Carlos Otávio Fiúza Moreira

Ampliación de las estrategias de consejería y prueba del VIH: desafíos técnicos y tensiones ético-políticas

Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.

Avaliação da qualidade da formação: contribuição à discussão na área da saúde coletiva

Visando contribuir com a discussao da implantacao e implementacao de mecanismos de avaliacao de qualidade da formacao na area da saude coletiva, sao abordadas neste artigo as principais caracteristicas de processos de avaliacao educacional a partir de alguns autores que tomam por base o conceito de qualidade. Entende-se ser necessaria a criacao de instrumentos de avaliacao em todos os niveis da educacao e que os instrumentos de avaliacao das instituicoes de ensino devam ser calcados em principios determinados pelos setores e representacoes pertinentes.

Trajetória profissional de egressos de cursos de doutorado nas áreas da saúde e biociências

OBJECTIVE To analyze the career path and professional satisfaction of alumni from the doctorate degree programs in health sector. METHODS Exploratory study with 827 alumni of doctoral programs in public health, biological and health sciences at the Fundação Oswaldo Cruz , RJ, Southeastern Brazil, from1984 to 2007. The subjects were grouped in three cross-temporal cohorts according to year. The profiles of the alumni were analyzed, their career paths mapped and information on the perceptions of the education they received and the reasons that led them to choose the institute for their doctoral courses gathered, as well as their evaluations of the courses. The data were collected by means of an online questionnaire. RESULTS There are differences between cohorts of alumni related to the periods they followed the courses, their distinct educational backgrounds and labor processes between those from the biological and health sciences areas, and to the specificities of the different areas where the institution offers doctoral courses: public health, biological and health sciences. CONCLUSIONS The results allow the academic management of the educational processes to expend its knowledge, thus establishing a baseline for tracking the trajectory of alumni, and may contribute to upgrading the follow up process of Brazilian graduate programs.OBJETIVO : Analizar la trayectoria y satisfaccion profesional de egresados de cursos de doctorado en el area de la salud. METODOS : Estudio exploratorio con 827 egresados de los cursos de doctorado de la Fundacion Oswaldo Cruz en las areas de la salud colectiva, biociencias y atencion a la salud, entre 1984 y 2007. Los individuos fueron agrupados en tres cohortes temporales. Se analizo el perfil de los egresados; se mapeo sus trayectorias profesionales, sus percepciones sobre la formacion recibida; sus motivaciones para escoger la institucion y realizar el doctorado; y las evaluaciones realizadas sobre los cursos. Se utilizo cuestionario en formato electronico para colecta de datos on-line. RESULTADOS : Existieron diferencias entre las cohortes de egresados, relacionadas con el periodo en que cursaron el doctorado, las distintas trayectorias de formacion y procesos de trabajo entre egresados de las areas de biociencias y salud y las peculiaridades de las diferentes areas en que la institucion ofrece cursos de doctorado: salud colectiva, biociencias y atencion a la salud. CONCLUSIONES : Los resultados posibilitan ampliar el conocimiento de las instancias de gestion academica sobre los procesos de formacion, estableciendo una “linea base” para el acompanamiento de la trayectoria de los egresados y contribuir con subsidios para el mejoramiento de los procesos de acompanamiento de egresados de los programas de postgrado.

Educação escolar e resiliência: política de educação e a prática docente em meios adversos

This paper is a theoretical essay constructed from a literature review. It aims to discuss the issue of resilience in school education. This article also searches to comprehend the meaning of the term resilience and how this concept fits the picture of the teacher at the same time provides practical and constructive attitudes of students, and the problems associated with the school routine. A search of literature on the subject occurred in the databases Medline, Google Scholar, Scielo, Lilacs (BIREME) between the years 2002 to 2008. Studies on the teachers resilience proved to be still rare, preliminary or insufficient. The studies also show that being resilient is not an attribute of the person but can be consolidated in teaching activities and that resilient environment of pedagogical action grows when there is an affective and emotional support necessary for people to work in constant climate of learning.This paper is a theoretical essay constructed from a literature review. It aims to discuss the issue of resilience in school education. This article also searches to comprehend the meaning of the term resilience and how this concept fits the picture of the teacher at the same time provides practical and constructive attitudes of students, and the problems associated with the school routine. A search of literature on the subject occurred in the databases Medline, Google Scholar, Scielo, Lilacs (BIREME) between the years 2002 to 2008. Studies on the teachers resilience proved to be still rare, preliminary or insufficient. The studies also show that being resilient is not an attribute of the person but can be consolidated in teaching activities and that resilient environment of pedagogical action grows when there is an affective and emotional support necessary for people to work in constant climate of learning.

Auto-avaliação nos programas de pós-graduação na área da saúde coletiva: características e limitações

The purpose of this paper is to discuss the characteristics and constraints of internal appraisals or self-assessments in Graduate Public Health Programs, conducted through a study of the report on 25 programs participating in the three-year CAPES evaluation (2001-2003). Three main aspects were considered: (a) tools and/or procedures employed; (b) self-assessment procedures; (c) products for upgrading program quality. The findings indicate that different tools are employed and used improperly. For most of the programs, it is not clear how ongoing processes take place, as the products presented are not directly related to the process as performed and the program quality assurance procedures. The importance of self-assessment is discussed as a tool for exploring the possibilities and boundaries of a process or an institution, as well as for taking decisions. A suggestion is presented: setting up a basic structure with working groups and a self-assessment coordination team; real participation and commitment among staff members and decision-makers; reliable data with effective use of the findings.

