A assistência às pessoas vivendo com HIV/AIDS: aprendendo a cuidar do vírus ou da pessoa?

O presente estudo descreve e analisa o aprendizado dos médicos residentes para a prática da assistência às pessoas que vivem com HIV/Aids desenvolvida em um serviço de Doenças Infecciosas e Parasitárias de um Hospital Universitário no Estado do Rio de Janeiro. É uma pesquisa de cunho etnográfico, com a observação do processo de treinamento em consulta em ato da atenção, realizada por médico residente, sob supervisão de staffs do serviço. Os aspectos multicausais da Aids suscitam demandas tanto nos pacientes quanto nos profissionais de saúde envolvidos na assistência a essas pessoas. O processo de ensino/aprendizado na medicina prioriza a doença, relegando a segundo plano, o doente com suas questões subjetivas, sociais, culturais e econômicas. Entretanto, ao lidarem com estas pessoas, os médicos entram em contato com aspectos objetivos e subjetivos do processo de adoecimento individual. É neste momento, que fica evidente as lacunas deixadas neste processo de aprendizado. Paulatinamente, os médicos vão aprendendo a cuidar do vírus e seus efeitos. Eventualmente aprendem a cuidar também da pessoa. Para o alcance de uma atenção integral e humanizada ainda é necessário ampliar e aprofundar as reformulações no processo de ensino/aprendizagem dos médicos. Mudanças essas que permitam o aprendizado de cuidar bem tanto da carga viral, do CD4 e dos anti-retrovirais quanto da pessoa que porta o vírus.

A Residência Médica: articulações entre a prática e o ensino

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender a peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

Produção discursiva sobre questões ambientais no currículo de Licenciatura em Geografia

Nas últimas décadas a preocupação com as questões ambientais tem se tornado mais presentes em diversos contextos sociais. As transformações de origem antrópica operadas no ambiente se intensificaram com os adventos tecnológicos característicos da modernidade que, em função da conjuntura política, econômica e social do capitalismo, consolidou uma lógica de dominação que, ao contrário do que enunciava, aprofundou e tornou mais complexo formas excludentes, discriminatórias e destrutivas de se relacionar com o outro e com o externo. Frente a isso, como movimento para diminuir ou sanar tais questões referentes a relação violenta do homem com o ambiente, a educação ambiental emerge apoiada em diferentes campos do conhecimento, manifestando-se de diversas formas. O presente estudo visa abordar essa temática analisando aspectos curriculares do curso de Licenciatura em Geografia com Ênfase em Meio Ambiente da Faculdade de Educação da Baixada Fluminense que se constitui propondo-se a formar de docentes de geografia que sejam também educadores ambientais. O ementário do curso foi analisado de modo a observar de que maneira as questões ambientais manifestam-se nos textos. Para isso, nos pautamos, sobretudo, na teoria do discurso, de Ernesto Laclau, e nas discussões e concepções sobre políticas curriculares construídas por Stephen Ball, Elizabeth Macedo e Alice Lopes. Buscamos compreender de que forma as significações ou associações presentes nas ementas contribuem para a formação de educadores ambientais, e sob qual perspectiva de educação ambiental isso ocorre. Analisamos o documento indicado cumprindo uma exigência de delimitação, uma vez que estamos cientes (e esse é um princípio importante da nossa abordagem) que a construção discursiva não se limita ao que é dito/escrito, mas se dá na interação social, arrolada pelas/nas disputas hegemônicas por significação e enunciação.

A Formação do Enfermeiro do Trabalho: uma discussão à luz da Determinação Social da Saúde

