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 objective of the study was to analyze the process of establishment of Continuing Education in Health, identifying its transformations, continuities and ruptures in the socio-historic context from the 1970s to 2005. The study is based on the theoretical-methodological framework of the Critical Analysis of Discourse. Based on the interviews made with the representatives of the development and management of the Continuing Education in Health policy in different historic moments, we attempted to understand the context, the texts and the social actors that compose the discourse in each period of time. The results indicate a process characterized by continuities and ruptures, and influenced by the ideologies that mark the discourse variations in each different period. Therefore, the discourses regarding the centrality of the work, with its demands for professionalization, qualification and training, coexist with the discourses regarding the centrality of the individual and with their need to know and learn in and with everyday life. We understand that Continuing Education in Health in Brazil is going through a process of reconfiguration under certain political, ideological and epistemological influences.
Article
The present article has the goal of analyzing the work process of a team at the Family Health and Primary Health Care Expanded Support Center located
in a municipality in the state of Pernambuco, Brazil. It is a case study with a qualitative focus and an analytical-descriptive nature. The techniques employed for the data collection were focus groups and analytical maps; for the organization and analysis, we adopted the technique of the Discourse of the Collective Subject. The analysis of the work process revealed in the discourse of the team conceptions regarding a ‘must be’ guided by what is recommended by the Brazilian Ministry of Health. However, the following aspects were identified: there is little success in the execution of the matrix support; there is no success in the development of agreements about the work process; the work is fragmented and has a focus on welfare; and there is no use of the technologies for analysis and family and populational intervention. We also observed that the planning of actions was rarely performed. This reveals a work that differs from what is considered adequate by the very same team. Problematic factors within and without the teams were also identified. We recommend beginning with an analysis of the work process that is to be performed by the very same team, which will contribute to reach more solutions.
Article
The goal of the present study was to describe the implementation of Primary Health Care in the Northeastern Region of Brazil and its correlation with social
indicators. It is an ecological study with data from the Primary Health Care Department (Departamento de Atenção Básica, in Portuguese) of the Brazilian Ministry of Health and from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, in Portuguese), and the variable of the study is the number of Community Health Workers, Health of the Family Teams and Health of the Family Support Centers. The calculation of the time trend of the Community Health Workers and of the Health of the Family Teams was performed using Poisson’s joinpoint regression. We observed a strong correlation (r ≥ 0.7) between the social indicators and the implementation of Primary Health Care and of the Health of the Family Center in the Northeastern Region, inadequate sanitary sewage systems, total fertility rate, houses with indoor plumbing, percentage of houses with garbage collection, life expectancy at birth, aging rate, and probability of living until the age of 60 years. The health and development variables presented a statistically significant (p< 0.05) change in the correlation and determination coefficient. There is a time trend regarding the increase in the implementation of Primary Health Care in the
Northeast, and there is also a strong correlation between the social and health indicators.
Article
Based on the dispersal of meanings that constitutes the naming of the ‘Health of the Worker’ field, we sought to comprehend what is at stake in the constant changes in nomenclature in this field. These changes occur within a timeline, but they happen concomitantly. Its inaugural landmark was found in the stability of the name ‘occupational medicine,’ a name institutionalized by the International Labour Organization in the beginning of the second half of the 20th century. This first gesture of naming was followed by other gestures, established in tense and contradictory relationships of replacement, recovering and concurrence, such as: occupational health, health and safety at work, and, more recently, among these variations, we found the addition of the term ‘Health of the Worker.’ The second-to-last name is the most stable one, and it is used by international and entrepreneurial organizations.
Article
In the research that originated this article, which was performed in the city of Rio de Janeiro, Brazil, between 2013 and 2015, we analyzed the work of the institutions regarding the crack scenes and the people who attend those institutions, with the goal of making them intelligible. In the perspective of the encounter between the Doctor’s Office in the Street (Consultório na Rua, in Portuguese) and those people present in those scenes who either have become users or not, we shed light on the relationships developed between this population and crack, between the Doctor’s Office in the Street and institutions such as the Police, social aid and other health services. Based on the data produced with the ethnography, one can comprehend two hubs for institutional action: one that is close to making someone die or letting them live, which indeed has a sovereign decision power, and the one according to which the institution offers itself as existential support and, therefore, changes after the encounter with those people it means to care for. We conclude that the existing and possible innovations in the health services are due to this way of working in which the institutions, through what was called ‘institutional responsibility,’ open themselves to transformations triggered by a ‘minority power.
Article
Considering sexuality as a fundamental part of human life, the present study had the goal of understanding how Nursing students represent sexuality.
