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.
Trabalho, Educação e Saúde (TES) publishes original contributions on the fields of education and health, discussing them from the perspective of contemporary work organization, from a critical and interdisciplinary perspective. To submit a text, please consult the Editorial Policy and the Instructions to Authors.
Editorial
Editorial.
Conjuncture Note
This conjuncture note aims to record historically the context of proposition of the Argument of Noncompliance with Fundamental Precept 709, the first action within the scope of the Federal Supreme Court led by an indigenous organization, the Articulation of Indigenous Peoples of Brazil, in the context of the COVID-19 pandemic. In this text, we present the mobilization of groups of researchers in indigenous health articulated with indigenous leaderships and indigenous movements who denounced the vulnerability and severe impacts of COVID-19 on indigenous peoples and the weaknesses of the federal government’s response. We highlight the work of researchers from the Indigenous Health Thematic Group of the Brazilian Association of Collective Health and the Fundação Oswaldo Cruz, who constituted a group of experts to support the decisions of Minister Luís Roberto Barroso within the scope of the Argument of Noncompliance with Fundamental Precept 709. We summarize the vast procedural record of the proposition of this non-compliance allegation, which presents evidence on the weaknesses of government planning and response during the critical period of the pandemic. In a context of health crisis and violation of rights, the indigenous movement valued science and enhanced the incidence of researchers for their resistance and struggle for the right to health.
Debate
Editor's Note
The so-called Economic-Industrial Health Complex (CEIS), as a project and public policy of the current and recent Workers' Party (PT) governments, is based on a certain diagnosis of reality: economic backwardness and technological dependence are the result of insufficient cutting-edge industrialization with high added value, low government investment in industrial policy and limited public-private interaction. As is easy to see, by the opposition, the mere enunciation already allows us to perceive what its formulators intend as ways of overcoming the state of affairs they reveal. However, the so-called Marxist Theory of Dependency (TMD), which has been around for just over 50 years, has made an important critical contribution to the real possibilities of development on the periphery of the capitalist system, especially on the Latin American continent. The publication of this debate results from the confrontation between these different perspectives on understanding reality and proposals for intervention in it. Structured from a problematizing basic text, followed by four other commentators, and ending with a rejoinder, it allows laypeople to understand the topic and its polemics. It offers those already initiated in the discussion perspectives of understanding and criticism that are still not very present in the public debate on the subject.
André Dantas e Letícia Batista Silva
Debate Editors
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Authors: Paulo Henrique de Almeida Rodrigues, Roberta Dorneles Ferreira da Costa Silva, Arthur Lobo Costa Mattos.
Abstract
This article, which plays the role of a problematizing text in the debate promoted by the journal Trabalho Educação e Saúde, in a thematic dossier on the Health Economic-Industrial Complex, criticizes this complex considering its theoretical-political choices, perspectives on the state-civil society relationship, diagnoses of the Brazilian and international reality, and developmental bets on the part of its main advocates. Based on the categories of the Marxist Theory of Dependency, the authors conclude that this
project – taken on as public policy by Brazil’s current federal government, in essence, by the forms and contents it defends and assumes – reinforces dependency and economic and technological subordination instead of overcoming it.
Keywords: economic policies; dependency-independence area; pharmaceutical industry; drug
production; national pharmaceutical assistance policy.
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Authors: Marco Aurélio de Carvalho Nascimento, Juliana Duffles Donato Moreira, Gabriela Rocha Rodrigues de Oliveira, Thalita Borges Oliveira.
Abstract
This article, which plays the role of text-commentator of the debate, in a thematic dossier on the Health Economic-Industrial Complex, defends this complex to overcome underdevelopment. It defends the active role of the state as a mobilizer of public and private agents with a view to national development, understands health as strategic vector due to its great economic potential, and the accumulation of capital as a potential promoter of industrial and social development. It concludes that the Brazilian reality requires bold strategies such as the Complex’s, in order to strengthen public policies of a universal nature and social welfare.
Keywords: health; development; innovation; unified health system; health economic-industrial complex.
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Author: Márcia de Oliveira Teixeira.
Abstract
This article, which fulfills the role of text-commentator of the debate in a thematic dossier, on the Economic Industrial Complex of Health, focuses its analysis on the research environment under which this Complex was consolidated at the interface of the debates on technosciences and the national policy of Science, Technology and Innovation in health. The text offers the reader a brief overview of the intellectual trajectory of the leading proponents of the Complex, which allows them to better understand the conclusion it reaches: their proposals do not overcome the neoliberal condition that is part of their own intellectual environment – and which, in the end, produces the underdevelopment they claim to overcome.
