Trata-se de pesquisa empírica à base de depoimentos de médicos, a respeito do avanço da lifestyle medicine no Brasil, tendência terapêutica contemporânea de caráter holístico que cresce cada vez mais entre os profissionais de saúde no mundo inteiro. Para uma corrente da medicina atual, a mudança em curso na atuação dos médicos os coloca como \"portadores\" (cf. Weber) socialmente autorizados de mudança dos estilos de vida \"não saudáveis\". Isso acontece através da consulta médica, que incorpora uma \"metodologia\" que vem sendo valorizada na formação e na prática desses profissionais, cujos efeitos incidem na concepção renovada, com tendência hegemônica, de \"consumo de saúde\". O desafio da prática médica hoje é encarado como tendo a ver com a implantação desse tipo de interesse, que exige a realização de um tipo de consulta que permita a avaliação do indivíduo, tendo em vista orientá-lo para o auto-cuidado. O desenvolvimento daquilo que se poderia chamar uma \"cultura de si\" permite uma aproximação com a idéia de \"promoção da boa saúde\", um conjunto de programas que acaba voltado para o estilo de vida, com orientações mais individuais que coletivas, porém sempre integrais. Nesse sentido, o intuito do médico também é despertar o interesse dos indivíduos para a \"vontade de não morrer\", de ter prazer de viver e viver com qualidade de vida. / This dissertation is based upon interviews with physicians about the advance of lifestyle medicine in Brazil, a holistic contemporary therapeutic that spreads between professionals of health in the whole World. To a specific current of medicine of our days, such actions of the physicians make them socially authorized \"carriers\" (Weber) of changes against unhealthy lifestyles. The mean through which it happens is the medical consultation which uses a methodology more and more valorized in the formation and practice of those professionals. Their effects induce on a renewed conception that presents a hegemonic trend -- health as a consumption good. The challenge of medical practice nowadays is seen as related to the implantation of this kind of medical care which demands a kind of consultation that allow an evaluation of the individual in order to advise him or her to self-care. The development of the so-called \"care of the self\" allows an approximation to the idea of \"promotion of a good health\", a set of programs that end up directed toward the lifestyle, made of advises more individual than collective, but always integral. In this sense, the purpose of the physician is to wake up in the individuals their interest in a \"will to not to die\", in enjoying life, and in living with quality of life.

Incomplete understanding of attrition from the physician workforce has hampered policy-makers’ efforts to achieve optimal alignment of the supply of physicians with population demand for medical services. This longitudinal study of Ontario primary care physicians uses health administrative data to characterize changes in physicians’ practice patterns over time. We examined the workload and scopes of practice of 21,240 physicians between 1992 and 2013. We found that physicians reduce their workloads gradually as they age, retiring from clinical practice at an average age of 70.5. Furthermore, we found that 60% of family physicians who stop providing comprehensive primary care continue to provide clinical services for an average of three years, with reduced workloads, before retiring fully. Our findings clarify the process of physician attrition from the workforce and will help to improve estimates of attrition and make physician workforce planning more accurate and effective.

