Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2018-05-10T17:55:02Z No. of bitstreams: 2 Jurema De Fátima Knopf.pdf: 1229963 bytes, checksum: b0f78e1af17b42b3d462c9404bf44dfc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-05-10T17:55:02Z (GMT). No. of bitstreams: 2 Jurema De Fátima Knopf.pdf: 1229963 bytes, checksum: b0f78e1af17b42b3d462c9404bf44dfc (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2013-06-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research has as objective to analyze the relation that was established between the “Movement of countryside workers landless” (MST) and Requião government in the formulation of educational policies in the countryside of Paraná (2003 a 2010). The problematization of this study is situated in a complex context of fight between the movement and the state, in which the social policies, especially the educational ones, intend to dodge the character of class of the bourgeois and to ensure the repetition of the relation of productions in the capitalist society. Contradictorily, and in the same movement, the access to social policies as a real “right” evidences the impossibility that this kind of state to keep what it promises in a formal scope. In this contradictory reality the MST has been affirming, through the education of the countryside, the right to education as a human condition, which must be guaranteed, including in camping conditions. It's from this context that appears our research question; how and what kind of relations were established between MST – PR, based on the constitution of the itinerary school, with the Requião government? Inside this central question we can also question: why did the State, especially the State of Paraná, in the Requião government, allowed this kind of school, since it has opposite objectives to the logic of control, maintenance and domain.To answer these questions we searched into the works of Lênin, Saes, Martorano, Neto, Caldart and Vendramini a bigger theory appropriation about the categories of study: Bourgeois State, Brazilian State, Government Policies, Social Policy and Education in the countryside, which crosses the analysis of this study. We also situate the role of the Education in the countryside, of the MST and the political orientation in Requião government in the constitution of the Itinerary School of the MST. We made, as well, a research in primary internal documents of the MST and institutional (of the SEED), in which we put in evidence nuances in the formulation and conduction of this school, that incorporate two distinct logics, the maintenance and the transformation of the social relations. We evidenced as well that the fight for Education of the countryside, since its specificity, put again into the society the historic demand of the universality of the public Brazilian school. We understand that the Itinerary Scholl as a policy of Education of the countryside conducted by MST and SEED-PR, in which the movement affirms in its conduction political and pedagogical autonomy as it inserts this school as part of the organicity in the camps and demands that the State recognize it as a public state-owned school. Therefore, the relations between MST-PR and the Requião government, in the constitution of the Itinerary Schools of Paraná, were marked by moments of massive fight that established a bigger tension, by conflicts and disputes of interest between the Movement and the State and by spaces of negotiation. The result of this relation is a possible school in the condition of the possible fight, what demonstrate that, even occupying the state gaps or spaces by the institution of the Education Coordination of the countryside during the consecutive mandates of the Requião Government, stayed the understanding of the role of the Bourgeois State, reaffirming, thus, its objectives and its oriented practices in the shock of forces. The result of this relation synthesizes the concrete conditions of the dispute in which it is established, ultimately, in any relation between the State and the Social Movement. / Esta pesquisa objetiva analisar a relação que se estabeleceu entre o MST e o governo Requião na formulação de políticas educacionais do campo no Estado do Paraná (2003 a 2010). A problemática deste estudo situa-se em um contexto complexo da luta entre o Movimento e Estado, na qual as políticas sociais, em particular, as educacionais visam escamotear o caráter de classe do Estado burguês, assegurando a constante repetição das relações de produção na sociedade capitalista. Contraditoriamente, e no mesmo movimento, o acesso a políticas sociais como “direito” real evidencia a impossibilidade desta forma de Estado garantir o que “promete” em âmbito formal. Nesta realidade contraditória o MST vem afirmando, por meio da Educação do Campo, o direito a educação como condição humana, garantido, inclusive em condições de acampamento. É deste contexto que surge nossa questão de pesquisa; Como e que relações se estabeleceram entre MST – PR, a partir da constituição da Escola Itinerante, com o governo Requião? Dentro dessa questão central cabe também indagar; por que o Estado, e particularmente o Estado do Paraná, no governo Requião, permitiu