Made available in DSpace on 2016-04-29T13:32:14Z (GMT). No. of bitstreams: 1 Debora Cristina Fonseca.pdf: 2005688 bytes, checksum: 0a41f0b32fbf8831362ae309b0eec40c (MD5) Previous issue date: 2008-09-24 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The aim of this study was to understand the meanings of adolescence built by health professionals who integrate the Family Health Strategy (Estratégia de Saúde da Família ESF) in a city in the interior of São Paulo State. It was an attempt to contextualize and discuss how the practice with adolescents has been conceived, thought and developed in health contexts and in the formation of doctors and nurses. These professionals have always been present in Family Health teams. The hypothesis adopted was that the naturalizing, universal and pathologic conceptions about adolescence are predominant. They represent an important element in the definition of health policies and practices applied to that population and, consequently, in the lack of effectiveness of these proposals. The theoretical and methodological reference of this study belongs to Social-historical Psychology, in the perspective of Vigotski (1995), Bock & Aguiar (2003) and Aguiar & Ozella (2006). This research was supported on the assumption that any concept or meaning is built in the relationship among men mediated by their objective conditions of life, social and historical realities as well as their symbolization process. Thus, it is a qualitative research, which used the semi-structured interview as a privileged instrument. The analysis was based on four interviews made with health professionals (doctors and nurses). The material collected was organized in pre-indicators, indicators and meaning cores. As a result, the meanings built about Family Health Strategy in integrality and care perspectives were emphasized. However, the discourses about the work routine pointed out to a fragmented practice, which arose from an organizational model of health services. The meanings built by the professionals about adolescence and their work with this group highlighted the predominant conception. It was defined as naturalizing, universal and pathological and also included the invisibility of the adolescent subjects in that context, confirming their inexistence in the professional formation. On the other hand, these professionals recognize the need for overcoming the dominant model. Anyway, they have shown difficulties in finding out ways to modify their practices / O objetivo do trabalho foi compreender os sentidos de adolescência construídos pelos profissionais de saúde que integram a Estratégia de Saúde da Família (ESF) de um município do interior do Estado de São Paulo. Buscou-se contextualizar e discutir como a prática com adolescentes tem sido concebida, pensada e desenvolvida no contexto da saúde e na formação dos profissionais médicos e enfermeiros, atores sempre presentes nas equipes de Saúde da Família. Partiu-se da suposição de que as concepções naturalizantes, universais e patológicas sobre adolescência são predominantes, constituindo-se um importante elemento na definição de políticas e práticas de saúde voltadas a essa população e, conseqüentemente, na falta de efetividade das propostas. Tendo como pressuposto que qualquer concepção ou sentido se produz na relação entre os homens, mediados pelas suas condições objetivas de vida, pelo contexto social, histórico e pelo seu processo de simbolização, o referencial teórico-metodológico adotado foi o da psicologia sócio-histórica, na perspectiva apontada por Vigotski (1995), Bock e Aguiar(2003) e Aguiar e Ozella (2006). Desta forma, trata-se de pesquisa qualitativa, que se utilizou da entrevista semi-estruturada como instrumento privilegiado. A análise baseou-se em quatro entrevistas realizadas com profissionais de saúde (médicos e enfermeiros), cujo material foi organizado em pré-indicadores, indicadores e núcleos de sentidos. Como resultados, foram evidenciados sentidos construídos sobre a Estratégia de Saúde da Família na perspectiva da integralidade e do cuidado. Porém, os discursos sobre o cotidiano de trabalho apontaram para uma prática fragmentada, resultante da apropriação do modelo organizativo dos serviços de saúde. Os sentidos construídos pelos profissionais sobre adolescência e o trabalho com eles evidenciaram a concepção predominante, caracterizada como naturalizante, universal e patológica e, ainda, a invisibilidade dos sujeitos adolescentes nesse contexto, ratificando também o seu não-lugar na formação profissional. Por outro lado, esses profissionais reconheceram a necessidade de superação do modelo dominante. Entretanto, apresentaram dificuldades de vislumbrar caminhos de modificação de suas práticas

