Orientador: Carlos Roberto Silveira Correa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T05:00:59Z (GMT). No. of bitstreams: 1 Fonseca_KarlaFabianaBegossoSampaioda_M.pdf: 1069706 bytes, checksum: 297fb6b6b8bf1eff89260fb47eacdb63 (MD5) Previous issue date: 2006 / Resumo: O presente estudo tem por objetivo compreender melhor, na relação Agente Comunitário-Comunidade, a percepção do Agente Comunitário de Saúde (ACS) quanto a Saúde Mental do município de Pedreira - SP. A metodologia utilizada foi a pesquisa qualitativa em saúde do tipo exploratória utilizando as práticas discursivas da produção de sentidos, tendo como instrumento de coleta de dados o grupo focal. Utilizamos os princípios teóricos da análise de conteúdo para lidar com a dimensão simbólica dos discursos presentes no grupo focal com agentes comunitários de saúde a partir da constituição ideológica dos sujeitos. A análise objetivou trabalhar o diálogo implícito na produção de sentidos e o encadeamento das associações de idéias. Os resultados mostram que: * O Agente Comunitário de Saúde de Pedreira não tem a percepção de que trabalha com redes sociais embora isso se apresente em suas falas; * O conjunto de Agentes Comunitários de Saúde se configura como um grupo; * Se identificam como cuidadores - cuidam do outro em uma ¿inter-ação¿ pois, convivem respeitando a subjetividade de cada pessoa que os solicita; * Foi reconhecida no grupo a estética da Terapia Comunitária implicando no empoderamento e no devir em contraposição ao dever / Abstract: The objective of the present study is to attain a better understanding of the relation Community Health Agent and its community as well as the perception by the Agent of the current Mental Health status in the municipality Pedreira, S P. The method employed was an exploratory mode in qualitative research in health using the discursive technique in the production of senses, using the focal group as an instrument of data gathering. The theoretical principles of analysis were used to deal with symbolic nature of the contents of the discourse presented by the focal group to the community agents based on the ideological constitution of the subjects. The objective of the analysis was to deal with the implicit dialogue in the production of the senses and the enchainment of the association of ideas. The results indicate that: ¿ the community health agent in Pedreira does not have the perception that he works with social networks, although that is regularly stated in his speech; ¿ the various agents represents a group that identifies itself as caretaker and that is characterized by the interaction with subjects involving sharing the same environment and respecting the subjectivity of each person demanding its attention; ¿ the esthetic of TC was recognized in the group, implicating a orientation towards empowerment and becoming in opposition to duty / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Estudo de desenvolvimento metodológico de elaboração e validação de medidas de avaliação em saúde. Teve como objetivo geral contribuir para o desenvolvimento de Indicadores de Avaliação de Programas de Controle de Infecção Hospitalar (PCIH) e específicos construir e validar o conteúdo dos indicadores construídos. Os procedimentos teóricos para validação dos indicadores de PCIH foram: a-seleção e construção dos indicadores; b-fundamentação do conteúdo científica dos indicadores; c-validação dos indicadores construídos. Foram construídos cinco indicadores: 1- (PCET) Estrutura Técnico-operacional do PCIH; 2- (PCDO) Diretrizes Operacionais de Controle e Prevenção de IH; 3- (PCVE) Sistema de Vigilância Epidemiológica de IH; 4- (PCCP) Atividades de Controle e Prevenção de IH; 5- (PCAE) Atividades Educacionais e Capacitação Técnica em controle de IH. A validação de conteúdo dos indicadores foi realizada por oito profissionais especialistas na área de controle de IH, a partir de um instrumento previamente elaborado e referiu-se a: 1º - manual operacional; 2º - atributos do conjunto dos indicadores; 3º - atributos individuais dos componentes de cada indicador; 4º - valoração da relevância dos componentes de cada indicador. Com exceção do indicador 5- PCAE, os demais foram todos validados / This aim of this study is to create methodology for the development and validation of evaluation measurements in healthcare. The overall objective was to contribute to the development of Performance Indicators for Hospital Infection Control (HIC) programs and more specifically to create and validate the content of the indicators developed. The theoretical procedures for the validation of the indicators for HIC programs were: a-the selection and creation of the indicators; b-determination of the scientific basis for indicator content; c-validation of created indicators. In all, five indicators were created: 1- (PCET) Technical/operational structure of HIC program; 2- (PCDO) Operational Guidelines for the Control and Prevention of HI; 3- (PCVE) Epidemiological Surveillance System; 4- (PCCP) Activities for the Control and Prevention of HI; 5- (PCAE) Educational Activities and Technical Education in the control of HI. The validation of the content of the indicators was conducted by eight specialists in the area of HIC using a previously developed instrument and addressed: 1º - operational manual; 2º - indicator set attributes; 3º - individual attributes of the components of each indicator; 4º - assessment of the relevance of the components of each indicator. With the exception of indicator 5-PCAE, all of the indicators were validated

