Yes / Background: Online communities hold great potential as interventions for health, particularly for the management of chronic illness. The social support that online communities can provide has been associated with positive treatment outcomes, including medication adherence. There are few studies that have attempted to assess whether membership of an online community improves health outcomes using rigorous designs. Objective: Our objective was to conduct a rigorous proof-of-concept randomized controlled trial of an online community intervention for improving adherence to asthma medicine. Methods: This 9-week intervention included a sample of asthmatic adults from the United Kingdom who were prescribed an inhaled corticosteroid preventer. Participants were recruited via email and randomized to either an “online community” or “no online community” (diary) condition. After each instance of preventer use, participants (N=216) were required to report the number of doses of medication taken in a short post. Those randomized to the online community condition (n=99) could read the posts of other community members, reply, and create their own posts. Participants randomized to the no online community condition (n=117) also posted their medication use, but could not read others’ posts. The main outcome measures were self-reported medication adherence at baseline and follow-up (9 weeks postbaseline) and an objective measure of adherence to the intervention (visits to site). Results: In all, 103 participants completed the study (intervention: 37.8%, 39/99; control: 62.2%, 64/117). MANCOVA of self-reported adherence to asthma preventer medicine at follow-up was not significantly different between conditions in either intention-to-treat (P=.92) or per-protocol (P=.68) analysis. Site use was generally higher in the control compared to intervention conditions. Conclusions: Joining an online community did not improve adherence to preventer medication for asthma patients. Without the encouragement of greater community support or more components / Funded by a pilot grant from the University of Leeds School of Psychology. A Fulbright Scholarship from the US-UK Fulbright Commission supported the first author

Investeringarna i Sverige inom folkhälsa genomförs på flera nivåer; både på regional och lokal nivå. Dessa investeringar genomförs av landsting och deras respektive kommuner. Folkhälsoarbetet är under ständig utveckling, även i Sörmland, där det sker en omorganisation där nya styrmetoder skapas. Syftet med studien var att studera styrning och organisation av folkhälsoarbetet i fem av kommunerna i Sörmland. För att besvara syftet med denna studie användes en kvalitativ metod där data samlades in med semistrukturerade intervjuer. Respondenterna i denna studie var fem strateger och samordnare från fem olika kommuner i Sörmland. Materialet analyserades med en manifest innehållsanalys. Resultatet som framkom var att de som arbetade med folkhälsofrågor i kommunerna har olika utbildning och erfarenhet. De flesta av dem arbetar 50 procent med folkhälsa, resterande procent med utredning och projektledning. Dessa betraktas som "vanliga uppgifter." Det finns ett folkhälsonätverk i Sörmland där kommunerna samarbetar vilket kan ses som samverkan. Respondenterna anser att politiken är ytterst ansvarig för folkhälsan och decentralisering förekommer i kommunerna. Alla kommuner använder planer och strategier; det varierar i hur evidensbaserat arbetet är och om omvärldsanalys genomförs. Detta genomförs dels genom nätverksmötena. På grund av folkhälsoarbetets organisering inom kommunerna, styrning och ansvarsfördelning mellan kommuner och politiker, samt hur uppföljning av folkhälsoarbetet ser ut så varierar förutsättningarna att förbättra folkhälsan i kommunerna. / In Sweden, investments in Public Health are conducted at several levels; both at the regional and the local level. These investments are conducted by the county council and their respective municipalities. Public health work is under constant development, as well as in Sörmland, where there is a reorganization in which new control methods are being discussed. The purpose of the study was to investigate the governance and organization of public health investments in five of the municipalities in Sörmland. To answer the purpose of this study , qualitative methods was used and data was collected by semi-structured interviews. The respondents in this study were five strategists and coordinators from five different municipalities in Sörmland. The material was analyzed by a manifest content analysis. The result that emerged was that public health workers in the municipalities have different educational backgrounds and experience. The majority of the public health workers work 50 percent in public health, and the rest in investigation and project management. These are regarded as “common tasks.” There is a public health network in Sörmland where municipalities work together which can be seen as cooperation. The respondents feel that the politicians are is ultimately responsible for the public health and decentralization is present in the municipalities. All municipalities use plans and policies; it differs in how evidence-based the work is, however social and environmental analyzes are carried out. This is carried out partly through networking meetings. Due to the organization of the public healthwork in the municipalities, control and allocation of responsibilities between municipalities and management, and the follow-up of public health-interventions makes it more or less effective when it comes to improving public health.

