Résumé Cette thèse est le rassemblement, par blocs homogènes, de notes d’orientation, de présentations orales, de textes variés, rédigés pour des revues scientifiques, comme chapitres de livres, pour des colloques ou des congrès, pour divers décideurs politiques, des années 80 à ce jour. Son but est de montrer leur cohérence avec un fil conducteur commun : le développement d’outils conceptuels et méthodologiques utiles pour la pratique de la médecine générale en particulier, pour le système de dispensation des soins plus globalement. L’impact espéré est une amélioration de la qualité des soins dispensés, à l’échelle individuelle (relation soignant/soigné) ou à l’échelle collective (système de santé). Les différents blocs se succèdent dans l’ordre suivant : q Chapitre 1 : Introduction. Bloc 1 : Concepts philosophiques q Chapitre 2 : La transdisciplinarité. Concept transcendant la multidisciplinarité (simple juxtaposition indépendante de différentes approches disciplinaires), l’interdisciplinarité (pénétration de différentes disciplines pour éclairer plus complètement un même phénomène) pour arriver à une compréhension globale et homogène où chaque discipline utilise des éléments des autres pour pallier ses manques et ses limites. q Chapitre 3 : La plainte, du normal au pathologique. Développements philosophiques et scientifiques, en complémentarité et en prise directe sur la réalité clinique, sur le normal et le pathologique, le moyen et le divergent, etc. q Chapitre 4 : Les quatre formes de la prévention. Prolongation du texte précédent, en définissant les trois formes classiques de la prévention (primaire au stade « normal », secondaire au stade pathologique mais pré-clinique, et tertiaire au stade clinique), et en introduisant le concept nouveau de prévention quaternaire, ou protection de la population et du système de soins de l’angoisse des soignés et des soignants. q Chapitre 5 : Critique et autocritique du principe de classification. Développement sur les nécessités contradictoires de l’homogénéité et de la complétude (donc du respect de toutes les nuances et de toutes les spécificités), et de la réduction et du traitement de l’information (donc de la prise en compte du classement et des catégorisations). Bloc 2 : Concepts politiques q Chapitre 6 : Les problèmes d’environnement en relation avec la santé. Rapport d’une recherche destinée à élaborer un outil opérationnel à l’usage des médecins généralistes, pour les aider à être sensibilisés aux problèmes d’environnement en relation avec la santé, à diagnostiquer les plus fréquents et les plus importants d’entre eux, et à les prendre en charge de manière non spécialisée. q Chapitre 7 : Faim de travail, fin de la santé. A partir de chiffres concrets, démonstration du lien entre morbidité/mortalité et statut socio-économique. Selon les temps et les lieux, les profils épidémiologiques sont différents, mais ce sont toujours les mêmes populations (position socio-économique basse dans la société, stress professionnel lié à la hiérarchie) qu’on retrouve dans le bas des échelles. q Chapitre 8 : L’éducation à la santé à la Maison Médicale de Forest. Rapport de 15 ans d’éducation et de promotion de la santé dans une maison médicale, sous différents angles (clinique, opérationnel, conceptuel, culturel etc). q Chapitres 9, 10, 11 et 12 : Les soins de santé de 1ère ligne ; Synthèse et communication, ou les fonctions de base de la médecine de famille ; Proposition « martyr » pour une restructuration de la 1ère ligne à Bruxelles ; Mise sur pied d’un centre pilote « urgences » ambulatoire. Plusieurs notes d’orientation proposant quelques modèles théoriques de systèmes de dispensation des soins, basés sur certains principes tels division en niveau de soins, filières de soins, intégration de l’ambulatoire et de l’hospitalier, prise en compte des spécificités des grandes métropoles, des problèmes liés à l’accessibilité et aux urgences. q Chapitre 13 : Les systèmes locaux de santé (SyLoS) : un élément de réponse à la crise du secteur de santé en Belgique ? Proposition, mise sur pied et évaluation de petites unités fonctionnelles de proximité, constituées de soignants intra- et extra-hospitaliers, dans un objectif commun d’amélioration de la qualité des soins, en partant de situations réellement vécues et ayant posé problème. q Chapitre 14 : Le financement forfaitaire à la capitation : une alternative au traditionnel payement à l’acte ? Revue de la littérature internationale sur les systèmes de financement des soins dans une vingtaine de pays différents. Démonstration des limites et des perversions du payement à l’acte intégral. Proposition d’un système de financement global mélangeant payement à l’acte, payement par forfait à la capitation, payement à l’objectif, payement structurel, payement par le patient. q Chapitre 15 : Les pratiques solo dispensent-elles des soins de moins bonne qualité ? Critiques et commentaires d’un article du BMJ sur le sujet. Tentative de réponses au départ d’éléments organisationnels, statistiques et épidémiologiques. Bloc 3 : Concepts relatifs à la pratique clinique q Chapitres 16 et 17 : L’assurance de qualité et le médecin de famille ; Les critères de qualité : tout le monde en parle. Synthèse théorique sur l’assurance de qualité en soins primaires. Définition des concepts de base : critères de qualité, standards et objectifs, méthodes, évaluation et indicateurs, limites et problèmes. q Chapitre 18 : Système de santé, système d’information et méthodes d’évaluation. Structuration du dossier médical global du médecin généraliste, positionnement dans les filières cliniques et de dispensation des soins, utilité pour l’auto-évaluation, la formation, la connaissance scientifique, l’assurance de qualité et la décision politique. q Chapitre 19 : La CISP, concepts généraux et développements. Construction de la Classification Internationale des Soins Primaires, version initiale. Nouveaux principes classificatoires développés au départ des limites de la CIM (Classification Internationale des Maladies) de l’OMS, utilisée dans les dossiers hospitaliers. Apports de la nouvelle (2e) version, CISP-2. Extension des classifications vers les thesaurus (LOCAS et TB3), au travers du transcodage CISP/CIM. q Chapitre 20 : L’approche par problèmes et les éléments du SOAP. Description de l’approche par épisodes (en lieu et place de la notion classique de diagnostics) et de