifestyle factors that increase the risk of being affected by the disease. Aim: The aim with this literature review was to describe patients experiences of lifestyle changes when living with diabetes type 2. Method: Literature overview where ten scientific articles were analyzed from the databases PubMed and Cinahl Complet, based on Friberg's analysis model. Results: The results are presented in five themes: Being diagnosed with diabetes type 2, the treatment of the healthcare staff and the importance of lifestyle changes, changed dietary habits, the importance of motivation for implementing lifestyle changes and emotions during lifestyle changes. These themes are presented in the results section. Summary: Many patients are in need of support and motivation to be able to undergo lifestyle changes. Health care professionals need increased knowledge about how they could work in a motivational and person-centered way to support patients who need a lifestyle change in type 2 diabetes.

No description available.

Transition into adulthood has been regarded as a priority in health. However, there is scarcity of literature on the transition of adolescents with intellectual disability. The purpose of this study was to develop a strategy for transition of adolescents with intellectual disabilities into adulthood based on the Transition Theory proposed by Meleis, Sawyer, Im, Hilfinger and Schumacher (2000). The research objectives of this study were in three phases: Phase I: Desk review  To explore the known factors about the transition process of adolescents with IDs into adulthood.  To identify gaps in literature on the transition of adolescents with intellectual disabilities’ transition into adulthood. Phase II: Mixed method  To explore and describe the experiences of caregivers and health care professionals on the transition of adolescents with IDs into adulthood.  To investigate challenges that hamper the transition process of adolescents with IDs into adulthood. Phase III: Development of strategy  To develop a strategy for transition of adolescents with IDs into adulthood informed by findings from phases I and II. A sequential exploratory mixed method approach was used. A purposive, snowballing and simple random sampling were used to select participants for this study. The study was conducted in Special schools, Non-Governmental Organisations and Care and Rehabilitation Centres based in Gauteng province of South Africa. Triangulation of data sources and data collection methods was used to sample one hundred and forty nine (149) participants aged 21-60+ years who experienced caring for individuals with intellectual disabilities. Interpretative analysis proposed by Terrablanche. Durrheim and Kelly (2006) was used for qualitative data limited to a sample of n=29 participants. Quantitative data was analysed by use of IBM Statistical Package of Social Sciences (SPSS: 24) with a blend of descriptive and inferential statistics limited to a sample of n=120. Five themes from both qualitative and quantitative results emerged that is, transition possibility; the role of different stakeholders; the provision and development of working skills; caregivers’ knowledge and understanding of guidelines and alterations to adapt to change. The development of the transition strategy bridged a significant gap that informs nurses, teachers, parents, policy-makers and other stakeholders in supporting transition of adolescents with intellectual disabilities into adulthood. / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2011-05-04T12:36:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Este trabalho tem como objetivo analisar as percepções de profissionais de saúde do município de Mesquita acerca da humanização em termos de mudanças em suas práticas de trabalho e de interação entre profissionais e usuários. Empregou-se neste estudo a abordagem qualitativa, com base em entrevistas de 15 profissionais de um hospital, campo eleito pelo fato de se tratar de um espaço historicamente investido de iniciativas que tentam promover a humanização da saúde. Como procedimentos metodológicos, foram utilizadas entrevistas semiestruturadas e observação participante para a coleta de dados e a técnica de análise de conteúdo do material coletado. Dentre os apontamentos deste trabalho estão a constatação de que a maioria dos profissionais de saúde não demonstrou deter grande conhecimento acerca das propostas de humanização. E que, muitas vezes, estas últimas são confundidas com acolhimento. Ficou evidente que a humanização para a grande maioria dos profissionais entrevistados é entendida como algo que depende da atuação do profissional e encontra-se altamente direcionado ao usuário. E ainda, que as ações pontuais e isoladas de outras estratégias assumem um caráter necessário, mas não suficiente à promoção da humanização. Este trabalho mostrou, a partir das percepções dos profissionais de saúde, que o ideal recomendado pelas propostas do Ministério da Saúde não se encontra bem estruturado no real do campo