La presente tesis desarrolla la creación y el diseño de un Centro de Salud Mental orientado a la prevención, tratamiento y control de trastornos mentales leves en el distrito de San Juan de Lurigancho, aplicando la teoría de la Neuroarquitectura y Entornos Curativos. Este proyecto tiene como objetivo, en trabajar la creación de una serie de lineamientos en base a como los aspectos perceptuales de los espacios en el diseño arquitectónico pueden contribuir a la recuperación de los pacientes, facilitando así la creación de una arquitectura sanadora. / This thesis develops the creation and design of a Mental Health Center aimed at the prevention, treatment and control of slight mental disorders in the district of San Juan de Lurigancho, applying the theory of Neuroarchitecture and Curative Environments. This project aims to work on the creation of a series of guidelines based on how the perceptual aspects of spaces in architectural design can contribute to the recovery of patients and facilitating the creation of a healing architecture. / Tesis

Vårdcentraler är en grundpelare i dagens vård, med privata och regiondrivna aktörer. Det är chefens ansvar att främja hälsa hos medarbetare och befolkning och samtidigt balansera den egna hållbarheten. Hur påverkar dagens krav och utmaningar arbetet som chef på vårdcentralen? Då kunskapen om detta är bristfällig fanns ett behov av att söka en djupare förståelse för chefernas upplevelser i vårdcentralens kontext. Syftet med studien var att undersöka vårdcentralchefers upplevelse av att främja en hållbar arbetsmiljö. Totalt genomfördes sju semistrukturerade intervjuer av chefer, med emellan tre till 30 års erfarenhet, inom Region Stockholm och Region Västra Götaland. Samtliga informanter hade grundprofessionen sjuksköterska. För att tolka intervjuerna genomfördes en innehållsanalys. Analysen resulterade i 13 underkategorier som sammanställdes i fem huvudkategorier: krav, främja delaktighet, utveckling, stöd och balans. Resultatet visade dedikerade chefer som kunde uppleva sig ensamma i sitt ansvar med komplexa krav. Genom ett närvarande och stödjande ledarskap önskade de skapa en hållbar arbetsmiljö. Stor vikt hade lagts på att bygga välfungerande team. Flera av informanterna hade tagit över vårdcentraler i en tid av transformation. Utmaningarna utgjordes av krav från ledning, medarbetare och medborgare. Hållbarheten var i sin tur samhörighet och samspel i arbetsgruppen, förmågan att ta och ge stöd samt rimliga ekonomiska förutsättningar. Resultatet av denna studie kan ge en ökad förståelse för hur chefens vardag på vårdcentralen ter sig och vilka utmaningar hen ställs inför. Att bygga bort upplevelsen av gränslöshet i chefsrollen skulle vara av stort värde. / Health centers are a cornerstone of today's health care, with private and regionally run actors. It is the manager's responsibility to promote the health of employees and the population while balancing their own sustainability. The results of this study can give an increased understanding of how the manager's everyday life at the health center is and what challenges they face. How do today's demands and challenges affect the work of the health center? Since the knowledge of this is lacking, there was a need to seek a deeper understanding of the managers' experiences in the health center's context. The aim of the study was to investigate the experience of health center managers in promoting a sustainable working environment. In total, seven semi-structured interviews were conducted by managers, with between three to 30 years of experience, within Region Stockholm and Region Västra Götaland. All informants had the basic profession nurse. To interpret the interviews, a content analysis was carried out. The analysis resulted in 13 subcategories compiled into five main categories: requirements, promoting participation, development, support and balance. The results showed dedicated managers who could feel alone in their responsibilities with complex requirements. Through present and supportive leadership, they wanted to create a sustainable working environment. Great emphasis had been placed on building well-functioning teams. Several of the informants had taken over health centers at a time of transformation. The challenges were demands from management, employees and citizens. Sustainability, in turn, was the affinity and interaction of the working group, the ability to take and provide support and reasonable financial conditions. Building away the experience of limitlessness in the managerial role would be of great value.

