This thesis investigates the emergence of an internationally renowned psychiatric community in Uganda. Starting at the beginning of colonial rule in 1894, it traces the changing nature of mental health care both within and beyond the state, examining the conditions that allowed psychiatry to develop as a significant intellectual tradition in the years following Independence in 1962. This ‘golden age’ of psychiatry saw Uganda establish itself as a leader of mental health care in Africa, an aspect of history that is all the more marked for its contrast with the almost complete collapse of mental health care after the expulsion of the Asian population by Idi Amin in 1972. Using a wide range of new source material, including interviews with psychiatrists, traditional healers, and community elders, this thesis pushes the history of psychiatry in Africa beyond the examination of government policy and colonial hegemony. It brings together the history of psychiatry with the histories of missionary medicine, medical education, and international health by asking what types of people, institutions, and organisations were involved in the provision of mental health care; how important the growth of Makerere Medical School was for intellectual and institutional psychiatry; and how ‘African’ mental health care had become by the end of the period. It presents a history of mental health care in a country that has tended to be overshadowed by Kenya in the historiography, yet whose engagement with medical missionaries and efforts to advance medical training meant that the trajectory of psychiatry came to be quite different. Focusing in particular on the significance of western-trained Ugandan medical practitioners for mental health care, the thesis not only analyses African psychiatrists as historical actors in their own right, but represents the first attempt to examine the development of psychiatric education in Africa.

The problem was to identify the differences in attitudes toward physical activity of students and faculty within a health, physical education, and recreation professional preparation program.

Although strategic planning has been used successfully in most major business institutions, higher education has been slow to adopt this management technique. Involvement in planning is a critical issue for allied health educational programs, such as physical therapy, which are relatively new to the academic environment. These programs face a continual need to update their curricula and clinical education based on rapid changes in the health care delivery system and the profession. The problem of this study was to determine the extent to which the strategic planning process is currently applied in institutions in the United States which offer accredited physical therapy educational programs. The population of this study was made up of the chief executive officers of the 115 public and independent institutions that offer physical therapy educational programs. Selected experts on strategic planning and chief executive officers were surveyed in two phases using a mailed questionnaire designed to measure the organization, characteristics, and impact of strategic planning in institutions that offer accredited physical therapy educational programs. Seventy-three percent of the chief executive officers responded, and 50.9 percent indicated their involvement with strategic planning by completing the questionnaire. The findings indicate that, although there is general agreement between the experts and the chief executive officers concerning the characteristics of strategic planning, differences exist. Differences were also identified between academic health centers and other types of institutions, between public and independent institutions, and between institutions by type of physical therapy degree offered. It was concluded that, in the opinion of the chief executive officers, strategic planning processes are being practiced in institutions that offer physical therapy programs, that this process is compatible with academic collegiality, that changes are made in policies and programs but not in the mission, that although faculty members including those from physical therapy are involved, the role and the involvement of these individuals is unclear, and that information-gathering and evaluation methods could be refined.

