The number of visits in health care increases every year. It leads to higher standards of health care professionals the skills to be able to prioritize and distinguish those who are most in need of medical care. And requires ability to take a professional approach. Treatment tends to be a unique experience that can be of great significance for the individual. All individuals have in responding different conditions, benefits and limitations. Fraudulent behavior such as cheat- ing and lies occurs in the encounter between people daily in society. Tax fraud, illegal work, exam cheating and stealing are society everyday events. There is no exception in health care, health care professionals is to assist the suffering people, some time to cure, often to relieve and always comfort. It happens that patients seeking for medically unexplained symptoms, with cleverly imitated symptoms try to fool themselves to care, This is based on a pathologi- cal need for affirmation, which is achieved by taking the patient role. These patients are re- ferred with Münchausen syndrome or artificial interference. These patients, as well as a pa- tient safety risk to the other patients because they occupy large resources, moreover, they are a danger to themselves by frequent unwarranted examinations and treatments. The aim was to describe the health professionals' experiences of treatment of Münchausen patients in health care. As the approach chosen a literature review where relevant articles have been collected from the databases PubMed, CINAHL, Medline AND Psychinfo. The result of the literature review showed that health care professionals are experiencing the meeting with Münchausen patients with challenging available a feeling of being uncomfortable in responding. Feelings of frustration, skills shortages and the feeling that the relation becomes unnatural and disor- dered occurs. Additionally tend Healthcare professionals to question their own competence both theoretically and clinically. / Antalet besök inom hälso- och sjukvården ökar varje år. Det leder till högre krav på hälso- och sjukvårdspersonalens kompetens att kunna prioritera och urskilja de som är i störst behov av sjukvård. Samt ställer krav på förmåga till professionellt bemötande av vårdpersonal. Bemötande tenderar vara en unik upplevelse som kan ha stor betydelse för den enskilda indi- viden. Alla individer har i bemötandet olika förutsättningar, fördelar och begränsningar. Be- drägligt beteende så som fusk och lögner förekommer i mötet mellan personer dagligen i samhället. Skattebedrägerier, svartjobb, tentamensfusk och stölder är samhällets vardag. Det är inget undantag inom hälso- och sjukvården, hälso- och sjukvårdspersonalens uppgift är att bistå lidande människor, någon gång bota, ofta lindra och alltid trösta. Det förekommer att patienter söker för medicinskt oförklarbara symtom, med skickligt imiterade symtom försöker de lura sig till vård, detta grundar sig i ett sjukligt behov av bekräftelse, vilket uppnås genom att inta patientrollen. Dessa patienter benämns med Münchausen syndrom eller factitious disorder. Dessa patienter är dels en patientsäkerhetsrisk gentemot andra patienter eftersom de upptar stora resurser, dessutom är de en fara för sig själv genom ofta förekommande obefo- gade undersökningar och behandlingar. Syftet var att beskriva hälso- och sjukvårdspersonals upplevelser av bemötande av patienter med Münchausen syndrom inom hälso- och sjukvår- den. Som metod valdes en litteraturöversikt där relevanta artiklar har samlats in från databa- serna PubMed, CINAHL, Medline och PsykINFO. Resultatet av litteraturöversikten visade att hälso- och sjukvårdspersonal upplever mötet med Münchausen patienter utmanande men också med känslor av att vara obekväma i bemötandet. Känslor av frustration, kompetensbrist samt känslor av att bemötandet blir onaturligt och rubbat uppstår. Dessutom tenderar hälso- och sjukvårdspersonalen ifrågasätta sin egen kompetens både teoretiskt och kliniskt.

