Cássio Silveira

Organização das práticas de atenção primária em saúde no contexto dos processos de exclusão/inclusão social

This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access.

Políticas sociais: desigualdade, universalidade e focalização na saúde no Brasil

O presente artigo tem por finalidade contribuir para o debate sobre as politicas sociais em saude e para a elaboracao de estrategias que viabilizem a organizacao de servicos de saude, a extensao da cobertura as regioes desprovidas de servicos e a consequente transformacao das condicoes de saude da populacao. Para isso, propoe uma reflexao sobre os sentidos das politicas, seus desdobramentos nas concepcoes da universalizacao e da focalizacao, e a pertinencia das concepcoes e praticas em saude estabelecidas nos ultimos anos quanto ao encaminhamento da diminuicao dos problemas da desigualdade e da pobreza. Esta analise toma como base a reflexao sobre a experiencia de implantacao do Programa de Saude da Familia na area central da cidade de Sao Paulo, seus desdobramentos e ajustes, alem do questionamento sobre as caracteristicas e a qualidade que devem configurar tal programa, de acordo com as especificidades de cada regiao do pais. Conclui-se o estudo com a afirmacao de que o principio da universalidade tem contribuido para o incremento do acesso aos servicos de saude, porem nao tem criado condicoes para o estabelecimento da equidade, necessitando para isso reformulacao e adaptacao de programas e acoes em saude.

Desigualdade social em saúde na população em situação de rua na cidade de São Paulo

Abstract To describe the sociodemographic characteristics, health status and access to services of the popula-tion living on the streets in a sample obtained from three homeless shelters in the downtown area of Sao Paulo. The sample included 251 subjects: 171 males, 78 females and 2 people who reported themselves as transgender. A structured questionnaire was applied about: sociodemographic characteristics, time on the street, physical activity, discrimination, social network and support, health status, alcohol or drug use, violence and access to health services. The subjects were adults, non-white, low education level, and with a monthly income lower than half the minimum wage. A third of the respondents had already been in this situation for more than 5 years. The health status for 45% of the respondents was considered good or very good health. The majority preferred to use primary care centers when needed and the precarious financial conditions and lack of family added to physical violence situations. Dis-crimination, poor hygiene and physical or mental disabilities are common in their lives. The challenge of formulating health policy is to incorporate the representations and care practices of these indi-viduals, but also the services, as a starting point for organizing care.Keywords: Homeless, Living Conditions, Health Conditions, Access to Health Services.

Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil

Os bolivianos no Brasil tem problemas sociais evidentes: insercao precaria no trabalho, falta de documentos e necessidades em saude. O estudo teve por objetivo conhecer as desigualdades geradas pelas condicoes de vida e de acesso aos servicos de saude entre os imigrantes bolivianos na cidade de Sao Paulo, Brasil. Foi feito um estudo transversal com 183 adultos, subdivididos pelo tempo de residencia no pais, com aplicacao de questionario semiestruturado. Os dados evidenciaram a permanencia e o envelhecimento desses imigrantes. A renda per capita e ascendente conforme o tempo no pais; na formacao escolar predomina o nivel medio; o tempo de permanencia no Brasil nao altera a situacao de trabalho; trabalham e vivem nas confeccoes e falam suas linguas de origem. Predominam as redes sociais familiares e de amigos. O acesso aos servicos de saude ocorre com progressiva inclusao em acoes de atencao primaria. Concluimos que ha um processo de exclusao decrescente, que acontece pelo acesso a documentacao, ao trabalho, ainda que precario, e pela oferta de servicos da rede publica de atencao primaria em saude.

Por um campo específico de estudos sobre processos migratórios e de saúde na Saúde Coletiva

Fil: Goldberg, Alejandro. Consejo Nacional de Investigaciones Cientificas y Tecnicas; Argentina. Universidade Catolica de Santos. Santos; Brasil. Universidad de Buenos Aires. Facultad de Filosofia y Letras. Instituto de Ciencias Antropologicas; Argentina

Comentários pertinentes sobre usos de metodologias qualitativas em saúde coletiva

Com este texto visamos contribuir para o debate sobre a avaliacao da producao e divulgacao de pesquisas que se baseiam em metodologias qualitativas no campo da saude coletiva. Procuramos relacionar as lacunas teoricas e metodologicas a indicios valorativos que atravessam os processos de pesquisa e avaliacao de artigos publicados. Na ausencia de explicitacao dos valores que conduziram as escolhas imbricadas nas pesquisas, alguns periodicos recomendam recursos de avaliacao que privilegiam procedimentos formais e tecnicos. A avaliacao e complementada com guias de confeccao de artigos, dentre os quais os check-lists, que fornecem os itens valorizados. Estes fatores contribuem para reducionismos teorico-metodologicos e reforcam a crenca na existencia de um unico metodo. Por fim, renovamos o apelo a imaginacao e a diversidade de concepcoes sobre o que pretendemos conhecer.

