Thesis (MPA (School of Public Management and Planning))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The purpose of this thesis is to determine the perceptions and expectations of employees at regional offices about the service delivered to them by central head office. A further objective is to establish what employees at regional offices expect from head office, attempting thereby to establish the current position of the head office (perceived image) in relation to their expectations (ideal image). The method of data collection is quantitative with a survey design technique in the form of questionnaires to be completed by all employees at regional offices in order to assess their perceptions and expectations. The basis of the theoretical and legislative framework of this research is service delivery. It is within the context of service delivery that internal customer service within the organisation, in particular, is conferred. The legislative framework is also dedicated to Batho Pele and the eight principles to highlight public service delivery. These principles should equally be applied when it comes to internal customer service. The main findings from this study are that employees and the four regional offices per se have different perceptions and expectations about the internal service delivered by central head office. This must be taken cognisance of because perceptions can be the core element of most organisational behaviour and the expectations that employees hold is important for the morale and effectiveness of organisations. The following objectives were achieved: A review of the policies, documents and annual reports to determine to what extent the central head office delivers an internal service to the regional offices. An evaluation as to how internal service delivery is being perceived. An evaluation of the ideal central head office. Established the shortcomings of the current internal service being delivered. It is also recommended that future research can be to ascertain how those negative feelings impacts on job satisfaction and commitment to the organisation and how it affects employee turnover. / AFRIKAANSE OPSOMMING: Die doel van hierdie tesis is om die persepsies en verwagtinge van werknemers by die streekkantore, oor die diens wat aan hulle verskaf deur sentrale hoofkantoor, te bepaal. 'n Verdere doel is om vas te stel wat werknemers by die streekkantore verwag van hoofkantoor. Sodoende probeer om vas te stel wat die huidige stand van die hoofkantoor (waargenome beeld) in verhouding tot hul (werknemers) verwagtinge (ideaal beeld) is. Die metode van data-insameling is kwantitatief met 'n opname ontwerp in die vorm van vraelyste. Hierdie vraelyste sal deur alle werknemers by die streekkantore voltooi word, om hul persepsies en verwagtinge te assesseer. Die basis van die teoretiese en die wetgewende raamwerk van hierdie navorsing is dienslewering. Dit is binne die konteks van dienslewering wat interne kliënte diens binne die organisasie, in die besonder, toegeken word. Die wetgewende raamwerk is ook toegewyd aan die agt beginsels van Batho Pele en dus openbare dienslewering te versterk. Hierdie beginsels moet ook toegepas word wanneer dit kom by die interne kliënte diens. Die belangrikste bevindings van hierdie studie is dat die werknemers en die vier streekkantore as sulks het verskillende persepsies en verwagtinge oor die interne diens gelewer deur die sentrale hoofkantoor. Dit moet kennis geneem word want persepsies kan die kern element van meeste organisatoriese gedrag wees en die verwagtinge wat werknemers hou is belangrik vir die moraal en doeltreffendheid van organisasies. Die volgende doelwitte was bereik: „n Hersiening van die beleid, dokumente en die jaarlikse verslae om te bepaal tot watter mate die sentrale hoofkantoor „n interne diens aan die streekkantore lewer. „n Evaluering oor hoe interne dienslewering waargeneem word. „n Evaluering van die ideale sentrale hoofkantoor. Die tekortkominge van die huidige interne diens wat gelewer word is vasgestel. Dit word aanbeveel dat toekomstige navorsing toegewy word om vas te stel hoe negatiewe gevoelens impak op werkstevredenheid en verbintenis tot die organisasie en ook hoe dit werknemer omset beïnvloed.