l’analyse de la relation soignant/soigné dans ses quatre dimensions (subjectif, objectif, appréciation et planification). q Chapitre 21 : Structuration du dossier médical électronique : concepts et histoire. A partir des notions cliniques de problèmes et de SOAP, élaboration et explicitation d’un nouveau modèle de dossier médical informatisé, constitué de la relation entre 7 éléments structurants (élément de soins, démarche, contact, sous-contact, service, dispensateur, temps). Ce nouveau modèle est la base du label des logiciels médicaux électronique belges. q Chapitre 22 : Casuistique appliquée. Application à vocation pédagogique du précédent modèle, à partir de deux cas cliniques exemplatifs. q Chapitre 23 : Le DUSOI/Wonca, un indice de gravité pour la médecine générale. Outil développé par la Wonca pour évaluer la gravité de l’état de santé d’un patient à un moment donné au cours de son évolution clinique, évaluation à la fois ponctuelle et diachronique. Application pratique à plusieurs situations réelles. q Chapitre 24 : Evaluation de l’état fonctionnel : les cartes COOP/Wonca. Outil également développé par la Wonca pour l’auto-évaluation fonctionnelle des patients. Il s’agit d’un jeu de 6 cartes représentant graphiquement dans un langage universel l’état de santé somatique, mentale et sociale, de manière à la fois ponctuelle et longitudinale, évalué par le patient lui-même. q Chapitre 25 : Valeurs, paradigmes et recherche en médecine générale. Comparaison des concepts fondamentaux de la recherche traditionnelle, de la recherche opérationnelle et de la recherche action. Intérêt relatif de chacun de ces types de recherche pour des questions et des situations spécifiques, de même que pour l’utilisation des méthodes quantitatives ou qualitatives. q Chapitres 26 et 27 : La CISP et le système SOAP, des outils pour bien décider dans l’incertitude (application à la clinique de la céphalée en médecine de famille) ; « Docteur, j’ai mal au genou », le point de vue du généraliste. Applications à la connaissance scientifique et à la pratique clinique des différents concepts développés dans les chapitres précédents à partir de deux situations fréquentes : les céphalées et les douleurs du genou. q Chapitre 28 et 29 : Vous vouliez des statistiques ? Statistiques Maison Médicale Santé Plurielle 2003. Méthode d’analyse des différentes données disponibles dans une maisons médicale, recueillies systématiquement en temps réel pendant l’activité clinique. Démonstration de son intérêt pour l’auto-évaluation de l’institution, son pilotage cohérent, et les rapports avec le politique. Les chiffres sont des chiffres et seulement des chiffres. Ils doivent être compris, contextualisés, critiqués, commentés et rendus utiles dans leur situation locale spécifique, mais aussi comme partie d’un paquet plus global de données épidémiologiques. q Chapitre 30 : Le bilan biologique de base, un examen inutile ? Définition critique « evidence-based medicine » des examens biologiques de routine de dépistage. q Chapitre 31 : Un projet d’assurance de qualité « diabète » à la Maison Médicale Santé Plurielle. Compte-rendu de l’expérience d’un programme d’assurance de qualité multidisciplinaire dans une maison médicale. Définition opérationnelle d’une série d’indicateurs, évaluation de ceux-ci avant et après le programme. Apports et limites de l’expérience. et q Chapitre 32 : Conclusion. Trente et un chapitres, c’est beaucoup. Et en même temps, c’est très peu : la médecine générale se pratique dans un contexte radicalement différent de ce qu’il était il y a moins de 50 ans. Si elle ne redéfinit pas clairement son rôle et ses outils, elle risque donc de se replier dans des positions défensives et passéistes qui, si elles sont nécessaires face à la médicalisation et à la spécialisation croissantes, ne suffisent cependant pas pour expliciter et faire reconnaître sa spécificité. Rappelons que celle-ci réside essentiellement dans la complexité, puisqu’il s’agit d’aborder l’humain à la fois sur le plan individuel, dans une approche bio-médicale et psychodynamique, et sur le plan collectif, en terme de santé publique, et en faisant appel à diverses disciplines telles que la sociologie, l’anthropologie, l’ethnomédecine. Au fil de ma pratique, j’ai ressenti la nécessité de construire, en dehors du champ bio-médical qui reste la référence essentielle au niveau du savoir académique, des outils spécifiques permettant d’augmenter la qualité des soins primaires. Les outils présentés au fil de cette thèse ont été élaborés dans un constant aller-retour entre la théorie et la pratique, et selon un cheminement traversant plusieurs disciplines. Certains de ces outils sont de type conceptuel, comme la transdisciplinarité, la prévention quaternaire, d’autres sont d’ordre méthodologique, la structure du dossier médical, le SyLoS, les classifications et le thésaurus, le carnet de bord. Tous ces outils visent à baliser la démarche du médecin généraliste, à lui donner des repères théoriques et pratiques à même de le guider dans la complexité des situations qu’il rencontre, le but ultime étant de soutenir une pratique de qualité respectant la singularité des histoires, des sujets rencontrés. Ces outils spécifiques ont été testés sur le terrain ; ils sont actuellement utilisés et intégrés par des médecins généralistes et d’autres professionnels des soins de santé primaires. Leur faisabilité et leur utilité pour améliorer la qualité des soins semblent donc démontrées, mais aussi certaines difficultés d’implantation puisqu’ils engagent les soignants dans une démarche réflexive, les amenant à se questionner sur le sens et l’efficacité de leurs pratiques, pour mieux les évaluer. Summary This thesis is the gathering, through homogenous blocks, of orientation’s notes, oral presentations and various texts, written for scientific journals, as book chapters, for colloquiums or conferences, for different political decision-makers, from the 1980s up until today. The goal is to demonstrate their coherence with a common direction: the development of conceptual and methodological tools for the practice of general medicine in particular, for the system of care-giving more globally. The hoped impact is an improvement of care quality, provided at the individual level (relationship care-receiver/care-giver) or at the collective level (health system). The different blocks are organized according to the