<p><p>Sammanfattning</p><p>Syfte och frågeställningar</p><p>Syftet med denna studie var att undersöka förekomsten av olyckor hos vuxna ridskoleryttare. Frågeställningarna var: Hur stor har förekomsten av olyckor varit hos vuxna ridskoleryttare under de senaste 5 åren? Hur stor har förekomsten av olyckor varit i samband med hantering av häst i förhållande till olyckor relaterade till fall från häst?</p><p>Vilka typer av skador är mest förekommande?</p><p>Vilka typer av olyckor är beroende på ålder, kön och ridvana?Metod</p><p>Studien genomfördes kvantitativt med enkäter som delades ut till vuxna på tre olika ridskolor i Stockholms län. 100 enkäter besvarades och kodades i Excel, dessa analyserades sedan med hjälp av statistikprogrammet SPSS.Resultat</p><p>Resultatet i denna studie visar på att 68 % av ryttarna inte varit med om en olycka medan</p><p>32 % varit med om en eller fler. 79 % av olyckorna inträffar då ryttaren ramlar av och de skador som är vanligast är hjärnskakning och mindre frakturer på revben och fingrar. Endast 21 % av olyckorna som skett var då ryttaren hanterat hästen. De flesta skador som uppkommer vid dessa tillfällen är sårskador då de blivit bitna av hästen samt frakturer och knäskador då ryttaren blivit sparkad. Påverkansfaktorer gällande förekomsten av olyckor var framförallt vilken ridvana ryttaren hade, ju längre denna ridit desto större risk. Även lektionens innehåll spelade roll, där hoppning och ridning i naturen visade sig inneha den största olycksfrekvensen.Slutsats</p><p>Förekomsten av olyckor i denna studie visade sig bero framförallt av hur länge ryttaren ridit på ridskola. Ridvana visade sig vara statistiskt signifikant även då man tagit hänsyn till andra störningsfaktorer. Ju längre ryttaren ridit desto större olycksrisk, sannolikt beror detta antagligen på svårare moment i ridningen. Även om skador sker i stallet så är det betydligt större risk att råka ut för en olycka vid ridning och då framförallt vid hoppning eller ridning i skogen.</p></p>

Sammanfattning Syfte och frågeställningar Syftet med denna studie var att undersöka förekomsten av olyckor hos vuxna ridskoleryttare. Frågeställningarna var: Hur stor har förekomsten av olyckor varit hos vuxna ridskoleryttare under de senaste 5 åren? Hur stor har förekomsten av olyckor varit i samband med hantering av häst i förhållande till olyckor relaterade till fall från häst? Vilka typer av skador är mest förekommande? Vilka typer av olyckor är beroende på ålder, kön och ridvana?Metod Studien genomfördes kvantitativt med enkäter som delades ut till vuxna på tre olika ridskolor i Stockholms län. 100 enkäter besvarades och kodades i Excel, dessa analyserades sedan med hjälp av statistikprogrammet SPSS.Resultat Resultatet i denna studie visar på att 68 % av ryttarna inte varit med om en olycka medan 32 % varit med om en eller fler. 79 % av olyckorna inträffar då ryttaren ramlar av och de skador som är vanligast är hjärnskakning och mindre frakturer på revben och fingrar. Endast 21 % av olyckorna som skett var då ryttaren hanterat hästen. De flesta skador som uppkommer vid dessa tillfällen är sårskador då de blivit bitna av hästen samt frakturer och knäskador då ryttaren blivit sparkad. Påverkansfaktorer gällande förekomsten av olyckor var framförallt vilken ridvana ryttaren hade, ju längre denna ridit desto större risk. Även lektionens innehåll spelade roll, där hoppning och ridning i naturen visade sig inneha den största olycksfrekvensen.Slutsats Förekomsten av olyckor i denna studie visade sig bero framförallt av hur länge ryttaren ridit på ridskola. Ridvana visade sig vara statistiskt signifikant även då man tagit hänsyn till andra störningsfaktorer. Ju längre ryttaren ridit desto större olycksrisk, sannolikt beror detta antagligen på svårare moment i ridningen. Även om skador sker i stallet så är det betydligt större risk att råka ut för en olycka vid ridning och då framförallt vid hoppning eller ridning i skogen.

