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 aim of the present study was to analyze the relationships between work, education and health in the strike of the education professionals of the Rio de Janeiro (Brazil) municipal network, in the year of 2013. This is a qualitative research, which adopted individual interviews and documentary research as its investigation technique, based on the trade union press. We chose the thematic analysis technique, and three main themes of interpretation were identified: work and defense of quality public education; collective learning and struggle pedagogy; and collective fight for health. From the angle of the historical understan-ding of the event, the strike materialized as a space for questioning the situation of work in schools and as a movement of struggle in defense of quality public education. Likewise, the strike raised reflections about the relationship between teaching as an occupation and the struggle for health. The conclusion is that the collective actions of workers are spaces of learning, of production of knowledge, and of intervention in health. It is an extended perspective of education and health, as a pedagogical praxis, which is carried out in the struggle and in the valorization of the collective experience of work.
Article
The goal of the present study was to understand the experience of the coexistence between the substitutive services and the psychiatric hospital. This is a study with a qualitative hermeneutic approach. The research was carried out in the Northeast of Brazil. It contemplated two scenarios: Center of Psychosocial Attention, and Psychiatric Hospital. It included 14 participants, 8 of whom were workers of the Center of Psychosocial Attention and 6 who were health workers at the Psychiatric Hospital. To obtain the information, an in-depth interview and a systematic observation were performed. The collection took place from August to October 2017. The analysis of the interviews was performed using the hermeneutics of Paul Ricoeur, through the following steps: speech to text transcription, exhaustive reading, structural analysis, wide-ranging comprehension of the text, interpretation and analysis. The results showed that there is a paradoxical coexistence between the psychosocial care services and the psychiatric hospital, even though the hospital service is not recognized and legitimized as part of the mental health network.
Article
The aim of the present study was to understand how the professional identities of the endemic combat agents are built. The endemic combat agent has a strategic role in the prevention and control of arboviruses such as dengue, chikungunya, zika, and yellow fever, which are serious public health problems in Brazil. The research was based on the concepts of qualification and professional identity, referenced by the sociology of work. This was an analytical study, conducted between 2014 and 2017, with a qualitative approach, carried out from focus groups, with 30 endemic combat agents from a sanitary district in Contagem (state of Minas Gerais). The data were analyzed according to the assumptions of the content analysis. Most of the agents were women and had completed high school. The results pointed out that there is a lack of knowledge on the part of the agents about the protocol for the execution of their work activities and about the technical contents related to dengue. The teaching-learning process occurs orally and through non-formal work processes. Failure to receive badges presented itself as an identity problem. It was concluded that the professional identities of the agents were built and rebuilt without a solid professional training and in precarious work conditions. Recognition, as an aspect of identity, occurs on the affective plane and not only in the work processes.
Article
This article presents meanings that women users of the Family Health Strategy program attribute to health and its relation to care. The qualitative method was applied, using as a theoretical reference the discussions of Canguilhem and Winnicott on the notion of health, as well as notes on the medicalization of life. The fieldwork was developed through in-depth interviews between May and July 2015, with users of the Family Health Strategy program, and was treated with a hermeneutical analysis. Health, related both to the absence of illness and to complete well-being, as well as to the disposition to face the sufferings inherent to life. There is a coexistence between the unconditional trust in medical technology and a wager on intuitive care modes or those originated from social relationships. The health service contributes to the access to the treatment and, at the same time, reinforces the commitment to the prevention of all the misfortunes of the body, as well as the idea that the right to health care is related to the individual responsibility to keep it perfect. In a culture marked by individualism and competitiveness, individuals living in contexts of deep social injustice submit to rules to prevent the risk of becoming ill, but their possibilities of creating unique ways of enjoying life are restricted.
Article
The study had the goal of assessing the organization of the work process of family health teams in a municipality in the state of Minas Gerais, Brazil. It was a quantitative, cross-sectional analytical research performed in 2014. We investigated the forms for the Self-Assessment for the Improvement in the Access and Quality of Primary Health Care of 73 teams. A total of 14 items of the subdimension organization of the work process were considered, and they were scored from 0 to 10, with 0 meaning complete inadequacy and 10 meaning complete adequacy of the team to the assessed pattern. The teams were classified from the ‘highly unsatisfactory’ pattern to the ‘highly satisfactory’ pattern. The significance level of the statistical analyses was set as values of p < 0.05. A total of 86.3% were classified in the highly satisfactory/satisfactory pattern, and 13.7% were classified as average/highly unsatisfactory. Three items ‒ ‘Defined territory, bond with the population and responsibility for the fulfilment of the health needs’; ‘Coordination of care’; and ‘Monitoring of exam requests’ ‒ had inadequate performances. The teams from urban areas scored better in the assessment. The odontology professionals were the category that scored the highest in the assessment. Special attention should be devoted to the teams with low scores. A better organization of the work process should be strengthened, with the goal of enhancing the performance in the care to health of the community.