El Centro de Salud Mental Comunitario es una nueva tipología que el MINSA empezó a implementar como una alternativa para la ayuda de pacientes con problemas psicológicos/psiquiátricos. Este proyecto se diseñó con el propósito de mejorar la tipología que actualmente se encuentra en desarrollo utilizando tanto la normativa nacional como proyectos referenciales de otros países que han desarrollado mejor este tipo de edificaciones. Como punto de partida, se tomó como énfasis la permeabilidad espacial con relación al exterior y contacto con la naturaleza a través de la arquitectura biofilica. Luego de investigar sobre los efectos positivos que tiene la arquitectura en el usuario, se decidió buscar un lugar estratégico para emplazarlo. Una vez decidido el terreno, se diseñó la nueva infraestructura cumpliendo todas las normas tanto nacionales como internacionales, siempre teniendo presente el énfasis elegido. El proyecto no solo se enfocó en el paciente que será atendido, sino también a los usuarios que desean acudir para informarse sobre el tema y tener un trato directo con los habitantes de la zona, siendo así un proyecto para la comunidad. / The Community Mental Health Center is a new typology that MINSA began to implement as an alternative for the help of patients with psychological / psychiatric problems. This project was designed with the purpose of improving the typology that is currently under development using both national regulations and reference projects from other countries that have better developed this type of building. As a starting point, the emphasis was on spatial permeability in relation to the outside and contact with nature through biophilic architecture. After investigating the positive effects that architecture has on the user, it was decided to look for a strategic place to locate it. Once the terrain had been decided, the new infrastructure was designed complying with all national and international standards, always keeping in mind the chosen emphasis. The project is not focused only on the patient who will be treated, but also on the users who wish to go to find out about the subject and have a direct relationship with the inhabitants of the area, thus being a project for the community. / Tesis

Federally Qualified Health Center (FQHC) organizations, which provide health care services to low-income, underserved patients, are underfunded. From 2000 to 2007, the cost of treating an FQHC patient increased by $146, while federal compensation to FQHCs increased by only $44 per patient. One FQHC organization in rural Alabama experienced financial losses from the fiscal year 2011 through 2014, jeopardizing services to approximately 6,000 low-income patients. The purpose of this qualitative case study was to analyze the subject organization and discover opportunities to improve financial performance. The research question pertained to the opportunities for improving profitability at the subject organization. The conceptual framework was the systems thinking model. Along with data from the literature review, reviews of the organization's archived data containing employee feedback and feedback from unstructured interviews of four of the 14 FQHC chief executive officers in Alabama were used to develop the profitability model. No employees were interviewed or surveyed during this study, however, a review of archived documents revealed information provided by employees that was helpful in developing the profitability model. To help determine the subject organization's performance, data from independent auditors, technical assistants, FQHC performance reports, the organization's electronic health record system, accounting system, meeting minutes and performance reports were coded, classified, and analyzed. Data from these sources was compared to the profitability model and a gap analysis was used to identify the areas and causes of poor performance. The results indicated that the rural environment impacted the organization's financial performance. The subject FQHC organization may be able to use the results of this study to improve profitability. This study contributes to positive social change by providing a profitability model that other FQHC organizations may use to improve their financial viability and expand services to underserved patients throughout the United States.

No description available.

Bakgrund: Allt fler människor är i behov av livsstilsförändringar. Människor sitter allt mer stilla och har osunda kostvanor vilket kan resultera i olika sjukdomar. Även användning av tobak, rökning och överdriven alkoholkonsumtion kan leda till ohälsa. Arbetet med livsstilsförändringar är viktigt för både distriktssköterskor och patienter. I det hälsofrämjande arbetet kan hälsorisker upptäckas. Distriktssköterskor ska främja god hälsa genom att förmedla och uppmuntra till goda levnadsvanor hos patienter. Syfte: Att beskriva distriktssköterskors erfarenheter av att arbeta med livsstilsförändringar inom hälsocentralen. Metod: Studien har genomförts utifrån kvalitativ metod med induktiv ansats. Data insamlades genom semistrukturerade intervjuer med fem stycken distriktssköterskor på tre olika hälsocentraler. Resultat: Analysen resulterade i fyra kategorier: Att covid-19 pandemin har påverkat arbetet med livsstilsförändringar, Att i samråd med patienten motivera till livsstilsförändringar, Att vilja ha fler förutsättningar för att kunna arbeta med livsstilsförändringar och Att ha ett givande arbete trots utmaningar. Slutsats: Distriktssköterskors erfarenheter var att allt fler patienter hade fått fler symtom på sjukdom under covid-19 pandemin och att hälsocentralerna hade prioriterat vilka som fått komma på besök. Distriktssköterskor ville ha bättre förutsättningar för att kunna arbeta med livsstilsförändringar. Detta genom att få mer tid, mer utbildningar och det material som behövdes till exempel blodtrycksmanschetter. Trots att arbetet med livsstilsförändringar kunde vara utmanande trivdes distriktssköterskor med sitt arbete.

