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.
Interview
Eduardo Sá Barreto é professor associado no Departamento de Economia e no Programa de Pós-graduação em Economia da Universidade Federal Fluminense (UFF), e pesquisador do Núcleo Interdisciplinar de Estudos e Pesquisas sobre Marx e o Marxismo (Niep-Marx). Possui doutorado e mestrado em Economia pela UFF e graduação em Ciências Econômicas pela Universidade Federal de Minas Gerais (UFMG). É autor dos livros Ecologia Marxista Para Pessoas Sem Tempo (Usina Editorial, 2022); O Capital na Estufa: Para a Crítica da Economia das Mudanças Climáticas (Editora Consequência, 2019); Marxism in the Age of Ecological Catastrophe: Theory and Praxis (Editora Routledge, 2024); entre outros, com temas relacionados à crise ecológica, crítica da economia política, história do pensamento econômico e filosofia da ciência. Nesta entrevista, Eduardo aborda o ecossocialismo como contrapartida à crise do Capital.
Imagem: Larissa Guedes(EPSJV/FIOCRUZ)
Article
The pharmaceutical workforce in municipal Primary Care has proven to be relevant, given the healthcare needs. The aim of this study was to analyze the rates of pharmacists working in Primary Care in municipalities and their relationship with investments in aquisition of medicines, considering the Municipal Human Development Index and the population size of Brazilian municipalities. The study includes primary data from 2021, which corresponds to Brazilian municipalities on a national scale, and secondary data from national databases. The average rate of pharmacists is 1.85 per 10,000 inhabitants. Municipalities with higher development indices have higher rates of pharmacists. Municipalities with low development indices, small size, in the North and Northeast regions are associated with none or one pharmacist per 10,000 inhabitants. Small municipalities showed a positive relationship between investment in medicines and the rate of pharmacists, meaning that places that invest more in medicines also have higher rates of pharmacists. However, municipalities with high development indices show a correlation with higher rates of pharmacists and invest more in medicines.
Article
With the aim of analyzing the repercussions of current management and financing policies of Primary Healthcare services in Brazil on the work of occupational therapists, an action research was carried out, operationalized as a community of practice, with 14 meetings, in which six occupational therapists from different regions participated, from April to October 2023. The transcripts of the meetings were thematically analyzed and the results were organized into three themes: the overloads and dehumanization of work in Primary Healthcare; the desire to offer quality care, learned in initial training, in contrast to the high demand for adaptability in fragmented work processes; and coping with these contingencies. The participating occupational therapists demonstrate the diversity of employment relationships, in a variety of services and populations served. The meetings in the community of practice enabled access to multiple realities of the work of occupational therapists, with repercussions on personal and professional daily life and health. In addition, tensions between training for community care in Primary Healthcare and the reality of individualized, fragmented work driven by goals are highlighted – evidencing contradictions between the policy of training for Primary Healthcare, the policy of implementation, and the execution of this work.
Article
The pharmacist’s role in managing self-limiting health conditions presents challenges related to clinical skills and confidence in providing effective care. The integration of simulations in education is one of the tools to enhance these clinical competencies. This research, conducted in Brasília in 2022, aimed to evaluate the clinical competencies of pharmacy professionals and students through remote realistic simulations, using a validated assessment instrument. The study occurred in three stages: development and provision of educational material with a description of the clinical case; remote realistic simulation of pharmaceutical consultations and peer evaluation; and quantitative analysis of participants’ performance. The research included 96 participants (professionals and students), and 40 clinical simulations were conducted, totaling 1,020 peer evaluations. Predominantly, the evaluations of clinical skills were positive, highlighting ‘verbal communication’ (88.6%), ‘definition of the health problem’ (86.4%), and ‘non-verbal communication’ (85.5%). However, the item on ‘vital signs measurement’ achieved only 57.3% satisfactory performance. Significant improvement in participants’ confidence was observed after accessing the material and simulation. Clinical simulations contribute to the development of clinical competencies, strengthening the capacity for pharmaceutical intervention in managing self-limiting health problems.
Article
This is a cross-sectional study aimed at evaluating the knowledge, self-efficacy, and collective efficacy of professionals working in multidisciplinary teams in the public service of the city of Campinas, Brazil, regarding the recommendations of the Dietary Guidelines for the Brazilian population. Validated selfadministered questionnaires were used to collect data and linear regressions were used to compare groups and identify factors influencing outcomes. The study involved a sample of 141 professionals from the health and education sectors, mostly women, aged 35 to 45 years, with a municipal employment contract of up to ten years. About half of the professionals knew the Guide, but only 28.9% of health professionals and 19.5% of education professionals used it. Nutritionists scored the highest in knowledge, with an overall average of 64.6 points. Health professionals had a higher proportion of high self-efficacy compared to education professionals. Nutritionists from both sectors and health professionals had higher collective efficacy scores than education professionals. Those with higher self-efficacy and longer careers were more likely to achieve high collective efficacy. The diagnosis highlighted the need for training on the Guide to increase knowledge and empower professionals for intersectoral work.
Article
This article aimed to discuss gender, race, and education as social markers that influence the participation of community health workers in matrix support in mental health in Belo Horizonte, Brazil, in 2023. The results are from a qualitative research study, using semi-structured interviews and participant observations as data production techniques. Intersectionality was used as an analytical tool. In the researched teams, it was observed that the majority of the agents were black women with high school education, while the majority of the professionals offering matrix support were white women with higher education. These racial and educational differences influence the relationships established between agents and supporters, being related to some mechanisms of exclusion of community health workers from the spaces of matrix support in mental health.
