Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-09-05T14:20:03Z No. of bitstreams: 1 gersonvieiradepaulajunior.pdf: 1020180 bytes, checksum: aceb94e3cf8215752e2083fdbc573b14 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-09-06T14:25:17Z (GMT) No. of bitstreams: 1 gersonvieiradepaulajunior.pdf: 1020180 bytes, checksum: aceb94e3cf8215752e2083fdbc573b14 (MD5) / Made available in DSpace on 2016-09-06T14:25:17Z (GMT). No. of bitstreams: 1 gersonvieiradepaulajunior.pdf: 1020180 bytes, checksum: aceb94e3cf8215752e2083fdbc573b14 (MD5) Previous issue date: 2013-10-21 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Compreender os processos implicados na inclusão da violência doméstica na agenda do setor saúde é importante para a formulação e implementação de políticas e projetos de intervenção. Sendo assim, buscou-se investigar crenças de gestores de saúde sobre violência doméstica. Foram realizados dois estudos em municípios de uma microrregião de Minas Gerais: um com 16 secretários municipais de saúde e outro com 19 coordenadores municipais da Estratégia Saúde da Família. Os dados foram coletados por meio de entrevista individual semiestruturada e tratados através da análise de conteúdo. Segundo os gestores, consumo de álcool, consumo de drogas ilícitas, falta de estrutura e de planejamento familiar, falta de diálogo e o modo e ritmo de vida atual / estresse cotidiano são os principais fatores geradores dos vários tipos de violência doméstica. Os coordenadores municipais da Estratégia Saúde da Família ressaltaram também o fator baixa renda. Além desses, os gestores de ambos os grupos destacaram outros fatores relacionados a situações mais específicas: forma como os pais foram criados e cultura da violência como forma de educar (violência doméstica contra crianças); rebeldia dos adolescentes e falta de habilidades dos pais para lidar com eles (violência doméstica contra adolescentes); falta de paciência de familiares / cuidadores e interesse em cuidar do idoso apenas pelo dinheiro dele (violência doméstica contra idosos); traição e ciúmes (violência entre parceiros íntimos). A prevenção da violência como papel do setor saúde foi mais destacada pelo grupo de secretários municipais de saúde. As dificuldades para intervenção mais ressaltadas foram: vítimas não relatam a violência, pouca participação da comunidade, recurso financeiro insuficiente, pouca articulação intersetorial e ausência de política específica. A sobrecarga de trabalho foi mais enfatizada pelos coordenadores da Estratégia Saúde da Família. Os gestores se mostraram preocupados e sensibilizados com a questão da violência doméstica, mas as ações ainda são pontuais. Os resultados assinalam a presença do modelo biomédico permeando o setor saúde. Conclui-se que a abordagem da violência doméstica apresenta-se como um desafio para o setor saúde. Recomenda-se maior enfoque desse assunto na formação e educação continuada dos profissionais, bem como formulação de políticas mais específicas. / Understanding the processes involved in the inclusion of domestic violence on the agenda of the health sector is important for the formulation and implementation of policies and intervention projects. Therefore, this paper sought to investigate the beliefs of health managers on domestic violence. Two studies were conducted in the municipalities of a micro region of Minas Gerais, one with 16 municipal health managers and another with 19 municipal coordinators of the “Family Health Strategy”. Data was collected through semi structured individual interviews and processed through the content analysis. According to managers of both groups, alcohol consumption, illicit drug use, lack of structure and of family planning, lack of dialogue and the manner and pace of current life/day-by-day stress are the main factors leading to various types of domestic violence. Municipal coordinators of the “Family Health Strategy” also highlighted the low income factor. Besides these, managers of both groups highlighted other factors related to specific situations: how parents were raised and the culture of violence as a mean of education (domestic violence against children); adolescent rebelliousness and lack of parenting skills in order to deal with them (domestic violence against teenagers); lack of patience from family/caregivers and interest in taking care of the elderly only for the money (domestic violence against the elderly); betrayal and jealousy (intimate partner violence). The prevention of violence as one of the roles of the health sector was more highlighted in the group of municipal health managers. The difficulties for further intervention were highlighted as: victims do not report the violence, little community involvement, insufficient financial resources, poor intersectoral coordination and absence of a specific policy. The workload was further emphasized by the coordinators of the “Family Health Strategy”. Managers were concerned and sensitized about the issue of domestic violence, but the actions to prevent it are still sporadic. The results indicate the presence of the biomedical model permeating the health sector. It is concluded that the approach to domestic violence is presented as a challenge for the health sector. It is recommended a greater focus on this issue when training and continuing education of professionals as well as the formulation of a more specific policy.