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-03-09T20:10:55Z No. of bitstreams: 2 Dissertação - Paulo de Alencar Monteiro Filho - 2015.pdf: 4580898 bytes, checksum: 33e64057727972599006284c69c140d4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-03-10T12:09:12Z (GMT) No. of bitstreams: 2 Dissertação - Paulo de Alencar Monteiro Filho - 2015.pdf: 4580898 bytes, checksum: 33e64057727972599006284c69c140d4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-03-10T12:09:12Z (GMT). No. of bitstreams: 2 Dissertação - Paulo de Alencar Monteiro Filho - 2015.pdf: 4580898 bytes, checksum: 33e64057727972599006284c69c140d4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-04-15 / The geography have increasingly been concerned to conduct a refined analysis of the socio-spatial relations, identifying and diagnosing problems in a heterogeneous society and simultaneously contribute to the planning and management of space. Thus, it is essential to understand how the relationships are aimed at establishing the quality of life of the population. In this sense the present study sought to interpret the public health of the city of Jataí (GO): its physical structure; management organization; polarizers points and their importance socio. For this research were adopted the following instruments: a literature review about the concepts of health networks; research before organs such as the Municipal Health Secretariat (SMS), Municipality of Jataí, Department of the Unified Health System (DATASUS), Brazilian Institute of Geography and Statistics (IBGE), among others. Semi-structured interviews covering the municipal manager were held, the technical and administrative Directions SMS; besides the use of questionnaires to sample form to health professionals of the Municipal Center Dr. Serafim de Carvalho. The analysis of municipal Jataí health revealed important information used to understand it. Initially there is the demographic question. The growth of population Jataiense brought new needs the sectors of public administration, especially in the health area. The increase in external causes such as violence, traffic and drug trafficking, combined with a structure not kept pace with population growth have made the viscous municipal and hospital-centered, culminating in a compulsory choking the Municipal Health Center Dr. Serafim de Carvalho. / A geografia têm se preocupado cada vez mais em realizar uma análise refinada das relações socioespaciais, identificando e diagnosticando os problemas de uma sociedade heterogênea e, simultaneamente contribuindo com o planejamento e gestão do espaço. Desta forma, torna-se fundamental compreender como se constituem as relações que visam estabelecer a qualidade de vida da população. Neste sentido o presente trabalho buscou interpretar a rede pública de saúde do município de Jataí (GO): sua estrutura física; organização de gestão; pontos polarizadores e sua importância socioespacial. Para esta pesquisa foram adotados os seguintes procedimentos metodológicos: revisão bibliográfica acerca dos conceitos de redes de saúde; investigação junto a órgãos como a Secretaria Municipal de Saúde (SMS), Prefeitura Municipal de Jataí, Departamento de Informática do Sistema Único de Saúde (DATASUS), Instituto Brasileiro de Geografia e Estatística (IBGE), entre outros. Foram realizadas entrevistas semiestruturadas abrangendo o Gestor municipal, as Direções técnica e administrativa do SMS; além da aplicação de questionários de forma amostral aos profissionais de saúde do Centro Médico Serafim de Carvalho. A análise da rede municipal de saúde de Jataí revelou importantes elementos que serviram para compreendê-la. Inicialmente destaca-se a questão demográfica. O crescimento da população jataiense trouxe consigo novas necessidades aos setores da administração pública, sobretudo na área de saúde. O aumento das causas externas como a violência, o trânsito e o tráfico de drogas, aliados a uma estrutura que não acompanhou o crescimento populacional tornaram a rede municipal viscosa e hospitalocentrica, culminando numa asfixia compulsória do Centro Municipal de Saúde.

