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
Article
In 1880, Marx wrote and published A Worker's Inquiry to investigate the living and health conditions of the French working class. In addition to the research itself, it had to do with politicizing and strengthening the French workers‘ struggle organizations. A Worker's Inquiry is, therefore, an investigation and politicization mechanism of the working class. The purpose of this assay was to analyze how current the 1880 A Worker's Inquiry is today. Four aspects of it were discussed: Development and use, labor accidents, working hours and intensity of the work, wages, and living conditions. The consistency of A Worker's is due to the Marxist theory that supports it. This essay states that Marx’ questionnaire and the form of “worker's inquiry” – understood as a mechanism for research and politicization – remain valid.
Article
This article aimed to discuss the challenges to the implementation of mental health actions in the Family Health Strategy in the context of deinstitutionalization and of the territorialization of care. We described, in the view of the family health managers and teams, the territorial context, forms of identification of the demands, and the mental health support and care practices. We also evaluated the challenges to building powerful psychosocial approaches and network care. The research field consisted of two territories in the municipality of Rio de Janeiro (Manguinhos and Complexo do Alemão), Brazil, with iconic features of the city's urban context, in the period studied (2009-2013). The researchers worked with qualitative and collaborative methodology strategies that included interviews with managers, focus groups with workers, and systematic visits to the field. The data collected showed specific trends, such as the accelerated expansion of the Family Health Strategy with impact on the work process; the discourse of the managers with evidence of opening for the inclusion of mental health in the Strategy; workers' narratives explaining their sense of unpreparedness and a low perception of the therapeutic potential of primary care; violence in the territories causing tension and ambivalence in relation to local authorities; direct association between mental health and violence in daily life.
Article
The urgency of changes in the field of mental health derived from the redirection of the assistance model introduced the issue of training as a decisive element to support of the Brazilian psychiatric reformation process. This article presents the results of the “Mental health policy in the city of Rio de Janeiro: A study on the methods of training and qualification of mental health teams” research project, which aimed to study how the psychosocial care teams at the psychosocial care centers in the municipality of Rio de Janeiro, Brazil, produce their continuing education agenda in mental health and how the professionals recognize the ways of producing knowledge, thinking, and acting at the place where work and the production of care come together. We use simple observation and focus groups to collect data. The analysis of the material sought to identify the association of the discursive practices, which draw existential territories, with the pedagogical practice in the work process, joined with the analyzer concept. In the investigation process it was possible to identify the production of new knowledge references, produced during work, capable of transforming the labor world and enabling ethical, responsible care, one that is focused on the users’ interests.
Article
Professional education needs to be considered and implemented as a strategic move, considering local and regional technological potential, enhancing their interaction with the labor world and, fundamentally, with the local community, with the primary function of citizen training and preparing the youth to be active agents in the social, economic, and cultural development processes. Based on this premise, this paper proposes an analysis of enrollment in professional education, especially data and information relevant to understanding the current scenario of the training of human resources in health promoted by federal institutions in Brazil. The study shows an apparent detachment between the federal vocational education network expansion policies in the health area and the Ministry of Health's needs to address the lack of mid-level health professionals, especially in the North, Northeast and Midwest, and particularly outside of the major urban centers.
Article
The main objective of this article is to analyse the bettermen of work's policy at a work's local scope through the professors and researchers' perspective. To this end, we have chosen a qualitative study, and a scientific-technical health unit located in the State of Rio de Janeiro was elected such as a research field. For data collection, information was gathered through ten individual semi-structured interviews. Analysis of data was done through discourse analysis and five main empirical categories of analysis were found: precariousness of the human relations; transition to the institutional management model; professors and researchers' labor intensification; pleasure-suffering experiences at work; and, lastly, the bettermen of the work. In addition, we also adopted such as object of study a policy implemented by Brazilian federal government, whose name is DesprecarizaSUS. The results show that the bettermen of work's policy must reach a range of political actions, which are not restricted to the administrative level. In according to the professors and researchers' perspective it is essential to establish the conditions to overcome the deterioration of human relations at work generated by the neoliberal context of public administration.
Article
When considering the Brazilian context of increasing agricultural productivity associated with monocultures, agribusiness, and the intensive use of pesticides, various negative externalities emerge as having social and environmental impact and affecting public health. The purpose of this article is to discuss the strengthening of agribusiness in Brazil, including its construction as a historical model of modernization expanding nationwide and growing in the Northeast. It also aims to address the issue of pesticides and health, correlating them to cases of human poisoning. To this end, we analyzed the modernization model anchored on the agribusiness, transgenics, and pesticides tripod, and discussed the cases of pesticide poisoning, via agricultural and domestic uses, through the systematization of National Toxicopharmacological Information System database between the years of 1999 and 2011 in the Northeast. We note that in recent years, agribusiness has strengthened itself and the number of pesticide poisoning cases have grown, especially in the Northeast, which has the highest rates of mortality caused by pesticide poisoning in Brazil, mainly affecting farm workers.
