Trabalho, Educação e Saúde - TES (Work, Education and Health) is an open access scientific journal, edited by the Joaquim Venâncio Polytechnic School of Health, from Oswaldo Cruz Foundation.
Editorial
Editorial
Article
Knowing how is organized the working process in any productive activity is essential to understand the impact on health workers. This knowledge is associated with the form how society is organized, which may result in the full development of the being, but also contribute to estrangement/alienation. The study that originated this article aims to understand how is organized the peasantry working process in two settlements, influenced by distinct factors: the Agribusiness and the Agroecology and, from this relationship, the labor’s estrangement/alienation and its impacts on the settlers’ health. It’s a multiple cases study, based on a qualitative approach, using semi-structured interviews and focus groups. The study was made between January and May 2016, in two sets of the Metropolitan Region of the Recife, Pernambuco, Brasil. Data processing and analysis followed a perspective that considers the totality and historicity of social relations and their articulation with particular social processes guided the data processing and analysis. The results show that the
condition of estrangement (and the struggle against it) occurs in different ways in the two settlements, but, in both cases, it’s related to the settler’s health. When influenced by agribusiness, presented in a specialized production, almost exclusively of goods and intensive use of pesticides. Regarding the influence of agroecology, has a diversified production, abolishing the use of pesticides and with less intensity at work.
Article
The article presents an analysis about the importance of militancy in the construction of a regional public policy of permanent education. Taking as a reference the political action of participants of the Commission for Integration Teaching-Service, in Region 28 of Health, in Rio Grande do Sul, Brazil, the analysis gives attention to the political space that Comission participants occupy not only in the political, but also in the execution of actions related
to permanent health education in the region. From the methodological point of view, the research was based on two main procedures: survey and analysis of secondary data, which covered legislation related to the policy of permanent education in health and the structuring of Commission for Integration TeachingService; semi-structured interviews with Commission for Integration Teaching-Service participants from Region 28 of Health of Rio Grande do Sul. As a result, it was verified that, although the Commission for Integration Teaching-Service was established by legislation with only advisory functions within the health regions, the committed performance of its participants in Region 28 of Health of Rio Grande do Sul is able to transform it into an important space (regional) of militancy and execution of policies of permanent education in health.
Article
The aim of this study is to discuss the contributions of the theatre of the oppressed in health promotion and to collaborate with the improvement
of the consolidation of this dialogue in practice experiences. Comparing the main perspectives of health promotion, there is a mismatch between the ethical, aesthetic and political foundations of the theatre of the oppressed and the theoretical assumptions of the behaviorist health promotion, because this kind of theatre pulls away from any attempt at domestication of bodies and norms of behavior, habits and lifestyles to reach healthy standards. There are greater consonance between the theatre of the oppressed and the new health promotion, its politicization and its searches to approach scientific and technical knowledge with popular knowledge, since both seek the fortification of humane practice that put in question the status quo and the social change towards a libertarian and critical transformation.
Article
This article aims to understand the meaning of the work for the higher education teacher in public and private institutions in their various regimes of work
flexibility based on the identification of instrumental and subjective rationality elements. The collection of data had multiple sources, such as the documentary analysis of institutions and teachers’ work contracts, direct observation and personal interviews. As a result it was noticed that: there is a preponderance of the substantive meaning of the work on the instrumental sense; the flexibilization alters the perception of individual performance and infers on its substantive sense, and life is arranged from the organization of work flexibilized.
Article
This article aims to identify and analyze the concepts of health present in teachers’ demands at the National Confederation of Education Workers, in
Brazil. It is the result of a documental research carried out on the resolutions of congresses held by the labor union in the period from 1999 to 2014. Using content analysis of documents, references to health were classified in demands either of economic-corporative or ethical-political nature. The results of the documental investigation indicate that, besides a strict concept of health marked by corporative demands, there is also a broad concept of health. The demand for health under the perspective of a social right guaranteed through public policies may be a fertile pathway for the defense of health in its ontological sense, rather than as an economic factor understood as merchandise and sufficient to reproduce the workforce.