following order: q Chapter 1 : Introduction. Block 1 : Philosophical concept q Chapter 2: Trandisciplinarity. Concept transcending the multidisciplinarity (simple juxtaposition independent from different disciplinary approaches) and the interdisciplinarity (penetration of different disciplines to more fully enlighten the same phenomenon) to reach a more global and homogenous understanding where disciplines use each others’ elements to overcome their own lacks and limitations. q Chapter 3: The complaint, from normal to pathological. Philosophical and scientific developments, complementing and directly connecting with the clinical reality, the normal and pathological, the average and the diverging, etc. q Chapter 4: The 4 forms of the prevention. Prolongation of the above-mentioned text, by defining the three classical forms of the prevention (primary at the “normal” stage, secondary at the pathological but pre-clinical stage and tertiary at the clinical stage), and by introducing the new concept of quaternary prevention, or protection of the population and the health system from the anguish of the care-receivers and givers. q Chapter 5: Criticism and auto-criticism of the principle of classification: Elaboration on the contradictory necessities of the homogeneity and completeness (thus of the respect of all the differences and specificities), and of the decrease and the treatment of the information (thus of the taking into account of the ranking and the categorizations). Block 2 : Political concepts q Chapter 6: The environmental problems relating to health. Report of a research aiming at elaborating an operational tool for the use of general practitioners, to help them become sensitive to environmental problems relating to health, to diagnose the most frequent and most important among those, and to take them over in a non-specialized manner. q Chapter 7: Hunger of work, end of health. From concrete numbers, demonstration of the link between morbidity/mortality and the socio-economical status. According to the times and locations, the epidemiological profiles are different but the same populations (low socio-economical position in the society, professional stress due to the hierarchy) are always found at the bottom of the ladders. q Chapter 8: Health education at the “Maison Médicale” of Forest. Report of 15 years of health education and promotion in a primary care health centre, from different angles (clinical, operational, conceptual, cultural etc.). q Chapters 9, 10, 11 and 12: First line health care; Synthesis and communication, or the basic functions of family medicine; “Martyr” proposition for the restructuring of the first line in Brussels; Establishment of a pilot ambulatory “emergency” center. Several orientation’s notes offering different theoretical models of care-providing systems, based on certain principles such as division into care levels, care networks, integration of the ambulatory and hospital, taking into account the specificities of large metropolises, of the problems related to the accessibility and to the emergencies. q Chapter 13: Local systems of health: a partial answer to the crisis of the health department in Belgium? Proposal, establishment and evaluation of small functional proximity units, consisting of intra- and extra-hospital care-givers, with the common goal of enhancing the quality of care, originating from real-life situations that have been problematic. q Chapter 14: Fixed financing by capitation: an alternative to the traditional fee for service payment? Review of the international literature about care financing systems in about twenty different countries. Demonstration of the limits and perversions of the integral fee for service payment. Proposal of a global financing system combining fee for service payment, fixed payment by capitation, target payment, structural payment, payment by the patient. q Chapter 15: Do solo practices provide less quality care? Criticisms and commentaries of a BMJ article on the topic. Attempt of an answer based on organizational, statistical and epidemiological elements. Block 3: Concepts related to clinical practice q Chapters 16 and 17: Quality insurance and the family doctor; Quality criteria: everybody speaks about it. Theoretical synthesis on quality insurance in primary care. Definition of the basic concepts: quality criteria, standards and objectives, methods, evaluation and indicators, limits and problems. q Chapter 18: Health system, information system and evaluation methods. Structuring the global medical record of general practitioners, positioning in the clinical and care-providing networks, use for the auto-evaluation, the formation, the scientific knowledge, the quality insurance and the political decision. q Chapter 19: ICPC, general concepts and developments. Construction of the International Classification of Primary Care, initial version. New classifying principles developed out of the limits of the ICD (International Classification of Diseases) of the WHO, used in hospital records. Contributions of the new (2nd) version, ICPC-2. Extension of the classification towards the thesaurus (LOCAS and TB3), through transcoding ICPC/ICD. q Chapter 20: Approach by problems and elements of the SOAP. Description of the approach by episodes (instead of the classical notion of diagnostics) and the analysis of relationship care-receiver/care-giver in the four dimensions (subjective, objective, appreciation and planning). q Chapter 21: Structuring of the electronic medical record: concepts and history. From the clinical notions of problems and SOAP, elaboration and clarification of a new model of computerized medical record, consisting of the relationship between 7 structuring elements (element of care, approach, contact, sub-contact, service, provider, time). This new model is the base for the label of Belgian electronic medical softwares. q Chapter 22: Applied casuistic. Application with pedagogical vocation of the former model, based on two exemplary clinical cases. q Chapter 23: The DUSOI/Wonca, a gravity index for the general practice. Tool developed by the Wonca to evaluate the gravity of a patient’s health status at a given moment in the course of his/her clinical evolution, evaluation both punctual and diachronic. Practical application to several real-life situations. q Chapter 24: Evaluation of the functional state: The COOP/Wonca