Esta tese teve como objeto de estudo a compreensão da emergência de realidades no ensino superior da saúde, segundo a singularidade da área de fisioterapia, mediante seus atos e vozes nas Diretrizes Curriculares Nacionais. Entendi ter-se organizado um movimento social por entre o debate das diretrizes curriculares. No encontro com profissionais da fisioterapia, procurei saber em que momento emergiu para esta profissão a possibilidade de mudança – sob a forma das Diretrizes Curriculares Nacionais – no saber-fazer-ensinar fisioterapêutico. Uso um movimento social por entre o debate das diretrizes curriculares. No encontro com profissionais da fisioterapia, procurei saber em que momento emergiu para esta profissão a possibilidade de mudança – sob a forma das Diretrizes Curriculares Nacionais – no saber-fazer-ensinar fisioterapêutico. Uso da ciência da complexidade e da teoria das realidades emergentes, para propor uma imagem e interpretação da conformação de novidades no ensino superior da fisioterapia, considerados os atos e as vozes de profissionais dessa área que militam pela educação e pelo lugar que a formação deve tomar na invenção de mundos (da técnica, do trabalho, das relações sociais, da ciência, da clínica em saúde). O delineamento metodológico utilizado para a realização da investigação foi o estudo de caso. Busquei, como atores-chave, profissionais da área da fisioterapia, atuantes na construção das Diretrizes Curriculares Nacionais, partindo dos especialistas no ensino de fisioterapia ligados à comissão de especialistas na Secretaria do Ensino Superior do Ministério da Educação, entre 1997 e 1999, e à Associação Brasileira de Ensino em Fisioterapia, a partir de 1999. Na construção dessas diretrizes curriculares, procurei o conhecimento das relações e interconexões provocadas pela área da fisioterapia junto à grande área da saúde e às transformações desejadas no âmbito do trabalho em equipes multiprofissionais e interdisciplinares, da integralidade da atenção em saúde e da apropriação do sistema de saúde brasileiro. Ao fazer a análise do relato de atos e vozes, desenhei sete categorias-movimento: ações e conexões dos atores; movimentos não lineares para a transformação curricular; sistemas dinâmicos no compartilhamento com a grande área da saúde; jogos de força; a singularidade da graduação em fisioterapia em um inventar-se no campo da saúde; movimento social como movimento de invenção de mundos e a emergência de realidade. Como tese, des-cubro/delineio as mudanças curriculares e seus focos como um dispositivo a três polos. Neste estudo, vislumbrou-se que as Diretrizes Curriculares Nacionais configuraram um produto/resultado de um coletivo composto por docentes, estudantes e profissionais de saúde, integrantes de redes e do movimento de associações que se propunham ao rompimento com o modelo instituído ou modelo tradicional, que buscavam possibilidades de mudança para a integralidade na atenção à saúde, o trabalho em equipes multiprofissionais de saúde e a consonância da formação e do desenvolvimento com os princípios do Sistema Único de Saúde. As inovações deveriam propiciar a integração entre educação e saúde na formação profissional da educação superior e sua participação na atenção às demandas de saúde da sociedade. A configuração em rede e o movimento associativo constituíram convicção na profissão e transversalidade interprofissional. As Diretrizes Curriculares Nacionais/Fisioterapia mostram uma emergência com atores da educação/ensino de fisioterapia engajados em processos e esforços de reconhecimento da profissão na equipe de saúde, em um sistema de acesso universal à saúde e na capacidade de práticas cuidadoras não limitadas à reabilitação. / This thesis aims to study to understand of the emergence of higher education in the realities of health, according to the singularity of the area of physiotherapy, through their actions and voices in the National Curriculum Guidelines. Understood to have an organized social movement among the discussion of curriculum guidelines. At the meeting with professional physiotherapy, I sought to know when this profession emerged to the possibility of change - in the form of the National Curriculum Guidelines - know-how-to-teach physiotherapy. Using the science of complexity theory and the realities of the emerging picture and to propose an interpretation of the formation of new higher education in physiotherapy, considered the actions and voices of professionals in this area that militate for education and where the training should go in the invention of worlds (of technology, work, social relations, science, health clinic). The design methodology used to conduct research was a study of case. Sough, as key actors, professionals of physiotherapy, working in the construction of the National Curriculum Guidelines, based on the experts in teaching physiotherapy related to the commission of experts in the Department of Higher Education of the Ministry of Education, between 1997 and 1999, and Brazilian Association of Education in Physiotherapy, since 1999. In the construction of these curriculum guidelines, sought the knowledge of the relationships and interconnections caused by the area of physiotherapy with the great health area and desired changes in the work in interdisciplinary and multidisciplinary