We chose to make a qualitative research based on the Social Representation theory. The study sample was composed of undergraduate Nursing students enrolled in a public institution. The data collection was performed with the aid of the IRaMuTeQ software, version 0.7 alpha 2, and it was based on Content Analysis. Sexuality was represented as something that should remain hidden both in the context of school and within the family. Even though their training was a factor that contributed to their change in conception about sexuality, feelings such as shame and shyness were present during the practices of the students, which verified that the representations are based on stereotypes and taboos. Thus, there is a visible need for more spaces for discussions within the university and within society, but discussions that understand the practice, and are not limited to theory.
Article
Based on the observation that the loss of autonomy in the capital market and managerialism have contributed to the emergence of alienation in the medical work of the Brazilian Unified Health System, we tried to analyze how this phenomenon occurs in primary health care. In 2015 and 2016, we interviewed and observed the work of 15 physicians in the municipality of Campinas (in the state of São Paulo, Brazil), reflecting upon the professional and clinical autonomy, and the management of the medical work. The analysis was made by constructig narratives by groups of topics, following a Marxist theoretical framework and the main studies regarding the medical profession in Brazil. Taking the similarities in the discourses, ways of working and
degree of alienation, we divided the physicians into four groups: activist, priest, missionary and technobureaucrat. We concluded that some dynamics intensify the alienation: the estrangement from planning; the fragmentation of care; and the prevalence of the biomedical model. In turn, some features of primary health care are related to a lower degree of alienation: the practice expanded on the territory and less focused on programmatical actions; the constitution on teams; the dialogue and the sharing of knowledge; a greater participation of the individuals in the care itself and in the health service.
Article
Work has a fundamental role in keeping the human being socially productive and recognized. In this context, mental health has been gaining distinguishable attention over the past decades. With the precarization, the underestimation of the worker, the technological innovations and the imminence of unemployment, the health of the worker is impacted negatively; consequently, this generates higher rates of absences due to mental illnesses. The present research had the goal of understanding how the care to the mental health of the worker in the Brazilian Unified Health System
works in a municipality of the state of Ceará (Brazil), and if there is the establishment of a causal nexus among health, illness and work. In order to do so,
we developed a qualitative research comprised of 12 participants ‒ users and professionals who answered a semistructured interview form. The information provided by the professionals was analyzed using the Iramuteq software, and that of the users was submitted to Bardin’s content analysis. The results indicate faults in the actions proposed by the Worker Health Reference Center, a lack of connection with the services in the network, difficulty in investigating the causal nexus, and a consequent underreporting of the cases. We concluded that it is necessary to develop connections among the health services in order to get a health care that is more comprehensive.
Article
In Brazil, despite the improvements in guaranteeing the human rights of Lesbians, Gays, Bissexuals, and Transsexuals, this population is still in a considerable situation of vulnerability. The goal of the present bioethics research was to understand the social representations of the Primary Health Care
workers regarding these people, following the premise that these representations can act as obstacles for the access to actions and services. A total of 15 workers from the network of the city of Florianópolis, in the state of Santa Catarina, Brazil, were interviewed. The data collected were analyzed quantitatively based on the Social Representation Theory, through the thematic analysis of the content. The results showed that the social representations on the part of the workers are strongly founded on religious and heterenomous morals, and they understand the group in question based on an idea of promiscuity, risk of acquiring sexuallytransmitted infections, stereotypes, and they understand their sexuality and gender identity as incorrect, biologically determined or even unnatural, subject to personal choice. Sexuality is a dimension of private life that cannot remain subjected to moralism. Social representations must be dealt with in the contexts of education and work in health, in order to broaden the access of the people in question regarding actions and services, as well as quality care.
Article
The study that originated the present article, which was performed in the city of Vitória, capital of the state of Espírito Santo, Brazil, in 2016, had the goal
of discussing the concept of experience in the works of Walter Benjamin and its possible intersections with the formulations of the Clinic of Activity approach. We sought to think of these thresholds to produce turning points in the field of the work clinics, and, with this goal, to present an array of conceptual and methodological questions based on Benjamin’s contributions. The text is organized according to the concepts that compose the Clinic of Activity, especially the concept of activity and the way in which this clinic approaches the issue of experience. Subsequently, we highlighted the concept of experience in the works of Benjamin and tried to establish a dialogue between the concepts of activity and experience in these approaches. With the analysis, we tried to show the importance of this conceptual-methodological confrontation when the transformation of the worlds of labor presents itself
as an ethical-political directive. We concluded that neither the concept of experience in the works of Benjamin nor the concept of activity within the Clinic
of Activity can be understood as part of the privatization of human experience, indicating a dimension of the work processes that is always collective.
Article
The article had the goal of evidencing and analyzing the changes regarding the expectations involving becoming a doctor throughout Medicine
undergraduate studies. Between April and June 2018, Medicine students enrolled in the first, fifth, eighth and tenth stages of a public higher education institution in the state of Santa Catarina, Brazil, took part in the study. After a questionnaire was applied, we analyzed 145 answers regarding the following question: Why did you choose to take Medicine course? Through content analysis, the data analysis evidenced a growing presence, throughout the course, of what we call ‘financial return,’ and, inversely, a decreasing interest in ‘helping others.’ The results, which were analyzed based on theories that approach the socialization and identity development processes, revealed that, in spite the fact that they are inserted into different sociocultural realities, the individuals find themselves involved with rituals and common stereotypes that are socially arbitrated by patterns that were socially and historically developed by the process of constitution of the medical identity.
