Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Resumo: As mudanças na política de saúde do país, a partir da década de 80, introduziram desafios quanto à forma de planejar, gerenciar e avaliar em contextos descentralizados e autônomos, nos quais exigem articulação intersetorial e intergovernamental e a participação da comunidade nas decisões do setor. A descentralização passou a ser entendida como uma prioridade para a consolidação do SUS. Apesar dos avanços, as atividades de vigilância, e outras de caráter coletivo permanecem historicamente dissociadas. Neste sentido, o presente estudo teve como objetivo geral identificar a concepção e o objeto de ação dos profissionais de enfermagem da Rede Pública de Saúde do município de Bauru. Trata-se de um estudo descritivo, com abordagem quantitativa, sendo utilizado um questionário estruturado contendo questões fechadas e abertas. A população do estudo envolveu enfermeiros e auxiliares de enfermagem. Desta maneira, esta pesquisa teve a participação de: 35 (95%) enfermeiros e 91(81%) auxiliares de enfermagem. Em relação à questão "conceituação de vigilância em saúde", surgiram cinco grupos de significados, que foram categorizados para fins deste estudo, como: "Quebra da cadeia epidemiológica em relação às doenças de notificação compulsória", "Ampliada para Vigilância epidemiológica e Sanitária", "Vigilância epidemiológica como um sistema", "Conceitua com o próprio tema de "vigília" - prevenção" e "Não responderam sobre conceituação de vigilância em saúde". Nas respostas dadas pelos enfermeiros, encontrou-se 31,4% (11) que "conceituam com o próprio tema de "vigília" - prevenção" e nos auxiliares de enfermagem, 34% (31). A categoria" não responderam sobre a conceituação de vigilância em saúde" teve um percentual alto, 20% (7) nos enfermeiros e 39,6% (36) nos auxiliares de enfermagem, provavelmente pela inexistência ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The changes from the 80’s in country health policy introduced challenges on how to plan, manage and evaluate in decentralized and autonomous contexts that require inter-sector and intergovernmental collaboration and community participation in the sector decisions. The decentralization is a priority for the consolidation of SUS. Despite advances, the surveillance activities and other collective character still are historically dissociated. In this sense, this study aimed to identify the conception and object of action of the nursing professional of Public Health in Bauru. This is a descriptive study with a quantitative approach, using a structured questionnaire containing opened and objective questions. The study population had nurses and nursing assistants. Thus, the participants of this research were: 35 (95%) nurses and 91 (81%) nursing assistants. Regarding the question "concept of health surveillance", there are five groups of meanings that have been categorized in this study as: "breaking the epidemiological chain in relation to notifiable diseases", "enhanced for Sanitary and Epidemiological Surveillance", "Epidemiological Surveillance system", "The concept with the theme "vigil"- prevention" and "No answer to the meaning of health surveillance. "In the nurses answers it was 31.4% (11) who answered "The concept with the theme "vigil "- prevention” and nursing assistants, 34% (31). The category "No answer to the meaning of health surveillance" had a higher percentage in nurses, 20% (7) and 39.6% (36) in nursing assistants, it is probably due to the lack of direct practice, as well as deficiencies in training, formal and the service itself. The question of how strict epidemiological surveillance of the city should be structured, 62.9% of nurses and 55% of nursing assistants answered that it should be centralized in the Department and those who think it should be ... (Complete abstract click electronic access below) / Orientador: Ilda de Godoy / Coorientador: Maria Helena Borgato / Banca: Jairo Aparecido Ayres / Banca: Sara Nader Marta / Mestre

Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-28Bitstream added on 2014-06-13T19:36:46Z : No. of bitstreams: 1 meza_he_me_botfm.pdf: 677255 bytes, checksum: abb1377459ccf7cf11be1d3d293e65f5 (MD5) / Ministério da Saúde / As mudanças na política de saúde do país, a partir da década de 80, introduziram desafios quanto à forma de planejar, gerenciar e avaliar em contextos descentralizados e autônomos, nos quais exigem articulação intersetorial e intergovernamental e a participação da comunidade nas decisões do setor. A descentralização passou a ser entendida como uma prioridade para a consolidação do SUS. Apesar dos avanços, as atividades de vigilância, e outras de caráter coletivo permanecem historicamente dissociadas. Neste sentido, o presente estudo teve como objetivo geral identificar a concepção e o objeto de ação dos profissionais de enfermagem da Rede Pública de Saúde do município de Bauru. Trata-se de um estudo descritivo, com abordagem quantitativa, sendo utilizado um questionário estruturado contendo questões fechadas e abertas. A população do estudo envolveu enfermeiros e auxiliares de enfermagem. Desta maneira, esta pesquisa teve a participação de: 35 (95%) enfermeiros e 91(81%) auxiliares de enfermagem. Em relação à questão conceituação de vigilância em saúde, surgiram cinco grupos de significados, que foram categorizados para fins deste estudo, como: Quebra da cadeia epidemiológica em relação às doenças de notificação compulsória, Ampliada para Vigilância epidemiológica e Sanitária, Vigilância epidemiológica como um sistema, Conceitua com o próprio tema de vigília - prevenção e Não responderam sobre conceituação de vigilância em saúde. Nas respostas dadas pelos enfermeiros, encontrou-se 31,4% (11) que conceituam com o próprio tema de vigília - prevenção e nos auxiliares de enfermagem, 34% (31). A categoria não responderam sobre a conceituação de vigilância em saúde teve um percentual alto, 20% (7) nos enfermeiros e 39,6% (36) nos auxiliares de