Keywords: CEIS; public policies; political economy; technosciences; health innovation.
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Comment 3 - The return of national subjugation in public health debates
Author: Maria de Fátima Siliansky de Andreazzi.
Abstract
This article, which plays the role of a text-commentator on the debate in a thematic dossier on the Health Economic-Industrial Complex, reinforces the criticism of this field of thought and political action, based on its foundations. It points out flaws in the historical analysis that forms its diagnosis of contemporary reality, points out the fetishization of the role of private initiative (of Schumpeterian matrix) and denounces the theoretical eclecticism that compromises the method and ignores the incompatibility, sometimes more or less, between the authors mobilized that give it its basis. It concludes that the result of these ‘combinations’, in the form of neo-developmentalism, is and has been a disservice.
Keywords: Political Economy of Health; neo-developmentalism; Health Industrial-Economic Complex;
imperialism; innovation.
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Authors: Áquilas Nogueira Mendes, Leonardo Carnut.
Abstract
This article, which plays the role of a text-commentator on the debate in a thematic dossier on the Health Economic-Industrial Complex, although it is also critical of this Complex, sets out to promote a critique of the critique offered by the basic text. This is because it considers that critics and the criticized are on the same ground when they attribute importance to the Health Economic-Industrial Complex in terms of its effective capacity, as a public policy, to reduce commercial and technological dependence
in health. Making use of the debate on the state promoted by the derivationist school and in defense of the theoretical-political position they adopt, the authors conclude by warning of the risk of socialdemocratizing anti-capitalist perspectives such as the Marxist Theory of Dependence.
Keywords: Health Economic-Industrial Complex; state; state-form; political economy; Marx.
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Rejoinder - The Health Economic-Industrial Complex as an alternative to maintaining underdevelopment
Authors: Paulo Henrique de Almeida Rodrigues, Roberta Dorneles Ferreira da Costa Silva, Arthur Lobo Costa Mattos.
Abstract
O This article, which plays the role of a rejoinder in a thematic dossier on the Health Economic-Industrial Complex, reviews the main text’s four comments, partly accepting and partly contesting them, in different proportions. As a synthesis of the problematizations that motivated the debate and the appreciations, favorable or unfavorable, received from different perspectives, the authors of the problematizing text return to their axis of analysis, but now from the ground traced by their critics.
Keywords: economic policies; dependency-independence area; pharmaceutical industry; drug production;
national pharmaceutical assistance policy.
Article
This is a descriptive and exploratory study, with a qualitative approach, which aims to describe the health care of women deprived of their liberty in a prision in Rio Grande do Norte, Brazil. A sociodemographic questionnaire and semi-structured interviews were used to collect the data, which was carried out between July and August 2023 with six health professionals, two psychology students, and two police officers working in a women’s prison. The textual content of the interviews was subjected to lexicographic analysis using Iramuteq software and analyzed in the light of the relevant literature. Three categories emerged: Health profile of women deprived of their liberty; Profile of care for women deprived of their liberty; and The interface between management and health care for women deprived of their liberty. It was concluded that the health care of women deprived of their liberty is permeated by significant challenges, including the lack of health promotion and prevention actions; the lack of structure, human resources and supplies within prisons; and the difficulty of escorts and bottlenecks in the operationalization of the Health Care Network outside prisons. Added to this is the lack of coordination between municipal and state management when it comes to implementing current legislation.
Article
Care and the bond between users and health professionals are frequently analyzed in the Brazilian health system. However, the impact of intersectionality on this relationship is still little explored. In this article, we present findings from a qualitative study on the bond between community health workers and elderly, black, peripheral women, known as Nanas, in Primary Health Care in Rio de Janeiro, Brazil. Fourteen agents were interviewed in their workplaces. Discourse analysis revealed that the agents demonstrated culturally competent health care for the Nanas. They were motivated by their intersectional characteristics, believing that they shared similarities with these users, as exemplified in the statement: “She could be my mother”. Previous research into the influence of gender, class, and race on health care has shown that the perception of concordance improves care, promoting greater affection and empathy between health professionals and users. Given the historical challenges faced by Primary Health Care in promoting social justice and providing equitable care to all patients, this study highlights the importance of cultural competence, an essential attribute of Primary Health Care and a tool for comprehensive care, being strengthened by diversity among health workers.
