O presente estudo caracteriza-se por um estudo de caso que busca analisar por meio dos itinerários terapêuticos, como a Política Nacional de Saúde Integral da População Negra atua no cotidiano e nos modos de vida de uma comunidade quilombola em Alagoas. A pesquisa tem como posição política a noção de saúde e direitos humanos. A comunidade quilombola Pau D\'arco, campo de estudo da presente pesquisa, encontra-se localizada no município de Arapiraca, e foi selecionada pelos seguintes critérios: 1 comunidade quilombola reconhecida há mais tempo; 2. comunidade que apresenta maior número de famílias em seu território; 3. comunidade que apresenta instalada em seus território Unidade Básica de Saúde. Os participantes da pesquisa foram 05 moradores da comunidade que apresentaram em seu histórico algum agravo em saúde e/ou doença, sendo eles: 01 jovem mulher da comunidade, acima de 18 anos; 01 adulta, 02 idosos e 01 idosa. Os 05 entrevistados possibilitaram a saturação do tema pesquisado. A pesquisa foi desenvolvida em quatro etapas. A primeira consistiu em revisão bibliográfica e leituras críticas de dissertações, teses, artigos, documentos do campo psi e consulta que versem sobre a relação entre a saúde e as populações quilombolas, bem como, consulta ao Sistema de Informação da Atenção Básica. A segunda etapa compreendeu o processo de inserção do pesquisador à comunidade pesquisada, com reuniões com as lideranças comunitárias e gestores, para anuência da pesquisa. Na terceira etapa foi realizada a identificação dos itinerários terapêuticos dos moradores da comunidade quilombola por meio de entrevista semiestruturada, as quais foram submetidas à análise por meio do método de análise de conteúdo. A quarta e última etapa consistiu na devolutiva da pesquisa para comunidade com apresentação de um possível projeto de intervenção produto técnico da investigação. O estudo teve como meta a construção dos itinerários terapêuticos como modo de compreensão das formas de cuidado produzidas pela comunidade negra rural estudada na relação com o desenvolvimento da Política Nacional de Saúde Integral da População Negra no território quilombola, no que se refere ao acesso, aceitabilidade e a qualidade do serviço de atenção básica prestado / This study is characterized by a qualitative research based on a case study that aims to analyze through therapeutic itineraries, such as the National Comprehensive Health of the Black Population Policy how it operates in everyday life and the ways of life of a quilombo community in Alagoas. The research has the theoretical basis guiding the approach to health and human rights. The quilombo community Pau D\'arco, study field of this research, is located in the city of Arapiraca, and were selected by the following criterion: 1 quilombo community recognized for a longer time; 2. community that has more families in its territory; 3. community that has installed in its territory a Basic Health Unit. The participants were 05 community residents who had in its history wornsen in health, which are: 01 young women of the community above 18 years old; 01 adult, 02 elderly and 01 elderly. The 05 intervieweds made possible saturation of the research topic. The research was developed in four stages. The first had consisted in literature and readings review critical dissertations, theses, articles, psi field documents and consultation that apply to the relationship between health and the quilombos population, as well as consulting the Primary Care Information System. The second stage comprises the insertion process of the researcher to the researched community, meetings with community leaders and managers for approval of the research. The third stage was carried out to identify the therapeutic itineraries of the residents of quilombo community through semi-structured interviews, which were submitted to analysis by the content analysis method. The fourth and final stage is the feedback of the search for the community with the presentation of a possible technical product intervention project research. The study was aimed at the construction of the therapeutic itineraries as way of understanding the forms of care produced by rural black community studied in relation to the development of the National Policy on Comprehensive Health of the Black Population in the quilombo territory, as regards access, acceptability and the quality of primary care services provided

