Rita de Cássia Marques

Health Education through Analogies: Preparation of a Community for Clinical Trials of a Vaccine against Hookworm in an Endemic Area of Brazil

Background Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. Methodology/Principal Findings An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an increase in the number who expressed fear of being vaccinated with a novel vaccine was seen after viewing the video (51.4% post-video versus 29.2% pre-video). Increases were also seen in the proportion who thought that participation in a vaccine trial would be inconvenient or disrupt their daily activities. Conclusions/Significance Even in rural, resource-limited populations, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research. The observed changes in the knowledge and perceptions of the research participants about hookworm infection and the experimental hookworm vaccine demonstrate that the video intervention was successful in increasing understanding and that the subjects acquired knowledge pertinent to the planned research.

A pesquisa científica na saúde: uma análise sobre a participação de populações vulneráveis

Thisisaqualitativestudywiththeaimtoanalyzetheparticipationofvulnerablepopulationsinscientifichealthcare� research.�ThestudywascarriedoutinAmericaninhas,�NovoOrientedeMinas,�MinasGerais,�Brazil,�withninevolunteersenrolled� in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structuredinterviewsaftertestingthevaccineandanalyzedusingBardinsContentAnalysismethod.�Mostvolunteersdecided� to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participatewasinfluencedbythesocio-economicandpsychosocialvulnerabilityofthepopulationandhowtheysymbolicallyconstruct� this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy.This is a qualitative study with the aim to analyze the participation of vulnerable populations in scientific health care research. The study was carried out in Americaninhas, Novo Oriente de Minas, Minas Gerais, Brazil, with nine volunteers enrolled in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structured interviews after testing the vaccine and analyzed using Bardin’s Content Analysis method. Most volunteers decided to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participate was influenced by the socio-economic and psychosocial vulnerability of the population and how they symbolically construct this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy. LA INVESTIGACION CIENTIFICA EN SALUD: UN ANALISIS SOBRE LA PARTICIPACION DE LAS POBLACIONES VULNERABLES RESUMEN: Estudio cualitativo con el objetivo de analizar la participacion de las poblaciones vulnerables incluidas en investigaciones sobre salud. El estudio se desarrollo en Americaninhas, Novo Oriente de Minas, en Minas Gerais Brasil, con nueve voluntarios de las pruebas clinicas para experimentacion de la vacuna contra Ancilostomideos, realizado por un consorcio internacional de instituciones de investigacion. Los datos fueron recogidos despues de las pruebas de la vacuna, mediante entrevistas semiestructuradas analizadas por medio del analisis de contenido de Bardin. La mayoria de los voluntarios decidio participar en el estudio motivados por la posibilidad de acceso a la atencion de la salud. Se concluye que la decision de participar en el estudio fue caracterizada por la vulnerabilidad socioeconomica y psicosocial de esa poblacion y por la forma como esos voluntarios construyen simbolicamente esta vulnerabilidad. El estudio indica la necesidad de preparar a la comunidad a participar en el estudio a traves de una educacion que se traduzca en una accion dada la necesidad de desarrollo de la autonomia de los sujetos participantes. DESCRIPTORES: Investigacion en salud. Poblaciones vulnerables. Autonomia personal.

Popular Beliefs about the Infectivity of Water among School Children in Two Hyperendemic Schistosomiasis Areas of Brazil

This article examines changing common knowledge of elementary school children to scientific knowledge related to the relationship between water characteristics and the transmission of schistosomiasis through health education. A review of the literature and two case studies from rural elementary schools in Brazil show how the prevailing concept of dirty and polluted water, which has operated as an epistemological obstacle for acquiring scientific knowledge, may be related to symbolic thought and cultural parameters. Through an educational intervention not commonly applied to health programs involving elementary school students in two schistosomiasis-endemic rural communities in Brazil this paper describes the difficulties researchers encountered in changing the prevailing perception that very dirty and polluted water provides optimal conditions for schistosome transmission, to the scientifically accepted view that transmission occurs most often in visually clean, although fecally contaminated water. This conceptual difficulty may be largely explained in terms of the symbolism involved in clean and dirty water and the life-giving quality of water. Based on our results, we recommend that knowledge about water-related beliefs and concepts among school children should be considered in school-based health education programs in areas of endemic schistosomiasis and possibly other intestinal infections.