Article
The study analyzed the development of family health teams in Brazil, based on secondary data from the Ministry of Health on family health teams deployed in December 2012 and 2015 in the National Register of Health Establishments, according to the municipalities' macro regions and population size. Also analyzed were hospitalizations for causes sensitive to primary care, based on the Hospital Information System, with reference to the year hospitalization took place. In 2015, more than 70% of the municipalities had joined the More Doctors Program (almost 40% of the family health teams), ensuring universalization in nearly 100% of the municipalities with smaller populations. In addition to the expansion, which included more than twenty million people, also analyzed was the replacement of the teams that had been deployed before, suggesting less turnover and fixation of the professionals, which may have been encouraged by funding from the Ministry of Health that reduced the municipalities' costs. Hospitalizations for causes sensitive to primary care further reduced after program implementation, suggesting its contribution to improving access to and the performance of primary care. There are still important challenges ahead, and the program is an effort to achieve system universality.
Article
The article aimed to reveal the production of knowledge on permanent health education based on a survey of Brazilian theses and dissertations produced since the enactment of the first ordinance on the National Policy for Permanent Education, in 2004 until the year 2013. Information on authorship, content, and findings were surveyed and evaluated from the bibliometric perspective. It was found that there is a predominance of authorship by women with training in nursing and social services and with institutional affiliation in Southern and Southeastern Brazil. It was noted that there is a concentration of descriptive and exploratory studies, qualitative approaches and semi-structured interviews as a data collection technique. When analyzing the bibliographic references, there were three categories: Ministry of Health publications, references from various authors, and references related to the method. The research sought to reinforce the need for the inclusion of ‘permanent education’ as a descriptor and revealed a concentration of studies in the fields of health policy, primary health care, and education.
Article
The study aimed to understand the Family Health Strategy process implementation and monitoring at a municipality in the state of Rio Grande do Sul, Brazil, using as qualitative research methodology. Sixteen managers were interviewed and documentary sources analyzed in the period ranging from August 2011 to May 2012. The material was submitted to the operative analysis proposal. It was noted that the first management team of the strategy triggered an effervescent process of transformation of a reality considered as fragmented and insufficient, having opted for outsourcing in worker hiring, for community participation, and for permanent education. The second management team chose to strengthen the emergency units, with no participation of social control. Work management and the municipal management's choices were Strategy weaknesses. The restructuring of primary care, which the Strategy aimed at achieving, was postponed. In conclusion, the study showed the complexity of undertaking the municipal management of the Unified Health System and of sedimenting primary care as the citizens' preferred port.
Article
An analysis was made of actions carried out by community health agents regarding community guidance on the rational use of medications in the Family Health Strategy in the municipality of Palmas, state of Tocantins, Brazil. This was a descriptive and exploratory study with a quantitative approach, done with 246 agents between January and April 2014. Data were collected via a questionnaire to verify the training and specific information on medications and on the risks of pharmacotherapy in their work. It was noted that 88%of the agents had no training on medications; 75.5% believed they did not have enough knowledge to provide guidance on medications; 80.41% said that the team never discussed topics on medications, and 90.20%felt they needed such training. The study revealed that these professionals sought information from various sources – medication insert leaflets were their main source (71.14%). Among the community health agents, respectively 52.46% and 50% asked for help from the nurse to solve issues and answer questions about pharmacotherapy. Among them, 68.03% considered it important to provide guidance to the families, but they said they need permanent education. There was a clear need for community agent qualification and training in promoting the rational use of medications, considering their role as health promoters in the community.
Article
In this article, we describe and discuss the main operational issues of participatory research fieldwork, highlighting the dilemmas of the researcher and research subject/collaborator relationship in the context of the Family Health Strategy activities in a territory where there is high social vulnerability. We created the research management group, consisting of managers, professionals (emphasizing the community health agents) and researchers, aiming to develop strategies and reflect on the results of the research. We undertook participant observation of daily life, field daybooks, we took systematic notes, and made transcripts of the meetings. The analysis methodology used was Thompson's in-depth hermeneutics. This methodological combination made it possible to emphasize everyday experiences, adding them to the ‘ground,’ to what supports the experiences, i.e. the local history, culture, politics, and the organization of the work in health, on intersubjective and social settings of the territory and of people's life history. In this context, the management group set the tone of the research actions, although its group process showed the tensions experienced by the Family Health Strategy. The horizontal dialogs conquered by the work done by this group allowed for a transformation and construction of knowledge shared among the field players and researchers, who were involved with the dilemmas experienced.
