Program evaluation has become an increasingly urgent task for organizations, agencies, and initiatives that have the obligation or motivation to measure program outcomes, demonstrate impact, improve programming, tell their program story, and justify new or continued funding. Evaluation capacity building (ECB) is an important endeavor not only to empower program staff to understand, describe, and improve their programs, but also to enable programs to effectively manage limited resources. Accountability is important as public funds for social programs continue to dwindle and program administrators must do their best to fulfill their program missions in ethical, sustainable ways despite insufficient resources. While ECB on its own valuable, as it can promote evaluative thinking and help build staff's evaluation literacy and competency, ECB presents a ripe opportunity for program staff to understand the principles of equity and inclusivity and to see themselves as change agents for societal transformation. In the present study, I developed, tested, and evaluated the concept of transformative ECB (TECB), a social justice-oriented approach, rooted in culturally responsive evaluation, critical adult education, and the transformative paradigm, which promotes not only critical and evaluative thinking, but also kaleidoscopic thinking. Kaleidoscopic thinking (KT) is thinking that centers social justice and human dignity through intentional consideration (turning of the kaleidoscope) of multiple perspectives and contexts while attending to the intersectional planes of diversity, such as culture, race, gender identity, age, belief system, and socioeconomic status. KT involves reflexivity, creativity, respect for diversity, compassion and hope on the part of the thinker when examining issues and making decisions. / Doctor of Philosophy / Program evaluation has become increasingly important for organizations seeking to measure program outcomes, demonstrate impact, improve programming, tell their program story, and make the case for new or continued funding. Evaluation capacity building (ECB) includes training that is important not only to help program staff to understand, describe, and improve their programs, but also to allow programs to successfully "do more" with less. While ECB on its own is valuable, as it can help program staff become more evaluation-minded and skilled, ECB presents a ripe opportunity for program staff to understand the principles of equity and inclusivity and to see themselves as drivers of social change. In this study, I developed, tested, and evaluated the idea of transformative ECB (TECB), a social justice-oriented approach, rooted in culturally responsive evaluation, critical adult education, and the transformative (social justice-related) framework. The TECB approach promotes not only critical thinking and evaluative thinking, but also kaleidoscopic thinking, which focuses on social justice and human dignity. KT involves reflexivity, creativity, respect for diversity, compassion, and hope on the part of the thinker when examining issues and making decisions.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Abstract : Since at least the 1980's, a growing number of companies have set up an ethics or a compliance program within their organization. However, in the field of study of business management, there is a paucity of research studies concerning these management systems. This observation warranted the present investigation of one company's compliance program. Compliance programs are set up so that individuals working within an organization observe the laws and regulations which pertain to their work. This study used a constructivist grounded theory methodology to examine the process by which a specific compliance program, that of Siemens Canada Limited, was implemented throughout its organization. In conformity with this methodology, instead of proceeding with the investigation in accordance to a particular theoretical framework, the study established a number of theoretical constructs used strictly as reference points. The study's research question was stated as: what are the characteristics of the process by which Siemens' compliance program integrated itself into the existing organizational structure and gained employee acceptance? Data consisted of documents produced by the company and of interviews done with twenty-four managers working for Siemens Canada Limited. The researcher used QSR-Nvivo computer assisted software to code transcripts and to help with analyzing interviews and documents. Triangulation was done by using a number of analysis techniques and by constantly comparing findings with extant theory. A descriptive model of the implementation process grounded in the experience of participants and in the contents of the documents emerged from the data. The process was called "Remolding"; remolding being the core category having emerged. This main process consisted of two sub-processes identified as "embedding" and "appraising." The investigation was able to provide a detailed account of the appraising process. It identified that employees appraised the compliance program according to three facets: the impact of the program on the employee's daily activities, the relationship employees have with the local compliance organization, and the relationship employees have with the