Made available in DSpace on 2016-04-29T14:17:58Z (GMT). No. of bitstreams: 1 Elisete Maria Ribeiro.pdf: 7853414 bytes, checksum: ca9d4beb14aec1e3814dc40e05452d22 (MD5) Previous issue date: 2009-11-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The field of health policy has incorporated new concepts that guide the qualification and practice of health professionals, following a trend of ensuring universal health care rights. Health services have required health professionals to adopt distinguished conducts in which they play a central role in delivering technical, operational and political excellence in their practices. This is because they are jointly responsible for ensuring an accessible, humanized, egalitarian and comprehensive health care, among other principles respected by the Brazilian Health System (SUS). This research sought to analyze, from a historic and institutional perspective, the service infrastructure quality, as well as Primary Health Care workers concepts and practices underpinning the implementation and the development of the Family Health Strategy in the Health Office of Curitiba. In order to meet such demand, a new professional profile emerges with a humanized approach, as well as generalist and resolute characteristics within the Family Health Strategy practice. Based on the theories raised by the attributes described by Starfield (2002) as critical or unique in Primary Health Care (first contact, comprehensiveness, longitudinality and coordination), the secondary attributes (family-centeredness, cultural competence and community orientation) and an attribute not only assigned to Primary Health Care (proper recording), the concepts and practices adopted by the Family Health Strategy in Curitiba are analyzed. Family Health was wholly taken and implemented within a specific technical and political timeframe and in a restricted fashion. It is defended only by a portion of significant professionals aligned to understand and embrace values, principles and attributes of Primary Health Care. Significant individuals demonstrate the progresses made in the qualification of working concepts and processes and the contradictions arising from an insufficient appropriation of ideologies by new stakeholders, which impair the delivery of a qualified Family Health Care work. This study presents how the Primary Health Care in Curitiba is organized and operates, in connection with the hegemony and qualified development of a city policy / O campo da política de saúde tem agregado novas concepções que orientam a formação e a prática dos trabalhadores de saúde, em uma tendência de garantia da universalidade do direito à saúde. O trabalho em saúde tem exigido condutas diferenciadas de seus trabalhadores, na condição de protagonistas da excelência técnica, operativa e política de sua prática profissional, por se constituírem como sujeitos corresponsáveis na garantia de acesso, humanização, equidade e integralidade da atenção em saúde, entre outros princípios do SUS. A pesquisa buscou analisar, no processo histórico-institucional, a qualificação da infraestrutura de serviços, bem como as concepções e práticas dos trabalhadores em APS que fundamentam a implantação e o desenvolvimento da estratégia Saúde da Família- SF, na SMS Curitiba. Para responder a tal demanda, demonstra-se a constituição de um novo perfil profissional, de abordagem humanizada, com características mais generalistas e resolutivas da pratica profissional em ESF. Com a base teórica no campo dos atributos descritos por Starfield (2002) como essenciais ou únicos em APS (primeiro contato, integralidade, longitudinalidade e coordenação), os atributos derivados (enfoque na família, valorização dos aspectos culturais e orientação na comunidade) e um atributo não exclusivo da APS (registro adequado), fundamenta-se a análise das concepções e práticas das ESF em Curitiba. Em sua integralidade, a Saúde da Família foi apreendida e implementada em tempo técnico e político especifico, de forma restrita, defendida por apenas um segmento de profissionais significativos, alinhados em compreensão e defesa de uma base de valores, princípios e atributos da APS. Assim, os sujeitos significativos demonstram os avanços na qualificação das concepções e processo de trabalho, e da mesma forma as contradições evidenciadas por uma insuficiente apropriação de bases ideológicas e adesão por parte de novos protagonistas que comprometem a qualificação do trabalho em Saúde da Família. Demonstra-se a capacidade de organização e funcionamento da APS em Curitiba, relacionada à hegemonia e desenvolvimento qualificado de uma política municipal

