Made available in DSpace on 2016-08-19T17:47:08Z (GMT). No. of bitstreams: 1 Dissertacao-EmniellePintoBorgesMoreira.pdf: 2297829 bytes, checksum: a30e1d39006389163a9c6afaeca65f24 (MD5) Previous issue date: 2016-06-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Currently in Brazil the arboviruses - dengue, zika virus and chikungunya fever - pose serious public health problems, especially because there are not vaccines against these diseases, which, in turn, increases the importance of controlling the vector, Aedes aegypti. The identification of high risk areas for transmitting dengue assists the study of the vector dispersion process. The objective of this study was to analyze the spatial-temporal distribution of dengue cases in residents of São Luís, Maranhão, Brazil, reported in the Information System for Notifiable Diseases (SINAN), relating them to the seven health districts (DS) of the county. This is an ecological study of secondary data of cases and deaths from dengue in residents of São Luís, Maranhão, Brazil, reported and confirmed in SINAN from 2000 to 2011. Statistical analysis was performed using STATA, version 10.0 and for the preparation of maps we used the model of discrete spatial variation and QGIS 2.8.1 software. During the study period there were reported and confirmed 17,318 cases of dengue with highest absolute frequencies in 2005, 2007, 2010 and 2011. There was a predominance among the the mixed race people. The first half of the year had more frequent cases. There was recorded an increase of occurrence of the disease in children under 15 and increased hospital admissions from 2002. The four serotypes were identified during the study period. In all of the DS there were reports of dengue cases, with greater concentration in DS Bequimão. The use of the space-time analysis tool in dengue cases allowed us to visualize and understand more holistically the areas of risk and vulnerability to disease in São Luís, especially in the urban area. / Atualmente no Brasil as arboviroses dengue, zika vírus e febre de chikungunya representam sérios problemas de saúde pública, especialmente porque não se dispõe de vacinas contra essas doenças, o que, por sua vez, aumenta a importância do controle do vetor, o Aedes aegypti. A identificação de espaços de maior risco para a transmissão da dengue auxilia os estudos do processo de dispersão do vetor. O objetivo deste trabalho foi analisar a distribuição espaço-temporal de casos de dengue de residentes em São Luís, Maranhão, Brasil, notificados no Sistema de Informação de Agravos de Notificação (SINAN), relacionando-os com os sete distritos sanitários (DS) do Município. Trata-se de estudo ecológico de dados secundários dos casos e óbitos de dengue em residentes de São Luís, Maranhão, Brasil, notificados e confirmados no SINAN de 2000 a 2011. Na análise estatística foi utilizado o STATA®, versão 10.0 e na elaboração dos mapas utilizou-se o modelo de variação espacial discreta e o software QGIS 2.8.1®. No período estudado foram notificados e confirmados 17.318 casos de dengue com maiores frequências absolutas em 2005, 2007, 2010 e 2011. Houve predomínio do sexo feminino e da raça parda. O primeiro semestre concentrou maior frequência de casos. Registram-se aumento da ocorrência da doença em menores de 15 anos, aumento de internações hospitalares a partir de 2002, tendo sido identificados os quatro sorotipos no período estudado. Em todos os DS houve registros de casos de dengue, com maior concentração no DS Bequimão. O uso de ferramenta de análise espaço-temporal nos casos de dengue permitiu visualizar e compreender de forma mais holística, as áreas de risco e de vulnerabilidade à doença no município de São Luís, sobretudo no perímetro urbano.