teams, the completeness of health care and ownership of the system Brazilian health. By doing the analysis of reported acts and voices, drew seven-movement categories: actions and connections of the actors, non-linear movements for curriculum transformation, dynamic systems in sharing with the broader health field, games of strength, the degree of uniqueness physiotherapy in an inventing themselves in the field of health social movement as a movement of invention of worlds and the emergence of reality. As a thesis, uncover/delineate changes in curriculum and its focus as a three-pole device. In this study, it was seen that the National Curriculum Guidelines configures a product/result of a collective composed of teachers, students and health professionals, members of networks of associations and movements that were intended to break with the established model or the traditional model, seeking possibilities of change for completeness in health care, work in multidisciplinary teams of health and consistent training and development with the principles of the Unified Health System Innovations should provide integration between health and education in vocational training higher education and participation in health care demands of society. The network configuration and associative movement in the profession and belief formed transverse cross. The National Curriculum Guidelines/physiotherapy show an emergency actors of education/teaching physiotherapy and processes engaged in efforts to recognize the profession in the health team, in a system of universal health care practices and the ability of caregivers not limited to rehabilitation. / Esta tese tiene como objeto de estudio la comprensión de la "emergência de realidades"en la enseñanza superior de la salud, según la singularidad del area de la fisioterapia, mediante sus actos y voces en las "Diretrizes Curriculares Nacionais". Comprendí haber organizado un movimiento social entre el debate de las "diretrizes curriculares". En el encuentro con profesionales de la fisioterapia, busqué saber en que momento emergió para esta profesión la posibilidad de cambios- sob la forma de las "Diretrizes Curriculares Nacionais"- en el saber-hacer-enseñar fisioterapeutico. Utilizo de la ciencia de la complexidad y de la teoria de las realidades emergentes, para proponer una imagen y interpretación de la conformación de novedades en la enseñanza superior de la fisioterapia considerados los actos y las voces de profesionales de esa area que luchan por la educación y por el lugar que la formación debe tener en la invención de mundos (de la técnica, del trabajo, de las relaciones sociales, de la ciencia y de la clínica en salud). El delineamiento metodológico utilizado para la realización de la investigación fue el estudio de caso. Busqué como actores principales, profesionales del area de la fisioterapia, actuantes en la construcción de las "Diretrizes Curriculares Nacionais", partiendo de los especialistas en la enseñanza de fisioterapia ligados a la comisión de especialistas en la " Secretaria do Ensino Superior do Ministério da Educacão" entre 1997 y 1999 y la "Associacão Brasileira de Ensino em Fisioterapia", a partir de 1999. En la contrucción de esas "diretrizes curriculares" busqué el conocimiento de las relaciones e interconexiones provocadas por el area de la fisioterapia junto a la gran area de la salud y las transformaciones deseadas en el trabajo en equipo multiprofesionales e interdiciplinares, de la integralidad de la atención en la salud y de la apropriación del sistema brasileño de salud. Al analizar el relato de actos y voces, dibujé siete categorias-movimiento:acciones y conexiones de los actores; movimientos no lineares para la transformación curricular; sistemas dinámicos compartidos con la gran area de la salud; juegos de fuerza; la singularidad de la graduación en fisioterapia en un "inventar"en el campo de la salud; movimiento social como movimiento de invención de mundos y la emergencia de realidades. Como tese, descubro los cambios curriculares y sus focos como un dispositivo a tres polos. En ese estudio se percebió que las "Diretrizes Curriculares Nacionais" configuraran un producto/resultado de un colectivo compuesto por docentes, estudiantes y profesionales de la salud, integrantes de redes y del movimiento de asociaciones favorables al rompimiento como el modelo instituido o modelo tradicional, que buscaban posibilidades de cambios para la integralidad en atención a la salud, el trabajo en equipos multiprofesionales de salud y la consonancia de formación y del desarrollo con los principios del "Sistema Único de Saúde". Las inovaciones deberian propiciar la integración entre educación y salud en la formación profesional de la educación superior y su participación en la atención a las demandas de salud de la sociedad. La configuración en red y el movimiento asociativo constituyeron convicciones en la profesión y trasversalidad interprofesional. Las "Diretrizes Curriculares Nacionais/fisioterapia"muestran una emergencia como actores de la educación/enseñanza de fisioterapia que trabajan en procesos y esfuerzos y reconocimiento de la profesión en el equipo de la salud, en un sistema de aceso universal a la salud y en la capacidad de prácticas cuidadoras no limitadas a la reabilitación.