Service delivery to children with severe disabilities (CSDs) in developing countries share some common characteristics. These include inaccessible services due to the fact that the majority of services are located in a few large cities, the focus of services are usually on school-age children (with few for pre-schoolers), many services require specialised staff and high technology equipment that is not always available and professionals who tend to work in isolation with minimal integration between services. A particularly vulnerable group within the sphere of CSDs are beginning communicators because of their inability to articulate their needs, feelings and rights. Programmes to specifically address these communication needs by equipping them with the necessary skills to interact and participate in society, are very limited. Often the first contact that primary caregivers of a CSD have with professionals, is with the community health nurse. Furthermore, they often remain the only professionals who provide continuous support and assistance to these caregivers. It is therefore clear that these nurses need to be equipped with the necessary knowledge and skills in order to assist caregivers in dealing with their children with severe disabilities. This can be done by training these nurses (through multiskilling) to function as transdisciplinary professionals. Furthermore, a need for appropriate materials for service delivery to this population also exists. Consequently the BCIP (Beginning Communication Intervention Protocol) was developed. The BCIP addresses four important communication domains, namely communication means (including objects, photographs, manual signs, PCS symbols and a simplified 4-option digital speaker), functions (namely informational functions e.g. requesting more, requesting help, etc. and social functions, e.g. greeting, drawing attention to self, etc.), partners (both adults and peers) and the deliberate creation of communication opportunities (e.g. by providing small portions, placing desired items out of research) etc. Care was taken to ensure culture sensitivity and the authenticity of the BCIP. Twenty community health nurses were trained in the application of the BCIP. Training employed adult learning principles and was one week long, followed by three follow-ups that were conducted in situ (at two weeks, six weeks and five months post-training). Multiple measurements were used to evaluate the knowledge and skills acquired after training, namely questionnaires, structured interviews, skill demonstrations (which were video recorded and rated by the researcher and an independent rater) and a focus group. Results indicated that the BCIP training is relevant in bringing about a significant change in the targeted domains, namely knowledge and skills. Peripheral behaviours (namely attitudes, job satisfaction and type of service delivery provided) were all rated high at the onset of the research and thus quantitative data failed to show improvement. On the other hand, qualitative data from the focus group suggested improvement. / Dissertation (PhD (Augmentative and Alternative Communication))--University of Pretoria, 2004. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

Philosophiae Doctor - PhD / Introduction: National community health worker (CHW) programmes are to an increasing extent being implemented in health systems globally, mirrored in South Africa in the ward-based outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge impacting the performance and sustainability of scaled-up CHW programmes is ensuring adequate support from and supervision by the local health system. Supervisory systems, where they exist, are usually corrective and hierarchical in nature, and implementation remains poor. In the South African context, the absence of any guidance on CHW supportive supervision has led to varied practices across the country. Improved approaches to supportive supervision are considered critical for CHW programme performance. However, there is relatively little understanding of how this can be done sustainably at scale, and effective CHW supervisory models remain elusive. Research to date has mostly positioned supervision as a technical process rather than a set of relationships, with the former testing specific interventions rather than developing holistic approaches attuned to local contexts. This doctoral study was exploratory in nature, seeking to generate an in-depth and contextualised understanding of the supervision phenomenon in one specific district in the North West Province (NWP) in South Africa. Using co-production methodology in an iterative approach, the study culminated in the formulation of a supportive supervision framework with CHWs and other frontline actors. Methods: The study was based on a holistic conceptual framework of supportive supervision, which was viewed as comprising three core functions ‒ accountability, development and support ‒ embedded in a complex and multi-level system of resources, people and relationships. To address the study objectives, the research used a mix of qualitative