O fator emergente transformado num problema global é o risco psicossocial do trabalho (RPT), por ter impacto maior nos profissionais da saúde, que por sua natureza, seriam mais vulneráveis, afetando quanto na saúde tanto em desempenho trabalhista. Sua importância, deve-se ao fato de serem menos tangíveis, de fato mais difícil de gerir e prevenir mediante abordagem proativa direcionadas ao origem, junto à sensibilização até políticas da gestão dos riscos. A pesquisa teve como objetivo comparar ocorrência de intervenções para prevenir RPT de profissionais da saúde no Brasil e no Perú. Fez-se revisão sistemática com base no scoping study nas bases PubMed, EBSCO-Host, BioMed Central, Embase, CINAHL, Lilacs, Cochrane Register of Trials, Web of Science e arquivo adicional da Ibict (Brasil) e da Concytec (Perú). Identificaram-se 2.466 estudos, restando 19, após a análise. A intervenção preventiva detectada como privilegiado e de maior utilidade, tem abrangência no treinamento, mas para dimensões intrínsecas à mudanças de comportamentos complexos, cujos assuntos foram: aperfeiçoamento do diálogo da equipe na gestão de conflitos; melhora de interação na prática profissional. Intervenções de sucesso foram, formatos interativos didáticos e mistas ou workshops inserindo compromisso de chefes e funcionários da saúde, acima de três semanas, para promoção de tarefas de prática profissional; ao redor de seis meses, para tarefas problemáticas na saúde, desenvolvimento de liderança na gestão educacional e trabalho colaborativo. Implicações para cultura preventiva nos estabelecimentos da saúde, precisa-se agir nas intervenções e planos de pesquisa, para o desenvolvimento e promoção de relações trabalhistas preconizadas e transparentes. / The emerging factor turned into a global problem is the psychosocial risk at work (PRW), and has an impact especially on health professionals, who by their nature affect work performance. In addition, they are less tangible and difficult to manage, and to be prevented through proactive, source-oriented models, ranging from sensitization interventions to risk management policies. The objective was to compare the presence of interventions to prevent PRW in health professionals in Brazil and Peru. A systematic review based on scoping study was developed, 2,466 studies were identified, leaving 19, post analysis. Preventive interventions (PI) with greater presence and usefulness are teaching-training, limited to changes in complex behaviors oriented to team communication development, conflict management and professional interaction improvements. The appropriate PI to promote tasks of professional practice in health are the mixed, didactic and interactive protocols with a minimum duration of three weeks, always with the participation of officials and workers; on the other hand, were about six months, for preventive tasks in health problems, leadership development in management and teamwork. In order to establish a preventive culture in health establishments, it is still necessary to develop PI on recommended and transparent labor relations, and research with controlled designs. / El factor emergente convertido en problema global es el risco psicosocial en el trabajo (RPT), y tiene impacto especialmente en profesionales de la salud, que por su naturaleza afectan el desempeño laboral. Además, resultan menos tangibles y difícil de gerenciar, y de prevenir a través de modelos proactivos orientados al origen, que abarcan desde las intervenciones de sensibilización hasta las de políticas de gestión de riscos. El objetivo fue comparar la presencia de intervenciones para prevenir RPT en profesionales de la salud en Brasil y Perú. Desarrollándose una revisión sistemática basada en scoping study en las siguientes bases de datos: PubMed, EBSCO-Host, BioMed Central, Embase, CINAHL, Lilacs, Cochrane Register of Trials, Web of Science, y adicionalmente en IBICT (Brasil) y CONCYTEC (Perú). Se identificaron 2,466 estudios y quedando 19, pos análisis. Las intervenciones preventivas (IP) con mayor presencia y utilidad son la capacitación-entrenamiento, circunscritas a cambios de comportamientos complejos orientados al desarrollo comunicacional en equipo, a la gestión de conflictos y a mejoras de interacción profesional. Las IP adecuadas para promover tareas de la práctica profesional en salud, son los protocolos mixtos, didácticos e interactivos o de workshops con duración mínima de tres semanas, siempre con participación de funcionarios y trabajadores; en cambio, fueron alrededor de seis meses, para tareas preventivas en problemas de salud, el desarrollo del liderazgo en gestión y trabajo en equipo. Para establecer cultura preventiva en establecimientos de salud, queda pendiente desarrollar IP sobre relaciones laborales preconizadas y transparentes, y de investigaciones con diseños controlados.