O objeto do presente estudo são as práticas profissionais dos psicólogos na Saúde, em especial na atenção básica. Faz um mapeamento das atividades realizadas por essa categoria profissional na rede básica de saúde do Município do Rio de Janeiro. O estudo adota três premissas: (1) a necessidade de construção de práticas nos serviços públicos de saúde, que extrapolem a assistência psicoterápica individual (2) a inadequação da formação profissional do psicólogo para prepará-lo para atuar na rede pública de saúde e (3) o entendimento de que mudanças na formação e na prática profissionais podem ser concomitantes. O desenho da pesquisa é qualitativo e exploratório. Os métodos de pesquisa utilizados na coleta de dados foram: (1) observações; (2) entrevistas individuais com roteiros semi-estruturados e (3) questionário de caracterização profissional. O estudo teve como cenários os serviços de Psicologia da rede básica de saúde do Município do Rio de Janeiro, os Fóruns de Saúde Mental e as Supervisões de Território. Os sujeitos da pesquisa foram os gestores e os psicólogos de uma área programática (AP 5) escolhida para aprofundamento do estudo. Os dados foram analisados a partir da Análise de Conteúdo de Bardin. Estipulou-se três eixos analíticos a partir da análise do material coletado: (1) Desafios às práticas; (2) Relação formação-prática profissional e (3) Iniciativas de Educação Permanente. Os resultados evidenciam que os desafios à prática na rede básica de saúde encontram-se intrinsecamente relacionados à demanda de priorizar atendimentos à casos graves, contexto da Reforma Psiquiátrica; (2) a formação profissional do psicólogo precisa ser continuamente revista de modo a se adequar às necessidades do Sistema Único de Saúde e (3) os Fóruns de Saúde Mental e as Supervisões de Território caminham na direção das propostas de Educação Permanente, constituindo-se como espaços fundamentais para a discussão e a mudança do processo de trabalho do psicólogo na rede. Faz-se necessário a continuidade das discussões sobre a prática profissional do psicólogo na Saúde de modo a auxiliar na resolução das dificuldades encontradas no cotidiano de trabalho. / The object of this study are professional practices of psychologists in the Comprehensive Health Care System (SUS), particularly in primary care services. The study adopts three assumptions: (1) the need of developing new practices in the public health services that can go beyond the individual psychotherapeutic care (2) the inadequacy of Psychology graduate schools in preparing professionals to work in the public health system and (3) the understanding that changes in the education and professional practice can be concurrent. The design of the study is qualitative and exploratory. Research methods included: (1) participant observation, (2) individual semi-structured interviews (3) questionnaire axis occupational characterization. The setting were the psychology services of the primary health network in Rio de Janeiro, the Boards of Mental Health and the supervision of Territory. The research subjects were system managers and psychologists of a programatic area (AP 5.0). The data were analyzed from the content analysis of Bardin. Three analytical axis were set up:(1) Challenges to professional practices, (2) Training and professional practice relation (3) Permanent Education Initiatives. The results show that the challenges to the practices in the basic health network are intrinsically related to the demand of prioritizing the treatment care of the serious cases, an amendment of the Psychiatric context, (2) a trained and graduated psychologist needs to be continually revising its own training, in order to fit the needs of the Unified Health System (3) the Boards of Mental Health and Territory supervision are moving in the direction of the proposed Education Committee, creating these essential spaces for discussion and changes for the psychologist work process on its field. Its been necessary the continuity of the discussions on the professional practice of the psychologist in Health as a way to assist the resolution of the difficulties found in daily work.

O objeto do presente estudo são as práticas profissionais dos psicólogos na Saúde, em especial na atenção básica. Faz um mapeamento das atividades realizadas por essa categoria profissional na rede básica de saúde do Município do Rio de Janeiro. O estudo adota três premissas: (1) a necessidade de construção de práticas nos serviços públicos de saúde, que extrapolem a assistência psicoterápica individual (2) a inadequação da formação profissional do psicólogo para prepará-lo para atuar na rede pública de saúde e (3) o entendimento de que mudanças na formação e na prática profissionais podem ser concomitantes. O desenho da pesquisa é qualitativo e exploratório. Os métodos de pesquisa utilizados na coleta de dados foram: (1) observações; (2) entrevistas individuais com roteiros semi-estruturados e (3) questionário de caracterização