corporate ethics identity. The study suggests that a company who is entertaining the idea of implementing a compliance program should consider all three facets. In particular, it suggests that any company interested in designing and implementing a compliance program should pay particular attention to its corporate ethics identity. This is because employee's acceptance of the program is influenced by their comparison of the company's ethics identity to their local ethics identity. Implications of the study suggest that personnel responsible for the development and organizational support of a compliance program should understand the appraisal process by which employees build their relationship with the program. The originality of this study is that it points emphatically that companies must pay special attention in developing a corporate ethics identify which is coherent, well documented and well explained. / Résumé : La présente recherche porte sur les systèmes de gestion connus sous l’appellation de « programme de conformité » et « programme d’éthique ». Plus particulièrement, elle étudie le processus par lequel un programme de conformité a été mis en place au sein d’une entreprise multinationale allemande œuvrant au Canada : Siemens Canada Limitée. Elle propose un modèle qui décrit le processus par lequel cette compagnie a implanté un programme de conformité au sein de son organisation. Dans le cadre de cette étude, un programme de conformité est conçu comme étant un système de gestion. Il s’agit donc d’un ensemble de processus, mis en place par une organisation, qui sont reliés ensemble et qui fonctionnent afin d’atteindre un même but. Dans le cas des programmes de conformité, ce but comporte deux volets : a) voir à ce que les individus travaillant au sein d’une organisation respectent les lois et règlements relatifs à leur travail, et b) énoncer un ensemble de normes d’ordre éthique et voir à ce qu’elles soient bien comprises au sein de l’organisation afin qu’elles puissent servir de guide lors de prises de décisions concernant des sujets possédant un enjeu d’ordre éthique. L’historique des programmes de conformité remonte, selon Head (1997), à la fin des années 1940. Initialement, les programmes tenaient surtout compte des lois antitrust et se développaient à mesure que de nouvelles dispositions légales étaient adoptées par les gouvernements. Toutefois, ils ont pris des caractéristiques plus contemporaines à partir des années 1980 suite à deux événements. Le premier était la mise en place d’un programme développé par un groupe réunissant de trente-deux entreprises réunies sous l’appellation de « Defense Industry Initiative on Business Ethics and Conduct » (DII). La justification de ce regroupement était de promouvoir un programme servant à convaincre le législateur qu’il était inopportun d’adopter de nouvelles réglementations puisque les compagnies avaient pris les mesures nécessaires afin d’assurer la conformité de leurs agissements avec les lois. La deuxième était l’introduction des « U.S. Federal Sentencing Guidelines » ; un ensemble de règles constituant une procédure uniforme servant à déterminer la peine à imposer aux organisations reconnues coupables d’un crime. Ces règles ont, en quelque sorte, incité les entreprises à adopter des programmes de conformité. Quant aux programmes d’éthique, leur historique remonte, selon Rasberry (2000) également aux deux mêmes développements mentionnés précédemment. Le premier département d’éthique au sein d’une entreprise aurait été mis sur pied vers 1985 par des compagnies du groupe DII. Les individus travaillant au sein de ces départements étaient désignés comme des « consultants en éthique ». La prolifération de ces départements a amené ces individus à fonder, en 1992, l’association connue à l’époque sous le nom de « Ethics Officer Association. » Les études portant sur les programmes de conformité ou les programmes d’éthique sont rares. Les quelques articles sur le sujet décrivent très peu leur fonctionnement ou comment ils ont réalisé leur mis en œuvre. Cette situation de disette documentaire s’explique par la réticence des compagnies à accueillir une étude de leur programme. Elles ne se sont pas à l’aise avec l’idée qu’un agent externe, sur qui elles n’ont aucun contrôle, effectue un examen de leurs opérations, surtout celles ayant un contenu délicat. Une exception à cette tendance générale est la compagnie Siemens qui a accepté de participer à la présente étude portant sur son programme de conformité. Le projet de recherche initialement proposé par le chercheur à Siemens visait à évaluer l’efficacité de leur programme de conformité. Toutefois, après examen de documents fournis par la compagnie, il s’est avéré qu’elle avait déjà effectuée une telle démarcher. Répéter cet exercice n’aurait servi qu’à infirmer ou corroborer les données qu’elle avait déjà en main. Au cours de discussions subséquentes avec le gestionnaire responsable de la conformité, ce dernier indiqua que la compagnie ne rencontrait aucun problème de gestion avec son programme. Sans problème managérial apparent, il indiqua qu’il serait tout de même intéressé à ce que le chercheur lui trouve quelque chose, une caractéristique ou une information, que la compagnie ignore à propos de son programme de conformité. Cet état de fait fut le point de départ de la présente recherche. Dans un premier