Este estudo problematiza a noção de coletivo na saúde, analisando os jogos e as disputas sobre essa expressão no campo das reformas sanitárias italiana e brasileira, visando compreender a singularidade da saúde coletiva. Tomando como ponto de partida o fato de que a saúde coletiva marca uma diferença no território da saúde, importa compreender a noção de “coletivo”, tomando-a como analisador, com a finalidade de acompanhar como ela se expressa na saúde e quais sentidos atualiza. Para fazer essa discussão, situamos nossa investigação em uma perspectiva genealógica, analisando a composição e a perda de sentidos dos territórios reformistas nos cenários italiano e brasileiro. Discutimos as imagens construídas para expressar o coletivo na saúde – a população, o grupo e a sociedade civil –, com o intuito de propor um modo diferente para pensar essa expressão, de caráter processual e intensivo, passando a entender o coletivo como potência. Não é a fixação dessa noção às formas que lhe são atribuídas que afirma a saúde coletiva, mas a força que caracteriza o coletivo como algo inespecífico, condição para a variação da potência. Acompanhando as experiências reformistas, ficou evidente que a imaginação e a composição de noções comuns são mecanismos disparadores da variação, ativando o desejo e as resistências. Analisar o coletivo na saúde coletiva de forma articulada com os movimentos reformistas italiano e brasileiro evidencia a singularidade dessa expressão no território da saúde. Considerar essa singularidade evita que, paradoxalmente, reproduza-se uma política que afirme os preceitos da medicina social ou da saúde pública no campo da saúde coletiva, abrindo a possibilidade para novas produções de sentido. / This study discusses the notion of the collective in healthcare through the analysis of the games and disputes that take place over this expression in the field of Italian and Brazilian healthcare reforms, with the objective of understanding the uniqueness of collective healthcare. Taking as its starting point the fact that collective healthcare marks a difference in the health area, it is impotant to understand the notion of "collective", taking it as an analyzer, with the objective of monitoring how it is expressed in healthcare and which concepts it updates. To make this discussion, we situate our research in a genealogical perspective, analyzing the composition and the loss of sense in reformist territories in the Italian and Brazilian scenarios. We discuss the images constructed to express the collective in healthcare – the people, the group and the civil society – in order to propose a different way to think this expression, that is procedural and intensive in character, comming to understand the collective as power. It is not the establishment of that notion to the forms assigned to it that asserts the public healthcare, but the strength that characterizes the collective as something unspecific, condition for the change in power. Following the reformist experiments, it became clear that the imagination and the composition of common notions are trigger mechanisms for variation, enabling desire and resistance. By analyzing the collective in collective healthcare in coordination with the Italian and Brazilian reform movements, we stress the uniqueness of this expression in the healthcare area. To consider this uniqueness prevents, paradoxically, the reproduction of a policy that affirms the precepts of social medicine or public healthcare in the field of collective healthcare, opening the possibility for new productions of meaning.

