Orientador: Solange L'Abbate / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T09:31:16Z (GMT). No. of bitstreams: 1 Vivot_ClaudiaCristiane_M.pdf: 1742438 bytes, checksum: a6d24f89393f18ab5da4a51e74d5fc9a (MD5) Previous issue date: 2014 / Resumo: A Secretaria Municipal de Saúde de Sorocaba/SP, por meio da Diretoria de Área da Assistência e Educação em Saúde, responsável pelo direcionamento do modelo de atenção à saúde e gestão das Unidades Básicas de Saúde, vem adotando diferentes estratégias de trabalho para o fortalecimento da Atenção Básica em Saúde em seu território. Em 2010, foram criados seis Colegiados de Gestão, compostos por cinco Unidades Básicas de Saúde cada. Foram constituídos também três Núcleos Técnicos, compostos por profissionais do nível central designados para apoiar a gestão das Unidades Básicas de Saúde. Nesse novo formato, houve uma revisão do papel dos apoiadores técnicos e a implementação de reuniões com coordenadores das Unidades Básicas de Saúde. A adesão dos técnicos da Diretoria de Área da Educação em Saúde a este modelo organizacional não ocorreu de modo homogêneo em todos os Colegiados. Nos Colegiados Leste e Centro Sul, as diferentes estratégias de trabalho foram discutidas em reuniões periódicas orientadas pelos princípios da Política Nacional de Educação Permanente em Saúde. Assumiu-se a premissa de que o desenvolvimento técnico-científico e ético dos coordenadores das Unidades Básicas de Saúde favoreceria o fortalecimento da Política Nacional de Atenção Básica. O objetivo geral dessa investigação de caráter qualitativo foi analisar essas reuniões, ocorridas de junho de 2010 a dezembro de 2012, como espaços de discussão de práticas relativas à qualificação da gestão e seus possíveis desdobramentos em relação aos coordenadores das Unidades Básicas de Saúde. As informações foram obtidas a partir da leitura das Atas das reuniões, dos relatos da autora que atuou como uma das apoiadoras dos referidos colegiados, complementadas por entrevistas semiestruturadas com os coordenadores das Unidades Básicas de Saúde e com os diretores da Diretoria de Área da Assistência e Educação em Saúde, que atuaram de 1998 a 2012. A análise das informações levou em conta os pressupostos da Educação Permanente, baseou-se no referencial teórico-metodológico da Análise Institucional, sobretudo os conceitos de instituição, implicação e analisador. Os resultados da investigação apontaram que nestes Colegiados de Gestão Leste e Centro Sul houve um expressivo avanço na construção coletiva de conhecimentos e ações voltadas ao enfrentamento dos problemas do cotidiano do trabalho, resultando numa maior aproximação entre a gestão e a assistência. Evidenciou-se também um aumento do vínculo entre os próprios coordenadores e entre estes e os apoiadores, construindo uma nova intersubjetividade. Esta investigação pretende contribuir para a institucionalização e difusão dessa estratégia de caráter inovador e estimular movimentos semelhantes em outros equipamentos das Secretarias Municipais de Saúde, buscando sempre o aprimoramento do Sistema Único de Saúde / Abstract: The Municipal Health Department of Sorocaba, SP, Brazil, through its Division for Health Treatment and Education, is responsible for managing the model of treatment dispensed at basic health units. In effect, the department has adopted different working strategies for strengthening primary health care in the municipality. In 2010, six management teams were set up, each one responsible for five basic health units. Three technical groups were also implemented, comprised of middle-level professionals assigned to back up the management of basic health units. With this new format the role of technical backers was revised and meetings were held with coordinators of basic health units. Acceptance of this model by technicians in the Division for Health Treatment and Education was far from homogeneous among the teams. In the eastern and south-central teams the different working strategies were discussed at periodic meetings, based on the principles found in the Brazilian National Policy for Continuing Education in Health. The premise was accepted that the technical, scientific and ethical training of the coordinators of basic health units favored the strengthening of the National Primary Care Policy. The overall objective of this qualitative investigation was to analyze