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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

A demanda de um centro de referÃncia nacional para hansenÃase no nordeste brasileiro: por que o excesso de pacientes? / The demand for a national reference center for leprosy in northeast Brazil: why the excess patients?

Maria Lucy Landim Tavares Ferreira 03 June 2009 (has links)
Atà 2000, o controle da hansenÃase no Brasil foi verticalizado. Desde entÃo, o processo de descentralizaÃÃo dessa doenÃa deu inÃcio a aÃÃes que priorizaram o nÃvel primÃrio de atenÃÃo à saÃde. Entretanto, a assistÃncia ainda permanece centralizada em algumas unidades de saÃde, como o Centro Nacional de ReferÃncia em Dermatologia SanitÃria D. LibÃnia (CDERM), em Fortaleza, CearÃ. O referido centro responde por 84% da detecÃÃo dos casos de hansenÃase do MunicÃpio. O objetivo deste estudo foi investigar os fatores associados à demanda excessiva de casos, em nÃvel secundÃrio de atenÃÃo, representado por esse centro de referÃncia. Um estudo transversal foi realizado com 600 usuÃrios, selecionados aleatoriamente nos ambulatÃrios do CDERM. Foram coletados dados socioeconÃmicos e demogrÃficos sobre o conhecimento da doenÃa e a percepÃÃo dos serviÃos. Oitenta e dois por cento dos participantes tinham baixa situaÃÃo socioeconÃmica, 90% vieram encaminhados por outras unidades de saÃde e 87% tinham a forma multibacilar. Sessenta e nove por cento receberam atendimento prÃvio em outras unidades de saÃde, 49% jamais ouviram falar de hansenÃase, 24% referiram sentir medo da doenÃa ou terem sofrido discriminaÃÃo, 39% dos usuÃrios referiram que o atendimento ininterrupto no horÃrio do almoÃo favorece a permanÃncia no CDERM, 57% e 27%, respectivamente, referiram que a medicaÃÃo complementar nunca faltou no CDERM e nas Unidades BÃsicas de SaÃde (UBS). Sessenta e um por cento consideraram que o compromisso dos profissionais no CDERM foi Ãtimo, contra 14% nas UBS. Os atores relatados pelos usuÃrios, especialmente logÃsticos e de qualidade de atendimento e dos profissionais, poderiam explicar a concentraÃÃo de usuÃrios nesse centro de referÃncia. / Until 2000, the Leprosy control in Brazil was a vertically integrated program. After this date, the program was considered a priority for primary care. However, the program remained centralized in some reference centers such as the D. LibÃnia National Reference Center for Sanitary Dermatology, located in Fortaleza, CearÃ, Brazil (CDERM), responsible for 84% of the case detection in this municipality. The goal of this study was to investigate the factors associated with use of these services, and the potential for integration into primary health care. A cross-sectional survey was conducted with 600 users randomly selected in the outpatient clinic of the CDERM with the objective of determining the factors associated with demand for these services. Social, economic and demographic data, knowledge about the disease and perception about the services were collected. Eighty two percent of the participants had low social and economic status, 90% were referred from other health units; 87% had the multibacillary form. Sixty-nine per cent reported previous visits to other health units (HU). Fortynine per cent have never heard about leprosy, 24% reported fear of being discriminated against or suffering discrimination. Complementary medication was never missed for 57% treated in the CDERM and for 27% in other HUs. The commitment of the professionals was considered exemplary by 61% in the CDERM and by 14% in the other HUs. These facts reported by users, especially logistic ones and those related to the quality of the assistance and of the professionals might explain the concentration of users in this reference center.
2

Descentralização das ações de vigilancia sanitária: impasses e desafios da sua implementação em municípios baianos