essa forma de escola, sendo que ela se articula a objetivos contrários à lógica de controle, manutenção e dominação. Para responder a estas indagações buscamos nas obras de Lênin, Saes, Martorano, Neto, Caldart e Vendramini maior apropriação teórica acerca das categorias de estudo: Estado Burguês, Estado Brasileiro, Políticas de Governo, Política Social e Educação do Campo, que perpassam a análise do estudo em questão. Também nos empenhamos em situar o papel da Educação do Campo, do MST e da orientação política do governo Requião na constituição da Escola Itinerante do MST. Realizamos, ainda, pesquisa em documentos primários internos do MST e institucionais (da SEED), nos quais evidenciamos nuances na formulação e condução desta escola, que incorpora duas lógicas distintas, a manutenção e a transformação das relações sociais. Evidenciamos que a luta por Educação do Campo, desde sua especificidade, recoloca para a sociedade a histórica demanda da universalização da escola pública brasileira. Entendemos a Escola Itinerante como uma política de Educação do Campo conduzida pelo MST e SEED-PR, na qual o Movimento afirma na sua condução, autonomia política e pedagógica ao inseri-la como parte da organicidade dos acampamentos e exige que o Estado a reconheça como escola pública estatal. Assim, portanto, as relações entre MST-PR e os governos Requião, na constituição da Escola Itinerante no Paraná, foram marcadas por momentos de luta massiva, por conflitos e disputas de interesses entre Movimento e Estado e por espaços de negociações. O resultado dessa relação é uma escola possível nas condições de luta possíveis, o que demonstra que, mesmo ocupando as brechas ou os espaços estatais mediante a instituição da Coordenação da Educação do Campo durante os mandatos consecutivos do governo Requião, permanecia o entendimento do papel do Estado burguês, reafirmando, assim, seus objetivos e suas práticas orientadas no embate de forças. O resultado desta relação sintetiza as condições concretas da disputa que se estabelece, em última instância, em qualquer relação entre o Estado e o Movimento social.

Orientador: Maria da Graça Garcia Andrade / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T16:47:03Z (GMT). No. of bitstreams: 1 Peroni_FabianadaMotaAlmeida_D.pdf: 3342965 bytes, checksum: 2fa1b0834d1de5e17a1418997e1b05c2 (MD5) Previous issue date: 2013 / Resumo: A organização de redes de atenção à saúde apresenta-se como uma estratégia para o alcance da integralidade, favorecendo a superação da fragmentação da assistência, tendo como foco as necessidades dos usuários. O estudo de itinerários terapêuticos tem sido utilizado para compreender o modo como se organizam e funcionam as redes de atenção à saúde, interrogando-as a partir das trajetórias de usuários na busca por cuidado. Nesta direção, a presente pesquisa teve por objetivo analisar a integralidade do cuidado à pacientes com câncer em dois municípios da macrorregião de Campinas, SP, sob a perspectiva do trabalho em rede na atenção à saúde. Trata-se de uma pesquisa de natureza qualitativa, que utilizou como principal estratégia metodológica o itinerário terapêutico de usuários com câncer. A reconstituição dos itinerários envolveu a realização de entrevistas em profundidade com pacientes com câncer de mama e próstata, anotações em diário de campo e consulta aos prontuários dos serviços de saúde, conformando o material empírico central a partir do qual foram construídas oito narrativas que expressam a experiência de busca por cuidado. Tendo em vista a necessidade de se considerar na análise dos itinerários o contexto loco-regional e a política de atenção em oncologia, foram também realizadas entrevistas com gestores e técnicos municipais, estaduais e federais, gerentes de serviços oncológicos e profissionais de saúde envolvidos na assistência a pacientes com câncer. À luz do referencial teórico utilizado, as categorias analíticas compreenderam o acesso ao cuidado, o vínculo usuário-equipe e a comunicação entre profissionais e serviços de saúde. A análise mostrou dificuldades para acesso a diagnóstico e tratamento vivenciadas pelos pacientes, ausência de comunicação efetiva entre equipes e profissionais de saúde, dificuldades de articulação entre os serviços, centralidade do cuidado nos serviços especializados e baixa responsabilização pela continuidade da assistência nos vários pontos da rede. Os resultados apontam a necessidade de se problematizar e rever o atual modelo assistencial aos pacientes com câncer, de modo a criar dispositivos que favoreçam o trabalho comunicativo entre gestores, profissionais e usuários, a assunção de novos papéis para as redes locais de saúde e o compartilhamento de responsabilidades e compromissos entre os diferentes pontos da rede no sentido da co-gestão da integralidade do cuidado. A organização de redes de atenção à saúde apresenta-se como uma estratégia para o alcance da integralidade, favorecendo a superação da fragmentação da assistência, tendo como foco as necessidades dos usuários. O estudo de itinerários terapêuticos tem sido utilizado para compreender o modo como se organizam e funcionam as redes de atenção à saúde, interrogando-as a partir das trajetórias