Background: To assess whether the standardized recommendation of patients with heart failure (HF), left-ventricular assist device (LVAD) and heart transplantation (HTx) to visit their dentist leads to improved oral conditions after 12 months. Methods: Patients from the Department of Cardiothoracic Surgery, Leipzig Heart Centre, Germany were examined at baseline and after 12 months. A dental (decayed-, missing-, and filled-teeth index (DMF-T)) and periodontal examination (periodontal probing depth, clinical attachment loss) was performed. At baseline, patients received a standardized recommendation to visit their dentist. At follow-up, a standardized questionnaire regarding the dental consultation was applied. Results: Eighty-eight participants (HTx: 31, LVAD: 43, HF: 14) were included. The majority of patients (79.5%) followed the recommendation to visit their dentist. Within the total cohort, periodontal treatment need was significantly reduced from 91% (baseline) to 75% (follow-up; p < 0.01). Only 10% of total cohort stated that they received periodontal treatment. The outcome in periodontal and dental treatment need at follow-up appointment revealed no statistically significant associations to the questionnaire regarding dentist consultation (p > 0.05). Conclusions: The simple recommendation to visit the dentist appears not enough to obtain sufficient dental and periodontal conditions in patients with severe heart diseases. Thereby, a lack in periodontal treatment of patients with HF, HTx and LVAD was identified, making interdisciplinary dental special care programs recommendable.

Made available in DSpace on 2014-12-17T15:43:48Z (GMT). No. of bitstreams: 1 AntonioWS_DISSERT.pdf: 1944652 bytes, checksum: 91ccd9ee2c5731107308efcbf756f2b5 (MD5) Previous issue date: 2012-12-19 / The accelerated industrialization, coming with the Industrial Revolution, caused profound changes in the working world. These changes led to the households risks from work environment. Trying to assist comprehensively the health of workers, Brazil has a program of Health Care Workers in the Primary Care, and the Family Health Strategy is the main entrance for this system. The study sought to determine if the actions of the health care worker have been developed in primary care through the Family Health Strategy. This is a quantitative study with a methodological evaluation, focusing on normative assessment. The sample was formed by professionals from Team Family Health Strategy, in the municipalities of Pau dos Ferros, Caic? and Natal in Rio Grande do Norte state. The sample consists of 202 professionals (Doctors, Nurses, Assistant / Technician Nursing and Community Health Workers) in 52 Health Family Units from the 3 municipalities cited. The instrument used consists of a checklist, from Manual of Primary Care 5 - Family Health - Occupational Health, Ministry of Health. The data were analyzed describing the variables by its frequency and doing a classification of cities from the scores obtained by each. It was observed that the Family Health professionals know the program of health care worker, however do not know the Manual of Primary Care 5, which is a guidance tool. As a result of non-appropriation of the FHT professionals with worker health, these activities are not performed, mainly surveillance in occupational health and health education labor / A industrializa??o acelerada, vinda com a Revolu??o Industrial, provocou mudan?as profundas no mundo do trabalho. Essas mudan?as levaram para o meio das fam?lias os riscos do ambiente do trabalho, em um processo de domiciliza??o do risco. Na busca de atender de forma integral ? sa?de dos trabalhadores, o Brasil integra a Aten??o ? Sa?de dos Trabalhadores ? Aten??o B?sica, tendo a Estrat?gia de Sa?de da Fam?lia como porta de entrada deste sistema. O estudo busca avaliar se as a??es de aten??o ? sa?de do trabalhador t?m sido desenvolvidas na aten??o b?sica, via Estrat?gia Sa?de da Fam?lia. Trata-se de um estudo quantitativo, com uma abordagem metodol?gica avaliativa, privilegiando a avalia??o normativa. Como p?blico alvo, est?o os profissionais da Equipe de Estrat?gia de Sa?de da Fam?lia, nos munic?pios de Pau dos Ferros, Caic? e Natal, no estado do Rio Grande do Norte. A amostra ? composta de 202 Profissionais (m?dicos, enfermeiros, auxiliar/t?cnico de enfermagem e agentes comunit?rios de sa?de) em 52 Unidades de Sa?de da Fam?lia dos 3 munic?pios. O instrumento de coleta utilizado ? constitu?do de uma Lista de Verifica??o, a partir do Caderno de Aten??o B?sica n? 5 Sa?de da Fam?lia Sa?de do Trabalhador, do Minist?rio da Sa?de. Analisaram-se os dados a partir de uma descri??o das vari?veis na forma de frequ?ncia percentual e da classifica??o dos munic?pios a partir dos escores obtidos por cada um. Observou-se que os profissionais da Sa?de da Fam?lia conhecem o programa de aten??o ? sa?de do trabalhador, no entanto n?o conhecem o Caderno de Aten??o B?sica n? 5, que ? um instrumento de orienta??o. Em consequ?ncia da n?o apropria??o dos profissionais da ESF com a sa?de do trabalhador, essas a??es n?o s?o realizadas, principalmente as a??es de Vigil?ncia em Sa?de do Trabalhador e Educa??o em Sa?de do Trabalhador