This dissertation examined the impact of Medicare Plan D on medication compliance in Medicare beneficiaries at University of Texas Health Center at Tyler, TX. Data were collected before and after the implementation of Plan D. The impacts of various types of benefits, such as private insurance, employer insurance and pharmacy assistance programs were evaluated in terms of impact on drug compliance. Medication compliance was found to increase in those respondents without Plan D. Plan D was found to be a predictor of those who spent less on basics in order to buy medications. Although compliance increased in general, these increases could not be attributed to the acquisition of a Plan D policy.

Made available in DSpace on 2016-04-28T18:23:28Z (GMT). No. of bitstreams: 1 Claudia L Passalacqua.pdf: 542023 bytes, checksum: d12f5515154be2bd94e524c3bbaa52b3 (MD5) Previous issue date: 2007-05-04 / This paper investigates a writing tool, namely Self-Portrait, whose aim is to collect data on an individual´s psychic expression. It comprises a 35 question questionnaire, made up of open-ended directed and self directed questions. The order of the answers is random, and some questions may be answered many times while others may never be answered. This writing tool was used in a group of psychologically disturbed women, who had been referred to a state health center in the outskirts of São Paulo city. Most women belong to the low and low-middle classes, with very few years of schooling, but, in general, with working experience, in the 30-60 age bracket. They were referred to the state health center by psychiatrists and psychologists, due to chief complaints such as depression, stress, etc. The group was coordinated by the research-psychologist and by an occupational therapist. Initially, the treatment aimed to engage the group in manual tasks and provide them with some space in which they could air their problems. On presenting the questionnaire to the women, the research-psychologist read them the iinstructions, their questions, and explained the procedures as well the terms of agreement. The questionnaire was kept in the health center and apart from the subjects and the therapist, nobody else had access to them. Due to all the conditions of public service assiduity, punctuality, follow-up sessions, among others the use of the self-portrait was not constant in all the sessions and wasn´t equally used by all the women. Since the activities were decided on by the group and took place in the inicial phases of the group´s functioning, it was hard to maintain group cohesion, as some women answered the questionnaires in each session while others took longer to write. These differences were inevitable once all the women shared a common physical space. The self-potrait questions aimed at categorizing those women´s realities: routine, family and professional life, emotional, psychological and existencial aspects and world knowledge. Moreover, the written account of their life experiences served as an oulet for the free expresson of their reality The therapeutical aim of the self-portrait was to investigate the efficiency of writing as a mechanism to surface the underlying phychic information, despite the fact that this written account was produced by women of varying literacy levels. Writing differs from speech in that writing can be crystalized in time, once it can be registered permanently. Besides, writing entails a distinctive connection between conscious and uncounscious contents. It leads the individual into an introspective journey, allowing for the re-enactment of past experiences. By means of this exercise, processes and memories are brought to the consciosness mind and may be modified when experienced again. This study falls into the category of case study, once it focus on aspect´s of a specific woman´s life: someone who, upon joining the group, felt incredbly miserable and was, from the very begining, given special treatment by the research-psychologist. The same rules which applied for the self-portrait within the group were used in private consultations. Semantic networks, formed by words that were repeated along the text, were used for the analysis of the written accounts, following Jung's Model of Typology / Este trabalho investiga um instrumento de escrita, intitulado Auto-Retrato, destinado a coletar dados sobre a expressão psíquica do indivíduo. Trata-se de um questionário de trinta e cinco questões, abertas, dirigidas ou semi-dirigidas, no qual a ordem das respostas é livre, assim como o fato de que algumas questões podem vir a ser respondidas inúmeras vezes e outras, nunca serem respondidas. O instrumento foi utilizado num grupo de mulheres, encaminhadas, pela saúde mental, a um posto de saúde da periferia de São Paulo. As mulheres pertenciam a classes sócio-econômico-culturais baixa e média baixa, em sua maior parte, com poucos anos de escolaridade, mas, no, geral, com experiência de trabalho, na faixa etária de 30 a 60 anos. Chegaram ao posto de saúde via encaminhamentos de psiquiatras e psicólogos, com queixas de depressão, estresse, entre outras. O grupo era coordenado pela psicóloga-pesquisadora e por uma terapeuta ocupacional. Inicialmente, seu objetivo era realizar atividades manuais e paralelamente a elas criar um espaço para a fala e escuta das mulheres entre si e pelas terapeutas. Ao apresentar o questionário às mulheres, a psicóloga-pesquisadora leu a elas suas instruções, suas questões, explicou-lhes as formas de utilização, juntamente com o Termo de Consentimento Livre e Esclarecido.O questionário era mantido no posto de saúde e apenas cada mulher e as terapeutas tinham acesso a ele. Devido a todas as condições que envolvem um atendimento público - assiduidade, pontualidade, continuidade do atendimento, entre outras - o emprego do Auto-Retrato não ocorreu de modo constante em todas as sessões e nem foi igualmente usado por todas as mulheres. Como as atividades eram decididas pelo grupo e no início de seu funcionamento, foi difícil manter a unidade do grupo, com algumas mulheres respondendo-o em todas as sessões, até por se tratar de um espaço físico comum. As questões do Auto-Retrato tinham como objetivo caracterizar a realidade dessas mulheres: vivências cotidianas, vida familiar e profissional, aspectos emocionais, psicológicos e existenciais, conhecimento de mundo e visava ser um continente para a expressão dessa realidade por meio da escrita. .. O emprego do Auto-Retrato teve como objetivo psicoterapêutico investigar a eficácia da escrita para a manifestação de conteúdos psíquicos subjacentes, não importando a variável de a escrita ser realizada por mulheres com diferentes graus de letramento. A escrita tem natureza diferente da fala, fixando-se no tempo, sendo registrada de uma forma permanente, e evocando um compromisso diferente com conteúdos conscientes e inconscientes. Inicia um processo de interiorização no indivíduo, possibilitando uma volta aos conteúdos veiculados. Por meio de seu exercício, processos e memórias são trazidos à consciência e modificados quando revividos. Este trabalho se constituirá em um estudo de caso, na medida em que focará o Auto-Retrato de uma mulher em específico, quem, por ter chegado ao grupo sentindo-se especialmente mal, foi, desde o início, atendida paralelamente de modo individual pela psicóloga-pesquisadora. As mesmas regras estabelecidas para o uso do Auto-Retrato no grupo, foram usadas para sua aplicação na terapia individual. Para a análise do texto escrito do Auto-Retrato os modelos teóricos empregados foram as redes semânticas, formadas pelas palavras que se repetiam no texto escrito, e o referencial teórico de Jung, principalmente, no que se refere aos tipos psicológicos por ele propostos