In our sedentary society, physical inactivity has become the biggest public health concern of the 21st century. In addition to physical health promotion, physical activity has been associated with a number of positive psychological and social outcomes. Psychologists are well positioned to provide physical activity counseling and may have ethical obligations to address physical activity with their clients. Training the next generation of psychologists about the role of physical activity and health is critical to ensure best practices in graduate education. Researchers have cited insufficient training as a barrier to integrating physical activity into clinical work, yet little is known about effective training in physical activity counseling. One way to address these barriers is to employ an online-based training program allowing greater accessibility for doctoral psychology students across the United States. This exploratory study evaluated the effectiveness of a constructivist online interactive intervention, and compared it with a more traditional online content intervention and a control group, for enhancing doctoral psychology students’ self-efficacy in using physical activity counseling. It was hypothesized that 1) online interactive intervention would enhance self-efficacy, knowledge, and use of physical activity counseling compared to the online content intervention; and 2) both of these active treatments would yield improvements in physical activity counseling outcomes (e.g. self-efficacy, knowledge of health benefits of exercise, practice of physical activity counseling with clients, and personal level physical activity) compared with a control group. Results partially supported the original hypotheses. Mixed ANCOVA analyses indicated that participants in both intervention groups showed more self-efficacy at post-intervention assessment compared to their control group peers but the interactive intervention was not more effective than the content based intervention. Participants in the intervention groups demonstrated more targeted knowledge of physical activity counseling at post-intervention compared to their control group peers. No differences were found in the practice of physical activity counseling with clients post intervention. This study indicates there may be promise in using online platforms for enhancing physical activity counseling self-efficacy among psychologists in training. Future studies should continue to assess the effectiveness of physical activity counseling and refine training interventions to examine the effects of such interventions among the next generation of psychologists.

This study is based on a content analysis of two primary sources: 1) literature published on lesbian, gay, bisexual and transgender (LGBT) youth in professional journals for school providers (school counselors, nurses, psychologists and social workers) over more than a 30-year period; and 2) materials developed for school providers on LGBT youth by states with laws, regulations and professional policies related to sexual orientation and/or gender identity in schools. Fifteen professional journals were identified that serve as primary and secondary journals for school providers. A total of 41 articles were published in these journals on LGBT youth between 1937 and 2005. Journal articles were coded by the investigator and a second coder, with an inter-rater reliability rate of .97. Most articles focused on identity development, and a majority provided information on developing a supportive school environment for LGB youth. Few focused on issues of salience for contemporary generations of LGBT adolescents, such as resiliency and strength or positive youth development. Only one article focused on youth of color, one on lesbian youth and none on transgender youth. Less than one-third included HIV/AIDS, only 7% mentioned HIV counseling and testing, and 2% mentioned lesbians' risk for STDs. Nearly three-fourths of articles (71%) focused on interventions with LGB youth (few included transgender youth), including the need to promote a safe school environment. Few empirical articles (19.5%), a handful of training articles (7.3%) no theoretical and very few review articles (2.2%) were published during this period. Although nearly one-third of the states had adopted laws, regulations or professional standards to prohibit discrimination of students on the basis of sexual orientation (and 4 included gender identity), no states other than Massachusetts had developed training materials for school providers on LGBT youth. However, Massachusetts' materials were never used since their program was defunded in 2002. Several states made training on LGBT adolescents available to school providers through professional and community organizations. Coupled with limited and outdated content in professional journals, school providers lack access to current multidisciplinary research, theoretical literature and information reviews needed to inform their work with LGBT students and their families.