Objectifs: Etudier l'évolution de l'introduction du rôle de l'IPA et proposer des recommandations pour les études ultérieures.Méthodes: Une revue de la littérature française et internationale concernant l'IPA. Participation à un groupe de travail national concernant l'avancement de ce rôle et les réformes éducationnelles. Une étude rétrospective comparant la prise en charge de patients hypoglycémiques en milieu pré-hospitalier par infirmiers et physiciens. Un questionnaire étudiant les perceptions des premiers étudiants en cursus IPA.Résultats: Différents niveaux de transferts de compétence et de collaboration médecin/infirmière existent déjà en France. Dans l'étude rétrospective, la qualité de soin des infirmières a été similaire à celle des médecins. Dans l'étude sur l'IPA, la majorité des étudiants a indiqué que les autres infirmières et docteurs ne sont pas au courant du rôle de l'IPA, et que des barrières bloquent son développement.Conclusions: La création du rôle d'IPA et le développement de la formation des infirmières en France peuvent répondre aux défis de santé publique, telle l'incidence croissante des maladies chroniques et la pénurie de médecins. Les recommandations suivantes furent proposées pour le développement du rôle de l'IPA : définir et faire reconnaître le rôle de la pratique infirmière avancée et ses compétences, promouvoir le rôle plus largement dans les disciplines médicales, soutenir les efforts de communication entre l'état et les professionnels de santé, développer des programmes au niveau master et doctorat, et promouvoir des travaux de recherche infirmiers et interdisciplinaires. / Background: In the context of public health challenges and health care reforms in France, the evolving advanced practice nurse (APN) role may be a solution. Objectives: To study the introduction of the ANP role and provide evidence-based recommendations for future research.Methods: A review of the international and French APN literature was performed. Participation in a national task force concerned advancement of the role and education reforms. In a retrospective study, nurses and physicians were compared in the pre-hospital management of hypoglycemic patients. Finally, a survey was administered to the first French APN Master's students to identify their perceptions of the APN role.Results: Variables levels of skill transfer and doctor-nurse collaboration currently exist in France. In the retrospective study, the pre-hospital quality of care of nurses was comparable to that of doctors. In the APN student survey, the majority indicated that other nurses and doctors were not aware of the APN role, and that barriers exist in role development. Conclusions: Creation of the APN role and advancement of nursing education in France can respond to public health challenges including the rising incidence of chronic diseases and an impending physician shortage. The following recommendations were proposed for APN role development: to define and recognize the advanced practice nurse role and related competencies, promote the role in a wider range of medical disciplines, facilitate clear communication between government and health care professionals, develop nursing Master's and Doctorate programs, and promote nursing and interdisciplinary research.

A partir das mudanças que vêm ocorrendo na política de saúde mental, surgiram várias inquietações no que diz respeito aos resultados deste processo para os usuários, familiares, e profissionais dos Centros de Atenção Psicossocial (CAPS). Estas inquietações se estenderam também ao significado que estava sendo constituído por estes sujeitos sobre os CAPS. Surgiu, então, o desejo de estudar as identidades que estão emergindo destes sujeitos que atuam no cenário do CAPS, no que concerne a sua participação e integração a este serviço, como também conhecer os significados que estão sendo construídos a respeito destes serviços. O presente estudo possui os seguintes objetivos: Conhecer a identidade dos usuários, familiares e profissionais que atuam no cenário do CAPS e conhecer os significados relacionados ao CAPS. A pesquisa foi realizada com onze usuários, onze familiares e doze profissionais. O estudo seguiu o caminho teórico-metodológico da Teoria Ego-Ecológica, proposto por Zavalloni. Esta teoria permite conhecer a identidade do indivíduo, suas peculiaridades e sua realidade através da representação que ele possui acerca de si mesmo e do grupo. Esta teoria permite também compreender cada sujeito/identidade inserido em seu contexto, assim como as relações estabelecidas entre ele e seus pares e entre eles e os