<p><strong>BAKGRUND:</strong> Sömn är ett regelbundet återkommande tillstånd som är livsnödvändigt för att kroppen skall återhämta sig på ett korrekt vis. Personer med insomni och sömnapné är två patientgrupper som lider utav långvariga sömnproblem. Orsakerna till den dåliga sömnen kan vara många, och därför är det viktigt för sjuksköterskan att vara lyhörd och kunna stötta patienterna med hjälp av sina kunskaper gällande de åtgärder och behandlingar som finns att använda sig av.</p><p><strong>SYFTE:</strong> Syftet med denna litteraturöversikt var att belysa vilka åtgärder sjuksköterskan kan tillämpa för att stödja patienter med långvariga sömnproblem.</p><p><strong>METOD:</strong> En litteraturöversikt där 13 vetenskapliga artiklar granskades och analyserades. Fribergs (2006) modell för litteraturöversikter användes vid datainsamling och analysförfarande.</p><p><strong>RESULTAT:</strong> Fyra kategorier framkom ur analysen av de vetenskapliga artiklarna: <em>egenvård, akupunktur, kognitiv beteendeterapi, </em>och <em>stödprogram.</em> Dessa kategorier gör det möjligt för sjuksköterskan att tillämpa stöd till patienterna. Hos patienter med långvariga sömnproblem har de stödjande åtgärderna visat sig ge ökad sömn- och livskvalitet. <em></em></p><p><strong>SLUTSATS: </strong>Forskningen kring de långvariga sömnproblemen har ökat under de senaste åren men trots det finns det bristande kunskap om hur sjuksköterskan kan ge de behandlingar och det stödet som patienterna med insomni och sömnapné behöver.</p> / <p><strong>BACKGROUND:</strong> Sleep is a periodic state which is essential for the body to recover in a proper manner. Insomnia and people with sleep apnea are two groups of patients out of long-term sleep problems. There are many causes of poor sleep, and that’s why there are so important for the nurse to be sensitive and support patients through their knowledge concerning the actions and processes that exist to use.</p><p><strong>AIM:</strong> The purpose of this literature review was to illustrate which measures nurse can apply to support patients with long-term sleep problems.</p><p><strong>METHOD:</strong> A literature overview, including 13 reviewed and analyzed articles. Fribergs (2006) model for literature overview were used in data collection and analysis procedure.</p><p><strong>RESULT:</strong> Four categories emerged from the analysis of the articles: <em>self-care, acupuncture, cognitive behavioral therapy, </em>and<em> support program</em>. These categories make it enable for the nurse to apply support to patients who suffer out of prolonged sleeping problem. Patients perceive that both their sleep and quality of life improves with the help of different treatments.</p><p><strong>CONCLUSION:</strong> Research into long-term sleep problems has increased in recent years. Despite this, there is a lack of knowledge about how nurse can provide treatment and support for patients with insomnia and sleep apnea.</p>

Bakgrund: Anställdas hälsa, individuella beteenden i ett organisatoriskt sammanhang och upplevd organisatorisk rättvisa är teoretiskt förenade av social utbytesteori, copingteori och teorier som beskriver konsekvenserna av social ojämlikhet. Empiriskt är förhållandet mer oklart. De få studier som hitintills har granskat relationen mellan organisatoriskt beteende och rättvisa visar på ett samband mellan hög grad av upplevd rättvisa och konstruktiva beteenden och mellan låg grad av upplevd rättvisa och destruktiva beteenden. Flera tidigare studier har visat på ett samband mellan organisatorisk rättvisa och hög hälsa och låg grad av utbrändhet. Relationen mellan organisatoriskt beteende, särskilt rörlighet mellan olika arbetsplatser, och hälsa är överhuvudtaget inte studerat i någon större omfattning och denna relation är i stort sett okänd. Syfte: Det övergripande syftet med föreliggande avhandling är att studera sambandet mellan organisatorisk rättvisa, individuellt organisatorisk beteende och hälsa. Metod: De ingående delstudierna i föreliggande avhandling ingår i en longitudinell panelstudie med tre olika datainsamlingstillfällen. Ett frågeformulär sändes ut till samtliga anställda, även de som hade slutat eller gått i pension under studietiden, i Arbetsmarknadsverket, AMV, i tre mellan svenska län 2001 (N=1010, svarsfrekvens: 78%), 2002 (N=1078, svarsfrekvens 75%) samt 2003 (N=1122, svarsfrekvens 74%). I delstudie I, en tvärsnitts och longitudinell valideringsstudie, användes variansanalys, ”multi-trait/multi-item”, logistisk regressionsanalys samt olika former av faktoranalys för att validera och utvärdera ett instrument (Hagedoorn m fl., 1999) avsett för att skatta individuella beteenden i ett organisatoriskt sammanhang. I delstudie II, en longitudinell panelstudie, användes korrelationsanalys och