Cette recherche porte sur le processus de transformation des cadres de l’expérience (Goffman E. , 1991) issue des pratiques participatives en situation de travail et ses effets sur l’apprentissage du métier de formateur des professionnels de santé. Les pratiques participatives des professionnels sont mises en objet par le choix d’une focale inscrite dans le courant de la microsociologie. L’observation des situations de travail s’est déroulée sur quatre années, par l’enregistrement de situations de travail in situ effectuées par les formateurs eux-mêmes, suivi d’entretiens de groupe et d’entretiens individuels semi-directifs. Nos référents théoriques sont issus du champ de l’apprentissage en situation de travail avec la notion de pratiques participatives (Billett S. , 2016), de la théorie des communautés de pratique (Wenger E. , 2005) et l’analyse des interactions avec les travaux de Goffman sur les rites de l’interaction (1974) et les cadres de l’expérience (1991). Notre hypothèse centrale consiste à penser que l’apprentissage du métier de formateur par le biais des pratiques participatives des acteurs en situation de travail suppose des processus de transformation des cadres de l’expérience. Les résultats montrent qu’un processus que nous nommons dynamique des cadres enchâssés produit une modification des positionnements professionnels des acteurs. La perception de leur environnement d’apprentissage change et leurs pratiques professionnelles se transforment. / This research focuses on the process of transforming the frameworks of experience (Goffman E., 1991) resulting from participatory practices in work situations and its effects on learning the profession of trainer of health professionals. The participative practices of these professionals will be the research subject through the choice of a focal point inscribed in the current of microsociology. The observation of the work situations was done lengthwise (considerer a changer longitudinally) over four years, by the recording of in situ work situations carried out by the trainers themselves, followed by group interviews, including a self-confrontation dimension and semi-structured individual interviews. Our theoretical references are originating from the field of workplace learning, including the notion of participative practices (Billett S., 2016), situated learning with the theory of communities of practice (Wenger E., 2005), the analysis of interactions with Goffman's work on the rites of interaction (1974) as well as the frame analysis (1991). Our central hypothesis consists in thinking that learning the profession of trainer through the participative practices of the actors in the work situation entails processes of transformation of the frameworks of the experience. The results show that a process, which we named dynamic enshrined frames, produces a modification of the professional positioning of the actors. The perception of their learning environment is changing and so are their professional practices.

The aim of this research is to know the training of health professionals in health promotion and disease prevention, and to examine its manifestation among the actions and interventions for prevention of tobacco, alcohol or cannabis consumption. The sample includes 225 professionals. The study used a self-made design of quantitative methodology (survey study). The most important results are: the formative limitations in health education and prevention of substance use and the fact that professionals who have received specific training in substance use tap more health education as a prevention tool in their daily activities. It is also noted that 80% of professionals believe they should improve quality training, and 67% quantity, always in relation to the tobacco, alcohol and cannabis use. Generally, the overload care and the lack of time are cited as factors preventing the health education activities. Finally, the study also shows that secondary prevention activities are the most used, while community interventions are underutilized by professionals. / L’objectiu d’aquesta recerca és conèixer la formació dels professionals sanitaris en matèria de promoció de la salut i prevenció de la malaltia, i com es concreten les seves intervencions en la prevenció del consum de tabac, alcohol i cànnabis. La base del treball és una mostra de 225 professionals de la salut. S’ha utilitzat un disseny propi de la metodologia quantitativa (estudi d’enquesta). Entre els resultats obtinguts destaquem: les limitacions formatives en educació per a la salut i en prevenció del consum de substàncies, i el fet que els professionals que han rebut formació específica en consum de substàncies utilitzen més l’educació per a la salut com a eina de prevenció en la seva activitat diària. També s’observa que el 80% dels professionals considera que hauria de millorar la seva formació en qualitat, i un 67% en quantitat, sempre sobre el consum de tabac, alcohol i cànnabis. En general, la sobrecàrrega assistencial i la manca de temps són esmentats com a factors que obstaculitzen les activitats d’educació per a la salut. Finalment, l’estudi posa de manifest que les activitats de prevenció secundària són les més realitzades, mentre que les intervencions comunitàries són poc utilitzades pels professionals.