Article
This article discusses the process of building a health education proposal for prenatal care for pregnant women and health professionals based on the theoretical framework of Paulo Freire. A qualitative study supported on the research-action methodology was carried out in a basic health unit in the municipality of Vitória, capital of the state of Espírito Santo, Brazil, 2014. Data were collected through participant observation with the audio recording of the meetings. The material was analyzed simultaneously, and at each meeting the partial results were submitted to the evaluation of the participants, who again discussed and reflected on the conclusions reached. Such evaluations enabled the preparation of a final report on the process with the proposition of reality transformation actions. The results showed that pregnant women and health professionals contributed differently and complementarily in the choice of topics for education on prenatal care, highlighting the importance of the interaction between servers and users in the construction of educational projects based on dialogue. Also highlighted were organizational and structural issues in health services that made it difficult to carry out the activities, causing the need for reflections-actions involving Unified Health System managers and administrators, so that education becomes a priority.
Article
Incorporating the perspective of rights and citizenship to public policies on food and nutrition goes through the social practice of the players involved in the implementation of these policies. The aim of the study was to understand the nutritionists' perceptions and practices on the human right to adequate food in the context of their professional activities in the National Program for School Feeding. The study was qualitative, developed in 2014, and data were collected by means of a focus group. Eleven nutritionists from municipalities located in the West Santa Catarina Mesoregion (Brazil) participated. The statements were recorded, transcribed, and analyzed according to the thematic content analysis technique. The results showed that the participants had a comprehensive perception of the human right to adequate food, in different dimensions and relations with the aspects related to it. The nutritionists emphasized the importance and the challenge of intersectoral action linked to the community. However, there appeared to be a limitation in teamwork and in dialog with the families, possibly due to fragile theoretical-methodological and political support for intervention in this field. The nutritionists' comprehensive perceptions on the human right to adequate food, although poorly substantiated from the theoretical and political viewpoint, showed the challenge to be faced in vocational training, both in undergraduate and in permanent education.
Article
This qualitative study introduces the theme of the tutelary counselors' representations to broaden the understanding of these social players' universe and to get to know their implications regarding the dynamics of their work process. The study was conducted in the city of Coronel Vivida, in the state of Paraná, Brazil, in 2013. A semi-structured questionnaire and an informal interview were used to collect the data, and the material was treated using the Collective Subject Discourse analysis technique. The results show that the tutelary counselors' perceptions went through the recognition of a few peremptory aspects inherent to their practice, such as impotence in the face of the disturbing social scenarios to which they are exposed, along with the restriction of the scope of their action linked to structural barriers in the existing social protection networks, in addition to the population's low levels of adherence to their work process. They also reveal a deep-seated satisfaction in the developments of work they have done and that which has a positive impact on juvenile violence; this satisfaction, in turn, is considered as fuel for the development of their professional skills. The considerations this study captured confirm the presence of relevant gradations inherent in the relational process of the tutelary counselors in their work environment, supporting the recognition of the guiding parameters of the intersubjective relationship between the tutelary counselor and the social praxis.
Article
Considering the breadth and complexity of the role that community health agents play in the Family Health Strategy, the purpose of the study presented in this article was to get to know the profile and the reality of these professionals' work to contribute to the consolidation of the Unified Health System. This was a quantitative study conducted in ten municipalities with more than 50,000 inhabitants in the state of Espírito Santo, Brazil, from July 2012 to August 2013. Family health units with complete teams were selected, and a total of 121 community health agents took part in the study. Data were collected through a self-administered structured questionnaire. The results showed that the agents' most frequent activities were home visits, registration updates, team meetings, and follow-up on the priority groups defined by the Ministry of Health. Although many of the agents completed the smart map and the health diagnosis, only 13.2 percent of them identified families at risk, and 14.9 percent surveyed the health issues of their micro-area. Thus, the true purpose of the smart map and of the health diagnosis, or of the agent's participation in the preparation of these instruments was questioned, which could be restricted only to formalize the practice.
Article
This study was carried out using a questionnaire to identify the knowledge of and belief in integrative and complementary practices and the National Integrative and Complementary Practices Policy. Taking part were 118 health professionals, all college graduates and working in the Health System in three Brazilian municipalities, in 2014. Descriptive and two-step cluster analyses followed. Most professionals have partial knowledge on complementary and integrative practices; they consider acupuncture and herbal medicine more efficient; they do not know anthroposophy and hydrotherapy; they believe less in homeopathy; they are unaware of the national policy on complementary and integrative practices; they consider that they did not get their knowledge during their undergraduate course, rather mainly by reading and family experience; they believe that these practices should be included in the undergraduate course, and that they are important for the profession and for the service. The cluster analysis allowed for identifying two groups that stood out insofar as knowledge and beliefs are concerned. We conclude that there is little knowledge about and little credibility in complementary and integrative practices, as well as little knowledge of the National Policy on Complementary and Integrative Practices.
Review