This research is one contribution to understanding the nature of policy and of power. the interaction of the state and its machinery with individuals at all levels, the tensions between public and private choices and responsibilities, between public health and clinical health care. Adapting a policy analysis approach, this thesis provides a case study of the development and implementation of reproductive health policies in Ghana. The aim is to enhance understanding of why there are differences between policy and practice and what the potentials are for integrating STD/HIV management into MCH/FP services in Ghana to improve reproductive health. This thesis argues that all elements of policy and policy analysis are located within a 'contextual framework' and are influenced by a range of contextual factors (defined and illustrated through the thesis) which are seldom taken into account in policy process and analysis. It is argued that understanding the different levels of context is fundamental to understanding the processes of policy development and implementation, the actions of actors at all levels and the policy outcomes. Using a multi-level focus and a combination of approaches, this thesis identifies the contextual factors and their manifestations at each level of the policy process and illustrates how they impact on policy. The analysis synthesises macro and micro dimensions gaining a more comprehensive understanding of the influences on and gaps between policy development and implementation. At the implementation level, 27 clinics were visited and 94 clinic staff interviewed in one rural region of Ghana, to ascertain what STD/HIV management services are actually being provided and what factors influence service provision (policy implementation). Interviews with community leaders and focus groups with villagers were conducted in the same region to explore community perspectives of disease and health care services and understand the factors influencing service utilisation (policy outcome). The role of the regional health administration as an intermediary was considered and understanding sought of the concepts of power which influence administrative and management structures. The national level interviews with government and Ministry of Health officials and with donor, NGO and national group representatives, provide further insight into the concepts of power and status and who influences policy making. Finally, all elements are brought together and discussed, a reworked framework is presented and suggestions for future policy and research directions are made.

A presente Tese oferece uma proposta teórico-metodológica para o estudo da Reforma Sanitária Brasileira e seus desdobramentos posteriores, baseada num esquema conceitual de onde derivam três categorias de análise - a de Esfera Pública, a de Fundo Público e a de Padrão de Financiamento Público - referidas aos determinantes sociais, econômicos e políticos que, interativamente, afetam as políticas sociais. Tem origem na constatação de que a VIII Conferência Nacional de Saúde propõe, e a Constituição de 1988 consagra, um conceito eminentemente político de Saúde, pelo qual todas as ações de Saúde são consideradas \"públicas\", por sua relevância social e sua participação no interesse geral, regidas por uma normatividade socialmente definida e sujeitas ao controle social institucionalizado. Desse modo, tornando a Saúde Pública o âmbito interinstitucional, multidisciplinar e popular das discussões e decisões sobre os processos saúde/doença da população - o que significa a definição de um mais amplo espaço para a Saúde Pública no interior da Esfera Pública. A aceitação generalizada das propostas da Reforma Sanitária, no período pré-Constituinte e na Constituinte, liga-se ao contexto da transição para a democracia, quando era reconhecida a falência do Padrão de Financiamento das políticas sociais adotado no regime militar, abrindo-se então espaço para proposições que visavam a um Padrão de Financiamento mais próximo do adotado na social-democracia. Entretanto, o redirecionamento do Fundo Público, pressuposto principal de viabilidade das atividades sociais e, principalmente, das mudanças constitucionais aprovadas, tem encontrado resistências e apresentado recuos, que não apenas recuperam os mecanismos viciados e distorcidos de financiamento, como têm desfigurado o modelo de Sistema único de Saúde proposto na Reforma Sanitária, tornando-o numa espécie de caricatura perversa. / The present Thesis offers a theoretical-methodological proposition for the study of the Brazilian Health Care Reform and its later developments. It is based upon a conceptual scheme from which three categories of analyses derive - that of the Public Sphere of Ation, that of Public Fund and that of Public Financing Pattern- referred to the social, economic ando political determinants, which interactively affect the social politics. It comes from the verification that the National Health Conference proposes, and the 1988 Constitution establishes, an eminently political concept of Public Health. By this political concept all health actions are considered \"public\", in way of their social relevance and their participation in the general interest. And so, they must be ruled by a socially defined \"normativeness\", and subject to the institutionalized social control. So turning Public Health into the interinstitucional, multidiscipline and popular ambit of discussions and decisions about health/illness pqpulations processes. And it means the definition of a wider space for Public Health into Public Sphere. The generalized acceptance of the Health Care Reform propositions in the period prior of the Constituent Assembly performance, and in the working period of the Constituent Assembly, is connected to the context of the transition to democracy. In this context the failure of the Public Financing Pattern of social politics adopted in the military regime was recognized. Then a space for propositions that aimed at a Financing Pattern closer to the used in the social-democracy was opening. And so the Public Fund - the main pressuposition of feasibility of the social activities, and especially of the approved constitutional changes, must be directed to the popular interest. However this redirecting of Public Fund has found resistences and presented setbacks, which not only recover the vitiated and distorted financing mechanisms, but have also disfigured the model of the Single Health System proposed in the Health Care Reform, turning it into a kind of perverse caricature.