Submitted by Gabriela Cristina Braga Bisco (gabrielacristina.bragabisco@gmail.com) on 2018-11-23T13:23:21Z No. of bitstreams: 1 DISSERTAÇÃO FINAL -converted.pdf: 2506755 bytes, checksum: d1cad9ebb16e9b26461c3d6852ded050 (MD5) / Approved for entry into archive by Jacqueline de Almeida null (jacquie@franca.unesp.br) on 2018-11-23T17:21:22Z (GMT) No. of bitstreams: 1 Bisco_GCB_me_fran.pdf: 2506755 bytes, checksum: d1cad9ebb16e9b26461c3d6852ded050 (MD5) / Made available in DSpace on 2018-11-23T17:21:22Z (GMT). No. of bitstreams: 1 Bisco_GCB_me_fran.pdf: 2506755 bytes, checksum: d1cad9ebb16e9b26461c3d6852ded050 (MD5) Previous issue date: 2018-05-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O direito à saúde no Brasil foi conquistado a partir de lutas e reivindicações da classe trabalhadora por melhores condições de vida. A criação do Sistema Único de Saúde (SUS) a partir da Constituição Federal de 1988 foi um marco para a população, ao garantir a saúde como direito de todos e dever do Estado. Diante dos retrocessos no campo dos direitos sociais, com o avanço do neoliberalismo a partir dos anos de 1990, o trabalho do/a assistente social na saúde é tensionado com desafios de diferentes naturezas, seja na direção social do trabalho profissional no cotidiano e na defesa dos princípios do projeto profissional e em sua própria condição de trabalhador/a. O estudo tem como pressuposto que o Serviço Social na Santa Casa de Franca/SP contribui de maneira efetiva para o acesso ao direito social à saúde, ainda que com todos os limites, a profissão avançou de maneira significativa neste espaço sócio ocupacional. Portanto, a pesquisa tem como objetivo geral estudar a política pública de saúde e a contribuição do trabalho do/a assistente social para a efetivação do direito à saúde na Santa Casa de Franca/SP. Como objetivos específicos, refletir o direito à saúde tendo como referência as atribuições do assistente social na saúde e, evidenciar as principais demandas do Serviço Social e como a categoria apresenta respostas qualificadas a essas demandas. Os resultados mostram que as demandas institucionais são complexas e demonstram as mais variadas expressões da questão social, exigindo cada vez mais um profissional crítico, propositivo e interventivo, capaz de refletir a realidade social dos sujeitos atendidos e dar respostas qualificadas às necessidades sociais e de saúde. Considera-se que o posicionamento ético e político do assistente social na defesa e na afirmação do direito universal à saúde, contribui para o acesso dos usuários ao SUS e cria possibilidades para uma transformação social, na direção de uma sociedade justa e igualitária, como apresentado pelo Serviço Social na Santa Casa de Franca/SP. / Healthcare right in Brazil was conquered through struggling and demands from the working class for better life conditions. The creation of the Unified Health System (SUS) in the Federal Constitution of 1988 was a landmark to the population, by granting the healthcare as a universal right and a State’s responsibility. In view of the setbacks on social rights, due to the advance of neoliberalism in the 1990’s, the social assistant’s work on healthcare social policies is stressed with challenges of several natures, either as a social drive of its daily routine of work or on its condition as a worker. The research adopts as premises that the Social Service in the Santa Casa of Franca/SP contributes effectively to the access of healthcare right, even with all the limitations involved, the profession has moved significantly forward in this occupational space. Therefore, the research has as a general objective to study healthcare policies and the contribution of the social assistant’s work to the effectiveness of the healthcare right in the Santa Casa of Franca/SP. As a specific objectives, to reflect healthcare right having as reference the attributions of the social assistant in field, to evidence main demands of the Social Service and to state how the category presents qualified answers to such demands. The results collected state that the institutional demands are complex, demanding a professional increasingly critic, propositional and inventive, able to reflect the social reality of the subjects addressed and to give qualified answers to social and healthcare issues. It is considered that an ethical and political positioning in defense of the healthcare right’s affirmation contributes for universal access of SUS’ users and creates possibilities for a social transformation toward a fairer and more egalitarian society, as presented by the Social Service in the Santa Casa of Franca/SP. / CAPES -1617827