As escolas médicas brasileiras encontram-se diante do desafio de mudar para formar protissional crítico, capaz de aprender a aprender, de trabalhar em equipe, de levar em conta a realidade social para prestar atenção humana e de qualidade. As mudanças necessárias são profundas porque implicam a transformação de concepções, práticas e de relações de poder, tanto nos espaços internos das universidades, como em suas relações com a sociedade, especialmente como os serviços de saúde e com a população. O objetivo deste estudo foi analisar algumas das principais causas das sucessivas histórias de resultados desfavoráveis nas tentativas de mudar a educação médica; analisar como essas questões e problemas cruciais vêm sendo tratados em dois processos de mudança na educação médica atualmente considerados promissores, quais sejam as transformações curriculares de Marília e de Londrina; e construir um conjunto de idéias, propostas e instrumentos que contribuam para a produção de mudanças efetivas na educação médica no Brasil. A metodologia adotada foi a de estudo de caso informado pelo referencial crítico-dialético. Foi feita uma análise política dos processos, assumindo o poder como categoria analítica central. Nos dois casos estudados estão em curso mudanças profundas no âmbito da organização institucional, das concepções e das práticas, bem como das relações entre professores, estudantes, profissionais dos serviços e população. Há avanços significativos, mas também problemas e conflitos, níveis diferentes de acumulação de poder técnico e político, sendo necessário um período de consolidação. / Brazilian medical schools have to face the challenge of changing so as to graduate professionals capable of critical and self conducted learning, of working in teams, of taking social reality into account in the clinical practice and of delivering health attention of good quality. Deep changes will be necessary as conceptions, practices and of relations of power inside and outside the university have to be addressed. This study meant to analyze the main causes of the previous unsuccessful experiences of changes in medical education in Brazil; to analyze how the identified critical questions are being dealt in two changing processes that are taking place in Marília and Londrina and build a set of ideals, proposals and tools that can be useful for changing medical education in Brazil. The adopted methodology was a case study orientated through the critical-dialectic reference. A political analysis was made, taking power as the central analytical category. Both of the studied cases reveal deep changes in the fields of institutional organization, conceptions and practices and relations between faculties, students, health professionals and people. Both groups present relevant results, but also problems and conflicts and different leveis of technical and political power accumulation, what makes necessary a consolidation phase to take place.

Esta tese teve como objeto de estudo a compreensão da emergência de realidades no ensino superior da saúde, segundo a singularidade da área de fisioterapia, mediante seus atos e vozes nas Diretrizes Curriculares Nacionais. Entendi ter-se organizado um movimento social por entre o debate das diretrizes curriculares. No encontro com profissionais da fisioterapia, procurei saber em que momento emergiu para esta profissão a possibilidade de mudança – sob a forma das Diretrizes Curriculares Nacionais – no saber-fazer-ensinar fisioterapêutico. Uso um movimento social por entre o debate das diretrizes curriculares. No encontro com profissionais da fisioterapia, procurei saber em que momento emergiu para esta profissão a possibilidade de mudança – sob a forma das Diretrizes Curriculares Nacionais – no saber-fazer-ensinar fisioterapêutico. Uso da ciência da complexidade e da teoria das realidades emergentes, para propor uma imagem e interpretação da conformação de novidades no ensino superior da fisioterapia, considerados os atos e as vozes de profissionais dessa área que militam pela educação e pelo lugar que a formação deve tomar na invenção de mundos (da técnica, do trabalho, das relações sociais, da ciência, da clínica em saúde). O delineamento metodológico utilizado para a realização da investigação foi o estudo de caso. Busquei, como atores-chave, profissionais da área da fisioterapia, atuantes na construção das Diretrizes Curriculares Nacionais, partindo dos especialistas no ensino de fisioterapia ligados à comissão de especialistas na Secretaria do Ensino Superior do Ministério da Educação, entre 1997 e 1999, e à Associação Brasileira de Ensino em Fisioterapia, a partir de 1999. Na construção dessas diretrizes curriculares, procurei o conhecimento das relações e interconexões provocadas pela área da fisioterapia junto à grande área da saúde e às transformações desejadas no âmbito do trabalho em equipes multiprofissionais e interdisciplinares, da integralidade da atenção em saúde e da apropriação do sistema de saúde brasileiro. Ao fazer a análise do relato de atos e vozes, desenhei sete categorias-movimento: ações e conexões dos atores; movimentos não lineares para a transformação curricular; sistemas dinâmicos no compartilhamento com a grande área da saúde; jogos de força; a singularidade da graduação em fisioterapia em um inventar-se no campo da saúde; movimento social como movimento de invenção de mundos e a emergência de realidade. Como tese, des-cubro/delineio as mudanças curriculares e seus focos como um dispositivo a três polos. Neste estudo, vislumbrou-se que as Diretrizes Curriculares Nacionais configuraram um produto/resultado de um coletivo composto por docentes, estudantes e profissionais de saúde, integrantes de redes e do movimento de associações que se propunham ao rompimento com o modelo instituído ou modelo tradicional, que buscavam possibilidades de mudança para a integralidade na atenção à saúde, o trabalho em equipes multiprofissionais de saúde e a consonância da formação e do desenvolvimento com os princípios do Sistema Único de Saúde. As inovações deveriam propiciar a integração entre educação e saúde na formação profissional da educação superior e sua participação na atenção às demandas de saúde da sociedade. A configuração em rede e o movimento associativo constituíram convicção na profissão e transversalidade interprofissional. As Diretrizes Curriculares Nacionais/Fisioterapia mostram uma emergência com atores da educação/ensino de fisioterapia engajados em processos e esforços de reconhecimento da profissão na equipe de saúde, em um sistema de acesso universal à saúde e na capacidade de práticas cuidadoras não limitadas à reabilitação. / This thesis aims to study to understand of the emergence of higher education in the realities of health, according to the