The introduction of Education, Health and Care (EHC) plans proposed in the Children and Families Act 2014 has aimed to give parents and children who are going through the assessment process greater control and choice in decisions, and enhance the multi-professional collaboration between education, health services and social care. This research seeks to evaluate to what extent parents’, children and young people’s, and professionals' experiences correspond to these values at an early stage of implementation. The methodology of this thesis is based on a realistic evaluation framework informed by the work of Pawson and Tilley (1997). Realistic evaluation aims to construct a programme theory which links three distinct broad aspects of a programme: its context, mechanisms and outcomes (C-M-Os). This research employs a programme theory of how an EHC assessment is conducted and has been developed from the current literature on person-centred theory. Person-centred theory has been chosen because of its corresponding value base to the SEND reforms and the recommendation of its use in a number of government policy documents including the SEND Code of Practice (DfE, 2014). The programme theory has been used to devise questionnaires that have sought to gain professionals' experiences of the assessment process, particularly in relation to multi-agency working, and their perceptions of the person-centred nature of the assessment. In addition, five case studies have explored these issues in more depth to ascertain whether the EHC assessment process in this authority is meeting the core aims of the Children and Families Act 2014. Semi structured interviews and card sorting tasks were devised using the programme theory and conducted with a total of one child, five families and five professionals from five individual EHC assessments. This analysis goes beyond a description of the facilitating factors and barriers to person-centred support and examines how person-centred outcomes arise from specific contexts and mechanisms. Findings suggest that experiences of face-to-face multi-professional collaboration were positive within the EHC assessment group. Nevertheless, professionals expressed frustration that in some cases colleagues were not able to attend meetings due to time constraints, capacity within their services and the commissioning arrangements of their services. Parental and professional experiences of the process appear to be positive. The research demonstrates one case study where a person centred planning approach was utilised very successfully from the perspective of all involved. However, there are significant concerns raised in both phases of this study as to the way in which children and young people are provided with opportunities of contributing to their EHC assessment. The findings are relevant to the development of the EHC assessment process in the local authority (LA) in which I am employed, and will contribute to the debate about the role of educational psychologists (EPs) in evaluating this national policy.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

Revised and extended version of the author's doctoral thesis. / Includes bibliographical references and index.

