Magister Administrationis - MAdmin / The generation of large volumes of solid and liquid wastes in urban and periurban areas of Ghana is a big problem for the people and government of Ghana. It contributes to the outbreak of many diseases in the country such as malaria, diarrhoea and typhoid fever. In managing the situation, a new concept called ecological sanitation (ecosan), which focuses on reuse of waste, has been introduced in the country. The objectives of the thesis were to criticise the environmental sanitation policy by analysing its content in relation to policy implementation arrangements, to discuss programmes and projects identified under the policy, to critically examine the implementation of an ecosan project as a way of achieving the goal and objectives by outlining its implementation processes, prospects and challenges, and to make appropriate recommendations. The analysis and discussion of the thesis were based on both primary and secondary data. The primary data, on one hand, were collected on the prospects and challenges that exist in the implementation of ecosan projects from Kumasi metropolis. The secondary data, on the other hand, were from books, journals and websites. From the research analysis, it emerged that the policy allows the implementation of many sanitation projects including ecosan. Secondly, stakeholders see ecosanto be a good approach to reduce waste generation in the country. However, the main challenges that exist in promoting the concept are inadequate financial support, unavailability of implementation guidelines and lack of knowledge about concept details. It is therefore argued that financial support, implementation guidelines and awareness-creation activities should be available in the implementation of ecosan in the metropolis. Government, private organisations, companies and individuals should each contribute their quota in the support and processes. / South Africa

<p>The generation of large volumes of solid and liquid wastes in urban and periurban areas of Ghana is a big problem for the people and government of Ghana. It contributes to the outbreak of many diseases in the country such as malaria, diarrhoea and typhoid fever. In managing the situation, a new concept called ecological sanitation (ecosan), which focuses on reuse of waste, has been introduced in the country. The objectives of the thesis were to criticise the environmental sanitation policy&nbsp / by analysing its content in relation to policy implementation arrangements, to discuss programmes and projects identified under the policy, to critically examine the implementation of an ecosan project as a way of achieving the goal and objectives by outlining its implementation processes, prospects and challenges, and to make appropriate recommendations. The analysis and discussion of the thesis were based on both primary and secondary data. The primary data, on one hand, were collected on the prospects and challenges that exist in the implementation of ecosan projects from Kumasi metropolis. The secondary data, on the other hand, were from&nbsp / books, journals and websites. From the research analysis, it emerged that the policy allows the implementation of many sanitation projects including ecosan. Secondly, stakeholders see ecosanto be a good approach to reduce waste generation in the country. However, the main challenges that exist in promoting the concept are inadequate financial support, unavailability of implementation guidelines and lack of knowledge about concept details. It is therefore argued that financial support, implementation guidelines and awareness-creation activities should be available in the implementation of ecosan in the metropolis. Government, private organisations, companies and individuals should each contribute their quota in the support and processes.</p>

<p>The generation of large volumes of solid and liquid wastes in urban and periurban areas of Ghana is a big problem for the people and government of Ghana. It contributes to the outbreak of many diseases in the country such as malaria, diarrhoea and typhoid fever. In managing the situation, a new concept called ecological sanitation (ecosan), which focuses on reuse of waste, has been introduced in the country. The objectives of the thesis were to criticise the environmental sanitation policy&nbsp / by analysing its content in relation to policy implementation arrangements, to discuss programmes and projects identified under the policy, to critically examine the implementation of an ecosan project as a way of achieving the goal and objectives by outlining its implementation processes, prospects and challenges, and to make appropriate recommendations. The analysis and discussion of the thesis were based on both primary and secondary data. The primary data, on one hand, were collected on the prospects and challenges that exist in the implementation of ecosan projects from Kumasi metropolis. The secondary data, on the other hand, were from&nbsp / books, journals and websites. From the research analysis, it emerged that the policy allows the implementation of many sanitation projects including ecosan. Secondly, stakeholders see ecosanto be a good approach to reduce waste generation in the country. However, the main challenges that exist in promoting the concept are inadequate financial support, unavailability of implementation guidelines and lack of knowledge about concept details. It is therefore argued that financial support, implementation guidelines and awareness-creation activities should be available in the implementation of ecosan in the metropolis. Government, private organisations, companies and individuals should each contribute their quota in the support and processes.</p>

