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
Ensaio
This essay is about Paulo Freire’s “untested feasibility” construct, and it aims to explore its potentialities in collective health. A total of 38 works by the author were analyzed, nine of which discuss untested feasibility, which enables the recognition of the construct’s underlying meanings. Three core ideas were explored for this understanding: the conditions and contexts of emergency of the untested feasibilities; examples; and the meanings of the untested feasibilities. The emergence of untested feasibilities results from a complex pedagogical process, which goes from the defamiliarization regarding reality to the critical perception of the subjects involved, which contributes to the development of untested feasibilities, as a step that precedes action. Even though some of the analyzed works mention examples of untested feasibilities, those were not clarifying regarding the understanding of the possible meanings of untested feasibility. Based on the ideas contained in Freire’s works regarding praxis, project, futurity, dream, utopia and hope, the comprehension of untested feasibility was based on the sense of collective project. We propose a pedagogy applied to collective health that incorporates “untested feasibility” as a possibility of transcending the technical training, which is based exclusively on informational contents, also investing in the capacities of indignation and denunciation and in the development of collective projects.
Article
The aim was to understand the main needs and demands of male rural workers regarding a Primary Health Care team in Southeastern Brazil. It is a qualitative study, which was guided by the hermeneutic-dialectical approach. We conducted 41 in-depth interviews, recorded notes on field journals, and collected secondary data. In the analysis, we used the levels of interpretation, which enabled the development of two thematic categories for the health needs: “increase in the supply of medicines” and “access to specialized and specific prostate exams.” We also developed two categories for the social demands: “acknowledgment as users of the health service” and “education in health groups dealing with male issues.” The discussion was based on the attributes of Primary Health Care and on the Social Markers and Intersectionality Theory. The study enabled us to comprehend the production process, to get to know the clinical-epidemiological characteristics, and to discuss the invisibility of the rural workers in the demand for and access to health services. We observed a high regard for the curative care model, and the positive contribution of the demand of the men to the strengthening of the movements of struggle for the right to social health.
Article
The research that originated the present article is related to the context of the theoretical category of ‘unfinished republics.’ It had the goal of analyzing the perception of the teachers of a pre-school education unit of a municipality in the state of Santa Catarina, Brazil, regarding the production of dignity through work, and was performed in the second semester of 2018. The data was collected using three instruments: individual interviews, focus groups and field journals. The data indicate the loneliness in the interface among teaching in pre-school education, neoliberalism and dignity through the echo of the voices of the teachers who announced the dismissal of their production of dignity through work, which affects directly and negatively their health condition. We indicate the conditions for the establishment of this dehumanizing situation and propose the recognition and stimulus to collective work as tools for transformation.
Article
This is a qualitative study that analyzed the practices of territorial care in mental health developed by nurses, community health workers and users of the psychosocial care centers and of primary health care. We conducted interviews, focus groups and free observation with 60 participants from the city of Fortaleza, state of Ceará, Brazil, in 2017. The data analysis was based on hermeneutics-dialectics in the face of a critical and reflective interpretive exercise. The results revealed that the territorialization process is developed by the multidisciplinary team from the Health of the Family Strategy, without the participation of the professional of the psychosocial care center. Even though they may sometimes develop community practices, they still privilege actions within the service itself and those focusing on the medicalization of mental suffering, without taking into consideration the singularities of the subjects, and with no interaction with the primary health care services. The community health workers, if trained, are potentially strategic actors to work on the interface between mental health and primary health care. In fact, the mental health outlook urges for the transformation of a model that privileges the reflection of new actions into multiple dimensions, with an emphasis on the connection of the services and the training of the workers that act in this context.
Article
The present qualitative and cross-sectional study has the aim of analyzing the perspective of the professionals of the psychosocial care centers regarding the matrix support as a psychosocial care strategy in mental health. We used ten semi-structured interviews with mental health service professionals from the municipality of Imperatriz, in the state of Maranhão, Brazil. We concluded that these professionals understand matrix support as an indispensable tool to organize psychosocial care, but it is still used incipiently in their everyday practice regarding the following challenges: coexistence of the psychosocial and biomedical models; lack of work conditions; lack of permanent and ongoing education in the care network; bureaucratization and verticalization of the management actions; and motivation to work on the part of the teams. Some successful experiences regarding matrix support for these workers resulted from the co-management of work processes between professional and users. We recommend that there be a clear direction of the work on the part of the management, with a definition of a team of matrix workers and a planning for its development, creating work processes that favor such a practice.
Article
The study that originated the present article had the goal of analyzing the culture of patient safety in primary health care in a large municipality in the state of Paraná, Brazil, according to the professional category. We conducted a cross-sectional study with primary health care workers, and the data was collected in 2017 through the application of a self-reported instrument called Survey on Patient Safety Culture for Primary Health Care (Pesquisa sobre Cultura de Segurança do Paciente para Atenção Primária, in Portuguese). The results indicated that the work process in each service where they work and the support from the managers were the dimensions of the safety culture that had the weakest evaluations. In general, there were differences of opinions regarding the perception of the safety culture on the part of the primary health care professionals, indicating the importance of the joint planning of health care strategies. The nurse technicians revealed a higher prevalence of weak evaluations of patient safety culture. On the other hand, the nurses revealed a lower prevalence of weak evaluations regarding safety culture.