Magister Public Health - MPH / Background: Actions on addressing the social determinants of health are necessary for reducing health inequities and improving health outcomes. These actions can, however, fall outside the scope of the health sector alone and require collaborative actions across sectors. Through the Western Cape Government’s stated commitment to following a whole-of-society approach to increase the wellness of people, this Province has committed to exploring intersectoral collaboration and action for health. This study is therefore aimed at exploring the experiences and perceptions of intersectoral collaboration and action for health amongst mid-level and frMethodology: The study design was qualitative and explorative in nature, using non-probability sampling to deliberately select study participants that were both relevant to the study and represented a diversity of views. Semi-structured interviews were conducted with seven health managers and non-participant observation of one intersectoral meeting was utilised to observe interactions that were relevant to the study. A thematic coding analysis approach was followed to inductively determine themes and analyse the data.ontline health managers working at the primary health care level in two sub-districts within the City of Cape Town, Western Cape Province. Results: Intersectoral collaboration for health at the primary health care level tends to take the form of collaborations between government departments, between the department of health and non-governmental organisations, between the public and private health sectors and between the Department of Health and the communities it serves. These collaborations overwhelmingly focus on expanding health services provision rather than addressing the social determinants of health. Conclusion: The concept of intersectoral collaboration and partnerships at the primary health care level in two sub-districts of the City of Cape Town, Western Cape, is perceived by health managers as being critical in addressing the social determinants of health. In practice, however, intersectoral collaboration and partnerships tend to focus on expanding health service provision and have limited value for addressing social determinants of health.

Introdução Sendo a cárie dentária um grave problema de saúde pública para a maioria dos indivíduos que moram em países do hemisfério Sul e para as populações com baixo status socioeconômico dos países de capitalismo desenvolvido, advoga-se o uso do flúor em saúde pública, como medida preventiva. Objetivo Descrever as percepções e opiniões dos delegados à 13ª Conferência Nacional de Saúde sobre o uso do flúor em saúde pública, com foco na fluoretação das águas de abastecimento público. Método - Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semiestruturados e analisados por meio da análise do discurso. Resultados Constatou-se desinformação dos delegados no tocante a vários aspectos do uso do flúor em saúde pública e os mesmos sentem necessidade de meios de divulgação efetivos sobre a água para consumo e sobre os níveis de flúor da água. Considerações Finais - Ideias equivocadas ou lacunas de conhecimento acerca de vários aspectos do uso do flúor em saúde pública revelam a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados, aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e os mecanismos utilizados no controle social / Introducion - As tooth decay a serious public health problem for most residents of countries of the southern hemisphere and for populations of low socioeconomic status in developed capitalist countries, the use of fluoride in public health is advocated as a preventive measure. Objective - To describe the perceptions of the delegates to the 13th National Health Conference on the use of fluorides in public health, focusing on the fluoridation of public water supplies. Method - An exploratory and descriptive research was performed with a qualitative approach and utilizing as the processing technique of statements the Discourse of the Collective Subject (DCS). A total of 310 participants responded. The data was collected using semi-structured questionnaires and analysed by the discourse analysis method. Results - Misinformation of the delegates concerning several of the use of fluoride in public health and the need of these delegates for effective means of disseminating information on water suitable for consumption and the levels of fluoride in water was found. Final Considerations - Erroneous ideas and knowledge gaps regarding the various aspects of the use of fluoride in public health underscore the need to improve societys level of understanding of questions relating to water fluoridation. The lack of knowledge of delegates, together with the data available in the literature on the defective monitoring and control of fluoride levels in the water, indicates the need to further evaluate the role of the social actors and the mechanisms used in the societal control