Orientador: Djalma de Carvalho Moreira Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T07:55:56Z (GMT). No. of bitstreams: 1 Campos_EneidaRached_D.pdf: 1590665 bytes, checksum: 4d824ace74d3c0a91782143ad65c17d0 (MD5) Previous issue date: 2011 / Resumo: Introdução: Ações são encadeadas nas linhas de cuidado para organizar o percurso assistencial do consumidor de saúde. Método: Determinação de interrelações entre os conceitos e as práticas da epidemiologia, da ciência da administração e da lógica de inferência para o estudo de linha de cuidado. Resultados: 1) Criação do Método de Planejamento Epidemiológico de Linha de Cuidado - PELC - para testar e determinar o melhor percurso assistencial e para garantir sua qualidade. O Método PELC forma uma Equipe de Árbitros para definir o Tratamento Padrão (TP) da linha de cuidado e seu Escore PELC-TP; compara cada linha de cuidado (LC) com o Tratamento Padrão e o resultado é representado no Escore PELC-LC; cria base de comparação entre o Grupo Caso- LC e o Grupo Controle-LC; instala estudos epidemiológicos para investigar os fatores clínicos-sociais-organizacionais mais determinantes para os resultados futuros da linha de cuidado. No estudo prospectivo, o Experimento de Gestão oferece as linhas do Grupo Controle-LC. O Sistema do Cuidado Advir monitora a qualidade do cuidado que está por vir. A Saúde Autorreferida pesquisa o grau de autopercepção de saúde do consumidor. 2) Aplicação do Método PELC com delineamento de caso-controle na linha de cuidado das crianças e dos adolescentes infectados pelo HIV. Definição do Tratamento Padrão com PELCTP= 100 e Escore PELC-RES = 51 (sucesso terapêutico). A análise de regressão logística mostrou os seguintes fatores como mais determinantes para PELCRES< 20 e para PELC-LC<75: ter adesão à terapia antirretroviral (OR=0,26; IC95%=0,09-0,69; p=0,007), ter consulta na otorrino (OR=3,9; IC95%=1,27-12,51; p=0,018), ter consulta no serviço social (OR=6,36; IC95%=1,53-44,36; p=0,024) e ter faltado em consultas de rotina (OR=13,01; IC95%=3,42-86,81; p=0,001). Conclusões: O Método PELC abre a discussão de uma nova linha de pesquisa para estudos locais ou multicêntricos de linhas de cuidado / Abstract: Introduction: Actions are linked in lines of care to organize the course of assistance of the healthcare consumer. Method: The determination of correlations between concepts and practices of epidemiology, of administration science and of logic of inference for the study of line of care. Results: 1) The creation of the Method of Epidemiological Planning for the Line of Care - PELC - to test and determine the best assistance course and to ensure its quality. The PELC Method compiles a Team of Referees to define the Standard Treatment (ST) of the line of care and its PELC-ST score; compares each line of care (LC) with the Standard Treatment and the result is represented in the PELC-LC score; it creates a base of comparison between the LC-Case Group and the LC-Control Group; installs epidemiological studies to investigate the most determining clinical-social organizational factors for future results of the line of care. In the prospective study, the Management Experiment offers the lines in the LC-Control Group. The Aftercare System monitors the quality of care that is coming. The Self-referred Healthcare researches the degree of health self-perception of the consumer. 2) Application of the PELC Method with the design of case-control in line of care of children and adolescents infected by HIV. Definition of the Standard Treatment with PELC-ST=100 and PELC-RES=51 score (therapeutic success). The analysis of logistic regression have shown the following factors as the most determinant for PELC-RES<20 and for PELC-LC<75: adhering to the antiretroviral therapy (OR=0.26; IC95%=0.09-0.69; p=0.007), have an appointment at the otolaryngologist (OR=3.9; IC95%=1.27-12.51; p=0.018), have an appointment at social services (OR=6.36; IC95%=1.53-44.36; p=0.024) have missed routine appointments (OR=13.01; IC95%=3.42-86.81; p=0.001). Conclusions: The PELC Method opens the debate of a new line of research for local or multicentre studies in lines of care / Doutorado / Epidemiologia / Doutor em Saude Coletiva