estudado. Evidenciou também que há a necessidade de implementar dispositivos conjuntos para a efetivação da humanização, assim como fortalecimento das iniciativas em vigência, principalmente quanto à continuidade e sustentabilidade, para que estas não percam suas forças e seextenuem. Este trabalho se encerra com a convicção de que o debate destas questões é de grande importância, já que tem repercussões diretas na qualidade do atendimento, das condições de trabalho e da dinâmica relacional em saúde. / This paper aims to examine the perceptions of health professionals in the city of Mesquita on humanization in terms of changes in their working practices and the interaction between professionals and users. Employed in this study a qualitative approach, based on interviews of 15 professionals in a hospital, field elected because this is an area that historically have been investing in initiatives that seek to promote the humanization of health care. As methodological procedures were used semi-structured interviews and participative observation to collect data and the technique of content analysis of material collected. The majority of health professionals have not hold much knowledge about the proposals for humanization. The concept if frequently confused with receptiveness. It was evident that the humanization is, to the vast majority of professionals interviewed, is perceived as something that depends on the performance of the professional and is highly targeted to the user. And also, that the stock off and isolated from other strategies take on a character necessary but not sufficient to promote the humanization. This study showed from the perceptions of health professionals, that the ideal proposed by the Ministry of Health is not well structured in the real field of study. Showed that there is a need to implement combined strategies for the comprehensive achievement of humanization, as well as strengthening the initiatives in place, mainly concerning continuity and sustainability, in order not to lose their power, leaking away. This paper concludes with the conviction that the discussion of these issues is of great importance, as it has direct impact on quality of care, working conditions and the dynamic relational health.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Os profissionais da área da saúde formam um dos grupos mais vulneráveis à infecção pelo Mycobacterium tuberculosis (Mtb). Segundo estimativas da Organização Mundial de Saúde (OMS), 8,8 milhões de pessoas estavam infectadas pelo Mtb e ocorreram 1,4 milhão de óbitos por tuberculose (TB) em 2010. A identificação de pessoas com Infecção Latente Tuberculosa (ILTB) é considerada pela OMS como uma prioridade no controle da doença, especialmente em países em desenvolvimento em que a incidência da doença ativa tem apresentado redução. O objetivo do presente trabalho foi avaliar, no Brasil, o custo-efetividade dos testes Prova Tuberculínica (PT) e Quantiferon TB Gold-In-Tube (QTF-GIT) no diagnóstico e tratamento da ILTB em profissionais de saúde atuantes na atenção básica, sob a perspectiva do Sistema Único de Saúde (SUS), comparando cinco estratégias que incluem o QTF-GIT, distintos pontos de corte para a PT e uso sequencial dos dois testes; e analisar o impacto do tabagismo sobre o risco de ILTB entre os profissionais de saúde, destacando-se a categoria da Enfermagem. Foi realizada uma avaliação econômica completa do tipo custo-efetividade, conduzida considerando uma coorte hipotética de 10.000 profissionais de saúde atuantes na atenção básica, com horizonte temporal restrito a um ano. Um modelo analítico de decisão, caracterizado por uma árvore de probabilidades de eventos, foi desenvolvido utilizando o software TreeAge ProTM 2013 para simular os resultados clínicos e impactos econômicos em saúde da nova tecnologia diagnóstica (QTF-GIT) versus a PT tradicional. Esse modelo simulou cinco estratégias diagnósticas para detecção e tratamento da ILTB: (a) PT, usando ponto de corte de 5mm; (b) PT, usando ponto de corte de 10 mm; (c) teste QTF-GIT; (d) PT, com ponto de corte de 5mm, seguida de teste QTF-GIT quando PT positiva; (e) PT, com ponto de corte de 10mm, seguida de teste QTF-GIT quando PT positiva. Foi realizada análise de sensibilidade determinística univariada. Na determinação dos fatores associados à ILTB, foi elaborado um modelo de regressão logística múltipla com seleção hierarquizada, utilizando o software Stata. A estratégia mais custo-efetiva foi a PT no ponto de corte ≥10mm, considerando como medida de desfecho tanto o número de indivíduos corretamente classificados pelos testes assim como o número de casos de TB evitados. A utilização isolada do QTF-GIT revelou-se a estratégia de menor eficiência, com RCEI= R$ 343,24 por profissional corretamente classificado pelo teste. Encontrou-se risco à ILTB significantemente maior para sexo masculino [OR=1,89; IC 95%:1,11-3,20], idade ≥ 41 anos [OR=1,56; IC 95%: 1.09-2,22], contato próximo com familiar com TB [OR=1,55; IC 95%: 1.02-2,36], status do tabagismo