Marilene Barros de Melo

Adesao ao Programa de Educacao Permanente para medicos de familia de um Estado da Regiao Sudeste do Brasil

Ongoing Health Education is a strategy for transformation of health practices, though the adherence of professionals is one of the challenges facing its implementation. Thus, the objective of this study was to investigate the factors associated with adherence of family doctors to the Ongoing Education Program in a southeastern Brazilian state from the perception of supervisors. It is a cross-sectional and quantitative study with the use of online questionnaires. Data were analyzed using the chi-square test with ongoing correction to determine the association between structure, topics, activities and difficulties of the supervisors working in Ongoing Health Education, difficulties of the physicians in Primary Health Care (PHC) and poor and good adherence to the program. Excellent medical participation was statistically related to the adequacy of physical space (p = 0.001), a multidisciplinary approach (p = 0.035) and epidemiological aspects (p = 0.043). Low adherence was associated with the inadequacy of the physical structure, difficulty understanding the methodology, less time in a supervisory position, multiple workdays, among others. A good adherence to Ongoing Health Education is a possibility for collective reconstruction of the everyday work of physicians in Primary Health Care.

Qualificação de agentes comunitários de saúde: instrumento de inclusão social

The work of community health agents (CHA) was established as a profession in the sphere of the National Health System (SUS) in 2002. Its activities contribute to the demographic diagnosis of communities, the promotion of educational activities, the participation of the population in public policy, and home visits. Training is the responsibility of technical schools and human resources education centers of the SUS. This research seeks to identify, analyze and understand the changes in the life of the CHA since the agents insertion in the Qualification and Professional Development Program and of his/ her professional practice. Methodologically, this is a qualitative study that uses focus groups. For data analysis, we used the technique of content analysis. It was found that the Program favors the consolidation of attention to health policies and contributes to the collective construction of knowledge. The Ministry of Health, by professionalizing the practice of the CHA, legitimizes the CHA´s knowledge supporting their inclusion in health services and increasing the local governance. For the CHA, training contributes to the overcoming of limits imposed by traditional practices and marks the production of knowledge. The ACS recognizes itself as a subject of action, and that training is a means of access to professionalization and social mobility.

Ato médico: perda da autoridade, poder e resistência

Facing the Bill no 25/02, from the Brazilian Senate, which had its genesis in the Federal Council of Medicine’s Resolution no 1627/01 and the objective of conditioning the access to health services to a previous authorization of the doctor, the authors tried to know the perceptions about the medical activity. In this sense, the same authors have developed a qualitative study in the field of the worker’s health, having interviewed 8 doctors and 13 workers. The content analysis technique has demonstrated that the doctor-patient relation has been constituted by the following categories: submission, conflict and resistance. This type of relation reinforces the conception of the individual as a mere bearer of a biological body and the “medical act” as a conjunction of cultural, corporative and marketing forces. Thus, this Bill seems to constitute a strategy to confront the current crisis of the medical hegemony, representing a regression to mechanist and mono-causality models, and demonstrating unfamiliarity with the important conquests on Collective Health.

O Programa de Qualificação e Desenvolvimento do Agente Comunitário de Saúde na perspectiva dos diversos sujeitos envolvidos na atenção primária em saúde

O Programa de Qualificacao e Desenvolvimento do Agente Comunitario de Saude (ACS) foi instituido pelo Ministerio da Saude visando investir em sua profissionalizacao. Este artigo teve por objetivo identificar, analisar e compreender as implicacoes do Programa de Qualificacao e Desenvolvimento concluido em 2009 pela Escola de Saude Publica do Estado de Minas Gerais na vida pessoal e laboral dos ACS e no processo de atencao a saude, na visao dos diversos sujeitos envolvidos na Atencao Primaria em Saude (APS): ACS, equipe de Saude da Familia, gestores, docentes e usuarios de 4 unidades basicas de saude em uma capital da regiao Sudeste. Este estudo tem carater qualitativo, utilizando como tecnicas de coleta de informacoes a analise documental, entre-vistas, grupo focal e questionarios. As informacoes coletadas foram analisadas por meio da tecnica de analise do discurso do sujeito e utilizando o programa SPSS, versao 16. Foram realizados 14 grupos focais com as unidades da Estrategia Saude da Familia, 4 com ACS e 4 com usuarios; 7 entrevistas, 4 com gestores e 3 com docentes do curso. No grupo dos ACS, ha predominio do sexo feminino e uma baixa rotatividade. Na analise do discurso, verificou-se que o programa investigado trouxe implicacoes favoraveis a vida pessoal e profissional do ACS e a APS. Contudo, e necessario estruturar o programa nos parâmetros da educacao permanente em saude, assegurando uma abordagem que propicie a construcao permanente de estrategias voltadas a melhoria das condicoes de vida e saude e a cidadania plena.

EXIGÊNCIAS DE PRODUTIVIDADE NA ESCOLA E NO TRABALHO E O CONSUMO DE METILFENIDATO

Este artigo e um ensaio teorico que apresenta diferentes estudos abordando as condicoes de producao do diagnostico do Transtorno de Deficit de Atencao/Hiperatividade (TDAH) e a eleicao do metilfenidato como principal terapeutica. Analisou-se o consumo e utilizacao do medicamento como dispositivo de produtividade, descrevendo as tendencias comuns de transgressao do seu uso. Discutiram-se as controversias que permeiam o diagnostico de TDAH e o abuso do metilfenidato como sintoma da sociedade pos-industrial. Concluiu-se que o nao cumprimento das exigencias de bom desempenho na escola e no trabalho tem contribuido para a configuracao do diagnostico de TDAH. Nesse contexto, ocorre a busca pelo farmaco como estrategia para melhorar o desempenho cognitivo.