temps, le chercheur proposa à la compagnie que la recherche porte sur le développement du programme de conformité. Toutefois, en cours de l’étude, le chercheur a dû modifier sa question de recherche en sa forme définitive et qui s’énonce comme suit : quelles sont les caractéristiques du processus par lequel le programme de conformité développé par Siemens a été intégré dans la structure organisationnelle existante et a gagné l’acceptation des employés ? Pour répondre à cette question, la présente étude a été menée selon une orientation constructiviste, utilisant la méthodologie de la théorisation enracinée. Elle a examiné le processus par lequel un programme de conformité spécifique, celui de Siemens Canada Limitée, a été mis en œuvre à travers l’ensemble de son organisation. En conformité avec les préceptes de cette méthodologie, elle ne fut pas menée en concordance avec un cadre théorique précis. Elle a plutôt procédé en tenant compte de certains construits théoriques qui ressortaient de la littérature dans le domaine de l’éthique et de l’éthique des affaires. Ces construits ont été utilisés strictement en tant que points de référence et non pas en tant que cadre théorique. Les données colligées au cours de l’étude provenaient de documents produits par l’entreprise et aussi des entrevues réalisées avec vingt-quatre gestionnaires travaillant pour Siemens Canada Limitée. Le chercheur a utilisé le logiciel QSR-Nvivo afin d’effectuer le codage des documents examinés ainsi que les transcriptions des entrevues. Le logiciel a également servi lors de l’analyse de l’ensemble des données. Quant à la triangulation, celle-ci a été effectuée en recourant à un certain nombre de techniques d’analyse et en comparant les découvertes (terme utilisé ici à la place de « résultats » afin de conserver le caractère qualitatif de l’étude) avec la théorie existante contenue dans la littérature académique. La description du processus de mise en œuvre du programme de conformité fournie par le chercheur ne provient pas d’un modèle préconçu provenant de la littérature traitant soit de l’éthique des affaires, soit des programmes de conformité. Le vocabulaire utilisé pour décrire le processus correspond soit à des mots utilisés par les individus participant à l’étude, ou des mots choisis par le chercheur qu’il estimait pouvaient résumer les idées exprimées par les participants. Ainsi, le modèle descriptif et le vocabulaire utilisé pour l’expliquer émergent de l’analyse des données. Le modèle descriptif du processus de mise en œuvre du programme de conformité émerge de l’expérience des participants et du contenu des informations trouvées dans les documents. Le vocable utilisé pour désigner ce processus est celui de « remoulage » et représente la catégorie de base qui a émergé des données. Ce processus principal est composé de deux sous processus : le premier désigné comme étant de l'« embedding » (incrustation) et le second désigné comme « appraisal » (appréciation). Le processus de remoulage intègre un nouvel élément structurel, le programme de conformité, dans la structure organisationnelle déjà existante. Toutefois, la particularité de ce processus est de parvenir à transformer la fibre constitutive de la structure organisationnelle sans modifier la structure en tant que telle. En quelque sorte, le « moule » initial est préservé, mais en le « remoulant », avec l'apport du programme de conformité, la compagnie se transforme. Étant donné qu'il s'agit d'un remoulage par le biais d'un programme de conformité, le résultat de tout cet effort doit se manifester, d'une part, par l'adoption, par les employés, de l'identité éthique promue par la compagnie et, d'autre part, par leur utilisation efficiente et constante des outils et des procédures rattachés au programme. Ce résultat à deux volets est atteint à la condition que les deux sous processus, soit ceux d'« embedding » et d'« appraising », parviennent à persuader les individus à être favorablement disposé à agir de façon concordante. Dans le cas de Siemens Canada Limitée, le processus de remoulage implique trois groupes distincts d'acteurs : le personnel corporatif mondial situé en Allemagne, le personnel canadien rattaché spécifiquement à la fonction de la conformité et, finalement, les employés à qui le programme a été présenté et qui doivent suivre les nouvelles procédures. Le personnel corporatif mondial et le personnel canadien à la conformité sont les maîtres du sous-processus d'« embedding ». Le groupe corporatif mondial est impliqué au développement du programme, à sa transmission aux entités régionales, et à la surveillance de son déploiement. Toutefois, les données recueillies au cours de cette étude ne permettent pas de fournir une description plus détaillée de leur travail. Le groupe du personnel canadien à la conformité devait voir à la diffusion du programme à l'échelle du Canada. Il devait fournir une formation aux employés et fournir une rétroaction au niveau corporatif quant aux résultats. Dans leur cas également, les données ne permettent pas une description plus détaillée de leur travail. Le troisième groupe d'acteurs, les employés, est principalement impliqué dans le sous-processus d'« appraising ». Ce groupe est composé de gestionnaires et de personnel non managérial qui ont reçu la formation sur la conformité et a eu à appliquer les nouvelles procédures. La présente