Embora sejam grandes os progressos com a promulgação da Constituição de 1988, que garante constitucionalmente a saúde como direito de todos e dever do Estado, esse direito não tem sido assegurado no mesmo nível e com a mesma qualidade de atenção, em especial, para a população negra. Depois de uma revisão sobre a história a influência das teorias racialistas e de gênero como categoria de análise na medicina, discute-se uma síntese da história recente das práticas médicas no Brasil e a reflexão critica sobre essas práticas centradas no tecnicismo. O objetivo deste estudo, parte da linha de pesquisa Pesquisa Psicossocial da Desigualdade: Relações Étnico-raciais, foi descrever que sentidos e significados médicos e médicas conferem aos temas médico-sociais na sua trajetória e formação, especialmente como concebem os determinantes sociais de gênero e raça Foram entrevistados 25 médicos (13 médicos e 12 médicas) que orientam e são preceptores de alunos da residência médica em um hospital universitário. O roteiro abordava o perfil sócio-demográfico e sua trajetória profissional; o seu nível de conhecimento e contato com os determinantes sociais (pobreza, gênero, cor/raça, nacionalidade, religião dos diferentes grupos populacionais) durante a formação acadêmica; que fatores consideravam relevantes para uma boa relação médico-paciente; seu conhecimento sobre Direitos Humanos e os princípios do Sistema Único de Saúde; as experiências na relação médico-paciente e de cuidado. Depois de um aquecimento propiciado pela situação da entrevista, entre os resultados, o estudo permitiu observar como os médicos entrevistados reconhecem alguns marcadores sociais da diferença que se transformam em desigualdade, os lugares sociais diferentes para homens e mulheres, brancos, amarelos e negros, lugares de maior ou menor privilégio e de obstáculo para o sucesso técnico. As diferenças e desigualdade de gênero foram mais fáceis de serem explicitadas e os entrevistados articulavam um repertório levemente maior para o tema. Todos os entrevistados, em algum momento, usaram o discurso sobre o instintivo e natural, e a maior parte deles compreende o masculino e o feminino de um modo muito conservador, com problemas para encontrar definições para perguntas supostamente simples. No caso da desigualdade racial, observamos que houve uma polarização: de um lado a negação das desigualdades entre brancos e não brancos, do outro temos a valorização da identidade branca, compondo bem com o racismo à brasileira. O contexto social foi associado à pobreza mais que qualquer outro indicador da desigualdade social. Cenas de racismo e sexismo institucional foram frequentes. Os poucos entrevistados que tinham uma noção mais sofisticada sobre gênero e raça eram aqueles que contaram com a oportunidade de desenvolver uma atividade de extensão, a iniciação científica ou que tiveram uma formação mais generalista, mais social. A trajetória trilhada na faculdade contribui, portanto, para a formação / Brazil\'s 1988 Constitution grants health as a human right to all and a duty of the State. Although great progress has been made since its enactment, this right has not been ensured at the same level and with the same service quality, particularly with regard to Afro-Brazilians. With close attention to history and the influence of racial and gendered theories, this article discusses the recent history of medical practices in Brazil and provides critical reflection on those practices that are centered on technique. The main purpose of this study, a part of the Psycho-social research on inequality: ethnic-racial relations research line, is to describe the meanings and significance that doctors give to medical social issues in their education. Special attention is given to their conception of the social determinants of gender and race. Twenty-five doctors (13 men and 12 women) were interviewed. All of them mentor medical students pursuing their residency at a University Hospital. The interviews script centered on their socio-demographic profile, their professional path and the degree of knowledge or contact with social determinants (poverty, gender, race/color, nationality, religion of the different population groups) during their academic formation, the factors they considered as relevant to a good doctor-patient relationship, their knowledge of Human Rights and the principles of the Sistema Único de Saúde (SUS) and their experiences in the care and doctor-patient relationships. Among its results, the study shows how the interviewed doctors recognize several social markers of difference that convert into inequity, the different social places for men and women, the white, the people of Asian descent and the black, places of greater or lower privilege and obstacle for technical success. The gender differences and inequalities were more easily explained and respondents articulated a slightly larger repertoire for the topic. All of the interviewees, at some moment, used the discourse on the instinctive and the natural, and most of them have a very conservative comprehension of the feminine and the masculine, and encountered problems in finding definitions for apparently simple questions. With regards to racial inequality, there was a polarization: on the one hand, the denial of inequalities among the white and the non white, on the other, a consistent evaluation of white identity, linked to the Brazilian racism. The social context was associated with poverty rather than any other indicator of social inequality. Evidence of racism and sexism were frequently observed in the interviews. The few interviewees that had a more sophisticated notion of gender and race were those who had had the chance to develop an extracurricular activity, the scientific initiation, or those who had had a more generalist and social education. Thus, the experience acquired during university contributes to the formation of their notions of social determinants in health

El propósito de la tesis es estudiar las características socioeconómicas y el estatus social subjetivo de las mujeres inmigrantes y analizar su relación con la salud. Así como, explorar los determinantes del estatus social subjetivo y como las mujeres explican la influencia de los mismos en sus trayectorias de salud. El estudio utilizó metodología cuantitativa y cualitativa. Se observó una asociación débil entre las medidas del estatus socioeconómico y la salud percibida. El estatus social subjetivo fue significativamente asociado con la salud percibida, lo que sugiere que puede ser un indicador relevante para el estudio de las desigualdades en salud Las entrevistas muestran las trayectorias de salud y las desigualdades en los determinantes sociales de salud de las inmigrantes en relación a la población Cántabra. Los determinantes del estatus social subjetivo y de la salud de las mujeres se encuentran, principalmente, en el contexto socioeconómico y político de España.