Article
This article aims to problematize, in the light of the precepts of workers’ health, the relationship between work and teachers’ health in a public school located in a territory of armed violence, as well as analyze their strategies of resistance and collective defense of health. This qualitative study was carried out through semi-structured interviews via videoconference due to the COVID-19 pandemic. The thematic content analysis technique was used, from which four categories of interpretation emerged: war scenario and teaching work; health and the perceptions of those fighting; resistance and strategies to defend health; and possible ways out. It was found that the experience of workers is fundamental to collective health protection. The violence that affects the work of teaching staff in the territory of armed violence was configured as a specific form of workplace violence. The teachers identified dialogue between the school, the community, and public security authorities as an effective solution for dealing with violence in the school environment. The construction of collective reflections and proposals emerged as a fruitful path for teachers’ work, which reaffirms the political and social role of the public school as an institution that represents the community and its workers.
Article
Resolvability in primary health care refers to how effective it can be in solving problems. It is a challenge influenced by the actions of different agents and organizations that make up a multi-level governance structure in implementing public policy. This article aimed to map the agents who influence the development of problem-solving primary care, identifying their roles. This is a qualitative study carried out in the Federal District through 22 focus groups with 245 professionals from the family health and oral health teams. The data was systematized using Atlas.ti 9.0® software and analyzed according to the multi-level governance framework. There is a governance network at the micro, meso, and macro social levels, but the results indicate that responsibility for resolving problems lies mainly with agents at the micro level, professionals from the local primary care teams, and managers, especially nurses, nursing technicians, and community health agents. At the other levels, state and non-state agents, from inside and outside the health sector, operate in different ways, notably by creating barriers to solving problems. Instances that promote the meeting of these agents, defining responsibilities and mechanisms for joint action, can favor resolvability in primary care and in the care network.
Article
Technological advances in science over the last century have led to changes in the relationship between doctors and patients, giving rise to the debate on the construction of a model for teaching professionalism in universities. In contrast to commercialization in the medical relationship with the community, the Unified Health System was born in Brazil, which has comprehensive care as one of its fundamental principles. Therefore, we propose to analyze the process of developing the competency profile related to professionalism from the perspective of students and its intersections with comprehensive care. This is a cross- sectional and exploratory case study with a qualitative approach. An online focus group was held with students completing their Medicine course. The material was analyzed according to the Meaning Interpretation Method. It was noticeable that attributes related to professionalism and integrality are being incorporated by students throughout their degree, such as: teamwork, self-reflection, respect for patients and social responsibility. The findings contextualized for this researched group can serve as a reflection to be considered in the scenario of other universities, promoting welcoming and effective medical training in meeting the needs of society, with medical professionalism and comprehensive care as guiding principles.
Article
This article results from a qualitative, cross-sectional, descriptive study based on a historical-dialectical approach. It aimed to understand aspects of the school trajectory and the perspectives of students and graduates regarding their expectations of high school technical training in health in the neoliberal scenario. Data was collected through four focus groups with students and graduates from four technical courses in the health area – clinical analysis, nursing, orthopedic immobilization, and radiology – from two public and two private technical schools in Mato Grosso do Sul, Brazil. Content analysis guided the data analysis. The school trajectory and expectations of students and graduates for technical training are in line with the problems faced by Brazilian youth and the ideals of neoliberal society, which prioritizes training for the working class in terms of employability, which rules out the possibility of dense training – which would allow for social insertion with criticality and better conditions for understanding the relationship etween health and society. However, it is in the midst of the contradictions of this society hat the school can contribute to overcoming class society in favor of the emancipation of the working class.
Article
The context of the Unified Health System is crossed by various training initiatives aimed at health professionals, managers, and organized civil society, among which the processes related to health monitoring and evaluation stand out. However, few initiatives in this area have been aimed at social control of this system. This article aims to analyze the formative and pedagogical trajectory of the training course in monitoring and evaluation for social control in the Unified Health System to outline reflections and notes pertinent to formative processes aimed at councilors and technical supporters working in spaces of social participation in health. This is an informative, referenced, dialogued and critical article, subdivided into three sections. In the first section, the theoretical framework on the relevance of training processes in the area of health monitoring and evaluation is reviewed; in the second section, the pedagogical and methodological bases of the course are presented; in the third section, the challenges and potentialities of the training process are systematized and discussed in the light of the technical-scientific literature in the area.