A presente Tese oferece uma proposta teórico-metodológica para o estudo da Reforma Sanitária Brasileira e seus desdobramentos posteriores, baseada num esquema conceitual de onde derivam três categorias de análise - a de Esfera Pública, a de Fundo Público e a de Padrão de Financiamento Público - referidas aos determinantes sociais, econômicos e políticos que, interativamente, afetam as políticas sociais. Tem origem na constatação de que a VIII Conferência Nacional de Saúde propõe, e a Constituição de 1988 consagra, um conceito eminentemente político de Saúde, pelo qual todas as ações de Saúde são consideradas \"públicas\", por sua relevância social e sua participação no interesse geral, regidas por uma normatividade socialmente definida e sujeitas ao controle social institucionalizado. Desse modo, tornando a Saúde Pública o âmbito interinstitucional, multidisciplinar e popular das discussões e decisões sobre os processos saúde/doença da população - o que significa a definição de um mais amplo espaço para a Saúde Pública no interior da Esfera Pública. A aceitação generalizada das propostas da Reforma Sanitária, no período pré-Constituinte e na Constituinte, liga-se ao contexto da transição para a democracia, quando era reconhecida a falência do Padrão de Financiamento das políticas sociais adotado no regime militar, abrindo-se então espaço para proposições que visavam a um Padrão de Financiamento mais próximo do adotado na social-democracia. Entretanto, o redirecionamento do Fundo Público, pressuposto principal de viabilidade das atividades sociais e, principalmente, das mudanças constitucionais aprovadas, tem encontrado resistências e apresentado recuos, que não apenas recuperam os mecanismos viciados e distorcidos de financiamento, como têm desfigurado o modelo de Sistema único de Saúde proposto na Reforma Sanitária, tornando-o numa espécie de caricatura perversa. / The present Thesis offers a theoretical-methodological proposition for the study of the Brazilian Health Care Reform and its later developments. It is based upon a conceptual scheme from which three categories of analyses derive - that of the Public Sphere of Ation, that of Public Fund and that of Public Financing Pattern- referred to the social, economic ando political determinants, which interactively affect the social politics. It comes from the verification that the National Health Conference proposes, and the 1988 Constitution establishes, an eminently political concept of Public Health. By this political concept all health actions are considered \"public\", in way of their social relevance and their participation in the general interest. And so, they must be ruled by a socially defined \"normativeness\", and subject to the institutionalized social control. So turning Public Health into the interinstitucional, multidiscipline and popular ambit of discussions and decisions about health/illness pqpulations processes. And it means the definition of a wider space for Public Health into Public Sphere. The generalized acceptance of the Health Care Reform propositions in the period prior of the Constituent Assembly performance, and in the working period of the Constituent Assembly, is connected to the context of the transition to democracy. In this context the failure of the Public Financing Pattern of social politics adopted in the military regime was recognized. Then a space for propositions that aimed at a Financing Pattern closer to the used in the social-democracy was opening. And so the Public Fund - the main pressuposition of feasibility of the social activities, and especially of the approved constitutional changes, must be directed to the popular interest. However this redirecting of Public Fund has found resistences and presented setbacks, which not only recover the vitiated and distorted financing mechanisms, but have also disfigured the model of the Single Health System proposed in the Health Care Reform, turning it into a kind of perverse caricature.