cards. Tool also developed by the Wonca for the functional auto-evaluation of patients. It consists of a game of 6 cards graphically representing in a universal language the somatic, mental and social health state, both punctually and longitudinally, evaluated by the patient him/herself. q Chapter 25: Values, paradigms and research in general practice. Comparison of the fundamental concepts of the traditional research, the operational research and the action research. Relative interest of each of these research types for specific questions and situations, as well as for the use of quantitative and qualitative methods. q Chapter 26 and 27: The ICPC and the SOAP system, tools to well decide in uncertainty (application to the headache in family medicine); “Doctor, my knee hurts”, the view point of the general practitioner. Applications to the scientific knowledge and to the general practice of the different concepts developed in the previous chapters based on two frequent situations: the cephalalgia and the knee pains. q Chapters 28 and 29: Did you want statistics? Statistics “Maison Médicale Santé Plurielle 2003”. Method of analysis of the various data available in a primary care health centre, systematically collected in real-time during the clinical activity. Demonstration of its interest for the institution’s auto-evaluation, its coherent piloting, and the relationship with the politics. Numbers are numbers and only numbers. They have to be understood, contextualized, criticized, commented and made useful in their specific local situation, but also as part of a more global package of epidemiological data. q Chapter 30: The basic biological assessment, a useful exam? Critical definition evidence-based medicine of the routine screening biological exams. q Chapter 31: A project of “diabetic” quality insurance at the “Maison Médicale Santé Plurielle”. Report of the experience of a multidisciplinary insurance quality program in a primary care health centre. Operational definition of a series of indicators, evaluation of the latter before and after the program. Contributions and limits of the experience. and q Chapter 32 : Conclusion. Thirty-one chapters, it is a lot. And at the same time it is very little: general practice is carried out in a radically different context than it was less than 50 years ago. If it does not clearly redefine its role and tools, there is a risk for it to fall back to defensive and passeist positions which, even though they are necessary facing the increasing medicalization and specialization, are nevertheless not enough to explain its specificity and make it acknowledged. Let us remember that the latter resides essentially in complexity, since it consists of dealing with the human being at the individual level, in a bio-medical and psychodynamic approach, and at the collective level, in terms of public health, and by bringing in various disciplines such as sociology, anthropology, ethno-medicine. In the course of my practice, I felt the need to construct, outside of the bio-medical field which remains the essential reference at the level of the academic knowledge, specific tools allowing to increase the quality of primary care. The tools presented throughout this thesis have been elaborated through a constant back and forth between theory and practice, and according to a path crossing several disciplines. Some of these tools are conceptual, such as the transdisciplinarity and the quaternary prevention, others are methodological, such as the structure of the medical record, the SyloS, the classifications and the thesaurus, the logbook. All these tools are meant to mark out the approach of the general practitioner, to give him some theoretical and practical points of reference able to guide him in the complexity of the situations he encounters, the ultimate goal being to maintain a practice of quality respectful of the singularity of encountered stories and subjects. These specific tools have been tested in the field; they are currently used and integrated by general practitioners and other professionals of primary health care. Their feasibility and use to enhance the quality of care seemed therefore demonstrated, as well as some implantation difficulties, since it engages the care-providers in a reflexive approach, leading them to question the meaning and efficacy of their practices, to better evaluate them.

The thesis aims at examining Descartes's so called cogito from a wider perspective, especially as regards to the role in the development of Meditationes de prima philosophia (1641) and in the context of other relevant texts. Being an attempt to give a broad account of Descartes's "first cognition" the study deals not only with the cogito itself, e.g. with its logical structure, but also with other key Cartesian doctrines, so that we can understand the cogito as an integral part of Descartes's philosophy. The thesis inquires for this reason into the question of meditator's identity, the methodological skepticism, the question whether logical principles are called into question in the First meditation, the problem of the Cartesian circle, the distinction between implicit and explicit knowledge, the doctrine of innate ideas and finally, the question how to explain, according to Descartes, the awareness of our thoughts. Sometimes the considerations become rather systematic and go beyond a mere exegesis of Descartes's philosophy, especially when they concern the problem with the presence of ego in cogito and the explanation of our self-consciousness. There are three competing approaches to the second issue mentioned that are introduced and assessed in the last chapter. I have chosen this way of...

This thesis is dealing with summary of findings about thematic instruction and using interdisciplinary relationships in teaching at Primary school. The starting point for the theoretical part is specialist literature about project and thematic instructions. The research section of the thesis is formed by methodological guide for teachers. In the methodological guide there are two complete teaching programs for 3rd year of Primary school. These programs use the themes of cultural and natural attractions of Telč and its surroundings for support of interdisciplinary relationships in teaching at Primary school. The part of the thesis contains an interview with a teacher, who checked the proposal in practise.