Article
Territorial Formative Self-Regulation was implemented in all municipalities in the state of Espírito Santo, Brazil, in 2020, and consists of a care model that aims to reorganize work processes from primary care to the hospital level. This manuscript aimed to analyze the satisfaction of doctors and health managers regarding implementing this self-regulation in the southern health region of the state. This is
a descriptive, documentary study with a qualitative approach. The public surveyed included cardiologists and psychiatrists, primary care physicians, primary health care managers, and a regional specialty center manager. The results showed that the interviewees perceived that Territorial Formative Self-Regulation contributes to bringing Primary Health Care closer to specialized care. However, there is still no reduction in waiting times and queues for the specialties analyzed. The conclusion is that this model could represent an opportunity to contribute to providing health services by improving access, efficiency, and quality of care and reducing operating costs.
Article
This article aimed to present the perceptions of the response to the COVID-19 pandemic in terms of the health work of Family Health Strategy professionals in the municipality of Rio de Janeiro, Brazil. The repercussions of COVID-19 on working conditions and relationships and the perception of the corresponding vaccination process in the municipality were analyzed. Sixteen semi-structured interviews were conducted with professionals who comprise the minimum strategy team in two family clinic units in two health program areas. The study aims to collaborate with the production of knowledge for dealing with public health emergencies in Primary Health Care, proposing actions and policies for the municipality at this level of care, and contributing to a greater understanding of the vaccination process in the Unified Health System.
Article
The article focuses on researchers’ interpretations of the meanings and legacies of the 2013 Journeys in Brazil. The topics highlighted by these subjects and their research experiences with 2013 are presented, in addition to the results of the research “Educational dimensions of the 2013 Journeys”. Eighteen semistructured interviews were conducted in person in the first half of 2023. The interviews are justified by the scarcity of academic production on the educational dimensions of the Journeys. As a result, academic interests in topics related to the event in question stand out, such as social movements, collective actions and political participation of youth. The interpretations of the deponents converge with regard to the causes and dynamics of 2013, considered a complex historical phenomenon, caused by the limits of Lula’s policies and dissatisfaction with representative democracy. Regarding the legacies, there is divergence: some consider them more positive (promoting renewal of political action); others, more negative (favoring the rise of the extreme right). In conclusion, we highlight the importance of treating the Journeys as a unique moment of political subjectivation of a progressive youth generation in the 2010s, as well as the
legacy of the agendas related to the right to the city.
Article
This study aimed to analyze the health care practices developed by Primary Health Care nurses in rural
contexts in the state of Bahia, Brazil, during the COVID-19 pandemic. A qualitative study was carried
out with 22 of these professionals, using semi-structured interviews. The analysis of practices covered
four dimensions: management, healthcare, teaching and participation/citizenship. The results indicated
that care practices in the rural context suffered a series of paradoxes, including interruption/alteration in
the areas of management, health care, teaching/research and social control, as well as the exacerbation
of barriers to achieving access, comprehensiveness, longitudinality and coordination of care. On a
positive note, surveillance actions became more central, as they served to guide the use of resources and
provide technical, logistical and operational support to reduce the spread of the virus. The panoramic
view of nurses’ practices during the pandemic revealed that despite advances in the dimensions evaluated,
limitations need to be overcome in order to ensure the sustainability of the Primary Health Care model,
the recognition and improvement of the practices developed by nurses in this area and their necessary
appreciation.
Article
This article analyzes the impacts of the implementation of neoliberal reforms and managerialism devices with private social organizations acting in the management of the public sector on the work process, professional training and subjectivity of community health workers. The study problematizes the principles of productivism, meritocracy and performativity in the ideology of managerialism applied to health. This is a qualitative study with an action-research approach. Individual interviews were carried out with ten community health workers from a family health unit in the municipality of Rio de Janeiro, state of Rio de Janeiro, Brasil. The data was interpreted using the content analysis technique, and the discussion of the results was organized into five categories: Challenges in the neoliberal context; The issue of professional training; Working conditions; Subjectivity in the work context; and Political practices of accommodation and resistance. The results showed the various forms of contestation against neoliberal policies in the organization of work. In the tension and contradictions of everyday work, subjects make and remake themselves, accommodate, adapt or resist, feel pleasure and suffer. The conclusion is that there is a need to strengthen spaces for listening, welcoming and dialogue, promoting critical training for community health workers and strengthening their articulating, educating and mobilizing role.
