Protagonist of breastfeeding or an instrument of child health policy?: the enunciation of women in official promotional and guidance materials to breastfeeding

This article examines recent promotion and guid ance materials to breastfeeding produced by the Brazilian Ministry of Health, identifying similari ties and differences between the discourses aimed at pregnant and lactating women, and those directed to health professionals in relation to the proposed meanings about women. Based on the theory of enunciation, we identified that, while the self or subject of enunciation is still present in the ana lyzed discourse (identified as Brazilian Ministry of Health), significant distinctions persist in the ap proach of the women's role. In manuals for health professionals, in which the woman is the subject of whom it talks about, she is commonly represented as an individual with subjectivity who is the protago nist of the process. On the other hand, in materials aimed at women, we observed that, in general, they are treated in an objectified way, revealed through a normative and imperative language, which quali fies them as an instrument of the official policy for child's health. We argue that understanding how the object spoken is created by/in these discourses, unveiling how positions and power relations are constructed in them, enables us to discuss this com munication that generally has neglected the experi ences and expectations of mothers in breastfeeding.Este artigo analisa materiais de promoção e orientação ao aleitamento materno recentes, pro duzidos pelo Ministério da Saúde (MS) brasileiro, identificando aproximações e diferenças entre os discursos voltados a gestantes e lactantes e aqueles dirigidos a profissionais de saúde em relação aos sentidos propostos acerca da mulher. Com base na teoria da enunciação, identificamos que, mesmo permanecendo o eu ou sujeito da enunciação dos discursos analisados, identificado como MS, per sistem distinções significativas na abordagem da mulher. Nos manuais para profissionais de saúde, nos quais a mulher é o sujeito sobre quem se fala, é mais comum ela aparecer representada como in divíduo dotado de subjetividade e protagonista do processo. Por outro lado, de modo geral, as mulheres são tratadas de forma objetificada nos materiais voltados a elas mesmas, o que se revela por meio de linguagem normativa e imperativa que as configura como instrumento da política oficial de saúde in fantil. Defendemos que compreender como o objeto de que se fala é constituído por/nesses discursos, assim como desvelar como neles se constroem as posições de sujeito e relações de poder, possibilita -nos problematizar essa comunicação que, de modo geral, negligencia as experiências e expectativas da mãe no processo de amamentação

Strategic planning in a public heath institution from 2012 to 2022: implication of the perceptions of the workforce and managerial decisions

Este artigo apresenta os mecanismos de elaboração do planejamento estratégico institucional do INCA em uma década e identifica aspectos subjetivos dos profissionais, mecanismos de gestão institucional e entraves gerenciais da Administração Pública como temas relevantes que impactam no processo. Além disso, problematiza o gerencialismo, a ênfase no estrito cumprimento de regras e a análise limitada de contexto nos serviços de saúde. O objetivo foi descrever a evolução do processo de planejamento e apresentar como a percepção de profissionais sobre cumprimento de normas gerenciais influencia na organização da gestão. Resulta de um estudo qualitativo, com o emprego de entrevista individual semiestruturada realizado em 2012 e de análise documental concluída em 2021. Resultados demonstram como aspectos intersubjetivos das relações de trabalho podem contribuir para afastar os trabalhadores da tomada de decisões estratégicas ou facilitar a participação e comprometimento para o aprimoramento da gestão de uma instituição. Conclui-se que a apropriação de gestores do debate de temas como conflito, motivação, liderança e subjetividade são fundamentais para o avanço e melhoria do processo de planejamento.This article presents the mechanisms for elaborating INCA’s institutional strategic planning in a decade and identifies subjective aspects of professionals, institutional management mechanisms, and managerial obstacles of Public Administration as relevant issues that impact the process. It also problematizes the managerialism, the emphasis on strict compliance with rules and the limited analysis of context in health services. The objective was to describe the evolution of the planning process and to present how the perception of professionals about compliance with management standards influences the organization of management. It is the result of a qualitative study, using a semi-structured individual interview carried out in 2012 and document analysis completed in 2021. Results demonstrate how intersubjective aspects of work relationships can contribute to distance workers from strategic decision-making or facilitate participation and commitment to improve the management of an institution. It is concluded that managers’ appropriation of the debate on topics such as conflict, motivation, leadership, and subjectivity are fundamental for advancing and improving the planning process

A comunicação sobre HIV nas práticas de saúde no Sistema Único de Saúde (SUS)- Brasil = The communication about HIV in health practices in the Unified Health System (SUS)-Brazil