As condições de saúde do trabalhador resultam de um conjunto de determinantes de natureza individual, como a herança genética e a biologia humana, e de condicionantes econômicos, socioculturais, políticos, tecnológicos e organizacionais. Estes se expressam no modo de viver dos indivíduos e dos grupos sociais. Assim, a determinação social da saúde se verifica pelo caráter histórico-social e pelo aspecto biopsicológico dos indivíduos. Diante disso despertaram algumas inquietações: a formação em enfermagem do trabalho continua pautada no modelo hegemônico, biologicista? Será que aborda conteúdos sobre o processo de produção social da saúde-doença? Delineou-se como objetivo geral do estudo: Analisar a formação do enfermeiro do trabalho, tomando como referência a discussão da determinação social da saúde. E como objetivos específicos: a) Caracterizar o perfil acadêmico e o Projeto Político-Pedagógico (PPP) dos cursos presenciais lato sensu em enfermagem do trabalho do Rio de Janeiro; b) Analisar a formação do enfermeiro do trabalho à luz da discussão sobre a determinação social da saúde; e c) Discutir a formação do enfermeiro do trabalho e as influências do contexto social na conformação dos currículos e na prática social deste. Constitui-se um estudo de cunho qualitativo, não experimental, transversal e descritivo. Foi realizada entrevistas semi-estruturadas com coordenadores (N = 03) e discentes (N = 15) de três cursos de especialização em enfermagem do trabalho, sendo dois de instituição pública e um de instituição privada de ensino. Aplicou-se a análise de conteúdo de Bardin. Também foi realizada a análise dos PPP dos cursos, uma vez que delineiam os objetivos e/ou missão do curso, o ementário e a grade curricular. A maioria dos alunos entrevistados e um coordenador não tinham ouvido falar sobre a determinação social da saúde. Todos os cursos abordam direta ou indiretamente conteúdos relacionados a este tema. Dentro da perspectiva da Saúde Coletiva, em que se insere a Saúde do Trabalhador, a formação do enfermeiro do trabalho deve considerar a história de vida e a forma de inserção do trabalhador na sociedade, bem como suas relações de reprodução social. Contudo, verifica-se que o ensino em enfermagem do trabalho continua pautado no enfoque positivista do processo saúde-doença, estabelecendo relações entre indicadores de saúde, desconsiderando o caráter histórico-social deste processo. Dentro de uma perspectiva social ordenada pelas relações capitalistas em que vivemos, é sem dúvida difícil pensar numa outra forma de abordar o ensino das diversas profissões da saúde. Todavia, é necessário repensar a formação e atuação dos profissionais de saúde, dentro de uma ótica inter, multi e transdisciplinar apontada pelo campo Saúde Coletiva, a fim de ampliar o olhar sobre o sujeito para além da visão centrada na doença, considerando os aspectos subjetivos envolvidos na determinação social da saúde. Logo, demandam-se mudanças nas formas de pensar os currículos e de conduzir o processo ensino-aprendizagem desses profissionais de saúde.

Monitoring well-being and changing environmental conditions in coastal communities: development of an assessment method

The intersection of social and environmental forces is complex in coastal communities. The well-being of a coastal community is caught up in the health of its environment, the stability of its economy, the provision of services to its residents, and a multitude of other factors. With this in mind, the project investigators sought to develop an approach that would enable researchers to measure these social and environmental interactions. The concept of well-being proved extremely useful for this purpose. Using the Gulf of Mexico as a regional case study, the research team developed a set of composite indicators to be used for monitoring well-being at the county-level. The indicators selected for the study were: Social Connectedness, Economic Security, Basic Needs, Health, Access to Social Services, Education, Safety, Governance, and Environmental Condition. For each of the 37 sample counties included in the study region, investigators collected and consolidated existing, secondary data representing multiple aspects of objective well-being. To conduct a longitudinal assessment of changing wellbeing and environmental conditions, data were collected for the period of 2000 to 2010. The team focused on the Gulf of Mexico because the development of a baseline of well-being would allow NOAA and other agencies to better understand progress made toward recovery in communities affected by the Deepwater Horizon oil spill. However, the broader purpose of the project was to conceptualize and develop an approach that could be adapted to monitor how coastal communities are doing in relation to a variety of ecosystem disruptions and associated interventions across all coastal regions in the U.S. and its Territories. The method and models developed provide substantial insight into the structure and significance of relationships between community well-being and environmental conditions. Further, this project has laid the groundwork for future investigation, providing a clear path forward for integrated monitoring of our nation’s coasts. The research and monitoring capability described in this document will substantially help counties, local organizations, as well state and federal agencies that are striving to improve all facets of community well-being.

Socio-economic conditions of the pond owners of Demra, Dhaka

On the basis of fish culture status 96 ponds of the study area were classified into 4 categories like wild stock (27%), extensive culture (24%), improved extensive culture (33%) and semi-intensive culture (16%). Percentage of small, medium and large ponds were 38, 44, and 18 respectively whereas education levels below SSC, below Bachelor and above were 43, 38 and 19 respectively and single owners belonged to 54% of the ponds. Per hectare yields of extensive, improved extensive and semi-intensive categories of culture were 1.3, 2.12 and 4.0 metric tons respectively and their net return were 46, 63 and 92 thousand taka respectively. Considering the problems of fish culture, multiple ownership was found to be the most important one.