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-06T18:58:20Z No. of bitstreams: 1 Maria Eunice N. Rutigliano.pdf: 1609867 bytes, checksum: 94ee40583b6ea66ec105b99f877d9d58 (MD5) / Made available in DSpace on 2015-04-06T18:58:20Z (GMT). No. of bitstreams: 1 Maria Eunice N. Rutigliano.pdf: 1609867 bytes, checksum: 94ee40583b6ea66ec105b99f877d9d58 (MD5) Previous issue date: 2014-08-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This is a case study with a qualitative approach about the Rehabilitation Center for Child Cerebral Palsy from Guarujá (CRPI), which is a philanthropic center of interdisciplinary rehabilitation. CRPI institutional mission is to increase social inclusion of children and teenagers with neuro-sensory-motor deficiencies, with an emphasis on families from Great Santos area. The center is a nonprofit institution that began its activities in 1963 at the residence of the founder Steffi Leonore Asch, in Guaruja. The theme of this study was chosen because of the importance of providing philanthropic institutions in the Brazilian social safety net. The goal is to reconstruct the trajectory of the CRPI, from its foundation to the present day, and research how it coordinates with the Brazilian public policies, particularly in the health and social fare fields. It was conducted a literature review focused on the public policies of social security and health care since the times of pre Federal Constitution, enacted in 1988 with the creation of the Sistema Único de Saúde (SUS), or Unified System for Health Care, including a a brief history of the creation of rehabilitation centers in Brazil. Besides the literature review, the study conducted structured and semi-structured interviews with 17 professionals of the institution and collected historical data available in the archives of the center, newspapers and official sites of the city of Guarujá. It was concluded that the institution followed the changes in public health policy and education, moving from a simply welfare institution to one with awareness about the policies of rights; from serve a population with only preserved cognition level to serve children with multiple disabilities. It also started to approach the public resources, especially with the current grant from the City of Guarujá and through partnerships with the Departments of Health and Education, which brought a situation of mutual dependence, or symbiosis, between CRPI and the Government of Guarujá. Key / Trata-se de um estudo de caso com abordagem qualitativa sobre o Centro de Reabilitação em Paralisia Infantil e Cerebral do Guarujá (CRPI), que é um Centro de reabilitação interdisciplinar filantrópico, e que tem como Missão Institucional a inclusão social de crianças e adolescentes com deficiências neuro-sensório-motoras, dando ênfase às famílias, procedentes da Baixada Santista. O CRPI é uma instituição do terceiro setor que começou suas atividades em 1963, na residência da fundadora Steffi Leonore Asch no Guarujá. O tema deste estudo foi escolhido devido à importância das entidades filantrópicas prestadoras de serviços na rede de proteção social brasileira e regional, com objetivo de reconstruir a trajetória do CRPI, desde sua fundação até os dias de hoje e pesquisar sobre a sua articulação com as políticas públicas, particularmente de saúde e proteção social. Foi feito um levantamento bibliográfico com foco na busca de leis que regem as políticas de saúde pública, previdenciária e assistencial desde sua fundação na era pré Constituição Federal promulgada em 1988 com a criação do SUS e após esta era, até os dias de hoje e também um breve histórico sobre a criação dos Centros de Reabilitação no Brasil. Foram realizadas entrevistas estruturadas e semi-estruturadas com 17 profissionais da instituição e colhidos dados históricos disponíveis nos arquivos do centro, jornais e sites oficiais do município do Guarujá. Concluiu-se que a instituição acompanhou as alterações das políticas públicas de saúde e educação, passando de uma Instituição assistencialista para a de conscientização sobre a política de Direitos; de uma clientela com nível de cognição preservado, para um perfil de crianças com múltipla deficiência; e, também a aproximação dos recursos públicos, contando atualmente com a subvenção da Prefeitura do Guarujá, por meio de parcerias com as Secretarias de Saúde e Educação. Existe uma dependência mútua positiva, isto é, uma simbiose do CRPI com a Prefeitura Municipal.

This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use of LHDs. LHDs and their system partners (hospitals, federally qualified health centers, and primary care providers) that utilize HIT as part of their QI decision making may have an easier time of using data to support evidence-based decision making and implementing the provisions of the Patient Protection and Affordable Care Act of 2010 in order to achieve population health for all.

Political science and tobacco policy--Theories of policy change--The global policy context--European countries and the EU--The UK: a case study--The United States--Other advanced industrial countries--Tobacco control policymaking in developing regions--The WHO Framework Convention on Tobacco Control (FCTC) / https://dc.etsu.edu/etsu_books/1104/thumbnail.jpg

The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the home. Home-based indoor tanning has the potential to be especially dangerous given the complete absence of safety regulations. Children are currently protected from exposure to health-harming substances like tobacco and lead; thus, legislation protecting them from artificial sources of ultraviolet radiation is yet another important step forward in improving public health.

