Educação permanente em saúde: metassíntese

OBJETIVO : Realizar metassíntese da literatura sobre os principais conceitos e práticas relacionados à educação permanente em saúde. MÉTODOS : Foi realizada busca bibliográfica de artigos originais nas bases de dados PubMed, Web of Science, Lilacs, IBECS e SciELO, utilizando os seguintes descritores: “ public health professional education ”, “ permanent education”, “continuing education ”, “ permanent education health ”. De um total de 590 artigos identificados, após os critérios de inclusão e exclusão, foram selecionados 48 para análise, os quais foram submetidos à análise individual, análise comparativa, análise com critérios de agrupamentos de elementos-chave e submetidos à metassíntese. RESULTADOS : Os 48 artigos originais foram classificados como elementos-chave em quatro unidades temáticas: 1) Concepções; 2) Estratégias e dificuldades; 3) Políticas públicas; e 4) Instituições formadoras. Foram encontradas três concepções principais de educação permanente em saúde: problematizadora e focada no trabalho em equipe, diretamente relacionada à educação continuada e educação que se dá ao longo da vida. As principais estratégias para efetivação da educação permanente foram a problematização, manutenção de espaços para a educação permanente e polos de educação permanente. O maior fator limitante foi relacionado à gerência direta ou indireta. Foram indicadas a necessidade de implementação e manutenção de políticas públicas, além de disponibilidade de recursos financeiros e de recursos humanos. As instituições formadoras teriam necessidade de articular ensino e serviço para a formação de egressos críticos-reflexivos. CONCLUSÕES : A articulação educação e saúde encontra-se pautada tanto nas ações dos serviços de saúde, quanto de gestão e de instituições formadoras. Assim, torna-se um desafio implementar processos de ensino-aprendizagem que sejam respaldados por ações crítico-reflexivas. É necessário realizar propostas de educação permanente em saúde com a participação de profissionais dos serviços, professores e profissionais das instituições de ensino.

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Permanent demand excess as business strategy: an analysis of the Brazilian higher-education market

Many Higher Education Institutions (HEIs) establish tuition below the equilibrium price to generate permanent demand excess. This paper first adapts Becker’s (1991) theory to understand why the HEIs price in this way. The fact that students are both consumers and inputs on the education production process gives rise to a market equilibrium where some firms have excess demand and charge high prices, and others charge low prices and have empty seats.Second, the paper analyzes this equilibrium empirically. We estimated the demand for undergraduate courses in Business Administration in the State of São Paulo. The results show that tuition, quality of incoming students and percentage of lecturers holding doctorates degrees are the determining factors of students’ choice. Since the student quality determines the demand for a HEI, it is calculated what the value is for a HEI to get better students; that is the total revenue that each HEI gives up to guarantee excess demand. Regarding the “investment” in selectivity, 39 HEIs in São Paulo give up a combined R$ 5 million (or US$ 3.14 million) in revenue per year per freshman class, which means 7.6% of the revenue coming from a freshman class.

Health education for children in the control of Schistosomasis

Health education for children is an important measure in the control of schistosomiasis especially considering the characteristics of the disease during childhood, such as high prevalence, high percent of treatment resistance, high rates of egg elimination and high level of reinfection, as reported in studies conducted in endemic areas. All of these facts indicate that children play a role in the maintenance and transmission of schistosomiasis. Historically in Brazil, Health Education concerning the major Brazilian endemies consists of a kind of vertical, interventionist and temporary action. An alternative would be to create a permanent health education process by assigning health education teachers to elementary schools. This would require expansion and improvement of teacher training and the development of programs taking into account: 1) the cognitive aspects of the child, the child's perception of reality and of the health/illness process; 2) the adaptation of instruction means and materials to the age group; 3) a "pedagogy of liberation" approach emphasizing the possibility of transforming life conditions since schistosomiasis is related to the lack of public services such as basic sanitation and clean domestic water supply.