A presença das Associações de Moradores na co-gestão do Programa Médico de Família de Niterói sugere uma série de indagações e problematizações, em um período histórico de extremas mudanças e de recuo dos movimentos sociais e é aqui apresentada como forma de reflexão acerca da gestão participativa. A entrada em cena das Associações de Moradores, como co-gestoras de políticas sociais de saúde, está devidamente articulada a um processo de democratização que vem ocorrendo desde o Movimento de Reforma Sanitária, culminando com a Constituição de 1988 e a construção do Sistema Único de Saúde. Assim, este trabalho tem a proposta de levantar algumas considerações sobre os movimentos sociais, principalmente sobre as lideranças das Associações de Moradores da Favela, na tensa relação entre gestão participativa e movimentos sociais. Diante deste fato, apresentamos as considerações daqueles que pensam sobre a relação entre Estado e Sociedade Civil, já que vamos discutir esta relação tomando como foco principal as Associações de Moradores co-gestoras do Programa Médico de Família- Niterói (PMFN). As pesquisas indicaram que há a ausência de conhecimento técnico por parte das lideranças das Associações de Moradores co-gestoras do PMFN para desenvolverem as suas atividades enquanto co-gestores e tomarem parte no processo de gestão. A partir deste contexto, buscamos, com esta pesquisa, elevar o nível de entendimento e contribuir para o aprofundamento do conhecimento sobre a atuação participativa de lideranças das associações de moradores na co-gestão de políticas sociais municipais. / Residents Association presence at shared management of Health Family Physician of Niterói highligts a roll of questions and problems, in a historical period of acute changes and returns of social movements. It is showed in this study as a reflection about shared management. Residents Association entry in the scenery, as share managers of social health policies is linked to democratization process that had occurred since Sanitary Reform Movement, culminating in 1988s Constitution, and Unified Health System construction. The purpose of this study is to find out some social movements aspects I stressed/high voltage relationship between shared management and social movements, in special about slum Residents Association leadershisp. In this way, we present reflections/considerations from persons who think about Govermment/Civil Society relationship focusing on Residents Associations who share Family Physician Program of Niterói (FPPN) shared management. Researches showed lack of techical knowledge of Residents Associations leardesship that share FPPN management to develop their activeities and to participate in shared management. In this point of view, inthis study we try to improve understanding level, and to contribute to a deeper knowledge abouti participative action of Residents Associations leaderships in shared management of municipal social policies.

A presença das Associações de Moradores na co-gestão do Programa Médico de Família de Niterói sugere uma série de indagações e problematizações, em um período histórico de extremas mudanças e de recuo dos movimentos sociais e é aqui apresentada como forma de reflexão acerca da gestão participativa. A entrada em cena das Associações de Moradores, como co-gestoras de políticas sociais de saúde, está devidamente articulada a um processo de democratização que vem ocorrendo desde o Movimento de Reforma Sanitária, culminando com a Constituição de 1988 e a construção do Sistema Único de Saúde. Assim, este trabalho tem a proposta de levantar algumas considerações sobre os movimentos sociais, principalmente sobre as lideranças das Associações de Moradores da Favela, na tensa relação entre gestão participativa e movimentos sociais. Diante deste fato, apresentamos as considerações daqueles que pensam sobre a relação entre Estado e Sociedade Civil, já que vamos discutir esta relação tomando como foco principal as Associações de Moradores co-gestoras do Programa Médico de Família- Niterói (PMFN). As pesquisas indicaram que há a ausência de conhecimento técnico por parte das lideranças das Associações de Moradores co-gestoras do PMFN para desenvolverem as suas atividades enquanto co-gestores e tomarem parte no processo de gestão. A partir deste contexto, buscamos, com esta pesquisa, elevar o nível de entendimento e contribuir para o aprofundamento do conhecimento sobre a atuação participativa de lideranças das associações de moradores na co-gestão de políticas sociais municipais. / Residents Association presence at shared management of Health Family Physician of Niterói highligts a roll of questions and problems, in a historical period of acute changes and returns of social movements. It is showed in this study as a reflection about shared management. Residents Association entry in the scenery, as share managers of social health policies is linked to democratization process that had occurred since Sanitary Reform Movement, culminating in 1988s Constitution, and Unified Health System construction. The purpose of this study is to find out some social movements aspects I stressed/high voltage relationship between shared management and social movements, in special about slum Residents Association leadershisp. In this way, we present reflections/considerations from persons who think about Govermment/Civil Society relationship focusing on Residents Associations who share Family Physician Program of Niterói (FPPN) shared management. Researches showed lack of techical knowledge of Residents Associations leardesship that share FPPN management to develop their activeities and to participate in shared management. In this point of view, inthis study we try to improve understanding level, and to contribute to a deeper knowledge abouti participative action of Residents Associations leaderships in shared management of municipal social policies.

