(Im)possibilities of implementing an unified health services management in the Brazilian National Health System (SUS) in a large municipality: the case of São Paulo city, Brazil

A construção da direção única na saúde constitui-se um desafio para a gestão local do SUS, particularmente para municípios de grande porte. Este artigo analisou o processo de implementação do SUS no município de São Paulo, visando identificar estratégias para viabilizar uma direção única, no período de 2001 a 2008. Com base em um estudo de caso, foram utilizados dados obtidos de informantes privilegiados da gestão e de documentos de gestão. O conceito de integração sanitária foi utilizado como categoria analítica. Foram analisados movimentos e estratégias dos atores institucionais envolvidos diretamente na gestão do SUS, os gestores municipal e estadual. Observaram-se avanços institucionais como a municipalização das unidades básicas de saúde estaduais e a habilitação do município na gestão plena do sistema municipal. Apesar dessa condição de gestão e da identidade político-partidária entre os governos municipal e estadual desde 2005, constatou-se a coexistência de dois subsistemas públicos de saúde pouco integrados. Um municipal, que concentrava os serviços de atenção básica; outro estadual, que concentrava parte considerável dos serviços de média e alta complexidades. Instrumentos de gestão adotados, como o sistema de regulação, mostraram-se frágeis para superar a falta de integração entre os referidos subsistemas. Como implementar a direção única no SUS implica uma (re)divisão de recursos e poder, discute-se que não bastam normas nem instrumentos de gestão para viabilizá-la. É um desafio estratégico para o SUS implementar processo de negociação, envolvendo os atores institucionais e políticos, visando a pactuação de um projeto político na saúde.The construction of a unified health management is a challenge to the local Brazilian National Health System (SUS) management, especially in large cities. This article analyzed the implementation process of the SUS in the city of São Paulo. Its objective was to identify strategies to implement the unified health management, in the period from 2001 to 2008. The method used was a case study and data collection was based on management documents and interviews. The concept of health services integration was used as analytical category. Movements and strategies of the SUS institutional actors in the city of São Paulo were analyzed. Institutional improvements were observed, like the municipalization of the state healthcare centers and the qualification of São Paulo in the full management of the municipal health system. Despite this SUS management status and the political party identity that has been occurring between state and city governments since 2005, there were two separate public health subsystems with litle integration between them: the municipal one, which concentrated the primary healthcare services, and the state one, concentrating most of the secondary and tertiary health services. The management tools used, such as the regulation system, proved to be fragile to overcome the lack of integration between those health subsystems. As the implementation of a unified health management in SUS implies a (re)division of resources and power, rules and management tools are not enough to make it feasible. Implementing a negotiation process between the institutional and political actors involved in a common political project in health is a strategic challenge

Influence of nationality on the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)

OBJECTIVE: In answer to the call for improved accessibility of neuropsychological services to the international community, the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS; MS) was validated in multiple, non-English-speaking countries. It was created to monitor processing speed and learning in MS patients, including abbreviated versions of the Symbol Digit Modalities Test, California Verbal Learning Test, 2nd Edition, and the Brief Visuospatial Memory Test, Revised. The objective of the present study was to examine whether participant nationality impacts performance above and beyond common demographic correlates. METHOD: We combined published data-sets from Argentina, Brazil, Czech Republic, Iran, and the U.S.A. resulting in a database of 1,097 healthy adults, before examining the data via multiple regression. RESULTS: Nationality significantly predicted performance on all three BICAMS tests after controlling for age and years of education. Interactions among the core predictor variables were non-significant. CONCLUSION: We demonstrated that nationality significantly influences BICAMS performance and established the importance of the inclusion of a nationality variable when international norms for the BICAMS are constructed

O agir leigo e o cuidado em saúde: a produção de mapas de cuidado

This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. the first stage included interviews with strategic actors (managers and policymakers) and key health professionals. the second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.Universidade Federal de São Paulo, Escola Paulista Med, BR-04023062 São Paulo, BrazilInst Univ Lisboa, Inst Super Ciencias Trabalho & Empresa, Lisbon, PortugalUniv Estadual Campinas, Fac Ciencias Med, Campinas, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, BR-04023062 São Paulo, BrazilWeb of Scienc

“Análise de propagandas dirigidas ao público infantil que explicitam um modelo de beleza e de comportamento voltados para as crianças”

Brincadeiras criativas ajudam as crianças na criação de soluções inusitadas à problemas, além de estimularem a aprendizagem, a criatividade e contribuírem para o desenvolvimento de habilidades de autocontrole. Essa máxima é apresentada por Susan Linn (2009) em “Arte, religião e descobertas científicas são todas enraizadas na nossa capacidade de brincar” in Criança e Consumo: Entrevistas – A importância do Brincar. Entretanto sabe-se que, cada vez mais, o tempo destinado às brincadeiras criativas está sendo substituído pelo tempo investido em mídias sociais e por brinquedos eletrônicos. Em atenção a isso, a presente pesquisa é direcionada à importância da atividade lúdica, que atualmente tem perdido espaço ao consumo desenfreado que atingiu o público infantil. Para o desenvolvimento do trabalho, foram analisadas quatro propagandas dirigidas a este público que de algum modo, transmitem um modelo de comportamento e beleza. A intenção dessa pesquisa é sensibilizar a todos sobre a necessidade de nos unirmos, enquanto sociedade civil e científica, para reivindicar o respeito aos direitos da criança, exigindo que haja no Brasil uma regulamentação da publicidade dirigida a elas, respeitando-se o desenvolvimento saudável e criativo das crianças durante a infância, ao invés de privilegiarmos a indústria, que utiliza os fortes apelos da mídia para torná-las consumidores precoce