[pt] O presente trabalho tem como objetivo através do pensamento de Ulrich Beck, analisar como a ascensão da globalização tem afetado o modelo de Estado nacional Westfaliano. É exposto como os Estados nacionais se caracterizaram como um espaço de intensas disputas políticas a partir da eclosão das revoluções do século XVIII. Em seguida é realizada a delimitação do quadro teórico de Ulrich Beck de modo a identificar como o autor realiza a interligação entre sua teoria da sociedade de risco e o impacto da globalização sobre o funcionamento dos Estados nacionais. Através da diferenciação entre os conceitos de globalização e globalismo é realizada a desmistificação de certas crenças, sendo possível compreender, como tem sido viável aos agentes econômicos imporem uma subordinação política dos Estados nacionais aos seus interesses de mercado. O globalismo é identificado como uma ideologia e a globalização como um fenômeno plural e irreversível. A partir de então verifica-se que as disputas de poder que se realizaram historicamente dentro dos limites do Estado nacional se desequilibram intensamente. Dessa forma compromete-se o funcionamento democrático da política dos Estados nacionais. São delimitados fenômenos que no entender de Ulrich Beck caracterizam-se como reais transformações sociais que afetam os Estados da atualidade. Tais transformações forçam uma reconfiguração no que tange a vinculação territorial do poder político. A partir dessa constatação abrem-se questionamentos a respeito de novas formas institucionais pósnacionais, que venham compensar o esvaziamento político e o déficit democrático por que passam os Estados nacionais contemporâneos. / [en] This paper aims through the thought of Ulrich Beck, to analyze how the rise of globalization has affected the Westphalian model of nation state. It is exposed as the nation states have been characterized as an area of intense political wrangling since the outbreak of the revolutions of the eighteenth century. Then it held the delimitation of the theoretical framework of Ulrich Beck in order to identify how the author makes the link between his theory of risk society and the impact of globalization on the functioning of national states. By differentiating between the concepts of globalization and globalism is held demystification of certain beliefs, and you can understand, as has been viable economic agents impose a political subordination of national states to their market interests. Globalism is identified as an ideology and globalization as an irreversible phenomenon and plural. Since then it appears that the power struggles that took place historically within the boundaries of the national state become unbalanced intensely. Thus committed to the democratic functioning of the policy of national states. Phenomena that are defined in the view of Ulrich Beck characterized as real social changes that affect the states today. These changes force a reconfiguration with respect to territorial linkage of political power. Based on this finding opens up new questions about post-national institutional forms, which will compensate the deflation political and the deficit democratic experienced by the contemporary nation states.

Orientador: Wilza Carla Spiri / Resumo: Diante da evolução tecnológica na área da saúde, as competências do enfermeiro, estão diretamente relacionadas a assistência, educação e gestão dos serviços de saúde prestados à população. Atualmente as Instituições Hospitalares possuem uma parcela significativa de alocações de enfermeiros, cujos administradores estão com o foco da atenção voltada às competências profissionais, visando diretamente a qualidade e custo da assistência prestada à população. O objetivo foi construir e validar um instrumento de avaliação de competências dos enfermeiros atuantes em um hospital. Trata-se de um estudo transversal, descritivo e metodológico, com abordagem quantitativa, para a validação do conteúdo de um instrumento de avaliação de competências do enfermeiro. Instrumento inicial de 69 itens e 6 dimensões, validado pela técnica Delphi, e análise da concordância e a consistência interna verificadas pelos Índice de Validade de Conteúdo (IVC), Coeficiente de Kappa (k) e coeficiente Alpha de Cronbach. Após aplicação e análise fatorial exploratória e confirmatória, teste de regressão logística multinomial o instrumento final ficou com 37 itens e 6 dimensões. Os juízes predominaram em 88,90% sexo feminino, média de tempo de atuação em gestão institucional e educacional de 23,2 anos. Em relação ao instrumento foi obtido IVC 0,95 e Alfa de Cronbach 0,92. Os juízes julgaram: 95,30% manter e 4,70% excluir as proposições, houve concordância quanto a representatividade do conjunto de afirmações fren... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Faced with technological developments in the health area, nurses' competences are directly related to the assistance, education and management of health services provided to the population. Currently, the Hospital Institutions have a significant portion of nurses' allocations, whose administrators are focused on professional competencies, directly targeting the quality and cost of care provided to the population. The objective was to construct and validate an instrument to evaluate the competences of nurses working in a hospital.This is a cross-sectional, descriptive and methodological study, with a quantitative approach, for the validation of the content of a nurse competency assessment tool. Initial validity of 69 items and 6 dimensions, validated by the Delphi technique, and concordance analysis and internal consistency verified by Content Validity Index (CVI), Kappa Coefficient (k) and Cronbach's Alpha coefficient. After application and exploratory and confirmatory factorial analysis, multinomial logistic regression test the final instrument was with 37 items and 6 dimensions.The judges predominated in 88.90% female, average time of performance in institutional and educational management of 23.2 years. In relation to the instrument was obtained CVI 0.95 and Cronbach's Alpha 0.92. The judges judged: 95.30% maintain and 4.70% exclude the propositions, there was concordance as to the representativeness of the set of affirmations against the theoretical universe. Of the 180 n... (Complete abstract click electronic access below) / Doutor

A presente pesquisa busca observar a articulação entre merchandising social e função educativa na telenovela brasileira como geradora de pautas para a imprensa e de temas de conversação nas redes sociais da internet. Entre as redes sociais, escolhemos o Facebook, como local de análise das conversações sobre os temas sociais. Para isso, realizamos um estudo de caso da telenovela Salve Jorge, de autoria de Gloria Perez, transmitida pela Rede Globo, por meio de uma metodologia que aborda tanto a recepção a partir dos conteúdos emitidos pela televisão, passando pelo repercussão na imprensa, como pelos posts no Facebook. A recepção foi vista de acordo com o que Martín-Barbero definiu como operadores perceptivos e suas destrezas discursivas. Um aspecto que merece destaque é que os temas sociais aparecem mais constantemente tratados na mídia hegemônica como jornais, revistas e tv, do que nas redes sociais, demonstrando que a conversação nesses locais nem sempre é pautada pelos discursos correntes dos produtores oficiais de conteúdo. / This research aims to observe the articulation between social merchandising and educational function in the in Brazilian telenovela themes as generating conversation on social networks of the internet. Between social networks, we chose Facebook, as local analysis of conversations about social issues. For this, we will hold a case study of Salve Jorge telenovela, written by Gloria Perez, broadcast by Rede Globo, through a methodology that addresses both the reception from the content broadcast on television as posts by principal Salve Jorge fanpages on Facebook last month display the plot. The reception will be seen from what Martín-Barbero coined as perceptual operators and their discursive skills. One aspect worth mentioning is that the social themes appear constantly treated in more mainstream media such as newspapers, magazines and television, that in social networks, demonstrating that the conversation at these sites is not always guided by current discourses of official producers of content.