Cette thèse vise un apport conceptuel et empirique au sujet du rapport à l’alcool chez les hommes et les femmes âgés de 55 ans et plus provenant de la population générale du Canada. Les deux objectifs généraux sont de mieux comprendre l’influence du contexte social/environnemental sur la consommation d’alcool des adultes âgés et de mieux comprendre la relation entre la consommation d’alcool et la santé. La thèse est composée de deux articles empiriques associés à chacun des objectifs. Plus précisément, le premier article tente d’évaluer l’impact des changements associés à l’alcool depuis les années 1990 dans le contexte canadien sur la consommation d’alcool (effet période) en comparant des adultes âgés de 55 à 74 ans provenant de deux enquêtes populationnelles canadiennes : CADS de 1994 (Canada’s Alcohol and other Drugs Survey) et GENACIS de 2004 (GENder, Alcohol, and Culture: an International Study). Il vérifie également si le contexte a un effet significatif sur les différences observées en tenant compte de l’âge, de la perception subjective de la santé et de la composition sociodémographique des échantillons. Les résultats montrent que les taux de buveurs, de consommation excessive, de buveurs de bière et de vin sont plus élevés en 2004, dans un contexte social/environnemental plus favorable à l’alcool. De plus, les profils de consommation d’alcool ne diffèrent pas entre 1994 et 2004 (volume, fréquence, quantité, quantité maximale), signifiant probablement l’influence des changements physiques qui accompagnent le vieillissement normal sur la modulation de la consommation d’alcool avec l’âge. Le deuxième article vise à dégager une typologie de buveurs et de non-buveurs chez les adultes âgés canadiens, à évaluer comment cette typologie est associée à l’état de santé ainsi qu’à comparer le rôle de l’alcool à celui d’un ensemble d’autres déterminants de la santé dans l’association à la santé (ici santé autoperçue). Les résultats issus de l’enquête GENACIS de 2004 montrent que les buveurs se perçoivent en meilleure santé que les non-buveurs, peu importe le profil de consommation d’alcool rapporté. Il est probable que l’état de santé autoperçue dicte le statut de buveur ou de non-buveur et non pas l’inverse. Les résultats montrent aussi que les caractéristiques démographiques, psychosociales et les comportements liés à la santé des adultes âgés sont davantage associés à la perception de leur santé que leur consommation (ou non-consommation) d’alcool seule. Les résultats de ce second article indiquent notamment que les bienfaits de la consommation d’alcool se définissent probablement par la biologie, mais pas seulement par la biologie. Il est recommandé de poursuivre l’étude du rapport à l’alcool chez les adultes âgés qui peut varier d’une cohorte et d’une période à l’autre. D’un point de vue de santé publique, la conceptualisation d’un modèle de santé qui cible les adultes âgés implique une meilleure compréhension de l’impact de la consommation d’alcool et d’autres déterminants de la santé sur l’état de santé. Les contributions et implications pratiques de la thèse ainsi que les principales limites et pistes de futures recherches sont présentées dans la discussion. / The aim of the thesis is to contribute to a better conceptual and empirical understanding of alcohol consumption among men and women aged 55 years and older from the general Canadian population. The two general objectives pursued are to gain a better understanding of the potential influence of the social/environmental context on drinking habits among older adults and to achieve a clearer discernment of the relation between alcohol consumption and health. The thesis comprises two empirical articles relating to each respective objective. More specifically, the first article verified whether contextual changes associated to alcohol and unique to the decade spanning the 1990s may have had an impact on alcohol consumption (period effect) by comparing two subsamples of older adults from two Canadian surveys: the 1994 CADS (Canada’s Alcohol and other Drugs Survey) and 2004 GENACIS (GENder, Alcohol, and Culture: an International Study). The article also assessed if the context had a significant effect on the differences observed when age, subjective perception of health and the sociodemographic composition of the samples were taken into consideration. Results first show that, in a social/environmental context that is more favourable to drinking in general, the rates of current drinkers, binge drinking, beer and wine drinkers are significantly higher in 2004. In addition, drinking profiles were not significantly different between 1994 and 2004 (volume, frequency, quantity, maximum quantity), pointing at the potential impact of normal physiological changes due to aging on drinking profiles. The second article aimed to build a drinking typology (including drinkers and non-drinkers) among older Canadian adults, to assess how the drinking typology was related to health status and to compare the role of alcohol with other determinants of health (demographic, psychosocial and health-related factors) in explaining health status. To do so, the subjective perception of health (subjective health) was used as a proxy for actual health status. Results from the 2004 GENACIS survey indicated that drinkers perceived themselves as being in better physical health than nondrinkers, regardless of the drinking pattern. Health status may explain drinking status and not the opposite. Results also showed that the demographic, psychosocial and health-related characteristics of older adults contributed significantly more to the variation in subjective health than the drinking status alone. Health benefits of drinking are explained by biological factors, but not exclusively by biological factors. In conclusion, alcohol research needs to emphasize the study of drinking among older adults, which can vary depending on the cohort and period under study. From a public health perspective, health-predicting models focusing on older adults need to be built on a better understanding of the impact of alcohol and other determinants of health on health status. Main contributions, practical implications, limitations of the thesis and recommendations for future research are presented in the discussion.