Submitted by Bianca de Fátima Pinheiro null (bih_pinheiro@hotmail.com) on 2017-03-25T00:39:00Z No. of bitstreams: 1 Defesa - Bianca Pinheiro - VERSÃO FINAL (1).pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-03-29T18:26:16Z (GMT) No. of bitstreams: 1 pinheiro_bf_me_bot.pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) / Made available in DSpace on 2017-03-29T18:26:16Z (GMT). No. of bitstreams: 1 pinheiro_bf_me_bot.pdf: 3735855 bytes, checksum: f6debe5602c92a8fb95b71a7c3ba52c9 (MD5) Previous issue date: 2017-02-24 / Neste trabalho foram analisados os custos financeiros decorrentes da implantação de um serviço de radioterapia intraoperatória (IORT), considerando os valores gastos para a construção do centro cirúrgico e demais dependências necessárias anexas a um serviço de radioterapia pré-existente, bem como os valores de aquisição de acessórios específicos para IORT para uso em um acelerador linear clínico. Foi comparada a realização do procedimento de IORT com o acelerador linear fixo e com o equipamento irradiador móvel (INTRABEAM®). Os dados obtidos foram coletados por e-mail e telefone junto aos serviços de radioterapia cadastrados na Sociedade Brasileira de Radioterapia, e junto aos fornecedores do ramo de radioterapia (Medical Systems, Elekta Medical Systems e ZEISS), além disso, o ambiente destinado para IORT do Hospital das Clínicas de Botucatu foi avaliado nos aspectos sócios econômicos. Foram analisados artigos publicados por serviço de radioterapia que realizam IORT, e selecionados os 10 principais, ilustrando a eficiência do procedimento. A pesquisa com os centros de radioterapia apontou que dos participantes apenas 17,7% realizam o procedimento. Os custos apontados para a instalação do serviço de IORT no Hospital das Clínicas de Botucatu somam a quantia de R$290.000,00. Comparando o Acelerador Linear com o INTRABEAM®, ambos possuem um tempo total gasto no procedimento semelhante. A avaliação do CONITEC do Ministério da Saúde mostrou não ser favorável para a incorporação da IORT usando o INTRABEAM® no SUS. Avaliando os repasses financeiros para o procedimento de IORT, o SUS ainda não incorporou nas suas diretrizes, no entanto, de acordo com a esfera privada, o procedimento de IORT custaria em torno de R$11.000,00, levando em consideração os gastos do Hospital das Clínicas de Botucatu, são necessárias à realização de 27 procedimentos para a reposição do investimento inicial. São ilustrados os benefícios terapêuticos da técnica de IORT frente à radioterapia convencional. Também estão ilustrados os parâmetros físicos analisados no processo de controle de qualidade dos procedimentos de radioterapia intraoperatória. O trabalho aponta que a IORT pode contribuir para minimizar a concentração de pacientes em processo de espera pelo tratamento convencional fracionado, e assim proporcionar maior conforto aos doentes, além de reduzir os custos dos procedimentos radioterápicos atualmente reembolsados pelos sistemas de saúde. / In this study, the financial costs resulting from the implantation of an intraoperative radiotherapy service (IORT) were analyzed, considering the amounts spent for the construction of the surgical center and other necessary dependencies attached to a pre-existing radiotherapy service, as well as the acquisition values IORT-specific accessories for use in a clinical linear accelerator. The IORT procedure was compared with the fixed linear accelerator and with the mobile radiator device (INTRABEAM®). The data obtained were collected by e-mail and telephone with radiotherapy services registered at the Brazilian Society of Radiotherapy, and with radiotherapy providers (Medical Systems, Elekta Medical Systems and ZEISS), and the environment for IORT Of the Botucatu Clinic Hospital was evaluated in the socioeconomic aspects. We analyzed published articles by radiotherapy service that performed IORT, and selected the 10 main ones, illustrating the efficiency of the procedure. The research with the radiotherapy centers pointed out that of the participants only 17.5% performed the procedure. The