Este estudo problematiza a noção de coletivo na saúde, analisando os jogos e as disputas sobre essa expressão no campo das reformas sanitárias italiana e brasileira, visando compreender a singularidade da saúde coletiva. Tomando como ponto de partida o fato de que a saúde coletiva marca uma diferença no território da saúde, importa compreender a noção de “coletivo”, tomando-a como analisador, com a finalidade de acompanhar como ela se expressa na saúde e quais sentidos atualiza. Para fazer essa discussão, situamos nossa investigação em uma perspectiva genealógica, analisando a composição e a perda de sentidos dos territórios reformistas nos cenários italiano e brasileiro. Discutimos as imagens construídas para expressar o coletivo na saúde – a população, o grupo e a sociedade civil –, com o intuito de propor um modo diferente para pensar essa expressão, de caráter processual e intensivo, passando a entender o coletivo como potência. Não é a fixação dessa noção às formas que lhe são atribuídas que afirma a saúde coletiva, mas a força que caracteriza o coletivo como algo inespecífico, condição para a variação da potência. Acompanhando as experiências reformistas, ficou evidente que a imaginação e a composição de noções comuns são mecanismos disparadores da variação, ativando o desejo e as resistências. Analisar o coletivo na saúde coletiva de forma articulada com os movimentos reformistas italiano e brasileiro evidencia a singularidade dessa expressão no território da saúde. Considerar essa singularidade evita que, paradoxalmente, reproduza-se uma política que afirme os preceitos da medicina social ou da saúde pública no campo da saúde coletiva, abrindo a possibilidade para novas produções de sentido. / This study discusses the notion of the collective in healthcare through the analysis of the games and disputes that take place over this expression in the field of Italian and Brazilian healthcare reforms, with the objective of understanding the uniqueness of collective healthcare. Taking as its starting point the fact that collective healthcare marks a difference in the health area, it is impotant to understand the notion of "collective", taking it as an analyzer, with the objective of monitoring how it is expressed in healthcare and which concepts it updates. To make this discussion, we situate our research in a genealogical perspective, analyzing the composition and the loss of sense in reformist territories in the Italian and Brazilian scenarios. We discuss the images constructed to express the collective in healthcare – the people, the group and the civil society – in order to propose a different way to think this expression, that is procedural and intensive in character, comming to understand the collective as power. It is not the establishment of that notion to the forms assigned to it that asserts the public healthcare, but the strength that characterizes the collective as something unspecific, condition for the change in power. Following the reformist experiments, it became clear that the imagination and the composition of common notions are trigger mechanisms for variation, enabling desire and resistance. By analyzing the collective in collective healthcare in coordination with the Italian and Brazilian reform movements, we stress the uniqueness of this expression in the healthcare area. To consider this uniqueness prevents, paradoxically, the reproduction of a policy that affirms the precepts of social medicine or public healthcare in the field of collective healthcare, opening the possibility for new productions of meaning.

abstract: Vaccinations are important for preventing influenza infection. Maximizing vaccination uptake rates (80-90%) is crucial in generating herd immunity and preventing infection incidence. Vaccination of healthcare professionals (HCP) against influenza is vital to infection control in healthcare settings, given their consistent exposure to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, 2011). Though vaccination is vital in disease prevention, influenza vaccination uptake among HCP is low overall (50% on average) (Pearson et al., 2006). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (90% vs. 60%). Therefore, influenza vaccination should be mandatory for HCP in order to best prevent influenza infection in healthcare settings. Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns, not best available scientific evidence. Nevertheless, HCP ethical responsibility to their patients and work environments to prevent and lower influenza infection incidence overrules such individual objections. Additionally, mandatory HCP influenza vaccination policies respect HCP autonomy via including medical and religious exemption clauses. While vaccination as a prevention method for influenza is logically sound, individuals’ actions are not always rooted in logic. Therefore, I analyze HCP perceptions and actions toward influenza vaccination in an effort to better explain low HCP uptake rates of the influenza vaccine and individual objections to influenza vaccination. Such analysis can aid in gaining HCP trust when implementing mandatory HCP influenza vaccination policies. In summary, mandatory HCP influenza vaccination policies are ethically justified, effective, scientifically-supported method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settlings. / Dissertation/Thesis / Masters Thesis Biology 2016

