Elza Machado de Melo

Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009

Adolescents are seeking new references and experiences, which may involve attitudes of risk and exposure to accidents and violence from external causes. These events constitute a serious Public Health problem. The scope of this study was to analyze the occurrence of accidents by external causes in adolescents from 10 to 19 years of age attended at sentinel urgency and emergency services in Brazil. Data from the 2009 Surveillance System for Violence and Accidents (VIVA 2009) was analyzed in 74 emergency units in 23 state capitals and the Federal District. The findings revealed that 6,434 adolescents (89.8%) were victims of accidents and 730 (10.2 %) were victims of violence. The main causes of the accidents were falls and traffic accidents, and assaults were predominant in violence. For both accidents and violence, non-white male adolescents were predominant and the events occurred most frequently on the public highways. A marked increase was detected, with hospitalization of victims of violence between 15 and 19 years of age. Understanding the epidemiological reality of external causes among adolescents represents an important tool for health prevention and promotion policies and the culture of peace seeking to reduce morbidity and mortality.

A organização da Atenção Básica em municípios integrantes do projeto de expansão e consolidação do saúde da família em Mato Grosso, Brasil

This article presents part of the results from the Baseline Study on the PROESF. The objective was to evaluate primary health care in the cities of Cuiaba, Varzea Grande, and Rondonopolis, Mato Grosso State, Brazil, based on the inter-subjectivity in human relations (among health workers, users of health services, and the public at large and within institutionalized levels of social control). A qualitative and quantitative methodology was used, including interviews with key informants; short meetings with managers; focal groups with managers; and interviews with users and health professionals from pre-selected health units. Scores were assigned to all the questions that indicated participatory processes in primary care practices in the various municipalities. Despite the geopolitical identity among the municipalities and their similar access to the same public policies, there was a significant difference in their performance of the functions pertaining to the organization of primary care and the Family Health Program, in terms of portal of entry into the system, longitudinality, comprehensiveness, and coordination. Differences were observed in the type of relations that were established (participatory versus non-participatory), corresponding to the previous difference.

Projeto Meninos do Rio: mundo da vida, adolescência e riscos de saúde

This study focuses on health risks among teenagers from two towns in the Sao Francisco River Valley (Ibiai and Morada Nova) and slums in Morro das Pedras, Belo Horizonte, Minas Gerais State, Brazil. The study discusses teaching and extracurricular activities by the Federal University in Minas Gerais in these localities, aimed at promoting health in adolescence. The authors use the Habermas communicative action theory as the main theoretical and methodological approach. The research adopted a qualitative and quantitative methodology, including dynamic observation, focus groups, interviews, and questionnaires answered by high school students. Sexuality, work, and violence were the main themes and were associated with numerous health risks. Work in the 10-to-14-year-old group was associated with nearly all types of health risks. The authors analyze the relations between context and adolescent behavior using the Habermasian concept of lifeworld colonization.

Violence against children: an analysis of mandatory reporting of violence, Brazil 2011

This article aims to describe and analyze reporting of violence against children from 0 to 9 years of age, issued by the public health services, in Brazil. Data from the Violence and Accident Surveillance System (Viva-SINAN) were used. The frequency of selected variables was calculated by age group (0-1; 2-5 and 6-9 years of age) as well as their Prevalence Ratios (PR). 17.900 cases were reported: 33% in the 0-1 year group; 35,8% in the 2-5 year group; and 31,2% in the 6-9 year group. Physical violence predominated among boys (PR: 1.22; CI 95%: 1,16-1,28 ); 6-9 years old (PR: 1,19; CI 95%: 1,12-1.27 ). Sexual violence predominated among girls, mulatto/afro-descendant (PR: 1.12; CI 95 %: 1.06 to 1.19 ); 6-9 years (PR: 4.63; CI 95%: 4.22- 5.08) with more chances of occurring at home (PR: 1.38 , CI: 95%: 1.29-1.48); psychological violence prevailed among girls, mulatto/afro-descendant (PR: 1.10; CI 95 %: 1.03-1.18 ), 6-9 years old (PR: 2.95; CI 95%: 2.69- 3.23), at home (PR: 1.40; CI 95%: 1.29-1.53); negligence predominated among boys (PR: 1.33 ; 95% CI: 1.27-1.39); 0-1 years and their parents were the most prevalent perpetrators.The results indicate the need to strengthen intersectoral actions aiming at extending the social protection and care network.

A Rede de Urgência e Emergência da Macrorregião Norte de Minas Gerais: um estudo de caso

Abstract The attention to the Urgency and Emergency sec-tors is a challenge to be faced by the Unified Health System and demands organization from the health managers. In order to respond to this demand, the State Secretary of Health has proposed the imple-mentation of the Urgency and Emergency Attention Network in the Northern Macro-region of Minas Gerais, and this article, a qualitative and exploratory research in the form of a case study, aims to unders -tand its function. The data was collected through documental research, observation and interviews with key-informants (members of the Managerial Committee and professionals of the Secretariat of State who accompany the Urgency and Emergency Attention Network in the North of Minas Gerais). The results point at difficulties, but also at positive aspects and advances. On the positive end are the network implementation, the Committee creation, the Emergency Mobile Health Care regionalization, the risk classification and the State support. On the negative end are the financing model, the large territory, the workers’ lack of prepare, and their high turnover. As advances, the better access to the services is highlighted. The conclusion is that this is a complex and dynamic process that involves many different actors. This network is an innovative and audacious action, which, despite the difficulties, has proved to be very positive.Keywords: Health Management; Emergency; Ur-gency; Health Care Network; Systems Integration.