Mental health reflects an array of causal influences that span biological, psychological, and social circumstances, with resultant underlying causal pathways to poor mental health outcomes in childhood that are complex. Key features of this complexity are reciprocal interactions between person and environment that take place over time. The core of this thesis seeks to attend to the complexity of development to move the field of developmental health forward toward greater explanation, and more successful prediction and prevention. The focal point of the thesis is the psychosocial determinants of childhood mental health, the resource domain of the developing child, and the interplay between characteristics of the individual child, the family, and the community. The eventual goal is to better understand why and how socioeconomic circumstances impact on developmental health. One component of this thesis focuses on the expansion of extant developmental theory. The other component focuses on the development of an analytic strategy that more appropriately reflects the intricacies of this theoretical expansion. In the process, data are analysed, principally as a heuristic strategy, to illustrate the analytical approach needed to support the theoretical framework. The specification of a bioecological conceptual framework suitable to guide research and policy in developmental health is the first principal objective of the thesis. A critical examination of the resource framework proposed by Brooks-Gunn, Brown, Duncan, and Anderson Moore (1995) reveals it to be centred on family and community resources, but otherwise silent with respect to the physical and psychological resources of the child. The quintessential point of this thesis is that theory in developmental health must be able to account for the contribution individuals make to their own development. A modified resource framework is proposed that acknowledges financial, physical, human, and social capital, within the domains of the individual child, the family, and the community. The second principal objective of the thesis, the development of analytical methods that focus on the individual child and the complexity of data generated by this theoretical approach, is then introduced. Theory and method are thus integrated when comprehensive measures of characteristics in multiple domains across developmental periods are modeled using longitudinal data from the Western Australian Pregnancy Cohort (Raine) Study (Newnham, Evans, Michael, Stanley, & Landau, 1993). The mothers of 2,860 children were enrolled at 18 weeks in pregnancy and the children have been followed at birth, one, two, three, five, and eight years of age. Eighty-nine per cent (2,537 /2,860) of families were available for follow-up at eight and 74 per cent (2,126/2,860) of families responded. Extensive demographic, psychological, and developmental data were available for the children and their families and a limited amount of data were available for the communities in which they reside. A measure of mental health morbidity, the Child Behaviour Checklist (Achenbach, 1991), was available for the children at two, five, and eight years of age. In the first instance, dichotomous summary variables are derived for the demographic, psychological, and developmental variables of interest. Variables are then selected for inclusion in one of several explanatory models. To create a mathematical representation of resource characteristics, the information for each child is concatenated as a series of binary strings. Frequency tabulation is then used to aggregate the data and odds ratios are calculated to determine the degree of risk associated with each string of code, or pattern of factors relative to a nominated mental health outcome. The results provided a scaffold from which this theoretical and analytical approach is compared and contrasted with the reviewed literature. Two principal themes of investigation are pursued. The first theme to be examined is the interplay between characteristics of the child, family, and community and the contribution children make to their own development. The specific approach models the interaction between selected characteristics of the child, family and community in each of four developmentally significant time periods. The theoretical position adopted in the present study suggests that the effect of any personal or contextual factor on later development, if a relationship does truly exist, is most likely to be differential. That is, it is a combination of influences that determines developmental outcomes for children, not any single factor acting independently. The modelling process demonstrates that, for the children involved, personal and contextual factors impact mental health differentially depending on various other individual, family and/or community characteristics. The modelling process identifies patterns of factors that impact relatively small, but significant, numbers of children because the models focus on the effect for individual children rather than the effect for the group. For example, one model suggests that the effect of intra-uterine growth restriction for the group as a whole may be minimal, but the impact for some children could be critical depending on the combination of family and community influences, such as the mothers level of education, the family’s experience of significant life stress, and residence in a relatively disadvantaged community. The second theme to be examined is the possibility that the accumulation of resource deficits or risk characteristics, over time, amplifies the likelihood of mental health problems in childhood. The approach models selected characteristics of the child in each of the four periods of development collectively, and it also models selected characteristics spanning each of the four time periods discretely. The results suggest that latency, pathway, and recency effects may operate simultaneously, and that timing and accumulated burden may both be important determinants of risk. For example, with regard to children whose family experienced life stress, these three effects operated in a systematic way to increase the degree of risk of a mental health problem. In summary, the aggregation of data at the individual level is a productive approach in seeking to explain population level social phenomena. While seemingly paradoxical, the identification of the joint, interactive effects between individual, family, and community characteristics, better allows for the quantification of family and community characteristics operating through multiple causal pathways.