costs indicated for the installation of the IORT service at Botucatu Clinic Hospital add up to the amount of R$ 290.000,00. Comparing the Linear Accelerator with INTRABEAM®, both have a total time spent in the similar procedure. The CONITEC evaluation of the Ministry of Health was not favorable for the incorporation of IORT using INTRABEAM® in the SUS. Evaluating the financial onlendings for the IORT procedure, the SUS has not yet incorporated into its guidelines, however, according to the private sphere, the IORT procedure would cost around R$ 11.000,00, taking into account the Botucatu Clinic Hospital, are necessary to carry out 27 procedures for the replacement of the initial investment. The therapeutic benefits of IORT versus conventional radiotherapy are illustrated. Also shown are the physical parameters analyzed in the quality control process of the intraoperative radiotherapy procedures. The study points out that IORT can contribute to minimizing the concentration of patients waiting for the conventional fractionated treatment, thus providing greater comfort to the patients, besides reducing the costs of the radiotherapy procedures currently reimbursed by the health systems.

Orientador: Marco Antônio Rodrigues Fernandes / Resumo: Neste trabalho foram analisados os custos financeiros decorrentes da implantação de um serviço de radioterapia intraoperatória (IORT), considerando os valores gastos para a construção do centro cirúrgico e demais dependências necessárias anexas a um serviço de radioterapia pré-existente, bem como os valores de aquisição de acessórios específicos para IORT para uso em um acelerador linear clínico. Foi comparada a realização do procedimento de IORT com o acelerador linear fixo e com o equipamento irradiador móvel (INTRABEAM®). Os dados obtidos foram coletados por e-mail e telefone junto aos serviços de radioterapia cadastrados na Sociedade Brasileira de Radioterapia, e junto aos fornecedores do ramo de radioterapia (Medical Systems, Elekta Medical Systems e ZEISS), além disso, o ambiente destinado para IORT do Hospital das Clínicas de Botucatu foi avaliado nos aspectos sócios econômicos. Foram analisados artigos publicados por serviço de radioterapia que realizam IORT, e selecionados os 10 principais, ilustrando a eficiência do procedimento. A pesquisa com os centros de radioterapia apontou que dos participantes apenas 17,7% realizam o procedimento. Os custos apontados para a instalação do serviço de IORT no Hospital das Clínicas de Botucatu somam a quantia de R$290.000,00. Comparando o Acelerador Linear com o INTRABEAM®, ambos possuem um tempo total gasto no procedimento semelhante. A avaliação do CONITEC do Ministério da Saúde mostrou não ser favorável para a incorporação da ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In this study, the financial costs resulting from the implantation of an intraoperative radiotherapy service (IORT) were analyzed, considering the amounts spent for the construction of the surgical center and other necessary dependencies attached to a pre-existing radiotherapy service, as well as the acquisition values IORT-specific accessories for use in a clinical linear accelerator. The IORT procedure was compared with the fixed linear accelerator and with the mobile radiator device (INTRABEAM®). The data obtained were collected by e-mail and telephone with radiotherapy services registered at the Brazilian Society of Radiotherapy, and with radiotherapy providers (Medical Systems, Elekta Medical Systems and ZEISS), and the environment for IORT Of the Botucatu Clinic Hospital was evaluated in the socioeconomic aspects. We analyzed published articles by radiotherapy service that performed IORT, and selected the 10 main ones, illustrating the efficiency of the procedure. The research with the radiotherapy centers pointed out that of the participants only 17.5% performed the procedure. The costs indicated for the installation of the IORT service at Botucatu Clinic Hospital add up to the amount of R$ 290.000,00. Comparing the Linear Accelerator with INTRABEAM®, both have a total time spent in the similar procedure. The CONITEC evaluation of the Ministry of Health was not favorable for the incorporation of IORT using INTRABEAM® in the SUS. Evaluating the financial onlendings for ... (Complete abstract click electronic access below) / Mestre