singularity of the area of physiotherapy, through their actions and voices in the National Curriculum Guidelines. Understood to have an organized social movement among the discussion of curriculum guidelines. At the meeting with professional physiotherapy, I sought to know when this profession emerged to the possibility of change - in the form of the National Curriculum Guidelines - know-how-to-teach physiotherapy. Using the science of complexity theory and the realities of the emerging picture and to propose an interpretation of the formation of new higher education in physiotherapy, considered the actions and voices of professionals in this area that militate for education and where the training should go in the invention of worlds (of technology, work, social relations, science, health clinic). The design methodology used to conduct research was a study of case. Sough, as key actors, professionals of physiotherapy, working in the construction of the National Curriculum Guidelines, based on the experts in teaching physiotherapy related to the commission of experts in the Department of Higher Education of the Ministry of Education, between 1997 and 1999, and Brazilian Association of Education in Physiotherapy, since 1999. In the construction of these curriculum guidelines, sought the knowledge of the relationships and interconnections caused by the area of physiotherapy with the great health area and desired changes in the work in interdisciplinary and multidisciplinary teams, the completeness of health care and ownership of the system Brazilian health. By doing the analysis of reported acts and voices, drew seven-movement categories: actions and connections of the actors, non-linear movements for curriculum transformation, dynamic systems in sharing with the broader health field, games of strength, the degree of uniqueness physiotherapy in an inventing themselves in the field of health social movement as a movement of invention of worlds and the emergence of reality. As a thesis, uncover/delineate changes in curriculum and its focus as a three-pole device. In this study, it was seen that the National Curriculum Guidelines configures a product/result of a collective composed of teachers, students and health professionals, members of networks of associations and movements that were intended to break with the established model or the traditional model, seeking possibilities of change for completeness in health care, work in multidisciplinary teams of health and consistent training and development with the principles of the Unified Health System Innovations should provide integration between health and education in vocational training higher education and participation in health care demands of society. The network configuration and associative movement in the profession and belief formed transverse cross. The National Curriculum Guidelines/physiotherapy show an emergency actors of education/teaching physiotherapy and processes engaged in efforts to recognize the profession in the health team, in a system of universal health care practices and the ability of caregivers not limited to rehabilitation. / Esta tese tiene como objeto de estudio la comprensión de la "emergência de realidades"en la enseñanza superior de la salud, según la singularidad del area de la fisioterapia, mediante sus actos y voces en las "Diretrizes Curriculares Nacionais". Comprendí haber organizado un movimiento social entre el debate de las "diretrizes curriculares". En el encuentro con profesionales de la fisioterapia, busqué saber en que momento emergió para esta profesión la posibilidad de cambios- sob la forma de las "Diretrizes Curriculares Nacionais"- en el saber-hacer-enseñar fisioterapeutico. Utilizo de la ciencia de la complexidad y de la teoria de las realidades emergentes, para proponer una imagen y interpretación de la conformación de novedades en la enseñanza superior de la fisioterapia considerados los actos y las voces de profesionales de esa area que luchan por la educación y por el lugar que la formación debe tener en la invención de mundos (de la técnica, del trabajo, de las relaciones sociales, de la ciencia y de la clínica en salud). El delineamiento metodológico utilizado para la realización de la investigación fue el estudio de caso. Busqué como actores principales, profesionales del area de la fisioterapia, actuantes en la construcción de las "Diretrizes Curriculares Nacionais", partiendo de los especialistas en la enseñanza de fisioterapia ligados a la comisión de especialistas en la " Secretaria do Ensino Superior do Ministério da Educacão" entre 1997 y 1999 y la "Associacão Brasileira de Ensino em Fisioterapia", a partir de 1999. En la contrucción de esas "diretrizes curriculares" busqué el conocimiento de las relaciones e interconexiones provocadas por el area de la fisioterapia junto a la gran area de la salud y las transformaciones deseadas en el trabajo en equipo multiprofesionales e interdiciplinares, de la integralidad de la atención en la salud y de la apropriación del sistema brasileño de salud. Al analizar el relato de actos y voces, dibujé siete categorias-movimiento:acciones y conexiones de los actores; movimientos no lineares para la transformación curricular; sistemas dinámicos compartidos con la gran area de la salud; juegos de fuerza; la singularidad de la graduación en fisioterapia en un "inventar"en el campo de la salud; movimiento social como movimiento de invención de mundos y la emergencia de realidades. Como tese, descubro los cambios curriculares y sus focos como un dispositivo a tres polos. En ese estudio se percebió que las "Diretrizes Curriculares Nacionais" configuraran un producto/resultado de un colectivo compuesto por docentes, estudiantes y profesionales de la salud, integrantes de redes y del movimiento de asociaciones favorables al rompimiento como el modelo instituido o modelo tradicional, que buscaban posibilidades de cambios para la integralidad en atención a la salud, el trabajo en equipos multiprofesionales de salud y la consonancia de formación y del desarrollo con los principios del "Sistema Único de Saúde". Las inovaciones deberian propiciar la integración entre educación y salud en la formación profesional de la educación superior y su participación en la atención a las demandas de salud de la sociedad. La configuración en red y el movimiento asociativo constituyeron convicciones en la profesión y trasversalidad interprofesional. Las "Diretrizes Curriculares Nacionais/fisioterapia"muestran una emergencia como actores de la educación/enseñanza de fisioterapia que trabajan en procesos y esfuerzos y reconocimiento de la profesión en el equipo de la salud, en un sistema de aceso universal a la salud y en la capacidad de prácticas cuidadoras no limitadas a la reabilitación.

