Violência institucional no âmbito da saúde reprodutiva : a percepção de mulheres usuárias do SUS, na cidade de Natal/RN

Institutional violence ranges from the most widespread lack of access to the poor quality of services provided. It includes abuses committed by virtue of the unequal power between patients and professionals within institutions. The aim of this study was to analyze the perception of women with regard to this type of violence, in the services offered at a reproductive health facility belonging to the National Health System (SUS) in Natal, Brazil. Interdisciplinary perspective is important, in that it provides interaction and complementarity between various disciplines, favoring, in an integrated way, a thematic approach in research activities, teaching and extension, involving professionals, students and researchers in medicine, social services, psychology, nursing, anthropology and physical therapy. A quantitative/qualitative approach was used, involving a sample of 401 women, as part of a transversal observational study. In the qualitative stage, which consisted of participatory observation and semi-structured interviews, we used an intentional sample of 10 individuals. The data were analyzed using logistic regression techniques, correspondence analysis and categorical thematic content analysis, showing that the 2 questions that investigated directly the perception of institutional violence obtained affirmative response frequencies of 28.2% and 31.8%, respectively. In regard to data collected in a field diary related to participatory observation, the main complaints referred to the health providerpatient relation, translated into dissatisfaction with the interpersonal relationship and with the resolution of the specific demand that required care. From content analysis, we classified 4 categories: Access; Information; Health professionalpatient relation; and Respect/dignity. We identified 6 subcategories: Impossibility of choice; Repressed demand; Communication difficulty; Asymmetric interpersonal relations; Privacy/confidentiality; Disrespect. We concluded, therefore, that the data presented show that in the reproductive health care programs, there are indicators of institutional violence. However, it is difficult to approach this phenomenon, mainly because of the power relations involved in the patient-health care provider interaction, resulting from unawareness that determinate situations violate sexual and reproductive rights. This can be explained by sociostructural questions that reveal marked inequalities, ratified by issues related to violation of the rights of National Health System (SUS) patients

Pedagogia Freinet: a construção de uma práxis em turmas de 5ª a 8ª séries

Ce travail que nous venons de présenter apport une systématisation sur la viabilité de la praxis de l´éducateur français Célestin Freinet (1896-1996). Il s´agit d´une étude qualificative, recherche-action, développée dans une école coopérative l´ École Freinet à Natal/RN Brésil, auprès des élèves du 5ème et 8ème séries de l´Enseignement Fondamental. Le problème central que nous a amené à cette recherche, a été le fait de vérifier les progressions dans la production scientifique et dans les pratiques des enseignants qui ont à la charge l´Éducation Infantine et les premières séries de l´Enseignement Fondamental. Tout cela en tenant compte en concevoir l´élève en tant que sujet actif de son apprentissage et coresponsable à l´organisation du travail scolaire. Toutefois, qaund-il s´agit des quatre dernières séries de l´Enseignement Fondamental (5ème au 8ème séries), les propositions progressistes sont prises comme quelque chose pratiquement impossible d´en mettre en marche. Pour attenuer la lacune théorique sur le sujet, nous avons offert un texte significatif pour les enseignants d´une façon générale, les chercheurs de l´académie et pour l´écolechamp de la recherché. Tout cela par le fait de ne pas donner de priorité à une technique ou à un principe, en particulier. Cette pédagogie est discutée autant que possible dans son contexte global et aussi sur le comment s´est manifestée dans sa práxis . Nous avons mis en relief les aspects importants pour le fonctionnement de la salle de classe, aussi que les estratégies utilisées pour la construction, communication et documentation des connaissances L´intervention nous a permis de construire l´objet par la réflexion en action, à partir des données obtenues pendant les observations, les entretiens, les enterviews, les moments d´études et de la quête des textes écrits. L´analyse a été faite à la lumière de la methodologie comprehensive (Kaufmann, 1996), entrelacée au materiau empirique et à la théorie. Cette forme d´analyse nous a permis d´obtenir la logique dans l´ensemble comme nous crayons que doit caracteriser la recherche aux Sciences Humaines et Sociales. Les considérations finales mettent l´accent d´un côté sur l´efficacité de la pédagogie Freinet, pour orienter le processus de l´enseignement apprentissage, en tous les dégres de l´enseignement et de l´autre côté nous montre la nécessité urgente de l´équipe de l´école champ de la recherche, de qualifier sa pratique à partir des références théoriques-pratiques de la pédagogie Freinet

Tuberculose: conhecimentos, representações sociais e experiências da doença na visão do portador

Tuberculosis is considered one of the most ancient human diseases, cases were registered 3900 years before Christ, and it is currently regarded as a serious public health problem in the world due to several factors such as income mismanagement, precarious standard of life and some sort of prejudice comprised by the word tuberculosis. Taking this into consideration, it was developed a descriptive and exploratory study aiming at analyzing the social representations of tuberculosis made by its patient from the Unidades de Saúde da Família (Family Health Units a public health program) in Campina Grande City PB, in relation to the decentralization of the policies that administrate the disease. It was interviewed 34 tuberculosis patient that were being treated from 2007 to 2008. The age group of the interviewees varied from 10 to 60 years old, but most of them were between 36 and 60 years old (58,8%, n=20), some were young adult and adult (21 35 years old), with 11 (32,3%) respondents, and, less frequent, children and teenagers (11 20 years old), with 03 (8,8%) participants. Data was collected through semi-structured interview. The questions that guided the research were elaborated based on the operational recommendations of DOTS strategy; that is: access to laboratory examinations; medication guarantee; directly observed treatment. Besides that, the experiences of the patient were considered in their relation with the family and the different social groups. The analysis of the discursive material was submitted to the Analyse Lexicale par Context d un Ensemble de Segments de Texte software - ALCESTE 4.7. Data interpretation showed five categories for the social representations of the tuberculosis patient that participated in DOTS strategy: 1) the accessibility of the health assistance service; 2) the patient perspective of the disease; 3) the change in the operation of the productive life; 4) the signals and symptoms of the tuberculosis disease; 5) the rearrangement and mechanisms used to face the disease. The Central Nucleus reveals that tuberculosis is a transmissible disease that can be prevented by people through educational practices, health promotion, active search for symptomatic respiratory and control of the carriers communication; these mechanisms should be incorporated to the routine of all participants of the family health groups. The Intermediate Elements, based on quotidian life, as well as the individual experiences of the tuberculosis patient, reveals prejudiced attitude and beliefs that lead to isolation and restriction of interpersonal relationship. Peripheral Elements were constituted by themes that showed the patient feelings of indignation because of the social barriers they had to face in the Family Health Units during the treatment. These elements demonstrate a negative perspective of the representation concerning the accessibility, i.e. inadequate structure of the health service; long distance to the Health Centre, this factormakes it difficult for the patient to continue the treatment; scheduling delay; and limited service regarding other requests (doctor, dentist etc). One expects to contribute for the construction of a new perspective of the health question between the different agents who make the assistencial institutions and formation of professionals, either in central or local scope