sujeitos de outros grupos com os quais se relacionam. Esta rede de relacionamentos intra e intergrupal possui significados que o Inventário Multifásico de Identidade Social (IMIS) permitiu conhecer e analisar de forma criteriosa e sensível. Este trabalho revelou o usuário com uma autopercepção fortificada, com esperança de constituir uma nova família e conseguir um emprego digno. Contudo, as mudanças observadas na identidade dos sujeitos com diagnóstico de transtorno mental não se estendem aos seus familiares que continuam sendo vistos de forma negativa, tanto pelos usuários como pelos profissionais. Para que a reabilitação social ocorra os familiares precisam ser incluídos neste processo, precisam se implicar mais no tratamento de seus familiares, e também os usuários e profissionais precisam modificar o modo como percebem e se relacionam com os familiares. O presente estudo mostrou que, apesar das dificuldades encontradas, o modelo psicossocial tem beneficiado a pessoa com transtorno mental, porém observa-se uma certa paralisia no movimento da Reforma Psiquiátrica. Indubitavelmente o modelo psicossocial beneficia a pessoa com transtorno mental severo, contudo, atualmente, corre-se o risco da cronificação destes sujeitos dentro do CAPS. O movimento da Reforma Psiquiátrica conseguiu mostrar que o modelo manicomial é ineficaz no tratamento das pessoas com transtorno mental, porém esse é só o começo do processo de reabilitação psicossocial. Faz-se necessário avançar neste processo e ir além do CAPS para que os usuários alcancem a vida. A falta de medicação e de alimentação, o número insuficiente de serviços e funcionários e a dificuldade em realizar uma assistência adequada vêm sobrecarregando e gerando estresse nos profissionais e, como um dos profissionais entrevistados fala, “O CAPS é uma estrutura em crescimento, que não sabemos aonde vai dar". / Many issues have come up due to the changes in the mental health policies concerning users, relatives and professionals at the Day-Care Units (CAPS). Those issues also consisted of the idea that was being made of the Day-Care Units by such individuals. This work has the purpose of studying the identities that are emerging from the perspective of such individuals who act on the Day-Care Unit scene, considering their roles and their commitment to that service, and of knowing how those services are being perceived by the individuals. The present study aims at: knowing the identity of the users, related and professional who act on the Day-Care Unit scene, and putting in evidence the meanings attributed to the Day-Care Unit. The research includes eleven users, eleven family members and twelve professionals. The study is methodologically based on the Ego-ecologic Theory by Zavalloni. This method allows to know the identity of the subject, his/her peculiarities and reality by means of selfrepresentation and the representation made by him/her about the group. This theory also enables understanding of the subject/identity as inserted in his/her environment, likewise the relations within themselves, their pairs and subjects from other environments. This internal and external network of relationships has meanings capable of accurate and sensible analysis by means of the Multistage Social Identity Inquirer. This work reveals the user with the strengthened self-awareness, hoping to constitute family and getting a fair job. However, the changes seen in mentally impaired are not followed by their relatives, who are still seen negatively both by users and professionals. In order that the social rehabilitation occurs, relatives must be included in the process, thus improving the bonds to their related ones. Users and professionals must modify the way they see and relate to their relatives too. The present study shows that, despite difficulties, the psychosocial model has been doing good to the mentally impaired, although noticing a certain paralysis of the Psychiatric Reform movement. No doubt the psychosocial model benefit the subject under severe mental impairment, however risking nowadays the perennial stay of those subjects within the Day-Care Unit. The movement of Psychiatric Reform has shown that the asylum model is not efficient in treating people mentally impaired, although psychosocial rehabilitation is just in the beginning. It is fundamental to move such process forward and beyond Day-Care Units so that the users can reach life. Lack of medication, food, services and staff to a proper care overload professionals, and quoting: “The Day-Care Unit is a growing structure which we know not where it is going to."