Recruitment of medical graduates to general practice careers in the UK, as in other developed countries, remains challenging. Currently general practice attracts fewer doctors than health care planners anticipate will be needed to meet the burgeoning health needs of an ageing population. Understanding the factors that influence doctors in their career choices is important to manpower planners, the profession and society as a whole. A two year postgraduate foundation programme for all doctors was introduced into the UK in 2006. One of its main intentions was to provide doctors with postgraduate clinical attachments that would assist them in making informed career choices. This has resulted, for the first time, in large numbers of recent medical graduates experiencing several specialties before applying for specialty specific training programmes. The main aim of this thesis was to assess the influence of a four month postgraduate attachment in general practice in the second foundation year on doctors' career intent. It was hypothesised that the attachment would have a positive impact on recruitment to general practice careers. This hypothesis was tested using a combined quantitative and qualitative approach. A literature review examined career decision making in medicine. It was divided chronologically into sections covering decision making at school, university and in the early postgraduate years. In addition a section focussed on decision making in careers other than medicine. A validated career inventory (sci 59) measuring change in career preference was selected for use in this study. The output is in the form of career rankings among 59 medical specialties. In addition, a semi-structured interview questionnaire was developed based on themes emerging from the literature review and was refined following piloting. Interviews were recorded, transcribed and thematically analysed using NVivo 7. The study was conducted in the Kent, Surrey and Sussex Deanery between 2005 and 2008. Participants (n=225) included all doctors whose second foundation year programme included a four month attachment in general practice. They were sent a sci 59 questionnaire at the beginning of their attachment and a further questionnaire at the end. Those responding to both questionnaires were invited to take part in an interview. 112 participants completed sci 59 questionnaires at the beginning and end of their 4 months attachment. Initial analysis demonstrated a small, statistically non-significant improvement in career intent towards general practice. Using a measure that reflects movement in ranking between the two questionnaires, further analysis showed a small, statistically significant, improvement in the ranking of general practice among participants who had low initial rankings for general practice. 30 participants were interviewed. Placements in general practice during the second foundation year were generally regarded in a very positive light. Doctors particularly valued ongoing relationships with patients as well as involvement with local communities. They commented on the high quality of supervision and the structured learning environment of their attachments. General practice was also seen as a better lifestyle option than other main specialties as well as offering flexible working opportunities. New findings included the observation that career ranking for general practice improved following a four month postgraduate attachment in general practice among those less inclined to general practice as a career in the first place. Thematic analysis of transcribed interviews revealed enhanced respect, among foundation doctors, for general practice as a career option irrespective of their own eventual career intent. This improved regard for general practice among doctors intent on specialising may be important in the context of persisting disparagement of general practice by some students, clinicians and teachers. It may also be helpful in engendering mutual respect and more effective working relationships between specialists and generalists in the future.

Patients' non-adherence to treatment is a widespread phenomenon in healthcare. Time preferences (how individuals value outcomes over time) are one cause for non-adherence. Using quasi-hyperbolic discounting, two options in the future are weighted consistently. However, when the early option becomes available the weighting changes. This creates the potential for non-adherence. The agency relationship that exists between patients and doctors implies hidden information. When the patient's time preferences are hidden from the doctor, the doctor must choose how to recommend treatments. Exploring how doctors make treatment decisions when time preferences are hidden from them, and how this impacts adherence, is therefore important. The first contribution of the thesis is to outline a model of the patient-doctor interaction incorporating quasi-hyperbolic discounting and hidden information. This shows that doctors should adapt to non-adherence when the probability a patient is present-biased is large enough. Secondly, a national survey of Scottish GPs explores whether doctors have different time preferences for themselves or their patients. Doctors do have the same private and professional time preferences, but value the health state differently between frames. Lastly, a laboratory experiment tests whether students in the role of a doctor adapt to non-adherence in the way predicted by the model. Students find the socially optimal level of treatment on average. Adaptation is stronger when using a performance payment, and results did not vary along demographic characteristics. The thesis highlights the importance of the patient-doctor interaction for generating nonadherence, not just patient preferences. It also shows that GPs' private time preferences may suitably substitute their preferences for patients. Finally, it points towards potential incentives for doctors to improve patient outcomes.

No description available.

