The field of work rehabilitation in Brazil recently incorporated changes in its underlying concepts and principles, expanding the definition of incapacity for work based on the biopsychosocial health model and adopting a territorial approach and inter-sector practices, with a view towards backing the implementation of an integrated inter-sector work rehabilitation model. However, these conceptual and normative advancements have still not been implemented in practice; they have actually come under threat from Brazil's on-going political crisis. This article discusses the current scenario in the work rehabilitation program under the Brazilian National Social Security Institute (INSS), presents the strides in the underlying theoretical premises and the concerns of work rehabilitation in the face of recent measures that reinforce the biomedical basis and the compensatory policy that led the program over the years, and signal the impending privatization of this social security service and right. The article suggests that work rehabilitation faces a scenario of uncertainties and concerns, intensified by the institutional undermining of the INSS. Rapid structural changes in the INSS and in the work rehabilitation program have undermined the gains that had promoted the initial development of a comprehensive, inter-sector work rehabilitation program aimed at healthy return to work.
Resumo Objetivo: Apresentar metodologia padronizada para vinculação de diferentes bancos de dados em saúde pública. Métodos: Artigo de revisão metodológica, com descrição específica de processos de tratamento de dados para vinculação (linkage) determinística entre bancos de dados estruturados. Instruiu-se como tratar os dados, selecionar chaves de vinculação e vincular os bancos, utilizando-se dois bancos de dados simulados no software R. Resultados: Foram apresentados os comandos utilizados para a vinculação determinística, do tipo inner_join. O processo de vinculação resultou em um banco de dados com 40.108 pares ao se utilizar apenas a chave “Nome”. Com a adição da segunda chave, “Nome da mãe”, o resultado caiu para 112 pares. Ao adicionar a terceira chave, “Data de nascimento”, apenas dois pares foram identificados. Conclusão: A vinculação de bancos de dados e suas análises são ferramentas válidas e úteis para os serviços de saúde, no apoio a ações de vigilância em saúde.
Vocational rehabilitation (VR) aims at improving work ability to facilitate workers’ return to work. VR is provided in Brazil by the public social security system. The aim of the present study was to analyze trends in VR indicators for Brazil from 2007 to 2016. Based on open-access, secondary aggregate data, we calculated the cumulative incidence of VR indicators. We fitted Prais-Winsten generalized linear regression models to estimate trends and calculated annual percent variation with the corresponding 95% confidence interval (95% CI). The mean cumulative incidence of referrals to VR services was 37.16/1000 temporary disability benefits granted and exhibited a decreasing trend of −6.92% (95% CI: −8.38; −5.43). The mean cumulative incidence of admissions to VR services was 57.34/100 referrals and exhibited an increasing trend of 3.31% (95% CI: 1.13; 5.53). The mean cumulative incidence of rehabilitation was 57.43/100 admissions and remained stable along the analyzed period, −2.84 (95% CI: −5.87; 0.29). Our findings evidence a reduction in the number of workers referred for VR, an increase of admissions, and stability in the cumulative incidence of rehabilitated workers.
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