Article
The article presents a mapping of the scientific
production regarding the access to health by the transsexual
population after 2008, an important year for trans health in
Brazil, in which the Transsexualizing Process of the Brazilian
Unified Health System (Processo Transexualizador do Sistema
Único de Saúde, in Portuguese) was created. The goal of
the present work was to conduct an integrative review of
the literature regarding the access to health by the Brazilian
transsexual and transvestite population in the MEDLINE,
LILACS and SciELO databases, using the following descriptors:
‘transsexuality,’ ‘transsexualism,’ ‘transvestitism,’ ‘transvestite’
and ‘transgendered,’ and 22 articles were selected. Considering
the scientific production analyzed, we verified countless
challenges regarding the access of the trans population to
the Brazilian Unified Health System, such as discrimination,
pathologization of transsexuality, lack of training on the
part of the professionals, improper embracement, lack of
resources to fund policies and programs geared towards
the fight against discrimination due to homophobia or trans/transvestite-phobia, as well as the lack of guarantee
of specific services – such as the transsexualizing process.
Article
Stress at work affects psychological, physical and social aspects of the workers, as well as the efficacy of the productive organizations. The goal of the present study was to comprehend occupational stress in the journalistic media under the perspective of the organization of labor. It is a qualitative research conducted through Bardin’s content analysis, based on the analytical categories previously defined by the World Health Organization in the ‘Work Organization & Stress’ report, under the perspective of the theoretical framework of Christophe Dejours. We classified 727 news stories that had ‘stress’ as a keyword, with 130 news stories specifically approaching the topic of stress at work. The news stories were divided into two categories, each with subcategories of their own: ‘Content of the Risks of Stress’ (47) and ‘Context of the Risks of Stress’ (59). We verified that the media has scarcely been working as the spokesperson for the workers in order to fulfill its social role, without stimulating them as social subjects. We propose that the news media stimulates actions that boost the prominence of the workers, based on the visibility of the current laws, and indicates more direct ways for the workers to be able to fight to guarantee their rights to health in the struggle against stress, with a critical perspective of the understanding regarding the organization of labor and its potentialities in the promotion of health.
Article
The discussions on the public-private relationship highlight the need to provide public management with more managerial and administrative autonomy, agility and flexibility in strategic sectors of the health care system. The qualitative research that was the origin of the present article had the aim of analyzing the work management at the State-Owned Family Health Foundation of Bahia (Fundação Estatal de Saúde da Família da Bahia, in Portuguese) and at the State Health Foundation of Sergipe (Fundação Estadual de Saúde de Sergipe, in Portuguese), using the technique of data triangulation and hermeneutic-dialectical analysis. Managers, workers and users from both states took part in the study, totaling twenty semi-structured interviews. The contextual factors and the actors were analyzed using a model that emphasized the dimensions of the macro- and microcontexts. The satisfactory performance regarding work management may be attributed to the variety and complexity of the factors faced by the direct administration. The interrelationship of the microcontext with subdimensions of the macrocontext contributed favorably to the implementation of the foundations. As contributions to the managers, we developed a table containing indicators for the monitoring of the attributions of the work management at the state-owned foundations. The results and potentialities of these experiences may help face the challenges to management in health, providing it with more efficacy, speed and solvability in health care and work management in the Brazilian Unified Health System.
Article
This The study assessed the work process of the professionals of an Extended Health of the Family Center (Núcleo Ampliado de Saúde da Família, in Portuguese) in Primary Health Care regarding the establishment of collective educational activities for the promotion of a healthy and proper diet. We used the qualitative approach method, based on a pilot study of a randomized and controlled community trial, with the participation of six professionals. The interviews followed a semi-structured script. Content analysis was employed to reveal the meanings of the speeches of the participants. Three categories emerged: integration of the team as the driving force of the work process; liberating education and engagement as the guiding axes for the implementation of collective activities regarding healthy eating; and challenges to the implementation of educational activities on healthy eating. The results show that the group methodology recommended by the Brazilian Ministry of Health is a good strategy for the organization and management of the work process. Moreover, it boosted the integration of the work force of professionals from different categories, resulting in the strengthening of the team in the practice of interdisciplinarity and in the development of collective spaces for exchanges, care and empowerment of the assisted individuals.
Article
The pharmacist plays an important role in the care for the users of primary health care by providing emancipatory self-care actions, education in health, promotion of health and of the reasonable use of medications. In this context, the present study, through an integrative review of the literature, had the goal of analyzing the types and benefits of the clinical pharmaceutic services developed in primary health care in Brazil. In the SciELO and PUBMED/MEDLINE databases, we gathered articles on the clinical pharmaceutic services developed in primary health care in Brazil published in Portuguese, English and Spanish between 2007 and 2017. The pharmacotherapeutic follow-up is the most studied service, while dispensation and guidance are the activities most often performed by the primary health care pharmacists. Regarding the benefits, the literature shows the coexistence, the importance and the multidimensionality of the clinical pharmaceutic services in the promotion of health and in the reasonable use of medications by the circumscribed community.
Review
SESTELO, José A. F. Planos de Saúde e Dominância Financeira. Salvador: EDUFBA, 2018. 397 pp.
Acknowledgements