Objectifs: Les patients hospitalisés aux soins intensifs (SI) sont souvent victimes d’erreurs médicales. La nature interprofessionnelle des équipes de SI les rend vulnérables aux erreurs de communication. L’objectif primaire du projet est d’améliorer la communication dans une équipe interprofessionnelle de soins intensifs par une formation en simulation à haute fidélité. Méthodologie Une étude prospective randomisée contrôlée à double insu a été réalisée. Dix équipes de six professionnels de SI ont complété trois scénarios de simulations de réanimation. Le groupe intervention était débreffé sur des aspects de communication alors que le groupe contrôle était débreffé sur des aspects techniques de réanimation. Trois mois plus tard, les équipes réalisaient une quatrième simulation sans débreffage. Les simulations étaient toutes évaluées pour la qualité, l’efficacité de la communication et le partage des informations critiques par quatre évaluateurs. Résultats Pour l’issue primaire, il n’y a pas eu d’amélioration plus grande de la communication dans le groupe intervention en comparaison avec le groupe contrôle. Une amélioration de 16% de l’efficacité des communications a été notée dans les équipes de soins intensifs indépendamment du groupe étudié. Les infirmiers et les inhalothérapeutes ont amélioré significativement l’efficacité de la communication après trois sessions. L’effet observé ne s’est pas maintenu à trois mois. Conclusion Une formation sur simulateur à haute fidélité couplée à un débreffage peut améliorer à court terme l’efficacité des communications dans une équipe interprofessionnelle de SI. / Objective: Patient hospitalized in intensive care units (ICU) are often victims of medical errors. The interprofessional nature of ICU teams makes them particularly vulnerable to communication errors. The primary objective of this project is to improve interprofessional communication in an ICU team using a high fidelity simulation-based training. Method A prospective, double-blind, randomized controlled trial was conducted. Ten teams of six ICU workers completed three simulated scenarios of resuscitation. The intervention group was debriefed on communication skills, whereas the control group was debriefed on technical resuscitation skills. Three months later, teams completed a fourth simulation without debriefing. All simulation sessions were coded for quality, efficacy of communication and team information-sharing by four blinded observers. Results For our primary end-point, improvement in communication in intervention group wasn’t greater than in control group. A 16% increase in communication effectiveness was noted in ICU teams independently of the studied group. Nurses and respiratory therapists significantly increased their communication effectiveness after three sessions. The effect did not last to three months. Conclusion The combination of high-fidelity simulation training and communication-oriented debriefing can produce short-term gains in communication effectiveness of an interprofessional ICU team.

A pesquisa tem o objetivo de analisar as atividades educativas de trabalhadores de enfermagem quanto ao público participante, levantamento de necessidades e resultados esperados. Foi desenvolvida com base no referencial teórico do processo de trabalho em saúde e enfermagem, trabalho em equipe, integralidade da saúde, educação continuada (EC) e educação permanente em saúde (EPS), com destaque para a distinção entre EC e EPS. O estudo foi realizado em um hospital de ensino localizado em uma região do município de São Paulo. Utilizando abordagem qualitativa, a coleta de dados foi realizada através de entrevista semi-estruturada e os sujeitos foram os enfermeiros gerentes de unidades, enfermeiros assistenciais, auxiliares e técnicos de enfermagem totalizando vinte e cinco participantes. No processo de análise, os dados empíricos foram analisados por meio de técnica de análise temática de Bardin e Minayo. Os resultados mostram que o público participante das ações educativas é majoritariamente composto por enfermeiros que participam de atividades externas como congressos e similares, e esse investimento no nível superior traduz a política institucional. Em contrapartida, para os trabalhadores de nível médio, as ações educativas são orientadas, sobretudo para a revisão de técnicas e utilização de novos equipamentos. O levantamento de necessidades de ações educativas de trabalhadores é realizado principalmente com base em erros e falhas, bem como na aquisição de novos equipamentos, o que traduz uma ação educativa focada nos procedimentos técnicos e distanciada da reflexão sobre a prática. Contudo, os resultados esperados apontam para a melhora da qualidade da assistência de enfermagem em diferentes sentidos. Em curto prazo, esta essa melhora está relacionada ao desempenho de procedimentos técnicos, apesar de também estar relacionada a à mudança de comportamento, desde que ocorra a sensibilização do trabalhador em relação ao cuidado, tal como ocorre com a introdução de