étude fournit une description détaillée du sous-processus « appraising ». Elle indique que les employés développent une appréciation du programme de conformité en considérant trois facettes. La première est en lien avec l'impact des changements apportés par le programme sur le quotidien vécu par les employés. À ce niveau, les employés apprécient le programme de conformité selon qu'il facilite leur travail ou qu'il le rend plus fastidieux. La deuxième facette est en lien avec la relation établie entre employés et le personnel rattaché à la conformité. À cet égard, les employés apprécient le programme de conformité selon le degré de collaboration et de confiance établi avec le personnel de conformité. La troisième facette identifiée est en lien avec l'identité éthique corporative. L'étude a identifié qu'une des composantes du programme de conformité est l'identité éthique corporative. Celle-ci est contenue et transmise par divers outils : tels que le code d'éthique, la déclaration de la mission de l'entreprise, la déclaration de la vision de l'entreprise, et autres. Or, les employés développent également une appréciation de cette identité éthique corporative par rapport à un référent particulier : l'identité éthique locale. L'étude indique que cette appréciation se fait selon deux ensembles de qualités. Le modèle décrit dans cette étude suggère qu'une société qui envisagerait de mettre en œuvre son propre programme de conformité devrait tenir compte des trois facettes du sous-processus « appraising ». L'étude suggère notamment que toute entreprise qui songe à développer un programme de conformité doit avoir un souci particulier quant à l'identité éthique de l'entreprise. Ceci est attribuable au fait que l'employé va s'identifier au programme de conformité et va l'accepter pourvu qu'il juge que l'identité éthique de l'entreprise et l'identité éthique locale s'accordent. Les découvertes de la présente étude devraient intéresser tout le personnel chargé de l'élaboration et le soutien organisationnel d'un programme de conformité. Ce personnel doit comprendre qu'une mise en œuvre réussie d'un programme de conformité n'est pas seulement conditionnelle à une bonne planification et à une bonne exécution. Elle est aussi dépendante des trois facettes contenues dans le sous-processus « appraising », tout particulièrement l'identité éthique corporative.

Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Spinal cord injury is a devastating sudden cause of disability which renders a person paralyzed and dependent on care immediately after the incident. A person who has suffered a spinal cord injury requires an intensive rehabilitation program to achieve physical independence as well as reintegration into the community. The aim of this study was to evaluate the rehabilitation program for patients with complete paraplegia at the Netcare Rehabilitation Hospital, a 120 bed private rehabilitation facility in Johannesburg, where rehabilitation for patients with physical disabilities is offered by an interdisciplinary team. The rehabilitation program was evaluated in terms of effectiveness including the degree of physical independence the patients achieved and how well the program prepared patients for successful integration into the community. The Functional Independence Measure (FIM), a standardized outcome measure that measures certain physical and cognitive functions and the Needs Assessment Checklist (NAC), an instrument designed to assess if the rehabilitation program is geared towards the patients’ individual needs were used as outcome measure. FIM scores were determined on admission and discharge and NAC scores were determined at discharge. A convenient, consecutive sample of sixteen patients with complete paraplegia (ASIA A), with a neurological level between T1 and T12, formed the study population. Consistently high FIM and NAC scores in the area of physical functioning suggested that the rehabilitation program at Netcare Rehabilitation Hospital was effective in terms of providing patients with physical independence. However, NAC results showed that the patients were not completely ready to reintegrate back to their communities. Areas that were identified as particularly problematic were knowledge on follow up health care services in the community, readiness for work and accessibility of the home and work environments. Therefore it is recommended that the rehabilitation team re-evaluate the program and incorporate strategies with the aim to improve it’s effectiveness in terms of preparing patients for community reintegration. It is also recommended that further research is conducted to assess the current success rate with regards to community reintegration and determine challenges to re-integration in order to assist with program panning. / AFRIKAANSE OPSOMMING: ‘n Spinaalkoordbesering is ‘n skielike oorsaak van gestremdheid wat die persoon verlam en afhanklik van sorg laat direk na die voorval. ‘n Persoon wat ‘n spinalkoordbesering opdoen benodig ‘n intensiewe rehabilitasie program om weer fisies onafhanklik te wees en ook om hom/haar voor te berei om weer by die gemeenskap in te skakel. Die doel van hierdie studie was om die rehabilitasie program by die Netcare Rehabilitasie Hospitaal, ‘n 120 bed private rehabilitasie fasiliteit in Johannesburg, waar rehabilitasie vir fisies gestremde persone deur ‘n