strukturell ekvationsmodellering, SEM, för att studera den reciproka relationen mellan individuella organisatoriska beteenden och hälsa. I delstudie III, en longitudinell panelstudie, användes faktor-, korrelations- och SEM-analyser för att belysa sambandet mellan upplevd organisatorisk rättvisa, hälsa och utbrändhet. I delstudie IV, en longitudinell panelstudie, användes varians och generell linjär modellering, GLM, ”repeated measures” analyser för att belysa sambandet mellan önskan att byta arbetsplats, faktiskt byte av arbetsplats, hälsa och utbrändhet. I delstudie V, en longitudinell panelstudie, användes varians-, korrelations- och SEM-analyser för att studera det reciproka sambandet mellan hälsa, utbrändhet och byte av arbetsplats. Resultat: Resultatet av delstudie I visade att Hagedoorn m.fl. (1999) instrument kan anses ha godkända psykometriska egenskaper, bortsett från delskalan ”aggressive voice” som uppvisade flera uppenbara svagheter. Delstudie II visade att relationen mellan individuella organisatoriska beteenden och hälsa framförallt är ensidigt: beteendet predicerar hälsan. Typbeteendet ”exit” predicerade sämre hälsa efter två år, medan typbeteendet ”considerate voice” predicerade bättre hälsa efter två år. Slutligen predicerade god fysisk hälsa typbeteendet ”exit” efter två år. Resultatet av Delstudie III visade att upplevd organisatorisk rättvisa är relaterat till god hälsa och låg grad av utbrändhet, både vid en tvärsnitts- och longitudinell jämförelse. De två olika sätten att studera organisatorisk rättvisa, antingen som ett globalt eller tredelat begrepp, bör betraktas som komplementära. I delstudie IV visade sig extern rörlighet, d.v.s. mellan olika arbetsplatser, i jämförelse med icke-rörlighet, har en gynnsam effekt på personlig och arbetsrelaterad utbrändhet. Resultatet visade också att samspelet mellan en önskan att byta arbetsplats och att faktiskt genomföra ett byte snarare är additiv snarare än interaktiv. Slutligen visade resultatet i delstudie V att rörlighet mellan olika arbetsplatser är en mer distinkt prediktor till hälsa och utbrändhet än hälsa och utbrändhet som prediktor till extern rörlighet. Önskan att byta arbetsplats, men inte upplevd organisatorisk rättvisa, visade sig ha effekt på faktiskt byte av arbetsplats. Slutsatser: Föreliggande avhandling har belyst det socialpsykologiska förhållandet mellan organisatorisk rättvisa, beteende och hälsa. Resultatet visar att upplevd organisatorisk rättvisa predicerar hälsa och låg grad av utbrändhet. Resultatet visar också att aktiva individuella organisatoriska beteenden predicerar psykosocial hälsa: ett proorganisatoriskt beteende predicerar psykosocial hälsa medan ett anti-organistoriskt beteende predicerar psykosocial ohälsa. Extern rörlighet har en positiv effekt på utbrändhet och rörlighet är en tydligare prediktor till psykosocial hälsa och utbrändhet än vad hälsa och utbrändhet är till rörlighet. / Introduction: Employee health, individual behaviors in an organizational context and perceived organizational justice are theoretically united. The empirical relationship, especially between behavioral responses and organizational justice and between behavioral responses, and especially job mobility, and health are not previously studied in any apparent extent. Aim: The main aim with the present dissertation was to study the relationship between organizational justice, behavioral responses, and health. Methods: The present study was designed as a longitudinal, three-wave, panel study. A questionnaire was mailed to all employees in three regional organizations of the Swedish National Labour Market Administration (AMV) at 2001 (N=1010, response rate: 78%), 2002 (N=1078, response rate: 75%) and 2003 (N=1122, response rate: 74%). In study I, a cross-sectional and longitudinal validation study, was analyses of variance, multi-trait/multiitem analyses, logistic regression analyses and different forms of factor analyses used to validate and evaluate the Hagedoorn et al. EVLN instrument. In study II, a longitudinal panel study, correlation and Structural Equation Modeling (SEM) analyses were used to elucidate the reciprocal relationship between behavioral responses and health. In study III, a longitudinal panel study, factor, correlation and SEM analyses were used to investigate the association between organizational justice, health and burnout. In study IV, a longitudinal panel study, was variance and General Linear Modeling (GLM) repeated measures analyses used to examine the relationship between turnover intentions, job mobility and health and burnout. In study V, a longitudinal panel study, variance, correlation, and SEM analyses were used to shed light upon the reciprocal relationship between health, burnout and job mobility with turnover