fumante [OR=1,75; IC 95%: 1.03-2,98] e categoria profissional da Enfermagem [OR=1,44; IC 95%: 1.02-2,03]. Concluiu-se que a PT no ponto de corte de 10mm é a estratégia diagnóstica mais custo-efetiva para ILTB entre os profissionais de saúde na atenção básica e que a ILTB está associada ao hábito do tabagismo e à categoria profissional de Enfermagem. / Health professionals form one of the groups most vulnerable to infection by Mycobacterium tuberculosis (Mtb). According to estimates by the World Health Organization (WHO), 8.8 million people were infected with Mtb and were 1.4 million deaths from TB in 2010. The identification of persons with Latent Tuberculosis Infection (LTBI) is considered by WHO as a priority in the control of disease, especially in developing countries where the incidence of active disease has shown reduction. The aim of this study was to evaluate, in Brazil, the cost-effectiveness of tests Tuberculin Skin Test (TST) and Quantiferon TB Gold-In-Tube (QFT-GIT) in the diagnosis and treatment of LTBI in health professionals working in primary care from the perspective of SUS, comparing five strategies that include the QFT -GIT, different cutoff points for TST and sequential use of two tests; and analyze the impact of smoking on the risk of LTBI among health professionals, highlighting the category of Nursing. A full economic assessment of the type cost-effectiveness was performed, conducted considering a hypothetical cohort of 10,000 health professionals working in primary care, with limited time horizont of one year. A decision analytical model, characterized by a tree of probabilities of events, was developed using the TreeAge ProTM software 2013 (TreeAge Software Inc, Williamstown, MA, USA) to simulate the clinical and economic impacts on health of new diagnostic technology (QFT -GIT) versus the traditional TST. This model simulated five diagnostic strategies for detection and treatment of LTBI (a) TST, using a cut-off of 5 mm; (B) TST, using 10 mm cut-off currently recommended by the TNP; (C) QFT-GIT test; (D) TST, with a cut-off of 5 mm, followed by QFT-GIT test when positive TST; (E) TST, with a cut-off point of 10 mm, followed by QFT-GIT test when positive TST. Univariate deterministic sensitivity analysis was performed to assess the robustness of the results. In determining the factors associated with LTBI, a multiple logistic regression model with hierarchical selection was made, using the Stata software. TST strategy at the cut-off ≥ 10mm was the most cost-effective strategy, while the QFT-GIT alone was the most effective strategy, but showed higher cost. It was found to significantly greater risk for LTBI male [OR = 1.89; 95% CI: 1.11 to 3.20], age ≥ 41 years [OR = 1.56; 95% CI: 1.09-2,22], close contact with a family with TB [OR = 1.55; 95% CI: 1.02-2,36], the smoker smoking status [OR = 1.75; 95% CI: 1.03-2,98] and professional nursing category [OR = 1.44; 95% CI: 1.02-2,03]. It was concluded that TST in 10mm cut-off is the diagnostic strategy more cost-effective for LTBI among health professionals in primary care and that LTBI is associated with the smoke and professional category nurse.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Os profissionais da área da saúde formam um dos grupos mais vulneráveis à infecção pelo Mycobacterium tuberculosis (Mtb). Segundo estimativas da Organização Mundial de Saúde (OMS), 8,8 milhões de pessoas estavam infectadas pelo Mtb e ocorreram 1,4 milhão de óbitos por tuberculose (TB) em 2010. A identificação de pessoas com Infecção Latente Tuberculosa (ILTB) é considerada pela OMS como uma prioridade no controle da doença, especialmente em países em desenvolvimento em que a incidência da doença ativa tem apresentado redução. O objetivo do presente trabalho foi avaliar, no Brasil, o custo-efetividade dos testes Prova Tuberculínica (PT) e Quantiferon TB Gold-In-Tube (QTF-GIT) no diagnóstico e tratamento da ILTB em profissionais de saúde atuantes na atenção básica, sob a perspectiva do Sistema Único de Saúde (SUS), comparando cinco estratégias que incluem o QTF-GIT, distintos pontos de corte para a PT e uso sequencial dos dois testes; e analisar o impacto do tabagismo sobre o risco de ILTB entre os profissionais de saúde, destacando-se a categoria da Enfermagem. Foi realizada uma avaliação econômica completa do tipo custo-efetividade, conduzida considerando uma coorte hipotética de 10.000 profissionais de saúde atuantes na atenção básica, com horizonte temporal restrito a um ano. Um modelo analítico de decisão, caracterizado por uma árvore de probabilidades de eventos, foi desenvolvido utilizando o software TreeAge ProTM 2013 para simular os resultados clínicos e impactos econômicos em saúde da nova tecnologia diagnóstica (QTF-GIT) versus a PT tradicional. Esse modelo simulou cinco estratégias diagnósticas para detecção e tratamento da ILTB: (a) PT, usando ponto de corte de 5mm; (b) PT, usando ponto de corte de 10 mm; (c) teste QTF-GIT; (d) PT, com ponto de corte de 5mm, seguida de teste QTF-GIT quando PT