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-04-18T11:34:05Z No. of bitstreams: 1 Carina Furlaneto Frazatto.pdf: 3078157 bytes, checksum: b5dc341e4fd1cd954528e260a5c4cb9d (MD5) / Made available in DSpace on 2018-04-18T11:34:05Z (GMT). No. of bitstreams: 1 Carina Furlaneto Frazatto.pdf: 3078157 bytes, checksum: b5dc341e4fd1cd954528e260a5c4cb9d (MD5) Previous issue date: 2018-03-16 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aims to reflect on the freedom health care, as proclaimed by the Psychiatric Reform, and how it has been effected under the SUS. Considering that mental health care in Brazil, historically marked by isolation in psychiatric institutions, has gradually been replaced by care in the Psychosocial Care Network (RAPS), this study comprises the freedom health care as opposed to isolation practices, whether performed in psychiatric hospitals or reproduced in mental health services out of it. It understands that the implementation of the new model of mental health care, regulated since 2001, through the Law 10.216, is the result of intense struggle by social movements in favor of the Psychiatric Reform, whose principles were in part embraced by public policies of health. The process of realization has taken place under controversies and challenges that need to be constantly discussed. This study is within the context of reviewing the scope and difficulties faced, proposing, as methodological point, the collection of data in medical records of users who were discharged from CAPS 1 of Marialva-PR during the year of 2015. Through the information collected: 1) we draw the profile of users in terms of age, marital status, schooling and occupation; 2) we constructed an overview of the care received by them, taking into account the origin of referrals, initial complaints, diagnostic classification, duration of medical monitoring, prevalence of psychiatric hospitalization, access to social benefits and the variety of registered interventions for the team; 3) we analyzed the aspects directly related to the medical discharge of the CAPS, identifying the professionals who recorded it in the medical record, the issues addressed around this procedure, the contact with the RAPS, the referrals made and the participation of the users in specific activities at the time of discharge . It was possible to recognize signs that suggest the realization of freedom health care. Diagnostic complaints and classifications confirm that the CAPS of Marialva-PR complies with the recommendations of the National Mental Health Alcohol and Other Drugs Policy regarding the public served, which is composed of people with severe and persistent mental disorders. The reduced number of patients referred for hospitalization during the period of medical monitoring in this CAPS and their accomplishment in the Psychiatric Emergency of a general hospital show that it is possible to achieve mental health care according to the principles of the Psychiatric Reform. The interdisciplinarity present in most of the interventions carried out by the team and in the preparation of the Therapeutic Projects also contributed to the effectiveness of this process. On the other hand, we identified incidents, such as the reception of users before the first psychiatric hospitalization, the indispensable nature of the medication, the expansion of interventions that go beyond the service space and ensure permanent contact with RAPS not only at the moment of discharge, but throughout the monitoring. Such difficulties are associated with the way in which we have historically understood and dealt with madness in our society and, when discussed in the light of epistemological questions, point to the existence of issues of the classical paradigm of psychiatry which need to be overcome. Thus, this study instigates the need to uncover traps that may constitute impediments and setbacks to the Psychiatric Reform, a field in permanent construction, for which we hope to contribute facing the challenge of caring in freedom health care / O objetivo deste estudo é refletir sobre o cuidado em liberdade, conforme apregoado pela Reforma Psiquiátrica, e como ele vem sendo efetivado no âmbito do SUS. Considerando que a assistência em saúde mental no Brasil, historicamente marcada pelo isolamento em instituições psiquiátricas, tem sido paulatinamente substituída pelo cuidado na Rede de Atenção Psicossocial (RAPS), este estudo compreende o cuidado em liberdade em oposição às práticas de isolamento, sejam elas realizadas nos hospitais psiquiátricos ou reproduzidas em serviços de saúde mental extra-hospitalares. Entende que a efetivação do novo modelo de atenção em saúde mental, regulamentado a partir de 2001, por meio da Lei nº 10.216, é resultante de intensa luta de movimentos sociais em prol da Reforma Psiquiátrica, cujos princípios foram, em parte, acolhidos pelas políticas de saúde. O processo de efetivação tem acontecido em meio a impasses e desafios que precisam ser constantemente discutidos. Este estudo se insere, portanto, no contexto de revisão dos alcances obtidos e das dificuldades enfrentadas, propondo, como recorte metodológico, o levantamento de dados em prontuários de usuários que receberam alta do CAPS 1 de Marialva-PR durante o ano de 2015. Por intermédio das informações recolhidas: 1) traçamos o perfil dos usuários em termos de faixa etária, estado civil, escolaridade e ocupação; 2) construímos um panorama sobre o cuidado recebido por eles, levando