intentions, organizational justice and age as affecting factors. Results: Study I showed that the Hagedoorn et al. EVLN instrument was a valid instrument with the exception for the aggressive voice subscale that presents some obvious and distinct deficiencies. The results of study II indicate that the relation between behavioural responses versus health is mainly one-sided: behavioural responses predict psychosocial health. The behavioural response ‘exit’ at baseline was associated with worse psychosocial health at the two-year follow-up, while ‘considerate voice’ predicted good psychosocial health at the two-year follow-up. Good baseline physical health predicted a high degree of ‘exit’ behaviour after two years. Study III showed that organizational justice is cross-sectionally and longitudinally associated with physical, psychosocial health, and burnout. The two approaches to study organizational justice, as a global or threefold construct, should be regarded as complementary rather than exclusive. The results of study IV showed that external mobility had a positive effect on personal and work-related burnout compared with non-mobility and that the combined effects of turnover intentions and job mobility are additive rather than interactive. Finally, the results of study V showed that job mobility is a more distinct predictor of health and burnout than health and burnout is of job mobility. Turnover intentions, but not organizational justice, proved to have an effect on job mobility. Conclusion: The present dissertation has elucidated the social-psychological relationship between organizational justice, behavioral responses and health. The results show that perceived organizational justice predicted good health and low degree of burnout. The results also show that active behavioural responses predict psychosocial health: pro-organizational behaviour, (considerate voice), was associated with high psychosocial health and a contra-organizational behaviour (exit) was associated with low psychosocial health. External job mobility showed a positive effect on burnout and is a more distinct predictor of health and burnout than health and burnout is of job mobility.

Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results. The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (&gt;3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS). Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances. Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain. Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain. The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up. In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

Orientador: Gustavo Tenório Cunha / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T19:49:26Z (GMT). No. of bitstreams: 1 Campos_AdilsonRocha_M.pdf: 1766105 bytes, checksum: 5a56d6691a49365e2e9b92f6a246a9a1 (MD5) Previous issue date: 2015 / Resumo: Este estudo procura resgatar a história da SMS (Secretaria Municipal de Saúde) do município de Campinas ¿ SP, no período anterior à implementação do SUS (Sistema Único de Saúde). Usa como fonte de informações, documentos arquivados junto ao CEDOC (Centro de Documentação) do CETS (Centro de Estudos dos Trabalhadores da Saúde) da SMS de Campinas ¿ SP e entrevistas abertas com sujeitos que foram atores centrais da história da SMS no período estudado. Em forma de depoimento busca descrever a atenção à saúde prestada no município desde os anos 1950 até 1988, correlacionando o perfil demográfico e as características sócio-econômicas da população, suas formas de organização e lutas políticas nos diferentes períodos analisados, considerando o modelo de atenção à saúde vigente no país e a conjuntura política municipal e nacional. Destaca as lutas sociais dos anos 1970 quando implantado um modelo de atenção baseado na Medicina Comunitária e dos anos 1980 quando implantado o Pró-Assistência 1. Conclui apontando para a importância do tripé formado pelos usuários, técnicos e trabalhadores da saúde e gestores da saúde, na elaboração, implantação e defesa de propostas implementadas em Campinas e outros municípios e que fizeram parte do Movimento Nacional pela Reforma Sanitária que levou à consagração do SUS na Constituição Federal e, em seguida, à sua implementação / Abstract: This study seeks to uncover the history of SMS (Municipal Health Board) of city of Campinas - SP, during the period before implementation of SUS (Unified National Health System). Using, as a source of information, documents filed by the CEDOC (Documentation Centre) of the CETS (Health Workers Studies Center) of SMS of Campinas - SP and open interviews with people who were key players in the history of SMS during the time period studied. In the form of testimony seeks to describe the health care provided in