This study analyzed whether African American students in the Atlanta University Center schools were knowledgeable about public health policies and programs concerning abused and neglected children. Two hundred and one (201) participants were selected utilizing convenience sampling. The study surveyed males and females of which 91% were African American students. A survey questionnaire was utilized to collect data. The findings of the study indicated that a majority or 57.2% of the students were not knowledgeable about public health policies for abused and neglected children. However, a majority of the students indicated that they were knowledgeable about public health problems and programs for this population. A majority or 84.1% indicated that they were not abused and neglected as children, but a significant percentage or 15.9% indicated that they were abused and neglected. When the chi square test for significance was applied, the null hypothesis was accepted indicating that there was no statistically significant evidence at the .05 level of probability that the students were abused and neglected when they were children.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-08-26Bitstream added on 2014-06-13T19:59:19Z : No. of bitstreams: 1 toledo_me_me_botfm.pdf: 1277726 bytes, checksum: 40700ca3c7c27cd63491348cb940ca5f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A urgência em saúde bucal, passa a ser destaque na atual política nacional de Saúde Bucal como um direito de cidadania. Passados 20 anos desde a implantação do SUS, este salienta a necessidade de se reorganizar os serviços com outro olhar, evidenciando que o binômio saúde–doença está na dependência de fatores sociais. Considerando que os serviços de urgência são includentes, não discriminatórios, com uma ampla superfície de contato com a população, promovendo uma captação passiva da provável população de maior atividade de doença, com agravos não só de origem biológica, mas também advindos de iniqüidades sociais, estes devem se preparar para um atendimento humanizado, minimizar iniqüidades, monitorar e avaliar técnicamente, participar da rede de referência e contra referência, para cumprir os princípios do SUS. Esta pesquisa analisou a prática de um serviço de urgência e emergência do SUS, com atendimento em Saúde Bucal, no município de São Paulo, em 2006, visando sistematizar saberes que possam contribuir para uma reorganização da assistência e construção de parâmetros que subsidiem o desenvolvimento de modelos de atenção a urgência adequados e humanizados. Foi analisada uma amostra dos Boletins Emergenciais dos atendimentos de um mês por trimestre do ano, digitalizados no sistema HOSPUB. Os resultados demonstraram que a faixa etária que mais procura o serviço é a de 20 a 29 anos com 45% de freqüência, não havendo distinção entre sexo, sendo 85% de pessoas da própria região. Foram realizadas 106.632 consultas no ano, 5,1% de Saúde Bucal, com uma média de 462,6 atendimentos/mês e 15,4 atendimentos/ plantão de 24 horas. A cobertura regional para consultas de urgência foi de 1 consulta/ ano a cada 67,8 habitantes. Foram realizados 2,5 procedimentos/atendimento, com uma espera de 60 minutos em média... / Urgency in health care, assumes a new prominent role in The National Oral Health Policy as a citizenship right. In 20 years of the SUS’s implantation, this system proves the need of restructuring the services with a new approach, putting in evidence the binomial health illness is on the dependence of social factors. Considering that services in urgency are comprehensive, not discriminatory, a large contact surface with the population, a passive capture of the likely population with the most activity of the illness, with disorders not only of biological origin, but also from social iniquities, these