This qualitative study explored traditional healers’ perceptions on collaborating with bio medical professionals. Purposive sampling was used to select study participants, and individual in-depth interviews were used to collect data. Thematic data analysis was conducted. The main findings of the study were that healers are very popular and highly respected amongst African communities. Traditional healers experienced mistrust and disrespect by biomedical health professionals who demonstrated ignorance on traditional medicine. Lack of motivation, incentives and financial support to conduct collaboration activities was another key finding including lack of clear policies and management structures for collaboration. Due to concern for their patients, healers resorted to practising covert collaboration such as not using official referral slips. Positively, healers experienced transformation in terms of knowledge gained from the training on basic HIV-TB epidemiology. There was clear evidence of high ethical practices amongst healers where they put their patients’ welfare ahead of their business interests / Health Studies / M.A. (Public Health)

Plusieurs études ont montré que la collaboration interprofessionnelle (CIP) produit des retombées positives pour les usagers, les professionnels de la santé et les organisations de soins. Cependant, les chercheurs estiment que son adoption dans les organisations et les services de santé est insuffisante. Cette situation conduit à des conflits souvent nuisibles entre les professionnels, à des erreurs médicales, à une augmentation des coûts de soins de santé et à des taux de mortalité élevés. Il existe un besoin de recherche pour identifier les variables associées à la CIP, particulièrement dans le domaine de la santé mentale (SM). La présente thèse vise à combler les lacunes susmentionnées et à permettre d’approfondir les connaissances que nous avons à l’heure actuelle sur la CIP. Trois cent quinze (315) professionnels œuvrant dans les équipes interdisciplinaires de soins primaires (N=101) et spécialisés (N=214) de SM, localisées dans quatre réseaux locaux de services (RLS) du Québec, ont participé à l’étude. Plusieurs variables reconnues comme étant fortement associées à la CIP dans la littérature scientifique du domaine de la santé ont été prises en compte et catégorisées dans un cadre conceptuel inspiré du modèle de Bronstein (2003). Trois objectifs spécifiques ont été fixés, et chacun a fait l’objet d’un article scientifique. Le premier article visait à identifier les variables associées à la CIP dans les équipes interdisciplinaires de SM implantées dans les RLS. Des analyses de régression linéaire ont été effectuées. Cinq variables liées aux caractéristiques interpersonnelles (l’engagement affectif envers l'équipe, le climat d'équipe, l’autonomie de l'équipe, le partage et l’intégration des connaissances), une variable liée au rôle professionnel (l’identification multifocale) et une autre liée aux caractéristiques personnelles (l’âge) étaient associées à la CIP. Le deuxième article visait à identifier les profils de professionnels de la SM selon leurs perceptions de la CIP ainsi que les variables associées pouvant les différencier. À l'aide de l’analyse typologique, quatre profils de professionnels en SM ont été identifiés. Deux profils présentaient un niveau élevé de perception de la CIP, un profil présentait un niveau moyen et un autre présentait un niveau faible. Le support organisationnel, la participation à la prise de décisions, la confiance mutuelle, l’engagement affectif envers l’équipe, les croyances aux bénéfices de la collaboration interdisciplinaire, le partage et l’intégration des connaissances étaient associés aux profils ayant des scores élevés de la CIP. Enfin, le troisième article a porté sur la comparaison des variables associées à la CIP selon le contexte de soins, à savoir : les soins primaires de SM (SP-SM) et les services spécialisés. Deux modèles de régression multivariée ont été réalisés, et ont permis d’identifier les variables significativement associées à chacun des contextes. Il s’agit du partage des connaissances pour les équipes de SP-SM, du soutien organisationnel et de l’âge pour les services spécialisés. Au regard de ce qui précède, des recommandations ont été formulées à l’intention des gestionnaires des services de SM, aux CSSS et organisations de soins. / Studies have shown that interprofessional collaboration (IPC) has a positive impact on service users, health professionals and healthcare organizations. However, researchers believe that the adoption of IPC in organizations and health services is insufficient, leading to conflict among professionals, medical errors, increased costs of care and higher mortality rates. While IPC has emerged over the past several years as a best practice, research is needed to identify variables associated with IPC, particularly in mental health (MH) which has received relatively little attention. The present thesis aims to fill these gaps