interdissiplinere span aangebied word, te evalueer. Die program is geevalueer in terme van twee uitkomste naamlik, die graad van fisiese onafhanklikheid wat die pasiënte behaal en tot watter mate die program pasiente voorberei vir herintegrasie in die gemeenskap Die “Functional Independence Measure” (FIM), ‘n gestandaardiseerde uitkoms skaal wat sekere fisiese en kognitiewe funksies meet en die “Needs Assessment Checklist” (NAC), `n instrument wat ontwikkel is om te evalueer of rehabilitasie programme pasiente se spesifieke behoeftes aanspreek. Is gebruik om the rehabilitasie program te evalueer. Die FIM is met toelating en ontslag voltooi en die NAC is met ontslag voltooi. ‘n Steekproef van sestien pasiente met volledige spinaalkoordletsels (ASIA A) tussen T1 en T12 het die studie populasie gevorm. Deurgans hoë FIM en NAC tellings vir fisiese funksionering het daarop gedui dat die rehabilitasie program by die Netcare Rehabilitation Hospital effektief is in terme van fisiese onafhanklikheid van pasiente. Aan die ander kant het die NAC tellings daarop gedui dat die program minder suksesvol is wat betref die voorbereiding van pasiente vir gemeeskapsintegrasie. Spesifieke probleem areas sluit in kennis van waar om opvolg gesondheidssorg in die gemeenskap te bekom, gereedheid vir werk en toeganklikheid van die huis en werksomgewing. Daar word aanbeveel dat die rehabilitasie span by Netcare Rehabilitasie Hospitaal die program herevalueer om die effektiwiteit van die program in terme van die voorbereiding vir gemeenskaps herintegrasie te verbeter. Dit word ook aanbeveel dat ‘n opvolg studie gedoen word om die huidige sukses ten opsigte van gemeenskaps herintegrasie te evalueer en sruikelblokke te identifiseer ten einde die span the help met program beplanning.

Doctor of Education / Department of Educational Leadership / W. Franklin Spikes / As individuals, we rely on the expertise of professionals to help us navigate the complex problems of modern life in areas such as medicine, accounting, social work, teaching, and the law. Although each profession has its own unique knowledge base, lexicon, and culture, they all share the need to keep members’ knowledge and skills current through continuing professional education. Driven by concerns like frequent law change, increasingly complex clients, and eroding public opinion, 46 states have instituted mandatory continuing legal education (MCLE) requirements for attorneys. The Kansas Continuing Legal Education (CLE) Commission administers MCLE in the state of Kansas by monitoring attorney compliance and accrediting CLE programs. In this study, the researcher used a mixed-methods approach to evaluate two existing data sets--survey outputs and focus groups transcripts--that were captured during the Kansas CLE Commission’s Education Initiative. The 260 CLE providers completing the survey and 22 focus group members varied demographically by structure (for-profit, nonprofit) and size (number of employees or course offerings). Using quantitative statistical tools and qualitative grounded theory methods, the researcher identified the current program planning and design, delivery, and evaluation practices of CLE providers in Kansas and evaluated these practices against best practices for any learning effort, as established by CPE research and theory. Study findings indicated that most Kansas providers plan, deliver, and evaluate CLE programs using more traditional, didactic, update-oriented approaches. Most participants reported CLE curricula that were focused on keeping attorneys up-to-date, delivering classes in traditional formats using speaker presentations, and evaluating programs with Level 1 reaction methods. Only some evidence existed of providers determining attorney needs using methods such as competency models or performance evaluations, refining course delivery according to learning styles, or evaluating programs at higher levels. Still, evidence was found of providers using creative ways to incorporate some best practices into their programs, such as partnering with the other stakeholders in the Kansas MCLE space (attendees, employers, and regulators) to plan and evaluate programs. Similarly, some providers are finding new ways to incorporate more interactive learning methods into their classrooms such as discussion groups, Q&A sessions, panels, mock trials, and networking. This research also provided important insights into the contextual realities and limitations that influence MCLE provider capabilities, priorities, or choices. Cultural norms of the legal profession such as a preference for traditional educational experiences, fierce opposition to any form of testing, and a focus on billable hours affect which best practices the providers are able to implement. Likewise, the diversity that exists across learning events, law practices, and providers in this space creates challenges to implementing new practices consistently across all programs. Finally, the fragmented, multistakeholder ownership of all Kansas MCLE processes means that providers alone are not able to implement fully the recommended best practices without the help of employer partners. This study added to the general body of knowledge concerning CLE programs with contemporary research, a new focus on providers as the source of data, and a context-specific assessment of current best practices application.