Article
The article describes the experience of the project “Training Indigenous Health Counselors of the DSEI/ MAO with the use of ICTs (Information and Communication Technologies),” conducted in 19 base centers of the Manaus Special Indigenous Health District in the state of Amazonas, Brazil, throughout 2021. It aimed to develop a training network for local indigenous health councilors based on the perspective of breaking away from ‘banking’ logic towards liberating practices for the action of councilors and promoting their participation in public Indigenous health policies. The activities combined different pedagogical strategies and interaction media, such as 22 face-to-face workshops, which trained 255 councilors and a distance education course, which trained 268 councilors, totaling 523 councilors; and the production of specific teaching material for the project in the form of three booklets. The training content included, in addition to fundamental notions of social control, information on the COVID-19 pandemic, the construction of approaches for social control action in the context of the health emergency, and hearings on coping with the pandemic in the territories and villages.
Article
This article presents results from an ethnography of documents, whose research object was the professionalization of nursing in Brazil. Based on primary documents, dated between 1925 and 1931, the objective was to analyze and discuss the ways in which the discourses constructed about the new profession and the new professional were sustained with an important influence from the eugenics movement. These speeches constituted structural violence, produced from a whitened place of power, which sought to build the socially accepted image of a profession that had broken with its colonial links of care, practiced in the country mostly by black women. From an anthropological and intersectional perspective, we sought to contribute to counter-narratives capable of questioning the hegemony that permeates the construction of the profession in the country.
Article
Bolsonarism is defined as a neo-fascist movement whose main social base is the upper middle class. Therefore, it managed to attract part of the medical category. It includes several ideological elements that were reflected in health policy between 2019 and 2022, including antipetism/anti- communism, neoliberalism, moral conservatism, homophobia, Christian fundamentalism, scientific denialism, antifeminism, and misogyny. We sought to analyze Bolsonarism’s reflexes on policies related to women’s health and sexual and reproductive rights during this period. Through historical and monographic procedures, with a qualitative, descriptive, and exploratory approach, indirect documentation and intensive direct observation were used for data collection, condensation of meaning, and hermeneutics- dialectics for its analysis. Moral conservatism and religious fundamentalism associated with anti-feminism and misogyny have marked policies aimed at women’s health and sexual and reproductive rights. We analyzed the fight of the Federal Council of Medicine against the concept of obstetric violence, the measures to hinder access to legal abortion, the difficulties for assisted reproduction, and the dismantling of the Stork Network, revealing the association between the medical profession and the Bolsonaro government.
Article
This article aims to problematize the issue of the invisibility of lesbians, gays, bisexuals, and transsexuals (LGBT) and its consequences on the access and health demands of these people, based on the needs and problems perceived in the social movement that makes up the main groups that form the Diversity Forum of Greater Florianopolis. This is a qualitative investigation that uses participant observation and interviews. Nine interviews were conducted with leaders of the LGBT movement in Florianopolis city, Santa Catarina, Brazil. As a result, it was observed that the population’s access opportunities were circumscribed by exclusionary and violence-producing professional practices based on acts of social discrimination. Often, exposure to non-heteronormative sexualities and gender identities could aggravate people’s vulnerability. The Unified Health System was crossed by constant heteronormative practices that disregarded the experiences of different sexualities among people. Due to this, the LGBT population was resistant to seeking health services, considering these spaces as places where they suffer prejudice and discrimination.
Article
This study aimed to understand the construction and performance of action plans to use the Safer Access tool in Primary Care in Porto Alegre city, Rio Grande do Sul, Brasil. To this end, a qualitative and descriptive-exploratory study was carried out, with focus groups, application of sociodemographic questionnaires and examination of action plans. Thirty-three professionals from eight health units participated in the study. The analysis of the data from the focal discussions reached three categories: assessment of the risk of violence; functioning of Safer Access; and performance of the decision-making group. The results demonstrate that the tool assists health teams in times of risk of violence. However, improvements are needed in the notification process and communication between professionals, sectors and the community, improving the use of action plans. Thus, to understand the true meaning of the Safer Access Program, it is necessary to interpret it in the work context, characterized by the precariousness of working conditions, which leads the government to outsource the solution to the problem of violence against health professionals.