services must be prepared for a humanized care of the population, minimizing inequities, with monitoring and technical assessment, participating in the network of reference and counter reference, fulfilling the principle of comprehensiveness in the SUS. This research examined the practice of an urgency and emergency service of the SUS, with Oral Health Care, in São Paulo, in 2006 with the goal of systematizing all knowledge that can contribute to a reorganization of such assistance towards the construction of parameters that subsidize the development of appropriate and humanized models of attention to the urgency. A sample of one month per quarter was analyzed, and inputted into the HOSPUB system. The results showed that the age group that most demand the service is from 20 to 29 years old with 45% of frequency and there is no meaningful distinction between sex and 85% of the demand is from individuals of the region itself. Regarding the conditions of service of the unit studied, from 106,632 consultations held in the year, 5.1% were of Oral Health, with an average of 462.6/month and 15.4 consultations/each 24 hours on-call. The regional coverage for emergency consultations on Oral health was 1 consultation / year for every 67.8 inhabitants. An average of 2.5 procedures... (Complete abstract click electronic access below)

Le programme Ville-Santé de l’OMS est une référence sur laquelle les acteurs ayant compétence à agir sur les espaces de vie des populations peuvent s’appuyer pour intervenir stratégiquement, de manière globale, intersectorielle, partenariale et participative en faveur de la santé des populations. Du point de vue de l’aménagement et la gouvernance des territoires, la thèse s’inscrit dans la démarche d’analyse a posteriori de la construction locale de la santé publique. Du point de vue géographique, l’un des aspects les plus intéressants de Ville-Santé est de voir comment les villes adhérentes cherchent à promouvoir des initiatives dans des lieux et configurations spatiales spécifiques et comment ces lieux et ces initiatives localisées contribuent à la santé et au bien-être.En définissant la santé comme « un état de complet bien-être physique, mental, social », l’OMS a contribué à diffuser un modèle des déterminants de la santé qui accorde une importance significative aux facteurs liés aux environnements physiques et sociaux. Le programme Villes-Santé a été lancé en 1986 afin de reconnaître le rôle des acteurs de l’urbain dans la promotion de villes susceptibles de concourir à l’épanouissement et la santé pour Tous. Au-delà de l’analyse des modalités d’adhésion de chacune des villes bretonnes concernées au réseau, la thèse évalue l’élargissement de la prise en compte de la santé dans les priorités locales, en s’intéressant plus particulièrement aux choix en matière de gestion et d'aménagement des espaces urbains / The Healthy Cities Project of World Health Organization is a reference that the actors competent to act on the living spaces of people can use to intervene strategically, globally, intersectoral, participatory and partnership for health populations. From the perspective of management and governance of territories, the thesis is in the process of post hoc analysis of the construction of local public health. From geographical point of view, one of the most interesting aspect of “Healthy Cities” is to see how the member cities seek to promote initiatives in places and specific spatial patterns and how these places and these initiatives contribute to local health and well-being.In defining health as "a state of complete physical, mental, social, well-being”, WHO has helped to disseminate a model of the determinants of health that attaches significant importance to factors related to physical and social environments. The Healthy Cities Program was launched in 1986 to recognize the role of actors in the urban development of cities likely to contribute to the vitality and Health for all. The goals of Healthy Cities were then reinforced, and rivaled or surpassed by the goals of sustainable development. Beyond the analysis of the terms of accession of each of the Breton towns involved in the network, the thesis seeks to assess the expansion of the inclusion of health in local priorities, with particular attention to the choices management and planning