Socio-economic survey of fisher families, 1958-59

Fisher families had been investigated by the Department of Commerce and Industries in earlier economic surveys conducted in 1935, 1938 and 1939 (Das Gupta, 1937 a & b; 1944 a & b). These surveys were directed at the general economic conditions of the urban and rural sectors of the population and therefore did not provide much information in particular on the life of the fisherman or his environment. The Department of Fisheries in 1954 conducted a rapid enquiry into the living conditions of fishermen to obtain some data on their income, indebtedness and general social conditions, at the request of the Canadian Co-operative Consultant for incorporation in his report on the "Status and Possibilities of Co-operative Development of the Fisheries of Ceylon” (MacDonald, 1954). The present survey was undertaken to provide more definite socio-economic information on the fishermen of Ceylon, covering such aspects as income, expenditure, indebtedness and living conditions. The survey was started in June, 1958, but was interrupted by the unsettled conditions of the Island at the time, taking therefore a little over a year for completion. Some of the data collected was used as a basis for a report on the living conditions of fishermen, incorporated in the “Guide to the Fisheries of Ceylon", a hand book published by the Department of Fisheries (Anon. 1958).

Characterization of the fisheries of the major and minor lakes of Uganda and the socio-economic factors influencing fishery exploitation

There is growing recognition that the performance of the fisheries sector depends on the communities responsible for activities within it. These communities include fishers, processors, fish mongers, traders, local leaders, fishery administrators etc. On the basis of this, characterisation and diagnostic studies were conducted in 1995 focussing on mainly the fishers and opinion leaders on the major and some minor water bodies in Uganda. The study revealed that the desire to earn income is the driving force behind the malfishing practices experienced on Uganda fisheries. The destructive fishing gears and fishing methods as responses advanced by the fishers and opinion leaders were seines and cast nets on lakes Victoria, Kyoga and Albert and to a less extent traps

Some aspects of fisheries of the Sylhet basin, Northeast Bangladesh

A comprehensive study on the fisheries aspect was done in the Sylhet basin, Bangladesh during 1994 through 1998. Maximum fishing effort was engaged in the period of April to September while the bulk catch came during the September-January, when less effort was exerted. Barbs comprised 19%, catfishes 18% and major carps 16% of the total catch. Chatla beel, a three years pile, showed the highest fish production. Nine types of nets, four types of hooks and five types of traps were found in operation in the basin. The highest daily mean catch was recorded in glzer jal (26.5 kg/day) and the lowest in the clzandi jal (2.5 kg/day). Behundi jal was the most efficient (0.89 kg/man/h) while chandi jal was the worst (0.12 kg/man/h) gear. Gill net (/ash jal) seems to be the best selective gear. Actual catch/effort always remained less than the projected catch/effort. Maximum economic point of effort lies around 7.0 mandays/km2 and the fishery is gradually moving towards over-fishing. Income of professional fishermen was comparatively high than that of non-professional subsistence groups.

Marketing of small indigenous species of fish (SIS) in three selected fish markets of Mymensingh

A socio-economic survey was conducted round the year in three fish markets at Mymensingh, Bangladesh. The selected markets were categorized as rural market (Sutiakhali market), a peri-urban market (Kamal Ranjeet market, BAU) and an urban market (Notun Bazar market, Mymensingh town). It was learnt from the survey that the availability of Small Indigenous Fish Species (SIS) declined to a great extent over the last few years and at presently many of such fish species are either threatened or at the edge of extinction. The supply of SIS was highest in KR market (37% of total) and more or less similar in Notun Bazar and Sutiakhali fish market (25 and 27% respectively). The total supply of SIS fluctuated from 25% to 35% throughout the year in these markets. About 48 SIS were found in the sampled markets over the survey period. The highest number of species (45) was found in KR market followed by Notun Bazar (42) and Sutiakhali (37) fish markets. During the survey, three critically endangered species namely, schilbid catfish, garua catfish and rita were found in these markets. Beside these, other 11 and 10 species were listed to be endangered and vulnerable respectively. The biodiversity of 21 SIS found in three markets were no threat at all. Three species (guntea loach, Indian glass barb and flying barb) were 'data deficient' as reported by the IUCN Red Book (IUCN-Bangladesh 2000). From the supply point of view small prawn, spotted snakehead, stinging catfish, pool barb, striped dwarf catfish, Gangetic mystus, walking catfish and tank goby were the prominent fish. The least available species found in this survey were lesser spiny eel, barred spiny eel, Gangetic ailia, freshwater garfish, zig-zag eel, flying barb, Ganges river sprat, freshwater river shad and dwarf gourami. The weight of SIS available in Notun bazar was highest and nearly double than other two markets. There was no significant difference recorded in the supply of SIS in Sutiakhali and KR markets. The average monthly SIS supply was 185, 192 and 467 kg in KR, Sutiakhali and Notun Bazar, respectively; therefore, the cumulative average supply was 844 kg per month in three markets. The price of SIS ranged widely from taka 50-450/kg depending on species, location of market, time of purchase and the condition of fish. In general small prawn, ticto barb, dwarf gourami, Gangetic leaffish, and Annandale loach were sold at a lower price (ranged taka 50-100/kg) and these species could be considered at the bottom of the market-price list. Other SIS like walking catfish, climbing parch, butter catfish, cotio and schilbid catfish valued as highest price (ranged taka 150-450/kg). There was no specific marketing chain for SIS in Mymensingh region. The components of marketing channels and their expansion varied with seasons and locations. The general pattern, however, was as this - after buying fish from fish farmer/fishermen, middlemen (locally known as Foria) used to buy fish to wholesale market and sell to the wholesalers. The retailers used to buy fish from wholesaler through auction to the highest bidders. The retailers then send the fish to particular market where the fish reached the consumers. The livelihood strategy of SIS retailers in three fish markets showed that socio-economic constraints such as low income, poor educational background, low economic status and lack of capital are the main constrains [sic]. Most of the retailers proposed that government should control the fish price throughout the year, so that the producers can get reasonable and stable price. Construction of cold storage and preservation facilities at market sites, improvement of road and communication, improvement of physical market facilities and reduction of market chain is essential. Credit facilities, improvement of their standard of living, health and sanitary condition, housing condition, children education and access to drinking water facilities were identified as additional aspects to improve socio-economic condition of SIS retailers.