de usuários na busca por cuidado. Nesta direção, a presente pesquisa teve por objetivo analisar a integralidade do cuidado à pacientes com câncer em dois municípios da macrorregião de Campinas, SP, sob a perspectiva do trabalho em rede na atenção à saúde. Trata-se de uma pesquisa de natureza qualitativa, que utilizou como principal estratégia metodológica o itinerário terapêutico de usuários com câncer. A reconstituição dos itinerários envolveu a realização de entrevistas em profundidade com pacientes com câncer de mama e próstata, anotações em diário de campo e consulta aos prontuários dos serviços de saúde, conformando o material empírico central a partir do qual foram construídas oito narrativas que expressam a experiência de busca por cuidado. Tendo em vista a necessidade de se considerar na análise dos itinerários o contexto loco-regional e a política de atenção em oncologia, foram também realizadas entrevistas com gestores e técnicos municipais, estaduais e federais, gerentes de serviços oncológicos e profissionais de saúde envolvidos na assistência a pacientes com câncer. À luz do referencial teórico utilizado, as categorias analíticas compreenderam o acesso ao cuidado, o vínculo usuário-equipe e a comunicação entre profissionais e serviços de saúde. A análise mostrou dificuldades para acesso a diagnóstico e tratamento vivenciadas pelos pacientes, ausência de comunicação efetiva entre equipes e profissionais de saúde, dificuldades de articulação entre os serviços, centralidade do cuidado nos serviços especializados e baixa responsabilização pela continuidade da assistência nos vários pontos da rede. Os resultados apontam a necessidade de se problematizar e rever o atual modelo assistencial aos pacientes com câncer, de modo a criar dispositivos que favoreçam o trabalho comunicativo entre gestores, profissionais e usuários, a assunção de novos papéis para as redes locais de saúde e o compartilhamento de responsabilidades e compromissos entre os diferentes pontos da rede no sentido da co-gestão da integralidade do cuidado / Abstract: The organization of healthcare network is presented as a strategy to achieve completeness, which favors the overcoming of care fragmentation, and focuses on the needs of users. The study of therapeutic itineraries has been used to understand how the healthcare networks organize and operate, interrogating them from the users trajectories in the search for care. Following this direction, the present study aimed to analyze the comprehensive care of patients with cancer in two counties in the macro-region of Campinas, SP, under the perspective of the health care network. This is a qualitative research which used the therapeutic itinerary of users with cancer as its main methodological strategy. The reconstitution of the itineraries involved conducting in-depth interviews with breast cancer and prostate cancer patients, daily field notes and medical records of health services, assembling, then, the central empirical material from which eight narratives expressing the experience of seeking care were constructed. Given the need to consider, in the analysis of the itineraries, the locoregional context and the oncology policy attention, interviews were conducted involving municipal, state and federal administrators, technicians, cancer service managers and health professionals involved in the care of cancer patients. In light of the theoretical framework used, the analytical categories comprehended the access to care, the staff-user relationship and the communication among professionals and health service workers. The analysis showed the difficulties patients faced to get access to diagnosis and treatment, lack of effective communication between teams and health professionals, difficulties of service coordination, centrality of care in specialized services and low accountability for continuity of care in various points of the health network. The results indicate the need to discuss and review the current model of cancer care in order to create devices that support the communicative work between managers, professionals and users, the assumption of new health networks roles and, lastly, the sharing of responsibilities and commitments in different areas of the network leading towards co-management of comprehensive care / Doutorado / Política, Planejamento e Gestão em Saúde / Doutora em Saúde Coletiva

La présente thèse est consacrée, sur la base d'une approche historique, aux Sports dans le Maroc contemporain. Elle traite plus particulièrement de l'évolution de l'athlétisme féminin. Son cadre chronologique se situe entre 1956, date d'accession du pays à l'indépendance et 2016 (Jeux Olympiques de Rio). Au nombre des problématiques autour desquelles elle s'article figurent en particulier les conditions générales prévalant dans le pays, notamment celles des femmes, de leur présence dans la sphère publique (dans l'accession que lui donne Habermas), et les difficultés auxquelles elles sont confrontées du fait, entre autres, de préjugés et de stéréotypes culturels et sociaux. De manière plus spécifique, sont également examinées les principales phases de l'évolution de cet athlétisme, les modalités de sa pratique