L'objectiu de la investigació ha estat conèixer perquè el col·lectiu d'infermeria no percep la seva professió al mateix nivell que unes altres acadèmicament similars i que es veu imbuït per una invisibilitat consentida pel mateix, per altres professionals de la salut, per les institucions i per la pròpia societat. Ens ha interessat esbrinar si això té a veure amb la presència majoritària de la dona en la infermeria. Estudi transversal quantitatiu i qualitatiu. Les estratègies utilitzades són la combinació i la triangulació.Els professionals de la infermeria la consideren vocacional, amb poca identitat professional, socialment secundària, amb responsabilitat, gran potencial de projecció i baixa consideració del propi professional respecte al rol autònom i la dependència mèdica. Important impregnació d'estereotips consentits pels mateixos professionals. La causalitat s'atribueix a la feminització.Els resultats de l'estudi comporten l'elaboració i implantació d'estratègies formatives en l'àmbit de la formació universitària i en el laboral. / The objective of the investigation has been to know because the nurses group does not perceive its profession at the same level that academically similar others and that is immersed by one invisibility allowed by the same one, by other professionals of the health, the institutions and the own society. It has interested to us to find out if this has to do with the majority presence of the woman in nursing. Quantitative and qualitative cross-sectional study. The used strategies are the combination and triangulation. The professionals of nursing consider vocational, with little professional identity, socially secondary, with responsibility, great potential of projection and low consideration of the own professional respect to the independent roll and the medical dependency. Important impregnating of stereotypes allowed by such professional. The causality is due to femininity. The results of the study tolerate the elaboration and implantation of educational strategies in the scope of the university formation and in the professional one.

Les médecins de famille, les pédiatres, les chiropraticiens et les physiothérapeutes sont parmi les professionnels de la santé les plus susceptibles de rencontrer des patients atteints d’une scoliose idiopathique adolescente. Les recherches démontrent que certaines lacunes existent à l’égard des connaissances acquises, par ces professionnels, dans le domaine musculosquelettique, incluant la scoliose. De plus, il ne semble pas exister d’informations sur le niveau de connaissances et la démarche clinique de ces professionnels en matière de scoliose, bien que les bonnes pratiques actuelles dictent une détection hâtive de cette condition pour en optimiser la gestion thérapeutique. Les objectifs de notre étude visaient donc à évaluer les connaissances ainsi que les aptitudes en matière de démarche clinique des professionnels les plus susceptibles à traiter des patients atteints d’une scoliose idiopathique adolescente. À l’aide d’un questionnaire semi-structuré, 51 professionnels de la santé ont été interviewés. Parmi ces professionnels recrutés par l'entremise de leur ordre professionnel respectif, on retrouvait 21 médecins de famille, 10 pédiatres, 10 chiropraticiens et 10 physiothérapeutes. Les entrevues évaluaient les connaissances en matière de signes cliniques, de facteurs de risque, de démarche clinique et de processus référentiel vers les soins spécialisés. De plus, les préférences des professionnels à l’égard des guides de bonne pratique ont été abordées. Parmi les professionnels interviewés, 59 % étaient des femmes, 43 % étaient âgés de moins de 40 ans et la moyenne d’années de pratique était de 20,3 ans. Les résultats démontrent qu’il existe des lacunes à l’égard des connaissances des signes cliniques et des facteurs de risque : moins du tiers des professionnels interviewés pouvaient mentionner au moins 2 signes cliniques et 31 % d’entre eux ne pouvaient se souvenir des facteurs de risque associés à la scoliose idiopathique adolescente; les médecins de famille étaient les moins connaissants dans ces domaines. De plus, en présence d’une mise en contexte nécessitant une référence urgente en soins spécialisés, 70 à 90 % des professionnels auraient référé le patient en dépit du fait que seulement 38 à 60 % d’entre eux considéraient cette situation comme urgente. Près de 40 % des professionnels mentionnaient qu’ils seraient inconfortables à gérer un patient atteint d’une scoliose. Néanmoins, la majorité d’entre eux reconnaissaient qu’il existe un problème en ce qui a trait à l’accessibilité aux soins spécialisés en orthopédiatrie. Presque la totalité c’est-à-dire, 98 % étaient favorables à la production de guides de bonne pratique et les accueilleraient positivement dans leur pratique quotidienne. Les conclusions de cette étude ont montré qu’il existe des vides en matière de connaissances de signes cliniques et de facteurs de risque de progression de la scoliose idiopathique adolescente; ces lacunes ont particulièrement été remarquées chez les médecins de famille. La majorité des professionnels reconnaissent l’importance de référer les conditions urgentes en soins spécialisés. Néanmoins, tous semblent souligner des difficultés dans ce processus référentiel. Une meilleure collaboration interprofessionnelle semble prometteuse en ce qui concerne la gestion de patients atteints d’une scoliose idiopathique adolescente. / Family physicians, peadiatricians, chiropractors and physical therapists are among health professionals most likely to encounter and treat patients with adolescent idiopathic scoliosis. Research shows that there are gaps in musculoskeletal knowledge among professionals but no studies assess knowledge of scoliosis among professionals most likely to treat patients with scoliosis. Best current practice dictates that