these meetings, which were held between June 2010 and December 2012, as spaces for discussing practices related to training in management and the possible results for coordinators of basic health units. The information was obtained from the minutes of these meetings and from reports by the author, who served as one of the backers of the above-mentioned teams. The information was completed with semi-structured interviews with coordinators of basic health units and with persons who had served as supervisors of the Division for Health Treatment and Education between 1998 and 2012. The analysis of the information took into account the premises of continuing education and the theoretical and methodological framework of institutional analysis, especially the concepts of institution, implication, and analyzer. Research results showed that there was a significant advance in the collective construction of knowledge and actions in the eastern and south-central teams, aimed at addressing everyday problems of work. This resulted in a closer relationship between management and treatment. Closer ties also resulted among the members themselves and between them and the backers, which led to new intersubjectivity. This study is intended as a contribution to the institutionalization and dissemination of this innovative strategy. The authors also hope that it will encourage similar movements in other areas of municipal health departments in the improvement of the Brazilian Federal Health System / Mestrado / Ciências Sociais em Saúde / Mestra em Saúde Coletiva

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-21T17:26:15Z No. of bitstreams: 1 Maria Angela Prates Puppin.PDF: 547986 bytes, checksum: 0f243d62e1cc1853f22cc7f0578b490f (MD5) / Made available in DSpace on 2015-12-21T17:26:15Z (GMT). No. of bitstreams: 1 Maria Angela Prates Puppin.PDF: 547986 bytes, checksum: 0f243d62e1cc1853f22cc7f0578b490f (MD5) Previous issue date: 2013 / Mestrado Profissional em Ensino na Saúde / Trata-se de um estudo sobre a interdisciplinaridade no processo de formação e sua articulação com saberes teóricos e práticas desenvolvidas no Curso de Residência em Enfermagem em Saúde Coletiva da Escola de Enfermagem Aurora de Afonso Costa, da Universidade Federal Fluminense, Rio de Janeiro. É uma pesquisa social, de natureza qualitativa, do tipo exploratória e descritiva. Teve como objetivos refletir sobre a formação em saúde e sua articulação com a interdisciplinaridade; discutir como vem sendo implementada a interdisciplinaridade, na teoria e na prática no Curso de Residência de Enfermagem em Saúde Coletiva; construir uma tecnologia educacional que contribua para a implementação da pedagogia interdisciplinar no curso citado. A coleta de dados foi realizada por meio de entrevistas semi-estruturadas com os docentes vinculados à citada Residência e com as enfermeiras residentes em Saúde Coletiva. Para análise dos dados, optou-se pela análise temática. O saber-fazer-ser integrado ao humano, a fragmentação e a diversidade dos saberes e a interdisciplinaridade como relação de poder-saber configuraram-se como as três categorias centrais, construídas a partir das unidades de significação. Tais categorias tiveram como substrato teórico os estudiosos envolvidos com a temática, com ênfase na obra do filósofo e epistemólogo Hilton Japiassu e do sociólogo e professor Michel Foucault. Os resultados obtidos revelam que a interdisciplinaridade ainda é um desafio enquanto eixo norteador da formação e da prática dos profissionais de saúde em geral, particularmente das Residentes do Curso de Enfermagem em Saúde Coletiva da UFF. Desenvolver um trabalho interdisciplinar não é tarefa fácil, já que envolve inúmeros aspectos, principalmente aqueles relativos às relações de poder e saber. A proposta foi, nesse sentido, apontar como a implementação do pensamento interdisciplinar significará ganhos expressivos no fortalecimento desta práxis. Concluiu-se que há necessidade de priorizar e favorecer, junto aos docentes e enfermeiros residentes do curso em tela, espaços de aprofundamento, reflexão e discussão sobre o tema, a fim de aprimorar habilidades permeadas pela pedagogia interdisciplinar na prática profissional em saúde. / This study explores how an interdisciplinary curriculum can successfully wed theory to practice in the Collective Health Nursery Internship Program delivered by