effective (tels les entraînements et les compétitions), les encouragements prodigués notamment par l'Etat en la matière et ayant facilité l'émergence d'athlètes féminines, le palmarès obtenu par une élite à divers niveaux, et comment certaines d'entre elles perçoivent rétrospectivement leurs parcours sportifs. Les récits et les témoignages oraux de 21 athlètes représentent précisément une part substantielle du matériau sur lequel se fonde cette thèse. Ils ont permis de compenser quelque peu la quasi-absence de documents d'archives officielles et celle d'études académiques traitant de l'histoire du sport au Maroc. En raison de leur dimension personnelle et subjective, ces témoignages et la mémoire qui les véhicule demeurent problématiques à maints égards. D'autant que l'auteure de cette étude, en sus de sa condition de femme, est elle-même une ancienne athlète et a fait partie du staff de l'Institut National d'Athlétisme. L'étude, qui se veut une contribution à l'histoire du Temps Présent, s'est cependant efforcée, en dépit de tous ces obstacles, d'analyser et d'évaluer l'évolution de l'athlétisme féminin au Maroc, avec ses performances et ses phases de régression ou d'effacement, depuis ses débuts jusqu'à aujourd'hui / This study deals with Sports in contemporary Morocco on the grounds of a historical standpoint. It focalises more particularly upon the gender dimension of Athletics during the period starting in 1956 (independence of Morocco) and ending in 2016 (Rio de Janeiro Olympic Games). Some major issues are addressed in this respect. This is the case of the general conditions prevailing in the country as regards women’s rights, their presence in the public sphere (as defined by Habermas) and the difficulties they have to face because of cultural and social prejudice and stereotypes. Along with these conditions, the study analyses the main stages, modalities (trainings) and “incentives” that have paved the way for the emergence of female athletes, the achievements of an elite at various levels, and how some them retrospectively perceive their sporting trajectories.Narratives and oral testimonies of twenty-one selected athletes have in fact provided a large part of the row materiel relied upon in this thesis. The use of this sort of data helps compensating, up to a certain extent, the lack of substantial official archives and specific academic studies dealing with sport’s history in Morocco. However, because of their personal and subjective dimension, testimonies and memory remain problematic in many respects Additional complications are due to the particular “statute” of the author of this thesis - having been herself an athlete and member of the National Athletic Training Institute.Despite these obstacles, the study, which the author would like to consider as a contribution to the historiography dealing with Morocco’s recent past and “immediate history”, tried nevertheless to analyse and assess the various stages that Athletics, performed by girls and women in this country, went through, with its ups and downs, from its early beginning to nowadays

This thesis focuses on creating a deeper understanding of European-made metal objects uncovered at a Late Mississippian period site by using an object itinerary theoretical framework. This theory allows for objects to be understood and analyzed without bias as it acknowledges Indigenous and archaeological perspectives by considering the many different contexts an object moves through. I apply this theory to these European-made metal objects that were transformed and used by the Chicasa as a way to introduce a more collaborative and holistic approach to the other analytical methods being used at Stark Farm (22OK778). This process was completed by using a variety of methods, from statistical analysis to thorough literature review, to investigate the different interactions and stoppage points that the objects have traveled along and through.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Le paludisme, la tuberculose et les infections respiratoires aiguës constituent un enjeu majeur de santé publique à Madagascar, les deux premières de ces maladies faisant l’objet de programmes nationaux de lutte largement inspirés et financés par des organisations internationales. Les méthodes diagnostiques, thérapeutiques et de prévention recommandées officiellement dans le système de santé conventionnel sont standardisées et reposent sur un corpus de connaissances scientifiques solidement établi. Parmi d’autres maladies, elles font explicitement partie des cibles des objectifs du développement durable (ODD). Pour les atteindre, les nations unies recommandent la mise en œuvre d’une Couverture Sanitaire Universelle (CSU). Madagascar a adopté les ODD et s’est engagé dans la voie de la mise en œuvre d’une CSU. Ces travaux sur le paludisme, la tuberculose et les infections respiratoires aiguës ont été menés dans le cadre de cette thèse de sociologie, en utilisant une approche qualitative (auprès de 83 individus) et quantitative (auprès d’environ 26.000 personnes interrogées, par enquêtes en populations), sur plusieurs terrains de Madagascar, impliquant des soignants, des soignés et des acteurs institutionnels. L’acceptation