Barreto, Raylene Logrado January 2008 (has links)
p. 1 - 95 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-01-23T18:41:40Z No. of bitstreams: 1 666666.pdf: 448801 bytes, checksum: 42dd2dd25aad8b4bd602a50c8462ca03 (MD5) / Made available in DSpace on 2013-01-23T18:41:40Z (GMT). No. of bitstreams: 1 666666.pdf: 448801 bytes, checksum: 42dd2dd25aad8b4bd602a50c8462ca03 (MD5) Previous issue date: 2008 / Este estudo analisa os fatores que interferem na descentralização das ações de Vigilância Sanitária nos municípios baianos em Gestão Plena do Sistema, identificando impasses e desafios na assunção das suas responsabilidades, enquanto gestores plenos do sistema de saúde municipal. Trata-se de uma pesquisa exploratória, de natureza qualitativa, descritiva, tendo utilizado o estudo de caso como estratégia de pesquisa. Os dados foram coletados através de entrevistas e análise de documentos e analisados à luz do conceito de descentralização enquanto fenômeno de natureza política por envolver transferência de poder do estado e ser por esta razão indutora de conflitos nas relações entre as esferas de governo da Federação brasileira. Os resultados evidenciaram que, embora venham sendo superados muitos obstáculos para estruturação das vigilâncias sanitárias municipais no gerenciamento do risco sanitário, e, conseqüentemente, para a promoção e proteção da saúde, ainda são muitos os desafios que se apresentam para a consolidação da VISA nestes municípios. Isto porque as insuficiências crônicas de recursos de toda natureza, além da histórica disputa de poder entre a instância estadual e municipal na tomada de decisão sobre ações e recursos para a saúde, se aprofunda na medida em que também se consolida o poder dos municípios na assunção de suas competências gerenciais na área da saúde decorrentes do processo de descentralização da saúde. Ao agregar evidências empíricas sobre o processo de descentralização da vigilância sanitária, este estudo busca contribuir para o fortalecimento desse processo no Estado da Bahia, na perspectiva da reorganização das estratégias para implementação das ações da VISA nos municípios baianos no sentido de superar os limites e impulsionar os avanços já adquiridos. / Salvador
3

Mécanismes et conditions locales de concrétisation de l'innovation inverse : le cas du Brésil / Mechanisms and local conditions for effective reverse innovation : the case of Brazil

Stainsack, Cristiane 28 November 2018 (has links)
Le travail de thèse porte sur l’innovation inverse et ses particularités managériales et organisationnelles au sein d’une filiale d’entreprise multinationale (EMN) localisée dans un pays émergent. Contrairement au modèle classique, l’innovation inverse peut se produire à partir d’un pays en voie de développement ou émergent, et ensuite être transférée vers un pays développé. Dans le cadre de cette recherche, nous nous intéressons au Brésil, un pays émergent où des entreprises mondiales disposent de centres de R&D de référence en Amérique Latine. L’innovation portée par la filiale d’une EMN est réalisée en fonction de divers facteurs et caractéristiques locales qui contribuent à ce que l’innovation menée par cette filiale se propage à l’échelle globale. Les objectifs de la recherche sont de mieux comprendre comment les EMN’s s’organisent dans une approche d’innovation inverse, de progresser sur l’éclairage théorique, et de proposer un modèle de management favorisant l’innovation mondiale à partir des initiatives locales dans un pays émergent. Nos travaux mettent en œuvre une démarche qualitative qui s’appuie sur une méthode d’études multi-cas. Notre contribution est un nouveau modèle théorique et fonctionnel pour l’innovation inverse prenant en compte les éléments qui contribuent à ce phénomène: l’intégration entre la maison mère et la filiale, la décentralisation de la R&D et la valorisation de compétences locales et l’insertion dans le système national d’innovation (SNI). Nos résultats de recherche ont mis en avant l’existence d’autres types d’innovations au-delà de l’innovation technologique qui induit une innovation mondiale. Nous avons observé que les innovations au niveau managérial, processus ou marketing sont absorbées au sein de la maison mère et diffusées vers d’autres filiales à une échelle mondiale. / Our research work concerns reverse innovation and its managerial and organizational features in a multinational corporation (MNC) subsidiary located in emerging markets. Unlike the traditional model, reverse innovation can occur from a developing or emerging country, and then be transferred to a developed country. Our empirical field is Brazil, an emerging country which hosts the reference R&D centers for Latin America of several global companies. The successful transfer to the global scale of an innovation coming from the subsidiary of an MNC depends on various factors and local characteristics that are explored in the thesis. The aims of this PhD dissertation are to better understand the mechanisms of reverse innovation in the context of MNCs, to advance theory and to propose a management model encouraging global innovation based on local initiatives in an emerging country. We show that practices carried out by MNC subsidiaries can have organizational, managerial and environmental implications that can account for the success of reverse innovation. Our research work implements a qualitative approach based on a multi-case study method. Our contribution is a new theoretical and functional model for reverse innovation that takes into account the elements that contribute to this phenomenon: the integration between the parent corporation and the subsidiary, the decentralization of R&D and the valorization of local skills and the insertion into the national system of innovation (SNI). Our research results highlight the existence of other types of innovation beyond technological innovation that lead to global innovation. We show that innovations at management, process or marketing level are absorbed within the parent company and disseminated to other subsidiaries on a global level.
4

Les réformes en santé en 2004 et en 2014 : nouvelle grammaire du discours ou re-fondation du système de santé français? / Health reforms in 2004 and in 2014 : new grammar's dicourse or new foundation of French Health system?