No description available.

Justificativa: As Internações por Condições Sensíveis à Atenção Básica são um conjunto de problemas de saúde, para os quais o acesso aos serviços de AB e ações efetivas poderiam reduzir a ocorrência destas internações, tornando-as um indicador de resultado para avaliação da qualidade e do acesso nesse nível de atenção. Assim, analisou-se o indicador de ICSAB, buscando fatores associados à sua ocorrência, a fim de avaliar a sua capacidade de verificar a resolutividade da atenção básica. Métodos: Realizou-se uma análise exploratória descritiva do ICSAB nas sete macrorregiões de saúde e 30 regiões de saúde do Rio Grande do Sul, com base na Cobertura de Saúde da Família, seguida de uma revisão da produção indexada sobre ICSAB, com o objetivo de verificar quais fatores estão correlacionados com o desfecho ICSAB. Por fim desenvolveu-se um estudo ecológico com medidas agregadas, testando o grau de correlação linear entre as variáveis selecionadas a partir da revisão, utilizando o coeficiente de correlação de Spearman Resultados: Foram encontrados na literatura diversos fatores correlacionados à ocorrência de ICSAB, tanto no âmbito da disponibilidade de serviços de saúde, como na perspectiva socioeconômica. Em relação a realidade do RS, encontrou-se correlação de ICSAB com quantidade de leitos (p=0.002), Proporção de pessoas com planos de saúde (p=0,001), IDH (p=0.004) e analfabetismo (p=0.001) e população menor de quatro anos (p=0,001). Considerações: O indicador ICSAB cumpre seu objetivo de tornar comparável de forma sintética a situação da Atenção Básica nas diversas possibilidades de recortes territoriais. Contudo, as variáveis que interferem nesse desfecho são diversas, operando de maneiras diferentes em cada contexto e necessitando de maior aprofundamento. Enquanto subsídio para políticas e ações de qualificação da Atenção Básica, a mudança desse indicador só ocorrerá quando esse dado servir como dispositivo inicial para entender processos complexos e locais, que ocorrerão através de processos de educação permanente. / Background: Hospitalizations for Sensitive Conditions to Primary Health Care (HSCPHC) are a group of health problems, for which access to Primary Health Care services and effective actions could reduce the occurrence of these hospitalizations, making them an outcome indicator for quality and access to this level of attention. Thus, the HSCPHC indicator was analyzed, looking for factors associated with its occurrence, in order to evaluate its capacity to verify the resolution of basic care. Methods: A descriptive exploratory analysis of the HSCPHC was carried out in the seven macro-regions of health and 30 health regions of Rio Grande do Sul, based on the Family Health Coverage, followed by a review of the indexed production on HSCBC, with the objective of verify which factors are correlated with the HSCPHC outcome. Finally, an ecological study with aggregate measures was developed, testing the degree of linear correlation between the variables selected from the review using Spearman's correlation coefficient Results: A number of factors correlated with the occurrence of HSCPHC were found in the literature, both in terms of the availability of health services and in the socioeconomic perspective. In relation to Rio Grande do Sul reality, we found a correlation of HSCBC with number of hospital beds (p = 0.002), Proportion of people with health plans (p = 0.001), HDI (p = 0.004) and illiteracy (p = 0.001) and population younger than four years (p = 0.001). Considerations: The HSCPHC indicator fulfills its objective of making the situation of Primary Health Care in the various possibilities of territorial cuts comparable in a synthetic way. However, the variables that interfere in this outcome are diverse, operating differently in each context and requiring further study. As a subsidy for policies and actions to qualify Primary Health Care, the change in this indicator will only occur when this data serves as an initial device to understand complex and local processes that will occur through processes of permanent education.