Article
In Myanmar, during the civil war following the February 2021 military coup many medical students suspended their studies. The University of Parma is committed to organize alternative courses for Myanmar medical students. The aim of this study was to examine through a mixed method the current educational needs of Myanmar medical students and the feasibility of alternative training courses. The quantitative research revealed that many students can attend educational activities online. The main difficulty concerns training through clinical practice, although some of them believe in the possibility that online simulation can partially make up for this deficiency. The training areas of main interest are: Mental Health, Emergency Medicine, Public Health, Healthcare Management. The qualitative study revealed that the students are confident that foreign universities can provide online training activities not only during the civil war, but also when peace has been established, and that such activities may be legally acknowledged. These results, in addition to documenting the resilience of the students involved in this research, respond well to the need to direct training to the effective actual needs whilst addressing the need to understand the specific context in which students will have to benefit from training, even in war situations.
Article
During the pandemic caused by the SARS-CoV-2 virus, associations and social movements belonging to rural populations have taken various actions to ensure the survival of their communities. The aim of the study was to analyze the effects of associative practices in guaranteeing the health of the rural population in the context of the pandemic. This is a qualitative case study in which the Landless Rural Workers’ Movement and three quilombola associations took part, covering three regions of Brazil (South, Southeast and Northeast). A total of 15 interviewswere conductedwith members of these movements between 2021 and 2022. The data was examined using thematic analysis. The actions organized in the territories were based on principles of solidarity, the management of community life and the defence of life, making responsibility for health and social rights a community matter. Popular organization during the pandemic has led to greater commitment within associations, settlements and encampments in the fight for health and rights, provoking community mobilization and political training that has made collectives stronger to build their struggle. Associativism, through grassroots organization, has fostered solidarity, political education and collective care, acting from an emancipatory health perspective.
Article
The National Policy for Integrative and Complementary Practices of the Brazilian Unified Health System is a set of norms and guidelines created to implement such practices. The study aimed to analyze the trajectory of this policy through official documents, focusing on the challenges related to health training and the impact of the hegemony of the biomedical model on the implementation of such practices. The study used descriptive documentary analysis and discursive textual analysis as data collection tools. Four documents were analyzed. The results showed that the most recent document details the trajectory of professional experiences with the practices, justifying the officialization of the policy. We identified the existence of a field of knowledge about practices before the regulation of the policy. However, the approach to teaching was considered incipient. The other documents analyzed presented only a description of the practices included in the policy. Encompassing the cultural dimension in teaching integrative and complementary practices can contribute to a diversified view of such practices in the Unified Health System, in order to break away from the scientific exclusivity of the biomedical model.
Article
The objective of the study was to analyze the guidelines for organizing work with the inclusion of digital technologies in the health sector, as presented in official documents from Brazil and Portugal. The document review, conducted in May 2024, included documents from the year 2011 onwards, resulting in 11 documents from Portugal and ten from Brazil. The findings indicate similarities in the regulatory frameworks of the two countries, including the process of semantic interoperability of information systems, electronic health record systems, the use of telehealth to support health and management decisions, and the promotion of electronic prescriptions. The differences are related to the definition of the support network for the implementation of technologies, as well as the use of artificial intelligence for epidemiological surveillance and triage and screening consultations in teledermatology within primary care units in Portugal. In Brazil, notable aspects include the institutionalization of the Digital Health Secretariat within the Ministry of Health and the establishment of the Digital Basic Health Unit in the context of Primary Health Care. By revealing the use of technologies to support practices, a thorough analysis of the documents can contribute to the implementation of public policies and to a democratic and inclusive digital transformation in both countries.
Article
This article discusses a proposal for the supervision of Primary Health Care workers who provide direct care to women in situations of domestic violence, through a space for debate on what they do and the emerging affections, considering issues of gender, women’s human and social rights. This proposal was part of an intervention research, offered after training on the subject in four Primary Health Care services in the municipality of São Paulo, Brasil, from 2020 to 2022. The technique used was participant observation with field diary records of monthly supervisions and semi-structured interviews with workers and managers. Through content analysis, the data was divided into the following axes: discussion of work - listening to women, gender perspective and human rights; the worker and her process; organization of work and teamwork; intersectoral network and organization of the supervision itself and the need for a framework. The supervision qualified theidentification and care of the cases, highlighting its dual character: monitoring care and critical reflection on ethical and political issues. It has an impact beyond the specific topic and is fundamental to the safety and practical success of the intervention, with management being essential in maintaining it. Supervision is advocated as part of Primary Care protocols for the care of cases of violence.
Article
The aim of the article is to conduct a historical analysis of the Federal Network’s role in offering technical health courses between 2017 and 2023, based on data obtained from the Nilo Peçanha Platform of the Ministry of Education. It starts from the inherent problematization of the low indicators of public sector participation in the training of health technicians, the curricularization of health through the pedagogy of competencies, and the advances of neoliberal policies that alter the relationships of human and professional training. The article is guided by the theoretical and methodological framework of historical and dialectical materialism, understanding that the relationship between work, education, and health constitutes a determination of social reality. The results corroborated the low participation of the Federal Network in offering technical courses and enrollments in health and the intense representativeness of the private sector. However, they revealed an important data point that endorses the political and social role of the Federal Network and, mainly, of the Federal Institutes: the continuous increase in the number of enrollments in integrated high school health education.
Review
MAIA, João R.; REIS, José R. F.; CRUZ, Leandra B. (org.). Pensar a loucura: trilhas literárias, culturais, históricas. Rio de Janeiro: Editora Fiocruz, 2023, 312 p.
Acknowledgements