em consideração a origem dos encaminhamentos, as queixas iniciais, a classificação diagnóstica, a duração do acompanhamento, a prevalência de internação psiquiátrica, o acesso aos benefícios sociais e a variedade das intervenções registradas pela equipe; 3) analisamos os aspectos relacionados diretamente à alta do CAPS, identificando os profissionais que a registraram no prontuário, as questões abordadas ao redor desse procedimento, o contato com a RAPS, os encaminhamentos realizados e a participação dos usuários em atividades específicas por ocasião da alta. Foi possível reconhecer sinais que sugerem a efetivação do cuidado em liberdade. As queixas e as classificações diagnósticas confirmam que o CAPS de Marialva-PR atende às recomendações da Política Nacional de Saúde Mental Álcool e Outras Drogas no que se refere ao público atendido, que é constituído por pessoas com transtornos mentais graves e persistentes. O número reduzido de usuários encaminhados para internação, durante o período de acompanhamento neste CAPS, e a realização das mesmas na Emergência Psiquiátrica de um hospital geral mostram que é possível concretizar a assistência em saúde mental conforme preconizam os princípios da Reforma Psiquiátrica. A interdisciplinaridade presente na maior parte das intervenções realizadas pela equipe e na confecção dos Projetos Terapêuticos também contribuiu para a efetivação deste processo. Por outro lado, identificamos percalços relacionados ao acolhimento dos usuários antes da primeira internação psiquiátrica, ao caráter indispensável do medicamento, à ampliação de intervenções que ultrapassam o espaço do serviço e garantam um contato permanente com a RAPS não só no momento da alta, mas durante todo o acompanhamento. Tais dificuldades estão associadas à forma como, historicamente, temos compreendido e lidado com a loucura em nossa sociedade e, quando discutidas à luz de questões epistemológicas, sinalizam a existência de questões do paradigma clássico de psiquiatria, as quais precisam ser superadas. Assim, este estudo instiga à necessidade de desvelar armadilhas que podem se constituir em impedimentos e retrocessos à Reforma Psiquiátrica, um campo em permanente construção, para o qual esperamos contribuir frente ao desafio de cuidar em liberdade

No description available.

This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

No description available.

This study investigates the representation of women's reproductive rights in the feminist blogopshere during 2009/10 United States health care reform. Focusing on two purposively selected feminist blogsites - Feministing and Jezebel- it critically examines the discursive and rhetorical strategies employed by feminist bloggers to contest the erosion of women's reproductive rights as proposed in health care reform legislation. While the reformation of the U.S. health care system was a lengthy process, my analysis is confined to feminist blog posts published in November 2009, December 2009 and March 2010. These three months have been designated as they are roughly representative of three pivotal stages in health care reform: the drafting of the House of Representatives health care reform bill and Stupak Amendment in November 2009, the creation of the Senate health care bill inclusive of the Nelson compromise in December 2009, and the passage of the finalised health care reform bill, the Patient Protection and Affordable Care Act and supplementary executive order, in March 2010. This study is informed by feminist poststructuralist theory and Foucault's conceptions of discourse and power - an appropriate framework for identifying and analysing the unequal power relations that exist between men and women in patriarchal societies. Foucault conceives of discourse as both socially constituted and constitutive and contends that through the constitution of knowledge, discourses designate acceptable ways of talking, writing, and behaving, while simultaneously restricting and prohibiting alternatives, thereby granting power and authority to specific discourses. However, Foucault also stresses the multi-directionality of power and asserts that though hegemonic discourses are privileged over others, power lays in discursive practice at all social sites; hence the socially and politically transformative power of contesting discourses. Critical discourse analysis is informed by this critical theory of language and regards the use of language as a form of social practice located within its specific historical context. Therefore, it is through engaging in the struggle over meaning and producing different 'truths' through the reappropriation of language that the possibility of social change exists. Employing narrative, linguistic and rhetorical analysis, this study identifies the discursive strategies and tactics utilised by feminist bloggers to combat and contest anti-choice health care legislation. The study further seeks to determine how arguments supportive of women's reproductive rights are framed and how feminist discourses are privileged while patriarchal discourse is contested. Drawing on public sphere theory, I argue that the feminist blogosphere constitutes a counter-public which facili tates the articulation and circulation of marginalised and counter-discourses. I conclude this study by examining the feminist blogopshere's role in promoting political change and transformation through alternative representations of women and their reproductive rights.

