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
The purpose of this descriptive quantitative study was to analyze institutional support among the teams that joined the Program for the Improvement of Access to and Quality of Primary Care. Data were collected from February to October 2014 from the program’s external evaluation database. The sample comprised 2941 respondents from module II, and the 22 managers who replied to module IV (on line). The variables were analyzed through descriptive statistics, using the IBM SPSS software, and the results were organized and grouped into three dimensions: Characteristics of the institutional support; the work of the institutional supporter, and management support in work process management and planning. It was noted that there is support in basic care; however, a normalizing and bureaucratic trait was identified in the actions supported. The institutional supporter was evaluated positively, although being overwhelmed by the excessive number of teams under their responsibility, evidencing the need for sizing that takes into account the way the support function operates. Due to the collection instrument’s characteristics, it was not possible to identify the interviewees’ concept of support, this being a limitation of the study.
Article
This is a qualitative study aimed at analyzing the reasons for job satisfaction and dissatisfaction, as reported by twenty nurses who work in two care models used in basic care in Brazil: The traditional model and the Family Health Strategy. Data were collected between March and May 2013, through triangulation, interviews, and observation; they were organized in the Atlas.ti software and examined based on content analysis. The study showed 25 different reasons for job satisfaction, and 23 different reasons for job dissatisfaction. There was no significant differentiation between the two care models, indicating that they are more related with municipal management and work conditions.
Article
A pesquisa buscou identificar e avaliar os problemas bioéticos envolvidos no cotidiano de trabalho de profissionais de duas equipes da Estratégia Saúde da Família. Neste estudo qualitativo, realizaram-se entrevistas individuais semiestruturadas com 16 profissionais da equipe de saúde da família de Salvador, Bahia, de fevereiro a outubro de 2015. Utilizou-se a análise de conteúdo proposta por Bardin, assim como a bioética principialista e o pensamento complexo de Edgar Morin. Identificaram-se duas categorias: ‘Problemas bioéticos no cotidiano de trabalho da equipe de saúde da família’ e ‘A relação interprofissional na equipe de saúde da família’. Na primeira categoria, evidenciaram-se falta de companheirismo e colaboração entre os membros da equipe; ações verticalizadas da gestão; dificuldades em preservar a privacidade do usuário e dos profissionais. Na segunda, destacaram-se a disparidade de poder nas relações interprofissionais e o encontro ‘frio’ entre núcleo de apoio e assistência à saúde da família e equipe. Concluiu-se que a equipe de saúde da família não tem avançado no aperfeiçoamento do trabalho em equipe interdisciplinar. Os problemas identificados ferem os princípios do enfoque principialista da bioética, esgarçam o tecido social do trabalho na Estratégia Saúde da Família e contribuem para a descaracterização da atenção básica.
Article
The study had as objective to avaliate, through an integrative review of the literature, the produced knowledge about the activities carried out by community health agents in Brazil and some other countries. The search of data has included: Journals of Higher Education Personnel Improvement Coordination Website; Scientific Electronic Library Online; Latin American and Caribbean Health Sciences Literature; Medical Literature Analysis and Retrieval System Online and US National Library of Medicine National Institutes of Health, and has happened from 2010 to 2014. Of the 240 studies identified, 27 were included in this review. The literature highlights the functions that the Community Health Agents have been promoting in a variety of actions in different geographical and cultural contexts. The Community Health Agent has different insertions in the labor market experiences and the fragilities that come from the communities’ socio-cultural contexts, to the need of greater recognition of the health system and the health staff. Its position, between the community and the health staff, is strategic and contributes to the health of the community. Therefore, it should be given proper training to their performance and access to lifelong education, resources and a greater appreciation of the health staff with the society.
Article
The aim of this study was to analyze how community health agents evaluate the work context and possible factors that contribute to their suffering/illness. This was a cross-sectional, descriptive, quantitative-qualitative study carried out with health agents from 13 municipalities in the central region of the state of Rio Grande do Sul, Brazil, in 2014. The ‘Work and Risk of Illness Inventory’ sociodemographic questionnaire and interview were used to collect data. The data were analyzed through content analysis. The situations of suffering were related to the lack of professional recognition, an excessive pace, work overload, conflicts with the community, lack of resolution of actions, unavailability of materials and inputs, in addition to the geographic location of the health unit and of the users’ homes, type of health strategy, and management. It was concluded that the health agent’s working environment can cause suffering/illness among these workers.