and to deepen the present state of knowledge about IPC, particularly in the MH field. Three hundred and fifteen (315) MH professionals working in interdisciplinary primary care teams (N = 101) and specialized MH teams (N = 214) located in four Quebec local service networks (RLS) participated in the study. Many of the variables recognized as strongly associated with IPC in the health sciences literature, were integrated and categorized within a conceptual framework inspired by the Bronstein model (2003). Three specific study objectives were established, with each one the subject of a scientific article. The first article aimed to identify variables associated with IPC in interdisciplinary MH teams. Linear regression analyzes were performed. Five variables related to interpersonal characteristics (emotional commitment to the team, team climate, team autonomy, knowledge sharing and integration), one variable related to professional role (identification multifocal) and another related to personal characteristics (age) were associated with IPC. The second article aimed to identify profiles of MH professionals according to their perception of IPC as well as other distinguishing variables. Using Cluster Analysis, four profiles of MH professionals were identified. Two profiles had high levels of IPC, one profile an average level, and the other profile a low level of IPC. Organizational support, participation in decision-making, mutual trust, emotional commitment to the team, belief in the benefits of IPC, knowledge sharing, and knowledge integration were associated with the profiles that revealed high IPC scores. By contrast, team conflicts were associated with the profile of MH professionals with the lowest IPC score. Finally, the third article focused on a comparison of IPC-related variables by care settings: primary health care (PHC) and specialized MH care. These two contexts of care differ in terms of their activities, clients served, the actors involved in care episodes of care and the roles of team members. Two multivariate regression models were performed, identifying the following variables as significantly associated with each of the care settings: knowledge sharing for PHC teams, and organizational support and age for specialized MH teams. Considering the above, recommendations have been made to managers, health and social service centers and care organizations for promoting IPC in interdisciplinary MH teams.

No description available.

Les Filles de la Charité de Saint Vincent de Paul sont arrivées au Panama en 1875 comme des exilées politiques, après avoir été expulsées du Mexique par son gouvernement, dont le Congrès avait voté contre la présence de toutes les congrégations religieuses dans le pays l'année précédente. Cinq ans après leur installation dans l'isthme, la Compagnie Universelle du Canal Français - sous la direction de Ferdinand de Lesseps - a commencé les travaux de construction d'un canal qui permettrait la navigation entre les océans Atlantique et Pacifique. L'entreprise serait un échec irrémédiable pour une variété de raisons, parmi lesquelles la condition désastreuse de la santé publique, et le gouvernement des États-Unis reprendra le projet d'ingénierie colossale et l'assainissement du pays. Les Filles de la Charité, qui ont été engagées par la Compagnie Universelle du Canal comme infirmières pour soigner les patients dans leurs hôpitaux, resteraient dans l'isthme au long des années épidémiques et élargiraient leur mission dans la mesure où l'ordre religieux continue d'avoir une forte présence au sein de la société panaméenne à ce jour. Le but principal de ce travail est de analyser un épisode précédemment inconnu de l'histoire autrement bien documentée de la construction du Canal de Panama: la contribution que cette congrégation a fait à la profession naissante d’infirmière pendant les pires années de la propagation des maladies infectieuses dans l'isthme, provoquée par la surpopulation des ouvriers du canal et l'ignorance de la cause et le remède de maladies épidémiques. C’est bien connu que la construction du canal a été possible grâce à la lutte contre le paludisme et l'éradication de la fièvre jaune, les maladies qui ont décimé la population au cours des 25 premières années du projet ; que des changements radicaux dans les conditions de santé publique ont été accomplies par les mesures mises en œuvre par le médecin de l'armée américaine le colonel William Crawford Gorgas ; mais la présence des Filles de la Charité dans les hôpitaux publics et privés dans la ville de Panama et de Colón pendant ce temps, tendant aux patients et exécutant les ordres du Dr Gorgas, est resté caché pour la plupart des publications sur le sujet. Peut-être que la découverte la plus importante qui a surgi des sources recherchées pour ce travail, est que la troisième grande maladie infectieuse que les médecins et leurs assistants ont combattu au cours de ces années a été la syphilis, qui a atteint des proportions épidémiques et était incurable