Com o processo da reforma psiquiátrica brasileira começam a ocorrer transformações do modelo assistencial em saúde mental, passando de uma abordagem voltada apenas para a doença, para outra que considera a existência de sujeitos com diversas necessidades e potencialidades. Nesse processo de mudanças faz-se importante a criação de uma rede de serviços que atuem conforme a lógica da atenção psicossocial aos usuários de forma singular, promovendo a autonomia e a reinserção social destes. Dentre esses serviços, é possível citar os Centros de Atenção Psicossocial. Este estudo possui o objetivo geral de discutir a relação social entre trabalhadores que atuam no CAPS e o usuário do serviço. Trata-se de uma pesquisa de natureza qualitativa, de abordagem fenomenológica, com a utilização do referencial de Alfred Schutz. Este estudo foi realizado em um Centro de Atenção Psicossocial, localizado no município de Chapecó, no estado de Santa Catarina. Os sujeitos do estudo constituíram-se em 14 trabalhadores e 14 usuários deste CAPS. A coleta das informações foi realizada por meio de entrevista fenomenológica com os participantes do estudo, nos meses de janeiro e fevereiro de 2011. As categorias que expressam as expectativas dos usuários quanto às ações dos trabalhadores do serviço relacionam-se com a espera pela sua melhora, com a expectativa de melhorias no serviço e pela expectativa de atenção dos trabalhadores do CAPS. Quanto aos trabalhadores, estes expressam a intencionalidade das suas ações em promover a autonomia e a qualidade de vida dos usuários; e na intenção de que ocorram melhorias na administração pública, no sentido de melhorar a atenção aos usuários do serviço. A partir da análise das expectativas dos usuários e das intenções dos trabalhadores quanto às ações no CAPS identificou-se convergências especialmente quanto à melhora dos usuários e quanto a melhorias no serviço público. A relação social estabelecida entre usuários e trabalhadores demonstrou ser permeada pela atenção psicossocial que os trabalhadores desenvolvem no serviço, pela expressão de que os usuários podem obter ajuda dos trabalhadores, pela relação de confiança e vínculo que vai sendo construída no cotidiano do serviço. Assim, é preciso que nos serviços de saúde mental a relação social entre usuários e trabalhadores esteja voltada para as necessidades de saúde dos usuários e para maneiras de melhor intervir sobre elas. / With the process of psychiatric reform, it begins to happen changes in the mental health care model, from an approach focused only in the illness, to other one, that considers the existence of the subjects themselves, with its various needs and potentialities. In this process of changes, it is important to create a network of services capable to act according to the psychosocial logic of attention to the user in a singular form, promoting their autonomy and social reinsertion. Among these services, it is possible to quote the Psychosocial Care Center (CAPS). The present study aims to discuss the social relation between the workers that act in a CAPS and the users of the service. It is a qualitative research, with a phenomenological approach, according to Alfred Schutz's referential. The study was carried out in a CAPS in Chapecó City, Santa Catarina State, Brazil. Actors of the study were 14 workers and 14 users of the CAPS. Data collection was realized with phenomenological interview, between January and February 2011. The categories that express the expectations of the users regarding the actions of the service’s workers are related to the wait for improving, to the expectation for improvements in the service and to the expectation of the worker’s attention. As for the workers, they express the intentionality of their actions in promoting the users’ autonomy and quality of life; as well as the intentionality that occur improvements in the public administration, in order to improve the attention to the users of the CAPS. From the analysis of the expectations of the users and the intentionality of the workers related to the actions in the CAPS, it were identified convergences especially regarding the improvement of the users and the public service. The social relation established between users and workers has shown to be permeated by psychosocial attention that the workers develop in the service, by the expression that users can obtain help from the workers, by the trust