positiva; (e) PT, com ponto de corte de 10mm, seguida de teste QTF-GIT quando PT positiva. Foi realizada análise de sensibilidade determinística univariada. Na determinação dos fatores associados à ILTB, foi elaborado um modelo de regressão logística múltipla com seleção hierarquizada, utilizando o software Stata. A estratégia mais custo-efetiva foi a PT no ponto de corte ≥10mm, considerando como medida de desfecho tanto o número de indivíduos corretamente classificados pelos testes assim como o número de casos de TB evitados. A utilização isolada do QTF-GIT revelou-se a estratégia de menor eficiência, com RCEI= R$ 343,24 por profissional corretamente classificado pelo teste. Encontrou-se risco à ILTB significantemente maior para sexo masculino [OR=1,89; IC 95%:1,11-3,20], idade ≥ 41 anos [OR=1,56; IC 95%: 1.09-2,22], contato próximo com familiar com TB [OR=1,55; IC 95%: 1.02-2,36], status do tabagismo fumante [OR=1,75; IC 95%: 1.03-2,98] e categoria profissional da Enfermagem [OR=1,44; IC 95%: 1.02-2,03]. Concluiu-se que a PT no ponto de corte de 10mm é a estratégia diagnóstica mais custo-efetiva para ILTB entre os profissionais de saúde na atenção básica e que a ILTB está associada ao hábito do tabagismo e à categoria profissional de Enfermagem. / Health professionals form one of the groups most vulnerable to infection by Mycobacterium tuberculosis (Mtb). According to estimates by the World Health Organization (WHO), 8.8 million people were infected with Mtb and were 1.4 million deaths from TB in 2010. The identification of persons with Latent Tuberculosis Infection (LTBI) is considered by WHO as a priority in the control of disease, especially in developing countries where the incidence of active disease has shown reduction. The aim of this study was to evaluate, in Brazil, the cost-effectiveness of tests Tuberculin Skin Test (TST) and Quantiferon TB Gold-In-Tube (QFT-GIT) in the diagnosis and treatment of LTBI in health professionals working in primary care from the perspective of SUS, comparing five strategies that include the QFT -GIT, different cutoff points for TST and sequential use of two tests; and analyze the impact of smoking on the risk of LTBI among health professionals, highlighting the category of Nursing. A full economic assessment of the type cost-effectiveness was performed, conducted considering a hypothetical cohort of 10,000 health professionals working in primary care, with limited time horizont of one year. A decision analytical model, characterized by a tree of probabilities of events, was developed using the TreeAge ProTM software 2013 (TreeAge Software Inc, Williamstown, MA, USA) to simulate the clinical and economic impacts on health of new diagnostic technology (QFT -GIT) versus the traditional TST. This model simulated five diagnostic strategies for detection and treatment of LTBI (a) TST, using a cut-off of 5 mm; (B) TST, using 10 mm cut-off currently recommended by the TNP; (C) QFT-GIT test; (D) TST, with a cut-off of 5 mm, followed by QFT-GIT test when positive TST; (E) TST, with a cut-off point of 10 mm, followed by QFT-GIT test when positive TST. Univariate deterministic sensitivity analysis was performed to assess the robustness of the results. In determining the factors associated with LTBI, a multiple logistic regression model with hierarchical selection was made, using the Stata software. TST strategy at the cut-off ≥ 10mm was the most cost-effective strategy, while the QFT-GIT alone was the most effective strategy, but showed higher cost. It was found to significantly greater risk for LTBI male [OR = 1.89; 95% CI: 1.11 to 3.20], age ≥ 41 years [OR = 1.56; 95% CI: 1.09-2,22], close contact with a family with TB [OR = 1.55; 95% CI: 1.02-2,36], the smoker smoking status [OR = 1.75; 95% CI: 1.03-2,98] and professional nursing category [OR = 1.44; 95% CI: 1.02-2,03]. It was concluded that TST in 10mm cut-off is the diagnostic strategy more cost-effective for LTBI among health professionals in primary care and that LTBI is associated with the smoke and professional category nurse.

Våld mot kvinnor i nära relation är ett globalt folkhälsoproblem vilket kränker de mänskliga rättigheterna hos den våldsutsatta kvinnan. Det är av stor vikt att hälso- och sjukvårdspersonal inom primärvården upptäcker dessa kvinnor för att tidigt kunna ingripa, omhänderta och stödja dem. Syftet med denna studie var att beskriva kvinnors upplevelse av mötet med hälso- och sjukvårdspersonal i primärvården efter att ha blivit utsatt för våld i nära relation. Denna studie är en kvalitativ deskriptiv studie där data samlats in med semistrukturerade intervjuer med totalt nio stycken kvinnor. Analysen utfördes med en kvalitativ innehållsanalys och resulterade i fyra stycken kategorier. Resultatet visade att hälso- och sjukvårdspersonal måste våga ställa frågan om våld och ta sig tid för kvinnorna samt ge vidare stöd och uppföljning. Det framkom hur avgörande relationen och förtroendet är till hälso- och sjukvårdspersonalen för om kvinnor ska våga berätta och söka hjälp.