novos projetos. Em médio e longo prazo espera-se que o trabalhador desenvolva consciência sobre o trabalho e abordagem reflexiva da prática, ou seja, que o trabalhador possa questionar-se sobre a prática do dia-a-dia e mudar o comportamento. Conclui-se que predomina uma prática educativa pautada na concepção de EC, porém mesclada a aspectos da EPS, pois os trabalhadores apontam a necessidade de ações educativas diferenciadas, com novos formatos, conteúdos e sentidos, de modo a promover a qualidade da assistência à saúde e de enfermagem / This study has the objective to analyze the educative activities of nurses and nursing assistants as the participating public, to survey the necessities and expected results. It was utilized a qualitative approach, with basis in a theoretic referential of the health work process, nursing, team work, health integrality, continuing education (EC), permanent education in health (EPS), and the relevant differences between EC and EPS. The study was conducted in a teaching hospital in São Paulo County. Using a qualitative approach, the data collection was done through a semi-structured interview and the subjects were nurse unity managers, assistant nurses, nursing technicians with a total of twenty five participants. In the analytical process, empirical data were analyzed through a thematic analysis technique of Bardin and Minayo. The results show that the participating public on the educative actions are mostly registered nurses whom participate on external activities as congresses and other outside activities, and this investment in a higher education level translates into the institutional politics. In a counteracting way, for workers on mid-level, the educative actions are oriented above all for technical revisions and the utilization of new equipment. The survey to identify the education necessities of these workers is done mostly on basis of errors and mistakes, as well as in the acquisition of new equipments, that is translated into an educational activity focused in the technical and further apart from the practical reflection. Therefore, the expected results points into the better quality of nursing support various ways. In short term, this betterment is related with the technical procedures, even though it is related with the behavior change that sensibleness the worker in relation to the care, as well as it occurs with the introduction of new projects. In middle and long term it is expected that the worker develop a consciousness about the work and their practical reflection that means, that the worker may question about the day to day practice and change the behavior. It is concluded that the practical education is related in the conception of EC, however mixed with aspects of EPS, because the workers point to the need of differentiated education, with new format, content and meanings, to promote the quality of health care and of nursing

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-04-04T13:23:31Z No. of bitstreams: 1 Cintia Bincoleto Fazion.pdf: 2723385 bytes, checksum: 9b12f04f9abc712949c7aabbb5e39553 (MD5) / Made available in DSpace on 2017-04-04T13:23:31Z (GMT). No. of bitstreams: 1 Cintia Bincoleto Fazion.pdf: 2723385 bytes, checksum: 9b12f04f9abc712949c7aabbb5e39553 (MD5) Previous issue date: 2017-03-23 / Fundação São Paulo - FUNDASP / This thesis proposes to analyze the interorganizational dynamics of cooperation and knowledge exchange between professionals who are part of a multidisciplinary team from a health and education service, from a private, non-profit organization. An investigation was carried out to find out whether there is a process of network integration and exchanges of knowledge and collaboration between them. The quantitative and qualitative research was carried out by applying a questionnaire to identify the existence of a network in the institution. The profile of the professionals, their competences, their positioning and the type of knowledge they shared were characterized. The data was entered in Excel and processed in the network analysis software, ORA.NetScenes. The network analysis identified four groups associated with the sectors in which the agents operate and presented a relatively centralized structure and with a few specialists with a chance of sharing knowledge and dynamics. The most indicated and the possible relational exchanges existing in the groups were verified . The institution presented a low density of links between the professionals and a restricted reciprocity in the relations between the agents. In order to stimulate individuals to act in a network, it is important to foster actions that stimulate interdisciplinary exchanges among professionals, resulting in benefits for the organization and the public served. In spite of developing a network analysis, not all the possibilities among the agents of the organization were explored / Esta tese propõe analisar as dinâmicas intraorganizacionais de cooperação e trocas de conhecimento, entre profissionais que integram uma equipe