early detection of adolescent idiopathic scoliosis leads to better decision-making regarding optimal course of management. The objectives of our study were to evaluate basic knowledge and the management skills of professionals most likely to encounter adolescent idiopathic scoliosis. We developed a semi-structured questionnaire and interviewed 51 health professionals. Among these professionals, who were recruited through their professional regulatory board registries, were 21 family physicians, 10 peadiatricians, 10 chiropractors and 10 physical therapists. The interview assessed knowledge of clinical signs and risk factors, management options, including referral to specialized care. We also discussed preferences and acceptability of clinical guidelines in regard to scoliosis. Among interviewed professionals, 59 % were female, 43 % were under 40 and mean years of practice was 20.3. Our results demonstrated gaps in knowledge with respect to clinical signs and risk factors. Less than a third of professionals were able to mention at least 2 clinical signs and 31 % were unaware of any risk factors associated with scoliosis progression. Family physicians appeared least knowledgeable in these areas. When presented with a situation where urgent referral was indicated, 70 – 90 % said that they would refer the patient although only 38 – 60 % rated this case as urgent. Close to 40 % of professionals indicated that they would not be comfortable doing the follow-up of a patient with a scoliosis. Nevertheless, the majority felt that accessibility to specialized care was a problem. Almost all (98 %) mentioned that the development of clinical guidelines would positively affect their daily practice. In conclusion, our study shows that knowledge gaps exist among professionals regarding clinical signs and risk factors of curve progression in adolescent idiopathic scoliosis. Most professionals recognize the importance of referring urgent cases to specialized care although there may be problems with access to peadiatric orthopedic specialists. Interprofessional collaboration may be a promising approach to improve management of patients with adolescent idiopathic scoliosis.

L’accessibilité aux soins de santé est une priorité de nombreux gouvernements à travers le monde. En Haïti, les gouvernements se sont succédés et ont tenté à travers les années des interventions dont les résultats ne sont souvent pas satisfaisants. Le programme d’assistance médicale cubain, actuellement appliqué dans le pays, est en œuvre dans plus d’une vingtaine de pays en développement, mais il existe très peu d’évaluations indépendantes qui permettent de l’appréhender. Cet ouvrage se donne pour objectif de vérifier le bien fondé de cette intervention en tenant compte du contexte, d’établir la plausibilité en fonction des moyens du pays et finalement, de proposer des solutions qui améliorent la situation. Pour répondre à ces objectifs, l’étude de cas a été adoptée comme stratégie de recherche. Cette technique permet de mieux analyser le contexte, et de comprendre ses effets sur le programme. Des entrevues semi-structurées ont été réalisées pour permettre de faire les analyses stratégique et logique nécessaires pour atteindre les objectifs sus-cités. Les entrevues ont visé successivement la compréhension du modèle théorique, la détermination des problèmes pertinents auxquels fait le système de santé, les causes de la difficulté de rétention des professionnels et finale l’analyse du modèle. L’évaluation a révélé que l’accessibilité aux soins de santé est complexe et qu’un grand nombre de facteurs l’influencent. En Haïti, ces facteurs ne sont pas différents de ceux recensés dans la littérature. Mais la composante géographique associée à l’aspect administratif du système de santé en général constituent les éléments qui auraient l’impact le plus important sur l’accessibilité du système de santé. Vu les conditions actuelles, la modernisation de la gestion représente l’avenue à privilégier en attendant que les moyens permettent d’agir sur les autres facteurs. La rétention des professionnels de santé est un facteur essentiel de l’accessibilité aux soins de santé. Pour être efficace, les mécanismes de rétention utilisés doivent s’accompagner de mesures comme l’amélioration des conditions de travail, ainsi qu’un salaire compétitif. Les conditions de vie dans le milieu rural haïtien ne peuvent en rien être comparées à celles des pays développés. On ne peut espérer les mêmes résultats avec les programmes de rétention utilisés par cette intervention. Tenant compte du contexte socioéconomique et du tableau épidémiologique haïtien, il serait peut-être plus efficient de créer de nouveaux corps de métier. Ces derniers devraient être en mesure de régler les problèmes de santé simples, et occasionneraient des coûts moins importants. Ce serait à court terme et même à moyen terme une solution viable dans le contexte actuel. Le programme actuel s’il semble respecter les données probantes en matière d’accessibilité aux soins, néglige d’incorporer les paramètres spécifiques au milieu haïtien, nécessaires à l’atteinte de ses objectifs. La politisation excessive est aussi un facteur qui à terme pourrait conduire à l’échec de ce programme. Si à court terme le programme parvient à augmenter le nombre de professionnels de santé dans le pays, il est peu probable que cela dure. Les moyens précaires du pays ne lui permettent pas de se payer des professionnels hautement qualifiés dans les milieux sous desservis. L’intervention pour réussir doit intégrer les caractéristiques particulières du milieu et mettre plus d’accent sur la gestion du système. / Health care accessibility is a priority for numerous governments across the world. In Haiti, governments have succeeded one another and attempted interventions across the years in which the results are not often