As práticas de cura populares, como a busca por terapeutas populares e medicamentos caseiros, foram um recurso bastante buscado para combater doenças. O exercício destas atividades populares descontentava alguns profissionais de saúde, e médicos e farmacêuticos envolveram-se profissionalmente para tentar controlar a prática da terapia popular. Neste sentido, almejamos analisar como médicos e farmacêuticos no estado de São Paulo, do período que compreendeu os anos 1892-1930, bem como os profissionais médicos e farmacêuticos ingleses, que atuaram entre 1815-1930, influenciaram nas mudanças legislativas da terapia popular. Para tanto, utilizamos uma perspectiva histórico-comparativa, partindo das reformas legislativas em saúde nos dois locais para compreender como médicos e farmacêuticos envolveram-se profissionalmente no combate às práticas de cura populares. Com isso, fatos como as epidemias da época e o comércio de medicamentos influenciaram na trajetória destes profissionais de saúde. Médicos, em especial, tiveram suas profissões destacadas após a investigação da trajetória profissional de apotecários e cirurgiões na Inglaterra. Farmacêuticos, na sequência, dependeram também dos caminhos trilhados especialmente por químicos e droguistas, trazendo novas conformações para as práticas de medicina popular exercidas pelos diversos charlatães ingleses do século XIX. Em São Paulo, a reorganização do espaço profissional após a nova legislação sanitária de 1892 no estado criava condições para que médicos ganhassem um lugar importante no campo da medicina e, ao lado de farmacêuticos, foram se adequando às necessidades públicas para se promoverem em suas profissões. Farmacêuticos, por sua vez, tentavam consolidar seu espaço na área de saúde especialmente pegando carona no inicial desenvolvimento da indústria de medicamentos em São Paulo. Concluiu-se que a terapia popular, embora ainda presente, foi passando por transformações em decorrência do desenvolvimento das profissões de saúde ao longo dos períodos respectivos considerados. O estabelecimento destas profissões de saúde mostrou uma mistura de interesses profissionais pessoais, em paralelo às necessidades da saúde pública, com o objetivo de melhorar as condições da população do estado de São Paulo e da Inglaterra / Popular medicine was a health resource very much searched to combat diseases in the nineteenth and twentieth centuries. Indeed the search of popular healers and domestic medicines were some of these popular practices. Some health professionals, such as physicians and pharmacists, were aware of the exercise of these popular practices. These health professionals have been involved in this issue in an attempt to control the practice of popular medicine. In this context, we aimed to analyse how physicians and pharmacists have influenced on the legislative changes of popular therapy. We considered two places in this study: São Paulo state from 1892 to 1930, and England, from 1815 to 1930. To achieve this goal, we utilized a historical-comparative perspective, which has commenced on the health legislative reforms in both places. The aim of this beginning was based on the understanding of how physicians and pharmacists have professionally worked on to control popular medicine. In this way, facts such as the epidemics and the trade of medicines have influenced in the professional course of them. Physicians have had their professions highlighted after the investigation of the professional trajectory of apothecaries and surgeons in England. Next, pharmacists have worked according to the professional procedures of the chemists and druggists. This action of both physicians and pharmacists has resulted in new insights for popular medicine which was executed by many English quacks of the nineteenth century. In São Paulo state, the reorganization of the professional space after the new sanitary legislation in 1892 has created other conditions for physicians. They have acquired an important place in medicine, and together with pharmacists, physicians were making themselves comfortable in order to achieve their professional goals. Pharmacists have tried to consolidate their place in health with the initial development of the pharmaceutical industry in São Paulo. We concluded that popular medicine, despite its presence today, was passing through changes due to the development of the health professions in each considered period. The establishment of these professions has shown a mixture of personal and professional interests, in parallel with public health purposes. All of these issues were connected with the improvement on health conditions of the people from São Paulo state and England

Trata-se de pesquisa empírica à base de depoimentos de médicos, a respeito do avanço da lifestyle medicine no Brasil, tendência terapêutica contemporânea de caráter holístico que cresce cada vez mais entre os profissionais de saúde no mundo inteiro. Para uma corrente da medicina atual, a mudança em curso na atuação dos médicos os coloca como \"portadores\" (cf. Weber) socialmente autorizados de mudança dos estilos de vida \"não saudáveis\". Isso acontece através da consulta médica, que incorpora uma \"metodologia\" que vem sendo valorizada na formação e na prática desses profissionais, cujos efeitos incidem na concepção renovada, com tendência hegemônica, de \"consumo de saúde\". O desafio da prática médica hoje é encarado como tendo a ver com a implantação desse tipo de interesse, que exige a realização de um tipo de consulta que permita a avaliação do indivíduo, tendo em vista orientá-lo para o auto-cuidado. O desenvolvimento daquilo que se poderia chamar uma \"cultura de si\" permite uma aproximação com a idéia de \"promoção da boa saúde\", um conjunto de programas que acaba voltado para o estilo de vida, com orientações mais individuais que coletivas, porém sempre integrais. Nesse sentido, o intuito do médico também é despertar o interesse dos indivíduos para a \"vontade de não morrer\", de ter prazer de viver e viver com qualidade de vida. / This dissertation is based upon interviews with physicians about the advance of lifestyle medicine in Brazil, a holistic contemporary therapeutic that spreads between professionals of health in the whole World. To a specific current of medicine of our days, such actions of the physicians make them socially authorized \"carriers\" (Weber) of changes against unhealthy lifestyles. The mean through which it happens is the medical consultation which uses a methodology more and more valorized in the formation and practice of those professionals. Their effects induce on a renewed conception that presents a hegemonic trend -- health as a consumption good. The challenge of medical practice nowadays is seen as related to the implantation of this kind of medical care which demands a kind of consultation that allow an evaluation of the individual in order to advise him or her to self-care. The development of the so-called \"care of the self\" allows an approximation to the idea of \"promotion of a good health\", a set of programs that end up directed toward the lifestyle, made of advises more individual than collective, but always integral. In this sense, the purpose of the physician is to wake up in the individuals their interest in a \"will to not to die\", in enjoying life, and in living with quality of life.