et la mise en œuvre des méthodes de prise en charge des maladies dépendent de facteurs logistiques et organisationnels, mais aussi des croyances et pratiques adoptées par les individus, les familles et les groupes sociaux ou professionnels. En pratique, les obstacles sont nombreux sur la voie d’un accès effectif des populations aux soins contre les maladies ciblées par les ODD et la CSU, y compris celles faisant déjà l’objet de programmes de lutte verticaux et soutenus internationalement. Les éléments représentatifs des zones étudiées dans cette thèse apportent un éclairage qui peut être utile pour la mise en œuvre d’une CSU à l’échelle du pays. Ils révèlent aussi les défis, pas seulement financiers, qui restent à surmonter. / Malaria, tuberculosis and acute respiratory infections constitute a major public health issue in Madagascar, the first two of which are the subject of national control programs largely inspired and financed by international organizations. The diagnostic, therapeutic and preventive methods recommended officially in the conventional health system are standardized and are based on a solid corpus of scientific knowledge. Among other diseases, they are explicitly targeted by the universal sustainable development goals (SDG). To reach them, the United nations recommend the implementation of an universal health coverage (UHC). Madagascar has adopted the SDG and is committed to the implementation of a UHC. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDG and UHC, including those already covered by vertical and internationally supported control programs. These works on malaria, tuberculosis and acute respiratory infections were carried out within the framework of this sociological thesis, using a qualitative methods (among 83 individuals) and quantitative methods (with about 26,000 people interviewed), by population surveys, on several fields in Madagascar, involving caregivers, cared population and institutional actors. The acceptance and implementation of these disease management methods depend on logistical and organizational factors, but also on the beliefs and practices of individuals, families and social or professional groups. In practice, there are many obstacles in the way of effective access to health care for diseases targeted by SDGs and UHC, including those already covered by vertical and internationally supported control programs. The representative elements of the studied zones of Madagascar presented in this thesis provide an insight that could be useful for the implementation of a CSU across the country. They also reveal the challenges, not just financial, that remain to be overcome.

Il s’agit d’étudier l’inscription en politique de l’ancien résistant et déporté Edmond Michelet (1899-1970) accédant à la carrière politique sous la Quatrième et la Cinquième République. Passant du gaullisme de guerre au gaullisme d’opposition puis au gaullisme politique dès le retour aux affaires de l’Etat du général de Gaulle en 1958, E. Michelet traduit son engagement en lien étroit avec la figure tutélaire du chef libérateur de la France. C’est donc en posant le degré de filiation, de pratiques et de mise en réseaux d’Edmond Michelet avec Charles de Gaulle, ses collaborateurs et ses détracteurs au sommet du pouvoir comme à la base de l’appareil militant, que se pose l’intérêt de notre étude. On insistera dans cette étude sur l’importance des trajectoires culturelles et idéologiques opérantes au sein des appareils politiques et dans l’environnement des gaullistes de De Gaulle à G. Pompidou. C’est l’occasion d’interroger enfin le style politique d’E.Michelet et le degré d’imprégnation des moments clés de son existence (les militances catholiques sociales de l’entre-deux-guerres ; la Résistance ; la déportation) adaptés à l’exercice original de ses activités politiques (militant et dirigeant de parti ; parlementaire ; membre de gouvernement, etc.). / It is a question of studying the registration in politics of the former Resistance fighter and the transported convict Edmond Michelet (1899-1970) reaching in the political career under the Fourth and the Fifth Republic. Passer-by of the war Gaullism in the Gaullism of opposition then the political Gaullism from the return to the affairs of the State of the general de Gaulle in 1958, Michelet translates its commitment in the service of the Gaullism into narrow link with the guardian face of the leader liberator of France. Thus while putting the degree of filiation, practices and putting in Edmond Michelet's networks with Charles de Gaulle, his associates and his detractors at the top of the power as on the basis of the militant device, arises the interest of our study. This study will emphasize the importance of operational trajectories within political apparatuses and in the Gaullist environment from De Gaulle to G. Pompidou. This is the opportunity to finally question the political style of E. Michelet and the degree of impregnation of the key moments of his life (the Catholic social militants of the inter-war period, the Resistance, the deportation) adapted to the exercise of his political activities (militant and party leader; member of government, etc.).

