Susana Maciel Wuillaume

Opinions by physicians from the Family Health Program on four health care priorities proposed by the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality

The aim of this study was to understand how physicians from a team in the Brazilian Family Health Program perceive their work in child health, as compared to the programs principles outlined in the Agenda for Commitment to Comprehensive Child Health and Reduction of Infant Mortality, under the Ministry of Health. The backdrop was the strategy for implementation of primary care under the Unified National Health System (SUS). Semi-structured interviews were held, and the material was submitted to content analysis. According to the findings, in general the Agenda is being met. However, there are difficulties with referral and counter-referral; the measures proposed by the Family Health Program require medical and sociological competence and face problems inherent to biomedical training; the infrastructure and inputs are precarious; and the training provided does not prepare physicians sufficiently for a more comprehensive approach. In conclusion, the primary care model in Brazil requires adjustments to the countrys reality, and partnerships that transcend the system are necessary.

Diagnóstico da Síndrome de Turner: a experiência do Instituto Estadual de Diabetes e Endocrinologia - Rio de Janeiro, de 1970 a 2008

OBJECTIVES: to describe the Rio de Janeiro State Institute of Diabetes and Endocrinologys experience in diagnosing Turner Syndrome (TS), focusing on the distribution of chromosomes, age, and typical signs and symptoms, according to life stage (breast feeding, childhood, adolescence and adulthood). METHODS: a descriptive study was conducted of 178 patients, attending the Institute between 1970 and 2008 for the purposes of statistical analysis of the percentage differences using Epi-Info-2000 and of the differences between the mean ages using Students t test and ANOVA Results: the caryotypes found were: 79 with 45,X (35.4%), 36 with isochromosome Xq (20.2%) and 63 with other mosaics (35.4%). The mean age on diagnosis was 12.6 years, this figure being lower in patients with 45,X. The syndrome was diagnosed during breast feeding in 11.3% of patients, during childhood in 25.3%, during adolescence in 51.1%, and in 12.4% in adulthood. In those diagnosed before the age of five years, 70,6% had 45,X, signs that led to a suspected diagnosis during breast feeding were a webbed neck and congenital lymphedema in the hands and feet associated with typical dysmorphias. In childhood and adolescence the sign was short stature. Cubitus valgus was found in 72.5% of patients and abnormal ears in 65% of those diagnosed at an age of less than one year. CONCLUSION: diagnosis of TS does not necessarily have to be late, as some typical characteristics may already be present at birth.

Médicos residentes e suas relações com/e no mundo da saúde e da doença: um estudo de caso institucional com residentes em obstetrícia/ginecologia

Investiga-se a percepcao dos medicos que concluiram a residencia em Obstetricia/Ginecologia no Instituto Fernandes Figueira, Fundacao Oswaldo Cruz, em 2004, sobre essa trajetoria. A pesquisa constou de duas etapas, observacao participante e construcao de fontes orais, procedendo-se a uma codificacao analitica qualitativa de todo o material coletado para posterior analise semiotica. Busca-se compreender a heranca cultural enraizada no discurso dos residentes sobre suas relacoes com/e no mundo da saude e da doenca, em particular: desvalorizacao da profissao, ressentimento pela perda de poder do saber medico, percepcao da medicina mais como negocio do que como oficio, incertezas pela duplicidade de papeis - aluno e profissional, dificuldade diante do sofrimento e da morte.

Mulher, Medicina e tecnologia nos discursos de residentes em Obstetrícia/Ginecologia

This study focused on revealing the cultural meanings assigned to womanhood and the health-disease process in women according to the discourse of medical residents in Obstetrics/Gynecology at the Fernandes Figueira Institute, a public reference hospital specializing in maternal-child care in Rio de Janeiro. The research had two components: participatory observation in Ob-Gyn meetings and recording of oral sources. The sign-based method was used to analyze the data. The methodology included qualitative analytical coding of interviews and subsequent semiotic analysis. According to the results: (a) women are seen essentially as mothers, and their illness focuses primarily on their childbearing function; (b) technological evolution, mainly with the increased use of imaging, has reduced the importance of semiology; and (c) within the biotechnological context medicalization is part of the material and semiotic practices.

Discursos médicos em construção: um estudo com residentes em Obstetrícia/Ginecologia do Instituto Fernandes Figueira/Fiocruz

Este estudo discute a construcao do discurso especializado, a partir do verbalizado por medicos apos dois anos de residencia medica em Obstetricia/Ginecologia no Instituto Fernandes Figueira, Fundacao Oswaldo Cruz. A pesquisa foi operacionalizada em duas etapas: observacao participante de reunioes clinicas da Obstetricia e da Ginecologia e construcao de fontes orais. Foi realizada analise semiotica das notas de campo e do material transcrito das entrevistas. Os resultados giram em torno de dois eixos: a caracterizacao do perfil do medico obstetra/ginecologista e a convivencia com o normal e o estranho no contato com as pacientes, como integrantes da construcao do discurso especializado, no ambiente escolhido para a pesquisa. Conclui-se que a residencia conduz ao discurso especializado, escudado, principalmente, na utilizacao de exames complementares, como os que fornecem imagens, visto que tais exames sao percebidos como revelando objetivamente o corpo real. Tal fato infunde seguranca nos residentes, mas, por outro lado, afasta-os da atencao a escuta da historia da paciente e da composicao da narrativa medica, fragmentando o processo de exercicio da semiologia clinica

Ordenando no tempo e no espaço: epistemologia narrativa, semiologia e raciocínio clínico

This article discusses the role played by narrative process as a constituent element of clinical practice. The research is based on how physicians who are finishing their residency in Pediatrics understand Medical Semiology as a fundamental structure for developing clinical reasoning. The doctors revealed awareness of the importance of their medical knowledge and clinical experience; hearing, observing and examining patients to improve their “clinical eye”, which according to their statements, goes beyond touch and sight, referring to listening and reflexively ordering, in time and space, the events of the health- illness process. None of the interviewees demonstrated absolute illusion that technological resources could independently reveal the state of health or illness of patients. We found that, although doctors make use of an epistemological-based narrative of medical knowledge, they are not aware of such.

Medical residents and their relations with and within the health and illness environment: an institutional case study with obstetrics/gynecology residents

Investiga-se a percepcao dos medicos que concluiram a residencia em Obstetricia/Ginecologia no Instituto Fernandes Figueira, Fundacao Oswaldo Cruz, em 2004, sobre essa trajetoria. A pesquisa constou de duas etapas, observacao participante e construcao de fontes orais, procedendo-se a uma codificacao analitica qualitativa de todo o material coletado para posterior analise semiotica. Busca-se compreender a heranca cultural enraizada no discurso dos residentes sobre suas relacoes com/e no mundo da saude e da doenca, em particular: desvalorizacao da profissao, ressentimento pela perda de poder do saber medico, percepcao da medicina mais como negocio do que como oficio, incertezas pela duplicidade de papeis - aluno e profissional, dificuldade diante do sofrimento e da morte.