Familiares cuidadores de usuários de serviço de saúde mental têm sido chamados a participar cada vez mais ativamente como provedores de suporte e cuidados às pessoas em situação de sofrimento mental. Neste contexto, a avaliação do serviço mostra-se central em se considerando a mudança de paradigma na assistência em saúde mental. O presente estudo objetivou avaliar a sobrecarga e a satisfação com o serviço de familiares cuidadores de pessoa em sofrimento mental, verificando sua relação com estresse, estressores do cuidado, qualidade de vida e enfrentamento. Participaram 54 familiares de usuários que frequentavam um serviço substitutivo de saúde mental em cuidado intensivo e semi-intensivo de uma cidade de médio porte do interior paulista. Os instrumentos utilizados foram: Escala de Sobrecarga dos Familiares de Pacientes Psiquiátricos (FBIS-Br); Escala de Avaliação da Satisfação dos Familiares em Serviços de Saúde Mental (SATIS-Br); Inventário de Sintomas de Stress para Adultos de Lipp (ISSL); Inventário de Estratégias de Coping de Folkman e Lazarus; Escala de Qualidade de Vida versão abreviada (WHOQOL-Bref) e Roteiro Complementar. Os dados foram tratados por meio de estatística não-paramétrica e se adotou valor p<=0,05. Verificaram-se moderada sobrecarga objetiva e de moderada a elevada sobrecarga subjetiva. Entre participantes com estresse, foi maior a sobrecarga objetiva (p=0,000) e subjetiva (p=0,04). As mulheres apresentaram maior sobrecarga objetiva devido à supervisão aos comportamentos problemáticos comparativamente aos homens (p=0,04). Foi encontrada maior sobrecarga objetiva entre participantes cujos usuários possuíam o diagnóstico de esquizofrenia (p=0,01). Verificou-se correlação positiva entre sobrecarga objetiva devido à assistência na vida cotidiana e tempo de diagnóstico (p=0,01) e tempo de tratamento (p=0,03). Observou-se correlação negativa entre sobrecarga objetiva e os domínios físico (p=0,04) e social (p=0,03) da qualidade de vida. Foi encontrada correlação positiva entre sobrecarga subjetiva e uso da estratégia de resolução de problemas (p=0,05). Em sua maioria, os cuidadores encontraram-se satisfeitos com o serviço frequentado pelo usuário. Verificou-se correlação negativa entre satisfação com resultado do tratamento e idade do usuário (p=0,006). Observou-se correlação negativa entre sobrecarga objetiva e satisfação com serviço (p=0,05). Dados descritivos apontaram para baixa participação do familiar cuidador no serviço e no tratamento do usuário. Concluiu-se que os familiares cuidadores apresentaram dificuldades no cuidado ao usuário. A sobrecarga apresentou impacto negativo na qualidade de vida dos participantes. O serviço de saúde mental não foi avaliado como possuindo recursos de alívio à sobrecarga do cuidador. Os dados apontam para a necessidade de maior articulação entre serviço substitutivo em saúde mental e rede básica, bem como elaboração e desenvolvimento de programas de intervenção que possam ajudar esses cuidadores no que diz respeito ao cuidado ao usuário e ao manejo de situações estressantes. (FAPESP). / Family caregivers of mental health service users have been called on to participate more actively in providing support and care to people with mental suffering. In this setting, service evaluation becomes central, considering the paradigm change that is taking place in mental health care. The goal of the present study was to evaluate family caregivers of individuals with mental suffering in terms of their overload and satisfaction towards the service, analyzing the relationship with stress, care stressors, quality of life, and coping. Participants were 54 relatives of individuals who attended a substitutive mental health service for intensive and semi-intensive care in a medium sized city in the state of Sao Paulo. The following instruments were used: Family Burden Interview Scale for Relatives of Psychiatric Patients (FBIS-Br); Satisfaction Assessment Scale for Relatives of Psychiatric Patients (SATIS-Br); Lipp\'s Inventory of Stress Symptoms for Adults (ISSL); Coping Strategy Inventory by Folkman and Lazarus; Quality of Life Scale, shorter version (WHOQOL-Bref) and a Complementary Script. Data were treated using non-parametric statistics and considering p<=0.05. It was found that objective burden was moderate and subjective burden was moderate to high. Participants with stress had higher objective (p=0.000) and subjective (p=0.04) burdens. Objective burden was greater among women, because of the supervision of problematic behaviors, compared to men (p=0.04). Participants who were caregivers of users diagnosed with schizophrenia showed greater objective burden (p=0.01). A positive correlation was found between objective burden due to everyday life care and time of diagnosis (p=0.01) and time of treatment (p=0.03). A negative correlation was observed between objective burden and the physical (p=004) and social (p=0.03) domains of quality of life. A positive correlation was found between subjective burden and using the problem solving strategy (p=0.05). Most caregivers were satisfied with the service attended by the user. A negative correlation was observed between satisfaction towards the treatment outcome and user\'s age (p=0.006). There was also a negative correlation between objective burden and satisfaction towards the service (p=0.05). Descriptive data pointed at the poor participation of family caregivers in the service and in the treatment of the user. In conclusion, family caregivers face difficulties in providing care to the user. The burden had a negative impact on the participants\' quality of life. The mental health service did not have resources to relieve caregiver burden. The data show that there is a need to improve the articulation between substitutive mental health services and the primary care level, as well as to design and develop intervention programs that could help those caregivers in terms of providing care to users and managing stressful situations. (FAPESP).