Colaboração interprofissional: um estudo de caso sobre os profissionais do Núcleo de Atenção ao Idoso da Universidade Estadual do Rio de Janeiro (NAI/UERJ), Brasil

O artigo analisa os sentidos da ‘colaboracao interprofissional’ a partir da percepcao dos profissionais de saude do Nucleo de Atencao ao Idoso da Universidade Estadual do Rio de Janeiro (NAI/UERJ). Trata-se de um estudo de caso, com abordagem qualitativa de carater descritivo-analitico. Na pesquisa que deu origem ao artigo, foi realizada revisao documental sobre o conceito de ‘colaboracao interprofissional’, alem de 13 entrevistas semiestruturadas com profissionais de diferentes areas do NAI-UERJ, no periodo de marco a junho de 2015. A perspectiva praxiologica de Pierre Bourdieu, sua sociologia da pratica, com destaque para as nocoes de habitus e campo, auxiliaram na analise e interpretacao, sendo crucial para a compreensao das relacoes entre praticas e formacao profissional dos agentes. Como parte dos resultados da pesquisa, apresentam-se, aqui, discussoes sobre distintas dimensoes da colaboracao interprofissional, no âmbito de suas interacoes na producao do cuidado.

Institutional context and VCT practitioner narratives: possibilities and limitations for HIV prevention in Rio de Janeiro, Brazil

BackgroundVoluntary Counseling and Testing (VCT) is an HIV prevention strategy that promotes the principles of confidentiality and informed consent. International research has highlighted VCT counselors’ isolation from service planning and the contradictions they negotiate between local values and global testing recommendations. In Brazil, studies have identified many limitations, including counselors’ difficulties to implement a vulnerability approach to HIV prevention as recommended in the country’s national guidelines. These studies, however, have not considered the particularities of the institutional contexts where counselors work. This research addresses these gaps in the VCT literature by exploring how VCT services are organized and how counselors perceive and perform their practices in the state of Rio de Janeiro, Brazil.MethodsThis is a case study of VCT services in the state of Rio de Janeiro. The research design included individual structured interviews with seven VCT service coordinators and twenty individual semi-structured interviews with VCT counselors. Participants were sampled according to gender, undergraduate degree and work trajectory to capture a diverse range counselor narratives.ResultsThe VCT services were relatively homogenous in terms of functioning and had a similar restricted roll of activities including individual counseling and occasional external prevention activities with groups vulnerable to HIV. All VCT services reported reductions in staff size. Some counselors used dialogical practices to build trust, guarantee confidentiality and adjust their practices in accordance with their clients’ values and practices. Others emphasized imperative messages or focused on risk and individual responsibility. Connections between how counselors perceive their practices and the organization of their work environment were observed.ConclusionsDue to the importance of counseling as a prevention strategy we recommend rethinking the relationship between counselors’ practices and the organization of VCT services. The challenges brought about by the expansion of “test and treat” programs globally and other social and symbolic aspects of the HIV epidemic, such as gender inequalities, must also be taken into account. Further reflection is also needed on the relationship between counseling guidelines and practices within the vulnerability approach to HIV prevention.

Formação, práticas e trajetórias de aconselhadores de centros de testagem anti-HIV do Rio de Janeiro, Brasil

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.

Formación, prácticas y trayectorias de consejeros de centros de test anti-VIH de Río de Janeiro, Brasil.

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.

Training, practices and paths of counselors at HIV testing centers in Rio de Janeiro, Brazil.

Perante a importância do aconselhamento na testagem anti-HIV, analisamos as diretrizes institucionais, as competências privilegiadas no treinamento profissional e os saberes/práticas de aconselhadores. Trata-se de estudo qualitativo centrado na análise documental, observação e entrevista com aconselhadores de Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro. A análise foi orientada pela teoria de Pierre Bourdieu. Foi evidenciado que o habitus profissional dos aconselhadores resulta da articulação dos treinamentos, da graduação e de experiências e interesses pessoais. A operacionalização de competências, como a escuta ativa, é limitada pela rotina dos serviços e escassez de espaços de reflexão. Para incrementar a prática do aconselhamento, é importante desenvolver competências no treinamento, manter a educação continuada e fazer adequações na rotina do serviço. Tais ajustes podem fortalecer a passagem das diretrizes à ação e o aprimoramento da organização e gestão dos CTA.Given the importance of counseling in HIV testing, we analyzed the institutional guidelines, the competencies encouraged during counselors’ professional training and these counselors’ knowledge and practices. This was a qualitative study based on document analysis, observation and interviews with counselors at HIV testing and counseling centers in the state of Rio de Janeiro. Bourdieu’s theory was the foundation for the analysis. It was shown that counselors’ professional habitus is produced by the connections between trainings, undergraduate experiences and personal interests and experiences. Putting competencies such as active listening into operation is limited by the routine within the services and lack of opportunities for reflection. In order to improve counseling practices, it is important to develop competencies within training, maintain the inservice education and make adjustments to healthcare service routine. These arrangements may strengthen the transition from guidelines to action and enhance the management and organization of the testing and counseling centers.