Article
This article describes the building process of a georeferenced interactive map that incorporates the issue of the coexistence of different types of bonds in the same essential health unit in the municipality of Itajaí, Santa Catarina, Brazil. The research period was from January to June 2023. It is argued that this issue has opened scenarios of tension in labor relations and, in fact, in the production of resolutive and continuous care. The map opens helpful fronts for the organizational process of the municipal strategy network and for the analysis of public policies to reflect on what is presented to the workforce. It can also be an evaluation tool for social control entities and society in general. The text seeks to assume a didactic character by providing readers with access to sufficient information so that they can appropriate the tools presented, thus enabling them to build their own maps.
Article
The study, carried out from May 2022 to April 2023, aimed to discuss the teaching of integrality in the Multiprofessional Residency Program in Family Health Strategy, based on the experience of residents of Belém, Pará, Brazil. The research adopted a cross-sectional approach with a quantitative and qualitative approach and data collection carried out by a semi-structured questionnaire with five axes of interest: sociodemographic data, previous knowledge, and knowledge about the principle of integrality, inclusion of integrality in the theoretical activities of the program, articulation of theoretical knowledge with professional practice and applicability of integrality in the health actions carried out by the professional teams. 29 residents of nursing, physiotherapy, dentistry and occupational therapy regularly enrolled in the program participated. The findings revealed that the participants recognize the importance of integrality in meeting users’ health needs, pointing out that the integral approach must be validated and legitimized as an inseparable part of care. But the learning of integrality still constitutes a conceptual and methodological challenge, a reality that needs to be evaluated in the planning and choice of strategies for health education. It is concluded that the teaching of residents should prioritize the approach of this principle in more depth, to favor a more meaningful and powerful learning.
Article
Health professionals say they do not feel safe dealing with demands related to sexual violence. In this context, Permanent Health Education, a policy of the Unified Health System that fulfills the requirements of permanent development of professional skills and competencies, has emerged. The aim of this study was to analyze workers’ understanding of work processes and how they are linked to Continuing Health Education for qualification in the Care Network for Victims of Sexual Violence, in management and
in the Lilac Area of the Nise da Silveira Women’s Hospital in Alagoas (Northeastern Brazil). This is a descriptive study with a qualitative approach. Three workshops were carried out involving two research groups. The respondents understand the impact that Permanent Health Education can have on the care provided to victims of sexual violence. This is because it is not a plastered training process, but is anchored in learning that provokes them to problematize both their work conduct and the work processes in which they are inserted, valuing the experience that each one carries with the intention of (re)thinking new forms of care and reducing communication noise in the face of dialogue.
Article
The primary focus of this article was to elucidate the theoretical and methodological underpinnings of a unique and innovative pedagogical endeavor undertaken at the Faculdade de Medicina of Universidade Federal da Bahia, Brazil, within the realm of ‘medical humanities.’ This is the domain of ‘Art and Health,’ introduced in 2016, where our aim was to devise a teaching approach that delves into and deliberates, in the context of medical practice, on issues pertaining to corporeality, gender, and health care. From this standpoint, we endeavored to harness the transformative power of art as a means of questioning a set of assumptions, principles, and values that underlie social interactions typically observed in therapeutic encounters. This article specifically delves into one module of this course: a module that employs instances of artistic performances to contemplate the physical aspect of human existence (corporeality) and the realm of everyday life.
Article
The objective of this study was to analyze the trajectory of legislation related to higher education in Brazil and its contributions to the privatization of education, in addition to describing the leading business groups in the field of higher education in the country. For this, an exploratory study of documentary analysis of the legislation and online documents was carried out and published between 1961 and 2023. Since the 1960s, a set of 29 normative acts (laws, bills, decrees, ordinances and provisional measures) related to education have been issued. Over the years, all Brazilian governments have implemented acts that favored the privatization process and the emergence of large economic education conglomerates. The intense privatization of higher education is closely related to the trajectory of normative instruments issued by different governments. Legislation shaped the country’s educational system and allowed the flexibility of the processes of creation and expansion of institutions, courses and vacancies. Therefore, large business groups have emerged in the field of education, with growing financial capital working in all areas of training and, in some cases, even specializing in health education.
Article
The study aimed to analyze the work process of the community health agent with the older adults population, with special emphasis on home visits in the municipality of Foz do Iguaçu, Parana (Southern Brazil). A cross-sectional, analytical-descriptive study with a mixed approach was designed. A total of 114 community health workers participated, with a predominance of women, mean age of 43.2 (SD 10.76) years, white skin color, married marital status, Catholic religion, and complete high school as the highest level of education. Three discursive categories emerged that describe the challenges faced by these professionals in working with the older people: the ‘epidemiological territory’ brings together the health demands of the elderly accompanied by the workers; the ‘clinical approach’ discusses aspects of the care model of the family health strategy; and ‘community life’ takes up the issue of social relations between the older people and the environment. The study showed that home visits are the main activity developed by community health workers with the older population. Findings of the study offer contributions to local health management through the discussion of the challenges faced by a significant segment of health professionals allocated to Primary Health Care.
