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Importance: Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs. Objective: To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits. Design, Setting, and Participants: The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed. Interventions: Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+. Main Outcomes and Measures: Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery. Results: A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31). Conclusions and Relevance: In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone. Trial Registration: ClinicalTrials.gov Identifier: NCT04844021.

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Este estudo traz dados de uma pesquisa de doutorado que objetivou conhecer a relação entre a precarização do trabalho e a saúde dos profissionais de um Centro de Atenção Psicossocial (CAPS). Trata-se de uma pesquisa de cunho qualitativo no campo da Saúde do Trabalhador. Foram realizadas entrevistas individuais semiestruturadas e observações sistemáticas com os trabalhadores. A partir dos depoimentos e das observações, foram percebidos problemas de ordem de gestão e de recursos materiais e humanos necessários para o bom funcionamento do serviço que geraram preocupação e sofrimento aos profissionais. Um outro componente que também colaborou para a precarização do trabalho desses profissionais foi o trabalho terceirizado. Além disso, os profissionais expressaram suas experiências e seu cotidiano de trabalho por meio de sofrimento, angústia e dificuldades para realização do trabalho. O sofrimento do trabalhador da saúde mental também tem suas particularidades, inerentes ao próprio tipo de trabalho, visto que tais profissionais estão expostos ao sofrimento e à dor de outras pessoas

This study brings data from a doctoral research which aimed to understand the relationship between the precarization of the work and the health of professionals from Psychosocial Care Center (CAPS). The study is qualitative research in the field of Occupational Health. Semi-structured individual interviews were carried out as well as systematic observation of the workers. Based on the interviewees' testimonies and analyzes, some management problems as well as lack of material and human resources necessary for the correct functioning of the service were noticed, which caused concern and suffering on the workers. Another component that also contributed to the precarious work of these professionals was outsourced work. Besides, workers expressed their experiences and their daily work through suffering, anguish, and difficulties in performing their work correctly. The suffering of mental health professionals also has its particularities, inherent to the type of work itself, since they are constantly exposed to other people's suffering and pain

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Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.

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BACKGROUND: Insights from behavioral economics, or how individuals' decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., "Nudge") powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? METHODS: The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians' use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. DISCUSSION: The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04844021 . Registered 14 April 2021.

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Este artigo tem por objetivo discutir o trabalho e a saúde de professores do ensino superior privado. Parte-se da premissa de que a precarização do trabalho é um dos principais fatores que degradam a educação e a saúde desses profissionais. Considerando a complexidade do tema, este artigo se fundamentou no materialismo histórico dialético e em estudos sobre saúde mental relacionada ao trabalho. Os dados foram obtidos por meio de entrevistas semidirigidas. Os resultados mostram que os docentes estão submetidos a condições precárias e intensificadas de trabalho. A preservação da idealização da atividade profissional é um facilitador da alienação que prende os docentes a uma representação do trabalho como missão, que, além de submetê-los a condições fisicamente desgastantes, também os sujeitam a pressão psicológica potencialmente adoecedora. Conclui-se que a mercantilização da educação e do ensino descaracterizam a função do educador e propiciam o desgaste, o mal-estar e o adoecimento.

This article aims to discuss the work and the health of professors who work at private institutions of higher education. It is assumed that the precarious work is one of the main factors which degrade not only education but also the health of those workers. Considering the complexity of the theme, this study was based on dialectical and historical materialism, in addition to studies about occupational mental health. Data have been collected through semi-structured interviews. Results showed that professors are subjected to precarious and intensified working conditions. To remain idealizing the profession is to facilitate an alienation that holds professors to see the work as a mission, what beyond to subject them to exhausting physical conditions, lead to a psychological pressure that may become a disorder. Thus, it is concluded that the commercialization of education distort the role of the educator and cause exhaustion, malaise and illness.