and quantitative methods. Three studies were conducted in a phased process: study 1 comprised a qualitative description of policy and practices in two districts related to the supervision of WBOTs; study 2 identified the main actors and mapped the supervisory system of WBOTs in the district, using social network analysis (SNA); and study 3 involved a qualitative exploration of workplace and interpersonal trust factors in the district and the supervisory system of WBOTs in the district. These three studies provided inputs for a workshop aimed at developing recommendations for a district-level, WBOT supportive supervisory framework. Four published papers reporting on the research conducted are presented in this thesis. It should be noted that the research was conducted during a turbulent political and administrative period in the NWP, when the WBOT programme changed from being a flagship programme for the country to one in crisis. This shifting context needs to be borne in mind when the findings are viewed and interpreted. Results: The study identified weaknesses in both the design and implementation of the supervisory system of WBOTs, with the absence of clear guidance resulting in WBOTs and PHC facilities performing their roles in an ad hoc manner, defined within local contexts. The study documented evidence of high internal cohesion within WBOTs and (where present) with their immediate outreach team leaders (OTLs). However, the relationships between WBOTs and the rest of the primary health care (PHC) and district health system were characterised by considerable mistrust – both towards other workers and the system as a whole. This occurred against a backdrop of increasing OTL vacancies, and the perceived abandonment of WBOT training and development systems and career opportunities. These findings are not dissimilar to those reported previously on the WBOT programme in South Africa and in programmes in other low-resource settings. Nevertheless, through its in-depth, exploratory and participatory approaches, this study provides additional insights into the phenomenon of supportive supervision. Firstly, in conceptualising supportive supervision as a set of ‘bundled’ practices within complex local health systems, the findings reflected the complexity of everyday realities and lived experiences. Secondly, through the embedded nature of the research and the phased data-collection process, the study was able to observe the impact of wider health system contexts and crises on the coalface functioning of the WBOT programme. Thirdly, the study emphasised how supportive supervision depends on healthy relational dynamics and trust relationships, and, finally, how a co-production approach can translate broad guidance, experience and theoretical understanding into meaningful, local practice owned by all the actors involved. Ultimately, the process of engagement, building relationships and forging consensus proved to be more significant than the supportive supervision framework itself. Conclusion: The lack of explicit, coherent and holistic guidance in developing CHW supportive supervision guidance and the failure to address supervision constraints at a local level undermine the performance and sustainability of CHW programmes. Effective supportive supervisory systems require bottom-up collaborative platforms characterised by active participation, sharing of local tacit knowledge and mutual learning. Supervisory systems also need to be designed in ways that promote relationships and generate trust between CHW programmes, other actors and the health system.

The aim of this study was to investigate human-animal interactions in the triad comprising the veterinarian, the animal and the preschool and in so doing to elucidate the role of the veterinarian in the health and education of preschool children. The area of focus was a comparison of preschools in high and low income areas in and around Pretoria by means of qualitative and quantitative observational methods. It was found that all preschools investigated, included animals in the curriculum and a majority visited the zoo. Interactions included direct contact between children and animals kept permanently or temporarily at school, animal themes and topics, animal protagonists in books, videos, toys and games and excursions to the zoo, urban farms, agricultural museums and animal welfare societies. Teachers felt that child-animal interactions contributed positively to the holistic development of the preschool child, but were worried about management of animals at school and the possibility of zoonotic diseases. As protein of animal origin, such as milk, eggs, meat and fish, formed part of the diet of preschool children, this could also result in a risk of zoonotic disease, particularly in developing areas, where meat and milk hygiene were found to be inadequate. In order to address