Health appears as a fundamental right on the Declaration of Human Rights of 1948 onarticle XXV. In humanitarian research, health is often viewed as a secondary theme anddid not have that much relevance. This has changed recently and nowadays health isconsidered an important factor. Social determinants of health are social factors, such ashousing, nutrition, and sanitation, that have a deep influence on one’s health. Thosedeterminants are particular to each individual and the conditions in which it lives and canbe modified by one’s migratory journey. In fact, migration in itself can be seen as a socialdeterminant of health, once the implications of the journey directly affect their health.Health inequity and the disparities caused by it are direct consequences of the socialdeterminants of health.This thesis analyses productions on refugee health in relation to the barriers existent inboth accessing and providing healthcare services to pregnant and postpartum women inGreece. The discussion chapter analyses the data found, discusses social determinants ofhealth, the resulting health disparities, and arguments through an intersectionality lens.The result chapter discusses the most important factors, suggests actions to overcome thebarriers and discusses the responsibility of the global society regarding inequalities.

A dramatic and historic evolution has occurred as mental health care has shifted from institutional-based care to community-based care. Framed by the social exchange theory, the purpose of this study was to identify the correlation of the leadership style of supervisors in residential care facilities with the organizational citizenship behavior of the residential care workers. The research questions focused on the correlation between the leadership styles and organizational citizenship behavior (OCB) with a secondary focus specifically on transformational leadership. Residential care workers in 3 states working in 65 facilities within a single organization completed 2 surveys: the Multifactor Leadership Questionnaire and the Organizational Citizenship Behavior Checklist. Forty-nine completed surveys were returned. The transactional leadership style was correlated to OCB in 2 defining subfactors: contingency reward r(42)=.424, p < .001 and management by exception/active r(42)=.417, p <.001. The transformational leadership style was correlated to OCB in 4 defining subfactors: idealized behaviors r(42)=.388, p <.001, instrumental motivation r(42)=.417, p <.001, idealized influence r(42)=.395, p <.001, and individual consideration r(42)=.371, p <.005. These findings have not been previously reported in mental health residential care settings. The generalizability of this study is limited by sample size and scope, because the employees come from facilities within a single corporate organization. Residential care is part of the overall positive social change in care of the mentally ill, by offering the mentally ill the opportunity of an enhanced, community-based life. This study begins the process of ensuring that sufficient evidence-based knowledge and scholarly practitioners are available to lead work that benefits this vulnerable population; additional study is recommended.

The purpose of this thesis is to investigate from a constructivist perspective, what protective measures managers take against violence and threats for social workers. The focus will be on two occupations: Social Services and Health and Care services. Also, to compare their protective measures and investigate if there are other protective measures to improve the safety of social workers. The method that has been used is the qualitative method, because the constructivist theory is best achieved by a method that goes in-depth and searches for context. Semi-structured interviews were conducted by using a strategic selection. The selection was homogenous, consisting of three managers from each occupation. The results show a constructed image made by the managers of a low rate of threats on the two occupations. The results also show similar constructed protective measures. For instance, a social worker can speak with the manager, have a personal alarm at home, or speak with a safety coordinator. Other common measures include contacting the occupational health service and handing over the matter to another employee. There is the possibility of bodyguard protection and taking a taxi from and to work in times of discomfort. Some differences are found as well, such as there are always two social workers for home visits in social services while there are only two social workers for first-time visits in Health and Care services. In conclusion, there are differences and similarities regarding the constructed protective measures employed in both occupations. Another conclusion is to develop and introduce new protective measures. There is a lack of research on how social workers experience the protective measures against violence and threats in the working places. Therefore, more research must be done on their experiences.