O presente trabalho fez parte do Projeto QualiSed, uma cooperação entre UFSCar, Unicamp e Cetesb, o qual realizou um levantamento das bases técnico-científicas para a derivação de critérios de qualidade de sedimentos (CQS) para proteção da fauna aquática dos ecossistemas. Nos últimos anos tem havido um grande interesse no desenvolvimento, aperfeiçoamento e aplicação de metodologias para avaliar o grau de contaminação de sedimentos. Estes, apesar de fornecerem habitat para muitos organismos aquáticos, também constituem, um importante depósito para muitos dos mais persistentes químicos que são introduzidos no ambiente. Visando comparar diferentes metodologias que foram desenvolvidas nos últimos anos para avaliar a toxicidade de contaminantes associados a sedimentos de água doce, subsidiando o estabelecimento de protocolos dos procedimentos de testes considerados mais adequados e analisando a qualidade do sedimento de alguns reservatórios do Estado de São Paulo, foram realizados testes de toxicidade aguda, utilizando-se o anfípodo Hyalella azteca como organismo-teste. Foram testados os sedimentos dos reservatórios Billings, Rasgão, Barra Bonita, Bariri e Promissão, além do sedimento do reservatório Pedro Beicht, que foi considerado sedimento controle. Conclui-se que, por meio dos resultados dos testes de toxicidade aguda, que o procedimento sugerido por BORGMANN & NORWOOD (1999) é simples e fácil de ser implantado, enquanto que o teste proposto pela USEPA (1994) é muito trabalhoso, pois exige calibração e monitoramento diário, apresentando um custo inicial bem mais elevado. Em relação à qualidade do sedimento dos reservatórios testados, o reservatório Billings não apresentou toxicidade aguda para nenhuma das amostras testadas, embora os resultados das análises químicas tenham evidenciado a presença de níveis elevados de metais pesados e de contaminantes orgânicos. Verificou-se toxicidade aguda nos reservatórios de Rasgão e Barra Bonita em todas as amostras testadas, e no reservatório de Bariri nas amostras coletadas em junho/2000, diferindo do reservatório de Promissão, o qual não apresentou toxicidade em nenhuma das amostras testadas. Entretanto, o reservatório não está livre de contaminação, já que foram encontrados níveis elevados de arsênio, níquel e cromo. / The present work was part of QualiSed Project, a cooperation among UFSCar, Unicamp and Cetesb, which conducted a survey of technical and scientific bases for derivation of sediment quality criteria (CQS) for protection of ecosystem aquatic fauna. In the last years, there has been a great concern in development, improvement and application of methodologies to evaluate the degree of contamination of sediments, which, although provide habitat to many aquatic organisms, constitute an important deposit for many of the most persistent chemicals added to the environment. Aiming to compare different methodologies to evaluate toxicity of contaminants associated with fresh water sediments, in order to subsidize the establishment of test procedure protocols considered more suitable and to analyse the quality of sediments of some reservoirs of the State of São Paulo, tests on acute toxicity were performed, by using the amphipod Hyalella azteca as test-organism. Sediments of Billings, Rasgão, Barra Bonita, Bariri and Promissão reservoirs were tested, in addition to sediments of Pedro Beicht reservoir which was considered the control sediment. The results of acute toxicity tests showed that the procedure suggested by BORGMANN & NORWOOD (1999) is simple and easy to implement, while the test proposed by USEPA (1994) is quite laborius, since it requires calibration and daily monitoring, presenting a more elevated initial cost. In relation to the quality of sediment ofreservoirs tested, Billings reservoir did not present acute toxicity to any samples tested, while chemical analysis results evidenced the presence of high levels of heavy metals and organic contaminants. Acute toxicity was found in Rasgão and Barra Bonita reservoirs in all samples tested, and at Bariri reservoir in samples collected in June/2000, differing from Promissão reservoir, which did not present toxicity in any samples tested. However, the reservoir is not free of contamination, since high levels of arsenic, nickel and chrome were found.