multidisciplinar de um serviço de saúde e educação, de uma organização privada sem fins lucrativos. Investigou-se se há um processo de integração em rede e trocas de conhecimento e colaboração entre eles. A pesquisa, de natureza quantitativa e qualitativa, foi realizada mediante aplicação de um questionário para identificar a existência de uma rede na instituição. Caracterizou-se o perfil dos profissionais, suas competências, seu posicionamento e o tipo de conhecimento que compartilham. Os dados foram inseridos no Excel e tratados no software para análise de redes, o ORA.NetScenes. A análise de rede identificou quatro grupos associados aos setores em que os agentes atuam e apresentou uma estrutura relativamente centralizada e com alguns poucos especialistas com chances de compartilharem trocas de conhecimentos e dinâmicas. Verificou-se os mais indicados e as possíveis trocas relacionais existentes nos grupos. A instituição apresentou uma baixa densidade de vínculos entre os profissionais e uma restrita reciprocidade nas relações entre os agentes. Para estimular os indivíduos a atuarem em rede entende-se importante fomentar as ações que estimulem as trocas interdisciplinares entre os profissionais, resultando em benefícios para a organização e para o público atendido. Apesar de desenvolver uma análise de redes, não se explorou todas as possibilidades entre os agentes da organização

A pesquisa tem o objetivo de analisar as atividades educativas de trabalhadores de enfermagem quanto ao público participante, levantamento de necessidades e resultados esperados. Foi desenvolvida com base no referencial teórico do processo de trabalho em saúde e enfermagem, trabalho em equipe, integralidade da saúde, educação continuada (EC) e educação permanente em saúde (EPS), com destaque para a distinção entre EC e EPS. O estudo foi realizado em um hospital de ensino localizado em uma região do município de São Paulo. Utilizando abordagem qualitativa, a coleta de dados foi realizada através de entrevista semi-estruturada e os sujeitos foram os enfermeiros gerentes de unidades, enfermeiros assistenciais, auxiliares e técnicos de enfermagem totalizando vinte e cinco participantes. No processo de análise, os dados empíricos foram analisados por meio de técnica de análise temática de Bardin e Minayo. Os resultados mostram que o público participante das ações educativas é majoritariamente composto por enfermeiros que participam de atividades externas como congressos e similares, e esse investimento no nível superior traduz a política institucional. Em contrapartida, para os trabalhadores de nível médio, as ações educativas são orientadas, sobretudo para a revisão de técnicas e utilização de novos equipamentos. O levantamento de necessidades de ações educativas de trabalhadores é realizado principalmente com base em erros e falhas, bem como na aquisição de novos equipamentos, o que traduz uma ação educativa focada nos procedimentos técnicos e distanciada da reflexão sobre a prática. Contudo, os resultados esperados apontam para a melhora da qualidade da assistência de enfermagem em diferentes sentidos. Em curto prazo, esta essa melhora está relacionada ao desempenho de procedimentos técnicos, apesar de também estar relacionada a à mudança de comportamento, desde que ocorra a sensibilização do trabalhador em relação ao cuidado, tal como ocorre com a introdução de novos projetos. Em médio e longo prazo espera-se que o trabalhador desenvolva consciência sobre o trabalho e abordagem reflexiva da prática, ou seja, que o trabalhador possa questionar-se sobre a prática do dia-a-dia e mudar o comportamento. Conclui-se que predomina uma prática educativa pautada na concepção de EC, porém mesclada a aspectos da EPS, pois os trabalhadores apontam a necessidade de ações educativas diferenciadas, com novos formatos, conteúdos e sentidos, de modo a promover a qualidade da assistência à saúde e de enfermagem / This study has the objective to analyze the educative activities of nurses and nursing assistants as the participating public, to survey the necessities and expected results. It was utilized a qualitative approach, with basis in a theoretic referential of the health work process, nursing, team work, health integrality, continuing education (EC), permanent education in health (EPS), and the relevant differences between EC and EPS. The study was conducted in a teaching hospital in São Paulo County. Using a qualitative approach, the data collection was done through a semi-structured interview and the subjects were nurse unity managers, assistant nurses, nursing technicians with a total of twenty five participants. In the analytical process, empirical data were analyzed through a thematic analysis technique of Bardin and Minayo. The results show that the participating public on the educative actions are mostly registered nurses whom participate on external activities as congresses and other outside activities, and this investment in a higher education level translates into the institutional politics. In a