Com a globalização, pessoas, empresas, organizações e países estão cada vez mais interdependentes, dando origem a inúmeros conflitos de interesses. A negociação internacional ganha relevo como meio de solução dos conflitos gerados no processo de globalização. Torna-se ainda mais relevante no contexto da pequena empresa, em que a limitação de recursos e a escassez de conhecimentos podem funcionar como fatores limitantes do processo de internacionalização. Nesse sentido, o presente trabalho propõe desenvolver uma estrutura conceitual que ajude a sistematizar o planejamento da negociação internacional na pequena empresa, a fim de auxiliar os administradores dessas empresas a aperfeiçoar o processo de preparação para a negociação internacional, contribuindo, ainda que indiretamente, para a internacionalização de pequenas empresas, podendo gerar reflexos positivos para a economia brasileira. Para isso, foram estudadas as dificuldades enfrentadas pelas pequenas empresas na negociação internacional e a forma como costumam se preparar para essas situações. Os resultados da pesquisa empírica foram comparados aos modelos de planejamento da negociação encontrados na literatura, a fim de desenvolver uma estrutura conceitual para o planejamento da negociação adaptado ao contexto das pequenas empresas. Foi realizada uma pesquisa empírica, de natureza qualitativa, no setor médico-odontológico de Ribeirão Preto. A pesquisa empírica consistiu de uma fase preliminar, de caráter exploratório, em que se buscou conhecer melhor o setor escolhido como objeto de estudo, através do levantamento de dados secundários, complementados com a realização de entrevistas com as instituições de apoio ao setor ? Associação Brasileira da Indústria de Artigos e Equipamentos Médicos, Odontológicos, Hospitalares e de Laboratórios (ABIMO) e Serviço Brasileiro de Apoio às Micro e Pequenas Empresas (SEBRAE). A seguir, foi realizado um estudo de casos múltiplos (pesquisa qualitativa). As unidades de análise foram as pequenas empresas industriais do setor médicoodontológico da cidade de Ribeirão Preto. / With the globalization process, people, companies, organizations and countries have become more interconnected, fact that can result in several interest conflicts. Thus, international negotiation has been highlighted as a way to solve these conflicts created by the globalization process. It has also become more and more important for a small businesses environment due to the lack of resources and knowledge, factors that can work as a compass for an internationalization process. In this sense, the present study proposes to develop a conceptual structure which can help to systematize the planning of the international negotiation in a small business, in order to assist these businesses? managers to improve the preparation process to the international negotiation, contributing, even in an indirectly way, to the small businesses internationalization creating positive consequences to the Brazilian economy. To reach this the difficulties that small businesses had in the international negotiation and the way they used to get prepared to these situations were studied. The results of the empiric research were compared to the models of the planning of negotiation we have found in the literature in order to develop a conceptual structure to the planning of negotiation adapted to the context of the small businesses. An empiric research was carried out, with a qualitative nature, in the medical and odontologic sector of Ribeirão Preto town. The empiric research consisted of a preliminary phase of an exploratory nature. The research had the goal of knowing the best sector chosen as the object of the study, through the secondary data, complemented with the interviews carried out with the institutions of support to the sector ? Brazilian Medical, Odontologic and Hospital supplies and equipment?s Industry and Laboratory Brazilian Association (ABIMO) and Brazilian Service of Support to Micro and Small Businesses (SEBRAE). After that, a study of multiple cases (qualitative research) was carried out. The units were the industrial small businesses of the medical and odontologic sector of Ribeirão Preto town.