Na metrópole de São Paulo, o maior crescimento urbano se deu em direção ao Leste da cidade de forma irregular sob muitos aspectos. Atualmente vivem na Região Leste de São Paulo, quase quatro milhões de pessoas, com pouquíssima oferta de trabalho e de serviços públicos e privados de qualidade. A grande maioria dessa população é dependente do Centro Expandido para usufruir de bons serviços e da ocupação de postos de trabalho, mas com mobilidade urbana atualmente muito comprometida. O objetivo desta tese é demonstrar que o planejamento urbano no Brasil para suas grandes cidades, tomando como exemplo São Paulo, cidade que tem sido pioneira em muitos aspectos nesse campo como em outros, não tem chegado a níveis conclusivos que permitam lidar com a principal problemática urbana: a de oferecer espaços públicos de qualidade enquanto áreas de convivência social através de Planos de Bairro, alcançando o tão necessário desenvolvimento urbano da região do extremo leste e outras regiões carentes do município de São Paulo. Esta tese apresenta uma metodologia para a criação de Planos de Bairro sustentáveis e com qualidade urbana, através da conjunção do sistema de Transporte Público com a política de Uso e Ocupação do Solo, que possa oferecer ao habitante local trajetos curtos entre moradia e trabalho, escola e comércio e a possibilidade de caminhar e praticar atividades ao ar livre por seu bairro, em vias urbanas com qualidade ambiental. / In São Paulo Metropolis, the largest urban sprawl felt towards the East Side of the city in an irregular way under all of the aspects. Nowadays, a population of almost 4 million people lives in the East Region of São Paulo, with a low level of employability offering and public and private services quality, with dysfunctional urban mobility. The objective of this thesis is to demonstrate that urban planning in Brazil for this big cities, taking the example of São Paulo, city which has been a pioneer in many aspects in this field as in others, has not reached conclusive levels that allow to deal with its main urban problems: to offer quality public spaces as areas of social interaction by Neighborhood Urban Plans, reaching the much needed urban development of the extreme east and other needy areas of São Paulo City. This thesis presents a methodology for the creation of sustainable Neighborhood Urban Plans with urban quality, through the conjunction of the Public Transportation System with a policy of Land Use, which can offer to the local inhabitant short displacement between home and work, school and commerce and the ability to walk and practice outdoor activities in his neighborhood, on environment quality full streets.

Na metrópole de São Paulo, o maior crescimento urbano se deu em direção ao Leste da cidade de forma irregular sob muitos aspectos. Atualmente vivem na Região Leste de São Paulo, quase quatro milhões de pessoas, com pouquíssima oferta de trabalho e de serviços públicos e privados de qualidade. A grande maioria dessa população é dependente do Centro Expandido para usufruir de bons serviços e da ocupação de postos de trabalho, mas com mobilidade urbana atualmente muito comprometida. O objetivo desta tese é demonstrar que o planejamento urbano no Brasil para suas grandes cidades, tomando como exemplo São Paulo, cidade que tem sido pioneira em muitos aspectos nesse campo como em outros, não tem chegado a níveis conclusivos que permitam lidar com a principal problemática urbana: a de oferecer espaços públicos de qualidade enquanto áreas de convivência social através de Planos de Bairro, alcançando o tão necessário desenvolvimento urbano da região do extremo leste e outras regiões carentes do município de São Paulo. Esta tese apresenta uma metodologia para a criação de Planos de Bairro sustentáveis e com qualidade urbana, através da conjunção do sistema de Transporte Público com a política de Uso e Ocupação do Solo, que possa oferecer ao habitante local trajetos curtos entre moradia e trabalho, escola e comércio e a possibilidade de caminhar e praticar atividades ao ar livre por seu bairro, em vias urbanas com qualidade ambiental. / In São Paulo Metropolis, the largest urban sprawl felt towards the East Side of the city in an irregular way under all of the aspects. Nowadays, a population of almost 4 million people lives in the East Region of São Paulo, with a low level of employability offering and public and private services quality, with dysfunctional urban mobility. The objective of this thesis is to demonstrate that urban planning in Brazil for this big cities, taking the example of São Paulo, city which has been a pioneer in many aspects in this field as in others, has not reached conclusive levels that allow to deal with its main urban problems: to offer quality public spaces as areas of social interaction by Neighborhood Urban Plans, reaching the much needed urban development of the extreme east and other needy areas of São Paulo City. This thesis presents a methodology for the creation of sustainable Neighborhood Urban Plans with urban quality, through the conjunction of the Public Transportation System with a policy of Land Use, which can offer to the local inhabitant short displacement between home and work, school and commerce and the ability to walk and practice outdoor activities in his neighborhood, on environment quality full streets.