Les produits traditionnels semblent être une « nouvelle » tendance pour les produits alimentaires. De nombreux travaux sont effectués pour définir ce qu’est le produit traditionnel. Cependant, nous observons par la littérature en sciences de gestion que le produit traditionnel alimentaire est un concept flou, qui manque de précision. D’ailleurs, nous ne pouvons pas savoir avec précision ce que le consommateur perçoit comme traditionnel dans un produit alimentaire. Dans l’optique d’apporter une vision différente, nous nous intéressons à comprendre les éléments traditionnels perçus dans le produit alimentaire. Nous mobilisons une revue de littérature en sciences sociales afin d’apporter de la clarté et structurer la traditionnalité perçue d’un produit alimentaire. Notre collecte de données utilise plusieurs méthodes qualitatives. Pour donner une nouvelle vision de ce qui est perçu comme traditionnel, nous faisons l’analyse à l’aide de la Grounded Theory. Avec les résultats de cette analyse, nous proposons quatre dimensions de la traditionnalité. Nous réalisons une triangulation méthodologique des données par une analyse statistique de données textuelles. Nos résultats sont concluants. La traditionnalité perçue d’un produit alimentaire est un concept expérientiel, à quatre dimensions : processuelle, dynamique, identitaire et rituelle. Cette conceptualisation apporte de la clarté en termes théoriques. Elle ouvre de voies pour le développement des outils de mesure. En termes managériales, la mise en évidence de la traditionnalité perçue d’un produit alimentaire et l’expérience de consommation ou d’élaboration offre des possibilités de développement aux producteurs. / Traditional food products seem to be a "new" trend. A lot of work has been done to define what is a traditional product. However, we observe from the literature review in management that traditional food product is a fuzzy concept, which lacks of precision. Besides we can not know precisely what the consumer perceives as raditional in food product. In order to provide a different point of view, we are interested in understanding the traditional elements perceived in the food product. We mobilize a literature review in the social sciences in order to bring clarity and structure to perceived traditionality of food product. Our data collection uses several qualitative methods. To give a new vision of what is perceived as traditional, we make an analysis using the Grounded Theory. Through the results of this analysis, we propose four dimensions of traditionality. We perform a methodological triangulation of the data by statistical analysis of textual data. Our results are conclusive. The perceived traditionality of a food product is an experiential concept, with four dimensions: process, dynamics, identity and ritual. This structuring brings clarity in theoretical terms. It opens up ways for the development of measurement tools. In managerial terms, the highlighting of the perceived traditionality of a food product and the elaboration or consumer experience offers development opportunities to producers.

A presente pesquisa tem como objetivos estudar e descrever o comportamento variável dos pronomes das séries TU e VOCÊ no Português Brasileiro Popular (PBPOP) falado em três Comunidades de Prática (CsPrát., ECKERT, 2012), localizadas em São José dos Campos (SJC-SP). Para levantar e descrever as variantes em questão, propus como método reunir um, dois, três ou mais falantes para entrevistar, constituindo, desse modo, molduras discursivas distintas (GOFFMAN [1974] 2012). Com base em Moreno Fernández (2012), analisei 37 Entrevistas Sociolinguísticas Semidirigidas (ESSDs) nas quais 66 falantes foram considerados e distribuídos em suas respectivas CsPrát. Essas CsPrát. foram classificadas em níveis de formalidade. Os entrevistados foram distribuídos em três faixas etárias, dois níveis de escolaridade, sexo (masculino e feminino) e procedência, como sugere a literatura laboviana; assim, essa pesquisa baseia-se na perspectiva variacionista, utilizada para descrever variação e mudança linguísticas, com o uso do pacote estatístico Goldvarb X. Além disto, interfaces teórico-metodológicas foram mobilizadas para embasar descrições, percepções, contextos linguísticos e sociais que poderiam ou não condicionar o uso das variantes quanto ao fenômeno mistura pronominal na fala popular de SJC-SP. Os resultados apontam a seguinte rota linguística: o uso dos pronomes das séries você e tu está deixando de ser variável, marcando os populares considerados como falantes que misturam pronomes por consequência de construtos sociais. Assim, em linhas gerais, no PB, misturar velhas e novas formas pronomianais faz parte do comportamento linguístico de certas Comunidades de Fala. / This research aims at studying and describing the variable behavior of the pronominal series tu and você in the Popular Brazilian Portuguese (POPBP) spoken at three Practice Communities (PractComm, ECKERT, 2012) located in São José dos Campos, São Paulo State (SJC-SP). To raise and describe the variants in question I proposed the method of interviewing one, two, three or more speakers, thus creating distinct discursive frames (Goffman [1974] 2012). Based on Moreno Fernández (2012), I analyzed 37 Semi Directed Sociolinguistic Interviews (SDSLIs) in which 66 speakers were considered and distributed in their respective PractComm. These PractComm were classified into levels of formality. The interviewed were divided into three age groups, two levels of school education, gender (male and female) and origin, as suggested by the Labovian literature. Therefore, this research is based upon the variationist perspective, used to describe variation and language change, with the use of the Goldvarb X statistical package. In addition, theoretical-methodological interfaces have been mobilized to support descriptions, perceptions, linguistic and social contexts that could or could not make the use of variants of the phenomenon \"pronominal mixture\" in popular speech to SJC-SP. The results show out the following linguistic route: the pronouns of series VOCÊ and TU in Brazilian Portuguese are ceasing to be variable rule, marking the popular crew considered as speakers that \"blend\" pronouns as a consequence of social constructs. In general lines, in PB, mix old and new forms is part of the linguistic behavior of certain speech communities.

