Thesis (M.S.)--University of Michigan, 1988.

Thesis (M.S.)--University of Michigan, 1988.

As ações voltadas à prevenção ao HIV/aids em serviços de atenção primária à saúde (APS) é uma estratégia proposta no Brasil desde meados dos anos 1990. Com o aumento do número de casos de aids no Brasil, houve a necessidade de elaborar uma estratégia de intervenção em HIV/aids, sendo a Unidade Básica de Saúde (UBS) um espaço privilegiado para realizar as ações de prevenção e acompanhamento das pessoas vivendo com HIV/aids. Não foram encontrados estudos que tratam da análise das ações neste âmbito da atenção no Estado do Mato Grosso (MT). Objetivo geral: Analisar a Vulnerabilidade Programática ao HIV/aids nas UBS de Cuiabá (MT). Pesquisa quantitativa, com base no conceito de Vulnerabilidade em sua dimensão programática; realizada por meio da aplicação de um instrumento com respostas fechadas e abertas, respondido por 69 gerentes, de junho a agosto de 2014. A análise foi realizada com base na reunião dos elementos constantes nos seguintes marcadores de vulnerabilidade programática: a) Infraestrutura para realização das ações de prevenção e assistência em HIV/aids; b) Respostas às necessidades de tratamento em HIV/aids; c) Ações de pré-natal e puerpério em relação a atenção às HIV/aids; d) Ações de prevenção em relação às HIV/aids; e) Integração das ações entre UBS, CRT/SAE em HIV/aids e maternidade. Cada elemento analisado foi estabelecido o valor de 1 quando a resposta era positiva (atende ao requisito) e 0 quando não. Com base na soma dos valores ponderados para cada um dos marcadores obteve-se valor mínimo e máximo de pontos; classificando as UBS segundo o score de alta vulnerabilidade (abaixo de 25%), média (25 a 75%) e baixa (75 a 100%). A maioria das UBS operava o modelo Estratégia da Saúde da Família (63,8%) e era gerenciada por Enfermeiros (79,1%). Maior parte encontra-se em média vulnerabilidade de âmbito programático; há alta vulnerabilidade nos marcadores d e e. As UBS possuem, em algum grau, vulnerabilidades no âmbito programático de Estrutura e Dinâmica de Organização do Serviço de Saúde e de Operacionalização das Ações na atenção às HIV/aids. São necessários investimentos na atenção em HIV/aids na APS no município de Cuiabá. / The implementation of HIV/Aids prevention actions at Health First Care Services (APS in Portuguese) is a strategy that has been adopted in Brazil since mid-90s. With the increasing number of Aids cases in the country, the need to create a strategy to curb this growing HIV/Aids curve has become urgent. Health First Care Services Unities have since then been a privileged space of prevention and caring for HIV/Aids infected people. No other studies about the analysis of these actions at Health First Care Services Unities in the State of Mato Grosso (MT) have been found. General objective of this research: to assess HIV/Aids programmatic vulnerability for HIV caring at Health First Care Services (UBS, in Portuguese) in Cuiabá, Mato Grosso State. Quantitative research, based on the vulnerability concept in its programmatic dimension; carried by applying an instrumental survey with open and closed answers, that have been replied by 69 UBS managers, from June to August 2014. The analysis has been carried based on assembling the elements present in the following programmatic vulnerability assessment tools: a) Infrastructure for delivering prevention and caring actions for HIV/Aids; b) Responses to the HIV/Aids treatment needs; c) Caring STD/HIV/Aids actions during pregnancy; d) Prevention actions regarding STD/HIV/Aids; e) Integration of treatment actions among Treatment and Reference Center/Specialized Ambulatory Service in STD/HIV and Aids, Basic Health Care Units and Maternity Hospitals. Each element has been studied and the 1 value has been stablished when the answer was positive and 0 when it was negative. Based in the sum of the average value for each one of the items a minimum and maximum standards have been acquired; Basic Health Care Units have been divided according to programmatic vulnerability degrees, being High (lower than 25%), Medium (from 25% to 75%) and Low (from 75% to 100%). Results: The majority of Basic Health Care Units carried Family Health Strategies (63.8%), managed by Nurses (79.1%). In general terms Basic Health Care Units vulnerability is medium. There is high programmatic vulnerability at Basic Health Care Units, in the d and e assessment criteria. Basic Health Care Units have to some degree vulnerability in the programmatic realm of Structure and Organization Dynamics in the Health Service and Operationalization of Actions in HIV/Aids caring. Investments in HIV/Aids caring and attention to the Health First Care Services in Cuiabá municipality are highly necessary.