As práticas de cura populares, como a busca por terapeutas populares e medicamentos caseiros, foram um recurso bastante buscado para combater doenças. O exercício destas atividades populares descontentava alguns profissionais de saúde, e médicos e farmacêuticos envolveram-se profissionalmente para tentar controlar a prática da terapia popular. Neste sentido, almejamos analisar como médicos e farmacêuticos no estado de São Paulo, do período que compreendeu os anos 1892-1930, bem como os profissionais médicos e farmacêuticos ingleses, que atuaram entre 1815-1930, influenciaram nas mudanças legislativas da terapia popular. Para tanto, utilizamos uma perspectiva histórico-comparativa, partindo das reformas legislativas em saúde nos dois locais para compreender como médicos e farmacêuticos envolveram-se profissionalmente no combate às práticas de cura populares. Com isso, fatos como as epidemias da época e o comércio de medicamentos influenciaram na trajetória destes profissionais de saúde. Médicos, em especial, tiveram suas profissões destacadas após a investigação da trajetória profissional de apotecários e cirurgiões na Inglaterra. Farmacêuticos, na sequência, dependeram também dos caminhos trilhados especialmente por químicos e droguistas, trazendo novas conformações para as práticas de medicina popular exercidas pelos diversos charlatães ingleses do século XIX. Em São Paulo, a reorganização do espaço profissional após a nova legislação sanitária de 1892 no estado criava condições para que médicos ganhassem um lugar importante no campo da medicina e, ao lado de farmacêuticos, foram se adequando às necessidades públicas para se promoverem em suas profissões. Farmacêuticos, por sua vez, tentavam consolidar seu espaço na área de saúde especialmente pegando carona no inicial desenvolvimento da indústria de medicamentos em São Paulo. Concluiu-se que a terapia popular, embora ainda presente, foi passando por transformações em decorrência do desenvolvimento das profissões de saúde ao longo dos períodos respectivos considerados. O estabelecimento destas profissões de saúde mostrou uma mistura de interesses profissionais pessoais, em paralelo às necessidades da saúde pública, com o objetivo de melhorar as condições da população do estado de São Paulo e da Inglaterra / Popular medicine was a health resource very much searched to combat diseases in the nineteenth and twentieth centuries. Indeed the search of popular healers and domestic medicines were some of these popular practices. Some health professionals, such as physicians and pharmacists, were aware of the exercise of these popular practices. These health professionals have been involved in this issue in an attempt to control the practice of popular medicine. In this context, we aimed to analyse how physicians and pharmacists have influenced on the legislative changes of popular therapy. We considered two places in this study: São Paulo state from 1892 to 1930, and England, from 1815 to 1930. To achieve this goal, we utilized a historical-comparative perspective, which has commenced on the health legislative reforms in both places. The aim of this beginning was based on the understanding of how physicians and pharmacists have professionally worked on to control popular medicine. In this way, facts such as the epidemics and the trade of medicines have influenced in the professional course of them. Physicians have had their professions highlighted after the investigation of the professional trajectory of apothecaries and surgeons in England. Next, pharmacists have worked according to the professional procedures of the chemists and druggists. This action of both physicians and pharmacists has resulted in new insights for popular medicine which was executed by many English quacks of the nineteenth century. In São Paulo state, the reorganization of the professional space after the new sanitary legislation in 1892 has created other conditions for physicians. They have acquired an important place in medicine, and together with pharmacists, physicians were making themselves comfortable in order to achieve their professional goals. Pharmacists have tried to consolidate their place in health with the initial development of the pharmaceutical industry in São Paulo. We concluded that popular medicine, despite its presence today, was passing through changes due to the development of the health professions in each considered period. The establishment of these professions has shown a mixture of personal and professional interests, in parallel with public health purposes. All of these issues were connected with the improvement on health conditions of the people from São Paulo state and England