Article
This study proposes to present the experiences in the work of the community health agent that integrate the intersubjective relations in the territory. Their bonds with the community come from their involvement with the same difficulties the population they attend faces. The goal was to analyze the daily practices the community health agent experiences in the Family Health Strategy territory, with emphasis on community relations and on the bonds that are maintained. This study’s approach involved a qualitative critical-reflective perspective carried out in the city of Fortaleza, state of Ceará, Brazil, from 2011 to 2013. Eleven community health agents and 22 users of two Family Health Strategy teams participated. Semi-structured interviews, systematic observation, and focus groups were used as data collection techniques. The data were analyzed under the assumptions of critical hermeneutics. The results show that, in the community health agent’s daily work, the relationships for health care and promotion have ties and affection in community struggles, demands, and in community needs. Information and communication through dialogue give sense and meaning to health practices and improve quality of life. The bonds between users and community health agents are considered powerful and resolutive.
Article
The study analyzed how sex education is provided to adolescents and young people from the perspective of the intersectoriality of health and education. The pedagogical and methodological characteristics used by teachers and professionals of the Family Health Strategy of a municipality in southern western Amazônia were surveyed, as were the perspectives of intersecting the school with health services for sex education. The survey was conducted between May and September 2013. A qualitative approach was used. After a semi-structured interview, content analysis was used to survey the thematic categories. Sex education was characterized by specific activities motivated by demand. The family was considered the main element responsible for sex education, and a lack of professional preparedness proved to be an important factor for this type of education not being provided. The intersectoral perspectives pointed out by the participants were limited to the actions already existing in practice, such as lectures and projects, among others. Intersectoriality for sex education seems to transit in the field of ideas, tied to the discourses. Although government initiatives encourage it, these perspectives have failed to account for the complexity involved in its legitimation. New strategies must be discussed for sex education.
Article
The study aimed to describe how the health conditionants and determinants topic was covered in the national and state health plans drafted for the period ranging from 2012 to 2015. It was a qualitative, documentary analysis-type study focusing on the health conditionants and determinants topic. These documents were queried on the websites of the Ministry of Health and of the state health departments of the 27 Brazilian states. Research was also carried out in the Management Report Construction Support System, on Google, and by e-mail. It was noted that the health conditionants and determinants issue is not present in Brazilian health plans. Most of the documents used the health planning framework in a normative perspective, as proposed in the Ministry of Health’s technical documents. The discussion on health conditionant and determinant models was not featured among the documents that were analyzed, and there was a mixed description of the topic through disaggregated data and composite indices. The study indicated the need for more attention and review of the health conditionant and determinant models used to prepare these technical documents.
Article
The efficient distribution of health professionals, especially physicians, is one of the main issues public health policy managers face. In an attempt to solve this problem, the state of Pernambuco, Brazil, is increasing the number of medical graduates, including in the interior, and encouraging medical residency programs with more openings and programs. Such actions are strategies for the establishment and provision of medical professionals. The general objective of the study that gave rise to this article was to introduce the medical residency policy as a strategy for training human resources for the Unified Health System and to demonstrate the lack of specialists in gynecology and obstetrics for the Unified Health System of Pernambuco, based on the lack of childbirth care. The results demonstrated an increased demand among physicians for the gynecology and obstetrics specialty over the years, but there is a great concentration of this specialty in the region near the capital city (Recife) and of deliveries in certain locations of the state.
Article
This study was based on the perception of similarities and differences in the theory-practice relationship in the master’s degree courses in academic and professional modes in the Public Health area in Brazil. It was assumed that, in this relationship, the proposals of the professional master’s degree course do not part from the agent’s professional practice as a scenario to build new knowledge and technologies, rather they tend to reproduce the hegemonic training model consolidated in the academic master’s degree course. Based on the ‘academy-professional context relations’, ‘teaching staff,’ ‘final work and justification for the course’ categories, the study was carried out using a qualitative approach through documentary analysis and course proposals, as well as using interviews with course coordinators. Seven colleges offering courses in these modes were selected to deepen the discussion. It is concluded that this relationship is more complex in the professional master’s degree course, and that, as provided for under the legislation, it sought to consolidate an identity that is distinct from specialization and academic master’s courses, a fact that may characterize the main difference between the modes. However, their processes still adopt the same frameworks and practices as the academic master’s degree course.