enfermagem, provavelmente pela inexistência... / The changes from the 80 s in country health policy introduced challenges on how to plan, manage and evaluate in decentralized and autonomous contexts that require inter-sector and intergovernmental collaboration and community participation in the sector decisions. The decentralization is a priority for the consolidation of SUS. Despite advances, the surveillance activities and other collective character still are historically dissociated. In this sense, this study aimed to identify the conception and object of action of the nursing professional of Public Health in Bauru. This is a descriptive study with a quantitative approach, using a structured questionnaire containing opened and objective questions. The study population had nurses and nursing assistants. Thus, the participants of this research were: 35 (95%) nurses and 91 (81%) nursing assistants. Regarding the question concept of health surveillance, there are five groups of meanings that have been categorized in this study as: breaking the epidemiological chain in relation to notifiable diseases, enhanced for Sanitary and Epidemiological Surveillance, Epidemiological Surveillance system, The concept with the theme vigil- prevention and No answer to the meaning of health surveillance. In the nurses answers it was 31.4% (11) who answered The concept with the theme vigil - prevention and nursing assistants, 34% (31). The category No answer to the meaning of health surveillance had a higher percentage in nurses, 20% (7) and 39.6% (36) in nursing assistants, it is probably due to the lack of direct practice, as well as deficiencies in training, formal and the service itself. The question of how strict epidemiological surveillance of the city should be structured, 62.9% of nurses and 55% of nursing assistants answered that it should be centralized in the Department and those who think it should be ... (Complete abstract click electronic access below)

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Introdução: Os modelos de gerência centralizados e descentralizados utilizados pela administração pública no Brasil é tema bastante discutido em razão da busca por um atendimento de qualidade prestado à sociedade, não sendo diferente na área da saúde. Nesse sentido o Estado do Acre fez a opção de implementar um modelo de gerência de unidades de saúde que pudesse efetivar a descentralização das unidades de saúde estaduais e estabelecer a participação da comunidade. Objetivos: Analisar o modelo de gerência de unidades de saúde de média e alta complexidade, implementada pelo Estado do Acre, por meio da Lei de Gestão Democrática do Sistema Público de Saúde do Estado do Acre (Lei n.1912/07) e da Lei de Autonomia Financeira das Unidades de Saúde Estaduais (Lei n.1.910/07), no período de 2007 a 2011. Métodos: A pesquisa de natureza qualitativa e descritiva foi realizada no período de 2013 a 2016, utilizando como técnica de coleta de dados secundários a análise de documentos, e de dados primários as entrevistas individuais com informantes-chave. Trata-se de um estudo de caso cuja análise buscou compreender o modelo adotado pelo Estado do Acre. Resultados: A partir do modelo de gerência implementado pelo Estado do Acre, as unidades de saúde sob a gestão estadual passaram a ser geridas por um Conselho Gestor, constituído por gestores, profissionais de saúde e usuários de saúde. O modelo proporciona a descentralização da gerência das unidades de saúde com autonomia para o conselho gestor planejar e executar os recursos financeiros cujo repasse se efetiva com o termo de compromisso. O modelo implementado com a participação da comunidade no conselho gestor executivo apresenta aspectos inovadores e controversos, e sua legalidade fora questionada pelo Tribunal de Contas do Estado do Acre. No entanto, analisando as normas que permitiram a implementação do modelo, verifica-se o cumprimento das normas do Sistema Único de Saúde. Considerações finais: O modelo implementado pelo Estado mostrou ser uma alternativa de gerência de unidades de saúde descentralizado e participativo de modo a incentivar a organização e realização dos conselhos gestores / Introduction: The centralized and decentralized management models used by public administration in Brazil is a topic that is much discussed because of the quest for quality care provided to society, and is not different in the health area. In this sense, the State of Acre made the option of implementing a model of health unit management that could effect the decentralization of state health units and establish community participation. Objectives: To analyze the model of management of health units implemented by the State of Acre through the Law of Democratic Management of the Public Health System of the State of Acre (Law n.1912 / 07) and the Financial Autonomy Law of the Units of State Health (Law n.1.910 / 07) in the period from 2007 to 2011. Methods: The qualitative and descriptive research was carried out in the period from 2013 to 2016, using as secondary data collection technique the analysis of documents and data Primary interviews with key informants. It is a case study whose analysis sought to understand the model adopted by the State of Acre. Results: Based on the management model implemented by the State of Acre, health units under state management were managed by a Management Council, made up of managers, health professionals and health users. The model provides the decentralization of health unit management with autonomy for the managing board to plan and execute the financial resources whose transfer is effective with the term of commitment. The model implemented with the participation of the community in the executive management council presents innovative and controversial aspects and its legality was questioned by the Court of Accounts of the State of Acre. Final considerations: The model implemented by the State has shown to be an alternative for the management of decentralized and participatory health units in order to encourage the implementation of the model. Organization and implementation of management councils