The purpose of this study is to investigate medical tourism in Jordan through the international patients‘ perspective. The aim is to contribute to a better understanding of international patients‘ consumption behaviour to seek medical treatment, and while at the destination. And also to better understand the medical tourists‘ perceptions of quality of healthcare services. This research was designed to facilitate the identification of the characteristics of medical tourists, their visit, their sources of information and the main pull/push factors influencing their decision to travel. Moreover, it was designed to identify the level of satisfaction held by medical tourists towards their patient experience and their satisfaction predictors, by translating, adapting and validating a patient-centred quality of care instrument and assessing its psychometric properties amongst them. This research used a mixed-methods case study approach. It was conducted in 7 private hospitals with a primary quantitative research method through 302 interviewer-administered questionnaires and descriptive quantitative statistics, Mann-Whitney U Non-Parametric Significance Tests, Principal Component Analysis (PCA) and Factor Analysis. As a complement, qualitative research through 20 semi-structured interviews and content analysis was conducted in order to provide further insights into this area of research. The findings suggest that word-of-mouth recommendations and reputation have the utmost role in informing international patients of healthcare options in Jordan. Furthermore, recommendations from family and friends are the second most important after availability of specialized treatments in influencing the 3 international patients‘ decision to seek international healthcare. Moreover, significant differences in these terms exist between first and repeat visitors, which hold important implications for tourism marketers. Further marketing implications also exist as most patients shift in the type of activities they and their companions undertake after the main treatment period is completed. In terms of satisfaction, Factor Analysis suggest that medical tourists satisfaction of quality of services in Jordan‘s hospitals is based on six predictors including nutritional care, nursing care, physician care, room atmosphere, the procedure for incoming patients and other hospital services. Both quantitative and qualitative analyses show that medical tourists are satisfied with the quality of health care services rendered to them. However, minor areas show less satisfaction. The findings raise issues regarding the recruitment of non-Arab speaking nurses. Drawing together these findings presents implications for medical tourism management, international healthcare marketing, policy-making, and continuous improvement of the services they provide.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-31Bitstream added on 2014-06-13T19:17:54Z : No. of bitstreams: 1 goncalves_ir_me_botfm.pdf: 601779 bytes, checksum: 08c8788e09edc5173219ac275445c574 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Nos últimos anos, o agente comunitário de saúde (ACS) tem sido objeto de estudos, voltados para a análise de sua identidade na Estratégia de Saúde da Família (ESF). Nesse contexto, o presente estudo buscou apreender como os agentes comunitários da ESF, da cidade de Botucatu/SP, se percebem em seu cotidiano de trabalho. A pesquisa incluiu ACS de todas as Unidades de Saúde da Família do referido município. Foram realizados três grupos focais com quinze ACS no total, sendo agrupados com um representante de cada unidade. Em cada reunião, o agrupamento ocorreu a partir da visita em cada unidade, sorteio dos sujeitos e convite para participação nos grupos focais, sendo definido de acordo com o tempo de experiência profissional. O conteúdo absorvido dos três grupos focais realizados foi sistematizado em oito temas e 19 subtemas para sua análise e discussão. A análise dos dados mostrou que as maiores dificuldades eram referentes às condições de trabalho, ao tipo de população atendida e a burocracia existente no cotidiano. No que tange as relações dos agentes comunitários com os usuários, a necessidade do vínculo ficou evidenciada para o exercício da profissão. O agente espera ser bem recepcionado e as relações muitas vezes se confundem e vão além da profissional, tornando-se por vezes relações de amizade. A falta de suporte e a troca de profissionais atuantes na equipe como um todo é relatada como um fator negativo levando a descontinuidade do trabalho desenvolvido. Para o ACS ele não parece ser visto com a devida importância na equipe e os difíceis casos encontrados nas visitas domiciliares não são considerados com o valor que precisariam ter, culminando assim na falta de resolutividade do serviço e no baixo suporte para ele. Algumas sugestões principais podem ser apontadas, como a melhora da elucidação dos propósitos da ESF para a população e para... / In the last few years, community health agents (CHAs) have