O Desenvolvimento de Novos Serviços (DNS) tem recebido atenção crescente, tanto por parte de gestores de operações de serviço, quanto por parte dos acadêmicos do setor. Esta dissertação parte do pressuposto que os modelos DNS, desenvolvidos a partir de experiências com serviços em massa e loja de serviços, não abordam na sua totalidade os desafios de operações de serviços marcadas por maior dinamismo, especialmente serviços profissionais. Partindo de um referencial teórico montado com o objetivo de identificar quais são as características dos serviços profissionais que potencialmente influenciam positivamente ou negativamente o desenvolvimento de novos serviços, esta dissertação utiliza uma metodologia de pesquisa baseada em estudos de caso múltiplo para avaliar se o panorama teórico construído anteriormente é condizente com dois casos de inovação em serviço profissional público. A partir destas conclusões, destacamos algumas implicações práticas que pudemos observar e analisamos de que forma o modelo DNS proposto por Edvardsson et al (2000) está preparado ou não para lidar com estas questões. / New Service Development (NSD) has received increasing attention from either service managers or service marketing researchers. This dissertation firstly discuss that NSD models developed from mass services or services shop experiences, do not totally comprehend more dynamic services challenges, specially professional services. Following a literature review that aims to identify which professional services characteristics may influence positively or negatively the new service development process, this dissertation uses a multiple case study research to evaluate if the theoretical framework built before is related to two public professional services innovations case. From theses conclusions, we point out some practical implications that we could observe and after that we analyze if the NDS model proposed by Edvardsson et al (2000) is or is not prepared to deal with theses questions.

Nos últimos anos observa-se o aumento da presença de um evento no Sistema Único de Saúde denominado judicialização da saúde. O crescente nu?mero de aço?es judiciais propostas para garantir o fornecimento de medicamentos tem sido motivo de preocupação, pelo seu aspecto emergencial, onerando e dificultando ações de planejamento e de controle por parte dos gestores públicos. Assim, a análise dos atores envolvidos nesse fenômeno torna-se relevante, afinal, elas atuam diretamente no perfil das ações judiciais. Desse modo, esta pesquisa propôs explorar as percepções dos médicos (prescritores) sobre a dispensação de medicamentos na Divisão Regional de Saúde - DRS XIII. Para isso, foi realizada uma busca por médicos prescritores utilizando a página do Tribunal de Justiça de São Paulo, o TJSP, o Sistema de Coordenação das Demandas Estratégicas do SUS, o S-Codes e/ou cadastro de paciente do Hospital das Clínicas de Ribeirão Preto, o HCRP. Foram selecionados aleatoriamente 72 prescritores para responderem um questionário composto por 15 questões. Dentre os principais resultados, uma constatação marcante foi a de que, na percepção dos médicos, sempre que possível, há a prescrição de medicamentos genéricos, o que consequentemente faz com que estes não prescrevam necessariamente medicamentos \"originais\", de referência e ou de marca. Por outro lado, não foi observada preocupação dos prescritores se o medicamento prescrito está incluído (ou não) na RENAME. Outra inferência interessante: médicos menos experientes (tempo de formação) não se mostraram avessos a orientar pacientes a seguir com ações judiciais, tanto quanto os médicos mais experientes. / In the last few years, there has been an increase in the occurrence of an event known as \"judicialization of health\" in the Brazilian Health Service (SUS). The increasing number of lawsuits that have been proposed to guarantee the supply of drugs has been a reason for concern because of its emergence, burdening and hindering planning and control actions by public managers. Thus, the analysis of the parts involved in this phenomenon has become relevant, as they act directly in the lawsuit profiles. Therefore, this research proposed to explore the perceptions of physicians (prescribers) in relation to the release of drugs in the Regional Health Division - DRS XIII. To do so, a search for prescribing physicians using the page of the São Paulo Court of Justice, the TJSP; the SUS Strategic Requests Coordination System; the S-Codes; and/or the patient registry of the Hospital das Clínicas of Ribeirão Preto, the HCRP, was carried out. Seventy-two prescribers were randomly selected to answer a questionnaire composed of 15 questions. Among the main results, a striking finding uncovered that in the physicians\' perception, whenever possible, there was a prescription of generic drugs, which means that they did not necessarily prescribe \"original\", reference and/or branded drugs. On the other hand, prescribers had no concern whether the prescribed drug was included in the RENAME. Another interesting inference: both the least and the most experienced physicians (by training time) were not averse to guiding patients to follow lawsuit.