A saúde do idoso sob a ótica da equipe do Programa de Saúde da Família é um estudo realizado nos quatro Núcleos de Saúde da Família, do Centro de Saúde Escola da Faculdade de Medicina e Escola de Enfermagem de Ribeirão Preto, da Universidade de São Paulo. Neste trabalho procuramos compreender como os trabalhadores das equipes de saúde estão percebendo a temática do idoso no Programa de Saúde da Família, as dificuldades enfrentadas, e quais os recursos utilizados para atender a essa população. Utilizamos como referencial teórico a Transição Demográfica e Epidemiológica, as diretrizes do Ministério da Saúde para o Programa de Saúde da Família e a Política Nacional do Idoso (PNI). Na construção deste trabalho contamos com a participação de 22 (vinte e dois) profissionais de saúde, dentre eles, médicos, enfermeiros, auxiliares de enfermagem e agentes comunitários de saúde. No percurso metodológico, utilizamos a entrevista semi-estruturada, sendo a ordenação dos dados realizada através do Discurso do Sujeito Coletivo a partir da identificação das Idéias Centrais e Expressões Chave presentes nos discursos individuais. Os resultados evidenciaram que nos núcleos com maior demanda de idosos é prioridade a sua assistência, as equipes buscam alternativas para melhor atender a essa população, ou seja, na formação de grupos, visitas domiciliárias ou em parcerias com outras instituições. Já os núcleos que possuem um número menor de idosos em suas áreas de abrangência, não têm o idoso como foco principal de sua atenção, pois há o predomínio da população adulto-jovem. Contudo, priorizam os idosos acamados e integram os demais nas atividades realizadas pelos núcleos. Percebemos que existe em todos os núcleos, independentemente do número de idosos presentes, uma sensibilização geral que expressa potencialidades no trabalho e na atenção à população idosa. / The elderly’s health under the view of the Family Health Program Team is a study that was conducted in the four Family Health Nuclei of the University Health Center of the University of São Paulo at Ribeirão Preto Faculty of Medicine and the University of São Paulo at Ribeirão Preto College of Nursing. In this study, an attempt was made at understanding how the workers on the health teams perceive the elderly-related topics in the Family Health Program, the difficulties faced and what resources they search for in order to assist this population. The Demographic and Epidemiological Transition, the Guidelines from the Health Ministry for the Family Health Program and the National Policies for the Elderly (PNI) were used as theoretical frameworks. Twenty-two (22) health professionals participated in this study among whom were physicians, nurses, nursing auxiliaries and community health agents. Data were collected by means of semi-structured interviews and organized through the Collective Subject’s Discourse based on the identification of the Main Ideas and Key Expressions present in individual discourses. The results showed that there was a care priority in the nuclei with a larger number of elderly participants, the teams searched for alternatives in order to better assist this population, that is, through the formation of groups, home visits or partnerships with other institutions. However, the nuclei with a smaller number of elderly participants in their coverage areas did not have the elderly person as their main focus of attention, since there was the predominance of a young adult population. Nevertheless, they prioritized the elderly who were in bed and integrated the others in all the activities carried out by the nucleus. It was noticed that there was a general sensitization in all the nuclei, regardless of the number of elderly people present, which demonstrates the potentialities in the work and care to individuals at this age range.