A Pedagogical approach of schistosomiasis an experience in health education in Minas Gerais, Brazil

The experience described here is part of an extensive program that aims to stimulate schools to develop health integrated projects from theme generators, i.e., themes that have a meaning for the community. It was developed in Jaboticatubas, a town in the metropolitan region of Belo Horizonte, capital of the state of Minas Gerais, Brazil, and the focus was schistosomiasis. The selection was based on the expressive and historical prevalence of this disease in the county, which has been known as the "capital of schistosomiasis", in a national press release since the 1960's. Schistosomiasis is also a theme pointed out by teachers as requiring more information and methodologies to work with their students, most of them living in areas of high risk of transmission. In addition, during the last years, this disease has been transmitted silently through an increasing rural tourism in that region, requiring integrated and effective control actions. The developed strategy included four schools, whose teachers, students, and families took part in the process. It emphasizes in a critical pedagogy approach, which focuses on health issues as themes that may mobilize the school community and awake the population to a work which integrates environment, health, and citizenship. The results demonstrate that teachers and students not only acquired new knowledge and methodological skills, but also gained confidence in their ability to improve their health conditions. Thus, the project promotes a critical education that can result a more permanent effect on the control of schistosomiasis as well as other benefits for the schools and for the population.

Student stress and quality of education

Today, managers are increasingly interested in knowing how the work in organizations aftects employees' health. Less common is the interest in stress erupting in the academic community - among students, faculty and administrators. The authors present a reflection paper focused on student stress. In this paper, they first examine McLean 's model of context, vulnerability and stressors. This model provides the framework for the student surveys and for the entire paper. Based on the students surveys, an assessment is made of how asma" group of students are coping with stress. The paper fina"y suggests what can be done by students, faculty, and administrators to insta" and/or improve social support systems that might reduce the harmful eftects of stress on students and thus impact the quality of education.

Higher education of tourism in Spain and its adaptation to the European higher education area

The international tourism system has deeply undergone structural changes in the last decades which not remain outside the subsystem higher education in tourism, especially in the European case. This article has two objectives: firstly, describes the European higher education area and the objectives, skills and subjects taught in the main Spanish universities that offer higher education in tourism. On the other hand, in the light of knowledge that researchers' descriptive models, provide experience of the implementation of European credit and thorough a deeply review of the literature on the topic higher education in tourism, to propose strategies that will enable other tourism higher education systems approach to the European reality. These policy proposals are aimed at agents and elements from higher education in tourism subsystem and they specifically include: the institutions providing education in tourism, the curriculum, the teaching methods, teachers and students.

What factors of satisfaction and motivation are affecting the development of the academic career in Portuguese higher education institutions?

An important constituent group and a key resource of higher education institutions (HEIs) is the faculty or academic staff. The centrality of the faculty role makes it a primary sculptor of institutional culture and has implications for the quality of the institution and therefore has a major role in achieving the objectives of the institution. Demand for academic staff in higher education has been increasing and may be expected to continue to increase. Moreover the performance of academic staff as teachers and researchers determines much of the student satisfaction and has an impact on student learning. There are many factors that serve to undermine the commitment of academics to their institutions and careers. Job satisfaction is important in revitalizing staff motivation and in keeping their enthusiasm alive. Well motivated academic staff can, with appropriate support, build a national and international reputation for themselves and the institution in the professional areas, in research and in publishing. This paper aims to identify the issues and their impacts on academic staff job satisfaction and motivation within Portuguese higher education institutions reporting an ongoing study financed by the European Union through the Portuguese Foundation for Science and Technology.

Health education: the role and functions of the specialist and the generalist

Education for health is a process in which all public health and medical care personnel are involved. People learn both formally (planned learning experiences) and informally (unplanned learning experiences). Since the patient, the client, the consummer and the community expect public health and medical care personnel to assist them with health and disease issues and problems, the response of the professional "educates" the customer whether the professional intends to educate or not. Therefore, it is incumbent on all public health and medical care professionals to understand their educational functions and their role in health education. It is also important that the role of the specialist in education be clear. The specialist, as to all other specialists, has an in-depth knowledge of his area of expertise, i.e., the teaching/learning process; s/he may function as a consultant to others to enhance the educational potential of their role or s/he may work with a team or with communities or groups of patients. Specific competencies and knowledge are required of the health education specialist; and there is a body of learning and social change theory which provides a frame of reference for planning, implementing and evaluating educational programs. Working with others to enhance their potential to learn and to make informed decisions about health/disease issues is the hallmark of the health education specialist.

Policies for decentralization and development of health education

How the policy of action and professional standards have influenced the development and decentralization of health education is discussed. It is concluded that a review of policies both of developing as well as of developed countries could help to put some observations into a perspective that is closer to the Brazilian reality.