counteracting way, for workers on mid-level, the educative actions are oriented above all for technical revisions and the utilization of new equipment. The survey to identify the education necessities of these workers is done mostly on basis of errors and mistakes, as well as in the acquisition of new equipments, that is translated into an educational activity focused in the technical and further apart from the practical reflection. Therefore, the expected results points into the better quality of nursing support various ways. In short term, this betterment is related with the technical procedures, even though it is related with the behavior change that sensibleness the worker in relation to the care, as well as it occurs with the introduction of new projects. In middle and long term it is expected that the worker develop a consciousness about the work and their practical reflection that means, that the worker may question about the day to day practice and change the behavior. It is concluded that the practical education is related in the conception of EC, however mixed with aspects of EPS, because the workers point to the need of differentiated education, with new format, content and meanings, to promote the quality of health care and of nursing

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2018-03-09T13:26:28Z No. of bitstreams: 1 ROSANGELA BAMPA SCHATTAN.pdf: 3383518 bytes, checksum: ba301e6aac13950aade92e5662106f61 (MD5) / Made available in DSpace on 2018-03-09T13:26:28Z (GMT). No. of bitstreams: 1 ROSANGELA BAMPA SCHATTAN.pdf: 3383518 bytes, checksum: ba301e6aac13950aade92e5662106f61 (MD5) Previous issue date: 2017-12-14 / Universidade Católica de Santos - Católica de Santos / Introduction: The work demand of college educators can generate great physical and psychological distress, with deleterious health effects, such as sleeping disorder. Objectives: To evaluate the association of social and psychological aspects of work and health with the sleeping characteristics of college educators, as well as correlate the work capacity with fatigue symptoms and minor psychiatric disorders and to compare the duration of sleeping and waking up hours before and after the vacation period. Materials and methods: This is a cross-sectional study of quantitative approach with 123 college educators at a University in Santos-Brazil during 2016 and 2017. Data collection was performed at two different moments: the first part was the application of an on-line instrument containing several validated questionnaires, adapted to the reality of the present investigation. The instrument was divided in three branches: 1. Social-demographic profile and life style; 2. Aspects related to the work; 3. Questions about sleeping conditions and health. The second part consisted of the completion of a diary of sleeping patterns and activities at the end of the academic semester (Phase 1 - before vacations, n=26) and at the beginning of the new one (Phase 2 - after vacations, n=16). For statistical evaluation, hypothesis tests of Pearson's Chi-square or Fisher's exact tests were used. Poisson regression analysis with robust variance, the one way ANOVA with repeated measures and the linear regression analysis were also applied. Results: Individuals average age was 56.3 years (SD 10.4 years), with a majority of the feminine sex (54.5%), living with a partner (74%), had a second job (67.4%), has been working in the institution for an average of 15.3 years (SD 10.4) with an average working hours in the institution of 24.5 hours/week. Most of the college educators showed bad sleeping quality during working days (70.1%), being a little less prevalent on non-working days (49%). College educators with chronic muscle skeletal symptoms showed higher prevalence ratio of bad sleeping quality during working days when compared with those with no symptoms (PR 1.84, CI 95% 1.06-3.20). During non-working days, the prevalence ratio was two times higher (PR 3.13, CI 95% 1.46-6.71). About 1/3 of the college educators showed insomnia symptoms (31.7%). Moreover, having a higher fatigue perception and being sedentary increased the insomnia prevalence ratio when compared to the college educators with lower fatigue perception and physically active (PR 2.66 - CI 95% 1.18-6.01 and PR 2.34 - CI 95% 1.04-5.25, respectively). No differences were observed between averages of sleeping aspects and activities concerning phases 1 and 2. The working capacity was negatively correlated with the fatigue disorders amongst the participants. Conclusion: College educators studied showed high prevalence of insomnia symptoms and bad sleeping quality. Chronic muscle skeletal symptoms, fatigue and sedentary habits negatively interfered in the sleeping patterns of the group. The vacation period did not interfere the sleep aspects evaluated. / Introdução: As exigências do trabalho docente no sistema de ensino superior podem gerar grandes desgastes físicos e psíquicos, com consequentes efeitos deletérios à saúde, dentre eles, os distúrbios do