As societies embrace notions of sustainability, there is an increasing interest in how to best educate students about these concepts. The field of sustainability education (SE) is an approach that has been developed to address this concern. SE frameworks seek to integrate into curricular contents and formats within campus learning environments, in order to systematically improve upon approaches and services developed to support student learning and development. My research offers insight into the relationships between the philosophical principles and praxes of sustainability education, with the aim to inform educators on how best to prepare students to address complex sustainability issues. I used three cases of University of Vermont courses and programs to explore theoretical and practical factors related to sustainability education and food systems, as follows: 1) a comparative analysis of Education for Sustainability (EfS) together with Sustainable Agriculture and Food Systems Education, 2) an integration of High Impact Educational Practices (HIEP) with the field of agroecology education, and 3) an in-depth program analysis that examined the role of HIEP in engaged learning alongside the EfS framework. I drew from two action research (AR) traditions that determine particular research methodologies for applied social research settings. The first is a systems approach to organizational learning, and the second is teacher research for curricular and program development. I also engaged in utilization-focused evaluation (UFE) with program stakeholders. Research methods included applied social and mixed methods associated with program evaluation. Three main research implications include: a) Agroecology education in experiential, immersion environments can serve as a primary vehicle for sustainability education; b) sequencing of food systems and sustainability curricula can lead to transformative learning; and c) AR and UFE can serve as tools for program development alongside sustainability education frameworks.

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

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

Introdução: A escola é um espaço privilegiado para o desenvolvimento de ações de promoção da saúde e melhoria das condições de bem-estar dos educandos. O Programa Saúde na Escola PSE, criado em 2007, é uma iniciativa intersetorial, entre Ministérios da Saúde e da Educação que objetiva implementar ações de diagnóstico, atenção, prevenção e promoção à saúde dos escolares, em escolas públicas brasileiras. O acompanhamento do estado nutricional de crianças e adolescentes é uma das atividades previstas para o PSE e é acompanhado sistematicamente pela Atenção Básica - AB dos SUS por meio do Sistema de Vigilância Alimentar e Nutricional SISVAN. Objetivo: Realizar um diagnóstico da estruturação do Programa nos municípios brasileiros, com foco nas ações de alimentação e nutrição e avaliar a evolução do estado nutricional de crianças e adolescentes com idades entre 7 e 18 anos, atendidos pela Atenção Básica e verificar qual o momento mais oportuno para a realização de intervenções que objetivem o adequado desenvolvimento do crescimento, e consequentemente, do estado nutricional em crianças e adolescentes. Metodologia: A tese está organizada em duas seções, sendo a primeira composta por um estudo transversal, com levantamento direto de dados com os gestores municipais do PSE do setor saúde, por meio de formulário eletrônico, com questões sobre a gestão do programa, estrutura do município e organização das ações de alimentação e nutrição e; a segunda seção é um estudo longitudinal de avaliação da tendência de variação do estado nutricional de escolares entre 7 e 18 anos, frequentadores da AB, com dados registrados no SISVAN, entre os anos de 2008 e 2012, com avaliação da média de escore-Z do indicador de IMC para-a-idade, em comparação com as curvas de referência da Organização Mundial da Saúde propostas em 2007. Resultados: Para a análise do Programa foi proposto um modelo lógico de avaliação, baseado nos componentes do PSE. Dentre os principais achados, destaca-se: Os municípios (n=380), que responderam o formulário possuem um número médio de 45 escolas e contam em média com 11 equipes de Saúde da Família. Cerca de 59 por cento dos municípios realizaram diagnóstico prévio para implantação do programa e apenas 62,8 por cento dos municípios pactuaram as ações do PSE no Conselho Municipal de Saúde. Cerca de metade dos gestores do programa (53,6 por cento ) são enfermeiros. Para potencializar as ações no ambiente escolar quase dois terços dos gestores municipais alegam contar com o auxílio de outros parceiros para a execução das ações. No que se refere às ações de alimentação e nutrição desenvolvidas nos municípios: 93,6 por cento tem no seu quadro de funcionários nutricionistas, sendo que cerca de 70 por cento possuem um nutricionista na alimentação escolar, 43,9 por cento contam com equipes de NASF e em 84,3 por cento das equipes de Núcleos de Apoio à Saúde da Família há um nutricionista. Dos respondentes, cerca de 62,5 por cento realizaram a Semana Saúde na Escola no ano de 2012 e 90 por cento declararam ser esta uma ação que fortalece o PSE no município. Na análise temporal do estado nutricional dos escolares, observou-se que em todas as idades a média do escore Z do IMC para a idade está acima de zero, sendo sempre maior do que o valor de referência. Ao longo das idades essa média apresenta crescimento entre as crianças com idades entre 7 e 10 anos, com uma pequena queda entre 10 e 14 anos e com uma tendência