Introdução Sendo a cárie dentária um grave problema de saúde pública para a maioria dos indivíduos que moram em países do hemisfério Sul e para as populações com baixo status socioeconômico dos países de capitalismo desenvolvido, advoga-se o uso do flúor em saúde pública, como medida preventiva. Objetivo Descrever as percepções e opiniões dos delegados à 13ª Conferência Nacional de Saúde sobre o uso do flúor em saúde pública, com foco na fluoretação das águas de abastecimento público. Método - Realizou-se pesquisa exploratória, descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). Ao todo, foram 310 respondentes. Os dados foram coletados por meio de questionários semiestruturados e analisados por meio da análise do discurso. Resultados Constatou-se desinformação dos delegados no tocante a vários aspectos do uso do flúor em saúde pública e os mesmos sentem necessidade de meios de divulgação efetivos sobre a água para consumo e sobre os níveis de flúor da água. Considerações Finais - Ideias equivocadas ou lacunas de conhecimento acerca de vários aspectos do uso do flúor em saúde pública revelam a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados, aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e os mecanismos utilizados no controle social / Introducion - As tooth decay a serious public health problem for most residents of countries of the southern hemisphere and for populations of low socioeconomic status in developed capitalist countries, the use of fluoride in public health is advocated as a preventive measure. Objective - To describe the perceptions of the delegates to the 13th National Health Conference on the use of fluorides in public health, focusing on the fluoridation of public water supplies. Method - An exploratory and descriptive research was performed with a qualitative approach and utilizing as the processing technique of statements the Discourse of the Collective Subject (DCS). A total of 310 participants responded. The data was collected using semi-structured questionnaires and analysed by the discourse analysis method. Results - Misinformation of the delegates concerning several of the use of fluoride in public health and the need of these delegates for effective means of disseminating information on water suitable for consumption and the levels of fluoride in water was found. Final Considerations - Erroneous ideas and knowledge gaps regarding the various aspects of the use of fluoride in public health underscore the need to improve societys level of understanding of questions relating to water fluoridation. The lack of knowledge of delegates, together with the data available in the literature on the defective monitoring and control of fluoride levels in the water, indicates the need to further evaluate the role of the social actors and the mechanisms used in the societal control

Le système de santé est traversé aujourd’hui par une tension forte entre deux logiques : l’une privilégie, dans la tradition humaniste, le soin inconditionnel à la personne, l’autre privilégie, au nom d’impératifs de gestion, le management au service de l’efficacité productive hospitalière. Placé au cœur d’une organisation complexe, le cadre de santé semble ainsi condamné à un mouvement de balancier entre une « culture-santé » et une « culture-entreprise », ce qui lui confère un positionnement professionnel délicat au sein de l’institution. Comment se positionne-t-il et vers quoi évolue-t-il ? Nous montrerons que ces acteurs sont en tension et fortement clivés entre une idéologie humaniste et une idéologie gestionnaire, à la recherche de leur identité qui semble désormais problématique. Héritier d’une histoire et positionné dans un entre-deux, il se cherche. Comment concilie-t-il concrètement ces deux logiques dans son quotidien ? En quête d’un modèle lui permettant de résister aux pressions gestionnaires, il adopte une « posture d’accompagnement », se reconstruit ainsi à partir de compétences pédagogiques dans un espace informel, pour créer un antidote au management technicien et réintroduire ainsi un équilibre identitaire. Leurs capacités réflexives renforcent leur posture d’accompagnement et constituent alors un moyen efficace pour dépasser les tensions institutionnelles entre soin et management. Une formation en Sciences Humaines et Sociales, au service de leur développement personnel et professionnel, stabilise leur système de valeurs et leur permet de reconquérir une possible identité. / The French health-care system is currently faced with tensions arising from two different visions of health-care: the first one focuses on the unconditional care given to the patient in accordance with the humanistic tradition. The second one focuses on management priorities aiming for an efficient and productive management of hospitals. At the heart of a complex organizational structure lie the health managers, whose roles inevitably shift back and forth between a ‘company culture’ vision and that of ‘health-care culture’, thereby jeopardizing their professional position. Where do health managers stand and what is their future role? The aim of this study is to show the difficulties of juggling the humanistic tradition with the management-based approach and defining their identity. Health managers often find themselves in overlapping positions and strive to combine and apply the two visions in their work on a daily basis. In need of a model to resist management pressures, they act as a ‘support function’. This support stance helps them redefine their position and balances out the negative effects of technical management in health-care. The ability to look back on their own experience reinforces this support function and allows them to overcome the tensions arising from the cleavage between health-care and management. Providing health managers with a specific training in social and human sciences for their personal and professional development would strengthen their ethical values and allow them to regain control of their identity.