Aurora de Afonso Costa Nursery School at Universidade Federal Fluminense (UFF), in Rio de Janeiro state. This qualitative social research has both an exploratory and descriptive nature, as it aims to discuss interdisciplinary delivery of both theoretical and practical instruction by the above referred non-degree post-graduate program. Data were collected via semi-structured interviews with the internship program faculty and with Collective Health intern nurses. Data theme analysis was conducted in the light of three central themes - the knowing-doing-being framework, knowledge diversity and fragmentation, and interdisciplinarity, which are viewed as the essential pillars of meaning-based knowledge-power relations. These categories are supported by the literature review which relies namely on the works by philosopher and epistemologist Hilton Japiassu and sociologist and educator Michel Foucault. Findings show that an interdisciplinary approach is still challenged as the foundation concept of the qualification and practice process of healthcare professionals in general, particularly with respect to the Collective Health Nursing Interns at UFF. Developing interdisciplinary work is not an easy endeavor since there are many perspectives at stake, especially those related to power and knowledge relations. The baseline directive of this study was to show how interdisciplinary thinking can yield significant gains and strengthen the teaching praxis. It can be concluded that further investigation, reflection and discussion about interdisciplinarity should be fostered and prioritized among the faculty and the interns so as to develop and enhance their professional practice and interdisciplinary teaching

Doctor of Philosophy / Department of Human Nutrition / Valentina M. Remig / Preventing foodborne illness and promoting safe food practices among all age groups is a high priority, particularly for college students because little about their food safety awareness and food handling practices has been reported. The research aim was to evaluate food safety attitudes, beliefs, knowledge, and self-reported practices of current upper-division college students, and to determine whether a three-module interactive educational intervention, developed for this study, positively influenced these variables. Comparisons between health and non-health majors were made. Two methods of data collection were used with volunteer health and non-health majors: focused food safety discussion groups during academic year 2004-05, and a pre-experimental design. Prior to engaging in either method, students completed an on-line food safety questionnaire (FSQ), adapted from a telephone survey used at K-State with older adults. The FSQ was administered again to those in the pre-experimental design group one week after exposure to the food safety educational intervention. Five weeks later, the FSQ was administered to determine whether changes in attitudes, beliefs, knowledge, and self-reported practices persisted over time. Focused food safety discussion group responses were qualitatively evaluated. Pre-experimental statistical analyses included Wilcoxin Signed Rank, Friedman, Mann-Whitney U, Chi Square tests, and Spearman rho. Focused discussion group findings indicated that students perceived themselves at low risk for foodborne illness; few used food thermometers; students without health backgrounds mimicked undesirable home practices; and students stated being open to changing non-recommended behaviors. Pre-experimental findings showed the effects of intervention were improved food safety attitudes, beliefs, and knowledge, with the strongest effects seen in health majors. Students' FSQ attitude scores increased from 114 to 122 (P<0.001), FSQ belief scores increased from 86 to 98 (P<0.001), and FSQ knowledge scores increased from 11 to 13 (P<0.001). Intervention resulted in some improved food safety self-reported practices for health majors but not non-health majors. Intervention module post-test scores improved significantly for all students; health majors had greater increases. Conclusions. Focused food safety discussion groups were useful for obtaining food safety information from college students; educational intervention improved college students’ food safety attitudes, beliefs, and knowledge and for health majors, some self-reported practices improved.