the city since the decade of 1950 until 1988, correlating the demographic and socio-economic characteristics of the population, their forms of organization and political struggles in the different time periods analyzed, considering the model of care the current health in the country and the municipal and domestic political context. Highlights the social struggles of the 1970s when deployed an attention model based on Community Medicine and 1980s when deployed Pro-assistance 1. The study conclude by highlighting the importance of the "tripod" formed by users, technical and health workers and health managers, in the preparation, implementation and defense of proposals implemented in Campinas and other cities and that were part of the National Movement for Health Reform which led to the consecration of the SUS (Unified Natiional Health System) in the Federal Constitution and then to implementation / Mestrado / Política, Planejamento e Gestão em Saúde / Mestre em Saude Coletiva

No Brasil, a qualificação dos recursos humanos para trabalhar na Estratégia Saúde da Família é baixa. Considerando a importância do Estado de São Paulo como pólo formador de recursos humanos para a área da saúde, estudou-se a situação dos egressos dos Programas de Residência em Medicina de Família e Comunidade (PRMFC) do Estado de São Paulo (ESP), que finalizaram a residência entre 2000 e 2009. Foi caracterizado o perfil sociodemográfico desses médicos e suas trajetórias profissionais após o término da residência médica, além da satisfação com o trabalho. Os dados foram coletados em 2012, por meio de um questionário eletrônico, dividido nos seguintes blocos: perfil sócio-econômico, atuação profissional, e atividades de Medicina de Família e Comunidade (MFC). Do universo de 234 egressos de 17 PRMFC do ESP, foram incluídos no estudo 129 pessoas de 14 instituições. A maior parte é do sexo feminino (58,1%) e está na faixa etária de 30 a 34 anos (55,8%). Moram predominantemente no ESP (79,1%) e em municípios de grande porte ou em metrópoles (89,1%). A graduação em medicina foi realizada principalmente na região sudeste (92,3%), sendo majoritária a participação do ESP (72,1%). Dos egressos respondentes, 98,4% atuam na área da saúde, sendo que 74,6% atuam na Medicina de Família e Comunidade e 48,1% atuam na docência. Referiram trabalhar em um posto de trabalho 33,9%, dois postos 33,9% e três postos 15,0%, estes não relacionados à docência. O local de trabalho atual mais frequente foi a Estratégia Saúde da Família (49,6%), seguida da Urgência e Emergência (26,7%), consultório particular e Unidade de Saúde Tradicional, com 19,7% cada e, por último, a gestão/gerência (18,9%). Em relação à trajetória acadêmica após a residência de MFC, 10,1% dos egressos fizeram outra residência médica, 57% realizaram especialização lato sensu e 31,8% stricto sensu. Possuem título de especialista em MFC 41,9% dos entrevistados. Mais da metade dos egressos participam da formação de médicos de família (52,7%), sendo que 83,7% têm interesse em realizar esse tipo de atividade. Dos médicos de família que atuam na área da MFC, a maioria está satisfeita ou muito satisfeita e 44,8% deles estão motivados. Conclui-se que os médicos de família egressos de PRMFC do ESP são predominantemente jovens e mulheres e moram em grandes centros urbanos, tendendo a se fixar mais no próprio ESP, local onde fizeram a residência médica. O local de atuação dos egressos é bastante diverso, já que a formação em MFC é ampla. Muitos egressos participam de atividades relacionadas à formação dos médicos de família sendo, portanto, peças fundamentais para a formação de novos profissionais capacitados para atuarem na Atenção Primária à Saúde. Além disso, a maioria deles está satisfeita com o trabalho na MFC, mas ainda faltam reconhecimento e valorização da especialidade. / In Brazil, human resource qualification to work in the Family Health Strategy is low. Considering that the State of São Paulo (SSP) is an important human resource forming center for healthcare, the situation of graduates in Residency Programs in Family and Community Medicine (RPFCM), who finalized their residency between 2000 and 2009, was assessed. The sociodemographic profile from these physicians was characterized, along with their professional careers after residency and job satisfaction. The data was collected in 2012 through an online questionnaire, which was divided into the following sections: socioeconomic profile, professional performance, and activities in Family and Community Medicine (FCM). From the total of 234 graduates from 17 RPFCMs of SSP, this study included 129 people from 14 institutions. The majority of participants are females (58.1%) and between the ages of 30 and 34 (55.8%). Most of them live in SSP (79.1%) and in larger