The Michelle P. Waiver (MPW) is the primary means of health insurance for more than 10,000 people in the state of Kentucky. The waiver is especially popular among families with young children with disabilities because it is robust in its benefit offerings and also one of the few Medicaid resources that does not include parental income as a qualifying factor in eligibility. Through the waiver, children receive a medical card as well as additional coverage for medical expenses that fall beyond the scope of traditional health insurance. For these young children to gain access to the comprehensive offerings of the MPW, their parents must apply for the waiver, negotiate the terms of service, and make critical health care decisions on their behalf, or at least until they reach adulthood—although this responsibility often extends throughout the child’s life. The present study builds upon recent research on parental uncertainty in caregiving for children with complex care needs. By combining two ecological approaches to health communication research, Brashers’s (2001) uncertainty management theory (UMT) and Ball-Rokeach, Kim, and Matai’s (2001) communication infrastructure theory (CIT), my aim in this dissertation was to explain how meso-level (e.g., community organization) interactions influenced parental caregivers’ experiences of uncertainty. I collected data through narrative interviews with 31 parents of children who are currently receiving services through the MPW and analyzed them using narrative thematic analysis. The analysis focused on the community-level communication that contributes to parent caregivers’ ability to successfully access and negotiate care within the MPW system. Findings show that parents experience unique personal, social, and medical uncertainties related to the MPW. In addition, the findings demonstrate that MPW-related uncertainty and decision making are managed with a variety of strategies aimed to decrease, increase, or maintain desired levels of uncertainty. Finally, findings showcase how one’s connectedness to community storytelling at the meso level, particularly within online communities and disability network communities supports their adaptive management of MPW-related uncertainty. This project contributes to the health communication literature theoretically by (a) expanding the conceptualization of the uncertainty in illness framework to include the means of health care (i.e., Medicaid) as a consequential element of an individual’s illness experience, (b) identifying two additional strategies of uncertainty management (i.e. advocacy and vigilance), and by (c) extending existing notions of residency, connectedness, and belongingness within the CIT framework to include membership in online and disability-specific networks. Practically, this project offers important insights that can guide future research exploring the role of meso-level communication in parent caregivers’ management of waiver-based care, such as in identifying the need for a systematic communication process that introduces potentially eligible families to the MPW.

This research study explored the experiences of 19 women who had been diagnosed with, or were still seeking the diagnosis of SLE (lupus) and their decisions regarding support group participation. The aim of this study was to evaluate the variety of factors influencing their choices in types and sources of support, their coping strategies and the reasons behind their decisions to either choose or not choose lupus support groups as a viable support resource. Those women identified as support groups attendees recalled a more emotion-focused response to their diagnosis and showed stronger reliance on seeking emotional forms of support. Conversely, those women who chose not to participate in groups (non-attendees) utilized more problem-focused strategies when they received their news of the illness and indicated more reliance on instrumental forms of support. Additionally, the women who do not attend support groups did not seem to have more social support from outside sources, but did show a tendency to utilize relationship-focused coping more than other forms of coping strategies overall. Both groups showed a heavy reliance on their medical providers for both emotional and instrumental forms of support suggesting this source as an important factor in individual choices in coping strategies and support sources. The decisions to attend or not attend differed only in the strategies they relied on and specific group structure, timing and locations. The results of this study supports earlier research in the types and sources of social support used in adapting to a chronic illness. This study also encourages incorporating individual support services through medical providers and the development of programs that acknowledge individual coping and support needs.

Den ökande globaliseringen bidrar till en kulturell mångfald i vården. Det finns få tidigare studier om ledarskap från mångkulturella arbetsplatser i Sverige och för att möjliggöra ett hållbart ledarskap av en hållbar mångkulturell arbetsplats behöver framgångsfaktorer i ledarskapet identifieras. I syfte att undersöka vilka upplevelser och erfarenheter vårdens chefer har av att leda mångkulturella medarbetargrupper har en kvalitativ intervjustudie genomförts. Totalt intervjuades 8 chefer från två olika sjukhus. Det insamlade materialet har transkriberats, analyseras och kategoriseras genom innehållsanalys (Elo & Kyngäs 2008). Resultatet visar att ledarskapet anpassades både utifrån individen och medarbetarens kulturella bakgrund. Det var främst språket som de intervjuade cheferna anpassade, men även på vilket sätt de kommunicerade med medarbetarna. Fördelar identifierades med en mångkulturell arbetsplats då personalen kunde tolka åt patienter och förmedla kunskap om kultur i medarbetargruppen. Informanterna upplevde inte att konflikter i medarbetargruppen härrörde från kulturella aspekter men däremot att missförstånd relaterade till språkförståelse kunde skapa konflikter. En förklaring till detta resultat kan vara att informanterna upplever det mer socialt accepterat att diskutera språkliga orsaker till konflikter än kulturella orsaker. Cheferna saknade stöd och utbildning i mångkulturellt ledarskap och uppgav att de fått kunskap genom erfarenhet och lärt av tidigare misstag. Författarna tror att cheferna kan få stöd genom mentorskap för att utveckla ett hållbart ledarskap och att färre misstag då skulle behöva begås. En organisatorisk tydlighet med regler och värdegrund ses också som viktiga för ett hållbart ledarskap.