This mixed-methods study examined patterns of dental health care utilization in adult Hispanic migrant farmworkers (AHMFW) with special emphasis on non-compliance with the American Dental Association (ADA) and the American Dental Hygienists Association (ADHA) recommendation of visiting the dentist at least once a year; while also exploring the group’s social and cultural construction of oral health. A total of 278 farmworkers responded to a close ended survey. Binary and hierarchical logistic regression analysis were employed in identifying predisposing, enabling, and needs factors associated with non-compliance. Following the survey, fourteen ethnographic interviews were conducted with respondents who volunteered to participate in this phase of the study. Most participants (79.5%) were non-compliant with the ADA and the ADHA recommendation. Binary logistic regression results indicated that AHFW reporting need for dental treatment were compliant with the recommendation. In contrast, those who brushed their teeth more often, experienced oral health impact, and reported poor perception of their mouth condition were non-compliant. Hierarchical logistic regression results pointed to those who used floss and reported need for dental treatment as compliant with the recommendation. Participants reporting poor perception of their mouth condition were non-compliant. Eight themes emerged from the qualitative analysis (understanding of the mouth, meaning of oral health, history of dental care; dental problems, barriers to dental care, caring of the teeth/mouth, medications, oral health quality of life). Farmworkers were knowledgeable of oral health, however, this knowledge, particularly the practice of brushing twice a day, made them less likely to seek regular dental care. Ultimately, a dental visit hinged on their limited finances, lack of dental insurance, and family responsibilities. Together, these decreased access to preventive dental services and increased risk of experiencing oral health problems.

This research study investigated the impact of staff education levels in ensuring implementation of effective health programmes: A comparative study of NPOs in City of Tshwane Metropolitan Municipality. The literature that was consulted explains the current level of education, worldwide and South Africa, challenges and reasons for lack of critical skills among health professionals and social workers. An exploratory approach was used in the study; by conducting a case study on two selected Non Profit Orgaisations (NPOs) namely, Hope for Life and Bophelong Life Community Hospice, both receiving funding from the Department of Health and Social Development and from the National Lotteries Distribution Trust (NLDTF) through the National Lotteries Board (NLB). Three methods of data collection were used to triangulate data, i.e. questionnaires, interviews and documentation reviews. Data was collected from staff members, NPO management and documentation from NPOs and Grant Funding System of the NLB. At the end of the study and using acquired information, a number of recommendations are made for the effective implementation of programmes for both NPOs and funding organisations such as NLB.

Objectif : Comprendre les tensions identitaires vécus par les professionnels de la santé, lorsque ceux-ci travaillent en partenariat avec des patients sur un comité d’amélioration continue. Devis : Étude qualitative ethnographique participative. Terrain de recherche : Une clinique de médecine de famille qui a décidé de former un nouveau comité d’amélioration de la qualité (CAQ) interdisciplinaire et d’y inclure des patients partenaires. Participants : Le CAQ était composé de deux patients partenaires, deux médecins de famille, deux résidents de médecine de famille, une pharmacienne, une infirmière clinicienne, un infirmier praticien spécialisé, une secrétaire, une réceptionniste, une agente de communication et une gestionnaire. Tous les participants ont été invités à participer à l’étude. Collecte des données : La collecte des données a commencé à l’automne 2017 et s’est terminé à l’été 2018. Elle comprenait des observations participatives, la tenue d’un journal de bord et des entrevues semi-dirigées. Résultats: À partir du cadre conceptuel développé par Ghadiri sur les menaces identitaires, notre étude met en lumière que le passage de la relation “soignant-soigné” à une relation “collègue-collègue” génère différentes tensions identitaires chez les professionnels, tant au plan de l’idéal du “bon” professionnel, de l’étanchéité des catégories patient-professionnel, du métissage des symboles associés à l’une ou l’autre de ces identités, et de l’équilibre intérieur entre les rôles de soignant et de collègue. Conclusion : Nos résultats offrent une grille de lecture originale et différente par rapport à la littérature scientifique existante, permettant de comprendre certains enjeux fréquemment rencontrés sur le terrain. Travailler en partenariat avec des patients n’implique pas, pour le professionnel, une relation de simple « collègue de travail », mais plutôt la construction d’un nouveau cadre relationnel, flexible et dynamique, prenant en compte une