Mara Helena de Andrea Gomes

Conceptions of health, illness and treatment of patients who use homeopathy in Santos, Brazil.

OBJECTIVE To investigate the conceptions of health and illness, the reasons for seeking homeopathy and continuing treatment, compliance and the meaning of the relationship between religiosity and health for patients who adhere to homeopathy. METHODS A qualitative study of 20 adult patients in Santos (Brazil) treated by homeopaths in the public and private sector for at least 2 years. Semi-structured interviews, organized by predefined thematic categories, the content of the interviews was analyzed. RESULTS The conceptions of health and illness of the interviewed patients are related to the idea of vital balance/imbalance mediated by body-mind interaction. Dissatisfaction with conventional treatment, family influence and suggestions of others were the reasons for seeking homeopathic treatment. Patients continued homeopathic treatment due to positive therapeutic results, cure without being aggressive to the organism, the holistic integrated approach, the preventive nature of the treatment and low prices of medicine. For these patients, the availability of homeopathy in the public health sector extends the possibility of access. The need for a wider dissemination of homeopathy and the difficulties in following the prescription are the main problems involved in continuing treatment. Faith is an important component. We found a correlation between the conceptions of health and illness and the principles of homeopathy, assimilated through a strong bond between patients and the homeopathic practitioners. CONCLUSION To investigate the beliefs, values and meanings that patients attribute to homeopathy helps to understand subjective aspects that may interfere with treatment compliance.

Impasses no processo de regionalização do SUS: tramas locais

Regionalization of the public health system aims to encourage and enhance efforts and measures involving the organization of local and regional public health, through coordinating all those involved. The barriers that often hinder the process of regionalization are linked to tensions and conflicts between objectives, integration and political factors. This article intends to reflect on the process of regionalization from an administrative and political point of view, highlighting issues of local autonomy due to the process of municipalization. In other words, if the process of municipalizing the health system in the last few decades has strengthened political autonomy in the cities, the proposal to rationalize the services structure by regionalization follows a more administrative logic. But as can be seen in the in the Greater ABC region of Sao Paulo, for example, the political side of this process will impose itself, one way or another, especially when each city tries to defend their own interests.

Retrato quase sem retoques dos egressos dos programas de pós-graduação em Saúde Coletiva, 1998-2007

We present the results of a data collection that allowed to identify where are and what the alumni of the Public Health post-graduation programs think about some attributes of their post-graduation, from 1998 to 2007. By means of two distinctive and concomitant phases, this subproject was initiated with information request along with the programs. The answers allowed the construction of a student census that defended thesis or equivalent, in three modalities: doctorate, academic and professional master. Besides the data provision that allowed us to construct and describe an academic-professional profile of the Public Health area alumni, the information allowed electronic contact with most of the alumni located. In the second phase, we sent the alumni a form to be answered online, with appreciative questions regarding the role of the post graduation on their intellectual and professional path, aiming to characterize their post-graduation degree. We forwarded some suggestions to future researches, as for example the creation of a standardized and digitalized enrollment form open to consultation.

O catador de materiais recicláveis: um agente ambiental

The activity of recyclable material collectors is configured as a means of social inclusion as it generates funds for the purchase of consumer goods. This essay aims to present aspects of the universe of the work of these collectors for the purpose of generating reflections on the environment, resources and labor. In the task of collecting, sorting, handling and transforming of garbage into a commodity, we found the survival mode of new agents, who expose themselves to the various risks of accidents and health and who are also socially vulnerable. Furthermore, there is no government support of any kind and they are at the mercy of fate in case of accidents, illness, material supply and income. Therefore, it is necessary for professionals working in health facilities and social services to recognize the precarious state of working with the collection of recyclable material and implement protective actions.

A cidade de Santos no roteiro de expansão da homeopatia nos serviços públicos de saúde no Brasil

In consonance with the principles of comprehensiveness, equity, and universality that underlie Brazils sanitary reform and creation of its Unified Health System, some municipalities have begun offering homeopathy as a treatment option. The article explores the context in which homeopathic treatment was introduced and gained ground in the city of Santos, São Paulo, down through its incorporation as an alternative in the public healthcare network. Homeopathy was introduced in Santos not only by doctors and pharmacists but also by prescribing mediums from spiritist centers. The request that the municipalitys primary-care services offer this alternative was possible thanks to the presence of all these players. The present analysis was based on interviews with the professionals who took part in the process, on technical reports, newspaper articles, and scientific journals, and on a book about the citys first spiritist society.

Regionalização da saúde na região do Grande ABC: os interesses em disputa

Regionalizar o Sistema Unico de Saude (SUS) implica a construcao conjunta de um planejamento que de conta da integracao, coordenacao, regulacao e financiamento da rede de servicos dentro de um territorio, em um processo continuo de negociacoes de toda natureza. O Pacto pela Saude de 2006 apresenta tres instrumentos para a gestao de um sistema regional de saude: o Plano Diretor Regional (PDR); a Programacao Pactuada Integrada (PPI); e o Plano Diretor de Investimentos (PDI). Este artigo se propoe debater, discutir e explicar a operacao desses instrumentos no sistema regional de saude do Grande ABC Paulista, que esta hoje sob a coordenacao do Departamento Regional de Saude I (DRS I). Tendo esse objetivo norteador, este estudo descritivo da regiao do Grande ABC baseia-se em dez entrevistas com secretarios e diretores municipais; gestores de hospitais; um gestor da Fundacao do ABC; e um gestor do DRS I. Concluiu-se que o PDR necessitaria ser atualizado para equilibrar a relacao entre oferta e demanda; o PPI e uma arena de competicao, em vez de um espaco de articulacao, negociacao e pactuacao; e o PDI e pouco significativo, uma vez que os recursos do Ministerio da Saude nao sao suficientes para as acoes de saude nessa regiao.

Graduação médica e especialização: uma incompatibilidade aparente

PURPOSE. Partial results of a continuous evaluation process of the undergraduate medical course at Escola Paulista de Medicina (EPM) started in 1989 are presented. METHODS. A survey on expectations and opinions about the medical course of EPM was carried out among faculty members, students and alumni. RESULTS. The authors call into question that the medical formation is non-terminal as indicated by the late entry to labor market. CONCLUSION. The authors consider that the phenomenon is not related to quality aspects but to the specialization process started during the medical course and completed only with graduated studies.

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.

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.

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.