Article
The present study has the goal of questio-ning the learning processes of adult workers in professional training in health. Considering that the training of health workers should expand the horizons of the students beyond biomedicine, we take as reference the studies by Kastrup on inventive cognition. These studies help us conceive a training that is different from the training focused on content and techniques. The research was developed based on an analysis of documents written by students and teachers of the Community Health Worker Technical Course in Rio de Janeiro, Brazil, in 2017. The interviews performed with the students were also analyzed. The analyses show how different pedagogical strategies favor the training of individuals-workers who are sensible of and engaged with the development of health practices that are not only established within biomedical knowledge. We noticed that the work performed made it possible for the students to question the relationships among education, culture and health, and, therefore, question their already ingrained health practices. These experiences opened the possibility for the students “to no longer be who they were” and strengthen themselves in the development of a diverse Unified Health System (Sistema Único de Saúde, in Portuguese) and a diverse society.
Article
The increase in the implementation of the Family Health and Primary Health Care Expanded Support Center in the state of Paraíba, Brazil, and its influence on the improvement in the quality of the assistance of the primary health care teams makes it relevant to get to know the organization of the work process within these centers. The study analyzed the planning actions, the offer of initial training and ongoing education, and the integration with the supported teams. Methodologically, it is a descriptive, quantitative and cross-sectional study. The data was obtained from module IV of the 2nd cycle of external evaluation of the Program for the Improvement of the Access to and Quality of Primary Health Care (Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, in Portuguese). The corochromatic map was developed using the TabWin software, and the descriptive analysis was made using the IBM SPSS Statistics software, version 20.0. Regarding the offer of initial training and ongoing education for the Center, we observed that the teams that underwent the former (50%) were more likely to be offered the latter (74.1%), and the courses were offered in larger municipalities. The initial training had as its most common activities the qualification/informational meeting workshops (20.7%) and the introductory course (20.7%). There is a weakness in the records and in the execution of the systematized planning, mainly regarding the monitoring and assessment of the actions. The integration between the Family Health Support Center teams and the reference teams is weak and not in line with the conceptual goals of the matrix support.
Article
The present article has the goal of describing and analyzing the general social conditions regarding race/ethnicity, gender, social class and schooling among a sample of 500 subjects (n = 250 men; n = 250 women), aged 60 years or older, who are users of the Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym) and live in the rural area of a medium-sized municipality in the state of São Paulo, Brazil, between 2015 and 2016. The design of the study is of a mixed nature, combining quantitative and qualitative techniques in order to describe and analyze the selected categories intersectionally. The data was collected using a structured questionnaire with closed questions regarding sociodemographic aspects. With the aid of the software IBM-SPSS (version 20.0), we produced a databank with descriptive and specific information. The obtained results confirm inequalities regarding gender and race/ethnicity, and the women who self-reported as being black are more vulnerable in terms of finances and schooling than the women who self-reported as being white and the men who self-reported as being white or black in the same age group. Lastly, the data enable us to counter the thesis that the 1988 Constitution and its adjacent policies would have provoked an interruption in the inequalities in generational terms.
Article
The study identified the pattern of evolution, distribution and expansion of the undergraduate medicine courses in Brazil and described the governmental processes related to the increase in the capacity of the courses. It is a descriptive study based on data available in the system of the Brazilian Ministry of Education about medical schools. With information about the courses dating back to the first that were implemented in the country, we could establish six periods of government for the analysis: from 1808 to 1963 (from the Monarchy to the first republican governments); from 1964 to 1988 (from the military dictatorship to the government of José Sarney); From 1989 to 1994 (Fernando Collor - Itamar Franco); from 1995 to 2002 (Fernando Henrique Cardoso); from 2003 to 2010 (Lula); and from 2011 to 2018 (Dilma Rousseff - Michel Temer). We observed a significant expansion of the schools starting with the military dictatorship and peaking in 2014 (Dilma Rousseff), and the implementation of the More Doctors Program (Programa Mais Médicos, in Portuguese). Throughout the analyzed periods, the teaching of Medicine became ever more privatized, and was partially shifted to the Northern, Northeastern and Midwestern regions of Brazil, and to medium-sized and small municipalities in the countryside of the states. The results indicate that the combination of the management by the government of the health, education and socioeconomic development policies had an influence on the expansion of the Medicine undergraduate courses and the marked intra- and interregional differences.
Article
Although research on care is predominantly associated with the health field, sociological studies emphasize that the elements that influence the health field are not restricted to it, insofar as it is the expression of intense social support and a fundamental attribute for the maintenance of collective life. The objective of the present study was to hypervisualize the sociological dimension of the care to problematize its transposition as a necessary factor to the social life for a technical action of health. A systematic literature review was conducted between 2003 and 2013 in the Virtual Health Library, PubMed, Scopus, Embase, Web of Science, Francis (Ovid), ProQuest Central, Academic Search Premier (EBSCOhost), and Jstor and Sage databases, with the single term care and its variants. Of the 262 articles identified, 15 on the social dimensions of care were selected. It was observed that care referred to the solidarity and quality of the interaction between subjects in micro-relationships and macro-structures, differing from its technical/technological application in health. It was also observed that it is more comprehensive to define care sociologically than by the specificity of an act, for it includes dimensions of solidarity, respect, zeal, and mutual help for the preservation of life. It was concluded that a sociological approach to care is necessary, even contributing to the health field.