coexistence identitaire de plusieurs identités. / Objectives: To understand the identity tensions experienced by health professionals during a partnership relationship with patients on a quality improvement committee. Design: Qualitative ethnographic study based on participatory observation. Setting: Family medicine clinic in Montreal who decided to create a new interdisciplinary quality improvement committee (QIC) and to include PP for the first time. Participants: The QIC consisted of two patient partners, two family physicians, two family medicine residents, one pharmacist, one nurse clinician, one specialized nurse practitioner, one secretary, one receptionist, and one manager. All members of the QIC were invited to participate in the study. Data collection: Data collection began in the winter of 2017, when the committee was created, and ended in summer 2018. It consisted of participatory observations, logbook notes, and semistructured interviews. Results: Through Ghadiri's theoretical framework on identity threats, health professionals experienced significant identity tensions. Transforming the “caregiver–patient” relationship into a “colleague-colleague” relationship generated identity upheavals among the professionals, relating to the “good professional” ideal, the impermeability of the patient and professional categories, the interweaving of the symbols associated with one or the other of these identities, and the inner balance between the roles of carer and colleague. Conclusion: our results provide an interpretive reading that is original and different from the current literature, shedding light on certain issues frequently encountered in the field. Working with patients does not, for the professional, imply a purely “collegial” relationship, but rather the construction of a new relational framework, flexible and dynamic, that takes into account the coexistence of multiple identities.

L’enseignement de la chirurgie nasale est difficile, car l’opération est pratiquée dans le nez en regardant par les narines. Cela signifie que le résident (étudiant en chirurgie) et le patron (chirurgien-enseignant) ne voient pas ce que l’autre fait dans le nez (Ahmidi et al., 2015). Une solution semble être la septoplastie vidéo-assistée (SVA) où une caméra est ajoutée à un instrument chirurgical et projette le champ opératoire sur un écran (Rahal & Charron, 2017). Le but de cette étude est de mesurer l’impact de la SVA sur le processus d’apprentissage des résidents en comparaison à la chirurgie conventionnelle. Projet en 2 étapes : 1. Création d’un outil de mesure a. Création du modèle du processus d’apprentissage au bloc opératoire selon les écrits de Piaget (Piaget, 1975) et Collins (Collins, Brown, & Newman, 1987) b. Création et Validation d’un questionnaire (Quivy & Van Campenhoudt, 2011) 2. Comparaison a. Recrutement de 5 patrons et 4 résidents pour effectuer 38 septoplasties b. Assignation aléatoire du spéculum vidéo vs conventionnel c. Réponse au questionnaire après chaque chirurgie Résultats : Pour chaque élément du modèle d’apprentissage mesuré à l’aide du questionnaire, la SVA s’est avérée supérieure de manière statistiquement et cliniquement significative. Discussion et Conclusion : La SVA améliore la vue du champ opératoire, la communication et le raisonnement clinique tout en permettant d’enseigner la chirurgie nasale à plusieurs étudiants à la fois. En conclusion, la SVA a un impact positif significatif sur le processus d’apprentissage des résidents en comparaison à la chirurgie conventionnelle. / Teaching nasal surgery is challenging since the operative field is within the nose and the surgeon perform the surgery by looking through the nostrils. This means the resident and the attending surgeon cannot see what each other are doing in the nose. A solution could be the Video-Assisted Speculum of Rosemont where a high definition flexible endoscope is mounted on a modified nasal speculum. While the surgery is performed in the usual fashion by looking in the nose, the surgery is displayed in the operative room. Methodology The aim of this study was to measure the impact of adding a camera to the nasal speculum on the learning process of residents compared to the conventional speculum. A questionnaire was developed and validated with the help of three experts in education. Then five surgeons and four residents were recruited to perform 32 consecutive septoplasties. Either the Rosemont or the conventional speculum was randomly assigned, and the questionnaire was filled by the participants after each surgery. The scores for the specula were compared with Mann-Whitney U Test. Results For all the 7 elements underlying the learning process of residents in the operative room, the video-assisted Rosemont speculum performed significantly better than the conventional speculum. Discussion and conclusion The Rosemont speculum contribute to offer a better view of the operative field to bystanders, it also helps with verbal communication and clinical reasoning while giving the opportunity to teach several residents at the same time. In conclusion, the Rosemont speculum has a positive impact on the learning process of nasal surgery.