relation and the establishment of bonds that are constructed in the quotidian of the service. Thus, it is necessary that in the mental health services, the social relation between users and workers be focused on the health needs of the users and in the better manners of intervening upon them. / Con el proceso de la reforma psiquiátrica brasileña, transformaciones del modelo de atención en salud mental comenzaron a ocurrir, pasando de un abordaje basado únicamente para la enfermedad a otra que considera la existencia de sujetos con distintas necesidades y potenciales. En ese proceso de cambios, es importante la creación de una red de servicios que actúen de acuerdo con la lógica de la atención psicosocial a los usuarios de manera singular, con la promoción de su autonomía y de su reinserción social. Entre esos servicios, es posible mencionar los Centros de Atención Psicosocial (CAPS). Este estudio tiene por objetivo general la discusión de la relación social entre trabajadores que actúan en el CAPS y los usuarios del servicio. Se trata de una investigación de naturaleza cuantitativa, de abordaje fenomenológico, con el uso del referencial de Alfred Schutz. Se realizó este estudio en un CAPS ubicado en el Municipio de Chapecó, en el Estado de Santa Catarina. Los objetos del estudio son 14 trabajadores y 14 usuarios del CAPS. El recogido de las informaciones se realizó a través de entrevista fenomenológica con los participantes del estudio, en los meses de enero y febrero de 2011. Las categorías que expresan las expectativas de los usuarios en cuanto a las acciones de los trabajadores del servicio se relacionan con la espera por su mejora, con la expectativa de mejora en el servicio y por la expectativa de atención de los trabajadores del CAPS. En lo que se refiere a los trabajadores, éstos expresaron la intención de sus acciones en promover la autonomía y la calidad de vida de los usuarios; y en la intención de que haya mejoras en la administración pública, en el sentido de desarrollar la atención a los usuarios del servicio. A partir del análisis de las expectativas de los usuarios y de las intenciones de los trabajadores en relación a las acciones en el CAPS, se identificó convergencias especialmente en cuanto a la mejora de los usuarios y en el servicio público. La relación establecida entre usuarios y trabajadores demostró ser permeada por la atención psicosocial que los trabajadores desarrollan en el servicio, por la expresión de que los usuarios pueden obtener ayuda de los trabajadores, por la relación de confianza y vínculo que se construye en el cotidiano del servicio. Así, es necesario que en los servicios de salud metal la relación social entre usuarios y trabajadores esté dirigida a las necesidades de salud de los usuarios y a maneras de mejor intervenir sobre ellas.

Submitted by Diego Gomes (diego.gomes@gmail.com) on 2016-04-26T18:23:39Z No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5) / Approved for entry into archive by Maria Almeida (maria.socorro@fgv.br) on 2016-05-09T12:55:02Z (GMT) No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5) / Approved for entry into archive by Maria Almeida (maria.socorro@fgv.br) on 2016-05-09T12:55:18Z (GMT) No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5) / Made available in DSpace on 2016-05-09T12:56:21Z (GMT). No. of bitstreams: 1 Thesis_Diego Braz Pereira Gomes.pdf: 1441990 bytes, checksum: eaa77253b29a0fe0108cafc8657d9327 (MD5) Previous issue date: 2013-01-13 / This thesis contains three chapters. The first chapter uses a general equilibrium framework to simulate and compare the long run effects of the Patient Protection and Affordable Care Act (PPACA) and of health care costs reduction policies on macroeconomic variables, government budget, and welfare of individuals. We found that all policies were able to reduce uninsured population, with the PPACA being more effective than cost reductions. The PPACA increased public deficit mainly due to the Medicaid expansion, forcing tax hikes. On the other hand, cost reductions alleviated the fiscal burden of public insurance, reducing public deficit and taxes. Regarding welfare effects, the PPACA as a whole and cost reductions are welfare improving. High welfare gains would be achieved if the U.S. medical costs followed the same trend of OECD countries. Besides, feasible cost reductions are more welfare improving than most of the PPACA