Made available in DSpace on 2016-04-25T20:21:18Z (GMT). No. of bitstreams: 1 Maria Elisa Gonzalez Manso.pdf: 1100752 bytes, checksum: a79f3c4334cb3dc3edbfbcb83487718d (MD5) Previous issue date: 2015-02-05 / This research aims to understand the explanatory model and the therapeutic itinerary of a group of patients affected by chronic diseases who are assisted by disease management programs carried out by operators of health plans and identify strategies of self-care that relate with the explanatory model. The thesis that moves this study is that the route that the patient uses for its treatment has deep roots in his own culture, being much larger than the model used by health professionals, also generated by the culture, but restricted by the biomedical vision. The meanings of terms such as health, cure, treatment, disability, dependence and others are not always equal in both models. If the meaning is too different, adherence to the treatment will be impaired, but the patient may still have obtained relief from their suffering. The methodology applied is qualitative, gathered through interviews with people with confirmed previous medical diagnosis of chronic disease who were already undergoing treatment, accompanied by chronic diseases management programs, which, according to the hegemonic healthy model, should know the diseases that affect them with a sufficient degree of information that would allow their full compliance. Because these are people linked to health plans, with a higher socioeconomic strata, they would fit the criteria of information, income, education and access to health care that would turn them into ideal patients and adherent to therapy. Reasons for non-adherence to treatment among these participants are what motivated this research and generated the hypothesis that the therapeutic itinerary of these patients, generated and engraved in their culture, originates from an explanatory model of the illness process much wider than the hegemonic model. So these diseased would present strategies of self-care, as part of this layman model, which allows them to carry on and manage their treatment both within and without the current prevailing model, strategies those that can be seen by health professionals as noncompliance. We believe that this study achieved its objectives, supporting the initial hypothesis of the research, showing that even in a theoretically disciplined group within criteria taken as ideal for joining the biomedical model of illness and treatment, people are immersed in their culture and find loopholes for the exercise of self-care. The work also showed that the crisis of the biomedical model, in this case, stems from the microphysics power relations and from the structural conditions of the health system and the people in the group are able to identify some of these flaws. We hope this research will contribute to this relevant nowadays debate as well as collaborate in the reflections on medicine and health education, broadening the discussion to incorporate the experiences and narratives of this group of patients / Esta pesquisa tem como objetivo perceber o modelo explicativo e o itinerário terapêutico de um grupo de doentes acometidos por afecções crônicas assistidos por programas de gerenciamento de doenças realizados por operadoras de planos de saúde e identificar estratégias de cuidar de si que se inter-relacionam com seu modelo explicativo. A tese que move este estudo é de que o itinerário que o doente utiliza para seu tratamento tem profundas raízes na cultura, sendo muito mais amplo do que o modelo dos profissionais de saúde, por sua vez também gerado na cultura, porém restringido pela visão da biomedicina. Os significados de termos como saúde, cura, tratamento, incapacidade, dependência, entre outros, nem sempre são correspondentes em ambos os modelos. Caso o significado seja muito diferente, a adesão ao tratamento ficará prejudicada, mas o doente pode ter obtido alívio para seu sofrimento. A metodologia empregada é qualitativa, realizada mediante entrevistas com pessoas com diagnóstico médico prévio confirmado de doença crônica e que já se encontravam em tratamento, acompanhadas por programas de gerenciamento de doenças crônicas, as quais, segundo o modelo de atenção à saúde hegemônico, deveriam conhecer as doenças que os acometem com um grau de informação suficiente que permitisse sua adesão plena ao tratamento. Por se tratarem de pessoas vinculadas a planos de saúde, portanto de estratos socioeconômicos mais elevados, preencheriam os quesitos de informação, renda, educação e acessibilidade ao sistema de saúde que os transformaria em pacientes ideais e aderentes à terapêutica. O porquê da não adesão ao tratamento entre estes participantes é que despertou esta pesquisa e gerou a hipótese de que o itinerário terapêutico destes enfermos, gerado e inscrito na cultura, origina-se de um modelo explicativo do processo de adoecer mais amplo do que o modelo hegemônico. Estes adoecidos apresentariam assim estratégias de cuidar de si próprios, como parte deste modelo dito leigo, que faz com que convivam e gerenciem seu tratamento tanto dentro quanto à revelia do modelo predominante, estratégias estas que podem ser vistas pelos profissionais de saúde como não adesão. Acreditamos que esta pesquisa atingiu seus objetivos, corroborando a hipótese inicial do trabalho, demonstrando que, mesmo em um grupo teoricamente disciplinado dentro de critérios tidos como ideais para a adesão ao modelo biomédico de adoecimento e tratamento, as pessoas estão imersas na cultura e encontram brechas para o exercício do cuidar de si. O trabalho mostrou ainda que a crise do modelo biomédico, neste caso, advém tanto das relações microfísicas de poder quanto das condições estruturais do sistema de saúde e que as pessoas do grupo conseguem identificar algumas destas falhas. Esperamos que esta pesquisa possa contribuir para este debate tão atual, além de colaborar nas reflexões sobre a medicina e sobre o ensino na saúde, ampliando a discussão ao incorporar as experiências e narrativas deste grupo de enfermos