As condições de saúde do trabalhador resultam de um conjunto de determinantes de natureza individual, como a herança genética e a biologia humana, e de condicionantes econômicos, socioculturais, políticos, tecnológicos e organizacionais. Estes se expressam no modo de viver dos indivíduos e dos grupos sociais. Assim, a determinação social da saúde se verifica pelo caráter histórico-social e pelo aspecto biopsicológico dos indivíduos. Diante disso despertaram algumas inquietações: a formação em enfermagem do trabalho continua pautada no modelo hegemônico, biologicista? Será que aborda conteúdos sobre o processo de produção social da saúde-doença? Delineou-se como objetivo geral do estudo: Analisar a formação do enfermeiro do trabalho, tomando como referência a discussão da determinação social da saúde. E como objetivos específicos: a) Caracterizar o perfil acadêmico e o Projeto Político-Pedagógico (PPP) dos cursos presenciais lato sensu em enfermagem do trabalho do Rio de Janeiro; b) Analisar a formação do enfermeiro do trabalho à luz da discussão sobre a determinação social da saúde; e c) Discutir a formação do enfermeiro do trabalho e as influências do contexto social na conformação dos currículos e na prática social deste. Constitui-se um estudo de cunho qualitativo, não experimental, transversal e descritivo. Foi realizada entrevistas semi-estruturadas com coordenadores (N = 03) e discentes (N = 15) de três cursos de especialização em enfermagem do trabalho, sendo dois de instituição pública e um de instituição privada de ensino. Aplicou-se a análise de conteúdo de Bardin. Também foi realizada a análise dos PPP dos cursos, uma vez que delineiam os objetivos e/ou missão do curso, o ementário e a grade curricular. A maioria dos alunos entrevistados e um coordenador não tinham ouvido falar sobre a determinação social da saúde. Todos os cursos abordam direta ou indiretamente conteúdos relacionados a este tema. Dentro da perspectiva da Saúde Coletiva, em que se insere a Saúde do Trabalhador, a formação do enfermeiro do trabalho deve considerar a história de vida e a forma de inserção do trabalhador na sociedade, bem como suas relações de reprodução social. Contudo, verifica-se que o ensino em enfermagem do trabalho continua pautado no enfoque positivista do processo saúde-doença, estabelecendo relações entre indicadores de saúde, desconsiderando o caráter histórico-social deste processo. Dentro de uma perspectiva social ordenada pelas relações capitalistas em que vivemos, é sem dúvida difícil pensar numa outra forma de abordar o ensino das diversas profissões da saúde. Todavia, é necessário repensar a formação e atuação dos profissionais de saúde, dentro de uma ótica inter, multi e transdisciplinar apontada pelo campo Saúde Coletiva, a fim de ampliar o olhar sobre o sujeito para além da visão centrada na doença, considerando os aspectos subjetivos envolvidos na determinação social da saúde. Logo, demandam-se mudanças nas formas de pensar os currículos e de conduzir o processo ensino-aprendizagem desses profissionais de saúde. / Workers' health conditions result from many determinants of individual nature, such as genetic inheritance and human biology, and of economic, socio-cultural, political, technological and organizational conditioning factors. These factors are expressed in the way of life of individuals and social groups. Thus, the social determination of health is verified through the social-historical character and the bio-psychological aspect of individuals. In the light of that some concerns were raised: Is the occupational health nursing formation still guided by the biologicist hegemonic model? Does it handles contents on the health-disease social production process? We delineated as a general objective of the study: Analyze the formation of the occupational health nurse, with reference to the discussion of social determination of health. And as specific objectives: a) To characterize the academic profile and the political-pedagogical project (PPP) from presential lato sensu occupational health nursing courses in Rio de Janeiro; b) Analyze the formation of the occupational health nurse in the light of the discussion on the social determination of health; and c) Discuss the formation of the occupational health nurse and the influences of social context in shaping their curriculum and social practice. This constitutes a study of qualitative nature, non-experimental, cross-sectional and descriptive. It was conducted semi-structured interviews with coordinators (N = 03) and students (N = 15), from three post graduation courses in occupational health nursing, being two from public institutions and one from a private educational institution. It was applied the Bardin content analysis. It was also carried out an analysis of the courses PPP, since they delineate the objectives and/or mission of the course, the program and the curriculum. Most of the students interviewed and a coordinator had not heard about the social determination of health. All courses cover, directly or indirectly, contents related to this subject. From the Public Health perspective, in which the Occupational Health is inserted, the occupational health nurses formation should consider the life history and the form of participation of workers in society and their relations of social reproduction. However, it appears that the occupational health nursing teaching is still guided by positivist approach of health-disease process, establishing health indicators relations, disregarding the social-historical character of this process. Within a social perspective ordered by capitalist relations in which we live in, is undoubtedly difficult to think of another way to approach the teaching of the various health professions. However, it is necessary to rethink the formation and performance of health professionals, within an inter, multi and interdisciplinary perspective appointed by the Public Health field in order to broaden the view on the subject beyond the sight focused on the disease, considering the subjective aspects involved in social determination of health. So it is required changes in the ways of thinking curriculum and of conducting the teaching-learning process of these health professionals.

