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This thesis sets out to explore some important gaps in the sociological and feminist understanding of the provision of maternity care and of women's health needs. The research was concerned with an exploration of the implementation of proposals for the provision of user-centred maternity care which emerged from the critiques of current medicalised provision. It evaluates the effects of an attempt to provide user-centred maternity care within the Primary Health Care sector (PHC) from both the women's and workers' perspectives and experience. The central questions addressed within the research have been: Firstly, to assess the degree to which such models of service delivery provide a user centred approach. Secondly, to identify the form of the relationship between the women users and providers from the practices and to develop an understanding of the mechanisms of interaction between them. Thirdly, to explore the extent to which the provision of such care is appropriate to match women users' self identified needs. Finally, to assess the potential of female health workers to adopt a form of provider and user relationship where the balance of power is altered in the users' favour. The main body of the research consisted of a qualitative study conducted in two general practices. These were chosen as specific examples of innovative practices attempting to provide a genuinely user-centred maternity service. The fieldwork consisted of three methodological components: Firstly, unstructured interviews were conducted with women users and workers. A sample of 30 women who were pregnant for the first time were interviewed on three occasions during their pregnancy and in the immediate post-natal period. In addition, 10 second time mothers were also interviewed post-natally. In terms of the workers', in depth interviews were conducted with midwives, GPs and practice nurses within the PHC setting. Secondly, observations were undertaken on the interactions between the women and workers and between members of the PHC team during the course of the women's antenatal and post-natal care. Finally, a structured questionnaire was used with a sample of women from one of the practice's well woman clinic. The research findings indicate the existence of a user-centred frame of reference held by female health workers - especially the midwives - for the provision of health care to women, which was opposed to the medical model. It explores the translation into practice of this model of maternity care and identifies the way that it functioned to enable women to exercise greater control over their health care and experience of pregnancy. Within this model the traditional 'with woman' role of the midwife was found to be central. Considerable convergence was found between the models held by the main parties in the interaction - issues concerned with choice, control and the provision of information were all found to be central to the care provided and to women's and workers' models. However, constraints on the effective implementation of the model were found in terms of the influence of professionalism (particularly on the GPs) and the dominance of the hospital system. These resulted in limits to the women workers' ability to meet the needs of women users.

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No / This article highlights the importance of examining physical and psychological health in the context of youth sexual exploitation by drawing on findings from an empirical research study undertaken between 2006 and 2011. Data were drawn from interviews with 24 sexually exploited young people and 61 professionals working in agencies supporting sexually exploited young people. A sequential mixed-method approach was employed to address the research study aims using interviews and a questionnaire survey. A significant range of physical and psychological health problems were reported alongside risks to health and barriers to health support for sexually exploited young people. Intentional self-harm and substance abuse were concordant themes from phases 1 and 2. Psychosocial vulnerability factors appear to undermine health and affect health-seeking behavior. Novel themes that emerged from this study included taxonomy of risk behaviors related to health.