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-07T14:44:21Z No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) / Made available in DSpace on 2015-04-07T14:44:23Z (GMT). No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) Previous issue date: 2014-11-03 / Introduction: The intersection between health, education and work permeates the institutionalization of the NHS since its proposed construction. The professional health education leads to permanent health education and the centrality of care practices and technologies. The axis training to practice and practice to the service becomes the object of this study. Objective: To characterize the profile of doctors and nurses working in health units belonging to the Primary Care of Guarujá SP Method: This was a study approved by the Ethics and Research Committee No. 452 727 / CEP UNAERP / 2013 prepared by A cross-sectional study. Participating physicians and nurses in health centers were to link the level of Primary Health, who were not on vacation or away for health reasons, answering a self-administered structured questionnaire developed by Brazil Telehealth and was drafted by a complementary conducted a descriptive analysis of all variables of the study. A descriptive analysis of all variables of the study was conducted. Qualitative variables were presented in terms of their absolute and relative values. Quantitative variables in terms of their values of central tendency and dispersion. To evaluate the association between categories of health professionals (doctors, nurses) and qualitative variables the Chi-square and Fisher's exact test was used. For quantitative variables, the normality and homogeneity of variances were assessed using Kolmogorov-Smirnov and Levene tests, respectively. As these two variables were not satisfied principles, the nonparametric Mann-Whitney U test was used. The significance level was 5%. Statistical package used was SPSS for Windows 17.0. Results: In relation to the research subjects shows that the professionals linked to units of family health were more accepted to participate. Regarding age, one realizes that professional family health (USAFA) are younger than those of basic health units (BHU) (p <0.05) sequence that also references the type of employment in the city. Regarding the type of employment shows that the higher prevalence in the APS will occur by CLT (p <0.05). The satisfaction expressed by health professionals when analyzed in the context of increased prevalence is a good level, highlighting only with respect to the health service system of the municipality which is rated as fair (p <0.05). Regarding the light for the job-analysis technologies in general feels empowered to play a familiar approach, community, the multidisciplinary work group activities and home visits (p <0.05). Conclusion: The knowledge of the profile of professional members of the body of human resources in health services points need qualification, first exposed in continuing education scenario and lack of introductory courses and approaches to the labor process in APS. The scenario might propose in relation to working technologies then requested the validation of professional a weakness in what is expected for the level of attention. The stability of the employment relationship must be worked with professionals especially in relation to the supervision of labor and production for the attention, remembering that the spaces of care are not just specific to a pathological clinical look. The reflection of the expanded clinic should be treated, in question, as a human resources policy not only to UBS. / Introdução: A interseção entre saúde, educação e trabalho permeia a institucionalização do SUS desde a sua proposta de construção. A educação profissional em saúde conduz a formação permanente em saúde e a centralidade das práticas e nas tecnologias do cuidado. O eixo formação para a prática e prática para o serviço torna-se objeto desse estudo. Objetivo: Caracterizar o perfil de médicos e enfermeiros que trabalham nas unidades de saúde pertencentes à Atenção Primária do município de Guarujá S.P. Método: Tratou-se de uma pesquisa aprovada pelo Comitê de Ética e Pesquisa nº 452.727/CEP- UNAERP/2013 elaborada mediante a um estudo transversal. Participaram médicos e enfermeiros das Unidades de Saúde que estavam com vínculo no nível de Atenção Primária a Saúde, que não estavam de férias ou afastados por motivos de saúde, respondendo um questionário estruturado auto-aplicado, desenvolvido pelo Telessaúde Brasil e um complementar elaborado pelos Foi realizada a análise descritiva de todas as variáveis do estudo. As variáveis qualitativa foram apresentadas em termos de seus valores absolutos e