No / The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2019-01-23T16:37:04Z No. of bitstreams: 1 Ana Gonçalez.pdf: 1703059 bytes, checksum: a04fbb3e23e280d09e42e7b689c1218f (MD5) / Made available in DSpace on 2019-01-23T16:37:04Z (GMT). No. of bitstreams: 1 Ana Gonçalez.pdf: 1703059 bytes, checksum: a04fbb3e23e280d09e42e7b689c1218f (MD5) Previous issue date: 2018-08-09 / A obesidade na criança e adolescente é uma doença crônica, epidêmica, de alta prevalência, multicausal e de complexa abordagem a qual envolve vários profissionais de saúde. Muitas pesquisas apontam para as dificuldades no enfrentamento da doença, no entanto, raros discorrem sobre as experiências dos profissionais de saúde que atuam no serviço público prestando cuidados a essas crianças e adolescentes, sobretudo a respeito das práticas e desafios enfrentados por eles durante o manejo desta doença nos diversos componentes de saúde. Este estudo buscou compreender, na perspectiva dos profissionais de saúde, como estes percebem suas práticas e respectivos desafios na assistência a esse público no serviço e entre os componentes de saúde. Trata-se de uma pesquisa qualitativa, mediante entrevista semiestruturada com profissionais de saúde que atuam no SUS na assistência com obesidade na criança e no adolescente de duas regiões da cidade de São Paulo. A captação da população foi por intermédio de indicação em bola de neve, de forma que contemplasse diversidades entre às formações profissionais, bem como à atuação nos diferentes componentes de atenção. Para a composição final da população deste estudo foi usado o critério de saturação teórica e o percurso analítico foi norteado pela análise de conteúdo temático. A captação encerrou-se com 16 profissionais, sendo 5 da atenção primária, 4 da secundária, 6 da terciária e um gestor da rede. Eles revelaram que as relações de trabalho com a equipe multiprofissional do respectivo serviço são positivas; o manejo da obesidade em crianças e adolescentes é complexo e desafiador pois o sistema de saúde apresenta problemas e não funciona na sua plenitude; quanto ao conhecimento sobre diretrizes que contemple a obesidade neste público, a maioria disse desconhecer e despontaram que suas atividades são baseadas em normas da instituição onde atuam assim como em suas práticas; a maioria não se articulava adequadamente entre os diferentes componentes de saúde; revelaram falhas no fluxo de referência e contra referência; disseram haver lacunas nos registros pois, as informações referentes a saúde do paciente não são integradas entre os diversos componentes de saúde; os profissionais não perceberam diferenças nas atribuições e competências por nível de atenção. Concluiu-se, a partir da prática e percepção desses profissionais de saúde, que eles enfrentam muitas adversidades os quais, por vezes, interferem em suas práticas gerando serviços nem sempre com a qualidade e articulação desejadas. Há diversidade de materiais e instrumentos norteadores para o manejo da obesidade, mas, poucos deixam claro condutas e fluxos que deverão ser seguidos, pois, são genéricas e não consideram as singularidades da criança e do adolescente. / Child and teenage obesity is a chronic, epidemic, high prevalence, multicausal and hard to approach disease, which involves multiple health professionals. Many researches show difficulties in facing the disease, but very few discourse on the experiences of the health professionals that work on the public service taking care of these youngsters, especially about the practices and challenges faced by them during the management of this disease in the different components of healthcare. This study aims to comprehend, through the perspective of the health professionals, how they perceive their practices and the respective challenges in the assistance to this public in the health system and in it¿s components of care. This is a qualitative research, conceived through semi structured interview with health professionals that act in SUS in the assistance of obese children and teenagers in two regions of São Paulo. The captation of the population was fulfilled by means of snowball indication, in such a way that it included diversity of professional formation and fields of actuation. To the final composition of the population, it was used the theoretical saturation criteria and the analytical path was guided by means of thematic content. The captation finished with 16 professionals, being 5 from the primary care, 4 from the secondary, 6 from the tertiary and one network manager. They revealed positive work relationships with the multiprofessional team of their respective level of care; the management of obesity in children and teenagers is complex and challenging because the health system presents problems and doesn¿t work in it¿s plenitude; regarding the awareness of the guidelines that cover obesity in this public, most of them declared not to have knowledge and pointed that their activities and practices are based on the norms of the institutions they work at; most didn¿t articulate well between the different components of healthcare, revealing reference/counter reference flow failures and gaps in the records due to the non integration of the patient's information about their health among the different levels of healthcare; the professionals didn¿t point differences between the attributions and competences of different levels of care. It was then concluded, from the practices and perceptions of these health professionals that act on the public network in the treatment of obese children and teenagers, that they face many adversities that, sometimes, interfere with their practices, resulting in services that may not reach the desired quality and articulation. There is a wide range of materials and instruments that guide the handling of obesity, but few are clear on the conducts and flows to be taken with obese children and teenagers as they are generic and don¿t consider the particularities of this public.