been the object of study in the analysis of their identity in the Family Health Strategy (FHS). In this context, the present study aimed at apprehending how community agents in the city of Botucatu/SP perceive themselves in their routine work. The study includes CHAs from all Family Health Units in the abovementioned city. Three focal groups consisting of a total number of fifteen CHAs were performed. The participants were grouped with one representative from each unit. In each meeting, grouping occurred from a visit to each unit, a random selection of subjects and an invitation to participate in the focal groups. Groups were defined according to the period of professional experience. The content absorbed from the three focal groups performed was systematized into eight themes and 19 sub-themes for analysis and discussion. Data analysis showed that the greatest difficulties were related to work conditions, the type of population assisted and the bureaucracy existing in routine work. As regards the relationship of community agents with users, the need for ties to exercise their profession was observed. Agents expect to be well received, and relationships are often mixed, reach beyond the professional sphere and, thus, sometimes become a friendship relation. The lack of support and the exchange of professionals working on the theme as a whole is reported as a negative factor that leads to discontinuity of the work developed. To the CHAs, they do not seem to be given their due importance on the team, and the difficult cases found during home visits are not as seriously considered as they should be, thus resulting in the lack of resolutivity in the service and little support to it. Some suggestions can be indicated, among which is the improvement in the elucidation of FHS purposes to the population and to the team itself... (Complete abstract click electronic access below)

Bakgrund: Vårdrelaterade infektioner är den vanligaste typen av vårdskada inom hälso-och sjukvården och leder till ökat lidande hos patienten, längre vårdtider samt högre kostnader. Vårdrelaterade infektioner kan förebyggas av hälso-och sjukvårdspersonalen genom följsamhet till basala hygienrutiner. Trots att det finns gällande föreskrifter kring detta är följsamheten bland hälso-och sjukvårdspersonalen låg. Det är därför viktigt att ta reda på vilka faktorer som kan ge personalen en ökad följsamhet till basala hygienrutiner. Syfte: Syftet med litteraturöversikten var att beskriva möjliga faktorer som kan påverka hälso- och sjukvårdspersonalens följsamhet till basala hygienrutiner med fokus på handhygien. Metod: Metoden för denna studie har genomförts som en litteraturöversikt och grundar sig på 13 vetenskapliga artiklar av både kvalitativ och kvantitativ metod, som sökts fram genom databaserna Cinahl, PubMed och PsycInfo. Resultat: Resultatet visade att det finns flera faktorer som påverkar hälso-och sjukvårdspersonalens följsamhet till basala hygienrutiner. Särskilt framträdande faktorer som ger ökad följsamhet var kunskap, utbildning och placering av hygienmaterial och handfat. Även tid, stressiga och akuta situationer påverkade följsamheten. Slutsats: Följsamheten till handhygien är låg, trots gällande föreskrifter och nationella insatser. Det finns flera faktorer att ta hänsyn till för att öka hälso-och sjukvårdspersonalens följsamhet till basala hygienrutiner och denna litteraturöversikt kan bidra med ökad kunskap om dessa faktorer. / Background: Healthcare-related infections are the most common healthcare injuries and lead to increased patient suffering, prolonged hospital stays and higher costs. Healthcare-associated infections can be prevented by healthcare personnel through compliance with basic hygiene routines. Although there are current regulations regarding this, the compliance of healthcare personnel is low. It is therefore important to find out what factors can give the staff an increased compliance to basic hygiene routines. Aim: The purpose of the literature review was to describe possible factors that may affect the compliance of healthcare personnel with basic hygiene routines focusing on hand hygiene. Method: The method of this study has been formed as a literature review and it is based on 13 scientific articles of both qualitative and quantitative methods, which were aquiered by search from the databases Cinahl, PubMed and PsycInfo. Findings: The results showed that there are several factors that affect the healthcare personnel’s compliance with basic hygiene routines. Particularly prominent factors that provide increased compliance were knowledge, training and placement of hygiene materials and sinks. Time, stressful and acute situations also affected compliance. Conclusion: Compliance to hand hygiene is low, despite current regulations and national efforts. There are several factors to consider in order to increase the compliance of healthcare personnel with basic hygiene routines, and this literature review can contribute to increased knowledge of these factors.