Esta pesquisa teve o objetivo de analisar os cuidados de crianças nascidas prematuras egressas de unidades neonatais, com foco nas perspectivas maternas sobre as necessidades essenciais e de atenção especial de saúde, em uma região brasileira de fronteira. Estudo misto, com análise quantitativa de informações em saúde de 951 prontuários de prematuros hospitalizados entre 2013 e 2017, utilizando-se testes estatísticos dos programas IBM SPSS Statistics versão 25 e R i386 versão 3.4.0; e abordagem qualitativa como eixo central, na perspectiva da hermenêutica filosófica, realizada a partir de quatro encontros com 18 mães de crianças prematuras egressas de terapia intensiva neonatal. O primeiro encontro aconteceu no hospital, para caracterizar crianças/famílias e classificar Crianças com Necessidades Especiais de Saúde (CRIANES), aplicando-se o roteiro \"Triagem CRIANES\", utilizado nas quatro etapas do estudo; a seguir, visita domiciliar, realizada após 15 dias da alta hospitalar, com entrevista em profundidade; dois contatos telefônicos ou por mensagem de texto instantânea (30 dias após a visita e aos seis meses de idade da criança). Oportunizaram-se novos encontros/contatos a partir das necessidades das mães. Elegeu-se para a análise, a interpretação de sentidos. A coleta de dados ocorreu em Foz do Iguaçu-Paraná-Brasil, entre julho de 2017 e maio de 2018. Os resultados mostram que o nascimento prematuro representou 10,3% e 43,3% necessitaram hospitalização. A prematuridade foi maior para mães argentinas. A idade média materna foi 27,2 anos, peso ao nascer 1.700g, idade gestacional 31,5 semanas, período de internação 23,1 dias, e diagnóstico de problemas pulmonares. A mortalidade apresentou uma média de 21,3%. O menor número de consultas pré-natal, intercorrências maternas, Apgar de 5º minuto abaixo de sete e complicações com o bebê foram correlacionados ao aumento dos dias de hospitalização. O menor peso ao nascer, menor idade gestacional, índices de Apgar de 1º e 5º minuto inferiores a sete e complicações aumentaram as chances de óbito. No tocante aos cuidados maternos, apreendeu-se que a interação entre mãe e filho se fortalece no processo de cuidar em domicílio, e são apontadas dificuldades para compartilhamento e aprendizado no hospital. As mães salientam fragilidades no preparo para cuidar, identificam os bebês como frágeis e pequenos, buscam atender as necessidades essenciais do filho pelo reconhecimento da relevância de um bom desenvolvimento e do entendimento das práticas de estimulação nos momentos do cuidado cotidiano. Consideram primordiais o aleitamento materno, afeto e seguimento à saúde para bom desenvolvimento. A falta de oportunidades institucionais para amparar o cuidado domiciliar repercutiram em desatenção no âmbito hospitalar e na atenção primária. As mães encontram dificuldades no reconhecimento de necessidades no hospital e manifestam preocupação com a saúde dos bebês após a alta e com sequelas advindas das complicações. As necessidades de \'uso de serviços\' e \'dependência medicamentosa\', foram reportadas para quatro crianças. Visitas domiciliares e contatos telefônicos foram considerados relevantes, indicativos de potencialização de apoio ao cuidado domiciliar. Compartilhar informações, reconstruir experiências e favorecer o diálogo são aspectos importantes para proporcionar confiança e autonomia para o cuidado no domicílio e incrementar a atenção às necessidades da criança prematura / This study aimed to analyze the care of children born prematurely in neonatal units, focusing on maternal perspectives on essential needs and special health care in a Brazilian border region. Varied study, with quantitative of health information from 951 medical records of premature hospitalized between 2013 and 2017, using statistical tests provided by IBM SPSS Statistics version 25 and R i386 version 3.4.0 programs; and qualitative approach as central axis, in the perspective of philosophical hermeneutics, realized from four appointment with 18 mothers of premature children who were hospitalized from intense neonatal therapy. The first appointment happened in the hospital to characterize the children/family and classify Children with Special Health Care Needs (CSHCN) applying the script \"Screening CSHCN\" using in the four stages of the study; next, home visit, realized after 15 days of discharge, with in-depth interview; two phone contacts or by instant message (30 days after the visit and six months of age of the child). It has become available new meetings/contacts from the maternal needs. The sense interpretation was elected for analysis. The data collection happened in Foz do Iguaçu- ParanáBrazil, between July 2017 and May 2018. The results shown that the premature born represented 10.3% and 43.3% needed hospitalization. The maternal mean age was 27,2 years, birth weight 1.700g, gestational age 31,5 weeks, hospitalization period 23,1 days and diagnosis of pulmonary problems. Mortality presented an average of 21.3%. The lower number of prenatal consultations, maternal complications, Apgar scores of 5 minutes below seven and