profissional. O estudo teve como cenários os serviços de Psicologia da rede básica de saúde do Município do Rio de Janeiro, os Fóruns de Saúde Mental e as Supervisões de Território. Os sujeitos da pesquisa foram os gestores e os psicólogos de uma área programática (AP 5) escolhida para aprofundamento do estudo. Os dados foram analisados a partir da Análise de Conteúdo de Bardin. Estipulou-se três eixos analíticos a partir da análise do material coletado: (1) Desafios às práticas; (2) Relação formação-prática profissional e (3) Iniciativas de Educação Permanente. Os resultados evidenciam que os desafios à prática na rede básica de saúde encontram-se intrinsecamente relacionados à demanda de priorizar atendimentos à casos graves, contexto da Reforma Psiquiátrica; (2) a formação profissional do psicólogo precisa ser continuamente revista de modo a se adequar às necessidades do Sistema Único de Saúde e (3) os Fóruns de Saúde Mental e as Supervisões de Território caminham na direção das propostas de Educação Permanente, constituindo-se como espaços fundamentais para a discussão e a mudança do processo de trabalho do psicólogo na rede. Faz-se necessário a continuidade das discussões sobre a prática profissional do psicólogo na Saúde de modo a auxiliar na resolução das dificuldades encontradas no cotidiano de trabalho. / The object of this study are professional practices of psychologists in the Comprehensive Health Care System (SUS), particularly in primary care services. The study adopts three assumptions: (1) the need of developing new practices in the public health services that can go beyond the individual psychotherapeutic care (2) the inadequacy of Psychology graduate schools in preparing professionals to work in the public health system and (3) the understanding that changes in the education and professional practice can be concurrent. The design of the study is qualitative and exploratory. Research methods included: (1) participant observation, (2) individual semi-structured interviews (3) questionnaire axis occupational characterization. The setting were the psychology services of the primary health network in Rio de Janeiro, the Boards of Mental Health and the supervision of Territory. The research subjects were system managers and psychologists of a programatic area (AP 5.0). The data were analyzed from the content analysis of Bardin. Three analytical axis were set up:(1) Challenges to professional practices, (2) Training and professional practice relation (3) Permanent Education Initiatives. The results show that the challenges to the practices in the basic health network are intrinsically related to the demand of prioritizing the treatment care of the serious cases, an amendment of the Psychiatric context, (2) a trained and graduated psychologist needs to be continually revising its own training, in order to fit the needs of the Unified Health System (3) the Boards of Mental Health and Territory supervision are moving in the direction of the proposed Education Committee, creating these essential spaces for discussion and changes for the psychologist work process on its field. Its been necessary the continuity of the discussions on the professional practice of the psychologist in Health as a way to assist the resolution of the difficulties found in daily work.

This study seeks to provide information relevant to public policy that will lead to increased access and utilization among this vulnerable population and to reinforce the validity of the behavioral model for vulnerable populations. This study is a secondary analysis of data collected in a study that examined adult, working-aged patients within the John Peter Smith Health Network, which is a large, urban, tax supported county health care system in Fort Worth, Texas. From a sampling frame of 10,000 patients, the study analyzed data for 243 low-income, white, working-age males, collected from computer assisted telephone interviews in 2000. Cross-tabulations and bivariate logistic regressions were used to analyze the effect of 8 independent variables (age, marital status, insurance, employment status, a usual source of care, competing needs, experiences with paperwork, and perceived health status upon 5 dependent variables pertaining to unmet health care, unmet prescription medicine needs, unmet dental needs, utilization of doctors in emergency departments, and overnight hospital stays. The results show the safety net system is failing to meet the needs of this vulnerable population. The findings indicate white men who found it necessary to forgo health care due to other needs were almost five (4.973) times as likely as those who did not find it necessary to forgo care due to other needs, to report having a problem getting the health care that they need (p = ≤ .001). The odds of having a problem getting needed dental care are about 66% lower for white men who have private insurance through work compared to those who do not have private insurance through work (p ≤ .05).

