Júlio Cesar Schweickardt

A Atenção Básica no Brasil e o Programa Mais Médicos: uma análise de indicadores de produção

This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Medicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Medicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases – SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Medicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Medicos Program professional were higher in Brazilian capital cities. The Mais Medicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Médicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Médicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases - SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Médicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Médicos Program professional were higher in Brazilian capital cities. The Mais Médicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.

O processo de alcoolização em populações indígenas do Alto Rio Negro e as limitações do CAGE como instrumento de screening para dependência ao álcool

CONTEXTO: Por meio de investigacao qualitativa e interdisciplinar da validade teorica do CAGE como instrumento de screening para dependencia ao alcool em populacoes indigenas do Alto Rio Negro, aborda-se a tematica do uso de alcool em grupos culturalmente diferenciados, estudando a atribuicao de significados do beber e as respostas dadas ao CAGE pelos indigenas entrevistados. METODOS: As contribuicoes de Geertz (1989) e Menendez (1982) viabilizaram a distincao entre o conceito biomedico de dependencia ao alcool e a nocao de problemas relacionados ao uso do alcool, correlata ao plano da transgressao da norma social pelos bebedores. Ambas as nocoes foram subsumidas ao conceito de processo de alcoolizacao que remete as relacoes ambiguas e conflitivas travadas entre bebedores e nao-bebedores em momentos historicos e situacoes sociais especificas. RESULTADOS: A analise das respostas ao CAGE mostrou incongruencia entre seus objetivos e pressupostos e o entendimento indigena sobre o instrumento, invalidando um uso produtivo. CONCLUSAO: Apesar da pretensao universalista do CAGE, a singularidade cultural indigena produziu novos e inesperados sentidos as perguntas-teste e gerou respostas infrutiferas para efetuar triagem de suspeitos de dependencia ao alcool, na realidade estudada.

Do “inferno florido” à esperança do saneamento: ciência, natureza e saúde no estado do Amazonas durante a Primeira República (1890-1930)

In the first two decades of the 20th century, publications of Euclides da Cunha, Alberto Rangel and Carlos Chagas about the Amazon presented from different perspectives a critique of what they considered unrealistic visions originated in the travel accounts of naturalists of 18th and 19th centuries. Alternatively, they proposed the analysis of the region from the perspective of new scientific knowledge, which included several areas - from geology to tropical medicine. Recent studies have indicated the need for more research on the institutions and local scientific practices, both in the development of ideas about the region and the definition of public policies. This article is proposed on this perspective, to reflect on the different ideas that were built by the medical-scientific thought about Nature and Society in the state of Amazonas during the Brazilian First Republic, when the rise and decline of the Amazonian rubber was experienced. It is understood that local physicians actively participated in scientific discussions related to tropical medicine, and put into practice the main theses about control and prevention of endemic diseases like malaria and yellow fever. This set of ideas and practices contributed to the definition of sanitation of the city of Manaus and the hinterland of state of Amazonas.

As Organizações da Sociedade Civil no enfrentamento à AIDS no Amazonas, Brasil

The scope of this paper was to analyze the perception of community-based organizations and their contributions to the history of tackling Aids in Amazonas State. It involved qualitative research with the use of oral and documental sources. Data were collected between June and September 2013 by means of semi-structured interviews with the leaders of eight organizations that work or worked with more vulnerable communities. Based on Discourse Analysis the conclusion drawn is that that the organizations perceive two distinct phases since the decentralization of funds from the Sexually-Transmitted Diseases Aids and Viral Hepatitis Department to the local leaders. The first phase was marked by the strengthening of organizations, collective empowerment and active political participation. The current phase has seen the distancing between organizations, a loss of political momentum and weakening of common response and organization.The scope of this paper was to analyze the perception of community-based organizations and their contributions to the history of tackling Aids in Amazonas State. It involved qualitative research with the use of oral and documental sources. Data were collected between June and September 2013 by means of semi-structured interviews with the leaders of eight organizations that work or worked with more vulnerable communities. Based on Discourse Analysis the conclusion drawn is that that the organizations perceive two distinct phases since the decentralization of funds from the Sexually-Transmitted Diseases Aids and Viral Hepatitis Department to the local leaders. The first phase was marked by the strengthening of organizations, collective empowerment and active political participation. The current phase has seen the distancing between organizations, a loss of political momentum and weakening of common response and organization.