durant cette période aussi. Le conflit créé par les patients syphilitiques et le traitement dont ils avaient besoin et le fait qu'ils ont reçu efficacement ce traitement des sœurs, qui ont été interdites par les règles de leur propre congrégation d'avoir contact avec eux, a culminé par le retrait des religieuses des hôpitaux, et la sécularisation et la professionnalisation des soins infirmiers au Panama. Les raisons pour lesquelles les sœurs dispensaient des soins aux patients syphilitiques durant les trente-trois ans qu’ils ont servi dans les hôpitaux de la nation, malgré et contre leur propre règle, résident dans leur piété et leur spiritualité, dont les détails seront examinés tout au long de cette thèse. Les contradictions qui, apparemment, résident dans l'aide des sœurs, qui peuvent être perçues à tort comme l'ambiguïté morale, fournissent un sujet précieux d'étude pour l'histoire de la religion de la région. Il faut souligner qu'un facteur déterminant dans cet épisode était le manque de règles juridiques qui caractérisent la pratique de la médecine jusqu'à la deuxième décennie du 20e siècle dans le Nord et l'Amérique latine. Ainsi, cette étude peut également contribuer au débat contemporain très opportun sur l'éthique des professionnels de la santé, et sur l'effet que peut avoir leur empathie dans le traitement de la maladie d'un patient..... / The Daughters of Charity of Saint Vincent de Paul arrived in Panama in 1875 as political exiles, after being expelled from Mexico by its Government, whose Congress had voted against the presence of all religious congregations in the country the previous year. Five years after their settling in the Isthmus, the Compagnie Universelle du Canal Français - under the direction of Ferdinand de Lesseps – began construction work for a canal that would allow navigation between the Atlantic and Pacific Oceans. The enterprise would fail irretrievably for a variety of reasons, among them the disastrous condition of public health, and the United States Government would take over the colossal engineering project and the country’s sanitation. The Daughters of Charity, who were hired by the Compagnie Universelle to nurse patients in their hospitals, would remain in the Isthmus throughout the epidemic years and would expand their mission to the extent that the religious order continues to have a strong presence within Panamanian society to this day.The main purpose of this work is to disclose a previously unknown episode of the otherwise well documented history of the construction of the Panama Canal: the contribution that this congregation made to the incipient nursing profession during the worst years of the spread of infectious diseases in the Isthmus, provoked by the overcrowding of the canal workers, the backwardness of the region and the ignorance of the cause and cure of epidemic diseases. It is public knowledge that the construction of the canal was possible due to the control of malaria and the eradication of yellow fever, the illnesses that decimated the population during the first 25 years of the project; that radical changes in public health conditions were accomplished by the measures implemented by US Army doctor Colonel William Crawford Gorgas; but the presence of the Daughters of Charity in public and private hospitals in Panama City and Colón during this time, tending to patients and carrying out Dr Gorgas’ orders, has remained hidden for the most part from publications on the subject.Perhaps the most significant discovery surging from the sources researched for this work, is that the third great infectious disease that the doctors and their assistants fought during these years was syphilis, which reached epidemic proportions and was incurable during this period too. The conflict created by the syphilitic patients and the treatment they required and the fact that they effectively received this treatment from the sisters, who were forbidden by the rules of their own congregation to have contact with them, culminated by the withdrawal of the nuns from the hospitals, and the secularization and professionalization of nursing in Panama. The reasons why the sisters provided care to syphilitic patients during the thirty-three years they served in the nation’s hospitals, despite and against their own Rule, reside in their piety and their spirituality, details of which will be examined throughout this dissertation. The contradictions that seemingly dwelled in the sisters’ aid, which may be wrongly perceived as moral ambiguity, provide a valuable subject of study for the history of religion of the region.It must be stressed that a determining factor in this episode was the lack of legal regulations that characterized the practice of Medicine until the second decade of the 20th Century in North and Latin America. Thus, this study may also contribute to the very timely, contemporary debate on the ethics of health professionals, and on the effect that their empathy may have in the cure of a patient’s illness...