Article
This study aimed to evaluate the satisfaction and burden of mental health professionals in a medium- sized municipality in São Paulo, Brazil. A quantitative-qualitative study was conducted using the Mental Health Services Professional Satisfaction Rating Scale and the Mental Health Services Professional Burden Rating Scale for quantitative data. In addition, qualitative data were obtained through the analysis of minutes of the Research Steering Committee meetings with the support of the NVivo Release 1.3 software. The results revealed that mental health professionals experienced less overload in services in their area but were dissatisfied with their work. Although satisfaction was relatively higher in the Alcohol and Drugs Psychosocial Care Centers and Psychosocial Care Centers II compared to the outpatient clinic, these differences were not statistically significant. In short, the findings indicate that greater dissatisfaction and less overload are not independent events and corroborate other studies. The triangulation of data sources contributed to a broader understanding of the topic, highlighting the importance of considering the satisfaction and burden of professionals in improving mental health care.
Article
The study presented here aimed to evaluate the perception of the quality of the learning process in the virtual environment of the students of the Health Program with Agent. It was a cross-sectional study conducted in 2022 with 9,145 students from the Community Health Agent Technician and Health Surveillance Technician courses with an Emphasis on Combating Endemic Diseases. Information on the quality of the learning process was obtained through the Constructivist On-Line Learning Environment Survey, which consists of 24 questions grouped into six dimensions: relevance, critical reflection, interaction, tutor support, peer support, and understanding. The sociodemographic profile of the participants and the primary forms of access to the course and monitoring were evaluated. Descriptive analysis was performed; for association analysis, the chi-square or Fisher’s exact test was used. Most participants are females aged 40 to 49 from the Northeast region; they perform activities at home and use their cell phones/smartphones. When considering the six dimensions evaluated, relevance, interaction, and support of colleagues obtained statistically significant differences between the students of the courses of Community Health Agent Technician and Health Surveillance Technician with Emphasis on Combating Endemic Diseases.
Article
The objective of this study was to evaluate the safety of health professionals who worked in the fight against the COVID-19 pandemic in 2020 in Brazilian health services. An online survey was conducted between June and September 2020, with health professionals from Brazilian public and private institutions, based on the Health workers exposure risk assessment and management in the context of COVID-19 virus, from the World Health Organization, and 2,832 records were analyzed. Race/color and professional category were variables related to the increase of covid-19 cases among professionals. Those who self-declared themselves non-white, technical and nursing assistants had a higher chance of positive results, indicating a higher susceptibility to infection related to socioeconomic level and/or professional category and a role played in patient care. The variables structure of the health units, location, test and availability of personal protective equipment were related to the degree of risk of contracting the disease. The importance of ensuring inputs and equipment to health professionals is highlighted, especially in a pandemic context and among those with low socioeconomic level who work on the front line. Risks in emergency and scarcity situations should be prospectively monitored, adjusting to patient safety initiatives.
Article
Self-medication exposes individuals to risks such as adverse reactions, intoxications, drug interactions, therapeutic failures and medication errors. In the COVID-19 pandemic, there was an increase in the purchase and consumption of pharmaceutical products by Brazilians. Therefore, the objective of the present study was to assess the prevalence of self-medication among university students, as well as the incidence and increase in practice during the COVID-19 pandemic. It has a cross-sectional and quantitative design, with 248 students from a university center in Zona da Mata, Minas Gerais. The findings show that 67.3% of the participants reported self-medication, 28.7% indicated an increase in self-medication during the pandemic and 30.9% indicated its initiation during this period. There was a significant difference regarding considering oneself capable of self-medication, having the habit of recommending medication to other people and consuming them at the recommendation of others. For those who increased the practice of self-medication during the pandemic, there was an association with the habit of recommending medication to other people. For those who started this practice in the pandemic period, the ability to self-medicate was associated. Thus, the results pave the way for educational measures on the irrational use of medication among higher education students, regardless of the area of training.