Introdução: Os modelos de gerência centralizados e descentralizados utilizados pela administração pública no Brasil é tema bastante discutido em razão da busca por um atendimento de qualidade prestado à sociedade, não sendo diferente na área da saúde. Nesse sentido o Estado do Acre fez a opção de implementar um modelo de gerência de unidades de saúde que pudesse efetivar a descentralização das unidades de saúde estaduais e estabelecer a participação da comunidade. Objetivos: Analisar o modelo de gerência de unidades de saúde de média e alta complexidade, implementada pelo Estado do Acre, por meio da Lei de Gestão Democrática do Sistema Público de Saúde do Estado do Acre (Lei n.1912/07) e da Lei de Autonomia Financeira das Unidades de Saúde Estaduais (Lei n.1.910/07), no período de 2007 a 2011. Métodos: A pesquisa de natureza qualitativa e descritiva foi realizada no período de 2013 a 2016, utilizando como técnica de coleta de dados secundários a análise de documentos, e de dados primários as entrevistas individuais com informantes-chave. Trata-se de um estudo de caso cuja análise buscou compreender o modelo adotado pelo Estado do Acre. Resultados: A partir do modelo de gerência implementado pelo Estado do Acre, as unidades de saúde sob a gestão estadual passaram a ser geridas por um Conselho Gestor, constituído por gestores, profissionais de saúde e usuários de saúde. O modelo proporciona a descentralização da gerência das unidades de saúde com autonomia para o conselho gestor planejar e executar os recursos financeiros cujo repasse se efetiva com o termo de compromisso. O modelo implementado com a participação da comunidade no conselho gestor executivo apresenta aspectos inovadores e controversos, e sua legalidade fora questionada pelo Tribunal de Contas do Estado do Acre. No entanto, analisando as normas que permitiram a implementação do modelo, verifica-se o cumprimento das normas do Sistema Único de Saúde. Considerações finais: O modelo implementado pelo Estado mostrou ser uma alternativa de gerência de unidades de saúde descentralizado e participativo de modo a incentivar a organização e realização dos conselhos gestores / Introduction: The centralized and decentralized management models used by public administration in Brazil is a topic that is much discussed because of the quest for quality care provided to society, and is not different in the health area. In this sense, the State of Acre made the option of implementing a model of health unit management that could effect the decentralization of state health units and establish community participation. Objectives: To analyze the model of management of health units implemented by the State of Acre through the Law of Democratic Management of the Public Health System of the State of Acre (Law n.1912 / 07) and the Financial Autonomy Law of the Units of State Health (Law n.1.910 / 07) in the period from 2007 to 2011. Methods: The qualitative and descriptive research was carried out in the period from 2013 to 2016, using as secondary data collection technique the analysis of documents and data Primary interviews with key informants. It is a case study whose analysis sought to understand the model adopted by the State of Acre. Results: Based on the management model implemented by the State of Acre, health units under state management were managed by a Management Council, made up of managers, health professionals and health users. The model provides the decentralization of health unit management with autonomy for the managing board to plan and execute the financial resources whose transfer is effective with the term of commitment. The model implemented with the participation of the community in the executive management council presents innovative and controversial aspects and its legality was questioned by the Court of Accounts of the State of Acre. Final considerations: The model implemented by the State has shown to be an alternative for the management of decentralized and participatory health units in order to encourage the implementation of the model. Organization and implementation of management councils

Purpose: The systematic review summarised the research investigating potential risk factors for impulsive behaviours in forensic populations. The empirical study examined the predictive utility of clinician rated, self-report and behavioural measures of impulsivity in detecting violence and antisocial behaviour in forensic mental health inpatient settings. Method: The review is comprised of 9 studies identified through electronic database searches using a structured search strategy and predetermined inclusion criteria. The empirical study employed a cross-sectional design using retrospective and prospective statistical analysis. Forty-three participants were recruited from secure forensic mental health inpatient settings across Scotland and data collected from clinician rated, self-report and behavioural measures of impulsivity. Results: The review found original evidence to suggest that traumatic brain injury, substance and alcohol misuse, trauma and sleep as possible predictors of impulsive behaviour in forensic populations. The empirical study found a relatively consistent relationship between impulsive behaviour and violent or antisocial behaviour in a sample of forensic mental health inpatients. Conclusions: The systematic review identified a limited number of risk factors thought to influence impulsive behaviour in forensic populations. The review highlights the need for future research with improved methodological design to further explore contributory factors for increased levels of impulsivity. Findings from the empirical study reveal clinician rating of impulsive behaviour to be the most sensitive in predicting future incidents of violent and antisocial behaviour, which may be supplemented by the addition of a self-report measure.

