Elizabeth Artmann

Planejamento e gestão em saúde: flexibilidade metológica e agir comunicativo

Este artigo pretende ser uma reflexao acerca das possibilidades e das lacunas do planejamento situacional no que tange ao desenvolvimento da imagem-objetivo de organizacoes dialogicas ou comunicantes. Estabelece, ainda, um inicio de dialogo com as correntes de planejamento de saude mapeadas no Brasil e define algumas tematicas de investigacao que podem oferecer o necessario complemento para que o planejamento cumpra sua funcao como agir comunicativo.

Acurácia em métodos de relacionamento probabilístico de bases de dados em saúde: revisão sistemática

OBJECTIVE To analyze both national and international literature on validity of record linkage procedure of health databases focusing on quality assessment of results. METHODS A systematic review of cohort, case-control, and cross-sectional studies that evaluated quality of probabilistic record linkage of health databases was conducted. Cochrane methodology of systematic reviews was used. The following databases were widely searched: Medline, LILACS, Scopus, SciELO and Scirus. A time filter was not applied and articles were searched in the following languages: Portuguese, Spanish, French and English. RESULTS Summary measures of the quality of probabilistic record linkage were sensitivity, specificity, and positive predictive value. There were identified 202 studies, and after applying the inclusion criteria, a total of 33 articles were reviewed. Only six had complete data on the summary measures of interest. The main limitations were: no reviewer to evaluate titles and abstracts; and no blinding of the articles authors in the review process. Most scientific publications in this field were from the United States, United Kingdom, and New Zealand. Overall, the accuracy of probabilistic record linkage of databases ranged from 74% to 98% sensitivity and 99% to 100% specificity. CONCLUSIONS Probabilistic record linkage of health databases has notably been characterized by high sensitivity and greater flexibility of the procedures sensitivity, indicating concern with data accuracy. The positive predictive value in studies shows a high proportion of truly positive record pairs. The quality assessment of these procedures has been proved essential for validating the results obtained in these studies, and can also contribute to improve large health databases available in Brazil.OBJETIVO: Analizar la literatura nacional e internacional sobre validez de metodos de relacionamientos nominales de base de datos en salud, con enfasis en las medidas de confirmacion de la calidad de los resultados. METODOS: Revision sistematica de estudios de cohorte, caso-controles y seccionales que evaluaron la calidad de los metodos de relacionamiento probabilistico de base de datos en salud. Fue utilizada metodologia Cochrane para revisiones sistematicas. Las bases consultadas fueron las mas ampliamente utilizadas: Medline, LILACS, Scopus, SciELO y Scirus. No fue utilizado filtro temporal y los idiomas considerados fueron: portugues, espanol, frances e ingles. RESULTADOS: Las medidas rapidas de la calidad de los relacionamientos probabilisticos fueron la sensibilidad, la especificidad y el valor predictivo positivo. De los 202 estudios identificados, posterior a los criterios de inclusion, fueron analizados 33 articulos. Solo seis presentaron datos completos sobre las medidas-rapidas de interes. Se observan como principales limitaciones la ausencia de revisor en la evaluacion de los titulos y de los resumenes de los articulos y el no-ocultamiento de la autoria de los articulos en el proceso de revision. Estados Unidos, Reino Unido y Nueva Zelandia concentraron las publicaciones cientificas en este campo. En general, el perfeccionamiento de los metodos de relacionamiento probabilistico de bases de datos vario de 74% a 98% de sensibilidad y 99% a 100% de especificidad. CONCLUSIONES: La aplicacion de relacionamiento probabilistico a bases de datos en salud se ha priorizado por la alta sensibilidad y mayor flexibilizacion de la sensibilidad del metodo, mostrando preocupacion con la precision de los datos que se obtendran. El valor predictivo positivo en los estudios apunta alta proporcion de pares de registros verdaderamente positivos. La evaluacion de la calidad de los metodos empleados se ha mostrado indispensable para validar los resultados obtenidos en estos tipos de estudios, pudiendo aun contribuir para la calificacion de las grandes bases de datos en salud disponibles en el Pais.