As ações voltadas à prevenção ao HIV/aids em serviços de atenção primária à saúde (APS) é uma estratégia proposta no Brasil desde meados dos anos 1990. Com o aumento do número de casos de aids no Brasil, houve a necessidade de elaborar uma estratégia de intervenção em HIV/aids, sendo a Unidade Básica de Saúde (UBS) um espaço privilegiado para realizar as ações de prevenção e acompanhamento das pessoas vivendo com HIV/aids. Não foram encontrados estudos que tratam da análise das ações neste âmbito da atenção no Estado do Mato Grosso (MT). Objetivo geral: Analisar a Vulnerabilidade Programática ao HIV/aids nas UBS de Cuiabá (MT). Pesquisa quantitativa, com base no conceito de Vulnerabilidade em sua dimensão programática; realizada por meio da aplicação de um instrumento com respostas fechadas e abertas, respondido por 69 gerentes, de junho a agosto de 2014. A análise foi realizada com base na reunião dos elementos constantes nos seguintes marcadores de vulnerabilidade programática: a) Infraestrutura para realização das ações de prevenção e assistência em HIV/aids; b) Respostas às necessidades de tratamento em HIV/aids; c) Ações de pré-natal e puerpério em relação a atenção às HIV/aids; d) Ações de prevenção em relação às HIV/aids; e) Integração das ações entre UBS, CRT/SAE em HIV/aids e maternidade. Cada elemento analisado foi estabelecido o valor de 1 quando a resposta era positiva (atende ao requisito) e 0 quando não. Com base na soma dos valores ponderados para cada um dos marcadores obteve-se valor mínimo e máximo de pontos; classificando as UBS segundo o score de alta vulnerabilidade (abaixo de 25%), média (25 a 75%) e baixa (75 a 100%). A maioria das UBS operava o modelo Estratégia da Saúde da Família (63,8%) e era gerenciada por Enfermeiros (79,1%). Maior parte encontra-se em média vulnerabilidade de âmbito programático; há alta vulnerabilidade nos marcadores d e e. As UBS possuem, em algum grau, vulnerabilidades no âmbito programático de Estrutura e Dinâmica de Organização do Serviço de Saúde e de Operacionalização das Ações na atenção às HIV/aids. São necessários investimentos na atenção em HIV/aids na APS no município de Cuiabá. / The implementation of HIV/Aids prevention actions at Health First Care Services (APS in Portuguese) is a strategy that has been adopted in Brazil since mid-90s. With the increasing number of Aids cases in the country, the need to create a strategy to curb this growing HIV/Aids curve has become urgent. Health First Care Services Unities have since then been a privileged space of prevention and caring for HIV/Aids infected people. No other studies about the analysis of these actions at Health First Care Services Unities in the State of Mato Grosso (MT) have been found. General objective of this research: to assess HIV/Aids programmatic vulnerability for HIV caring at Health First Care Services (UBS, in Portuguese) in Cuiabá, Mato Grosso State. Quantitative research, based on the vulnerability concept in its programmatic dimension; carried by applying an instrumental survey with open and closed answers, that have been replied by 69 UBS managers, from June to August 2014. The analysis has been carried based on assembling the elements present in the following programmatic vulnerability assessment tools: a) Infrastructure for delivering prevention and caring actions for HIV/Aids; b) Responses to the HIV/Aids treatment needs; c) Caring STD/HIV/Aids actions during pregnancy; d) Prevention actions regarding STD/HIV/Aids; e) Integration of treatment actions among Treatment and Reference Center/Specialized Ambulatory Service in STD/HIV and Aids, Basic Health Care Units and Maternity Hospitals. Each element has been studied and the 1 value has been stablished when the answer was positive and 0 when it was negative. Based in the sum of the average value for each one of the items a minimum and maximum standards have been acquired; Basic Health Care Units have been divided according to programmatic vulnerability degrees, being High (lower than 25%), Medium (from 25% to 75%) and Low (from 75% to 100%). Results: The majority of Basic Health Care Units carried Family Health Strategies (63.8%), managed by Nurses (79.1%). In general terms Basic Health Care Units vulnerability is medium. There is high programmatic vulnerability at Basic Health Care Units, in the d and e assessment criteria. Basic Health Care Units have to some degree vulnerability in the programmatic realm of Structure and Organization Dynamics in the Health Service and Operationalization of Actions in HIV/Aids caring. Investments in HIV/Aids caring and attention to the Health First Care Services in Cuiabá municipality are highly necessary.

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.

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.