satisfactory. The Cuban medical care program, nowadays applied in the country, has been implemented in more than about twenty developing countries, but little independent assessment has been conducted to allow capturing it. This assessment has given itself the objective of verifying mainly the well-founded of this intervention; by taking into account not only the context but also the practical aspect regarding the country’s wealth. The case study has been chosen as analyzing technique. It allows a better understanding of the context and its effects on the project. Some semi-structured interviews have been done to help the strategic and logic analysis important for reaching the goals of this study. The interviews enable us to do the modeling of the intervention, to understand all the problems currently existing within the health system, the causal model of the retention difficulties and finally the analysis of the logic model. The evaluation revealed that accessibility to healthcare is complex, and a huge number of factors influence it. In Haiti those factors do not differ from those found in the literature review, but geographical accessibility associated to the management of the healthcare system constitute the elements that have the most important impact in the accessibility of the system. In view of actual conditions, the modernization of management constitutes the pathway to be favored until other important aspects can be resolved. Health professionals retention is an important part of accessing healthcare, but must also be accompanied by improvement of working conditions and competitive salaries. The living conditions in rural Haitian cannot be compared to any developed country; therefore, the same results cannot be expected. New professions accounting for the socio-economic and the epidemiologic contexts of the country should provide a more efficient solution. The current program is evidence based, however; it neglects to integrate specific parameters of the Haitian context that is important to attain its objectives. Excessive political interference is also a factor that eventually could drive to its failure. In short-term, the program succeeds in increasing the number of health professionals in the country, it is unlikely that situation continues based on the country’s poor resources. To be successful, the intervention must include the specific characteristics of the environment and emphasize more the managerial aspects of the system, if it wants to achieve sustainable results.

Introduction: La participation sociale "optimale" peut se définir comme une congruence parfaite entre les attentes de l'individu et sa réalité. La conciliation travail-famille fait appel à l'équilibre des différentes sphéres de vie du travailler. On peut alors s'interroger sur la perception de l'optimalité qu'ont les professionnels de la réadaptation quant à leur propre niveau de participation, conciliant plusieurs sphéres de vie et les facteurs qui influencent cette participation. But: Explorer la perception de l'optimalité de la participation sociale chez des professionnels de la réadaptation et les facteurs identifiés par ces derniers comme l'influençant. Méthode: Étude qualitative d'orientation phénoménologique auprés de treize professionnels de la réadaptation à l'aide d'un guide d'entrevue composé de questions ouvertes. Les données recueillies ont été enregistrées sur bande audio et transcrites intégralement (verbatim) suivi d'une analyse de contenu. Résultats: Les participants, majoritairement des femmes (12/13) étaient âgés de 31 à 44 ans et avaient entre un et trois enfants dont l'âge variait de 7 mois à 12 ans. L'optimalité de la participation est perçue comme: la possibilité (ou non) d'accomplir ses activités significatives tout en prenant en charge ses différentes responsabilités. Parmi les cinq facteurs environnementaux perçus comme ayant une influence (l'aspect financier, le soutien du conjoint, le temps, la flexibilité des horaires au travail et la structure familiale) la structure familiale apparait comme déterminante du possible et influence ainsi grandement les attentes individuelles.Conclusion: La conciliation travail-famille est un phénomène complexe qui gagne à être étudié dans sa globalité plutôt qu'en silo. / Introduction: Optimal social participation, which is the ultimate goal targeted by rehabilitation professionals for their clients, can be defined as perfect congruence between an individual's expectations and reality. Work-family dynamic requires balance between the different spheres of a worker's life. This raises questions about the perception that rehabilitation professionals have regarding their own optimal social participation, reconciling various life spheres, and the factors influence this participation. Purpose: To explore the perception of rehabilitation professionals regarding their optimal social participation, and the factors they identify as influencing this participation. Method: Qualitative study with a phenomenological orientation among 13 rehabilitation professionals using an interview guide consisting of open questions. The data was audio-recorded and transcribed in full (verbatim) followed by content analysis. Results: Participation were mostly women (12/13) aged 31 to 44 years having one to three children aged from 7 months to 12 years old. Optimality of participation is perceived as the ability (or not) to carry out important activities while fulfilling one's various responsibilities. Of the five environmental factors perceived to have an influence (financial aspects, spousal support, time, flexible work schedule, and family organization), family organization appears to be a determinant of possibility and thus greatly influences individual expectations. Conclusion: Work-life balance is a complex phenomenon that should be studied holistically rather in a siloed mode.