Training aspects for a trawling fishery

Trawling experiments carried out by the United Nations Development Programme Project and the Uganda Department of Fisheries, strongly suggest that the trawling method of fishing, if introduced on Lake Victoria, would bring about a tremendous increase in fish production from the lake. It is recognised, however, that before trawling is introduced, its economic, social, technical, biological and manpower implications must be carefully analysed. I now propose to discuss the training aspects of a trawl fishery on Lake Victoria.

Graduate Education for Leadership in Sustainable Development Innovation , Practice and Research

This paper reflects on the motivation, method and effectiveness of teaching leadership and organisational change to graduate engineers. Delivering progress towards sustainable development requires engineers who are aware of pressing global issues (such as resource depletion, climate change, social inequity and an interdependent economy) since it is they who deliver the goods and services that underpin society within these constraints. In recognition of this fact the Cambridge University MPhil in Engineering for Sustainable Development has focussed on educating engineers to become effective change agents in their professional field with the confidence to challenge orthodoxy in adopting traditional engineering solutions. This paper reflects on ten years of delivering this course to review how teaching change management and leadership aspects of the programme have evolved and progressed over that time. As the students on this professional practice have often extensive experience as practising engineers and scientists, they have learned the limitations of their technical background when solving complex problems. Students often join the course recognising their need to broaden their knowledge of relevant cross-disciplinary skills. The course offers an opportunity for these early to mid-career engineers to explore an ethical and value-based approach to bringing about effective change in their particular sectors and organisations. This is achieved through action learning assignments in combination with reflections on the theory of change to enable students to equip themselves with tools that help them to be effective in making their professional and personal life choices. This paper draws on feedback gathered from students during their participation on the course and augments this with alumni reflections gathered some years after their graduation. These professionals are able to look back on their experience of the taught components and reflect on how they have been able to apply this key learning in their subsequent careers.

Graduate education for leadership and organisational change in sustainable development

This paper reflects on the motivation, method and effectiveness of teaching leadership and organisational change to graduate engineers. Delivering progress towards sustainable development requires engineers who are aware of pressing global issues (such as resource depletion, climate change, social inequity and an interdependent economy) since it is they who deliver the goods and services that underpin society within these constraints. They also must understand how to implement change in the organisations within which they will work. In recognition of this fact the Cambridge University MPhil in Engineering for Sustainable Development has focussed on educating engineers to become effective change agents in their professional field with the confidence to challenge orthodoxy in adopting traditional engineering solutions. This paper reflects on ten years of delivering a special module to review how teaching change management and leadership aspects of the programme have evolved and progressed over that time. As the students who embark on this professional practice have often extensive experience as practising engineers and scientists, many have already learned the limitations of their technical background when solving complex problems. Students often join the course recognising their need to broaden their knowledge of relevant cross-disciplinary skills. The programme offers an opportunity for these early to mid-career engineers to explore an ethical and value-based approach to bringing about effective change in their particular sectors and organisations. This is achieved through action learning assignments in combination with reflections on the theory of change to enable students to equip themselves with tools that help them to be effective in making their professional and personal life choices. This paper draws on feedback gathered from students during their participation on the programme and augments this with alumni reflections gathered some years after their graduation. These professionals are able to look back on their experience of the taught components and reflect on how they have been able to apply this key learning in their subsequent careers. Copyright © 2012 September.

Planning humanitarian projects with educational focus in Guinea rural areas

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Acção Humanitária, Cooperação e Desenvolvimento