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
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Article
This study examined the coordination of care based on data from the National Program for the Improvement of Quality and Access to Primary Care. It was a descriptive study based on questionnaires answered by 1,313 users and 324 primary care teams in the city of Rio de Janeiro (Brazil), in 2012. Dimensions such as the organization of the gateway, resolution and continuity of care, horizontal integration, organization of flows and access to the referral network, informational continuity, and communication among professionals were analyzed. The results indicated that primary health care has established itself as the preferred gateway. Users reported that primary care teams sought to solve their health issues, the electronic medical record was available, although it had not been integrated into the other levels, and the professionals stated they held weekly meetings and got matrix support. However, there was a long waiting time for specialized care and a lack of communication among professionals, a fact that not only hindered the users in their pursuit for care, but also revealed networking weaknesses. There was progress in the process of strengthening primary care and challenges to the establishment of the Health Care Network that minimized the possibilities for care coordination by the primary care teams.
Article
The aim of this study was to analyze factors associated with the identification and reporting of abuse of children and adolescents in the course of the practice of physicians working in primary care, as well as the influence their training had in this practice. Carried out between 2010 and 2012, the survey involved 227 Family Health Strategy physicians in municipalities of the state of Ceará, Brazil. Bivariate and multivariate logistic regression analyses were done based on data from questionnaires the participants responded to. Most reported not having been trained in the subject during their undergraduate studies (73.6%), that they did not know the form used to report violence (59%), and that the unit where they worked did not have such a form available (80.5%). Most also reported not knowing institutions they could refer victims of abuse to (85.6%). Of the participants, 53.1% had already identified at least one case of abuse of children and adolescents during their professional practice and 52.6% reported the case. Time since graduation, awareness of the notification form, and confidence in protection agencies were associated with the identification of abuse. The availability of the notification form at the unit and knowledge of a place to refer the victims to were factors for notification. It was concluded that there is a need to discuss and guide training physicians in the identification of this issue and in the handling of its notification.
Article
This study aimed to evaluate the quality of life at work and the main correlated factors for people with disabilities. This was a cross-sectional study carried out in 2012 at a reference center for the rehabilitation of people with disabilities located in the city of João Pessoa, the state capital of Paraíba, Brazil. The sample consisted of 110 individuals who answered a sociodemographic questionnaire; a validated scale was used to assess the quality of life at work. Cronbach's Alfa test, the Kaiser-Meyer-Olkin test, and Bartlett's sphericity test were done for data analysis. The level of internal consistency of the scale was satisfactory (α = 0.85), attesting to the reliability of the instrument that was used. The correlation matrix between scale items showed the possibility for factor analysis (KMO = 0.60) and Bartlett (p<0.001). Insofar as views on the quality of life at work is concerned, 67.9% pointed to dissatisfaction; 21.4%, had an intermediate evaluation, and 10.7% claimed to be satisfied. The most correlated factors were salary (0.74), possibility for professional growth (0.73), opportunity to express opinions (0.71), hour load and amount of work (0.66). It was concluded that the quality of life at work of people with disabilities is not satisfactory, mainly due to issues such as salary, working hours, inadequate amounts of work, and hurdles in career advancement.
Article
The study aimed to describe the views nursing students had on the psychosocial impacts and on the coping strategies of a population made vulnerable in the context of the construction of the Petrochemical Complex in Rio de Janeiro, Brazil. It was a descriptive research action using a qualitative approach and including 18 nursing students by means of the application of photovoice techniques and focus groups during the month of May 2015. The data were subjected to analytical content treatment. As consequences of the plant's construction process, participants only highlighted drug consumption and trafficking, sexual violence, and the availability of health services as social impacts with great potential to lead to psychological issues in the population, such as anxiety and depression. Only two participants problematized strategies to cope with environmental stressors focused on collective action. It was concluded that including a cross-section mode of the socio-environmental theme – and its relation to the mental health of populations made vulnerable by the industrial project construction contexts in the country, in undergraduate courses and other academic spaces – is essential to encourage the critical, reflective, and political skills of future nurses on the relationship between development projects, environmental degradation, equity and psychological impact on the population.
Article
This study sought to understand the coexistence between students, professors, and professionals at basic health units. This was a qualitative research study with a hermeneutic phenomenological approach, based on the philosophical theoretical frameworks of Martin Heidegger and carried out with students, network services professionals, and professors monitoring students in their activities at basic health units in the metropolitan area of a large city in southern Brazil. Data were collected through recorded interviews guided by a list of questions from November 2013 to March 2015. Participants, totaling 23 respondents, were selected intentionally. Coexistence among students, professors, and professionals at the basic health unit proved to be permeated by different ways of being. They unveiled conflicts related to language, specifically in verbalization and listening. This relationship was recognized as important for teaching-learning and for reflections on adjustments in the work process.