Text in English with abstracts and keywords in English and Setswana / Aim: The purpose of the research was to determine the magnitude and factors associated with gestational diabetes mellitus (GDM), and to explore the experiences of gynaecologists/obstetricians and midwives in the monitoring and prevention of GDM- related adverse maternal outcomes in order to propose best practice guidelines which may be implemented to overcome the problem. Methods: A concurrent mixed methods design was used. Participants for the quantitative study were selected using systematic random sampling, with purposive sampling being used for the qualitative part of the study. A total of 2000 medical records were reviewed using a checklist, in addition to which 7 gynaecologists/obstetricians and 12 midwives were interviewed using an in-depth interview guide. Descriptive and inferential statistics were used for the quantitative part, while Colaizzi’s manual qualitative data analysis method wasused for the qualitative part of the study. Findings: The magnitude of GDM was found to be 2.2%. Age and family history of diabetes mellitus were found to be factors associated with GDM (at p < 0.001). Other factors such as obesity, previous GDM, previous history of fetal macrosomia and multiple gestations were identified by respondents as factors related with GDM. In addition, the study explored the experiences of health professionals (HPs) in the monitoring and prevention of adverse maternal outcomes related to GDM, with the results showing some differences in screening and diagnostic techniques. It was also shown that lifestyle modification (physical exercise, diet management) and medication were utilised for managing women with GDM. In this regard, all the HPs agreed that creating awareness is the best intervention for preventing GDM as well as its adverse maternal outcomes. Conclusions: The magnitude of GDM is increasing, and much needs to be done to draw attention to the burden that GDM places on the health of pregnant women and the public. Since GDM is not considered a public health problem, little is being done to monitor the condition and its adverse maternal outcomes. It is hoped that the best practice guidelines developed from this research study may assist in reducing the adverse maternal outcomes of GDM in Ethiopia / Maikaelelo: Lebaka la patlisiso e ne e le go tlhotlhomisa go nna teng le mabaka a a golaganeng le bolwetsi jwa sukiri jwa baimana (GDM), le go tlhotlhomisa maitemogelo a dingaka tsa malwetsi a basadi (gynaeologists/ obstetricians) le babelegisi mo go tlhokomeleng le go thibeleng ditlamorago tse di maswe mo baimaneng tse di amanang le GDM gore go tshitshinngwe dintlhakaelo tse di gaisang tse di ka diragadiwang go fenya bothata. Mekgwa: Go dirisitswe thadiso ya mekgwa e e tlhakantsweng. Banni-le-seabe ba thutopatlisiso e e lebelelang dipalopalo ba ne ba tlhophiwa go diriswa go tlhopha sampole ka go se latele thulaganyo, mme go tlhopha sampole ka maikaelelo go ne ga diriswa mo karolong ya thutopatlisiso e e lebelelang mabaka. Go sekasekilwe palogotlhe ya direkoto tsa kalafi tse 2 000 go diriswa lenanetshekatsheko, mme mo godimo ga moo, go ne ga nna le dipotsolotso le dingaka tsa malwetsi a basadi di le supa le babelegisi ba le 12 go diriswa kaedi ya dipotsolotso tse di tseneletseng. Dipalopalo tse di tlhalosang le tse go sweditsweng ka tsona di ne tsa diriswa mo karolong ya dipalopalo ya thutopatlisiso, fa go dirisitswe mokgwa wa ga Colaizi wa tokololo ya data ya mabaka mo karolong e e lebelelang mabaka. Diphitlhelelo: Go nna teng ga GDM go ne ga fitlhelwa e le 2.2%. Dingwaga le hisetori ya bolwetsi jwa sukiri ya baimana mo lelapeng di fitlhetswe e le dintlha tse di golaganeng le GDM (ka p < 0.001). Dintlha dingwe, jaaka go nona phetelela, GDM mo nakong e e fetileng, go nna teng ga macrosomia ya masea mo nakong e e fetileng le boimana jwa masea a feta bongwe di ne tsa supiwa ke batsibogi jaaka dintlha tse di golaganeng le GDM. Go tlaleletsa foo, thuto e ne ya sekaseka maitemogelo a baporofešenale ba boitekanelo (HPs) mo tlhokomelong le thibelo ya ditlamorago tse di sa siamang mo baimaneng tse di golaganeng le GDM, mme dipholo di bontshitse dipharologano dingwe mo dithekeniking tsa go sekirina le go phekola. Go bonagetse gape gore phetolo ya mokgwa wa botshelo (katiso ya mmele, tsamaiso ya mokgwa wa go ja) le kalafi di ne tsa diriswa go laola bolwetsi jwa basadi ba ba nang le GDM. Mo lebakeng le, baporofešenale botlhe ba boitekanelo ba ne ba dumelana gore go dira temoso ke tsereganyo e e gaisang ya go thibela GDM ga mmogo le ditlamorago tsa yona tse di sa siamang mo baimaneng. Ditshwetso: Go nna teng ga GDM go a oketsega, mme go tshwanetse go dirwa go le gontsi go lemosa ka mokgweleo o bolwetse jono bo o bayang mo boitekanelong jwa baimana le setšhaba. Ka ntlha ya gore GDM ga e kaiwe jaaka bothata jwa boitekanelo jwa setšhaba, ga go dirwe go le kalo go tlhokomela bolwetsi le ditlamorago tsa jona tse di sa siamang mo baimaneng. Go solofelwa gore dintlhakaelo tsa tiriso e e gaisang tse di dirilweng mo thutopatlisisong eno di ka thusa go fokotsa ditlamorago tse di sa siamang tsa GDM mo baimaneng kwa Ethiopia. / Health Studies / D. Litt. et Phil. (Public Health)