Article
The present study had the goal of analyzing, based on the discussions about interprofessional education and collaborative practices in the context
of the psychiatric reform, the political-pedagogical project of an integrated residency in mental health program taking place in the city of Belo Horizonte,
in the state of Minas Gerais, Brazil. Through a qualitative approach, we performed the analysis of the thematic content of the political-pedagogical project
of the program, which resulted in three broad themes: theoretical-pedagogical perspective; diversification of the care strategies; multiprofessional work in the interdisciplinary logic. The information found was complemented and delved into with the performance of semistructured interviews with the actors involved in the tutorship and coordination of the program. Among the findings, we highlight the potential of the program to strengthen the process of deinstitutionalization and of qualification of the mental health public policy, by enabling a joint learning among residents of different areas and workers at the services involved. Through the creation of the necessary competences for the development of a work that is collective and committed to the comprehensiveness of the care in health, the program emphasizes the need for interprofessionality and collaborative practices, going beyond technicism. The choice of the psychosocial care network as a privilege space for teaching-learning processes, without using the psychiatric hospital, questions the
stagnant training practices and enables the expansion of forms of care.
Article
Many factors contribute to the difficulty in accessing and remaining in Higher Education in Brazil. The objective of the present study was to identify the
difference in the performance of the students due to socioeconomic conditions, schooling and study habits. We conducted an analytical cross-sectional study based on the data of the National Student Performance Exam (Exame Nacional de Desempenho dos Estudantes, in Portuguese), with a sample of 196,856 students from health courses in 2013. The clear obstacle faced by the students from underprivileged social classes to their admission and permanence in Higher Education requires a constant struggle for greater social justice. While the current situation remains unchanged, it is the role of the government to provide strategies to make viable the access to Higher Education through affirmative policies and resources to make it possible
for the underprivileged to invest in their education. The permanence scholarship presented itself as crucial in the struggle for equity, and it enabled a better
performance on the part of the students, especially due to their stronger ties with the Higher Education Institution.
Ensaio
This essay analyzes the overmedicalization (unnecessary and unwanted medicalization) generated in the medical care to the ill in primary health care, and discusses how it happens and how to avoid it. The analysis combines three sets of conceptions/knowledge: conceptions of illness (dynamic/ontological); conceptions of causation (ascending/multidirectional); key conceptual and structuring ideas about medical knowledge (anatomopathological, physiopatological, semiological, epidemiological). Overmedicalization is due to the cognitive movements of the professionals in the development of diagnoses and therapies. It originates from the ontological conception of illness with ascending causation (causal flow that goes from the simplest material elements to more complex levels and dimensions), in combination with the overestimation of the anatomopathological key idea, which generates excessive diagnostic and pharmacotherapeutic interventions. In order to avoid overmedicalization, we propose the virtuous association of the dynamic conception of illness, with multidirectional causation and balanced used of the key conceptual ideas of the illnesses. This facilitates: a qualified listening; the contextualization of the cases; a more rigorous use of complementary exams; the recognition of the limits of the biomedical diagnoses; the overcoming of the metonymical reasoning (which disregards anything that is not scientifically-established knowledge); an expansion of the interpretation that goes beyond the 'illnesses' and treatments that go beyond drugs/surgeries, exploring the knowledge of the users and professionals and the return of the problems to autonomous supported management.
Ensaio
This article analyzes the impact of the ongoing changes, with the enactment of Brazilian Federal Law no. 13415, from February 16th, 2017, in the training of youths, especially regarding the approach to health in schools. We discuss how the changes in the Law of National Education Guidelines and Foundations (Lei de Diretrizes e Bases da Educação Nacional, in Portuguese), introduced by the aforementioned law will affect education in health in school settings, reviving the debate about education in health in schools, the proposal of health as a cross-sectional topic, and the approach to health in schoolbooks. The counter-reformation of secondary education will mean, in practice, the adaptation or suppression of content that was previously mandatory with the establishment of training itineraries and syllabus arrangements with a potential to take the debate away from the fields of Social Sciences and Humanities, fields that are commonly expected to contribute to overcome the strictly biomedical conceptions and practices of the health-illness process. We consider that health professionals, teachers, researchers and students should expand this debate and effectively take part in the struggle for the reversal of the counter-reformation as it was enacted.
Review
ALBURQUERQUE, Gregorio G. de; VELASQUES, Muza C. C.; BATISTELLA, Renata Reis C. (Org.). Cultura, politecnia e imagem. Rio de Janeiro: EPSJV, 2017. 318 p
Interview