Article
The study presented in this article aimed to analyze social participation in a health promotion initiative carried out in the city of Campo Grande, Mato Grosso do Sul, Brasil. This survey was conducted in 2009 based on a qualitative approach involving document analysis, interviews (with managers and technicians), focus groups (regional directors), and content analysis with data triangulation. The views on social participation were not restricted to the experience, since the institutionalization of participation channels in the city and regional urban boards stood out, and they are seen as progress made in the democratic processes and as drivers of the greater involvement of the members of the board in urban planning decisions. However, barriers to democratic exercise were highlighted: The need for training in policy for advisers, the fragility of the population's presence in participatory instances, difficulty in coordinating with the legislative, a lack of knowledge and access to information, difficulties in acting as an adviser, and disbelief in the participatory process, which causes the evasion of leaderships. It was noticed that these collegiate spaces were strengthened and that the leaders in the neighborhoods came around common objectives, forming a growing spiral of participation driven by a network of community support.
Article
The study aimed to evaluate the role played by the Unified Health System’s position, career, and wage plan in Guarulhos municipality, in the state of São Paulo, Brazil, as a possible tool to improve labor relations, as recommended by the Ministry of Health. The research carried out between 2013 and 2014 was based on the collection and the analysis of the content of interviews conducted with managers and health worker focus groups. It was noted that the position, career, and wage plan has a strong technical and administrative bias, being seen as a tool for organizing workers in positions/jobs at health service locations. It is emphasized that initiatives that could promote professional fixation and development towards a career were affected budgetary restrictions that have compromised their application under the law. Hiring under it, which takes place via a public contest, included only direct administration employees, and the hiring of human resources through non-state partnerships was concomitant with its implementation. It was concluded that the position, career and wage plan is an important, albeit limited tool to improve work in the Unified Health System, and it is necessary to expand discussions on the effects of the State’s Administrative Reform in health and its impacts on the organization of the workforce and on the concept of precarious work, linked only to the observance of labor and social rights.
Article
The work presented here resulted from document research, semi-structured interviews, and focus groups with health teams, resident supporters, and primary care management on the joint experience between the matrix support and reference teams at family health units in the context of the reformulation of the care model being implemented in a municipality in the state of São Paulo in the first half of 2009. The authors reflected on the experience based on three dimensions: The initial understanding of the proposal, daily work, and the impact on the matrix support work process. It was found that there were proposal-understanding issues in the matrix support and that it came up against the predominance of biological healing practices and limits with regard to solving the population's problems. The integration among professionals enabled joint pacts, interdisciplinary work, and the construction of common therapeutic projects, allowing for promising prospects. We hope that these findings subsidize the current discussions on the planning and management of the matrix support in the local health system.
Article
The aim was to investigate the views and actions of health professionals working with people with physical disabilities at rehabilitation institutions with regard to social inclusion, the humanization of health, and academic training. A descriptive qualitative study was carried out using observations and semi-structured interviews as tools for data collection. Three categories originated from the results: The social aspects of the subject, expertise and knowledge on social inclusion and training, and the concept of humanization of health. We found the complexity of rehabilitating people with physical disabilities and to identify hurdles that need to be overcome, such as difficulties in early and adequate access to Unified Health System services; the lack of public policy and law effectiveness and efficiency with regard to health and accessibility, and a lack of sociocultural and humane training of the professionals involved. We concluded that the role played by academic training and effective public policies related to health and accessibility are fundamental to the social inclusion of people with disabilities because the process is related with interconnected aspects that require intersectoral work to ensure quality rehabilitation care.
Article
The study that originated this article aimed to understand the representations of Family Health Strategy professionals and users about education in health. It was an study carried out using a qualitative approach and participant observation and interview techniques through content analysis. It was conducted in 2008 and 2009. The group's representation denoted ‘education’ and ‘health’ as assets of social, cultural, and historical value that should be preserved in the family and in society at large, anchoring health care on strategies that overlap the prescription of procedures and behaviors. However, health service professionals and users associate ‘health education’ to the conveyance of technical knowledge, which should be done by trained professionals. Prevailing in health education practices were prescribing healthy habits in the individual dimension; thematic groups focused on specific diseases or health conditions; the users' passive behavior; difficulties in adherence, and mandatory actions. All study subjects viewed the conveyance of knowledge and the prescribing of habits for individual self-care the prevalent ways of representing health education. Observed health education practices can be characterized as traditional health care practices.
Article
The study that led to this article featured the results of an integrative review of literature on the management of work in the Unified Health System, and its purpose was to analyze the different scientific contributions, experiences, and strategies the municipalities developed in the area. The PubMed and SciELO databases were used for data collection in 2014. After applying the inclusion and exclusion criteria, 22 articles were analyzed. Most were published in the 2010–2011 biennium and referred to major cities or states. Two thematic categories were constructed: Work management concepts and issues related to the worker's functional life, such as provisioning and guaranteeing labor rights. It was noted that there has been evolution in the human resources term for the conception of work management; an expansion process in public employment at the municipal level and in the various forms of selection adopted; in employment bond stability from the 2000s, and that there are difficulties in attracting and securing professionals, as well as in the non-consolidation of the career, position and salary plan as a strategic tool for managing the work. The complexity of the issue and the need for constant studies were evident due to the importance of these factors for the Unified Health System.