The Johnson City Community Health Center is one of over 1200 community health centers serving over 22 million patients across the United States. Community health centers primarily serve patients with low income or without health insurance, but most serve all the members of their communities. These centers provide many services and treat health problems in a holistic manner in order to improve the health of their communities and also allow the members of those communities to progress. The Johnson City Community Health Center is compared to successful CHCs from across the nation to determine if it has characteristics to be successful in this community. A SWOT Analysis is conducted by evaluating the Marketing Mix, or the Product, Price, Placement, and Promotion, of the center and also by examining the Political, Economic, Social, and Technological environments it operates in. This research determines the internal Strengths and Weaknesses and external Opportunities and Threats of the Johnson City Community Health Center and concludes that it does have the characteristics needed to be successful in the community. This research can be used by center management to improve services, but it can also be used by other researchers to continue evaluations of community health centers across the nation.

Made available in DSpace on 2016-06-02T19:48:20Z (GMT). No. of bitstreams: 1 4305.pdf: 2120950 bytes, checksum: 959d202140129b116f54d9eadf3aab57 (MD5) Previous issue date: 2012-02-29 / The objective of this study was to understand the psychological and cultural meanings of health professionals of Primary Health Care (PHC) on the issue of women in situations of domestic violence served by them including their uncertainties and difficulties. We tried to interpret the views of these professionals, or their ideas, perceptions and concepts with which they work. The research consisted of Basic Health Units (BHU) of a municipality in the state of Sao Paulo. This is a qualitative study with semi-structured interviews, which contents were analyzed for their utterances expressed during these interviews. We tried to close the final number of participants for sampling by empirical and theoretical saturation. In other words, utterances (corresponding to the empirical data "raw") were analyzed, interview by interview, and were organized into categories formulated in accordance with the theoretical view of the researchers, the interruption of data collection occurred when the empirical data did not support anymore the formulation of new analytical categories and also no longer contributed to the deepening of the categories set out above, in the judgment of the researchers. The results are the 14 subjects that after transcribed, correspond to a corpus of 42,336 words. Respondents comprise a relatively heterogeneous group, with regard to trained professionals (nurses, nursing assistant, nurse, doctors, dentists and pharmacists). For each of the pre-made categories, which were translated into the proposed topics to the participants, were formulated analytical categories: themes or types of statements related to the problems surrounding the issue of women in violent situations (understanding of the phenomenon), emerged in these three Categories: About the violence, risk factors, gender issues. In pre-category themes or types of statements related to the first reception and care for women victims of violence were raised three categories: APS and violence against women, Dynamics of the reception and first aid, Notification. In the themes or types of statements related to other procedures to be undertaken in the APS and women in situations of violence fell into two categories: secondary and tertiary preventive measures and Prevention. Finally, the pre-category: themes or types of statements about the possible difficulties in personal and institutional care provided in APS appeared four: Social and psychosocial, educational difficulties, intrasectoral difficulties, and intersectoral difficulties. The work of discussion of these results was performed