Esta pesquisa se desenvolveu a partir da parceria entre o Projeto APOIAR do Laboratório de Saúde Mental e Psicologia Clinica Social do Instituto de Psicologia da USP e a ABRELA (Associação Brasileira de Esclerose Lateral Amiotrófica). O estudo refere-se à investigação e compreensão de aspectos afetivos, emocionais e de qualidade de vida dos profissionais da área de saúde, enfocando sua relação com cuidadores e pacientes portadores de Esclerose Lateral Amiotrófica (ELA), doença degenerativa dos neurônios motores, sem prognóstico de cura, embora com a consciência mantida até a morte. Foi empregado o método clínico de pesquisa em onze profissionais, médicos, assistentes sociais, fisioterapeutas respiratórios e motor, nutricionista e terapeuta ocupacional, no setor da Neuromuscular da UNIFESP/Escola Paulista de Medicina em parceria com a ABRELA. Foram empregados como instrumentos: Entrevista Psicológica Semi Estruturada, Método de Rorschach pelo Sistema de Avaliação Aníbal Silveira (sendo alguns índices selecionados) e o Questionário de Vida de McGill. Os dados foram tratados considerando o grupo de forma geral e não de modo individualizado. Principais resultados obtidos apontam para a maturidade do grupo de profissionais, a sensibilidade da maioria à dor e ao sofrimento dos pacientes, com respostas que denotam afetividade, frustração diante da falta de cura e sucesso no tratamento. Demonstram qualidade de vida preservada, e os dados sugerem que trabalham na área que escolheram apesar das dificuldades que sentem. Sugere-se que sejam implementados programas que possam dar aos profissionais de saúde o suporte necessário para que se mantenham como o grupo estudado nessa pesquisa, em condições de dar conta do contato com pacientes com enfermidades graves e crônicas como a ELA. / The actual research was possible due to the partnership between the Project APOIAR (SUPPORT) of the Laboratory of Mental Health and Clinical Psychology of the Institute of Psychology of USP University of Sao Paulo, and ABRELA ( Brazilian Association of Amyotrophic Lateral Sclerosis ( ALS ). This study intends to investigate and better understand the Quality of Life and emotional aspects of health professionals in their relationship with ALS patients and their carers. ALS is a degenerative illness which affects motor neurons causing severe physical impediments, even tough its patients continue lucid up to their death. This illness does not have a prognosis of cure. We have applied the Clinical Method of survey and research on eleven professionals physicians, social workers, motor and respiratory physiotherapists, nutritionist and occupational therapist from de Department of neuromuscular of UNIFESP/ Federal Paulista Medical School and partnership with ABRELA. The study Instruments used were the Semi- Structured psychological Interview, the Rorschach Method ( the Evaluation System by Anibal Silveira) and the Questionnaire of Quality of Life. The collected data considered the group as a whole and not individuals. The main results point towards the maturity of the group of health professionals and their sensitivity related to the pain and suffering of patients, with answers showing affection and frustration due to impossibility of cure and success of treatment. The results show preserved Quality of Life and suggest that those health professionals work within their chosen specialty despite their difficulties.The study suggests the need of implementing programs which give health professionals the necessary support, as shown in this study, so that they can deal with their patients with serious and chronic illnesses such ALS.

Made available in DSpace on 2016-08-10T10:54:59Z (GMT). No. of bitstreams: 1 PEDRO URIEL GONCALVES LIMA.pdf: 785716 bytes, checksum: 2b01eb823bb69a2ffb205c6f57db876a (MD5) Previous issue date: 2016-03-11 / With the advent of the Psychiatric Reform and the enactment of Law 10.216 - 12 establishing a new vision for the treatment of people with mental illness, the implementation of Psychosocial and Therapeutic Residences Care Centers have been imposed as support for the new model of care for these patients. Through Satisfaction Assessment Scales Brazilian was aimed in this study to evaluate the degree of satisfaction of residents and staff of these homes, to reflect whether such dwellings or not brought benefits proposed by the Law. It was found that only 1.9% of the professionals they said very dissatisfied with the service, the majority, 62.7%, are satisfied with the work they do. With regard to residents, some data draw attention, such as 44.4% feel respected by professionals, 66.7% feel that professionals understand well your problems. After analyzing the verbal material collected in interviews of professionals and residents, it was possible to understand the dissatisfaction of professionals as to salary issues and incentives for training, and realize how much the occupant is received by the service. / Com o advento da Reforma Psiquiátrica e a promulgação da Lei 10.216-12 que instituiu uma nova concepção para o tratamento de pessoas com doenças mentais, a implantação dos Centros de Atenção Psicossocial e Residências Terapêuticas se impuseram como respaldo para o novo modelo de atendimento a estes pacientes. Por meio de Escalas Brasileiras de Avaliação da Satisfação objetivou-se neste estudo avaliar o grau de satisfação de moradores e funcionários dessas residências, para refletir se tais moradias trouxeram ou não benefícios propostos pela Lei. Foi constatado que apenas 1,9% dos profissionais se disseram muito insatisfeitos com o serviço, a maioria, 62,7%, estão satisfeitos com o trabalho que realizam. Com relação aos residentes, alguns dados chamam a atenção, tais como 44,4% se sentem respeitados pelos profissionais, 66,7% sentem que os profissionais compreendem muito bem seus problemas. Após analisar o material verbal coletado nas entrevistas dos profissionais e dos moradores, foi possível compreender as insatisfações dos profissionais quanto a questões salariais e incentivos à qualificação, além de perceber o quanto o morador é acolhido pelo serviço.