Liberating critical pedagogy of Paulo Freire in the scientific production of Nursing 1990-2017

OBJECTIVE To analyze the theoretical and methodological application of Paulo Freires critical pedagogy in the scientific production of nursing. METHOD An integrative review was carried out with consultation of the databases: LILACS, BDENF, MEDLINE, PUDMED and CINHAL. We included studies in the Spanish, English and Portuguese languages, published from 1990 to 2017. RESULTS A total of 38 articles were analyzed, of which the main concepts adopted were: dialogue/dialogicity, awareness/critical awareness and questioning. Regarding the application of the method, it was noticed the predominance of the adoption of elements such as culture circles, thematic phase and horizontality relation of the nurse with the individuals involved. CONCLUSION Nursing has partially appropriated the Freires referential. However, it reveals the intentionality of a transformative practice that requires deepening for the implementation of the method in its full.

A Caridade criando hospitais em Minas Gerais (Brasil) - séculos XVIII-XX

O artigo e fruto de uma pesquisa sobre o Patrimonio Cultural da Saude em Minas Gerais (Brasil) e se dedica a compreender a construcao de hospitais fomentados pelas acoes caritativas de catolicos, leigos ou religiosos, entre os seculos XVIII e XX. O movimento catolico leigo sempre foi forte em Minas Gerais favorecido pelas proibicoes da Coroa Portuguesa em torno da livre circulacao de religiosos, considerados suspeitos de contrabandear o ouro das minas. A primeira Santa Casa, a de Vila Rica, surge de uma irmandade. A caridade tambem e o mote de outro grupo de leigos que teve grande importância no Brasil, especialmente no seculo XX – os vicentinos. Assinala-se ainda a divulgacao dos ideais de caridade de Frederico Ozanam com base na obra de Sao Vicente de Paula. Por vicentinos e preciso entender tanto o movimento leigo abrigado nas conferencias da Sociedade Sao Vicente de Paula, como os religiosos: os padres lazaristas e as irmas vicentinas. O terceiro grupo estudado e o dos medicos catolicos, fruto do associativismo profissional incentivado pela igreja catolica. As Santas Casas com suas irmandades, os vicentinos e o associativismo catolico integram movimentos reconhecidos no mundo todo. Nesse contexto social de grande participacao catolica nas obras de caridade, restava aos medicos integrar o movimento, com o desprendimento dos atendimentos muitas vezes gratuitos e com o esforco para criar hospitais para a populacao carente. No seculo XX, a capital de Minas Gerais, embora fruto de decisao de republicanos e positivistas portadores dos idearios da modernidade, continuou se valendo da caridade crista para tratar dos pobres.

Continuing education: speeches by professionals of one Basic Health Unit

Objective: To analyze the speeches of health professionals about continuing education in the daily life of a basic health unit. Method: Qualitative study developed at a primary health care unit of Belo Horizonte, based on the theory of Agnes Hellers daily life with critical discourse analysis. In-depth interviews with 25 professionals were developed. Results: Recycling, updating, institutional responsibility, continuous learning, discomfort and transformation, revealed by vocabulary, interdiscourse, temporality, modality, evaluation and institutional social practice. Professionals blame the institution, but value continuing education for the transformation in work processes and attention to users. Final considerations and implications for practice: The discomfort provides action-reflection and changes in the attention to users. Recycle and update relates the professionals adaptation to technological updating, without necessarily producing changes. To expand discussion with professionals about daily potential, for recognition and appreciation of continuing education in daily life, as an instrument of change in social practices.

Ocupação do espaço e sua relação com a progressão da hanseníase no Nordeste de Minas Gerais - século XIX

A hanseniase e prevalente em paises subdesenvolvidos, uma vez que as precarias condicoes de vida da populacao favorecem seu aparecimento. Tem grande importância para a saude publica devido a sua magnitude e a seu alto poder incapacitante, atingindo, sobretudo, os individuos na faixa etaria economicamente ativa. No Nordeste de Minas Gerais, ha um padrao de alta endemicidade para essa doenca; por isso, ha muito tempo a regiao e alvo de politicas publicas de controle. Entretanto, tais medidas nao causaram o impacto desejado para reduzir sua expressao na regiao, tornando imprescindivel compreender melhor o fenomeno em suas varias dimensoes, inclusive a historica. Este artigo tem como objetivo analisar a ocupacao do espaco e a progressao da hanseniase no Nordeste de Minas Gerais, no seculo XIX. Para tanto, optou-se pelo estudo documental de natureza historica que possibilitou a interpretacao dos fenomenos sociais ligados a hanseniase. A analise historica permitiu concluir que a chegada e a progressao da hanseniase no nordeste mineiro estiveram ligadas aos movimentos economicos e sociais de descoberta e desenvolvimento da regiao, ocasionando o ciclo de transmissao da doenca.