these fears, the literature was reviewed with regard to zoonotic diseases which could affect preschool children in South Africa. Incidence and prevalence were not well documented and the comparative significance could not be assessed. Therefore the comparative morbidity of diseases diagnosed by the paediatric department of a hospital serving the low income areas studied and a private practice serving the high income areas, were investigated. It was discovered that zoonotic disease formed a very minor proportion of diseases diagnosed. The diagnoses were, however, based on symptoms rather than aetiology and zoonotic causes for, in particular, respiratory and gastro-intestinal disease, could not be excluded. In the light of this, criteria were proposed for the prevention of zoonotic disease outbreaks at preschools. An outbreak of zoonotic disease at a preschool was documented and the application of primary health care principles suggested. Constraints were found to be mainly administrative. Co-operation between the departments of Health and Agriculture was complicated by financial implications which had not been budgeted. Despite this, the intervention was successful in controlling the disease and preventing further outbreaks. The presence of a veterinarian as part of the primary health care team was advocated. Within the preschool it was found that teachers lacked knowledge in the fields of animal ethology and management. Cost, ease of management and appeal to children were taken into account in the choice of animals by preschools. Rodents and birds were considered preferable to carnivores. Housing was evaluated and criteria suggested for management systems which would benefit both children and animals. Death and euthanasia of animals kept permanently at preschool was investigated and suggestions made for a teaching strategy to facilitate understanding by children of the abstract concepts of life, death and grief. A method was developed for the analysis of animal content in literature, games and toys at preschools. It was found that animals were central to the theme of a majority of the books and toys. Realistic fiction where anthropomorphic animals were the central protagonists, had most appeal for children and it was suggested that these could be used in veterinary extension materials for prevention of zoonotic diseases or promotion of animal welfare. An evaluation system was proposed which included the input of veterinary ethologists. Animal facilities visited by preschools during excursions were evaluated. It was found that they were not sufficiently child-centred and environmen¬tally safe for young children. It was suggested that veterinary public health officials should become involved in order to improve animal well-being, particularly with regard to handling facilities and hygiene. In conclusion, a schematic representation of the multitude of roles for veterinarians in the holistic development of the preschool child was drawn up. The roles for different veterinary specialities were also tabulated in order to illustrate the important part played by this profession in the health and education of preschool children. / Die doel van die studie was om mens-dier-interaksies in die driehoek tussen veearts, dier en die kleuterskool te ondersoek om sodoende die rol van die veearts in die gesondheid en opvoeding van die voorskoolse kind aan te dui. Kwalitatiewe en kwantitatiewe navorsingsmetodes is gebruik om kleuterskole in die lae en hoë inkomste-gebiede in en om Pretoria te vergelyk. Alle kleuterskole wat ondersoek is, het diere in die kurrikulum ingesluit en die meerderheid skole het uitstappies na die dieretuin onderneem. Kind-dierinteraksies het die volgende ingesluit: direkte kontak tussen kind en dier op skool; diere in temas, stories, boeke, speletjies en speelgoed; asook uitstappies na die dieretuin, landelike museums, stedelike plase en dierwelsynsorganisasies. Onderwyseresse het gemeen dat die interaksies positief bygedra het tot die holistiese ontwikkeling van die voorskoolse kind, maar het kommer uitgespreek oor bestuur en siektes van diere. Omdat proteïene van dierlike oorsprong deel uitmaak van die dieet van voorskoolse kinders, was soönose ook 'n moontlikheid, veral in kinders van ontwikkelende areas waar dit uitgewys was dat higiëne met betrekking tot vleis en melk, nie na wense was nie. 'n Literatuurstudie het aangetoon dat die algemeenheid en omvang van soönotiese siektes, wat moontlik gevaarlik kon wees vir voorskoolse kinders, nie volledig genoeg omskryf was nie. Die vergelykende morbiditeit van siektes by Ga-Rankuwa Hospitaal se kinderafdeling (pasiënte van lae-inkomste gebiede) en 'n private praktyk in die oostelike voorstede van Pretoria (hoë inkomste gebied), is dus ondersoek. Soönotiese siektes het 'n klein deel uitgemaak van die siektes wat gediagnoseer was, maar die diagnose was op simptome, eerder as die etiologie van die siektes, gebaseer. Die vermoede bestaan dat veral siektes wat gediagnoseer is as respiratories en gastro-enteries, 'n soönotiese oorsprong kon gehad het. 