Os sistemas de saúde orientados pelos princípios da APS tem se apresentado com melhores índices de saúde e como tal, possibilita o alcance de melhor qualidade na atenção pré-natal a gestantes adolescentes, fundamental para a saúde materna e neonatal. O objetivo foi avaliar a atenção pré-natal as adolescentes em unidades da rede básica de saúde no município de Ribeirão Preto-SP, segundo os atributos da Atenção Primária a Saúde, como proposto por Starfield. A relevância do estudo é fornecer informações e subsídios para a Secretaria Municipal da Saúde a fim de que novas estratégias para reorganização dos serviços e para capacitação dos profissionais de saúde possam ser fomentadas, no sentido de adequar e potencializar a atenção em saúde e a atuação intersetorial como rede de apoio social às adolescentes grávidas. Estudo seccional e descritivo de abordagem quantitativa realizado com profissionais de saúde (médicos e enfermeiros) que atendem diretamente as adolescentes no pré-natal. Tais profissionais pertencem a 11 Unidades de Saúde que inclui Centro Saúde Escola, Unidade Básica de Saúde e Unidade de Saúde da Família, perfazendo o total de 36 profissionais (17 médicos e 19 enfermeiros). Foi aplicado o instrumento de Avaliação da Atenção Primária (Primary Care Assessment Tool- Brasil) versão profissionais para analisar a presença e extensão dos atributos da APS na atenção pré-natal as adolescentes. Na análise dos dados, para as variáveis contínuas foram calculadas as medidas de tendência central (média e mediana) e dispersão (desvio padrão) e proporções foram utilizadas para variáveis categóricas. O estudo teve aprovação do Comitê de Ética em Pesquisa com Seres Humanos da Escola de Enfermagem de Ribeirão Preto-USP. O escore das 11 unidades de saúde para o atributo Acesso de primeiro contato (acessibilidade) obteve-se escore 3,5 o que revela um baixo grau de orientação para APS dos profissionais das unidades que pertencem. Os atributos Longitudinalidade, Coordenação (integração de cuidados), Coordenação (sistemas de informação) e Integralidade obtiveram escores >= 6,6 indicam forte presença e extensão adequada de cada atributo. O Escore essencial ficou abaixo de 6,6. Com relação aos atributos da APS, entre os profissionais que atuam nas Unidades Básicas de Saúde, os valores dos escores por atributo estão assim distribuídos: Acessibilidade obteve escore 3,4 o que revela um baixo grau de orientação para APS dos profissionais da UBS e os demais atributos obtiveram escores >= 6,6. O Escore essencial foi de 6,4. Entre os profissionais que atuam nas Unidades de Saúde da Família, os atributos acessibilidade obteve escore 3,6 os demais atributos obtiveram escores >= 6,6. O escore essencial foi de 6,6. Houve, portanto melhor desempenho no escore essencial para as unidades com equipes de Saúde da Família. Na análise por categoria profissional, verificamos que os escores essenciais foram de forte grau de orientação para APS (Escore 11 Unidades 6,6/Escore UBS 6,6/Escore PSF 6,7) entre os profissionais médicos, enquanto entre os enfermeiros apresenta baixo grau de orientação (Escore 11 Unidade 6,4/Escore UBS 6,3/Escore PSF 6,5). / Health systems guided by the principles of Primary Health Care (PHC) has performed with the best health indices and as such enables the achievement of better quality in prenatal care for pregnant teenagers, crucial to maternal and newborn health. The objective was to evaluate the prenatal care for adolescents conducted in units of primary care network in the city of Ribeirão Preto, São Paulo state, according to the attributes of Primary Health Care, as proposed by Starfield. The relevance of this study is to provide information and subsidies to the Municipal Health Secretariat so that new strategies for reorganizing services and training for health professionals could be encouraged, in order to adapt and enhance health care and intersectoral action as social support network to pregnant teenagers. This sectional and descriptive study with quantitative approach was performed with health professionals (physicians and nurses) that assisted directly the teenagers in prenatal care. These professionals belong to 11 Health Units which include Teaching Health Center, Basic Health Unit and Family Health Unit, totaling 36 professionals (17 physicians and 19 nurses). The Primary Care Assessment Tool (Primary Care Assessment Tool-Brazil) version for professionals was used to analyze the presence and extent of the attributes of PHC in prenatal care for adolescents. In analyzing the data, measures of central tendency (mean and median) and dispersion (standard deviation) were calculated for continuous variables and proportions were used for categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. The score of the 11 health units for the attribute first contact access (accessibility) was 3.5 which show a low degree of affiliation of the professionals to the PHC. The attributes longitudinality, Coordination (integration of care), Coordination (information systems) and Comprehensiveness obtained scores >=6.6 which indicate strong presence and appropriate extension for each attribute. The crucial score was below of 6.6. Among professionals working in Basic Health Units and with respect to the attributes of the PHC, the score values per attribute are as follows: Accessibility obtained score 3.4 which indicate a low degree of affiliation of the professionals from Basic Health Units to the PHC, and the other attributes obtained scores >=6.6. The crucial score was 6.4. Among the professionals working in the Family Health Units, the attribute accessibility obtained 3.6 and the other attributes obtained scores >=6.6. The crucial score was 6.6. There was therefore the best performance related to the crucial score for units with Family Health Teams. In the analysis by occupational category, it was found that the crucial scores were for strong degree of guidance to the PHC (11 Units score 6.6/ Basic Health Unit score 6.6/Family Health Program score 6.7) among physicians, while among nurses it presented low orientation degree (11 Units score 6.4/Basic Health Unit score 6.3/ Family Health Program score 6.5).