ascendente após os 15 anos para ambos os sexos. A tendência de aumento dos valores também é observada ano a ano. Entre o período analisado (anos de 2008 a 2012) ocorre um incremento constante nesta média, sendo este um reflexo do incremento do peso corporal destas crianças e adolescentes. O comportamento do escore-Z deveria ser constante e em uma população saudável a distribuição seria praticamente igual ao das curvas de referência. Conclusão: O PSE possui ferramentas que lhe conferem capacidade de enfrentar os desafios em saúde e as ações devem ser planejadas e discutidas de maneira a propiciar um ambiente de práticas e hábitos saudáveis. O Estado Nutricional apresenta uma tendência de aumento anual do IMC médio dos escolares, reforçando os diferentes estudos que mostram o aumento do excesso de peso em todas as fases do curso da vida. O melhor momento para a intervenção entre crianças e adolescentes é o intervalo entre os 10 e 14 anos, onde há uma tendência de declive na curva de IMC para a idade. / Introduction: The school is a privileged space for the development of health actions and promotion as well as the improvement of the students health conditions. The Program Health in the School - PSE, created in 2007, is an intersectoral initiative, between Education and Health department that objectives to implement action of diagnosis, attention, prevention and promotion of the students health, in Brazilian public schools. The monitoring of the nutritional status of children and adolescents is one of the activities planned for the PSE and systematically followed by Primary Care - PC of SUS through the Food and Nutrition Surveillance System - SISVAN. Objective: Realize a diagnosis of the structure of the Program in the cities, with focus to the actions of feeding and nutrition and to evaluate the evolution of the nutritional status of children and adolescents (ages between 7 and 18 years), taken care by the PC and to verify the most opportune moment for the accomplishment of interventions that objectify the adequate development of growth in children and adolescents. Methodology: The thesis is organized in two sections of results, the first presents a transversal study, with direct survey of data answered by the municipal managers of the PSE of the sector health, through an electronic form, with questions about the management of the program, structure of the city and organization of actions; the second section is a longitudinal study of evaluation of the trend of variation of the nutritional state of adolescent children and (public-target of the PSE), assisted by the basic attention to the health, with data registered in the SISVAN, with evaluation of the average of the Z-score of the IMC for-the-age, in comparison with the curves of reference of the World Health Organization proposed in 2007. Results: For the analysis of the Program it has been considered a logical model of evaluation, based on the components of PSE. Among the main findings, we detach: The cities that had answered the form possess an average number of 45 schools and count with in average on 11 teams of Health of the Family. About 59 per cent of the cities made a previous diagnosis for implementation of the program and only 62.8 per cent of the cities had agreed to the actions of the PSE in the City council of Health. About half of the managers of the program (53.6 per cent ) are nurses. To potentiate the actions in the school environment almost two third parts of the municipal managers allege to count with the aid of other partners for the execution of the actions. In what the actions of developed feeding and nutrition are mentioned in cities 93.6 per cent has nutritionists among their employees, and about 70 per cent of them has a nutritionist who cares for the feeding program at the school. 43.9 per cent count on NASF teams and in 84,3 per cent of the NASF teams there is a nutritionist. Of the respondents, about 62,5 per cent had carried through the Health Week in the School in the year of 2012 and 90 per cent had declared to be this an action that fortifies the action of the PSE in the city. In the secular analysis of the nutritional state of the pertaining to school, we can always observe that in all ages the average of the score Z of the IMC for the age is above of zero, being ever bigger than the value of reference. To long of the ages this average presents growth between the children with ages between 7 and 10 years, with a small fall between 10 and 14 years and with an ascending trend after the 15 years for both girls and boys. The trend of increase of the values also is observed year after year. During the analyzed period (years of 2008 the 2012) occurs a constant increment in this average, being this a consequence of the increment of the corporal weight of these children and adolescents. The behavior of Z-score would have to be constant and in a healthful population the distribution would practically be equal to the one of the reference curves. Conclusion: The PSE offers tools that confers it ability to face the health challenges and the actions must be planned and discussed in order to provide an environment of healthy practices and habits. The Nutritional Status shows a trend of annual increases in mean BMI in schoolchildren, reinforcing the different studies showing the increase of overweight at all stages of the life course and bringing more alert about this specific age group. The best time to an intervention among children and adolescents is in the interval between 10 and 14 years, where there is a trend of decline in the BMI curve for age.