Accuracy of probabilistic record linkage applied to health databases: systematic review

OBJECTIVE To analyze both national and international literature on validity of record linkage procedure of health databases focusing on quality assessment of results. METHODS A systematic review of cohort, case-control, and cross-sectional studies that evaluated quality of probabilistic record linkage of health databases was conducted. Cochrane methodology of systematic reviews was used. The following databases were widely searched: Medline, LILACS, Scopus, SciELO and Scirus. A time filter was not applied and articles were searched in the following languages: Portuguese, Spanish, French and English. RESULTS Summary measures of the quality of probabilistic record linkage were sensitivity, specificity, and positive predictive value. There were identified 202 studies, and after applying the inclusion criteria, a total of 33 articles were reviewed. Only six had complete data on the summary measures of interest. The main limitations were: no reviewer to evaluate titles and abstracts; and no blinding of the articles authors in the review process. Most scientific publications in this field were from the United States, United Kingdom, and New Zealand. Overall, the accuracy of probabilistic record linkage of databases ranged from 74% to 98% sensitivity and 99% to 100% specificity. CONCLUSIONS Probabilistic record linkage of health databases has notably been characterized by high sensitivity and greater flexibility of the procedures sensitivity, indicating concern with data accuracy. The positive predictive value in studies shows a high proportion of truly positive record pairs. The quality assessment of these procedures has been proved essential for validating the results obtained in these studies, and can also contribute to improve large health databases available in Brazil.OBJETIVO: Analizar la literatura nacional e internacional sobre validez de metodos de relacionamientos nominales de base de datos en salud, con enfasis en las medidas de confirmacion de la calidad de los resultados. METODOS: Revision sistematica de estudios de cohorte, caso-controles y seccionales que evaluaron la calidad de los metodos de relacionamiento probabilistico de base de datos en salud. Fue utilizada metodologia Cochrane para revisiones sistematicas. Las bases consultadas fueron las mas ampliamente utilizadas: Medline, LILACS, Scopus, SciELO y Scirus. No fue utilizado filtro temporal y los idiomas considerados fueron: portugues, espanol, frances e ingles. RESULTADOS: Las medidas rapidas de la calidad de los relacionamientos probabilisticos fueron la sensibilidad, la especificidad y el valor predictivo positivo. De los 202 estudios identificados, posterior a los criterios de inclusion, fueron analizados 33 articulos. Solo seis presentaron datos completos sobre las medidas-rapidas de interes. Se observan como principales limitaciones la ausencia de revisor en la evaluacion de los titulos y de los resumenes de los articulos y el no-ocultamiento de la autoria de los articulos en el proceso de revision. Estados Unidos, Reino Unido y Nueva Zelandia concentraron las publicaciones cientificas en este campo. En general, el perfeccionamiento de los metodos de relacionamiento probabilistico de bases de datos vario de 74% a 98% de sensibilidad y 99% a 100% de especificidad. CONCLUSIONES: La aplicacion de relacionamiento probabilistico a bases de datos en salud se ha priorizado por la alta sensibilidad y mayor flexibilizacion de la sensibilidad del metodo, mostrando preocupacion con la precision de los datos que se obtendran. El valor predictivo positivo en los estudios apunta alta proporcion de pares de registros verdaderamente positivos. La evaluacion de la calidad de los metodos empleados se ha mostrado indispensable para validar los resultados obtenidos en estos tipos de estudios, pudiendo aun contribuir para la calificacion de las grandes bases de datos en salud disponibles en el Pais.

Interdisciplinaridade no enfoque intersubjetivo habermasiano: reflexões sobre planejamento e AIDS

Este artigo se propoe a discutir a interdisciplinaridade na perspectiva de Habermas por ser este enfoque considerado relevante e bastante promissor para a area da saude, na medida em que permite uma abordagem mais ampla e ao mesmo tempo integradora das diversas racionalidades/especializacoes que perpassam este objeto tao complexo. Sao apresentados alguns conceitos basicos do paradigma habermasiano para discutir a possibilidade de construcao de um projeto interdisciplinar na area da saude, destacando o papel assumido pela linguagem na qualidade de articuladora da acao em geral e de todas as formas de saber ligadas a atuacao sobre o mundo, considerado em seu conceito triplice ampliado e em relacao ao mundo vital. Nesta discussao toma-se, ainda, como referencia, conceitos do Planejamento Estrategico Situacional e o exemplo do processamento parcial de um problema de aumento de incidencia da AIDS a partir do olhar da secretaria de saude de um municipio de medio porte.

Planejamento e gestão em saúde: histórico e tendências com base numa visão comunicativa

This article aims to present a condensed overview of major trends in Brazil, establish a general taxonomy of models of health management and planning, based on the international scene and support the proposal for a communicative planning. In a context of democratization, argues for a pluralistic conception and concludes that the various currents, albeit with different perspectives and referrals theoretical and methodological dialogue in a process of mutual exchange and learning.