As condições de saúde do trabalhador resultam de um conjunto de determinantes de natureza individual, como a herança genética e a biologia humana, e de condicionantes econômicos, socioculturais, políticos, tecnológicos e organizacionais. Estes se expressam no modo de viver dos indivíduos e dos grupos sociais. Assim, a determinação social da saúde se verifica pelo caráter histórico-social e pelo aspecto biopsicológico dos indivíduos. Diante disso despertaram algumas inquietações: a formação em enfermagem do trabalho continua pautada no modelo hegemônico, biologicista? Será que aborda conteúdos sobre o processo de produção social da saúde-doença? Delineou-se como objetivo geral do estudo: Analisar a formação do enfermeiro do trabalho, tomando como referência a discussão da determinação social da saúde. E como objetivos específicos: a) Caracterizar o perfil acadêmico e o Projeto Político-Pedagógico (PPP) dos cursos presenciais lato sensu em enfermagem do trabalho do Rio de Janeiro; b) Analisar a formação do enfermeiro do trabalho à luz da discussão sobre a determinação social da saúde; e c) Discutir a formação do enfermeiro do trabalho e as influências do contexto social na conformação dos currículos e na prática social deste. Constitui-se um estudo de cunho qualitativo, não experimental, transversal e descritivo. Foi realizada entrevistas semi-estruturadas com coordenadores (N = 03) e discentes (N = 15) de três cursos de especialização em enfermagem do trabalho, sendo dois de instituição pública e um de instituição privada de ensino. Aplicou-se a análise de conteúdo de Bardin. Também foi realizada a análise dos PPP dos cursos, uma vez que delineiam os objetivos e/ou missão do curso, o ementário e a grade curricular. A maioria dos alunos entrevistados e um coordenador não tinham ouvido falar sobre a determinação social da saúde. Todos os cursos abordam direta ou indiretamente conteúdos relacionados a este tema. Dentro da perspectiva da Saúde Coletiva, em que se insere a Saúde do Trabalhador, a formação do enfermeiro do trabalho deve considerar a história de vida e a forma de inserção do trabalhador na sociedade, bem como suas relações de reprodução social. Contudo, verifica-se que o ensino em enfermagem do trabalho continua pautado no enfoque positivista do processo saúde-doença, estabelecendo relações entre indicadores de saúde, desconsiderando o caráter histórico-social deste processo. Dentro de uma perspectiva social ordenada pelas relações capitalistas em que vivemos, é sem dúvida difícil pensar numa outra forma de abordar o ensino das diversas profissões da saúde. Todavia, é necessário repensar a formação e atuação dos profissionais de saúde, dentro de uma ótica inter, multi e transdisciplinar apontada pelo campo Saúde Coletiva, a fim de ampliar o olhar sobre o sujeito para além da visão centrada na doença, considerando os aspectos subjetivos envolvidos na determinação social da saúde. Logo, demandam-se mudanças nas formas de pensar os currículos e de conduzir o processo ensino-aprendizagem desses profissionais de saúde. / Workers' health conditions result from many determinants of individual nature, such as genetic inheritance and human biology, and of economic, socio-cultural, political, technological and organizational conditioning factors. These factors are expressed in the way of life of individuals and social groups. Thus, the social determination of health is verified through the social-historical character and the bio-psychological aspect of individuals. In the light of that some concerns were raised: Is the occupational health nursing formation still guided by the biologicist hegemonic model? Does it handles contents on the health-disease social production process? We delineated as a general objective of the study: Analyze the formation of the occupational health nurse, with reference to the discussion of social determination of health. And as specific objectives: a) To characterize the academic profile and the political-pedagogical project (PPP) from presential lato sensu occupational health nursing courses in Rio de Janeiro; b) Analyze the formation of the occupational health nurse in the light of the discussion on the social determination of health; and c) Discuss the formation of the occupational health nurse and the influences of social context in shaping their curriculum and social practice. This constitutes a study of qualitative nature, non-experimental, cross-sectional and descriptive. It was conducted semi-structured interviews with coordinators (N = 03) and students (N = 15), from three post graduation courses in occupational health nursing, being two from public institutions and one from a private educational institution. It was applied the Bardin content analysis. It was also carried out an analysis of the courses PPP, since they delineate the objectives and/or mission of the course, the program and the curriculum. Most of the students interviewed and a coordinator had not heard about the social determination of health. All courses cover, directly or indirectly, contents related to this subject. From the Public Health perspective, in which the Occupational Health is inserted, the occupational health nurses formation should consider the life history and the form of participation of workers in society and their relations of social reproduction. However, it appears that the occupational health nursing teaching is still guided by positivist approach of health-disease process, establishing health indicators relations, disregarding the social-historical character of this process. Within a social perspective ordered by capitalist relations in which we live in, is undoubtedly difficult to think of another way to approach the teaching of the various health professions. However, it is necessary to rethink the formation and performance of health professionals, within an inter, multi and interdisciplinary perspective appointed by the Public Health field in order to broaden the view on the subject beyond the sight focused on the disease, considering the subjective aspects involved in social determination of health. So it is required changes in the ways of thinking curriculum and of conducting the teaching-learning process of these health professionals.