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Trata-se de um estudo sobre prática da educação em saúde, com ênfase no autocuidado bucal e fundamentado nas Metodologias Ativas de Ensino-Aprendizagem (MAEA). As metodologias ativas possuem, dentre suas características, o deslocamento do protagonismo do educador para o educando, incentivando a sua inserção como principal responsável pela sua aprendizagem. Objetivou interagir, debater e promover a saúde e o autocuidado, com destaque na saúde bucal, de acordo com a realidade do grupo de adolescentes no contexto do Sistema Único de Saúde. O estudo foi desenvolvido por meio de duas oficinas, totalizando a participação de 40 adolescentes, em dias distintos e sequenciados. Centrou-se na reflexão do cotidiano, nos interesses, necessidades e nos contextos social e cultural dos adolescentes, buscando estimular um processo de desconstrução/construção de conhecimentos, propiciando a busca de novos e diferentes saberes. A experiência da prática educativa relatada recebeu avaliação positiva na percepção de seus educandos, bem como facilitou o diálogo e a interação entre os mediadores e adolescentes. Verificou-se a participação intensa dos adolescentes durante as oficinas e a reflexão crítica sobre o cuidado em saúde, ligada aos problemas da vida. A prática educativa promoveu a construção de possibilidades compartilhadas ao lidar com adversidades cotidianas e conflitos familiares, pois revelouse exitosa e repleta de potencialidades crítico-reflexivas na tomada de decisão em saúde, segundo a visão dos adolescentes (AU).

This study addressed the practice of health education, with emphasis on oral self-care and based on Active Teaching-Learning Methodologies (ATLM). The active methodologies present, among their characteristics, displacement of protagonism from the educator to the student, encouraging their insertion as the main responsible for their learning. It aimed to interact, discuss and promote health and self-care, with emphasis on oral health, according to the reality of the group of adolescents within the context of the Brazilian Unified Health System. The study included two workshops, involving participation of 40 adolescents, on different and sequenced days. It focused on the reflection of daily life, interests, needs and the social and cultural contexts of adolescents, aiming to stimulate a process of deconstruction/construction of knowledge, providing the search for new and different knowledge. The reported experience of educational practice was positively evaluated in the perception of students, and facilitated the dialogue and interaction between mediators and adolescents. There was intense participation of adolescents during the workshops and critical reflection on healthcare, related to life problems. The educational practice promoted the construction of shared possibilities in dealing with daily adversities and family conflicts, as it proved to be successful and full of criticalreflexive potentialities in health decisionmaking, according to adolescents' standpoint (AU).

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This article results from a research carried out among nursing professionals at the Hospital das Clínicas da Universidade Federal de Uberlândia (MG), located in Uberlândia (MG), Brazil, and aimed to examine the relations between these professionals' work, health and living conditions. Data were collected through semistructured interviews and observations in the work environment. The results indicate the common occurrence of physical and mental health problems, mainly resulting from stress and exhaustion provoked by work conditions, which cause interferences in their living conditions. Paradoxically, the results show that these workers do not realize their health treatments systematically. The analysis of their work, in combination with the gender issue and the specific nature of nursing work, contributed to a better understanding of this professional group's work, living and health conditions.

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Este artigo é resultado de pesquisa realizada com profissionais de enfermagem do Hospital das Clínicas da Universidade Federal de Uberlândia, MG, e teve por objetivo investigar as relações entre o trabalho, a saúde e as condições de vida daquelas profissionais. Os dados foram coletados através de entrevistas semi-estruturadas e de observações do ambiente de trabalho. Os resultados apontam ser comum a ocorrência de problemas de saúde orgânicos e psíquicos decorrentes principalmente do estresse e do desgaste provocado pelas condições laborais, com reflexos nas condições de vida. Paradoxalmente, os dados revelam que aquelas trabalhadoras não realizam seus tratamentos de saúde de forma sistematizada. A análise do trabalho, articulada à questão de gênero e à especificidade da atividade de enfermagem, contribuiu para melhor compreensão das condições de trabalho, vida e de saúde desse grupo profissional.

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