complications with the baby were correlated with the increase in the days of hospitalization. The lower birth weight, the lower gestational age, Apgar scores of first and fifth minutes less than seven and complications increases the death chances. Regarding maternal care, it was found that the interaction between mother and son strengthened in the process of home care, and difficulties were identified for sharing and learning in hospital environment. The mothers accentuate fragilities in the preparation to care, identify the babies as fragile and small, search to meet the essential needs of the child for relevance recognition of a good development and the understanding the practices of stimulation in the moments of daily care. Breastfeeding, affection and health follow-up for good development are considered paramount. The lack of institutional opportunities to support the home care had repercussions about inattention in hospitable scope and primary care. The mothers find difficulties in recognition of needs in the hospital and manifest concern about the health of their babies after discharge and with sequels due to complications. The needs of \"use of service\" and \"medicine dependency\" were reported relevant for four kids. Home visits and phone contacts were considered relevant, how indicative of potentialization of support for home care. Sharing information, rebuild experiences and favor dialogue are important aspects to provide confidence and autonomy for home care and increase the attention to the needs of the premature children

Purpose: This study examined differences in oral health status and dental treatment needs by HMO regions in Virginia. Methods: The Division of Dental Health (DDH), Virginia Department of Health (VDH), completed the 1999 Virginia Oral Health Needs Assessment (VSOHNA) with the cooperation of the Virginia Department of Education. The survey used a probability proportional to size (PPS) sample design in selecting school children from public schools in the Commonwealth of Virginia. Surface (DMFS/dfs) and tooth-level (DMFT/dft) data were collected as indicators of dental disease on all children. Child-level data was also recorded for each student consisting of age, race, gender, enrollment in a free and reduced lunch program, medical insurance status, dental insurance status, and history of dental visits. A descriptive and regression analysis was completed to examine the relationship between HMO regions and oral health status indicators. Results: The survey included more than 5,000 children in 200 schools and 52 school districts. The mean DMFT/dft levels were 1.47 (.33) and 1.7 (.03), respectively. The mean level of untreated decay (dt) for all schoolchildren was 0.66 (0.01). First graders had the highest levels of untreated disease at 0.71, while third graders had a mean of 0.66. The Central region of the state appeared to have the highest level of untreated decay. Conclusion: There were no significant differences in the percentage of "caries-free" children between the HMO regions. Untreated dental disease of Virginia schoolchildren varied according to the region in which they lived.

Profissionais de saúde, atuantes em serviços que oferecem aconselhamento genético (AG), carecem de instrumentos objetivos para avaliar os desfechos do AG e para \"dar voz\" aos usuários desses serviços. O desconhecimento desses desfechos pode impactar diretamente na efetividade e nos benefícios do aconselhamento, na qualidade de vida, na promoção da saúde e no empoderamento dos aconselhados. Tais instrumentos são escassos na maioria dos países e inexistentes no Brasil. Nesse contexto, o presente estudo teve como objetivo adaptar culturalmente e validar a Genetic Counseling Outcome Scale/GCOS-24, originalmente elaborada no idioma inglês britânico. Após aprovação pelo Comitê de Ética em Pesquisa das instituições participantes, conduzimos uma investigação metodológica, que incluiu 204 usuários (pacientes, acometidos ou em risco para doenças genéticas, ou um de seus familiares/cuidadores) do Serviço de Genética Médica de um hospital universitário do interior paulista, durante o período de outubro de 2014 a dezembro de 2015. O processo de adaptação e validação da GCOS-24 compreendeu as fases de tradução e retrotradução, comitê de especialistas, validação semântica, estudo piloto e estudo de campo, por meio de análise estatística apropriada. A validação semântica demonstrou que a GCOS-24 é composta por itens considerados relevantes para a condição de saúde dos participantes do estudo, os quais foram facilmente compreendidos pelos mesmos. A versão adaptada apresentou confiabilidade satisfatória (?Cronbach=0,71) e estabilidade moderada (ICC=0,52), mensuradas, respectivamente, pelo Coeficiente Alfa de Cronbach e Coeficiente de Correlação Intraclasse. O processo de adaptação e validação da GCOS-24 para brasileiros foi finalizado. O produto final deste trabalho, a EDAG-24 (Escala de Desfechos do Aconselhamento Genético/EDAG-24), foi considerada válida e fidedigna à sua versão original, com potencial para mensurar os desfechos do aconselhamento