¿Se sabe sobre el niño? Acompañamiento terapéutico y educación inclusiva

En este trabajo se pretende pensar la práctica de acompañamiento terapéutico como una modalidad de apoyo a la inclusión escolar desde una formulación del (no) saber del acompañante terapéutico que trabaja en la escuela guiado por el psicoanálisis. A través de viñetas clínicas, trataremos trés actores y sus discursos que circulan en el universo de la inclusión escolar: educadores, expertos y, finalmente, el acompañante terapéuticoThis article aims to argue about the practice of therapeutic accompaniment as a clinical modality of support for school inclusion through the formulation on the therapeutic companion’s (non) knowledge, for those who work guided by psychoanalysis. Through clinical vignettes, we will approach three actors and their speeches that circulate in school inclusion’s universe: educators, specialists and finally the therapeutic companionEste trabalho se propõe a pensar a clínica do acompanhamento terapêutico como uma modalidade de apoio à inclusão escolar a partir de uma formulação sobre o (não) saber do acompanhante terapêutico que trabalha na escola orientado pela psicanálise. Através de vinhetas clínicas, abordaremos três atores – os educadores, os especialistas e, finalmente, o acompanhante terapêutico – e seus discursos que circulam no universo da inclusão escola

Rewriting the ‘Duchess of Malfi’

This article addresses issues of text adaptation in full-scale ESL drama production. After choosing to present Webster’s The Duchess of Malfi, participants in the English Drama Workshop at Padua University set about the task of adapting the play in order to make it more suitable for a group of non-native speakers of English acting in front of an audience made up predominantly of non-native speakers. Substantial changes were made during the adaptation process: as well as cutting and simplifying the text, certain characters were eliminated while others were doubled (or rather tripled) and one scene was totally rewritten. When implementing these changes, the group had to take account of both the student-actors’ linguistic competence and the size and composition of the cast, most of the members of which were female. It is argued that text adaptation in ESL drama is not only a way of creating a more appropriate product, but also greatly enriches the process leading up to the performance. The students gained deeper insights into the text and were also able to achieve a strong sense of ownership of the final production. This article addresses issues of text adaptation in full-scale ESL drama production. After choosing to present Webster’s The Duchess of Malfi, participants in the English Drama Workshop at Padua University set about the task of adapting the play in order to make it more suitable for a group of non-native speakers of English acting in front of an audience made up predominantly of non-native speakers. Substantial changes were made during the adaptation process: as well as cutting and simplifying the text, certain characters were eliminated while others were doubled (or rather tripled) and one scene was totally rewritten. When implementing these changes, the group had to take account of both the student-actors’ linguistic competence and the size and composition of the cast, most of the members of which were female. It is argued that text adaptation in ESL drama is not only a way of creating a more appropriate product, but also greatly enriches the process leading up to the performance. The students gained deeper insights into the text and were also able to achieve a strong sense of ownership of the final production

Primary healthcare and the construction of thematic health networks: what role can they play?

The enhancement of primary healthcare has been a core strategy for the empowerment of the Brazilian Unified Health System (SUS). Recent guidelines issued by OPAS and the Ministry of Health highlight the role it has played as a thematic communication network center, a regulating agent for the access and use of services required for comprehensive healthcare. Sponsored by PPSUS/Fapesp, this study examines the possibilities of the primary healthcare network exercising such a strategic function. Life narratives involving 15 regular users were produced in two cities of ABC Paulista, which have adopted the Family Health Strategy for the organization of their primary healthcare networks. The study presents three main findings: the primary healthcare network serves as an outpost of SUS by producing user values even for high complexity service users; the primary network is perceived is a place for simple care needs; there is shared impotence between users and teams when it comes to the network functioning as the coordinator of care, indicating that it does not possess the technological, operational and organizational material conditions or symbolic conditions (values, meanings, and representations) to be in a central position in the coordination of thematic healthcare networks.O fortalecimento da atenção básica tem sido valorizado como estratégia central para a construção do SUS. Diretrizes recentes emanadas pela OPAS e pelo MS destacam seu papel como centro de comunicação de redes temáticas, como reguladora do acesso e utilização dos serviços necessários para a integralidade do cuidado. O presente estudo, financiado com recursos PPSUS/Fapesp, problematiza as possibilidades da rede básica exercer tal função estratégica. Foram produzidas narrativas de vida de 15 usuários altamente utilizadores de serviços de saúde em dois municípios do ABC paulista, que adotaram a Estratégia de Saúde da Família para organização de suas redes básicas. O estudo apresenta três achados principais: a rede básica funciona como posto avançado do SUS, produzindo valores de uso mesmo para os pacientes utilizadores de serviços de alta complexidade; a rede básica é vista como lugar de coisas simples; há uma impotência compartilhada entre usuários e equipes quando se trata da rede básica funcionar como coordenadora do cuidado, indicando como ela não reúne condições materiais (tecnológicas, operacionais, organizacionais) e simbólicas (valores, significados e representações) de deter a posição central da coordenação das redes temáticas de saúde.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina PreventivaInstituto Superior de Ciências do Trabalho e da Empresa Instituto Universitário de Lisboa Faculdade de Ciências Médicas Departamento de Saúde ColetivaUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de Saúde ColetivaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL