Marcos Claudio Signorelli

Um projeto político-pedagógico de graduação em fisioterapia pautado em três eixos curriculares

Abstract Introduction: UFPR Litoral with its innovative PPP (Political-Pedagogical Project), based on Complexity Theory, is finalizing the implementation of its first Physical Therapy graduating group. Objectives: To comment some of the theoretical basis which sustain the project, presenting the experience of PPP’s collective construction process, focusing three curricular components. Metodology: Qualitative, with a theoretical-reflexive approach. Results: PPP’s construction resulted in a curricular organization based in three componets: TPF (Theoretical and Practical Fundaments), LP (Learning Projects) and CHI (Cultural and Humanistic Interactions). TPF consists about 60% of the curriculum, comprehending thematic modules elaborated by interdisciplinary professors team, based on the contextualized situation of the profession reality outside the campus. All contents taught follow Brazillian national curricular guidance and national health system. The PA allows students to develop projects, mediated by professors involving the triad: teaching-research-extension. These are contextualized to the reality of Parana’s coastal commu-nities, and also extended or amplified to other communities. The CHI (consisting 20% of the curriculum) allows the future professionals to experience the complexity of human being and its integration to the surrounding environment, once they share experiences with other graduation courses and communities. Conclusions: Throughout all these processes, UFPR students demonstrate distinguished characteristics, that come from generalist, humanist, critical and reflexive praxis, as recommended by national curricular guidance. So we hope these experiences provide articulation of knowledge and practices, developing qualified professionals and conscious citizens who care for the collectivity.Keywords: Teaching. Curriculum. Physical therapy. Education. Profession.

Violência doméstica contra mulheres e a atuação profissional na atenção primária à saúde: um estudo etnográfico em Matinhos, Paraná, Brasil

A violencia domestica provoca multiplas repercussoes na saude das mulheres e gera desafiadora agenda para os profissionais do SUS. Objetivou-se analisar como profissionais de saude atendem tais mulheres, problematizando a nocao de acolhimento em saude. Adotou-se pesquisa qualitativa e aproximacao etnografica com profissionais de uma unidade basica de saude (UBS) de Matinhos, Parana, Brasil. A pesquisa revelou atendimentos centrados em: (1) preceitos biologizantes, com foco em lesoes fisicas e medicalizacao; (2) dialogo, escuta ativa, questoes psicossociais e estabelecimento de vinculos, destacando-se agentes comunitarios de saude nesta abordagem. A escassez de estrutura local oficial para manejo da violencia domestica enseja atuacao inscrita sob a gramatica do acolhimento, preconizada pelo SUS, descrita pela literatura, verbalizada na UBS, mas pouco problematizada. Com este artigo buscou-se, portanto, contribuir com tal debate, nao no estabelecimento de prescricoes, porem no levantamento de indagacoes e principalmente visibilizando e traduzindo vozes de quem trabalha diuturnamente com esse desafio.Domestic violence has multiple repercussions on womens health and raises a challenging agenda for health professionals in Brazilian Unified National Health System (SUS). The aim of this study was to analyze how health professionals treat these women problematizing the notion of acolhimento (receptiveness or openness to patients). A qualitative ethnographic research approach was used with health professionals from a primary care unit (PHU) in Matinhos Parana State Brazil. The study revealed care that was focused on: (1) biologizing principles with a focus on physical lesions and medicalization and (2) dialogue active listening psychosocial questions and establishment of ties especially featuring community health agents in this approach. The limited official local structure for handling domestic violence justifies treatment oriented by the grammar of acolhimento recommended by the SUS described in the literature and verbalized in the PHU but rarely problematized. This article thus proposed to contribute to this debate not by establishing prescriptions for action but by raising questions and mainly highlighting and translating the voices of those who deal with this challenge on a daily basis.

Intimate partner violence against women and healthcare in Australia: charting the scene