Prevalence of Trypanosoma cruzi infection among Bolivian immigrants in the city of São Paulo, Brazil

With the urbanisation of the population in developing countries and the process of globalisation, Chagas has become an emerging disease in the urban areas of endemic and non-endemic countries. In 2006, it was estimated that the prevalence of Chagas disease among the general Bolivian population was 6.8%. The aim of the present study was to determine the prevalence of Trypanosoma cruzi infection among Bolivian immigrants living in São Paulo, Brazil. This study had a sample of 633 volunteers who were randomly selected from the clientele of primary care units located in the central districts of São Paulo, Brazil. Infection was detected by two different ELISA assays with epimastigote antigens, followed by an immunoblot with trypomastigote antigens as a confirmatory test. The prevalence of the infection was 4.4%. Risk factors independently associated with the infection were: a history of rural jobs in Bolivia, knowledge of the vector involved in transmission, and having relatives with Chagas disease. Brazil has successfully eliminated household vector transmission of T. cruzi, as well as its transmission by blood transfusion. The arrival of infected immigrants represents an additional challenge to primary care clinics to manage chronic Chagas disease, its vertical transmission, and the blood derivatives and organ transplant programs.

Introdução a uma cartografia sociológica: a Revista de Saúde Pública, 1967 a 1977

Through reliance on a social cartography method based on Karl Mannheims sociology of knowledge, the article analyzes the first ten issues of Revista de Saude Publica, published by the University of Sao Paulo. Articles and editorials are mapped in order to understand the periods transformations. In the realm of the journals editorial line, tensions are noted between complying with the principles of the institution and international transformations, which demanded an openness to interdisciplinary topics. Special focus is placed on sub-fields, dominated by an epidemiology that was in flux as it absorbed new knowledge in the context of the formation of the field of public health.Through reliance on a social cartography method based on Karl Mannheims sociology of knowledge, the article analyzes the first ten issues of Revista de Saúde Pública, published by the University of São Paulo. Articles and editorials are mapped in order to understand the periods transformations. In the realm of the journals editorial line, tensions are noted between complying with the principles of the institution and international transformations, which demanded an openness to interdisciplinary topics. Special focus is placed on sub-fields, dominated by an epidemiology that was in flux as it absorbed new knowledge in the context of the formation of the field of public health.

Economia solidária e reabilitação vocacional no campo da drogadição: possibilidades e limites das práticas atuais

This paper contributes to the debate on the potencial of work in the recovery process of addicts. The vocational rehabilitation principles are analyzed and compared to the Brazilian guidelines for the work rehabilitation of this population. In this analysis we compare the underlying concept of health and the emancipatory potential in both perspectives. The literature on vocational rehabilitation was raised through a literature review on Medline, Pubmed and Lilacs, with the following key words: vocational rehabilitation, substance abuse treatment & work. The Brazilian Government guidelines were collected in the official publications available online by the Ministry of Health and Ministry of Labour and Employment of Brazil. The analysis of the material pointed out that the vocational rehabilitation practiced in North America and Europe focus on users of mental health services, proceeding to the work inclusion through the bias of the disease. The vocational rehabilitation emphasizes the replacement in the formal labor market, through programs aimed at skills training to get and keep a job. On the other hand, the Brazilian public policies are guided by the principles of cooperative and social economy. It privileges the human ethics in its entirety, as the subject and the purpose of higher economic activity, focusing on the strengths and resources of the work, rather than the limitations imposed by the disease or the socioeconomic status that has generated the situation of exclusion.

Limites e imposições dos instrumentos de controle do trabalho de agentes comunitários de saúde da Estratégia Saúde da Família

Ser considerado elemento de uniao entre moradores e servico nao revela de imediato a abrangencia das funcoes, nem oferece visibilidade das exigencias a que os agentes comunitarios de saude estao expostos no cotidiano de trabalho diante das atribuicoes previstas pela Estrategia Saude da Familia. O objetivo desse estudo e analisar os instrumentos de controle da acao social dos agentes comunitarios e suas possibilidades de emancipacao, a partir da nocao de agir comunicativo de Jurgen Habermas. Trata-se de pesquisa qualitativa, realizada numa Unidade Basica de Saude da cidade de Sao Paulo (SP), por meio de entrevista semiestruturada com 14 agentes comunitarios com experiencia minima de dois anos. Como resultado, destacamos o dominio da razao instrumental sobre a razao comunicativa nas atividades de planejamento, nos criterios tecnicos de decisao e avaliacao, bem como nos instrumentos de registro do trabalho. Verificamos oportunidades de emancipacao nas acoes comunicativas em que os agentes comunitarios, por meio do dialogo, desenvolvem acoes de entendimento mutuo com os pacientes que complementam as acoes tecnicas. E tambem por meio do dialogo orientado a construcao de consensos que processos cooperativos de trabalho em equipe sao elaborados em torno de objetivos comuns. Consideramos que os agentes comunitarios resistem aos ditames das acoes instrumentais atraves do entendimento intersubjetivo promovido pela racionalidade comunicativa que permeia o mundo da vida, efetivando situacoes de emancipacao das tensoes e conflitos inerentes ao trabalho de mediacao.