The ETSU dental hygiene program is very competitive and rigorous for those admitted. Student dental hygienists may experience higher levels of anxiety and more stressors while completing their course work and clinical hours than they have previously experienced in general education and prerequisite courses. These increased number of stressors and higher levels of anxiety may have negative impacts on students’ academic performance and success in clinical learning environments. A better understanding of the actual need for a stress reduction and anxiety management curriculum will facilitate creating and implementing this type of curriculum. A total of 44 current ETSU dental hygiene students were included in the study, juniors (55%) and (45%) seniors. Nearly all respondents reported their current stress and anxiety levels are affecting their lives (97.5%). Consistently over a third of students who completed surveys from the ETSU dental hygiene program are experiencing physical symptoms of stress and anxiety including headaches, gastrointestinal distress, trouble sleeping, eating too much or too little daily, tense muscles, worry or phobias, anger or hostility, irritability or hostility, and nervousness 2-3 times a week. The average stress level of the 44 ETSU dental hygiene students reported on a 1-10 scale was a 7.65. Nearly half (40%) of all ETSU dental hygiene students currently enrolled reported their stress level as 8 out of 10 with 10 defined as “I can only think of my stress and anxiety”. Further research including an educational intervention to help teach students skills and coping mechanisms to manage and reduce stress and anxiety was recommended.

Many factors influence poor oral health among disadvantaged populations including socioeconomic circumstances, knowledge of disease prevention strategies and ability to implement those strategies, public policies, insurance status, insurance policies, dental providers and other challenges to accessing dental care. Often these issues converge and result in early disadvantages to achieving good oral health (Horton & Barker, 2010). Addressing even some of the factors that contribute to poor oral health may provide ways to change the dental health status of historically underserved populations. The purpose of this research is to explore my role as a practitioner and researcher in the creation of a hygienist-based, community-site located, teledentistry supported system of dental care for underserved populations and the intersection of my experiences with cultural, societal and educational occurrences. This autoethnography examined my own experiences and also explored the experiences of a small sample of others who participated in onsite dental care systems utilizing hygienists as the prevention-focused primary care provider. As Ellis and Bochner (1996) note “Autoethnography stands as a current attempt to, quite literally, come to terms with sustaining questions of self and culture” (p. 193). The findings that emerged from my work included a realization that the dental industry creates and perpetuates the collective neglect of large portions of the US population. Some of this neglect is embedded in traditional power structures in dentistry, gender bias and distrust in professional skills as a result of separate professional education structures. The result for many people is untreated dental disease, a profound lack of health equity, increased shame due to poor oral health as well as missing school. There are ways to address the collective neglect of the dental industry through the reframing of the dental hygienist as the prevention-focused primary care oral health provider in professional education programs then integrating this provider type into community settings like schools.

One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 (22% in 2017 vs. 12% in 2013) for the overall population. However, the magnitude of increase differs in different age groups and ethnic groups. More statistically significant findings show greater utilization rates among beneficiaries of 19-64 than 65-74 and 75+ years old. Also, more significant findings show lower utilization among Black than White, Hispanic or Asian beneficiaries. The partial restoration significantly reduced the dental related ER visits among Medi-Cal beneficiaries from 2015 to 2017. However, the reduction is largely seen in beneficiaries of 19-64 years old in the ethnic groups of White and Black with reductions of 20 and 15 visits per 1,000 enrollees respectively in 2017 comparing to 2013. The dental related ER visits were lower for Hispanics and Asians, and remained very low among those 65 years old and above. In addition, the partial restoration resulted in increases in participation of dental care providers in the Medi-Cal program.