Enfermeiros e saúde pública em Belo Horizonte: combatendo doenças e educando para a saúde (1897-1933)

ABSTRACT This article analyzes the organization of nursing in the city of Belo Horizonte between 1897 and 1933 – before the institutionalization of this knowledge field through the creation of the Carlos Chagas Nursing School. At this time, public health actions were mainly geared towards combating and controlling epidemic and endemic diseases and for hygiene and health education of the population. Between the late nineteenth century until the 1910s, health actions had diseases as their axis, and the nurses carried out the activities in isolation hospitals, leper hospitals, hostels and homes under the guidance and monitoring of doctors, or informally and unsupervised as a way of helping others. The 1920s and 1930s marked a period of transformation in public health, with emphasis on prevention and sanitary education. Since then the organization of two fronts of nurses in prevention and health promotion has been observed: the “visiting nurses” and the “school nurses”, whose work was based on guidelines and practices advocated by contemporary health education. The present study reveals a universe around the nurses which was almost not explored in the context of the history of nursing, especially with regard to this history in Minas Gerais, particularly the capital city Belo Horizonte.

Sobre a varíola e as práticas da vacinação em Minas Gerais (Brasil) no século XIX

This article discusses the impact of smallpox and vaccination practices used against the disease used in the province of Minas Gerais, in Brazil, during the Imperial Period (1822-1889). Despite the existence of services responsible for the organization and dissemination of the vaccine in the country since the early 19th century, some administrative and cultural factors, as identified in documents produced by the provinces public health authorities at the time, had a negative impact upon the full implementation of both practice and organization of services aimed at the dissemination of smallpox vaccination. Based upon historiographic sources, it is argued that despite the trend towards centralization observed at different governmental spheres during the structuring of the Imperial State, in particular, in the provision of vaccination services, there was a prevailing disharmony between the different agencies responsible for the implementation and management of such services. A further contributor to the difficulties in the service implementation was the resistance of the population to submit to the vaccination, a phenomenon that can be best understood through examination of the social construction of perceptions about diseases and the vaccination method used against the smallpox.

La investigación científica en salud: un análisis sobre la participación de las poblaciones vulnerables

Thisisaqualitativestudywiththeaimtoanalyzetheparticipationofvulnerablepopulationsinscientifichealthcare� research.�ThestudywascarriedoutinAmericaninhas,�NovoOrientedeMinas,�MinasGerais,�Brazil,�withninevolunteersenrolled� in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structuredinterviewsaftertestingthevaccineandanalyzedusingBardinsContentAnalysismethod.�Mostvolunteersdecided� to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participatewasinfluencedbythesocio-economicandpsychosocialvulnerabilityofthepopulationandhowtheysymbolicallyconstruct� this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy.This is a qualitative study with the aim to analyze the participation of vulnerable populations in scientific health care research. The study was carried out in Americaninhas, Novo Oriente de Minas, Minas Gerais, Brazil, with nine volunteers enrolled in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structured interviews after testing the vaccine and analyzed using Bardin’s Content Analysis method. Most volunteers decided to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participate was influenced by the socio-economic and psychosocial vulnerability of the population and how they symbolically construct this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy. LA INVESTIGACION CIENTIFICA EN SALUD: UN ANALISIS SOBRE LA PARTICIPACION DE LAS POBLACIONES VULNERABLES RESUMEN: Estudio cualitativo con el objetivo de analizar la participacion de las poblaciones vulnerables incluidas en investigaciones sobre salud. El estudio se desarrollo en Americaninhas, Novo Oriente de Minas, en Minas Gerais Brasil, con nueve voluntarios de las pruebas clinicas para experimentacion de la vacuna contra Ancilostomideos, realizado por un consorcio internacional de instituciones de investigacion. Los datos fueron recogidos despues de las pruebas de la vacuna, mediante entrevistas semiestructuradas analizadas por medio del analisis de contenido de Bardin. La mayoria de los voluntarios decidio participar en el estudio motivados por la posibilidad de acceso a la atencion de la salud. Se concluye que la decision de participar en el estudio fue caracterizada por la vulnerabilidad socioeconomica y psicosocial de esa poblacion y por la forma como esos voluntarios construyen simbolicamente esta vulnerabilidad. El estudio indica la necesidad de preparar a la comunidad a participar en el estudio a traves de una educacion que se traduzca en una accion dada la necesidad de desarrollo de la autonomia de los sujetos participantes. DESCRIPTORES: Investigacion en salud. Poblaciones vulnerables. Autonomia personal.