Perrin, Faouzia 14 March 2019 (has links)
L'inscription perpétuelle sur l'agenda politique des problèmes récurrents liés à la « crise du système de santé » français depuis les années 1970-1990 justifie l’intérêt de la science politique.Tandis que l’affirmation forte d’un État, seul responsable légitime de la politique de santé, était la marque de la réforme en 2004, les discours de la réforme de 2014-2016 sont emprunts d’une nouvelle grammaire conjuguant territorialisation et gouvernance.La territorialisation comme réponse à la crise de l’État providence et la nouvelle gouvernance comme réponse à la crise de la gouverne de l’État sont des phénomènes décrits par les analystes des politiques publiques dans d’autres secteurs.Cependant, la « crise du système de santé » se présente comme étant de nature économique, fonctionnelle et organisationnelle et non pas politique. La rhétorique de la réforme promeut des solutions en tant que réponses à des problèmes décrits à l’aune de ces motifs.Nous nous proposons d’étudier non pas les problèmes justifiant la mise sur l’agenda, mais la fabrique de la réforme, l’étiquetage des problèmes, les solutions mises en mots dans les discours, les éléments de légitimation des solutions, la trame cognitive et les éléments normatifs constitutifs du discours de la réforme.Nous montrerons qu’une approche pluridisciplinaire associant courant cognitif de l’analyse des politiques publiques empruntant à la théorie de Kuhn, démarche pragmatique en référence à John Dewey, et théorie politique, ainsi qu’épistémologie de la santé croisée avec la connaissance en santé publique, permet de renouveler l’analyse de cette politique publique finalement singulière.La première étape de notre travail sera de procéder à une généalogie de l’ère de la réforme ayant débuté dans les années 1970, en intégrant deux oubliés, politique de santé publique et décentralisation en santé. Puis, nous nous attacherons à une déconstruction des deux notions communes de la rhétorique de la réforme : « santé » et « système de santé ». Enfin, nous analyserons cette dernière à l’aide des outils théoriques empruntés à la sociologie.Ayant ainsi repéré le cadre cognitif et normatif de la politique de santé en France et défini les thèmes-clefs qui la constituent, nous aborderons par une étude de contenu les discours des moments 2004 et 2014.À l’issue de cette étude, nous approfondirons notre étude par l’analyse du fondements de la crise et des éléments les plus signifiants constitutifs des derniers discours étudiés : gouvernance et démocratie en santé.Notre enquête met en évidence le motif central de la réforme : la fabrique d’une réforme perpétuelle comme processus de légitimation de l’État républicain. Au-delà de la réforme, se manifestent, un public en démocratie ainsi qu’un problème public, la question des principes de la politique de santé ainsi que de sa finalité / The repeated and persistent appearance of issues related to the Health System crisis on every political agenda justifies the interest of political science in this field of research.As the 2004 reform’s bottom line was a strong affirmation that only the government can be legitimately responsible for health policy -a statement still favored by recent reforms- numerous official speeches about the last year’s reform contain a new language, using the “ territorialisation” and “gouvernance ” words.In fact, “territorialisation” as an answer to the Welfare State crisis, and “gouvernance” as an answer to the crisis in the ways of State governing, are both well-known Political Science subjects.Yet, the health crisis is not purported to be a political issue, but due to economics rather, mainly a functional and organizational one. As a consequence, matching solutions are usely thought in an economic and administrative way.Using cognitive and pragmatic approaches, our study neither aims at defining the terms of said crisis, nor justifying its presence on the political agenda. Rather, it addresses the solutions that are brought forward in the so-called ‘reform factory’ that are political speeches, as they have the power to legitimate deciding actors or their action.The first step taken in our method will consist in reporting bibliographic references for a political and historical deconstruction of the French health system, as well as analyzing the ‘health’ concept, in order to describe the cognitive framework of health policy. Special attention vill be paid to decentralization et public health.Then, these categories should prove to be helpful to study the current trends in the 2004 and 2014 periods of health reform in a discursive analysis, as we intend to do.To further investigate health reform manufacturing, we will focus on the new themes observed in these speeches : « gouvernance » et health democracy.Our thesis is that, through the language at play among these actors, there is a semantic fight loaded with power challenges to the State role in health Policy and therefore in the place ought to be given to the various actors in health public Policy. Finally, throw reforms, a new public for democracy came forward and new issues, that are principles and goals of health policy, appeared.

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