Background: Funding practices in Ontario's acute care sector have undergone a substantive shift away from ‘lump-sum funding’ towards a combination of population-needs and performance-based financing (MOHLTC, 2013). In contrast very little is known about how funds are distributed across the province’s public health sector, specifically the 36 public health units (PHUs) that are mandated to deliver health promotion and disease prevention programs across Ontario. In fact the funding arrangement utilized by the public health sector has remained unchanged for several years, despite the growing burden of responsibilities on PHUs in terms of evolving population health needs and more expansive programmatic and performance expectations. Current literature on the processes, variables and overarching principles that govern the distribution of funds across PHUs remains considerably limited. Objectives: The objectives of this study were to develop a better understanding of how PHUs in Ontario are currently funded, and to examine what principles public health professionals believe should guide the distribution of resources across PHUs. The project sought to identify the fundamental principles that public health professionals believe should inform future thinking around public health funding. Methods: The perspectives of public health professionals who have proximal links to the current public health funding process served as the basis of the data discovery component for this study. A total of 14 in-depth interviews were conducted with a number of public health professionals to gather their insights on the current funding arrangement, and explore what principles they believe should be used to guide allocation decisions in the public health sector. Interviews were followed by a web survey to examine how public health professionals rank principles and perceive trade-offs between competing principles. Results: Public health professionals proposed a total of 12 principles to guide the distribution of resources across PHUs. These principles were grounded in three core social value judgments (need, equity, and transparency and accountability). The study provides important insights into the fundamental principles that public health professionals believe should guide allocation decisions and illustrates the complexity associated with distributing limited resources across health units, as well as possible directions for future research on this topic.

Background: Funding practices in Ontario's acute care sector have undergone a substantive shift away from ‘lump-sum funding’ towards a combination of population-needs and performance-based financing (MOHLTC, 2013). In contrast very little is known about how funds are distributed across the province’s public health sector, specifically the 36 public health units (PHUs) that are mandated to deliver health promotion and disease prevention programs across Ontario. In fact the funding arrangement utilized by the public health sector has remained unchanged for several years, despite the growing burden of responsibilities on PHUs in terms of evolving population health needs and more expansive programmatic and performance expectations. Current literature on the processes, variables and overarching principles that govern the distribution of funds across PHUs remains considerably limited. Objectives: The objectives of this study were to develop a better understanding of how PHUs in Ontario are currently funded, and to examine what principles public health professionals believe should guide the distribution of resources across PHUs. The project sought to identify the fundamental principles that public health professionals believe should inform future thinking around public health funding. Methods: The perspectives of public health professionals who have proximal links to the current public health funding process served as the basis of the data discovery component for this study. A total of 14 in-depth interviews were conducted with a number of public health professionals to gather their insights on the current funding arrangement, and explore what principles they believe should be used to guide allocation decisions in the public health sector. Interviews were followed by a web survey to examine how public health professionals rank principles and perceive trade-offs between competing principles. Results: Public health professionals proposed a total of 12 principles to guide the distribution of resources across PHUs. These principles were grounded in three core social value judgments (need, equity, and transparency and accountability). The study provides important insights into the fundamental principles that public health professionals believe should guide allocation decisions and illustrates the complexity associated with distributing limited resources across health units, as well as possible directions for future research on this topic.