Este trabalho é sobre um modelo metodológico desenvolvido para investigar um curso de Especialização em Ensino de Ciências (Física, Química e Biologia) para professores em serviço do Estado de São Paulo. O curso foi ofertado pelo governo paulista por meio programa REDEFOR junto à Faculdade de Educação da Universidade de São Paulo. Testamos o modelo construindo indicadores para uma amostra de 400 planos de ensino produzidos durante o curso por 246 professores. A partir da leitura e interpretação dos planos selecionados na amostra e de respostas dadas às enquetes aplicadas ao longo do curso, investigamos o uso das Tecnologias da Informação e Comunicação (TIC) na proposição de atividades de ensino. Para automatizar o processo, incorporamos ao modelo três programas computacionais: o NVIVO, o EXCEL e o SPSS que, combinados com técnicas de análises qualitativas e quantitativas o fortaleceram. Vários testes estatísticos puderam ser empregados nas análises realizadas com os indicadores construídos, dentre esses, o da regressão múltipla em que os indicadores das enquetes se comportaram como variáveis preditoras (independentes) do estudo e os indicadores dos planos de ensino como variáveis dependentes. Nas enquetes edificamos dois indicadores: Formação (indFOR) e Vida Diária e Trabalho (indVDT) ambos para antes e durante o curso. Confrontamos cada um desses indicadores com indicadores de uso de TIC dos planos de ensino: Quantidade (indQTIC) e Variedade (indVTIC). Na análise da regressão múltipla, os resultados mostraram que apenas os indicadores indVDT-antes e indVDT-durante apresentaram diferenças estatisticamente significativas em suas médias para a quantidade e para a variedade de uso de TIC. A associação dos dois indicadores de Vida Diária e Trabalho com cada indicador dos planos de ensino foi fraca em torno de 0,25, ou seja, aproximadamente 5% da variância da quantidade ou da variedade do uso de TIC poderiam ser explicadas pelo conjunto de indicadores. Aprofundamos a investigação de indTICenqVDTd via análise de Cluster para identificar os grupos estatisticamente significativos nessa variável em conjunto com os indicadores de uso de TIC de quantidade e variedade e com o indicador de notas oficiais das SD. Encontramos dois grupos, sendo que o primeiro (grupo 1) detinha os melhores resultados (em média) em todos os indicadores. Já o segundo grupo (grupo 2) apresentou os piores resultados (em média) de todos os indicadores incluídos na análise de Cluster. A combinação das respostas dadas a itens de enquetes com a quantidade e a variedade de uso de TIC encontrada nas SD e com o desempenho expressos pelas notas oficiais das SD, nos levaram a concluir que, quando o professor conhece as TIC e as utiliza durante seu ato de planejar, a qualidade do plano de ensino tende a melhorar e, isso poderá, como consequência, trazer melhorias para a qualidade de suas aulas. O modelo metodológico que desenvolvemos é versátil e o consideramos como a principal contribuição deste trabalho para a área da Educação. Por ele, outros recursos utilizados em aulas como: atividades experimentais, músicas, poesias, histórias em quadrinhos, receitas de culinária etc. poderiam ser mensurados e investigados. / This work is about a methodological model developed in order to investigate a course of specialization in science education (Physics, Chemistry and Biology) for in-service teachers of the State of São Paulo. The course was offered by the state government through the REDEFOR program in the Faculty of Education, University of São Paulo. We tested the model building indicators for a sample of 400 education plans produced during the course by 246 teachers. From the reading and interpretation of the plans selected in the sample and the answers to surveys applied throughout the course, we investigated the use of Information and Communication Technologies (ICT) in proposing educational activities. To automate the process, the model incorporated three computer programs: NVIVO, EXCEL and SPSS which strengthened it, by combining with techniques of qualitative and quantitative analysis. Several statistical tests could be used in analysis with built indicators, among these, the multiple regression in which the indicators behaved as predictor variables (independents) and the indicators of educational plans as dependent variables. With the surveys we build two indicators: Formation (indFOR) and Daily Life and Work (indVDT) for both before and during the course. We compared each of these indicators with ICT use indicators of educational plans: Quantity (indQTIC) and Variety (indVTIC). In the analysis of multiple regression, the results showed that only the indVDT-before indicators and the indVDT-during statistically had significant differences in their average for the amount and the variety of ICT use. The association of the two indicators of Daily Life and Work with each indicator of educational plans was weak around 0.25, ie about 5% of the variance in the amount or variety of ICT use could be explained by the set of indicators. We deepen the research indTICenqVDTd via Cluster analysis to identify statistically significant groups in this variable together with the amount of ICT use indicators and variety and the indicator of official notes of SD. We found two groups, the first (group 1) held the best results (on average) in all indicators. The second group (group 2) showed the worst results (on average) of all indicators included in the cluster analysis. The combination of responses to polls items with the quantity and variety of ICT use found in SD and performance expressed by the official notes of SD, led us to conclude that when the teacher knows ICT and use it for your act of planning, syllabus quality tends to improve, and this may, as a consequence, bring improvements to the quality of their classes. The methodological model we have developed is versatile, considered as the main contribution of this work to the area of Education. For it, other resources used in classes as experimental activities, songs, poetry, comics, cooking recipes etc. They could be measured and investigated.