relativos. As variáveis quantitativas em termos de seus valores de tendência central e de dispersão. Para se avaliar a associação entre as categorias de profissionais de saúde (médicos, enfermeiros) e as variáveis qualitativas foi utilizado o teste de Qui-quadrado e o teste exato de Fisher. Para as variáveis quantitativas a normalidade e homogeneidade das variâncias foram avaliadas através de Kolmogorov-smirnov e Levene respectivamente. Como as variáveis não apresentaram esses dois princípios satisfeitos, foi utilizado o teste não paramétrico U Mann-Whitney. O nível de significância foi de 5 %. Pacote estatístico utilizado foi SPSS for Windows 17.0. Resultados: Em relação aos sujeitos da pesquisa exibe que os profissionais vinculados às unidades de saúde da família tiveram maior aceite em participar. Em relação à faixa etária percebe-se que os profissionais de saúde da família (USAFA) são mais novos que os das unidades básicas de saúde (UBS) (p<0,05) sequência que também faz referência ao vínculo de trabalho no município. Em relação ao vínculo de trabalho apresenta que a maior prevalência na APS dar-se-á por CLT (p<0,05). A satisfação expressa pelos profissionais de saúde quando analisadas em âmbito de maior prevalência é de um nível bom, destacando apenas com relação ao sistema de serviço de saúde do município que é avaliado como regular (p<0,05). Em relação às tecnologias leves para o trabalho em análise geral sente-se capacitados em desempenhar a abordagem familiar, comunitárias, o trabalho multiprofissional, as atividades de grupo e visitas domiciliares (p<0,05). Conclusão: O conhecimento do perfil desses profissionais integrantes do corpo de recursos humanos dos serviços de saúde aponta necessidade de qualificação, primeiramente exposto no cenário de educação continuada e pela falta de cursos introdutórios e de abordagens para o processo de trabalho na APS. O cenário pode propor em relação às tecnologias de trabalho então solicitadas na validação dos profissionais uma fragilidade no que se espera para o nível de atenção. A estabilidade do vínculo empregatício deve ser trabalhada com os profissionais principalmente em relação à supervisão do trabalho e da produção para com a atenção, lembrando que os espaços de atendimento não são apenas específicos de um olhar clínico patológico. A reflexão da clínica ampliada deve ser tratada, em questão, como uma política de recursos humanos não somente para a UBS.

Helkiah Crooke (1576-1648) was a London physician who wrote the first comprehensive anatomy manual in the English vernacular, Mikrokosmographia (1615). This dissertation demonstrates the significance of Crooke’s example for several lines of inquiry. His story shows the essential role of humanistic study in the development of an effective early modern physician. It also demonstrates how reading an anatomy manual as a literary work illuminates the paradigms underpinning the relationships between books and bodies in the early modern era. Furthermore, examining the performative aspects of the physician’s profession alongside dramatic literary characters elucidates the relationship between the professional sphere and the public stage and, consequently, the ramifications of that relationship for Crooke’s historical characterization. Ultimately, the project shows how and why Crooke and Mikrokosmographia are perfectly positioned to lend insight on a large number of medical practices and experiences in the early modern period. While scholars frequently cite the book as a reference on early modern thinking about bodies, almost all of this use has consisted of material excerpted without systematic analysis of the way the text is put together or close examination of the cultural conditions of the book’s production. Furthermore, several of the extant accounts of Crooke’s life contradict one another, neglect crucial evidence, or make unsupported claims, leaving confusing questions regarding the education and career of the man who authored this important text. This dissertation rectifies several misconceptions regarding Crooke and his book, providing new interpretation of the creation of Mikrokosmographia and Crooke’s memory in the history of medicine. The project explores the anatomy manual’s cultural currency and the relationship of the book and its author to contemporary writing more readily recognized today as literary works. It also questions existing categorizations of early medical texts as it works to demonstrate the role of such writing in shaping authors’ identities and careers as well as affecting the lives and health of the public, recovering the fullest picture of Crooke’s life story and the most extensive bibliography of his writing to date.