Article
The aim was to investigate health literacy and association with social and demographic factors, self-perception of health and quality of life in adults. This is a cross-sectional study with adults between 20 and 59 years, users of primary health care, conducted in the basic health units, from February to May of 2015 – probability sample. Health literacy was evaluated by means of Short Assessment of Health Literacy for Portuguese-speaking Adults. Descriptive statistical analysis, bivariate analysis (p ≤ 0.20) and multiple logistic regression (p ≤ 0.05) were performed. Inadequate health literacy was recurrent and initially associated with sex, schooling, last grade concluded with approval, minimum formal study, Brasil Economic Classification Criterion, health insurance, family arrangement, importance attributed to health, grade attributed to own health, attendance to the basic health unit and two domains of the test World Health Organization Quality of Life (social relations and environmental). In the final model of logistic regression, only schooling remained associated with health literacy, in a way that individuals with less schooling had more chance of having inadequate health literacy. The findings suggest the need to develop health education strategies for adult users of primary care.
Article
Different conceptions of care permeate the health sector playing an important role in the practices adopted in all fields, including mental health. This research sought meaning for mental health care in the Psychosocial Care Network of Brazilian Unified Health System. The study is methodologically of a phenomenological qualitative nature, from the heideggerian hermeneutics referential. The analytical path was also inspired by the reference of Visual Anthropology and its ethnographic approach. The efforts undertaken in this research came up from the selection of 21 photographs that depict different experiences about the care exercised inside some devices of mental health. From these images, the meaning of care exercised in the Psychosocial Care Network devices emerged as still linked to the notion of care based on effective actions and operations considered appropriate only by following protocols, welfare criteria and activities recommended on manuals. The care deemed necessary for the scope of mental health is one that values people, is interested in their feelings and expectations as to what professionals can come to collaborate to meet the needs, reduce people’s suffering and to the reconfiguration of health devices.
Article
This article presents a synthesis of observations developed in a research that had as objective to elaborate a pedagogical project to qualify the community health agents in health surveillance of the worker based on the perception of the subjects themselves. It was a qualitative study carried out in 2016, in Vitória da Conquista, Bahia, Brazil, which used the theoretical reference of action research and the focus group technique to approach the subjects. The first stage of the results exposes the view of the nurses regarding the qualification of the agents in health surveillance of the worker, and the second describes the participation and the perception of the community health agents in the construction of the pedagogical proposal of training. The nurses recommended that the training in health surveillance of the worker be built based on the assumptions of permanent education and showed interest in participating in this educational process. There was unanimity of the participating agents regarding the need for training. They suggested contents, methodology and didactic material for the construction of the pedagogical proposal, expressing the desire to participate in an educational process able to overcome the barriers of training, as a true process of permanent education in health.
Article
The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases
to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.
Article
The objective of this article is to present the process of elaboration of educational material to support actions with young people in the thematic of drugs, result of emancipatory action research, developed during 14 workshops, with researchers and health workers. It was organized in three axes: the structural dimension, which analyzes the production-distribution-drug-consumption phenomenon in the context of contemporary social structure and dynamics; the superstructural dimension, which discusses hegemonic ideology and values in contemporary society and its relation to the phenomenon of drugs; and the axis that analyzes the responses of youth to social contradictions, with discussion about the possibility of political organization as a process of strengthening youth to cope with distress. The parts that make up each axis are: a base text; indication of films and complementary texts; questions to deepen the discussion; pedagogical strategies. The didactic material favors critical and radical educational processes, those that expose the social contradictions that are at the basis of the production-circulation-drug-consumption phenomenon, and overcome formations that focus on the drug and that blame the user, processes that commonly put away the young people of the discussion.
Article
Mental health care is dependent on qualified human resources to respond dynamically to the service users’ needs. This qualification by reflection on the work processes is essential for effective change to a community and biopsychosocial perspective. The Community of Practice is a theoretical framework that fosters collaborative learning through mutual engagement in common projects and negotiation of meanings. The research had as objective to systematize the use of Community of Practice for improving mental health care, by systematic review at Capes Portal and Virtual Health Library in March 2015. We found nineteen articles and nine of them were selected for analysis. The studies evaluated the Community of Practice as positive to improve the services offered to the population, provide training from experts, and implement new methods of work. They highlight weaknesses (financial resources, initial misalignment between the participants, group conflicts) and potentialities (real engagement of participants, virtual participation, access to specialists, integration of professionals, users and families in a singleproject; training needs in context). We expected to clarify possibilities for training and investigative strategies for continuing education in mental health.