O objetivo do estudo foi descrever e analisar as articulações que se realizam entre as equipes da Estratégia de Saúde da Família (ESF) e Centros de Atenção Psicossocial Infantojuvenil (CAPSi), tendo em vista as ações voltadas à atenção em saúde mental de crianças adolescentes. Além disso, visou-se conhecer os facilitadores e obstáculos encontrados no cotidiano do trabalho para sua efetivação; apreender a expectativa dos entrevistados sobre como elas deveriam ser; conhecer outras formas de apoio em saúde mental recebidas pelas equipes de SF. Para tanto, foram realizadas entrevistas semi-dirigidas com gerentes, ou outro profissional por ele indicado, de 5 CAPSi e 13 Unidades Básicas de Saúde com equipes de SF, de cinco regiões distintas no município de São Paulo, totalizando 18 entrevistas que foram transcritas e submetidas a técnicas de análise de conteúdo. Constatou-se que a articulação entre CAPSi e SF se dá prioritariamente por encaminhamento de casos, apoio matricial ou parceria para casos pertinentes ao CAPSi. O contato ocorre ocasionalmente, de acordo com a demanda e, nessas situações, se dá por telefone, pessoalmente ou por meio de relatório; ou regularmente, em reuniões entre os serviços, envolvendo, em algumas regiões, apenas os gerentes e, em outras, parte das equipes de CAPS e SF. Dentre as estratégias, foram mencionadas discussões de casos, intervenções conjuntas, reuniões gerenciais e fóruns de saúde mental. Quanto aos objetivos, destacam-se ampliar a resolutividade dos casos, fortalecer a rede e apoiar as equipes de SF para lidar com saúde mental. Os principais obstáculos apontados foram: problema de dimensionamento e recursos humanos do CAPS; sobrecarga de tarefas, agenda rígida, falta de capacitação, grande rotatividade dos profissionais das equipes de SF; falta de profissionais e equipamentos de saúde mental na rede. O conhecimento pessoal dos trabalhadores dos diferentes serviços foi considerado como importante facilitador para articulação, no entanto, uma maior proximidade foi mencionada como necessária. Todas as regiões pesquisadas contam com Núcleo de Apoio à Saúde da Família que auxilia as equipes nas questões que envolvem saúde mental. A lógica do encaminhamento e da desresponsabilização bem como a hegemonia do modelo biomédico, a departamentalização do trabalho por núcleos de especialidades e a consequente fragmentação dos cuidados se mostram vigentes no cotidiano dos serviços / The objective of this paper was to describe and analyze the articulation of interventions between Family Health Strategy (ESF) and Psychosocial Care Centers for children and adolescents (CAPSi) teams considering mental health care for children and adolescents. In addition, we aimed to identify the factors that facilitate or hinder the articulation of actions between the teams in daily work; to understand workers expectations of these factors and other kinds of mental health support received by ESF teams. In order to achieve these objectives, semi-structered interviews were conducted with five CAPSi and 13 ESF managers, or other professionals of the teams suggested by him/her, from five different regions of São Paulo city, Brazil. The 18 interviews have been transcribed and subjected to content analysis techniques. It was found that the relationship between ESF and CAPSi occurs mostly by referral of cases, matrix support or partnership for cases concerning CAPSi. The contact between them occurs occasionally, according to the demand and usually happens by phone, personally or through paper reports. In some cases, contact takes place via regular meetings between the services involving the managers or other workers of CAPSi and ESF teams, depending on the region. The strategies used for the contact of teams mentioned in the interviews were case discussions, joint interventions, management meetings and mental health forums. The main goals of the joint work were to increase case resolution, strengthen care networks and give support to the ESF teams to deal with mental health. The main obstacles mentioned were: lack of CAPSi in the city, lack of human resources in the existing services; overhead tasks, rigid schedule, lack of training in mental health and frequent changes of ESF professionals; as well as lack of services and professionals in the mental health network. Personal connection among workers from different services was considered an important factor to facilitate the development of partnerships between teams. All the surveyed regions have Family Health Strategy Support Centers that helps ESF teams on issues involving mental health. The referral of users to specialized services, the lack of responsibility for mental health cases, the hegemonic biomedical model, the departmentalization of work by specialized sections and the fragmentation of care have been found as main working procedures in the services