Os valores da cultura masculina envolvem comportamentos de risco à saúde, sendo que a forma como os homens constroem e vivenciam a sua masculinidade torna-se uma das matrizes masculinas dos modos de adoecer e morrer. Objetivos: Considerando-se a relevância para o planejamento de políticas de saúde, este estudo abarcou, enquanto objetivo geral: Descrever e analisar os fatores associados à procura dos serviços de saúde por pessoas do sexo masculino e sexo feminino. Os objetivos específicos visaram: Descrever o perfil sócio-demográfico e clínico-epidemiológico de homens e mulheres que procuram os serviços de saúde nos níveis de complexidade primário e secundário; Descrever variáveis relacionadas à procura e aderência aos serviços de saúde entre homens e mulheres e entre os níveis de complexidade primário e secundário; Comparar a procura e aderência aos serviços de saúde entre homens e mulheres considerando-se os níveis de complexidade primário e secundário; Caracterizar os serviços de saúde que apresentam aspectos considerados adequados relacionados à procura e aderência entre o sexo masculino e o feminino. Métodos: Trata-se de um estudo transversal, no qual se utilizou roteiro estruturado de entrevista, aplicado mediante seleção aleatória de homens e mulheres que se encontravam, no momento da coleta de dados, nos seguintes serviços de saúde do município de Ribeirão Preto: Núcleos de Saúde da Família I e IV da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, além de ambulatórios e enfermarias clínicas e cirúrgicas do Hospital Estadual de Ribeirão Preto. As variáveis dependentes deste estudo foram: o sexo do usuário (considerado como indicador cultural) e a procura pelo serviço de saúde (considerada como indicador do uso de serviços de saúde). As variáveis independentes do estudo incluíram: características sócio-demográficas e clínico-epidemiológicas. A amostra do estudo foi composta por 320 pessoas. Para a análise de associação entre variáveis empregou-se a Razão de Prevalência e seu Intervalo de Confiança a 95%. Resultados: Os resultados sugerem como fatores de risco para a não procura: ser do sexo masculino, o horário de funcionamento das unidades de saúde versus o horário de trabalho do usuário e a referência de não possuir nenhuma doença. Em contrapartida, os fatores de proteção contra a não procura, ou seja, de favorecimento da procura foram: ser usuário de Unidades com Equipe de Saúde da Família, ser do sexo feminino e do lar, estar situado na faixa etária de 50 a 65 anos, possuir domicílio próprio, juntamente, com uma renda individual e familiar maior que quatro salários míninos, ser aposentado/pensionista, comparecer aos retornos e ser acompanhante de algum familiar ou outros aos serviços de saúde. Conclusão: É relevante a efetiva consolidação de um modelo de atenção à saúde que questione a contradição existente entre os dados epidemiológicos quanto à saúde masculina e a posição dos serviços de saúde de permanecerem no senso comum da invulnerabilidade dos homens ao adoecimento. / The values of the masculine culture involving health risk behaviors, and how men construct their masculinity and experience becomes one of the matrices of the male modes of illness and death. Objectives: Considering the relevance for the planning of health policies, this study encompassed, while overall goal: To describe and analyze the factors associated with seeking health services for males and females. The specific objectives aimed at: Describe the socio-demographic, clinical and epidemiological study of men and women seeking health services at the levels of primary and secondary complexity; describe variables related to demand and adherence to health services for men and women and between levels of complexity primary and secondary; Compare and demand adherence to health services for men and women considering the levels of primary and secondary complexity; characterize health services that have considered aspects related to demand and adequate adhesion between sex male and female. Methods: This is a transversal study in which we used structured interviews applied by random selection of men and women who were at the time of data collection, the following health services in Ribeirão Preto: Family Health Unit I and IV of the Faculty of Medicine of Ribeirao Preto, University of São Paulo, as well as ambulatories and clinical and surgical wards from the State Hospital of Ribeirão Preto. The dependent variables in this study were: the user gender (regarded as cultural marker) and demand for health services (considered as an indicator of the use of health services).The independent variables of the study included: socio-demographic, clinical and epidemiological characteristics. The study sample consisted of 320 people. For the analysis of association between variables it was used the prevalence ratio and its confidence interval at 95%. Results: The results suggested as risk factors for non-seeking: being male, the opening hours of health facilities versus user\'s working hours and not reporting any disease. In contrast, protective factors against non-demand, that is, facilitation of search, were: to be anuser of the Family Health Unit, being female and work at home, being situated at the age of 50 to 65 years, owning their own home, along with an individual and family incomes greater than four times the minimum wage, retired / pensioner, from returns appear to be a companion of a family member or other health services. Conclusion: It is relevant to the effective consolidation of a model of health care to question the contradiction between the epidemiological data regarding the position of men\'s health and health services which remain in the common sense of invulnerability to the disease of men.