Article
The aim of this study was to understand the essential elements of the systematization process of the clinical practice of a pharmacist in primary health
care. This systematization was based on the framework of pharmaceutical care practice, which provides the foundation for comprehensive medication management services. The methodology utilized was autoetnography, built collaboratively between the authors. The data have been produced through participant observation, field journals, reflections and semi structured interviews with pharmacists who are building clinical practices in primary health care. The results have demonstrated that the main elements associated with the systematization of clinical practices are ‘the construction of a new professional identity in a multiprofessional team’ as well as ‘the incorporation of new activities in the work routine’, that, combined, result in ‘Integration of comprehensive medication management services in the flow of the health unit’. In this way, in order for the pharmacist to legitimize his role in patient care,
it is necessary to change, to transform, to reorganize and to rebuild his practice.
Article
This study intended to analyze the assigned meaning and the contributions of the work of the Family Health Support Centers, as well as the barriers and challenges to the daily practice of matrix support. This is a qualitative study involving multiple cases, which was performed in six cities in Bahia, Brazil. Semi-structured interviews were conducted with 43 professionals from the support centers and 40 from the family health teams. We used the theoretical reference of the matrix support in the pedagogical, therapeutic and institutional dimensions. The results were grouped into three categories: (Mis) Understandings about the work of the support centers; Infrastructure and working conditions; Appreciation and management of work. Our study has unveiled divergent understandings among supporters and family health teams about the role of the matrix support process, with conflicting expectations and implications for work. The current infrastructure has proved to be insufficient and inappropriate for the work of matrix support. The little appreciation of the support centers was also highlighted through the low adherence of the community to the collective activities, unsatisfactory wages and excessive workload. Misunderstandings about the innovative nature of matrix support and structural difficulties indicate outstanding challenges for achieving the supportive function.
Article
This study aimed to analyze the experiences of pleasure-suffering of eight assistants in administration of a university that requested removal motivated by some dissatisfaction. The study, carried out between September of 2013 and August of 2015, was referenced in the Psychodynamics of Work. We chose semi-structured interviews and content analysis. Different aspects related to work emerged from three central categories: pleasure; suffering; defensive strategies and fight for recognition. Concerning suffering, the interviewees pointed out the stigma and invisibility of the middle activities, constant concern with conflicting aspects of work, somatization and work intensification. The experiences of pleasure were related to salary conditions, work qualification, symbolic retribution and possibilities of recognition. Faced with suffering, defensive strategies were highlighted in the fight for recognition: prioritizing qualification; verbalization of problems; and search for instruments of conflict protection, among others. In the expectation of minimizing dissatisfaction the interviewees used the removal that proved to be successful in part of the cases, helping them in the re-signification of work and preservation of health. This instrument, however, does not act in the origin of the experiences of pleasure-suffering. Suffering, besides being intrinsic to work, is situated in an organizational context that creates obstacles to the individual possibility of re-signifying it through removal.
Article
The blood sector regulations in Brazil started to require specific levels of schooling geared to technical and practical knowledge of hemotherapy and immunohematology. This article aimed to identify, understand and analyze the images, ideas and perceptions about hematology y technical course taught in a school of public health, in Brazil. Methodologically, this was action research carried out between March 2012 and December 2013, with teachers, students and technical references. We found that the course was considered relevant, with good content, despite its centralization in the city in the southeast of the country. We conclude that schooling in hematology is done urgently, however, inserting techniques and process of labor relations in the field of Hematology is marked by weakness and absence of the guidelines.