genético, realizado em serviços de genética clínica / Health professionals working in services that offer genetic counseling (GC) lack objective instruments to measure the GC outcomes and to give voice to the users of these services. The unawareness of these outcomes can directly impact the effectiveness and benefits of counseling, life quality, health promotion and the empowerment of the patients. Such instruments are scarce in most countries and nonexistent in Brazil. In this context, this paper aimed to culturally adapt and validate the Genetic Counseling Outcome Scale /GCOS-24, originally made in British English. After the approval of the Research Ethics Committee of the participating institutions, we conducted a methodological investigation, which included 204 users (patients, affected or at risk for genetic diseases, or one of their relatives/caregivers) from the Medical Genetics Service of a university hospital in the countryside of the state of Sao Paulo, during the period from October 2014 to December 2015. The process of adaptation and validation of the GCOS-24 comprehended the phases of translation and back-translation, committee of experts, semantic validation, pilot test and field study, through appropriate statistical analysis. The semantic validation revealed that GCOS-24 consists of items that were considered relevant to the health condition of the study participants, which were easily understood by them. The adapted version presented satisfactory reliability (?Cronbach=0,71) and moderate stability (ICC=0,52), measured, respectively, by the Cronbach\'s Alpha Coefficient and Intraclass Correlation Coefficient. The adaptation and validation process of the GCOS-24 to Brazilians was finalized. The final product of this paper, the EDAG-24 (Escala de Desfechos do Aconselhamento Genético/EDAG-24), was considered valid and reliable to its original version, with potential to measure the genetic counseling outcomes conducted in Clinical Genetics Services

Introdução: Na adolescência, existem muitas marcas prejudiciais ao desenvolvimento decorrentes dos processos deletérios de desgaste que os grupos populacionais mais subalternos vem sofrendo. Os escolares do ensino fundamental tornam-se, portanto, potenciais alvos para intervenções que possam prevenir ou amenizar esta realidade. As escolas são os loci privilegiados para encontrar este grupo social e, portanto, reconhecer e enfrentar as necessidades em saúde. Objetivo geral: Identificar as possibilidades das escolas no reconhecimento e enfrentamento das necessidades em saúde de sua população e a articulação com as demais instituições do território. Metodologia: estudo exploratório e descritivo, com abordagem qualitativa. Os dados foram coletados por meio de entrevistas semidiretivas com roteiro previamente testado, com os trabalhadores das escolas municipais e unidades de saúde de São Paulo e tratados com o programa de análise lexical ALCESTE. Resultados: inexiste uma sistematização para o reconhecimento das necessidades de saúde do escolar, as ações de enfrentamento estão voltadas a atender emergências e encaminhamentos aos serviços de saúde. As necessidades reconhecidas e enfrentadas referem-se à adaptação dos alunos com necessidades educacionais especiais em meio a outros alunos, que ocorrem nas salas de aula, e menos em outros momentos da presença dos escolares na instituição. A relação entre escola, o setor saúde e os demais encontra-se desarticulada. Conclui-se ser imperativo monitorar as necessidades em saúde e as vulnerabilidades dos escolares que permitem verificar que existe um grande campo de atuação interdisciplinar na saúde coletiva. / Introduction: In adolescence, there are many brands affects the development of deleterious processes resulting from wear which population groups have suffered more underlings. The schoolchildren become therefore potential targets for interventions that could prevent or ameliorate this situation. Schools are privileged loci to meet this social group and, therefore, recognize and address the health needs. General Objective: To identify the opportunities for schools to recognize and cope with the health needs of its population and coordination with other institutions in the territory. Methodology: exploratory and descriptive, qualitative approach. Data were collected through interviews with semi-direct route previously tested, with workers at local schools and health units in Sao Paulo and treated with ALCESTE lexical analysis program. Results: does not exist a systematic method to the recognition of the needs of school health, coping actions are intended to meet emergencies and referrals to health services. Needs recognized and addressed relate to the adjustment of students with special educational needs among other students, that occur in classrooms, and less at other times the presence of students at the institution. The relationship between school, the health sector and the other is disjointed. It is imperative to monitor the health needs and vulnerabilities of the school verifying that there is a large field of interdisciplinary work in public health.