A violencia por parceiro intimo contra mulheres e comum em todos os paises, gerando desafiadora agenda para o setor saude. A troca de experiencias entre paises, referente as estrategias de enfrentamento do problema, pode constituir-se em subsidio para fomentar debates e promover reflexoes. Este artigo pretende apresentar e refletir sobre aspectos do contexto australiano no âmbito de respostas do setor saude a violencia por parceiro intimo, cartografando o cenario que cerca essa questao. A metodologia foi desenhada combinando pesquisa bibliografica, dialogo com diferentes atores e visitas in loco. Foram descritos aspectos historicos, contemporâneos e conceituais acerca das respostas da saude a violencia por parceiro intimo na Australia e apresentadas algumas estrategias, politicas publicas e projetos que vem sendo desenvolvidos no pais. Merecem relevo: rastreamento e busca ativa de casos de violencia por parceiro intimo; abordagem em atencao primaria com todos os membros familiares; respeito as diversidades; ensaios randomizados envolvendo mudancas na formacao dos profissionais e no sistema de saude no que tange ao cuidado de mulheres vivenciando violencia por parceiro intimo. Apesar das limitacoes ao abordar tema tao complexo, espera-se estimular reflexoes e discussoes.Intimate partner violence against women is a common problem in all countries and generates a challenging agenda for the health sector. Exchanging experiences between different countries, specifically strategies to respond to this problem, can constitute a tool for stimulating debate and promoting reflection. The scope of this article is to present and reflect on aspects of the Australian health sector response to intimate partner violence, and chart the scenario that surrounds this issue. We draw on a range of methods, combining a literature review and a dialogue with different stakeholders and site visits. We describe historical, contemporary and conceptual aspects of healthcare responses to intimate partner violence in Australia. Further we present some of the strategies, public policies and innovative projects that have been developed in this field in Australia. Some of the strategies include: screening vs. case-finding; primary care approaches for dealing with all family members; respect for diversity; and new randomized trials aiming for sustainable health system change for enhanced health professional care of people experiencing intimate partner violence. Despite the limitations of this approach to such a complex theme, we hope to stimulate thinking and discussion.

Violência e sofrimento social no itinerário de travestis de Santa Maria, Rio Grande do Sul, Brasil

No ano de 2012, realizamos pesquisa etnografica com travestis de Santa Maria, Rio Grande do Sul, Brasil, por meio de observacao participante, entrevistas e acompanhamento de suas vidas cotidianas. Durante esse periodo, percebemos que as violencias fisica e simbolica e o sofrimento delas decorrentes eram invariantes, condicao com a qual tinham que lidar em seus itinerarios, em suas praticas e afazeres diarios. Este artigo discute as violencias vivenciadas nas trajetorias percorridas pelas travestis (familia, escola, delegacias, servicos de saude), procurando, sobretudo, compreender como tais violencias estao relacionadas as experiencias nos servicos de saude e como os servicos de saude por elas acessados reagiram as violencias.The authors conducted an ethnographic research with transgender persons in Santa Maria, Rio Grande do Sul State, Brazil, in 2012, using participant observation, semi-structured interviews, and following their everyday lives. These individuals invariably experienced physical and symbolic violence and the resulting distress, a condition they had to deal with in their careers and daily practices and tasks. The article discusses the violence experienced by transvestites (in the family, school, police precincts, and health services), specifically seeking to understand how such violence relates to their experiences with health services and how the latter respond.

Domestic violence against women and professional intervention in primary healthcare: an etnographic study in Matinhos, Paraná State, Brazil

A violencia domestica provoca multiplas repercussoes na saude das mulheres e gera desafiadora agenda para os profissionais do SUS. Objetivou-se analisar como profissionais de saude atendem tais mulheres, problematizando a nocao de acolhimento em saude. Adotou-se pesquisa qualitativa e aproximacao etnografica com profissionais de uma unidade basica de saude (UBS) de Matinhos, Parana, Brasil. A pesquisa revelou atendimentos centrados em: (1) preceitos biologizantes, com foco em lesoes fisicas e medicalizacao; (2) dialogo, escuta ativa, questoes psicossociais e estabelecimento de vinculos, destacando-se agentes comunitarios de saude nesta abordagem. A escassez de estrutura local oficial para manejo da violencia domestica enseja atuacao inscrita sob a gramatica do acolhimento, preconizada pelo SUS, descrita pela literatura, verbalizada na UBS, mas pouco problematizada. Com este artigo buscou-se, portanto, contribuir com tal debate, nao no estabelecimento de prescricoes, porem no levantamento de indagacoes e principalmente visibilizando e traduzindo vozes de quem trabalha diuturnamente com esse desafio.Domestic violence has multiple repercussions on womens health and raises a challenging agenda for health professionals in Brazilian Unified National Health System (SUS). The aim of this study was to analyze how health professionals treat these women problematizing the notion of acolhimento (receptiveness or openness to patients). A qualitative ethnographic research approach was used with health professionals from a primary care unit (PHU) in Matinhos Parana State Brazil. The study revealed care that was focused on: (1) biologizing principles with a focus on physical lesions and medicalization and (2) dialogue active listening psychosocial questions and establishment of ties especially featuring community health agents in this approach. The limited official local structure for handling domestic violence justifies treatment oriented by the grammar of acolhimento recommended by the SUS described in the literature and verbalized in the PHU but rarely problematized. This article thus proposed to contribute to this debate not by establishing prescriptions for action but by raising questions and mainly highlighting and translating the voices of those who deal with this challenge on a daily basis.

Voices from low-income and middle-income countries: a systematic review protocol of primary healthcare interventions within public health systems addressing intimate partner violence against women

Introduction Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC. Methods and analysis A systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines. Ethics and dissemination This systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal. PROSPERO registration number CRD42017069261.