Justificativa: As Internações por Condições Sensíveis à Atenção Básica são um conjunto de problemas de saúde, para os quais o acesso aos serviços de AB e ações efetivas poderiam reduzir a ocorrência destas internações, tornando-as um indicador de resultado para avaliação da qualidade e do acesso nesse nível de atenção. Assim, analisou-se o indicador de ICSAB, buscando fatores associados à sua ocorrência, a fim de avaliar a sua capacidade de verificar a resolutividade da atenção básica. Métodos: Realizou-se uma análise exploratória descritiva do ICSAB nas sete macrorregiões de saúde e 30 regiões de saúde do Rio Grande do Sul, com base na Cobertura de Saúde da Família, seguida de uma revisão da produção indexada sobre ICSAB, com o objetivo de verificar quais fatores estão correlacionados com o desfecho ICSAB. Por fim desenvolveu-se um estudo ecológico com medidas agregadas, testando o grau de correlação linear entre as variáveis selecionadas a partir da revisão, utilizando o coeficiente de correlação de Spearman Resultados: Foram encontrados na literatura diversos fatores correlacionados à ocorrência de ICSAB, tanto no âmbito da disponibilidade de serviços de saúde, como na perspectiva socioeconômica. Em relação a realidade do RS, encontrou-se correlação de ICSAB com quantidade de leitos (p=0.002), Proporção de pessoas com planos de saúde (p=0,001), IDH (p=0.004) e analfabetismo (p=0.001) e população menor de quatro anos (p=0,001). Considerações: O indicador ICSAB cumpre seu objetivo de tornar comparável de forma sintética a situação da Atenção Básica nas diversas possibilidades de recortes territoriais. Contudo, as variáveis que interferem nesse desfecho são diversas, operando de maneiras diferentes em cada contexto e necessitando de maior aprofundamento. Enquanto subsídio para políticas e ações de qualificação da Atenção Básica, a mudança desse indicador só ocorrerá quando esse dado servir como dispositivo inicial para entender processos complexos e locais, que ocorrerão através de processos de educação permanente. / Background: Hospitalizations for Sensitive Conditions to Primary Health Care (HSCPHC) are a group of health problems, for which access to Primary Health Care services and effective actions could reduce the occurrence of these hospitalizations, making them an outcome indicator for quality and access to this level of attention. Thus, the HSCPHC indicator was analyzed, looking for factors associated with its occurrence, in order to evaluate its capacity to verify the resolution of basic care. Methods: A descriptive exploratory analysis of the HSCPHC was carried out in the seven macro-regions of health and 30 health regions of Rio Grande do Sul, based on the Family Health Coverage, followed by a review of the indexed production on HSCBC, with the objective of verify which factors are correlated with the HSCPHC outcome. Finally, an ecological study with aggregate measures was developed, testing the degree of linear correlation between the variables selected from the review using Spearman's correlation coefficient Results: A number of factors correlated with the occurrence of HSCPHC were found in the literature, both in terms of the availability of health services and in the socioeconomic perspective. In relation to Rio Grande do Sul reality, we found a correlation of HSCBC with number of hospital beds (p = 0.002), Proportion of people with health plans (p = 0.001), HDI (p = 0.004) and illiteracy (p = 0.001) and population younger than four years (p = 0.001). Considerations: The HSCPHC indicator fulfills its objective of making the situation of Primary Health Care in the various possibilities of territorial cuts comparable in a synthetic way. However, the variables that interfere in this outcome are diverse, operating differently in each context and requiring further study. As a subsidy for policies and actions to qualify Primary Health Care, the change in this indicator will only occur when this data serves as an initial device to understand complex and local processes that will occur through processes of permanent education.