OBJETIVO: Avaliar os efeitos de um Programa de Promoção do Envelhecimento Saudável na Qualidade de Vida de idosos durante o seu desenvolvimento anual, identificando fatores preditores dos efeitos observados. MÉTODOS: Estudo com amostra de 83 idosos participantes do programa do GAMIA (HCFMUSP) entre 2000 e 2002. A qualidade de vida foi mensurada utilizando-se o World Health Organization Quality Of Life (WHOQOL-Bref) no início e ao término do programa. Os índices de QV foram correlacionados com variáveis clínicas, funcionais e sócio-demográficos utilizando-se a Cumulative Illness Rating Scale (CIRS), as Escalas de Atividades de Vida Diária de Katz e Lawton e dados obtidos nos prontuários. O envolvimento em atividades sociais e de lazer, bem como dados referentes a autopercepção do idoso em relação a saúde e QV foram obtidos por questionário elaborado pelos autores. A análise estatística foi realizada com os testes ao nível de significância de 5%. RESULTADOS: Dos 83 idosos predominaram os do sexo feminino (79,5%) e a média geral de idade foi de 69,30 anos. As mulheres melhoram mais no domínio psicológico (p = 0,035) e mostraram uma tendência de melhora no domínio relações sociais (p = 0,074). A análise global dos dados mostrou uma redução no domínio físico do WHOQOL- BREF (p = 0,014) e elevação dos domínios psicológico e meio ambiente (p = 0,029 e p = 0,007 respectivamente), detectando-se tendência de elevação nos domínios relações sociais e geral (p = 0,062 e p = 0,052). Constatou-se uma relação inversa entre multimorbidades e qualidade de vida, principalmente nos domínios físico, relações sociais e meio ambiente. Em relação às Atividades de Vida Diária, todos os idosos da amostra alcançaram a pontuação máxima na Escala de Katz e 92,8% na Escala de Lawton. Dos 83 idosos da amostra, 78 (93,9%) afirmaram ser possível ter uma boa qualidade de vida na velhice. DISCUSSÃO: Como a avaliação clínica destes idosos revelou doenças desconhecidas previamente e determinou a utilização de novos medicamentos a percepção que o idoso tem em relação a sua saúde pode ter sido o fator preponderante para a piora no domínio físico. A melhora dos domínios psicológico e meio ambiente podem estar relacionados ao suporte psicológico e social que o idoso recebe dos colegas e profissionais e dos benefícios das atividades em grupo, bem como às tendência de elevação observada nos domínios relações sociais e geral. As mulheres, além de constituírem a maioria dos participantes, se beneficiam mais que os homens no programa do GAMIA. CONCLUSÕES: Apesar do declínio dos índices no domínio físico, o idoso obteve melhora da qualidade de vida nos demais domínios do WHOQOLBref. O GAMIA é um modelo de promoção da saúde que contribui, efetivamente, para a melhora da qualidade de vida no envelhecimento. / OBJECTIVE: To evaluate the effects of a Program for Promotion of Healthy Aging on Quality of Life of elderly during their annual development, identifying predictors of the observed effects. METHODS: The sample included 83 elderly participants in the program GAMIA (FMUSP) between 2000 and 2002. Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-Bref) at the beginning and end of the program. QOL scores were correlated with clinical, functional and sociodemographic using the Cumulative Illness Rating Scale (CIRS), the Scale of Activities of Daily Living Katz and Lawton and data obtained from the files. Involvement in social activities and leisure, as well as data relating to perception of the elderly in relation to health and QOL were obtained by questionnaire developed by the authors. Statistical analysis was performed to test the significance level of 5%. RESULTS: Of the 83 elderly, female patients predominated (79.5%) and overall mean age was 69.30 years. Women improve more in the psychological domain (p = 0.035) and showed a trend of improvement in social relationships domain (p = 0.074). Data analysis showed a reduction in the physical domain of WHOQOL-BREF (p = 0.014) and increased psychological health and environment (p = 0.029 and p = 0.007 respectively), detecting upward trend in social relationships and general ( p = 0.062 and p = 0.052). There was an inverse relationship between Multimorbidity and quality of life, especially in the physical, social relationships and environment. Regarding the Activities of Daily Living, all seniors in the sample reached the maximum score on the Katz scale and 92.8% in the Scale of Lawton. Of the 83 seniors in the sample, 78 (93,9%) said it possible have a good quality of life in old age. DISCUSSION: As clinical evaluation of elderly revealed previously unknown diseases and ordered the use of new drugs, the perception that the elderly have about your health may have been negative and contributed for the deterioration in the physical domain of WHOQOL-BREF. Improvement in psychological health and the environment can be related to psychological and social support that the elderly receive from peers and professionals and the benefits of group activities, as well as the upward trend observed in the social relationships and general. Women also constitute the majority of participants, benefit more than men in the program GAMIA. CONCLUSIONS: Despite the decline in rates in the physical domain, the elderly received better quality of life in other domains of the WHOQOL. The GAMIA is a model of health promotion to contribute effectively to the improvement of quality of life in aging.