O reconhecimento e enfrentamento das necessidades de saúde da população de um dado território de abrangência estão estreitamente vinculados aos princípios básicos do SUS, em especial aos conceitos de integralidade e eqüidade, na medida em que implicam por parte das equipes de saúde o esforço de tradução e atendimento às mesmas. Diante disso, este estudo buscou compreender, no cotidiano do processo de trabalho em saúde, quais os sentidos que norteiam a identificação de necessidades de saúde pelos profissionais da estratégia Saúde da Família, como ocorre e que profissionais decidem pelo enfrentamento às necessidades de saúde da população usuária do serviço. Tratou-se de um estudo descritivo, na perspectiva qualitativa, fundamentado na Teoria da Intervenção Práxica da Enfermagem em Saúde Coletiva TIPESC, cujo método para interpretação dos discursos referenciou-se na hermenêutica-dialética. A técnica para análise do processo de trabalho das equipes foi realizada com base no Fluxograma Analisador do Modelo de Atenção de um Serviço de Saúde, proposto por Merhy (1997) e alterado por Fracolli (1999). Constituiu-se como fonte do material empírico o conjunto das entrevistas semi-estruturadas realizadas com médicos, enfermeiras, auxiliares de enfermagem e agentes comunitários de saúde das equipes da estratégia Saúde da Família. Os resultados fizeram emergir os seguintes sentidos que norteiam a identificação de necessidades de saúde pelos profissionais: necessidades de saúde relacionada a agravos e necessidades de saúde relacionada às más condições de vida. Os produtos que resultaram do atendimento às necessidades de saúde, consultas médicas, procedimentos, equipamentos, medicamentos e atenção especializada, estão em consonância com os sentidos que permeiam a identificação de necessidades, ou seja, trazem uma concepção necessidade de saúde aproximada com a doença. Em relação à decisão pelo enfretamento, a decisão pelo atendimento é tanto do profissional que primeiro tem contato com a situação quanto da equipe de saúde, tendo como ponto de partida às situações levantadas nas visitas domiciliárias ou quando a Unidade Básica de Saúde (UBS) é demandada. Conclui-se que os modos pelos quais os profissionais das equipes de Saúde da Família reconhecem e enfrentam as necessidades de saúde apresentadas pela população usuária do serviço, vinculam-se às concepções de saúde e doença que perpassam o modelo assistencial sob o qual o serviço se encontra organizado, assim como as práticas de saúde desenvolvidas no cotidiano do processo de trabalho das equipes. Neste sentido, tais concepções representam um dos limites a ser superado para que se consiga avançar na direção de um modelo assistencial cujas práticas tenham por finalidade a integralidade do cuidado, tomando as necessidades de saúde como orientadoras destas / The recognition and confrontation the population health needs from a specific region are closely linked to the basic principle of SUS (The Brazilian Health System), especially to the concepts of integrity and equity, meaning to the Family Health Teams, the effort to translate and render these identified needs. This study tries to understand which senses orientate the health needs identification by the Family Health strategy professionals. How does it happen and which professionals decide by facing the health needs from the population. The study was descriptive, in the qualitative perspective based on the Nursing Praxis Intervention Theory in Collective Health TIPESC, whose methodology to interpret the speeches was validated in the dialectic hermeneutics. The technique to the work process analysis was done according to the Analysis Flowchart from a Health Service Care Pattern proposed by Merhy (1997) and altered by Fracolli (1999). The set of semi-structured interviews performed with physicians, nurses, nursing auxiliaries, and community health agents from the family health teams is the source of empirical material of this study. The results showed the following senses which orientate the health identification needs by the professionals: health needs related to injuries and health needs related to bad life quality. The outputs which resulted in rendering health needs, medical appointments, proceedings, equipment, medication, and specialized attention are in accordance with the senses which permeate the needs identification. It means that they bring a health conception associated to diseases. As far as the decision for facing needs the decision for rendering services belongs to the Professional who has had the first contact with the situation as much as the health team, having as a starting point the home visits data or consultation with the Basic Health Unit (UBS). It is possible to conclude that the ways that the Family Health Teams recognize and face the health needs presented by the population are linked to the health and sickness conceptions which are present in the assistance model in which the service is organized, as well as the quotidian service practices are developed in the working process of the health teams. Thus, such conceptions represent one of the limits to be overcome in order to advance towards an assistance pattern whose practices aim at integrating care having health needs as their guidelines