Article
Food and Nutrition Education is the field of knowledge that takes into account the representations about eating and food, knowledge and values of food, with a view to the autonomy of choice of subjects in matters related to food and nutrition. This text is the result of a theoretical research aimed at identifying the trajectory of Food and Nutritional Education in Brazil, which outlined it as a field of knowledge. The current policies of this field of knowledge are the result of overcoming a past where educational approaches focused on food predominated that took place in a decontextualized, normative and strictly biological way. This trajectory involves disputes in its theory and practice that show that the resolution of the food problem in Brazil is permeated by a profound economic and social restructuring. We highlight the need for the practices of Food and Nutrition Education to be guided by the critical and emancipatory perspective of education.
Review Article
The distribution of doctors in Brazil is marked by inequalities, impairing integral and universal access to health, the basis of the Unified Health System. The Mais Médicos Program reached the peak of emergency provision in 2016, with 18,088 doctors in 4,509 municipalities, one of the most significant interventions of its kind in the world. A systematic review was conducted to gather evidence of the Program’s effects on Primary Health Care and impacts on the health of the population served. 570 studies were extracted, and the final selection included 32 articles. Regarding the effects of the Program, there was a rapid expansion in coverage and improvement in the comprehensiveness and humanization of Primary Health Care and a significant impact on hospitalizations due to conditions sensitive to this care, reducing approximately 23,000 hospitalizations in three years and saving R$30 million for the Unified Health System. Points that were detrimental to the potential impact of the Program were also identified: deviations in focus, changes in priority criteria, and improper replacement of doctors already hired by others from the Mais Médicos Program, in addition to the rupture caused by the departure of 8,500 Cuban doctors in November 2018. It is estimated that the relaunch of the Program in 2023, mainly based on existing evidence, will promote the continuity of its progress.
Review Article
Health is indicated as one of the justifications for the existence of physical education as a school curricular component. However, a limited view of health still prevails, focused especially on biological and behavioral issues. A resolution of 2018 established single ingress into physical education courses, instituting that there will no longer be separate ingress for bachelor’s and teaching degree, and that students should choose one or other specific qualification only in the second half of the course. The objective of this study was to analyze the syllabi of the new curricula of undergraduate courses in physical education of public universities in the southern region of Brazil, specifically in relation to their approach to the theme of collective health. This is a descriptive-analytical study with documentary analysis where 708 syllabi of subjects of 11 courses were analyzed. Three courses had no disciplines related to the theme collective health. We identified 17 compulsory subjects, 13 offered in the common stage and four in the specific stage of the degree. It is concluded that there are few insertions of the theme of collective health in undergraduate courses in physical education, especially in the specific stage of the course.
Interview
Matuzza Sankofa é redutora de danos, presidenta do Centro de Convivência “É de Lei”, com sede em São Paulo, capital, pioneiro no Brasil desde 1998 na promoção da redução de riscos e danos, sociais e à saúde, associados à política de drogas. É também coordenadora do projeto Respire, fundadora e presidenta da Casa Chama, que atua com mulheres trans que vivem em situação de rua. Nessa entrevista, Matuzza nos fala sobre a redução de danos na relação com a saúde e como ela conflui para a sua trajetória de vida.
Foto: Acervo EPSJV
Memory
This text celebrates the ideas and legacy of educator Carlos Rodrigues Brandão, who unfortunately died on July 12, 2023. To honor Brandão, we chose to take as a basis the work entitled O educador: vida e morte (The Educator: Life and Death), which completed 42 years and served as inspiration for the title of this text. Indeed, the distance of time does not erase the educator’s spirit of a loving and libertarian vocation. Brandão ruthlessly criticized social injustices while indicating daily outlets for emancipatory educational work. Brandão’s thought has not withered; poetic and amusing, it remains alive and flourishing among us. As in the reflection of Rubem Alves (1983, p. 17): “And the educator,did he die? Educators are like old trees. They have a face, a name, a story to be told.”
Review
Resenha crítica da Obra:
FILIPPON, Jonathan; FRANCIS, Sodré; ANDRADE, Maria Angélica Carvalho; SIQUEIRA, Carlos Eduardo (org.). Capitalismo, austeridade e saúde no Brasil: perspectivas da economia política. São Paulo: Hucitec, 2022. 295 p.
Review
Resenha crítica da Obra:
FREITAS, Carolina; BARROS, Douglas; DEMIER, Felipe. (Orgs.). Junho e os dez dias que abalaram o Brasil (2013-2023). São Paulo: Usina Editorial, 2023.
Acknowledgements