Introduction : Les pressions sont fortes envers les professionnels de la santé pour qu’ils appliquent une pratique factuelle. Toutefois, un écart important demeure entre les résultats des recherches et la réalité clinique. Par son aspect interactif, le Web 2.0 peut contribuer à l’application des données probantes en facilitant l’accès et l’échange de connaissances. Objectif : Ce projet de recherche s’inscrit dans une étude visant à élaborer une plateforme informatisée pour les professionnels travaillant avec la clientèle ayant subi un accident vasculaire cérébral (AVC). L’objectif de la présente étude est de décrire la perception des professionnels de la santé face à l’introduction du Web 2.0 dans leur pratique. Méthode : Un devis de recherche qualitatif avec une approche phénoménologique a été utilisé. Des entrevues individuelles semi-structurées ont été menées auprès de 24 professionnels et gestionnaires. Résultats : Les personnes interviewées étaient toutes des femmes avec un âge moyen de 45 ans (± 18). Le transfert des connaissances est l’utilité du Web 2.0 qui émerge des participants comme étant la plus importante. Les répondants ont également exprimé avoir besoin d'une plateforme conviviale. Les résultats soulignent également un paradoxe lié au temps. En effet, les répondants estiment que le Web 2.0 pourrait leur permettre de sauver du temps, cependant ils affirment qu'ils n'auront pas le temps de l'utiliser. Conclusion : Bien que le Web 2.0 demeure un outil de transfert de connaissances peu intégré dans la pratique, les professionnels travaillant avec la clientèle AVC perçoivent généralement positivement son introduction dans leur pratique. / Introduction: Health professionals are increasingly encouraged to adopt an evidence-based practice. However, gaps continue to be observed between scientific evidence and practice. Through its interactive capabilities, Web 2.0 can contribute to an evidence-based practice by improving exchange of relevant clinical and scientific information’s. Objective: This study is a part of a project that wants to design a Web 2.0 platform for health professionals working with stroke patients. The aim is to gain a better understanding of professionals’ perceptions of Web 2.0 before platform development. Methods: A qualitative study following the phenomenological approach was chosen. We conducted individual semi-structured interviews with 24 clinicians and managers. Results: Interviewed people were all women with a mean age of 45 years (± 18). Knowledge transfer was identified to be the most useful outcome of a Web 2.0 platform. Respondents also expressed their need for a user-friendly platform. Results also highlight a time paradox. Clinicians feel that the Web 2.0 will help them save time while they argue that they will not have time to use it. Conclusion: While Web 2.0 remains a knowledge transfer tool not yet integrated in clinical practice, professionals working with stroke patients generally receive its implementation positively.