Les nouveaux besoins en matière de soins et de prise en charge des patients ont contribué à la création des réseaux de santé. En plein développement, ils font partie intégrante du paysage du système sanitaire français. L’impact, pour les professionnels de santé, du travail en réseau fait aujourd’hui l’objet de plusieurs recherches et résultats contrastés, mais a peu été étudié du point de vue de la Psychologie Sociale, du Travail et des Organisations. Cette thèse a pour objectifs d’une part, de décrire les effets de la participation à un réseau de santé au niveau des pratiques professionnelles et au niveau de la santé psychique au travail, et d’autre part, d’examiner les variables et processus pouvant rendre compte de la variabilité de ces effets. Cette recherche privilégie une approche du réseau de santé comme un lieu potentiel de socialisation et de personnalisation (Malrieu & Malrieu, 1973) pour les professionnels qui en font partie La recherche sur le terrain a été réalisée en collaboration avec le réseau de santé ville-hôpital RéPPOP Midi-Pyrénées (Réseau Prévention et Prise en charge Obésité Pédiatrique) qui a la particularité de fonctionner sur la base de Trios/Duos de partenaires pour la prise en charge de l’enfant. Autour du médecin référent, ces partenaires peuvent être des diététicien(ne)s, des psychologues, des kinésithérapeutes… Nous posons l’hypothèse selon laquelle les effets de l’appartenance à un réseau de santé varient en fonction de variables individuelles (ancienneté de l’appartenance au réseau de santé et motivations initiales d’adhésion) et de variables organisationnelles (structuration en Duo/Trio et liens avec l’équipe de coordination du RéPPOP Midi-Pyrénées). Pour autant, une variable-clé, susceptible de moduler ces relations, sera placée au centre de notre recherche : la dynamique collective des Trios/Duos, analysée en référence aux concepts de « travail collectif », « collectif de travail » et « activité collective » (Caroly, 2010).Une étude par entretiens semi-directifs de recherche a été menée auprès de 20 professionnels libéraux et membres du réseau RéPPOP Midi-Pyrénées répartis en 4 Trios et 4 Duos. L’analyse des données a permis de caractériser trois types de dynamiques collectives différenciées quant aux ressorts du travail collectif, aux étayages du collectif de travail et à l’orientation intra-RéPPOP ou hors-RéPPOP de l’activité collective. Les résultats permettent d’appréhender comment chacune peut influer sur la relation entre transformation des pratiques et évolution de la santé psychique. De nouvelles perspectives de recherche et d’action auprès des partenaires du réseau sont proposées à l’issue de ces analyses. / The new needs as regards care and taking charge of patients have contributed to the creation of health networks. As they are growing fast, they are an integral part of the French sanitation system. The impact, on the health professionals, of networking is, today, the object of contrasted research and results, but has little been studied as far as Social Psychology, Work and Organizations are concerned. The aim of this thesis is, on the one hand, to describe the effects of the participation to a health network where professional practices and psychic health at work are concerned and, on the other hand, to examine the variables and process accounting for the variability of these effects. This research privileges an approach to the health network as a place of socialization and personalization (Malrieu & Malrieu, 1973). The research on the ground is carried out in collaboration with the health network town-hospital RéPPOP Midi-Pyrénées (Prevention and Taking charge of Pediatric Obesity Network) , which has the specificity to work on the basis of Trios/Duos of partners to take charge of children. Those partners can be doctors, dieticians, psychologists, physiotherapists… However , another key-variable, able to moderate these relationships, will be taken into account : the collective dynamics will be analyzed according to the theoretical concepts of “collective work”, “working collective” and collective activity (Caroly, 2010).We assume that the effects of being part of a health network vary according to individual variables ( length of time in the health network and initial adhesion motivations ) and to organizational variables ( structuring in Trios/Duos and links with the coordination team of the RePPOP Midi-Pyrénées ). Which will be modulated by the functioning dynamics between partners of the Trio/Duo. In a clinical approach, we have carried out semi-guided interviews with twenty private professionals and members of the RePPOP Midi-Pyrénées network, divided into 4 Trios and 4 Duos. The data analysis enabled us to characterize three kinds of collective dynamics, distinguished on collective work resources, working collective stayings and collective activity orientation. The results show how each pattern can have an influence on the relationship between practices changes and psychological health evolution. The results have enabled us to identify new explanatory elements of the variability due to belonging to a health network which supports research and application prospects on the ground next to the concerned professionals.