cities or metropolitan areas (89.1%). Their medical degree was predominantly obtained in the southeast region (92.3%), mostly from the SSP (72.1%). From the 129 participants, 98.4% are healthcare practitioners. From these, 74.6% work in Family and Community Medicine and 48.1% work in education. They reported having one (33.9%), two (33.9%), or three (15.0%) job positions, not related to education. The most frequently reported current workplace was Family Health Strategy (49.6%), followed by Urgency and Emergency (26.7%), private practice (19.7%), Traditional Health Unit (19.7%) and healthcare management (18.9%). Regarding academic career after FCM residency, 10.1% did another residency, 57.0% obtained a lato sensu specialization and 31.8% acquired a stricto sensu degree. A specialization in FCM was perfomed by 41.9% of the participants. Over half of the participants are training the next generation of family physicians (52.7%), while 83.7% of these intend to follow this career. The majority of family physicians working in FCM are satisfied or very satisfied in the chosen career, and 44.8% of them are motivated. In conclusion, residency graduates from RPFCM-SSP are predominantly women and young, living in large urban centers, tending to locate in SSP where their residency was acquired. The working environment of the graduates is quite diverse, since the aptitude learned at FCM is ample. Many graduates actively participate in activities related to the training of family physicians, therefore, are a fundamental part in training new professionals to work in Primary Health Care. Moreover, most of them are satisfied with their jobs in FCM, despite the lack in recognition and appreciation for this healthcare specialty.

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No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertação roberto barcellos.pdf: 945783 bytes, checksum: 7e1ee727b4082901916d30284acd2e19 (MD5) Previous issue date: 2014 / Universidade Federal Fluminense / Introdução: Na população norte-americana, os níveis séricos de creatinina em negros são habitualmente maiores do que na população branca, pois estes possuem reconhecidamente maior massa muscular. Esta diferença justificou a partir do ano de 2006, o emprego nos Estados Unidos da América de um ajuste pela raça quando se utiliza as fórmulas para a estimativa das taxas de filtração glomerular (TFG). Questionamos se este ajuste pode ser empregado na população brasileira cuja origem e miscigenação são bastante diferentes da população norte-americana, sem a criação de um viés. Objetivo: O objetivo principal do presente estudo foi de avaliar e comparar os níveis séricos de creatinina em brancos, pardos e negros em uma amostra da população brasileira discutindo a necessidade do uso ajuste pela raça nas fórmulas que empregam a creatinina nesta população. Material e métodos: Os resultados foram extraídos de um estudo de população oriundo do Programa Médico de Família de Niterói (PMF), RJ. A análise da creatinina foi feita pelo método de Jaffé. Compararam-se os níveis séricos de creatinina entre brancos, pardos e negros classificados segundo critérios do IBGE. Posteriormente, foram estimadas as TFGs empregando-se a fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) com e sem ajuste pela raça. Resultados: Um total de 712 participantes (54,7% do sexo feminino) tiveram seus níveis séricos de creatinina analisados. A média de idade da população foi de 43 ± 12 anos. Trinta por cento eram brancos, 43 % pardos e 27% negros. A média da creatinina nos homens foi maior que a das mulheres (0,99 ± 0,23 mg/dl vs. 0,77 ± 0,17 mg/dl, p<0.001). Entretanto, não foram identificadas diferenças significativas nos níveis séricos de creatinina entre brancos (0,86 ± 22 mg/dl), pardos (0,87 ± 22 mg/dl) e negros (0,88 ± 25 mg/dl). Os níveis séricos de creatinina em mulheres brancas, pardas e negras foram respectivamente 0,76 ± 0,15 mg/dl, 0,77 ± 0,17 mg/dl e 0,79 ± 0,17 mg/dl. Os valores correspondentes para homens foram respectivamente 1,00 ± 0,23 mg/dl, 0,98 ± 0,19 mg/dl e 1,01 ± 0,30 mg/dl. Ao se utilizar a fórmula da CKD-EPI sem ajuste pela raça, não houve diferença significativa entre brancos, pardos e negros. Entretanto, se o ajuste pela raça tivesse sido aplicado, os valores da TFG teriam sido significativamente maiores (p< 0,001) resultando em um erro. Conclusão: Não houve diferença significativa nos níveis de creatinina sérica entre brancos, pardos e negros na população estudada. O emprego do ajuste pelo fator raça na população brasileira poderia trazer um viés no cálculo da TFG, superestimando os valores para pardos e negros / Background: Serum creatinine levels are usually higher among black people in the United States due to increased muscle mass justifying the addition of