A démarche stratégique (gestão estratégica hospitalar): um instrumento de coordenação da prática hospitalar baseado nos custos de oportunidade e na solidariedade

Este texto e uma apresentacao geral da metodologia de gestao estrategica hospitalar de M. Cremadez e F. Grateau (Franca), incluindo os objetivos, as fases e as principais ferramentas do enfoque. O trabalho destaca os aspectos microeconomicos do mesmo e suas possibilidades para estruturar redes de servicos atraves da pactuacao de metas e objetivos entre hospitais. Inclui a apresentacao de um caso de aplicacao do enfoque como instrumento de coordenacao regional da especialidade de cirurgia geral dos hospitais de uma area programatica (AP-4) da cidade do Rio de Janeiro.

Política, gestão e participação em Saúde: reflexão ancorada na teoria da ação comunicativa de Habermas

The article discusses the appropriation of the theory developed by Habermas to analyze health policies and management. The fundamental concepts of the discursive theory of democracy as a deliberative policy, procedural democracy, the public sphere and civil society are analyzed. An attempt is made to demonstrate that the concepts of deliberative policies are grounded on basic theoretical categories of Habermass conception of language, namely the theory of communicative action (TCA): lifeworld and system; communicative action and discourse; the ideal speech situation. The possibility of translating the categories presented in analytical categories, such as the experiences of social participation in deliberative forums and the results for the formulation and implementation of policies and health management is discussed. The conclusion drawn is that the theoretical categories reveal great explanatory potential and analytical categories are important provided that they are mediated and contextualized.

A liderança como intersubjetividade lingüística

This paper sums up some concepts regarding leadership and seeks to highlight the growing importance of the vision of a leader in assisting in organizational learning, based on team-work, and in coordinating linguistic communication processes oriented towards understanding the organizations mission, structure, and dynamics. Upholding that, in addition to their ability to implement strategic management, leaders must also develop communication skills and support change, in order to manage more effectively intersubjective relationships among organizational subjects, to make the organization more competent.

Trabalho em equipe interdisciplinar de saúde como um espaço de reconhecimento: contribuições da teoria de Axel Honneth

This theoretical study aims to correlate the discussion about interdisciplinary teamwork in public health institutions with the key concepts of contemporary philosopher Axel Honneth with regards to what he called the Struggle for Recognition. We start by revising the notion of subject in Honneths theory, especially based on his dialogue with Donald Winnicotts psychoanalysis. We highlight that this subject is eminently social; its constitution depends on the recognition of others regarding its otherness and the legitimacy of its belonging to a social group. Next, we show that this recognition occurs through a process of struggle, which is essential for developing the capacity to love and to relate to others. We then argue that the work in interdisciplinary teams can be configured as a potent space for the recognition of professionals, as discussed by Honneth. Teams may thus facilitate the development of creative work and innovations in the organization of care provided to patients.This theoretical study aims to correlate the discussion about interdisciplinary teamwork in public health institutions with the key concepts of contemporary philosopher Axel Honneth with regards to what he called the Struggle for Recognition. We start by revising the notion of subject in Honneths theory, especially based on his dialogue with Donald Winnicotts psychoanalysis. We highlight that this subject is eminently social; its constitution depends on the recognition of others regarding its otherness and the legitimacy of its belonging to a social group. Next, we show that this recognition occurs through a process of struggle, which is essential for developing the capacity to love and to relate to others. We then argue that the work in interdisciplinary teams can be configured as a potent space for the recognition of professionals, as discussed by Honneth. Teams may thus facilitate the development of creative work and innovations in the organization of care provided to patients.

Humanização da saúde em um serviço de emergência de um hospital público: comparação sobre representações sociais dos profissionais antes e após a capacitação

This article presents the results of a study of the type before and after training in Shelter with Risk classification compared to the humanization of social representations of health among 111 health professionals in an emergency hospital. Data collection was performed using the technique of free evocation and analysis was done using the EVOC software. The results showed changes in the symbolic meaning attributed to terms inducers towards incorporation of the right perspective in the representation of the Unified Health System, the translation of Humanization in health as Shelter, and the progression of understanding the Shelter, the humanistic focus to the qualification of processes of care of the users demand at emergencies. The results indicate that the differences found in the core before and after training were due to an apprenticeship, which based in peripheral elements, was able to question the core elements and interchange between the central and peripheral system, recognizing the functional complementarity between these two systems and the relationships between representations and practices. However, the method does not assert the persistence of such changes in the social representations of the objects studied in depth or measure the changes in daily practices.