A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT) e o acesso ao Processo Transexualizador no Sistema Único de Saúde (SUS): avanços e desafios

This study aimed to analyze how the Brazilian Ministry of Health (MS) is implementing the Sex Reassignment Process (SRP) in the Unified Health System (SUS), through research of public domain official documents, systematization of surgerys quantitative data and analysis of meeting reports of the LGBT Health Technical Committee (CTSLGBT) of the MS. We conducted exploratory research combining quantitative and qualitative methods, using as methodological basis the normative proposal of health programs and systems evaluation study. The study resulted in the total data calculation of sex reassignment surgeries performed by the SUS (2008-2016), which highlight no deaths and unequal regional access; and in the monitoring of the implementation of actions of the National LGBT Health Policy by a specific committee appointed by the MS. Despite considerable progress, challenges remain. Currently, the most threatening hurdle is the possibility of a setback imposed by conservative sectors from the Executive and Legislative branches. Therefore, the visibility of achievements is a decisive step toward maintaining and enhancing SRP in the SUS.

Violence and social distress among transgender persons in Santa Maria, Rio Grande do Sul State, Brazil

No ano de 2012, realizamos pesquisa etnografica com travestis de Santa Maria, Rio Grande do Sul, Brasil, por meio de observacao participante, entrevistas e acompanhamento de suas vidas cotidianas. Durante esse periodo, percebemos que as violencias fisica e simbolica e o sofrimento delas decorrentes eram invariantes, condicao com a qual tinham que lidar em seus itinerarios, em suas praticas e afazeres diarios. Este artigo discute as violencias vivenciadas nas trajetorias percorridas pelas travestis (familia, escola, delegacias, servicos de saude), procurando, sobretudo, compreender como tais violencias estao relacionadas as experiencias nos servicos de saude e como os servicos de saude por elas acessados reagiram as violencias.The authors conducted an ethnographic research with transgender persons in Santa Maria, Rio Grande do Sul State, Brazil, in 2012, using participant observation, semi-structured interviews, and following their everyday lives. These individuals invariably experienced physical and symbolic violence and the resulting distress, a condition they had to deal with in their careers and daily practices and tasks. The article discusses the violence experienced by transvestites (in the family, school, police precincts, and health services), specifically seeking to understand how such violence relates to their experiences with health services and how the latter respond.

Mulheres da segurança pública do litoral do Paraná, Brasil: intersecções entre gênero, trabalho, violência(s) e saúde

Resumo Este artigo busca compreender as relacoes entre genero, violencias e o processo saude-doenca de mulheres que trabalham na area de seguranca publica no litoral do estado do Parana. A metodologia foi qualitativa, por meio de pesquisa etnografica com 50 mulheres (policiais civis e militares, e agentes penitenciarias), realizada em tres municipios balnearios da regiao entre marco de 2014 e marco de 2015. A analise dos resultados revelou: 1) dilemas concernentes as sobrecargas de trabalho impostas pela conjuntura local, marcada pela sazonalidade; 2) exposicao as violencias (principalmente institucional e de genero) e repercussao na saude dessas mulheres; 3) relacoes de poder, assinaladas pelas hierarquias das corporacoes e assimetrias de genero entre profissionais homens e mulheres. Esta pesquisa evidenciou: como as profissionais femininas nas instituicoes de seguranca publica sofrem diretamente o impacto das violencias e desigualdades de genero em suas vidas pessoais e profissionais; e as resistencias e rearranjos dessas mulheres nas instituicoes, suas reinvencoes em meio a um ambiente de hegemonia tradicionalmente masculina.

La violencia y el sufrimiento social en el itinerario de las personas transgénero de Santa María, Río Grande do Sul, Brasil

No ano de 2012, realizamos pesquisa etnografica com travestis de Santa Maria, Rio Grande do Sul, Brasil, por meio de observacao participante, entrevistas e acompanhamento de suas vidas cotidianas. Durante esse periodo, percebemos que as violencias fisica e simbolica e o sofrimento delas decorrentes eram invariantes, condicao com a qual tinham que lidar em seus itinerarios, em suas praticas e afazeres diarios. Este artigo discute as violencias vivenciadas nas trajetorias percorridas pelas travestis (familia, escola, delegacias, servicos de saude), procurando, sobretudo, compreender como tais violencias estao relacionadas as experiencias nos servicos de saude e como os servicos de saude por elas acessados reagiram as violencias.The authors conducted an ethnographic research with transgender persons in Santa Maria, Rio Grande do Sul State, Brazil, in 2012, using participant observation, semi-structured interviews, and following their everyday lives. These individuals invariably experienced physical and symbolic violence and the resulting distress, a condition they had to deal with in their careers and daily practices and tasks. The article discusses the violence experienced by transvestites (in the family, school, police precincts, and health services), specifically seeking to understand how such violence relates to their experiences with health services and how the latter respond.