race adjustment in creatinine-based equations to estimate glomerular filtration rate (GFR). We speculate if this adjustment would create a bias when used in the Brazilian population whose origin and racial admixture is quite different from the American people. Objective: The aim of the present study was to assess if serum creatinine levels are different between white, brown (mixed-race background) and black people in a Brazilian population. Methods: Data were extracted from a community-based health program in Brazil. We compared serum creatinine levels in self-defined white, black and brown adults. Additionally, we also estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, with and without race adjustment. Results: A total of 712 participants (54.7% females, 43 ± 12 years old) were enrolled. Thirty percent of the subjects were white, 43% brown and 27% black. As expected, males had serum creatinine higher than females (0.99 ± 0.23 mg/dl vs. 0.77 ± 0.17 mg/dl, p<0.001). However, no significant differences were found between whites (0,86 ± 22 mg/dl), brown (0,87 ± 22 mg/dl) and blacks (0,88 ± 25 mg/dl). Serum creatinine levels for white, brown and black females were 0.76 ± 0.15 mg/dl, 0.77 ± 0.17 mg/dl and 0.79 ± 0.17 mg/dl, respectively. Correspondent values for males were 1.00 ± 0.23 mg/dl, 0.98 ± 0.19 mg/dl and 1.01 ± 0.30 mg/dl, respectively. When using the CKD-EPI equation without race adjustment, the eGFR was not different between white, brown and black subjects. However, if race-adjustment were adopted, estimated GFR values for Blacks would be significantly higher than for Whites (p<0.001). Conclusion: No significant differences in serum creatinine levels were found between white, brown and black people in this sample of a Brazilian population. It raises the question if the race-adjustment in creatinine-based equations for GFR estimation in our population would be appropriated

No Brasil, a qualificação dos recursos humanos para trabalhar na Estratégia Saúde da Família é baixa. Considerando a importância do Estado de São Paulo como pólo formador de recursos humanos para a área da saúde, estudou-se a situação dos egressos dos Programas de Residência em Medicina de Família e Comunidade (PRMFC) do Estado de São Paulo (ESP), que finalizaram a residência entre 2000 e 2009. Foi caracterizado o perfil sociodemográfico desses médicos e suas trajetórias profissionais após o término da residência médica, além da satisfação com o trabalho. Os dados foram coletados em 2012, por meio de um questionário eletrônico, dividido nos seguintes blocos: perfil sócio-econômico, atuação profissional, e atividades de Medicina de Família e Comunidade (MFC). Do universo de 234 egressos de 17 PRMFC do ESP, foram incluídos no estudo 129 pessoas de 14 instituições. A maior parte é do sexo feminino (58,1%) e está na faixa etária de 30 a 34 anos (55,8%). Moram predominantemente no ESP (79,1%) e em municípios de grande porte ou em metrópoles (89,1%). A graduação em medicina foi realizada principalmente na região sudeste (92,3%), sendo majoritária a participação do ESP (72,1%). Dos egressos respondentes, 98,4% atuam na área da saúde, sendo que 74,6% atuam na Medicina de Família e Comunidade e 48,1% atuam na docência. Referiram trabalhar em um posto de trabalho 33,9%, dois postos 33,9% e três postos 15,0%, estes não relacionados à docência. O local de trabalho atual mais frequente foi a Estratégia Saúde da Família (49,6%), seguida da Urgência e Emergência (26,7%), consultório particular e Unidade de Saúde Tradicional, com 19,7% cada e, por último, a gestão/gerência (18,9%). Em relação à trajetória acadêmica após a residência de MFC, 10,1% dos egressos fizeram outra residência médica, 57% realizaram especialização lato sensu e 31,8% stricto sensu. Possuem título de especialista em MFC 41,9% dos entrevistados. Mais da metade dos egressos participam da formação de médicos de família (52,7%), sendo que 83,7% têm interesse em realizar esse tipo de atividade. Dos médicos de família que atuam na área da MFC, a maioria está satisfeita ou muito satisfeita e 44,8% deles estão motivados. Conclui-se que os médicos de família egressos de PRMFC do ESP são predominantemente jovens e mulheres e moram em grandes centros urbanos, tendendo a se fixar mais no próprio ESP, local onde fizeram a residência médica. O local de atuação dos egressos é bastante diverso, já que a formação em MFC é ampla. Muitos egressos participam de atividades relacionadas à formação dos médicos de família sendo, portanto, peças fundamentais para a formação de novos profissionais capacitados para atuarem na Atenção Primária à Saúde. Além disso, a maioria deles está satisfeita com o trabalho na MFC, mas ainda faltam reconhecimento e valorização da especialidade. / In Brazil, human resource