Ação comunicativa, democracia e saúde

Procuramos fundamentar com a Teoria da Acao Comunicativa de Habermas a afirmacao de que saude como direito so e possivel se for um produto da autonomia de todos os envolvidos, exigindo, portanto, o estabelecimento de uma relacao indissociavel com a democracia. Inicialmente sao apresentados os conceitos de entendimento linguistico, acao comunicativa, discurso e mundo da vida e como eles se articulam para dar origem a uma teoria social. A seguir, e mostrado como Habermas se utiliza dessa teoria para a formulacao de uma Teoria do Direito e da Democracia. Transpondo a Teoria de Habermas para a saude, chegamos a proposicao de que saude como direito pode ser entendida como resultante do confronto entre, de um lado, os imperativos sistemicos, mediados pelo dinheiro e pelo poder e, de outro, os processos comunicativos de formacao politica da opiniao e da vontade, proprios do mundo da vida e mediados pela solidariedade. Finalmente, retomando as analises de Illich, Foucault, Pollack, Arouca e outros, procuramos identificar como esses autores tratam aqueles elementos - poder, dinheiro e solidariedade - chegando a conclusao de que a adocao da Teoria da Acao Comunicativa e util, pois permite incorporar as criticas as praticas de saude, sem, contudo, abrir mao do atendimento de legitimas necessidades dos cidadaos.

Saúde, democracia e organização do trabalho no contexto do Programa de Saúde da Família: desafios estratégicos

Democracy should work towards satisfying diverse interests (for the common good), which is indispensable for establishing consensuses between the various stakeholders whenever possible. Since the mid-1970s, Brazil has undergone important political and democratic changes, making this a period of fundamental transformation in the countrys health paradigms. With the 1988 Constitution and the creation of the Unified National Health System (SUS), health system administrators, workers, and patients are dealing with a new way of conceiving, organizing, developing, and producing healthcare services, namely the social healthcare production model. However, to promote a real break with the previous Flexnerian health model, labor relations must overcome the flexibilization (casualization) of health work through such measures as consistent investments in human resources management, with the creation of means for discussing democratic administration. The current article aims to rethink the relations between democracy and health, reflecting analytically on the work management practices in the Family Health Program (FHP) in the context of policy reforms. Consolidation of the FHP as the key element for reorganizing primary healthcare in Brazil will allow shaping new institutional arrangements, capable of impacting the countrys sociopolitical culture, thereby contributing to fairer and more effective policies with solidarity, as proposed under the National Health System.

O contraditório direito à saúde de pessoas em privação de liberdade: o caso de uma unidade prisional de Minas Gerais

This paper aims to analyze the realization of the right to health of people deprived of liberty, by means of focus groups conducted with three subjects involved in the prison context: imprisoned people, prison officers, and health professionals in a male prison in Ribeirao das Neves, Minas Gerais, Brazil. The discussions were recorded, transcribed, and underwent discourse analysis. The right to health, understood as full access to good-quality health services, is put into question as an actual phenomenon, since, considering that public services are scrapped, this access is restricted to those who can pay for it. State neglect with regard to the right to health of imprisoned people is justified by the disciplinary role played by prison. Poor working conditions and moral judgment on the prisoner’s behavior indicate a refusal to recognize the legitimacy of his right to health. Although the Brazilian laws claim that health is a right of all and a duty of the State, we find out the lack of realization of this right both for imprisoned people and for the professionals working in the prison.

Teaching of leprosy: current challenges

In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals.

Homens, vítimas e autores de violência: a corrosão do espaço público e a perda da condição humana

Trata-se de estudo qualitativo, realizado no Municipio de Ribeirao das Neves-MG, com o objetivo de compreender o envolvimento dos homens com a violencia. A metodologia consistiu de grupos focais organizados segundo sexo, faixa etaria e regiao administrativa do Municipio, sendo, ao todo, trinta grupos, com 231 participantes, recrutados aleatoriamente. Para analisar, foi utilizado o metodo hermeneutico-dialetico e, a luz da teoria politica de Hannah Arendt, a violencia foi interpretada como dominacao que perpassa as relacoes humanas. Homens e mulheres foram identificados como possiveis autores e vitimas de violencia, o envolvimento de cada um sendo definido a partir de relacoes desiguais que estabelecem. Os numeros da violencia, assim como as explicacoes centradas em teorias biologicas, podem levar a conclusao prematura de que os homens sejam mais violentos do que as mulheres. A fundamentacao teorica e a contextualizacao mais profundas permitem clarear outras faces desse importante problema.