Os sistemas de saúde orientados pelos princípios da APS tem se apresentado com melhores índices de saúde e como tal, possibilita o alcance de melhor qualidade na atenção pré-natal a gestantes adolescentes, fundamental para a saúde materna e neonatal. O objetivo foi avaliar a atenção pré-natal as adolescentes em unidades da rede básica de saúde no município de Ribeirão Preto-SP, segundo os atributos da Atenção Primária a Saúde, como proposto por Starfield. A relevância do estudo é fornecer informações e subsídios para a Secretaria Municipal da Saúde a fim de que novas estratégias para reorganização dos serviços e para capacitação dos profissionais de saúde possam ser fomentadas, no sentido de adequar e potencializar a atenção em saúde e a atuação intersetorial como rede de apoio social às adolescentes grávidas. Estudo seccional e descritivo de abordagem quantitativa realizado com profissionais de saúde (médicos e enfermeiros) que atendem diretamente as adolescentes no pré-natal. Tais profissionais pertencem a 11 Unidades de Saúde que inclui Centro Saúde Escola, Unidade Básica de Saúde e Unidade de Saúde da Família, perfazendo o total de 36 profissionais (17 médicos e 19 enfermeiros). Foi aplicado o instrumento de Avaliação da Atenção Primária (Primary Care Assessment Tool- Brasil) versão profissionais para analisar a presença e extensão dos atributos da APS na atenção pré-natal as adolescentes. Na análise dos dados, para as variáveis contínuas foram calculadas as medidas de tendência central (média e mediana) e dispersão (desvio padrão) e proporções foram utilizadas para variáveis categóricas. O estudo teve aprovação do Comitê de Ética em Pesquisa com Seres Humanos da Escola de Enfermagem de Ribeirão Preto-USP. O escore das 11 unidades de saúde para o atributo Acesso de primeiro contato (acessibilidade) obteve-se escore 3,5 o que revela um baixo grau de orientação para APS dos profissionais das unidades que pertencem. Os atributos Longitudinalidade, Coordenação (integração de cuidados), Coordenação (sistemas de informação) e Integralidade obtiveram escores >= 6,6 indicam forte presença e extensão adequada de cada atributo. O Escore essencial ficou abaixo de 6,6. Com relação aos atributos da APS, entre os profissionais que atuam nas Unidades Básicas de Saúde, os valores dos escores por atributo estão assim distribuídos: Acessibilidade obteve escore 3,4 o que revela um baixo grau de orientação para APS dos profissionais da UBS e os demais atributos obtiveram escores >= 6,6. O Escore essencial foi de 6,4. Entre os profissionais que atuam nas Unidades de Saúde da Família, os atributos acessibilidade obteve escore 3,6 os demais atributos obtiveram escores >= 6,6. O escore essencial foi de 6,6. Houve, portanto melhor desempenho no escore essencial para as unidades com equipes de Saúde da Família. Na análise por categoria profissional, verificamos que os escores essenciais foram de forte grau de orientação para APS (Escore 11 Unidades 6,6/Escore UBS 6,6/Escore PSF 6,7) entre os profissionais médicos, enquanto entre os enfermeiros apresenta baixo grau de orientação (Escore 11 Unidade 6,4/Escore UBS 6,3/Escore PSF 6,5). / Health systems guided by the principles of Primary Health Care (PHC) has performed with the best health indices and as such enables the achievement of better quality in prenatal care for pregnant teenagers, crucial to maternal and newborn health. The objective was to evaluate the prenatal care for adolescents conducted in units of primary care network in the city of Ribeirão Preto, São Paulo state, according to the attributes of Primary Health Care, as proposed by Starfield. The relevance of this study is to provide information and subsidies to the Municipal Health Secretariat so that new strategies for reorganizing services and training for health professionals could be encouraged, in order to adapt and enhance health care and intersectoral action as social support network to pregnant teenagers. This sectional and descriptive study with quantitative approach was performed with health professionals (physicians and nurses) that assisted directly the