qualification to work in the Family Health Strategy is low. Considering that the State of São Paulo (SSP) is an important human resource forming center for healthcare, the situation of graduates in Residency Programs in Family and Community Medicine (RPFCM), who finalized their residency between 2000 and 2009, was assessed. The sociodemographic profile from these physicians was characterized, along with their professional careers after residency and job satisfaction. The data was collected in 2012 through an online questionnaire, which was divided into the following sections: socioeconomic profile, professional performance, and activities in Family and Community Medicine (FCM). From the total of 234 graduates from 17 RPFCMs of SSP, this study included 129 people from 14 institutions. The majority of participants are females (58.1%) and between the ages of 30 and 34 (55.8%). Most of them live in SSP (79.1%) and in larger cities or metropolitan areas (89.1%). Their medical degree was predominantly obtained in the southeast region (92.3%), mostly from the SSP (72.1%). From the 129 participants, 98.4% are healthcare practitioners. From these, 74.6% work in Family and Community Medicine and 48.1% work in education. They reported having one (33.9%), two (33.9%), or three (15.0%) job positions, not related to education. The most frequently reported current workplace was Family Health Strategy (49.6%), followed by Urgency and Emergency (26.7%), private practice (19.7%), Traditional Health Unit (19.7%) and healthcare management (18.9%). Regarding academic career after FCM residency, 10.1% did another residency, 57.0% obtained a lato sensu specialization and 31.8% acquired a stricto sensu degree. A specialization in FCM was perfomed by 41.9% of the participants. Over half of the participants are training the next generation of family physicians (52.7%), while 83.7% of these intend to follow this career. The majority of family physicians working in FCM are satisfied or very satisfied in the chosen career, and 44.8% of them are motivated. In conclusion, residency graduates from RPFCM-SSP are predominantly women and young, living in large urban centers, tending to locate in SSP where their residency was acquired. The working environment of the graduates is quite diverse, since the aptitude learned at FCM is ample. Many graduates actively participate in activities related to the training of family physicians, therefore, are a fundamental part in training new professionals to work in Primary Health Care. Moreover, most of them are satisfied with their jobs in FCM, despite the lack in recognition and appreciation for this healthcare specialty.

Medical treatments with statins are prescribed to patients with increased risk of cardiovascular events. The benefits from statin treatment are well documented in clinical trials, but long-term adherence in patients is low, indicating that patients have an uncertainty about the necessity and benefits of treatment. The aims of this thesis were to investigate how patients and doctors view different aspects of statin treatment. Further aims were to investigate if the cardiovascular risk level in patients affects their views about different aspects of statin treatment. Yet further aims were to compare health behaviours and views about risk factors in patients using statins to a non-treated population. Data was obtained from patients (n = 829), doctors (n = 330) and a population sample (n = 720) using postal questionnaires. Views about the effect of statin treatment were assessed in different ways for patients and doctors. Patients based their assessments on their own situation, and doctors’ treatment decisions and assessments of anticipated effect of treatment were based on two hypothetical patient cases. The results indicate that patients greatly overestimate the general effect of statins, compared to efficacy results reported from clinical trials. Patients’ previous coronary heart disease or high overall risk were factors not associated with their views and expectations of treatment effect. Statin users with an internally perceived health control and patients satisfied with their doctor’s treatment explanation reported higher beliefs in treatment necessity and benefits. Statin users reported having better health behaviours and generally rated risk factors as more important than the non-treated population. Doctors had suboptimal understanding of the number of patients expected to benefit following five years of statin treatment and had a varying understanding of statins’ ability to prolong life. Overall the results illustrate that patients and doctors have different perspectives and views of the benefits from statin treatment which puts emphasis on how statin treatment is discussed in the clinical setting.