by means of a gender perspective. It can be concluded from the difficulty of PHC professionals in meeting the women in violent situations, and these difficulties begin to address the woman who is in this situation to the development / implementation of the plan of care. There is a need for intersectoral work of the network to approach these women and full inclusion in school curricula of the problem for society to constantly look for gender equality and so you can prepare your professionals to meet these women. The limits of the research were identified. / O objetivo deste trabalho foi compreender significações psicológicas e culturais de profissionais de saúde da Atenção Primária à Saúde (APS) sobre a questão das mulheres em situação de violência doméstica por eles atendidas, incluindo suas eventuais dúvidas e dificuldades. Procuramos interpretar os pontos de vista desses profissionais, ou seja, suas ideias, percepções e conceitos com que trabalham. O campo de pesquisa foi constituído por Unidades Básicas de Saúde (UBS) de um município do interior do Estado de São Paulo. Trata-se de um estudo qualitativo com entrevistas semidirigidas, cujos conteúdos foram analisados quanto às enunciações expressas durante esses depoimentos. Procurou-se fechar o número final de participantes pela técnica de amostragem por saturação empírica e teórica. Noutros termos, as enunciações (correspondentes aos dados empíricos brutos ) foram analisadas, entrevista por entrevista, e foram organizadas em categorias formuladas de acordo com a visão teórica dos pesquisadores; a interrupção da coleta de dados deu-se quando os dados empíricos não mais subsidiaram a formulação de novas categorias analíticas e também não mais contribuíram para o aprofundamento das categorias anteriormente formuladas, segundo o julgamento dos pesquisadores. Os resultados dizem respeito a entrevistas com 14 sujeitos que, depois de transcritas, corresponderam a um corpus de 42.336 palavras. Os entrevistados compõem um grupo relativamente heterogêneo quanto às formações profissionais (enfermeiros, auxiliar de enfermagem, técnico de enfermagem, médicos, odontólogos e farmacêutico). Para cada uma das pré-categorias formuladas, que foram traduzidas em questões propostas aos participantes, foram formuladas categorias analíticas. A primeira correspondeu a temas ou tipos de enunciados relacionados à problemática que envolve a questão da mulher em situação de violência (compreensão do fenômeno); nestas surgiram três categorias: Sobre a violência, Fatores de riscos, Questões de gênero. A segunda correspondeu a enunciados relacionados à recepção e aos primeiros cuidados às mulheres em situação de violência foram levantadas três categorias: APS e a violência contra mulher, Dinâmica da recepção e primeiros cuidados e Notificação. Da terceira pré-categoria, relativa a temas ou tipos de enunciados relacionados aos outros procedimentos a serem empreendidos na APS quanto às mulheres em situação de violência, emergiram duas categorias: Medidas preventivas secundárias e terciárias e Prevenção. Por fim, na pré-categoria relativa aos temas ou tipos de enunciados sobre as eventuais dificuldades pessoais e institucionais nos atendimentos realizados na APS, foram elaboradas quatro: Questões sociais e psicossociais, Dificuldades educacionais, Dificuldades intrasetoriais, Dificuldades intersetoriais. O trabalho de discussão destes resultados foi realizado por meio da perspectiva teórica de gênero. Podese concluir a dificuldade dos profissionais da APS no atendimento das mulheres em situação de violência, sendo que essas dificuldades iniciam-se na abordagem inicial da mulher que se encontra nessa situação até a elaboração/execução do plano de cuidado. Observa-se a necessidade do trabalho da rede intersetorial para a abordagem integral dessas mulheres e a inserção da problemática nos currículos escolares para que a sociedade caminhe em busca da igualdade de gênero e para que possa preparar seus profissionais para o atendimento dessas mulheres. Os limites da pesquisa foram apontados.