teenagers in prenatal care. These professionals belong to 11 Health Units which include Teaching Health Center, Basic Health Unit and Family Health Unit, totaling 36 professionals (17 physicians and 19 nurses). The Primary Care Assessment Tool (Primary Care Assessment Tool-Brazil) version for professionals was used to analyze the presence and extent of the attributes of PHC in prenatal care for adolescents. In analyzing the data, measures of central tendency (mean and median) and dispersion (standard deviation) were calculated for continuous variables and proportions were used for categorical variables. The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. The score of the 11 health units for the attribute first contact access (accessibility) was 3.5 which show a low degree of affiliation of the professionals to the PHC. The attributes longitudinality, Coordination (integration of care), Coordination (information systems) and Comprehensiveness obtained scores >=6.6 which indicate strong presence and appropriate extension for each attribute. The crucial score was below of 6.6. Among professionals working in Basic Health Units and with respect to the attributes of the PHC, the score values per attribute are as follows: Accessibility obtained score 3.4 which indicate a low degree of affiliation of the professionals from Basic Health Units to the PHC, and the other attributes obtained scores >=6.6. The crucial score was 6.4. Among the professionals working in the Family Health Units, the attribute accessibility obtained 3.6 and the other attributes obtained scores >=6.6. The crucial score was 6.6. There was therefore the best performance related to the crucial score for units with Family Health Teams. In the analysis by occupational category, it was found that the crucial scores were for strong degree of guidance to the PHC (11 Units score 6.6/ Basic Health Unit score 6.6/Family Health Program score 6.7) among physicians, while among nurses it presented low orientation degree (11 Units score 6.4/Basic Health Unit score 6.3/ Family Health Program score 6.5).

Using critical feminist theories and methodologies, my research investigates the power relations and influences at play within the field of children's environmental health. I begin with the research question of how a parent's everyday purchase of a toy or other children's product is "hooked into" extra-local governance (agenda-setting, rule-making and monitoring). Focusing on Bisphenol A and phthalates as an example, in-depth interviews were conducted with six government officials (three federal and three municipal), three non-governmental organization (NGO) representatives, a politician, six higher education faculty members and a parent, as well as two focus groups of 23 parents. Legislation and other relevant documents from governments, NGOs, industry and media were analyzed together with reports of their activities and attitudes to theorize "how things work" in the identification and management of toxic substances in products for sale, with a special interest in how this affects children's environmental health. My research revealed the influence of neo-liberalism, corporate power and over-reliance on strictly evidence-based biomedical reductionism in slowing down assessment and regulation of chemicals while many health professionals and grassroots activists have called for swifter responses based on the precautionary principle, as favoured by European governments. That is, politics and bureaucracy, with the approval of industry, over the past two decades, have clung to reductionist science as the only paradigm for understanding toxicity, thus slowing down regulatory processes. Although the historical and epistemological power relations mapped in my research work together to legitimize scientific certainty rather than the precautionary principle, I argue that the resulting regulatory logjam has been and could be addressed by reference to European examples, knowledge produced by collectives and the establishment of upstream and equity-based public health strategies with public input into the process.