Article
With the instrumentalization of the health policy, planning, and management area, the public health physicians’ political ethos has been being put into question in their training. Thus, we aimed to characterize the curricular components related to this area in undergraduate courses in collective health in Brazil. In June 2014, a secondary data survey of the curricular matrices was carried out on the Ministry of Education’s website, the unit of analysis of which was the curricular component, using the reference term for undergraduate courses in collective health as a parameter. The courses present ‘collective health’ as the main denomination (60%). Most of the courses are spread in the Northern and Southeastern regions (27%) and in public institutions (93%). On the contents in the nomenclatures, ‘health planning’ is the most cited (up to seven times in the same matrix) and in 60 percent of the total courses; 87 percent of the courses do not feature the term ‘Unified Health System’ as a component name. It was concluded that without a curricular standardization future public health physicians will have different profiles, acting in a more specific perspective leaning towards a more planning management format and with gaps regarding the political contents and the ideological defense of the Unified Health System.
Article
The study that gave rise to this article was a qualitative, exploratory-descriptive one aimed at analyzing how nursing graduates experience competitiveness. Data collection took place between March and May 2015. The subjects were twenty undergraduate nursing students from two colleges in Maceió, state of Alagoas, Brazil. A semi-structured interview was used to collect the information and undertake the thematic analysis. The theoretical framework used to analyze the data came from Caniato and Rodrigues’ views on competition, which has its theoretical and philosophical base Freudian psychoanalysis and the critical theory of the Frankfurt School, especially that of Adorno and Horkheimer. It was noted that competitiveness is part of the students’ experience because it is considered an inherent characteristic of the human being, who, naturally, lives with it in the capitalist system. This competitive behavior might increase in undergraduate studies, according to the environment, to one’s personality/nature, and to the situations experienced. It was noted there is conflict, since the students considered competitiveness as a necessity in view of the labor ‘market,’ but saw it as a more negative characteristic.
Article
The incredible growth in the number of Physical Therapy schools in Brazil needs to be analyzed. There was a 476 percent increase in the number of courses located in major cities and in private educational institutions between 1995 and 2008. Aiming to analyze the distribution of Physical Therapy schools in the different Brazilian regions, identifying the institutions offering presence and distance education, a quantitative, exploratory, and cross-sectional study was carried out based on secondary data collected from the e-MEC site in 2015. The number of openings and school distribution were listed based on population estimates. Physiotherapy courses are concentrated in large cities, making it difficult for the population in the interior to have access to them. The highest concentration is in the states of São Paulo (239 courses), Minas Gerais (152 courses), and Paraná (120 courses), where most professionals are also located. Course distribution analysis identified the need to invest in opening courses in Northern Brazil. The unbridled growth of Physical Therapy schools, coupled with the lack of criteria for opening new courses in the country, reiterates inequalities in the distribution of professionals.
Article
The overall objective of the study was to investigate limits and possibilities of problem-based learning in the training of the physiotherapist. The study is characterized as qualitative research, and data were collected through interviews and questionnaires conducted with teachers and students of a physical therapy course, in addition to classroom observations. The data were analyzed based on content analysis. The three thematic blocks defined in advance addressed the health-disease process conception, perception, and focus of the curriculum. Finally, we indicate the perception of the health-disease process, the lack of theoretical bases, of student participation, the difference in personalities, and individualized study as limits in the physiotherapist’s training. The potentialities pointed out relate to good communication, joint work promoting professional skills, mutual help, and discussion of subjects, such as content integration, and independent studies. This study showed signs that in the training investigated there are more limits than possibilities regarding forming a more critical, reflective, and humanistic professional. We also recognize the possibility of Problem-Based Learning as pedagogical practice in favor of a more humane and critical training.
Ensaio
This article discusses the uniqueness of Brazilian social inequality, which produces a structural ‘rabble’ legitimized by a value hierarchy that segregates people into people and sub-people, citizens and sub-citizens; people who must be seen and respected, on the one hand, and people to be disdained, devalued on the other. Subsequently, we discuss how the social inequality scheme is reproduced in public health, which is considered of poor quality and, in practice, contradicts the constitutional precepts pursuant to which the Unified Health System was created, not benefiting the idealized proposal at its core to ensure inclusive, egalitarian citizenship. Finally, we propose reflections about the role social workers play in public health through the provision of direct service to users, especially through educational actions, considering them as an opportunity to work with the ‘rabble,’ aspects that maintain such class exactly in a situation of sub-citizenship and, therefore, receiving inhumane care from public health services.
Review
Trabalho e saúde no capitalismo contemporâneo: enfermagem em foco. Helton Saragor de Souza e Áquilas Mendes (orgs.). Rio de Janeiro: DOC Content, 2016, 116 p.
Review
Escola ‘sem’ partido: esfinge que ameaça a educação e a sociedade brasileira. Gaudêncio Frigotto (org.). Rio de Janeiro: LPP/Uerj, 2017. 144 p.