O Sesp nunca trabalhou com índios: a (in)visibilidade dos indígenas na atuação da Fundação Serviços de Saúde Pública no estado do Amazonas

From 1960 to 1990, the Fundação de Serviços de Saúde Pública (Public Health Services Foundation) was in charge of a network of health services across Brazil, in continuation of work previously done by the Serviço Especial de Saúde Pública (Special Public Health Service). The article presents a 2010 research conducted in the state of Amazonas regarding the Foundations activities among indigenous populations based on interviews with the Foundations personnel and the analysis of its documentation. The findings indicate that while the Foundation had no formal policy for indigenous populations, in practice its staff did serve indigenes since in most municipalities in the interior of Amazonas they comprised a significant number of the inhabitants.From 1960 to 1990, the Fundacao de Servicos de Saude Publica (Public Health Services Foundation) was in charge of a network of health services across Brazil, in continuation of work previously done by the Servico Especial de Saude Publica (Special Public Health Service). The article presents a 2010 research conducted in the state of Amazonas regarding the Foundations activities among indigenous populations based on interviews with the Foundations personnel and the analysis of its documentation. The findings indicate that while the Foundation had no formal policy for indigenous populations, in practice its staff did serve indigenes since in most municipalities in the interior of Amazonas they comprised a significant number of the inhabitants.

Divulgação e jornalismo científico em saúde e ambiente na Amazônia

Os textos aqui reunidos procuram testemunhar a trajetoria dessa experiencia unica e inovadora. Mais do que reproduzir um curso de especializacao, representam uma oportunidade para discutir algumas questoes: a area da divulgacao e do jornalismo cientifico, nas suas diferentes interfaces e nuances conceituais; o processo de formacao e de ensino para profissionais de comunicacao envolvidos nas instituicoes de pesquisa e nos meios de comunicacao (radio, TV, internet, jornal); o entendimento do processo de fazer ciencia; os varios e diversos dialogos entre ciencia e midia, jornalista e pesquisador, ciencia e sociedade; e, por fim, a tomada da regiao amazonica como objeto de todos esses processos.

A emergência da Aids no Amazonas

This article analyzes the historical, social, and political context in which Aids emerged in the Brazilian state of Amazonas, and how local responses were shaped by changes taking place on a national political level. Documental sources from governmental and non-governmental institutions were researched, and the information was supplemented and clarified by oral sources - testimonials of activists and health professionals/managers who have led the organization of healthcare for people with HIV/Aids in the state. This research reveals that the lack of coordination between healthcare institutions and the dearth of any real political will to fight the epidemic in the state have hampered the planning and execution of public strategies and actions covering the whole welfare system in the state.

A hanseníase no Amazonas: política e institucionalização de uma doença

This article discusses the historical aspects of the policies for controlling Hansens disease in the state of Amazonas from the second half of the nineteenth century until the dismantling of this model in 1978. We present the historical changes in the local institutions and policies, and their relationship with national policies. The history and policies related to Hansens disease in the state of Amazonas are analyzed through the following institutions: Umirisal, the Oswaldo Cruz Dispensary, the Paricatuba Leprosarium, the Antonio Aleixo Colony, and the Gustavo Capanema Preventorium. We seek to show that these institutions cared for the people who suffered from Hansens disease and those related to them, and were also responsible for carrying out the policies for fighting and controlling the disease.This article discusses the historical aspects of the policies for controlling Hansens disease in the state of Amazonas from the second half of the nineteenth century until the dismantling of this model in 1978. We present the historical changes in the local institutions and policies, and their relationship with national policies. The history and policies related to Hansens disease in the state of Amazonas are analyzed through the following institutions: Umirisal, the Oswaldo Cruz Dispensary, the Paricatuba Leprosarium, the Antônio Aleixo Colony, and the Gustavo Capanema Preventorium. We seek to show that these institutions cared for the people who suffered from Hansens disease and those related to them, and were also responsible for carrying out the policies for fighting and controlling the disease.

A contribuição da Fundação Oswaldo Cruz para o ensino de pós-graduação na Amazônia Legal: experiências nos estados de Amazonas e Rondônia

Legal Amazonia (AL) possesses evident social inequity, which is expressed by different indexes, including human resource qualification and STI production. From the viewpoint of graduate education, whereas the Southeast Region offers 46.6% of the graduate programs in Brazil, only 5.27% of these programs are located in the Northern Region. The AL is characterized by an ethnic and cultural mosaic and by possession of the most significant biological diversity of the planet. Therefore, the AL should be included in public policy proposals focused on reducing its social inequities. Thus, aiming to contribute to the expansion of STI in the AL, through the training of teachers, researchers and technicians in the region, the Oswaldo Cruz Foundation (Fiocruz) has offered a variety of graduate courses in partnership with local, Amazonian institutions. This article proposes to report and discuss the Fiocruz experiences, particularly those developed in the Brazilian states of Amazonas and Rondonia.