Este estudo problematiza a noção de coletivo na saúde, analisando os jogos e as disputas sobre essa expressão no campo das reformas sanitárias italiana e brasileira, visando compreender a singularidade da saúde coletiva. Tomando como ponto de partida o fato de que a saúde coletiva marca uma diferença no território da saúde, importa compreender a noção de “coletivo”, tomando-a como analisador, com a finalidade de acompanhar como ela se expressa na saúde e quais sentidos atualiza. Para fazer essa discussão, situamos nossa investigação em uma perspectiva genealógica, analisando a composição e a perda de sentidos dos territórios reformistas nos cenários italiano e brasileiro. Discutimos as imagens construídas para expressar o coletivo na saúde – a população, o grupo e a sociedade civil –, com o intuito de propor um modo diferente para pensar essa expressão, de caráter processual e intensivo, passando a entender o coletivo como potência. Não é a fixação dessa noção às formas que lhe são atribuídas que afirma a saúde coletiva, mas a força que caracteriza o coletivo como algo inespecífico, condição para a variação da potência. Acompanhando as experiências reformistas, ficou evidente que a imaginação e a composição de noções comuns são mecanismos disparadores da variação, ativando o desejo e as resistências. Analisar o coletivo na saúde coletiva de forma articulada com os movimentos reformistas italiano e brasileiro evidencia a singularidade dessa expressão no território da saúde. Considerar essa singularidade evita que, paradoxalmente, reproduza-se uma política que afirme os preceitos da medicina social ou da saúde pública no campo da saúde coletiva, abrindo a possibilidade para novas produções de sentido. / This study discusses the notion of the collective in healthcare through the analysis of the games and disputes that take place over this expression in the field of Italian and Brazilian healthcare reforms, with the objective of understanding the uniqueness of collective healthcare. Taking as its starting point the fact that collective healthcare marks a difference in the health area, it is impotant to understand the notion of "collective", taking it as an analyzer, with the objective of monitoring how it is expressed in healthcare and which concepts it updates. To make this discussion, we situate our research in a genealogical perspective, analyzing the composition and the loss of sense in reformist territories in the Italian and Brazilian scenarios. We discuss the images constructed to express the collective in healthcare – the people, the group and the civil society – in order to propose a different way to think this expression, that is procedural and intensive in character, comming to understand the collective as power. It is not the establishment of that notion to the forms assigned to it that asserts the public healthcare, but the strength that characterizes the collective as something unspecific, condition for the change in power. Following the reformist experiments, it became clear that the imagination and the composition of common notions are trigger mechanisms for variation, enabling desire and resistance. By analyzing the collective in collective healthcare in coordination with the Italian and Brazilian reform movements, we stress the uniqueness of this expression in the healthcare area. To consider this uniqueness prevents, paradoxically, the reproduction of a policy that affirms the precepts of social medicine or public healthcare in the field of collective healthcare, opening the possibility for new productions of meaning.

Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation. This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management. The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations. The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.

This thesis takes as its focus the Maggie’s Cancer Centres exploring for the first time the impact of their designed gardens. This research is situated within the immediate context of Maggie’s ambitions as an organisation and looks closely at their design process. It is also set within the wider debates about the effects of green space on health and the historical context of the restorative garden. By exploring both historical and contemporary examples, it argues that a healthcare garden may be a space for transformation. Using four different Maggie’s gardens as case studies, the research seeks to investigate the role of these outdoor spaces and their impact on users. Through ethnographic and sensory methods, each garden is considered and mapped. It looks at the design brief and the intentions of the designers’, but the core work is an exploration of the experiences of staff and visitors. The focus is on the everyday use of these gardens as well as the design historiography. The experiences of gardens within healthcare are examined in order to expose the ways in which gardens, people, health and care are entwined. Through the qualitative research process this thesis develops a new hypothesis as to how healthcare gardens may operate – offering a new definition for them as “resilient places”. Careful analysis of the data reveals the specific networks and affordances presented by these gardens. The thesis argues, based on the evidence of users, that healthcare gardens can uniquely embrace certain “essences” where essence is defined as conveying a quality or attribute. These garden essences are identified as thresholds, sensory richness, the density of time and homeliness. The thesis also argues that a healthcare garden can provide specific and unique opportunities for care and this, in turn, can enhance the healing ethos of an organisation such as Maggie’s.