Article
Legitimated by the World Health Organization, Complementary and Alternative Medicine have shown an increasing demand in the Western world. Professional training is considered one of it’s biggest challenges to its advance in the Brazilian National Health System. The descriptive quantitative study presents the availability of modules of Complementary and Alternative Medicine in six public institutions of higher education at the state of Rio de Janeiro, 2014, identified on these respective websites and secretariat, and classified according to the variables: institutions of higher education, health subarea, level of education (undergraduate and graduate), subtopics of Complementary and Alternative Medicine (Homeopathy, Acupuncture, Meditation etc.); Format (mandatory, elective or optional) and content (informative or formative). The results shows an offer of 56 modules distributed in almost all sub-areas of health care, mainly in Medicine, Pharmacy and Nursing, with a predominantly optional and informative approach. The main themes are Homeopathy, Meditation and Body Practices. The analysis of this offer, based on the perspective of integral care and referenced in national and international literature, points out challenges for the expansion and qualification of the teaching of Integrative and Complementary Practices, among them the integrated insertion in health courses aiming at the interaction and complementarity between knowledge.
Article
Analyses of work accidents and organizational anomalies are traditionally based on external consultancy, or internal or external analysis, which generally fails in terms of the engagement and involvement of internal actors during the diagnosis or creating solutions. This paper aims to analyze if the interventionist method called Change Laboratory used in the analysis of organizational determinants and latent conditions of work accidents promotes agency and expansive learning of the involved actors, contributing to visualize/construct possible changes in the conception and development of the activity of construction of large buildings. Six sessions of Change Laboratory were analyzed to identify the micro-cycles of learning, facilitated by series of double stimulation. The sessions led to the engagement of the actors who created their own artefacts or appropriated the concepts or models, such as the timeline of the airport building, vicious circle, activity system, contradictions identified in origin of the anomalies and the possible solutions for future building projects. The study showed that the Change Laboratory can be used in systemic analysis of work accidents and anomalies. It is a powerful instrument for organizational collective learning when the group of actors becomes involved at comprehending, analyzing and creating solutions.
Article
The objective of this article is to understand the performance of the supporters in a public maternity hospital in the state of Alagoas, Brazil, during the course of implanting the National Humanization Policy, moreover, this study analyzed how the promotion and development of National Humanization Policy practices have been happening in the institution. So, it emphasizes the implementation of the guideline value of labor and worker, including, in this path, the difficulties and facilities found by the supporters combined with the management bodies and also in the fulfillment of intervention processes. The present study is based on the social health research field with qualitative approach. It has been analyzed institutional documents and conducted in-depth research with key actors in this process. The data analysis in methodological basis was Hermeneutics Dialectic. It was built an analytical matrix with two macro categories and six operative categories to organize and present the data collected. The analysis of data allowed to understand the main strategies used by supporters in daily lives of their work, which leads to National Humanization Policy progress and point disconnections and critical nodes to be problematised.
Article
This is a qualitative study focused on the connections between the child guardian council and the health sector as well as the partnership during the years 2013 and 2014. The study included 45 tutelary councilors in the Metropolitan Region of Fortaleza, Ceará, Brazil. Data were built by semi structured interviews and their contents were analyzed. The conclusion pointed to the child guardian council is health sector partner and the lack of a partnership. This mismatch between the child guardian council and the health sector actions demonstrates intersectional gaps. Solving dialogue from a clinical approach and with the rights assurance would result in lower costs and more successful actions in reducing the violence against children and adolescents.
Review
Review
*
Ensaio
The expansion of the influence of medicine on social demands and moral issues has been the subject of intense discussions, but many experts claim that the analysis has lost rigor. By this essay, we recover the deeper senses of the term medicalization and discuss two interrelated assumptions: if public policies with a positive impact on the population health levels would meet a demedicalizing role and if the deepening of democracy could be considered an essential condition to face the medicalizing processes. We summarize core concepts related to the main driving forces of medicalization processes and also changes associated with increased control over nature transforming life as we know it, highlighting the advance of capitalist economic order on other spheres as the state and the community. We argue that any long-range demedicalizing perspective would depend at least two hypotheses interrelated, corresponding to the model that guides the response to health needs, and the strength of democracy in its double meaning, either as a politics category able to put the majority sectors of society at the heart of state decisions, either as an economic category able to change the economic effects of capitalism in the state-society relations.
Erratum