De nos jours, la problématique de recherche du meilleur itinéraire est très étudiée dans diverses applications telles que pour le mode de transport doux (vélo) ou piétonnier, pour l’interception d’un objet mobile ou encore pour la combinaison des modes de transport (multimodal). Dans cette optique, notre objectif consiste à chercher un meilleur itinéraire pour les services d’urgence. Notre étude est réalisée en partenariat avec le SMUR du Mans (Sarthe) qui fournit le contexte opérationnel. Dans un premier temps, ce travail de recherche consiste à exploiter l’historique des trajectoires empruntées par le service d’urgence pour avoir une meilleure estimation du temps de parcours. Afin de réaliser cette tâche, nous proposons une méthodologie partant de la phase de la modélisation des objets mobiles passant par une étape d’analyse statistique et de data mining et allant jusqu'aux phases de l’implémentation et de la validation. Concernant la phase de la modélisation, nous proposons une approche qui fait le lien entre une modélisation et une gestion des objets mobiles par des Types Abstraits de Données (TAD) et une modélisation conceptuelle basée sur MADS. En vue d’avoir une meilleure estimation du temps de parcours, une méthode d’Analyse des Correspondances Multiples et une technique de création d’arbres et de règles de décision sont utilisées. Pour le processus de la validation de notre méthode d’estimation du temps de parcours, nous procédons par une comparaison entre les itinéraires proposés par application d’un algorithme de recherche du plus court chemin et les trajectoires empruntées par le service d’urgence. Dans un deuxième temps, et pour pouvoir prendre en considération la temporalité et l’incertitude sur les estimations du temps de parcours causées par les différents types de perturbations, le mode dépendant du temps avec graphe par intervalle et la notion de degré d’optimisme seront retenus pour l’implémentation de notre calculateur. On propose deux versions de recherche d’itinéraires : un seul et unique chemin le plus rapide et les k premiers chemins optimaux. Afin de minimiser le risque de blocage, la deuxième version sera bénéfique dans le cas où deux équipes partent pour une même intervention. Chacune d’entre elles empruntera un chemin différent afin d'optimiser les chances d'arriver rapidement sur les lieux d'intervention.Enfin, et pour prendre en considération en temps réel les événements exceptionnels prévus (manifestations, travaux publics), les changements des caractéristiques physiques du réseau routier, les conditions météorologiques et les événements imprévus (embouteillages, accidents) qui peuvent influer sur le choix d’itinéraires, nous proposons un système d’aide à la prise en compte des perturbations du trafic en temps réel. / The present-day issue of looking for the most appropriate route is widely studied for various applications such as cycling or pedestrians, the interception of a mobile object, multimodal or combining means of transport.With this approach, our objective is to search for the best itinerary for emergency vehicles. Our study has been carried out in partnership with the SMUR (emergency medical assistance) in Le Mans, which has provided an operational context.Our research work firstly dealt with the records of the routes used by emergency vehicles so as to obtain a more accurate estimation of journey times. For this task, our methodology begins with a phase of modelising mobile objects using statistical analysis and data mining to reach phases of implementation and validation. During the modelisation phase, we propose the use of an approach that creates a link between modeling and management of mobile objects by Abstract Data Types (TAD) and conceptual modeling based on MADS. So as to improve estimation of journey time a method of Multiple Correspondence Analysis and a technique for creating trees and decision rules were used. For the validation process of journey time, we compared routes suggested by a research algorithm application for the shortest trip and the routes used by the emergency services.Secondly, so as to take into consideration time value and the uncertainty of journey time estimations due to disturbances, the mode depending on time with graph per interval and the notion of degree of optimism will be retained for the implementation of our calculator. We propose two versions of itinerary research: a single unique fastest route and the first k optimal routes. So as to minimize the risk of blocking, a second version is of benefit in the case of two emergency units leaving for the same intervention. Each will use a different route to maximize the chances of arriving on the scene quickly Intervention.The ultimate stage involved considering in real time the consequences of exceptional foreseen events (demonstrations, roadworks), changes in the physical characteristics of the road network, weather conditions and those that could not be predicted (traffic congestion and accidents) that can influence the choice of a route, for which we propose a system to help in the management of such a disturbance in real time.