'n Uitbreek van 'n soönotiese siekte by 'n kleuterskool is ondersoek en daar is voorgestel dat primêre gesondheidsorgmetodes gebruik word om dit te bekamp. Teenkanting op administratiewe vlak was die belangrikste probleem wat ondervind was, maar ten spyte daarvan kon die ondersoek suksesvol verloop. Die rol van die veearts as deel van die primêre gesondheidspan is ook hierdeur beklemtoon. Binne die kleuterskool is gevind dat daar 'n gebrek aan kennis is oor diere-etologie en dierebestuur. Kostes, praktiese versorgingsmetodes en die stimuluswaarde van diersoorte, was belangrike aspekte in die keuse van diere wat by skole aangehou is. Daarom was knaagdiere, voëls en vissies meer gewild as honde en katte. Die behuising van die diere is geëvalueer volgens voorgestelde kriteria wat tot voordeel van beide diere en kinders kan strek. Die dood en genadedood van diere by twee kleuterskole is ondersoek en voorstelle is gemaak uit 'n opvoedingkundige oogpunt, om die kinders konsepte betreffende lewe, dood en rou te laat begryp en ook om dit te kan verwerk. 'n Metode is ook ontwerp vir die analise van boeke en speelgoed en daar is bewys dat diere 'n hoofrol gespeel het in die meerderheid boeke en speelgoed by voorskole. Kinders het boeke verkies waar die hoofkarakters antropomorfiese diere was en die omgewing vergelykbaar was met die lewenswêreld van kinders. 'n Voorstel is dus gemaak dat sulke karakters gebruik word om veeartsenykunde voorligtingsboodskappe oor soönotiese siektes of dierwelsyn oor te dra aan jong kinders.Stedelike plasies, die dieretuin, landboumuseums en die Dierebeskermingsvereniging in Pretoria is besoek en daar is bevind dat dit nie veilig genoeg vir jong kinders is nie. Daar word dus aanbeveei dat veeartse in diens van plaaslike owerhede se gesondheidsdienste sulke plekke besoek, om voorstelle oor verbeterde veiligheid en higiëne te maak.Ten slote is 'n skematiese voorstelling van die veelsydige rol van veeartsenykundiges in die holistiese ontwikkeling van die voorskoolse kind saamgestel. Die verskillende rolle vir verskillende spesialiteite is ook voorgelê om die belangrike bydrae van veeartsenykunde tot die gesondheid en opvoeding van voorskoolse kinders aan te dui. / Thesis (DPhil)--University of Pretoria, 1995. / Production Animal Studies / unrestricted

Submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / This mixed methods study aimed to assess the functioning and processes of the Fast Queue Service Point in order to analyse the quality of care rendered in primary health care (PHC) facilities in the eThekwini district of the KwaZulu­ Natal Province in South Africa. The Fast Queue Service Point provides service in PHC facilities for health care users requiring short consultations. Congestion of PHC facilities is a result of increased access to PHC services with the introduction of free PHC services. This congestion was aggravated by the decentralization of services from hospitals to PHC level such as the introduction on Nurse Initiated Management of Anti-Retroviral Therapy (NIMART). In 2010, the National Core Standards (NCS) for health establishments were formulated further to the PHC Service package, to address issues of quality. An explanatory sequential mixed methods study design was used and data collection was conducted in two phases; the quantitative data collection phase consisting of two subsets of observations namely; the retrospective record review and structured observations of the Fast Queue Service Point process. The Statistical Package for the Social Sciences (SPSS) version 22 was used to analyse data. During the second phase semi-structured interviews were conducted with PHC staff members to describe their experiences of the Fast Queue Service Point and to clarify issues from the quantitative phase. Although Fast Queue Service users received sufficient care, there were important care assessments that had been inadequately performed or omitted. These included discussing side effects of medications and or immunizations and management thereof. Childrens' weights were not interpreted, an important aspect for children under five years of age. There was also lack of supportive supervision coupled with shortage of resources and too many time-consuming written records that were required to compile accurate statistics. Retraining and in-servicing of health personnel and making resources available, would assist in strengthening patient assessment, management and recording thereof. While clinic managers require to offer supportive supervision to health care providers, provision of lower categories of staff would be beneficial in supporting PNs and ENs so that they have time to compile records for statistics purposes, which were found to be taking up the bulk of their time. The framework for continuous quality improvement in implementing a Fast Queue Service in PHC settings was developed based on the findings of the study / D

