Marisa Barletto

Identidade da agente comunitária de saúde: tecendo racionalidades emergentes

Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.

Identity of community health agents: composing emerging rationalities

Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.

Social representations of drinking water: subsidies for water quality surveillance programmes

A qualitative study was developed aimed at understanding the social representations of water consumption by a segment of the population of a small town in Brazil. A total of 19 semi-structured interviews were carried out and subjected to a content analysis addressing opinion on drinking water, characteristics of drinking water and its correlation to health and diseases, criteria for water usage and knowledge on the source and accountability for drinking-water quality. Social representations of drinking water predominantly incorporate the municipal water supply and sanitation provider and its quality. The identification of the municipal water supply provider as alone responsible for maintaining water quality indicated the lack of awareness of any health surveillance programme. For respondents, chlorine was accountable for conferring colour, odour and taste to the water. These physical parameters were reported as the cause for rejecting the water supplied and suggest the need to review the focus of health-educational strategies based on notions of hygiene and water-borne diseases. The study allowed the identification of elements that could contribute to positioning the consumers vs. services relationship on a level playing field, enabling dialogue and exchange of knowledge for the benefit of public health.

Qualidade da informação sobre óbitos por causas externas em município de médio porte em Minas Gerais, Brasil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

Identidad de la agente comunitaria de salud: el tejido de racionalidades emergentes

Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.Analisamos a identidade da agente comunitaria de saude (ACS) a partir da categoria genero em dialogo com as categorias espaco publico e privado/domestico e saberes populares e cientificos. A profissao de ACS e desvalorizada nao por ser ocupada quase totalmente por mulheres, mas por ser um trabalho visto como feminino - condicao historicamente marcada pela desigualdade de genero, associando a mulher aos cuidados domesticos e a subordinacao. Essa profissao reflete posicoes de genero hegemonicas e a definicao de sua identidade se da no dia a dia, na convivencia com a equipe de saude e comunidade, repleta de conflitos e afetos e nas praticas cotidianas marcadas por hierarquias. Concomitantemente, carrega a possibilidade de um horizonte emancipatorio, definido na criacao do trabalho comunitario e ordenado para o cumprimento do principio da integralidade.

Quality of data on deaths from external causes in a medium-sized city in Minas Gerais State, Brazil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

Calidad de los datos sobre muertes por causas externas en una ciudad de tamaño medio en Minas Gerais, Brasil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

IDENTIDADES, MEMÓRIA E ESPACIALIDADE NA FESTA DO ROSÁRIO

This text proposes some refl ections on the constitution of social space and time in a district of the city of Vicosa (MG) starting from the memory of its gr...