Made available in DSpace on 2016-04-26T14:55:07Z (GMT). No. of bitstreams: 1 Maria Elisa Gonzalez Manso.pdf: 1100752 bytes, checksum: a79f3c4334cb3dc3edbfbcb83487718d (MD5) Previous issue date: 2015-02-05 / This research aims to understand the explanatory model and the therapeutic itinerary of a group of patients affected by chronic diseases who are assisted by disease management programs carried out by operators of health plans and identify strategies of self-care that relate with the explanatory model. The thesis that moves this study is that the route that the patient uses for its treatment has deep roots in his own culture, being much larger than the model used by health professionals, also generated by the culture, but restricted by the biomedical vision. The meanings of terms such as health, cure, treatment, disability, dependence and others are not always equal in both models. If the meaning is too different, adherence to the treatment will be impaired, but the patient may still have obtained relief from their suffering. The methodology applied is qualitative, gathered through interviews with people with confirmed previous medical diagnosis of chronic disease who were already undergoing treatment, accompanied by chronic diseases management programs, which, according to the hegemonic healthy model, should know the diseases that affect them with a sufficient degree of information that would allow their full compliance. Because these are people linked to health plans, with a higher socioeconomic strata, they would fit the criteria of information, income, education and access to health care that would turn them into ideal patients and adherent to therapy. Reasons for non-adherence to treatment among these participants are what motivated this research and generated the hypothesis that the therapeutic itinerary of these patients, generated and engraved in their culture, originates from an explanatory model of the illness process much wider than the hegemonic model. So these diseased would present strategies of self-care, as part of this layman model, which allows them to carry on and manage their treatment both within and without the current prevailing model, strategies those that can be seen by health professionals as noncompliance. We believe that this study achieved its objectives, supporting the initial hypothesis of the research, showing that even in a theoretically disciplined group within criteria taken as ideal for joining the biomedical model of illness and treatment, people are immersed in their culture and find loopholes for the exercise of self-care. The work also showed that the crisis of the biomedical model, in this case, stems from the microphysics power relations and from the structural conditions of the health system and the people in the group are able to identify some of these flaws. We hope this research will contribute to this relevant nowadays debate as well as collaborate in the reflections on medicine and health education, broadening the discussion to incorporate the experiences and narratives of this group of patients / Esta pesquisa tem como objetivo perceber o modelo explicativo e o itinerário terapêutico de um grupo de doentes acometidos por afecções crônicas assistidos por programas de gerenciamento de doenças realizados por operadoras de planos de saúde e identificar estratégias de cuidar de si que se inter-relacionam com seu modelo explicativo. A tese que move este estudo é de que o itinerário que o doente utiliza para seu tratamento tem profundas raízes na cultura, sendo muito mais amplo do que o modelo dos profissionais de saúde, por sua vez também gerado na cultura, porém restringido pela visão da biomedicina. Os significados de termos como saúde, cura, tratamento, incapacidade, dependência, entre outros, nem sempre são correspondentes em ambos os modelos. Caso o significado seja muito diferente, a adesão ao tratamento ficará prejudicada, mas o doente pode ter obtido alívio para seu sofrimento. A metodologia empregada é qualitativa, realizada mediante entrevistas com pessoas com diagnóstico médico prévio confirmado de doença crônica e que já se encontravam em tratamento, acompanhadas por programas de gerenciamento de doenças crônicas, as quais, segundo o modelo de atenção à saúde hegemônico, deveriam conhecer as doenças que os acometem com um grau de informação suficiente que permitisse sua adesão plena ao tratamento. Por se tratarem de pessoas vinculadas a planos de saúde, portanto de estratos socioeconômicos mais elevados, preencheriam os quesitos de informação, renda, educação e acessibilidade ao sistema de saúde que os transformaria em pacientes ideais e aderentes à terapêutica. O porquê da não adesão ao tratamento entre estes participantes é que despertou esta pesquisa e gerou a hipótese de que o itinerário terapêutico destes enfermos, gerado e inscrito na cultura, origina-se de um modelo explicativo do processo de adoecer mais amplo do que o modelo hegemônico. Estes adoecidos apresentariam assim estratégias de cuidar de si próprios, como parte deste modelo dito leigo, que faz com que convivam e gerenciem seu tratamento tanto dentro quanto à revelia do modelo predominante, estratégias estas que podem ser vistas pelos profissionais de saúde como não adesão. Acreditamos que esta pesquisa atingiu seus objetivos, corroborando a hipótese inicial do trabalho, demonstrando que, mesmo em um grupo teoricamente disciplinado dentro de critérios tidos como ideais para a adesão ao modelo biomédico de adoecimento e tratamento, as pessoas estão imersas na cultura e encontram brechas para o exercício do cuidar de si. O trabalho mostrou ainda que a crise do modelo biomédico, neste caso, advém tanto das relações microfísicas de poder quanto das condições estruturais do sistema de saúde e que as pessoas do grupo conseguem identificar algumas destas falhas. Esperamos que esta pesquisa possa contribuir para este debate tão atual, além de colaborar nas reflexões sobre a medicina e sobre o ensino na saúde, ampliando a discussão ao incorporar as experiências e narrativas deste grupo de enfermos