Resumo: Introdução: Dimensões comunicacionais permeiam as práticas dos profissionais de saúde. Desde a criação do SUS (Sistema Único de Saúde), em 1988, no Brasil, são enfatizados princípios como a humanização do cuidado e a valorização dos aspectos relacionais, sociais e culturais na comunicação com usuários e entre profissionais. Com relação à Aids, políticas de saúde buscaram informar e mudar comportamentos, enfatizando o diagnóstico precoce, o tratamento adequado e a prevenção. Apesar da epidemia do HIV ter estimulado muitas inovações na educação e comunicação em saúde, ainda se verificam ações predominantemente prescritivas, baseadas no saber biomédico, responsabilizando indivíduos por seus problemas de saúde. Objetivos: O presente trabalho investigou como a comunicação envolvendo o HIV atualmente é abordada nos cenários de práticas do SUS. Metodologia: Foi realizada uma análise temática de conteúdo em busca bibliográfica na literatura brasileira especializada publicada de 2000 a 2018 na SciELO (Scientific Electronic Library Online). Resultados: Obtivemos 15 artigos que mostram a comunicação utilizada como instrumento de fomento à adesão, prevenção, detecção e tratamento do HIV, mas também como competência para lidar com dilemas éticos e morais. Conclusão: Embora ainda seja restrita, a produção acadêmica em comunicação sobre HIV nos serviços aponta mudanças em direção às necessidades do usuário.Palavras-chave: comunicação; serviços de saúde; Sistema Único de Saúde (SUS); HIV; Aids.Abstract: Introduction: Communication dimensions permeate the practices of health professionals. Since the creation of the Brazilian Health Care System (SUS), in 1988 in Brazil, principles such as humanization of care and appreciation of relational, social and cultural aspects of communication between users and professionals and in professional teams have been emphasized. In relation to AIDS, health policies have sought to inform and change behaviors, emphasizing early diagnosis, appropriate treatment and prevention. Although the HIV epidemic has stimulated the development of technologies in health education and communication, there still predominate prescriptive actions aimed at biomedical knowledge and blaming individuals for their health problems. Objectives: This study investigated how communication regarding HIV has been addressed in SUS practices. Methodology: A thematic analysis of bibliographic search content was carried out in specialized Brazilian literature published from 2000 to 2018 in SciELO (Scientific Electronic Library Online). Results: The 15 articles obtained display communication as a tool to promote adherence, prevention, detection and treatment of HIV, but also point to its importance in dealing with ethical and moral dilemmas. Conclusion: Although it is still restricted, the academic production of HIV communication in services indicates a trend towards addressing the needs of the users.Keywords: communication; health services; Unified Health System (SUS); HIV; Aids

Concepciones de comunicación en las directrices curriculares nacionales para cursos de medicina en Brasil: cultura y contexto

Comunicación oral presentada en el 3er Congreso Internacional de Comunicación en Salud (3ICHC), celebrado los días 19 y 20 de octubre de 2017 en la Universidad Carlos III de Madrid.Desde la homologación de las primeras directrices nacionales para cursos de grado en Brasil (2001- 2004), la comunicación aparece como una de las “competencias o habilidades generales” para cursos de la salud, pero competencia no es sinónimo de habilidad, y supone la necesidad de interpretar elementos del contexto para utilizar adecuadamente los recursos de conocimiento, habilidades y actitudes en la práctica profesional

Quality of Life of Mothers of Brazilian Children with Congenital Zika Virus Syndrome and Associated Factors

Objective: To evaluate the quality of life of mothers of Brazilian children with congenital Zika virus syndrome (CZS) and associated factors. Material and Methods: This cross-sectional study assessed the quality of life (QoL) of 65 mothers of children diagnosed with CZS using the WHOQOL-bref questionnaire. Information related to mothers and children's characteristics and aspects of QoL (physical, psychological, social and environment domains) was collected. Data were presented using descriptive and inferential statistics. Associations between independent variables and quality of life outcome were carried out through bivariate analyses, adopting a 5% significance level. Results: The “physical” domain showed the highest score (65.98 ± 17.62), while the “environment” domain showed the lowest score (48.55 ± 14.75). The quality of life for the physical domain was associated with maternal schooling and child's sex, while the psychological domain was associated with family income and child's sucking difficulty. Conclusion: Socioeconomic characteristics and comorbidities were associated with mothers' QoL. Knowledge of QoL determinants and their impact on different dimensions of life can serve as a guide for interventions aimed at improving the QoL of this population

¿Es necesaria una segunda reforma de la atención primaria en España?

[ES] El Sistema Nacional de Salud (SNS) español, creado en 1986, tiene como uno de sus pilares la atención primaria de salud (APS). Desde su nacimiento, el modelo español de APS ha sido objeto de elogios y de críticas. El actual momento de crisis de financiación de las políticas públicas, entre ellas la de salud, está resucitando viejos debates y planteando otros nuevos. El presente artículo examina los datos que se conocen sobre el grado de aceptación del modelo de APS por parte de los ciudadanos españoles, así como datos del debate de administraciones, pacientes y profesionales durante los últimos cinco años. Al final, los autores tratan de extraer algunas conclusiones que los decisores políticos deberían tener en cuenta para, partiendo de las fortalezas y debilidades comúnmente admitidas del modelo de APS, hacer frente a la difícil situación actual evitando errores derivados de decisiones improvisadas a causa de las urgencias del momento. [EN] Created in 1986, the Spanish National Health System adopted Primary Health Care (PHC) as one of its building blocks. Since the beginning, the Spanish PHC model has been the subject of both praise and criticism. Nowadays, a crisis in public policy funding--including health funding policies--is resurrecting old debates and raising new ones. This paper analyzes the data available about the degree of acceptance of PHC from the perspective of Spanish citizens as well as data about the debate produced in the last five years by politicians, patients and health workers. At the end of the paper the authors seek to draw some conclusions based on the commonly acknowledged strengths and weakness of the PHC model, which decision-makers ought to take into consideration in order to avoid mistakes caused by improvised decisions elicited by the requirements of the moment.S

Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children