O objetivo do estudo foi descrever e analisar as articulações que se realizam entre as equipes da Estratégia de Saúde da Família (ESF) e Centros de Atenção Psicossocial Infantojuvenil (CAPSi), tendo em vista as ações voltadas à atenção em saúde mental de crianças adolescentes. Além disso, visou-se conhecer os facilitadores e obstáculos encontrados no cotidiano do trabalho para sua efetivação; apreender a expectativa dos entrevistados sobre como elas deveriam ser; conhecer outras formas de apoio em saúde mental recebidas pelas equipes de SF. Para tanto, foram realizadas entrevistas semi-dirigidas com gerentes, ou outro profissional por ele indicado, de 5 CAPSi e 13 Unidades Básicas de Saúde com equipes de SF, de cinco regiões distintas no município de São Paulo, totalizando 18 entrevistas que foram transcritas e submetidas a técnicas de análise de conteúdo. Constatou-se que a articulação entre CAPSi e SF se dá prioritariamente por encaminhamento de casos, apoio matricial ou parceria para casos pertinentes ao CAPSi. O contato ocorre ocasionalmente, de acordo com a demanda e, nessas situações, se dá por telefone, pessoalmente ou por meio de relatório; ou regularmente, em reuniões entre os serviços, envolvendo, em algumas regiões, apenas os gerentes e, em outras, parte das equipes de CAPS e SF. Dentre as estratégias, foram mencionadas discussões de casos, intervenções conjuntas, reuniões gerenciais e fóruns de saúde mental. Quanto aos objetivos, destacam-se ampliar a resolutividade dos casos, fortalecer a rede e apoiar as equipes de SF para lidar com saúde mental. Os principais obstáculos apontados foram: problema de dimensionamento e recursos humanos do CAPS; sobrecarga de tarefas, agenda rígida, falta de capacitação, grande rotatividade dos profissionais das equipes de SF; falta de profissionais e equipamentos de saúde mental na rede. O conhecimento pessoal dos trabalhadores dos diferentes serviços foi considerado como importante facilitador para articulação, no entanto, uma maior proximidade foi mencionada como necessária. Todas as regiões pesquisadas contam com Núcleo de Apoio à Saúde da Família que auxilia as equipes nas questões que envolvem saúde mental. A lógica do encaminhamento e da desresponsabilização bem como a hegemonia do modelo biomédico, a departamentalização do trabalho por núcleos de especialidades e a consequente fragmentação dos cuidados se mostram vigentes no cotidiano dos serviços / The objective of this paper was to describe and analyze the articulation of interventions between Family Health Strategy (ESF) and Psychosocial Care Centers for children and adolescents (CAPSi) teams considering mental health care for children and adolescents. In addition, we aimed to identify the factors that facilitate or hinder the articulation of actions between the teams in daily work; to understand workers expectations of these factors and other kinds of mental health support received by ESF teams. In order to achieve these objectives, semi-structered interviews were conducted with five CAPSi and 13 ESF managers, or other professionals of the teams suggested by him/her, from five different regions of São Paulo city, Brazil. The 18 interviews have been transcribed and subjected to content analysis techniques. It was found that the relationship between ESF and CAPSi occurs mostly by referral of cases, matrix support or partnership for cases concerning CAPSi. The contact between them occurs occasionally, according to the demand and usually happens by phone, personally or through paper reports. In some cases, contact takes place via regular meetings between the services involving the managers or other workers of CAPSi and ESF teams, depending on the region. The strategies used for the contact of teams mentioned in the interviews were case discussions, joint interventions, management meetings and mental health forums. The main goals of the joint work were to increase case resolution, strengthen care networks and give support to the ESF teams to deal with mental health. The main obstacles mentioned were: lack of CAPSi in the city, lack of human resources in the existing services; overhead tasks, rigid schedule, lack of training in mental health and frequent changes of ESF professionals; as well as lack of services and professionals in the mental health network. Personal connection among workers from different services was considered an important factor to facilitate the development of partnerships between teams. All the surveyed regions have Family Health Strategy Support Centers that helps ESF teams on issues involving mental health. The referral of users to specialized services, the lack of responsibility for mental health cases, the hegemonic biomedical model, the departmentalization of work by specialized sections and the fragmentation of care have been found as main working procedures in the services

La loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de soins donne une définition unique des réseaux de santé. Ils représentent aujourd’hui une forme organisationnelle inscrite dans les politiques régionales de santé et sont soutenus financièrement par les agences régionales de santé (ARS). La recherche menée a pour objet la participation des personnes malades au fonctionnement et à l’activité d’un réseau de santé. En effet, si les textes législatifs consacrent la place de l’usager dans le système de soins et si la politique de santé proclame sa participation, qu’en est-il dans la réalité quotidienne des pratiques au sein d’un réseau de santé ? Cette recherche s’intéresse ainsi de manière plus spécifique aux interactions entre les professionnels et les usagers en envisageant le réseau comme un espace de coopération. L’étude comparative de deux réseaux de santé diabète montre comment – face à une double contrainte, celles des politiques de santé et celle d’une régulation économique dominante - ce dispositif est soumis à une logique gestionnaire le conduisant à devenir une réponse instrumentale aux dysfonctionnements du système de santé, tel que les cloisonnements multiples du système de santé, une pénurie démographique de professionnels