sono. Objetivos: Avaliar os fatores associados ao sono de docentes universitários, bem como correlacionar a capacidade para o trabalho com os sintomas de fadiga relacionada ao trabalho e comparar a qualidade do sono, horários de dormir e acordar antes e após o período de férias. Materiais e Métodos: Estudo transversal, de abordagem quantitativa, com 123 docentes de uma Universidade da Baixada Santista, entre 2016 e 2017. A coleta de dados foi efetuada em dois momentos: primeira etapa, aplicação de um instrumento de forma on line, contendo vários questionários validados e adaptados à realidade do estudo. O instrumento foi dividido em três blocos: 1. Perfil sociodemográfico e estilo de vida; 2. Aspectos relacionados ao trabalho; 3. Questões sobre sono e saúde. A segunda etapa compreendeu o preenchimento do diário de sono e de atividade no final do semestre letivo (Fase 1- antes das férias, n=26) e no início do semestre (Fase 2 ¿ após as férias, n=16). Foram realizados os testes de hipóteses Qui-quadrado de Pearson ou Exato de Fischer, a análise de regressão de Poisson, com variância robusta, o teste de ANOVA oneway de medidas repetidas e a análise de regressão linear. Resultados: A idade média dos pesquisados era de 56,3 anos (DP 10,4 anos), sendo a maioria do sexo feminino (54,5%), moravam com o companheiro (74%), tinham segundo emprego (67,4%), trabalhavam na instituição em média há 15,3 anos (DP 10,4 anos) e com jornada de trabalho média na instituição pesquisada de 24,5 horas/semana. A maioria dos docentes apresentou qualidade de sono ruim nos dias de trabalho (70,1%), sendo essa prevalência um pouco menor nos dias de folga (49%). Os docentes com sintomas musculoesqueléticos crônicos apresentaram maior razão de prevalência de qualidade de sono ruim nos dias de trabalho em relação aos docentes sem sintomas (RP 1,84, IC 95% 1,06-3,20). Já nos dias de folga, essa razão de prevalência foi duas vezes maior (RP 3,13, IC 95% 1,46-6,71). Cerca de 1/3 dos docentes apresentaram sintomas de insônia (31,7%), sendo que uma maior percepção de fadiga e ser sedentário aumentaram a razão de prevalência de insônia em relação aos docentes com menor percepção de fadiga e fisicamente ativos (RP 2,66 - IC 95% 1,18-6,01 e RP 2,34 - IC 95% 1,04-5,25, respectivamente). Não foi verificada diferença entre as médias dos aspectos de sono e de atividades entre as fases 1 e 2. A capacidade para o trabalho foi negativamente correlacionada com a fadiga entre os docentes pesquisados. Conclusão: Os docentes pesquisados apresentaram elevada prevalência de sintomas de insônia e de qualidade de sono ruim, sendo que os sintomas musculoesqueléticos crônicos, fadiga e sedentarismo interferiram negativamente no sono dos docentes. O período de férias não interferiu nos aspectos de sono avaliados.

The purpose of this study was to find out the attitudes and beliefs of minority college students enrolled at Missouri College in Brentwood, Missouri in reference to the dental hygiene profession. In particular, does their oral health and dental knowledge relate to their knowledge of profession of dental hygiene? One hundred and six students gave their consent to participate in the study via Survey Monkey. The study was conducted in May 2015 for a period of four weeks. Four statements were designed to gauge minority students’ knowledge of dental hygiene as a career. No differences were found based on gender, age, education and ethnicity. A difference was found based upon the respondent’s program of study. Further research is needed spread the word about dental hygiene programs and to explain the role of the dental hygienist.

This qualitative study focused on the dental disparities in Blount County, TN and sought to determine if there are enough dental clinics within the dental safety net. Interviews were conducted with 18 individuals who were either service providers or clients of organizations such as the Salvation Army, Alcoa Good Samaritan Clinic, the local health department, Trinity Dental Clinic, Volunteer Ministry Center, Remote Area Medical, and Blount Memorial Hospital. Inclusion criteria for clients included: homeless or living below the poverty level, uninsured, 18 to 65 years of age, has not seen a dentist in the past year and currently suffering a dental problem. The most obvious common theme among the 11 clients interviewed was that they struggle with getting dental care. Patients were asked when the last time they had seen a dentist and they answered years ago, most over ten years ago. Eight of the eleven clients did not know of any facilities they could go to. Cost was the main reason for these clients not seeking dental care. Two dentists were asked about the reasons for disparities in dental care. The major common themes between the dentists were cost, access to care, and education. All five case managers said that they had clients experiencing dental needs ranging from a simple cleaning to an abscess. Currently in Blount County only one dental clinic serves over 17,000 residents who live in poverty.