components, proving to be a good alternative. The second chapter documents that life cycle general equilibrium models with heterogeneous agents have a very hard time reproducing the American wealth distribution. A common assumption made in this literature is that all young adults enter the economy with no initial assets. In this chapter, we relax this assumption – not supported by the data – and evaluate the ability of an otherwise standard life cycle model to account for the U.S. wealth inequality. The new feature of the model is that agents enter the economy with assets drawn from an initial distribution of assets. We found that heterogeneity with respect to initial wealth is key for this class of models to replicate the data. According to our results, American inequality can be explained almost entirely by the fact that some individuals are lucky enough to be born into wealth, while others are born with few or no assets. The third chapter documents that a common assumption adopted in life cycle general equilibrium models is that the population is stable at steady state, that is, its relative age distribution becomes constant over time. An open question is whether the demographic assumptions commonly adopted in these models in fact imply that the population becomes stable. In this chapter we prove the existence of a stable population in a demographic environment where both the age-specific mortality rates and the population growth rate are constant over time, the setup commonly adopted in life cycle general equilibrium models. Hence, the stability of the population do not need to be taken as assumption in these models. / Esta tese contém três capítulos. O primeiro capítulo usa um modelo de equilíbrio geral para simular e comparar os efeitos de longo prazo do Patient Protection and Affordable Care Act (PPACA) e de reduções de custos de saúde sobre variáveis macroeconômicas, orçamento do governo e bem-estar dos indivíduos. Nós encontramos que todas as políticas foram capazes de reduzir a população sem seguro, com o PPACA sendo mais eficaz do que reduções de custos. O PPACA aumentou o déficit público, principalmente devido à expansão do Medicaid, forçando aumento de impostos. Por outro lado, as reduções de custos aliviaram os encargos fiscais com seguro público, reduzindo o déficit público e impostos. Com relação aos efeitos de bem-estar, o PPACA como um todo e as reduções de custos melhoram o bem-estar dos indivíduos. Elevados ganhos de bem-estar seriam alcançados se os custos médicos norte-americanos seguissem a mesma tendência dos países da OCDE. Além disso, reduções de custos melhoram mais o bem-estar do que a maioria dos componentes do PPACA, provando ser uma boa alternativa. O segundo capítulo documenta que modelos de equilíbrio geral com ciclo de vida e agentes heterogêneos possuem muita dificuldade em reproduzir a distribuição de riqueza Americana. Uma hipótese comum feita nesta literatura é que todos os jovens adultos entram na economia sem ativos iniciais. Neste capítulo, nós relaxamos essa hipótese – não suportada pelos dados – e avaliamos a capacidade de um modelo de ciclo de vida padrão em explicar a desigualdade de riqueza dos EUA. A nova característica do modelo é que os agentes entram na economia com ativos sorteados de uma distribuição inicial de ativos. Nós encontramos que a heterogeneidade em relação à riqueza inicial é chave para esta classe de modelos replicar os dados. De acordo com nossos resultados, a desigualdade Americana pode ser explicada quase que inteiramente pelo fato de que alguns indivíduos têm sorte de nascer com riqueza, enquanto outros nascem com pouco ou nenhum ativo. O terceiro capítulo documenta que uma hipótese comum adotada em modelos de equilíbrio geral com ciclo de vida é de que a população é estável no estado estacionário, ou seja, sua distribuição relativa de idades se torna constante ao longo do tempo. Uma questão em aberto é se as hipóteses demográficas comumente adotadas nesses modelos de fato implicam que a população se torna estável. Neste capítulo nós provamos a existência de uma população estável em um ambiente demográfico onde tanto as taxas de mortalidade por idade e a taxa de crescimento da população são constantes ao longo do tempo, a configuração comumente adotada em modelos de equilíbrio geral com ciclo de vida. Portanto, a estabilidade da população não precisa ser tomada como hipótese nestes modelos.