CEO competence and development is a continuing concern in the NHS. As a key feature of any CEO leadership role is responsibility for organisationally critical decisions, and there is an increasing recognition of the role context plays in effective leadership behaviour. This study examines the role of contextual intelligence in relation to PCT CEO decision making behaviour. To do this, the research addresses four questions: a) what does the literature say about CEO contextual intelligence? b) what factors do PCT CEOs say they take into account in different decision making contexts? c) what contextual factors do they actually take into account? and d) what impact do the contextual factors have on their decision making behaviour. A systematic literature review resulted in a model of CEO contextual intelligence for CEO decision making. Semi-structured interviews with 24 PCT CEOs in a NHS region about factors influencing their decisions on generic strategies, national policies, regional strategies and local plans revealed a hierarchy among contextual factors applying to different decision strata. Semi-structured interviews and analysis of CEO diaries two months later of the same focal decisions show the real critical factors to be:- national policies themselves, the Strategic Health Authority and the decision making process, for regional strategies; and Top Management Team and structure for local plans. Altogether, the research reveals that the PCT CEO’s decision making context is rationally bounded; the relevant contextual factors differed significantly from the literature derived model; the actual factors in practice differed from what were espoused; choice of factors vary depending on decision trigger strata which links to degrees of CEO autonomy; and macro level factors which were indicated as significant from the systematic review were in fact ignored in practice. A PCT CEO model of contextual intelligence is developed together with a two dimensional model of underlying structures guiding PCT CEO decision making behaviour. The findings have implications for governance structures in the NHS, CEO decision making and senior leader development in ii the NHS in the context of the 2012 Health and Social Care Act. Areas for further research in public sector, NHS and contextual intelligence are also identified.

Problems concerning the planning and practicing of health care currently exist. Countries are spending more funds on medical care without making a discernible dent in the health status of their citizens. This lack of success in obtaining health is obviously a problem for everyone experiencing ill health or the effects thereof It also creates a personal problem for all health workers, because a halt is being called to profligate spending on health that will affect all. The problems underlying tl:e health care crisis are rising costs, unequal distribution, low productivity, poor heali..ii status, and a lack in sensitivity towards the communities it serves. The multi-disciplinary, complex nature of these problems in health care, their magnitude and their inter-relatedness indicate that traditional approaches to health care planning and management have been inadequate or have failed. An alternative approach to solve these problems is to adopt a holistic view, i.e., to see all parts (components) which contribute to the problem as parts of the whole. By viewing the problem as a whole, more enduring solutions may be formulated. The aim of this study was to employ and evaluate the adoption of a systems approach to solve "real life" problems. The Soft Systems Methodology of Peter Checkland was utilized to assess the situation within the Oral Health Service of the SAMS and to identify relevant systems to improve the situation. The need for a Preventive System and a Performance Measurement System was established. These two systems were planned, developed and implemented using and obeying systems rules and techniques. Both these systems were evaluated and found to be highly efficient, effective, cost-effective and made a positive net contribution to the Oral Health Service of the SAMS. It is finally concluded that the adoption of a systems approach to identify and solve "real life" problems was effective and efficient. It is therefore recommended that a systems approach to the management of oral health, and probably health too, should be embraced by the encumbered health industry. / Dissertation (MChD)--University of Pretoria, 1993. / gm2013 / Community Dentistry / unrestricted

This thesis aimed to examine service contact among children and young people with mental health problems, and has three complementary parts. The first is a secondary analysis of data from the British Child and Adolescent Mental Health Survey (BCAMHS) 2004, which explored mental health related service contact in relation to psychopathology over three years. The second and third parts focussed on young people with ADHD in transition from child services, which is a particularly challenging time. This involved a qualitative interview study of young peoples’ experiences, and an analysis of primary care prescribing of ADHD medication over the transition period using a cohort from the Clinical Practice Research Datalink from 2005-2013. Less than a third of children with a psychiatric disorder in BCAMHS reported contact with child mental health services. Instead, teachers were the most frequently used service, with two-thirds reporting mental health related contact. Interviews with young people with ADHD highlighted themes including concerns around medication management post transition and need for information. The prescribing analysis found that the majority of adolescents on ADHD medication at age 16 stopped during the transition period. This continuing disparity between estimates of symptom persistence and medication persistence suggests that many may be stopping medication from which they could still benefit; as various barriers have been identified to ongoing prescribing. In summary, the findings of these three linked studies suggest common themes in terms of unmet needs and gaps between policy and practice in mental health services for children and young people. One of the chief implications is the need for oversight and policy levers to ensure the implementation of best practice, accompanied by complementary efforts to better understand and overcome other barriers to providing optimal care, including research into knowledge and attitudes of different groups and the provision of targeted training.

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.