médicaux ou encore une spécialisation technique croissante des activités en santé. Mais en même temps, ces réseaux constituent un espace expérimental propice à la mise en œuvre d’une pratique communautaire en santé. Le corpus de données a été constitué principalement à partir de 31 entretiens biographiques auprès des personnes diabétiques, d'entretiens thématiques auprès des professionnels salariés des réseaux et d’observations des pratiques d’éducation thérapeutique, une prestation de service proposée par les réseaux. Cette prestation de service interroge les modalités possibles d’un travail ensemble dans la gestion d’une maladie chronique entre les professionnels et les personnes malades. En fonction des conceptions en santé des professionnels et des logiques d’action en présence, l’étude montre deux tendances : une personne malade partenaire des soins et un patient auxiliaire de soins. Par ailleurs, les réseaux étudiés présentent des modalités organisationnelles différentes, un modèle linéaire et un modèle satellitaire où la coordination d’acteurs occupe une place majeure. Derrière ce terme de coordination se cache, dans les deux cas, un principe de rationalisation des activités en santé propre au système sanitaire actuel. Les réseaux sont ainsi soumis à une instrumentalisation économique, ils deviennent des prestataires de l’offre de soins sur un territoire. Cette instrumentalisation des réseaux de santé est mise en œuvre principalement par des procédures d’évaluation. Celles-ci s’appuient sur des données épidémiologiques et reposent sur une approche quantitative de résultats en santé. Dans une logique gestionnaire, la personne malade doit adopter des comportements conformes aux normes de santé pour permettre l’atteinte des objectifs organisationnels planifiés dans le cadre d’une politique de santé publique. Face au développement des maladies chroniques, le champ de la santé s’est modifié, mais le système de santé français reste organisé selon une logique biomédicale. L’évaluation prend appui sur des savoirs normatifs, et les pratiques des professionnels sont très imprégnées par cette logique biomédicale. Néanmoins, l’étude montre que les réseaux créent un espace propice à une pratique communautaire en santé par la création d’une proximité sociale. Les deux réseaux mettent en perspective une appropriation par les usagers des questions concernant leur santé. Une mise en mouvement des patients et des professionnels s’opère en marge des objectifs opérationnels affichés d’un réseau de santé. Ainsi, les réseaux constituent tout à la fois des espaces démocratiques réflexifs et un outil au service d’un processus de rentabilisation des activités en santé. / The law of March 4th 2002 concerning patients' rights and the quality of the care system formalizes health networks and provides a single definition. They now account for an organizational form registered in regional politics of public health and are financially supported by the regional health agencies (RHA). The conducted research is about the sick's participation in a health network operation and activity. Indeed, if the legislation grants the user a thorough place in the health care system and if health policy proclaims his participation, what happens in the daily reality of practices within a health network? So this research deals more specifically with the interactions between professionals and users by considering the network as an area of cooperation. The comparative study of two Burgundy diabetes health networks shows how - facing a double constraint, those of public health policies and that of a dominant economic regulation - this device is subject to a managing logic leading to become an instrumental response to health system dysfunctions, such as multiple barriers of the health system, a demographic shortage of health professionals or even an increasing medical specialization of health activities. But even these networks constitute an experimental space favorable to the implementation of a community health practice.The data base has mainly been formed from 31 biographical interviews of diabetic people, thematic interviews of professionals employed in networks and observations of the patient's therapeutic education practices, a service offered by the two networks. This service examines the possible ways of working together in the management of chronic illness between professionals and the sick. According to the conceptions of health among professionals and logic of action involved, the study shows two trends: a sick person, either partner in patient care or in care giving.Moreover, the studied networks present two different organizational terms, a linear model and a satellite model where the coordination of actors plays a major role. Behind this term of coordination lies, in both cases, a principle of rationalization of health activities specific to the current health system. Networks are thus subject to an economic exploitation; they become providers of the offer of health care in a given territory. This instrumentation of health networks is mainly implemented by assessment procedures. It relies on epidemiological data and is based on a quantitative approach about health outcomes. In a managerial logic, the sick person should behave in accordance with health standards to enable the achievement of organizational goals planned as part of a public health policy.With the development of chronic diseases, the field of health has changed, but the French health system is still organized on a biomedical logic. The evaluation is based on normative biomedical knowledge, and professional practices are also very much imbued with biomedical logic. Nevertheless, the study shows that networks create a favorable space for a community health practice by creating a social proximity. Both networks put into perspective the idea that users have a hold on questions concerning their health. Patients and professionals become actors besides operational objectives displayed in a health network. Thus, networks are simultaneously democratic spaces of thought and a tool dedicated to the efficiency of health activities.