Using critical feminist theories and methodologies, my research investigates the power relations and influences at play within the field of children's environmental health. I begin with the research question of how a parent's everyday purchase of a toy or other children's product is "hooked into" extra-local governance (agenda-setting, rule-making and monitoring). Focusing on Bisphenol A and phthalates as an example, in-depth interviews were conducted with six government officials (three federal and three municipal), three non-governmental organization (NGO) representatives, a politician, six higher education faculty members and a parent, as well as two focus groups of 23 parents. Legislation and other relevant documents from governments, NGOs, industry and media were analyzed together with reports of their activities and attitudes to theorize "how things work" in the identification and management of toxic substances in products for sale, with a special interest in how this affects children's environmental health. My research revealed the influence of neo-liberalism, corporate power and over-reliance on strictly evidence-based biomedical reductionism in slowing down assessment and regulation of chemicals while many health professionals and grassroots activists have called for swifter responses based on the precautionary principle, as favoured by European governments. That is, politics and bureaucracy, with the approval of industry, over the past two decades, have clung to reductionist science as the only paradigm for understanding toxicity, thus slowing down regulatory processes. Although the historical and epistemological power relations mapped in my research work together to legitimize scientific certainty rather than the precautionary principle, I argue that the resulting regulatory logjam has been and could be addressed by reference to European examples, knowledge produced by collectives and the establishment of upstream and equity-based public health strategies with public input into the process.

Made available in DSpace on 2014-12-17T15:45:08Z (GMT). No. of bitstreams: 1 AndrezzaKAMP_DISSERT.pdf: 1412729 bytes, checksum: ea9e38a76733214abb3a361e6d66bd2b (MD5) Previous issue date: 2014-03-27 / A Estrat?gia Sa?de da Fam?lia (ESF) apresenta-se como um espa?o privilegiado para a efetiva??o de pr?ticas de educa??o em sa?de orientadas pelo di?logo entre o saber cient?fico e o saber popular, uma vez que ? nesse espa?o de sa?de que profissionais e indiv?duos/fam?lia se interrelacionam, criam v?nculos, dialogam e constroem solu??es para o enfrentamento dos problemas de sa?de da popula??o. O objetivo geral deste estudo foi analisar os limites e as possibilidades de efetiva??o da educa??o em sa?de voltada para a coletividade na ESF de Pau dos Ferros/RN. Nesse sentido, buscou-se conhecer as concep??es de educa??o em sa?de dos profissionais de n?vel universit?rio da ESF; observar onde as pr?ticas de educa??o eram desenvolvidas; conhecer os conte?dos e metodologias utilizadas para a efetiva??o das pr?ticas de educa??o em sa?de e caracterizar os espa?os onde tais pr?ticas eram desenvolvidas. Trata-se de uma pesquisa qualitativa, de car?ter descritivo-explorat?rio realizada junto a nove equipes localizadas na zona urbana do munic?pio. Foram investigados 28 profissionais que atuam nessas equipes, dentre os quais elencamos: quatro m?dicos, oito enfermeiros e dezesseis cirurgi?es dentistas. Fez-se uso da entrevista semiestruturada e da observa??o baseada em princ?pios etnogr?ficos. Os dados foram analisados com base na t?cnica de an?lise de conte?do de Bardin. O estudo obedeceu aos aspectos ?ticos contidos na Resolu??o 196/96 que regulamenta as Pesquisas Envolvendo Seres Humanos. Os resultados apontam que as concep??es e pr?ticas de educa??o em sa?de dos profissionais da ESF s?o orientadas por uma educa??o banc?ria , pautadas pela transmiss?o e reprodu??o de conhecimentos. As tem?ticas s?o desenvolvidas de forma verticalizada, dissonantes da realidade de vida e sa?de dos usu?rios. As pr?ticas educativas s?o ofertadas majoritariamente por enfermeiros e estudantes de gradua??o em est?gio na USF. Em sua maioria n?o s?o planejadas em equipe, e est?o direcionadas ? preven??o de doen?as, distanciando-se da promo??o da sa?de. As principais dificuldades apontadas para a efetiva??o da educa??o em sa?de dizem respeito ? dificuldade de trabalhar em equipe, ? falta de apoio da gest?o, ? estrutura f?sica inadequada e a pouca ades?o dos profissionais as pr?ticas educativas. Portanto, a educa??o em sa?de praticada na ESF n?o consegue instrumentalizar os sujeitos para que estes tenham autonomia e possam tornar-se sujeitos de suas vidas, de sua hist?ria. A pr?tica educativa centrada na transmiss?o de conhecimentos ainda ? uma realidade presente na ESF, constituindo-se em um desafio a ser superado