From the 1970s to the present time, the World Health Organization (WHO) explains the importance of health promotion in the world. The increased interest in promoting health and increasing health costs for the economies contributed to the recognition of health care as an important area of research. One of the most important aspects of these research currently is the Telehealth, using Information and Communication Technologies (ICT) to try to provide universal access to health. The use of Interactive Digital TV technology helps in accessing remote locations and creates the opportunity to distribute applications across their infrastructure. Dealing with the problems that arise from the convergence of these concepts is of great importance. The architectural description process helps in the development of applications and systems based on the referenced concepts. However, there are no frameworks to help the description of architectures for this particular domain. This paper proposes the ARCHealth an enterprise architecture framework created to assist the architecture development process in accordance with ISO/IEC/IEEE 42010:2011. The ARCHealth was based on the principles of primary health care, taking into account the main concerns of stakeholders and the specific area. / Desde a década de 1970 até o presente momento, a Organização Mundial da Saúde (OMS) expõe a importância da promoção da saúde no mundo. O aumento do interesse na promoção da saúde e os custos de saúde crescentes para as economias contribuíram para o reconhecimento dos cuidados à saúde como uma importante área de pesquisa. Uma das vertentes mais importantes dessas pesquisas atualmente, é a Telehealth, que utiliza das Tecnologias de Informação e Comunicação (TIC) para tentar prover acesso universal à saúde. O uso da TV Digital Interativa auxilia no acesso a locais remotos e cria a oportunidade de distribuir aplicações através de sua infraestrutura. Lidar com os problemas que surgem a partir da convergência desses conceitos é de grande importância. O processo de descrição de arquitetura auxilia no desenvolvimento de aplicações e sistemas baseados nos conceitos referenciados. Porém, não existem muitos frameworks que auxiliem a descrição de arquiteturas para esse domínio específico. Este trabalho propõe o ARCHealth, um enterprise architecture framework criado para auxiliar o processo de desenvolvimento de arquitetura em conformidade com a norma ISO/IEC/IEEE 42010:2011. O ARCHealth foi elaborado com base nos princípios de Atenção Primária à Saúde, levando em consideração as principais preocupações das partes interessadas e do domínio específico.

La croissance continue et rapide du trafic de données dans les infrastructures de télécommunications, impose des niveaux de débit de transmission ainsi que de puissance de traitement de l’information, que les capacités intrinsèques des systèmes et microcircuits électroniques ne seront plus en mesure d’assurer à brève échéance : le développement de nouveaux scenarii technologiques s’avère indispensable pour répondre à la demande de bande passante imposée notamment par la révolution de l’internet, tout en préservant une consommation énergétique raisonnable. Dans ce contexte, l’intégration hétérogène fonctionnelle sur silicium de dispositifs photoniques à émission par la surface de type VCSEL utilisant des miroirs large-bandes ultra-compacts à cristaux photoniques constitue une stratégie prometteuse pour surmonter l’impasse technologique actuelle, tout en ouvrant la voie à un développement rapide d’architectures et de systèmes de communications innovants dans le cadre du mariage entre photonique et micro-nano-électronique. / The ever-growing demand for high-volume fast data transmission and processing is nowadays rapidly attaining the intrinsic limit of microelectronic circuits to offer high modulation bandwidth at reasonable power dissipation. Silicon photonics is set to break the technological deadlock aiming at a functional photonics-on-CMOS integration for innovative optoelectronic systems paving the way towards next-era communication architectures. Among the others photonic building blocks such as photodiodes, optical modulators and couplers, power-efficient compact semiconductors sources in the near-infrared telecommunication bands, characterized by performing modal features as well as thermal resiliency constitute an essential landmark to be achieved. Within such context, InP-based long-wavelength vertical-cavity surface-emitting lasers (VCSELs) using one-dimensional Si/SiO2 photonic crystals as wideband compact mirrors are proposed as next generation emitters for CMOS integration.