Article
This study aimed to compare the evaluation of the working environment and the rates of alcohol abuse, depression and Burnout Syndrome among health care workers from a public and a private hospital of the metropolitan region of Porto Alegre, Rio Grande do Sul, Brazil, between January 2009 and January 2010. It is a quantitative study of descriptive and comparative type. Participants were 182 health workers, which 92 from public hospital and 90 from private hospital. Participants answered five instruments individually: sociodemographic and labor questionnaire, Alcohol Use Disorders Identification Test, Beck Depression Inventory, Maslach Burnout Inventory and Work Context Assessment Scale. Data were analyzed by descriptive statistical analysis and Student t test for comparison of means between groups of the two hospital types. Results indicated that the work context was rated significantly more negative by workers of the public hospital. The data also showed higher rates of illness in professionals working in this type of institution. It was concluded that mental illness of health workers is more related to the type of working environment (public or private) than professional category.
Article
Several undergraduate programs in public health have been created in Brazil since 2008. Previous publications have described the opening process, the student profile, and the experiences these courses have had. Here we present a general profile of courses that were opened between 2008 and 2014. The information was obtained from the Brazilian Association of Public Health's Undergraduate Forum in Public Health Coordination and from the courses' institutional homepages. During the study period, there was a significant increase in the number of undergraduate programs in public health in the country; new job openings grew sixfold, and 285 people got bachelors degrees in public health. In early 2014, there were 18 courses in operation (17 in the public sector), with a total of 2,532 students enrolled. While graduate-level training in public health predominates in the Southeast, undergraduate courses are well spread in the country, although there is a need for further expansion to meet the Unified Health System's demands. Although these courses' training guidelines are similar, there are differences in their nomenclatures. The challenges to be faced in the further consolidation of undergraduate courses in public health as a training modality include the needs of the national curriculum guidelines, the continued expansion of the courses, the professional recognition of the graduates, and their greater incorporation into public health in the labor market.
Ensaio
This essay aimed to analyze the need for new professional excellence guided by collective deliberation, debating the ethics applied to health issues in the Brazilian and Spanish experiences. The practical functioning of the bioethics committees in Spain is making progress in constituting the deliberative method as collective participation in professional decisions, discussing the importance of deliberative democracy to build new ethical civility. In Brazil, after the first decades of the construction of the Unified Health System, the professionals’ participation has widened, primarily in the health councils and, with CNS resolution No. 196/96, also in the ethics committees for research involving human subjects, improving new affirmative, organization and collective commitment actions aiming to expand responsibility in the construction and execution of public policies. Ethical deliberation becomes a central feature: professional decisions that were paternalistic and private in act have gradually expanded to collective and socially active deliberation, suggesting the need for a new professional excellence, beyond the merely technical and clinical–individual one. Brazilian bioethics takes on a leading role in the transformation of professional excellence guided by critical solidarity and commitment to public-social matters in deliberation collectives that take the population's quality of life into account.
Ensaio
This study aimed to know the perception of people with chronic non communicable diseases on their health, illness and care, as well as to analyze the practices of the primary care teams with these patients. It was a descriptive and exploratory research project using a qualitative approach, and was carried out in 2014 in the city of Sapucaia do Sul, state of Rio Grande do Sul, Brazil. Data collection was made through semi-structured interviews and focus discussions. The interpretative analysis was based on hermeneutics. The results portrayed a disincentive to adhere to the prescribed diet and dissatisfaction with both the monitoring practices and the care network. Considering the cultural, symbolic, and social dimensions may help rethink proposed diets and service planning, and continuing education opens up possibilities for improvements in care.
Erratum
No editorial com número de DOI: 10.1590/1981-7746-sol00033, publicado no periódico Trabalho, Educação e Saúde, 15(1):5–6, na página 6:
Onde se lia:
“Marcela Alexandra Pronko”
Leia-se:
“Marcela Alejandra Pronko”
As for the editorial DOI number 10.1590/1981-7746-sol00033, published at the journal Trabalho, Educação e Saúde, 15(1):7–8, page 8:
Where it reads:
“Marcela Alexandra Pronko”
It should read:
“Marcela Alejandra Pronko”
En el editorial con número de DOI: 10.1590/1981-7746-sol00033, publicado en la revista Trabalho, Educação e Saúde, 15(1):9–11, en la página 11:
Donde se lee:
“Marcela Alexandra Pronko”
Debe leerse:
“Marcela Alejandra Pronko”