Article
The goal of the article was to characterize and analyze the organization of the work processes in mental health services in the municipality of Campina Grande, in the state of Paraíba, Brazil. It is a quantitative, retrospective and documentary study that was performed between July and August 2014. The data was collected from a form based on an instrument validated for the study, considering a sample composed of 402 medical records. In order to process the statistical analyses, we used the SPSS software, version 17.0. We observed that the users were predominantly adult women with a clinical diagnosis of schizophrenia associated with other clinical diagnoses. Regar-ding the admissions to psychiatric hospitals before and after enrolling in the service, we noticed a statistically significant reduction. The high number in the records of workshops held was an important progress. The main limitations of the study were the mistakes in the medical records, which do not make them less important or irrelevant, though. We stress that the comprehensive and communal embracement of the users with mental disorders and their families, which is in line with the psychiatric reform norms, requires, among other things, higher investments in the infrastructure of the services, equipment and technologies, institutional support, qualification and commitment of the management in the ongoing education processes.
Article
Quality and universal health care is a right that should be guaranteed through public policies, proper funding, and through the adequate training of the health professionals. One of the strategies identified to overcome this challenge is the Education for the Work in Health Program (Programa de Educação para o Trabalho em Saúde, PET-Saúde, in the Portuguese acronym; PET-Health henceforth), which has the goal of promoting the interaction of students and professors with the health services. The goal of the present study was to compare, using the results of the 2013 National Nursing Student Performance Exam (Exame Nacional de Desempenho dos Estudantes dos cursos de Enfermagem, in Portuguese), the performance of the individuals who took part in the mentioned program with that of those who did not. It is an observational study, with a cross-sectional and analytical perspective, which was conducted between February and June 2017. The research analyzed the performance through the weighted arithmetic means regarding general training, professional training and Collective Health. The sample was composed of 30,289 students, 876 of which took part in the PET-Health. The students involved with the program performed better in every segment, with a statistically significant difference (p < 0.001) in comparison to those who did not take part in the program. The results indicate that the program in question has the power to understand the need for training within the Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym) regarding the knowledge on Collective Health and the professional area, which should be a guiding element in the development of the syllabuses of Nursing Courses.
Article
Article
In many countries there are initiatives of adapting the medical training to the needs of the health systems. In Brazil, the More Doctors Program (Programa Mais Médicos, in Portuguese) introduced the most recent changes, establishing a new regulatory framework in the medical training, which is expressed in the National Syllabus Guidelines, emphasizing the development of professional abilities in primary health care. In the present study, we tried to analyze the social representations of medicine students about the work in primary health care within the context of the implementation of the aforementioned guidelines. In order to do so, 149 medicine students from ‘traditional’ and ‘new’ public courses in the Northeastern region of Brazil answered a sociodemographic questionnaire and a free evocation script in the second semester of 2017. The results show a student profile that corresponds to the ‘first university student generation’ of the ‘new schools’. In these schools, the social representations of the medicine students are more in line with the new guidelines, with an emphasis on the evocation of terms such as ‘bond,’ ‘responsibility’ and ‘community.’ In the ‘traditional’ schools, the terms that stood out the most were ‘underappreciation,’ and ‘precariousness,’ which suggests that these students do not have enough experience in primary health care. We hope that the innovative experiences that were analyzed can be multiplied and deepened in the radicality needed for the strengthening of the Unified Health System (Sistema Único de Saúde, in Portuguese), with training that is in line with the social needs.
Ensaio
In the present essay, in celebration of the 50th anniversary of his manuscript, we revisit the classic book Pedagogy of the Oppressed, by Paulo Freire. Amidst difficult times for Brazil, and at a time in which we see the rise of the Non-Partisan School Movement (Movimento Escola sem Partido, in Portuguese), among other ‘advancements’ of conservatism, the masterpiece of the patron of Brazilian education is more current and vigorous than ever before. Here, even though we recognize that Freire's essay meant a certain ‘revolution’ in pedagogy, our focus is on what we consider his central, though little debated, thesis: the pedagogy of revolution. Moreover, in the end, we show that Freire was one of the pioneers in Brazil of the post-colonial thinking, and this must work as a point of convergence with this libertarian school of thought, whose revival renews the hopes and utopia of the Left.
Ensaio
The study has the goal of discussing what is a concept based on the adoption of the Marxist theoretical framework to define it, with the intent of answering whether the existence of a concept of health is possible or not. We read Marxist authors who deal with the relationship between thought and objective reality, trying to rely on many different authors within this framework, in order to enrichen the current debate in Collective Health. As a result, we understand that that the concept is the way in which thought apprehends the objects that are present in objective reality and that, precisely because it does not contain the concrete-factual features that are present in each particular case, it enables us to understand them based on their abstract-universal objects. Therefore, we conclude that, even though health is an extremely complex object, the existence of its concept is possible, and, according to our frameworks, this concept must refer to the socio-historic whole and to the politicization of the technical dimension that is historically implicated with this social.
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