Cette thèse de science politique propose de comparer l’européanisation des politiques de santé en Suède et en France dans une perspective historique et interactionniste. Depuis les années 1990, de nombreuses études ont démontré l’importance croissante des interventions de l’Union européenne dans le domaine de la santé. Mais peu de travaux se sont interrogés sur la manière dont l’institutionnalisation de l’action publique européenne s’articule avec les changements des politiques de santé nationales sur la longue durée. Partant du postulat selon lequel les systèmes de santé font partie des secteurs les plus solidement ancrés dans les espaces nationaux et sont organisés selon des modèles institutionnels très divers, il s’agit de comprendre comment les dimensions européennes des politiques de santé ont été construites et incorporées dans les systèmes nationaux. La comparaison entre les politiques de santé en Suède et en France se justifie d’une part par le fait que ces pays correspondent à deux grands types d’organisation des systèmes de santé existant au sein de l’Union européenne, respectivement les systèmes nationaux de santé et les systèmes d’assurance maladie, et d’autre part en raison de l’histoire européenne contrastée de ces deux pays, la France étant un État-membre fondateur et la Suède n’ayant rejoint l’UE que tardivement et sans enthousiasme. Nous pouvons ainsi démontrer sur une période longue et pour deux cas contrastés que les effets de l’intégration européenne ne se réduisent pas aux pressions européennes sur des systèmes de santé plus ou moins fit. En retraçant les trajectoires d’européanisation des politiques de santé suédoises et françaises sur une longue période et pour plusieurs enjeux clefs des modèles nationaux en termes d’organisation des soins (démographie médicale et choix des patients) et de santé publique (lutte contre le cancer, le tabagisme et l’alcoolisme), cette thèse montre que l’européanisation des politiques de santé est le fruit d’un travail politique ancien de construction d’acteurs domestiques en interactions. / This PhD thesis, in the field of political science, offers to compare the Europeanisation of health policies in France and Sweden, in a historic and interactionist perspective. Since the 1990s, numerous studies have shown the growing significance of the European Union’s intervention in the health sector. However, few of them have looked at how the institutionalisation of European public action interplays with national health policy changes in a long-term approach. Based on the premise that health systems are strongly embedded in national settings and are organised along very different institutional models, the aim is to understand how the European dimension of health policies have been built and incorporated into national systems. The comparison between health policies in Sweden and France is justified on the one hand by the fact that each country represents one of the two main type of health systems existing in the European Union, the national health and national insurance system respectively; and on the other hand by the contrasting European histories of these two states, France being one of the founding members and Sweden having joined the EU at a later stage and with little enthusiasm. We can thus show on a long period of time, and for two different cases, that the effects of European integration cannot be reduced to European pressures on health systems that are more or less fit. By tracing the trajectories of Europeanisation of Swedish and French health policies on a long period, and for key issues for the national models regarding healthcare services (demography of health care professionals and patient’s choice) and public health (fight against cancer, tobacco and alcohol addictions), this dissertation shows that the Europeanisation of health policies results from the long-term political work of construction of domestic actors in interaction.

The primary question at issue in this paper is the following: given the similarities between the two countries with regard to welfare state institutions, why have the United States and the United Kingdom diverged on the issue of health care? Drawing on sociological institutionalism, a branch of the new institutionalist paradigm, this paper provides an answer to this question: during the formative years of the health care stories in the two countries, variations in institutional and cultural conditions produced contrasting policy outcomes. More specifically, this paper discusses how the combination of institutions (political, labor, and medical) and culture led to private insurance in the United States and public insurance in the United Kingdom. Of course, this paper has implications for several areas of scholarship, as well as for current policy debates on a wide range of issues.