Submitted by Vasti Diniz (vastijpa@hotmail.com) on 2017-12-27T13:35:13Z No. of bitstreams: 1 arquivototal.pdf: 6153186 bytes, checksum: a8c4706f7510bfbfd12619172e5b49eb (MD5) / Made available in DSpace on 2017-12-27T13:35:13Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 6153186 bytes, checksum: a8c4706f7510bfbfd12619172e5b49eb (MD5) Previous issue date: 2017-02-22 / The adoption of universality, of integrality and equity as foundations of health rights, was evidenced in the 1988 constitutional text, based on the historical construction of a health mentality that resulted in the reformulation of the Health System and the replacement of the Social Security model by the Model Of Social Security in Brazil. However, the notion of Health as a universal right is still an obstacle to the consolidation of health practices of subnational subjects (professionals, managers and users), of the consolidation of “Sistema Único de Saúde” (SUS) - Unified Health System - and of the establishment of the political character of SUS, as a mechanism for access to the improvement of living conditions through health. Thus, the present study sought to investigate the social representations that the professionals of the “Unidades Básicas de Saúde da Família” (UBSF) - Basic Units of Family Health, in Cariri from Paraíba, have regarding the SUS as a political right, based on the constant participation of the subjects and, these representations influence the attention in health practiced by these professionals. In turn, all these elements result in deficient or nonexistent effectiveness of cidadanização, which raises the need to strengthen it through the SUS cidadanização process, understood here as the intensification of participation, especially in SUS management instances. The originality of this work rests on the scarcity of academic research on the Cariri, region of Paraíba, exposes the difficulties to understand the local social reality and the consequent elaboration and execution of public policies for the region, which is made up of 29 municipalities. For the accomplishment of this work, the sample was chosen for convenience of the population formed by professionals that work in 02 UBSF of 05 municipalities of the region with greater quantitative population and offer of health services. Data collected through questionnaire (80), semi-structured interviews (42), and Focal Group (06) were treated with the Survey technique for quantitative data, and the Collective Subject Discourse Analysis for both qualitative data Analyzed in the light of the Theory of Social Representations. The field work points to the non-visualization of SUS as a political right, resulting from struggles and mobilization of society, based on elements such as clientelism and power relations established among the subjects involved in the health care process. The information of the interlocutors also indicates the scarcity or difficulty of continuous training regarding the innovations of health procedures; The lack of knowledge about the universality importance and of healthcare reform as a commodity, expressed in the implementation of health policies and health quality programs, such as the “Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica” (PMAQ-AB) - National Program for Improving Access and Quality of Basic Care. Thus, it is observed that health professionals still work in the perspective of the health insurance model implemented by the “Instituto Nacional de Assistência Médica e Previdência Social” (INAMPS) - National Institute of Medical Assistance and Social Security. / A adoção da universalidade, da integralidade e da equidade como fundamentos dos direitos em saúde se evidenciou no texto constitucional de 1988, a partir da construção histórica de uma mentalidade sanitária que resultou na reformulação do Sistema de Saúde e na concepção de saúde pública com a substituição do modelo de Seguro Social pelo modelo da Seguridade Social no Brasil. Assim, o presente estudo tratou de investigar as representações sociais que os profissionais das Unidades Básicas de Saúde da Família (UBSF) no Cariri Paraibano têm a respeito do SUS enquanto direito político, fundamentado na participação constante dos sujeitos (profissionais, gestores e usuários) e, como estas representações influenciam na atenção em saúde praticada por estes profissionais. Por sua vez, todos estes elementos resultam na deficiente ou inexistente efetivação da cidadania o que suscita a necessidade de reforço da mesma por meio do processo de cidadanização do SUS, entendida aqui como a intensificação da participação, especialmente nas instâncias de gestão do SUS. A originalidade deste trabalho repousa na escassez de pesquisas acadêmicas sobre a região do Cariri Paraibano, expõe as dificuldades para o entendimento da realidade social local e a consequente elaboração e execução de políticas públicas para a região, que é constituída por 29 municípios. Para a realização deste trabalho foi escolhida uma amostra por conveniência da população formada por profissionais que atuam em 02 UBSF de cada um dos 05 municípios pesquisados, totalizando 10 UBSF e seguindo o critério de maior quantitativo populacional e oferta de serviços de saúde. Os dados coletados por meio de questionário (80), entrevistas semiestruturada (42) e Grupo Focal (06) foram tratados com a técnica de Levantamento, para os dados quantitativos, e a Análise de Discurso do Sujeito Coletivo, para os dados qualitativos, ambos analisados à luz da Teoria das Representações Sociais. O trabalho de campo aponta para a não visualização do SUS enquanto Direito Político, resultado de lutas e mobilização da sociedade e para o fato dos profissionais de saúde ainda trabalharem na perspectiva do modelo previdenciário de saúde executado pelo Instituto Nacional de Assistência Médica e Previdência Social (INAMPS). A estes dados acostam-se elementos como o clientelismo e as relações de poder estabelecidas entre os sujeitos envolvidos no processo da atenção em saúde na região do Cariri. As informações dos interlocutores, indicam ainda, a escassez ou dificuldade de capacitação continuada com relação as inovações dos procedimentos em saúde; o desconhecimento da importância balizar da universalidade e da Reforma Sanitária como elementos fundamentais de construção e manutenção do SUS e o choque entre a concepção de saúde enquanto direito e de saúde enquanto mercadoria, expresso na implementação das políticas de saúde e dos programas de qualidade em saúde, a exemplo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB).