Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-12-16T14:50:00Z No. of bitstreams: 1 isabelcristinaweissdesouza.pdf: 2197570 bytes, checksum: 489bf8c299e3c543850c7b1898858eee (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-12-19T12:36:34Z (GMT) No. of bitstreams: 1 isabelcristinaweissdesouza.pdf: 2197570 bytes, checksum: 489bf8c299e3c543850c7b1898858eee (MD5) / Made available in DSpace on 2016-12-19T12:36:34Z (GMT). No. of bitstreams: 1 isabelcristinaweissdesouza.pdf: 2197570 bytes, checksum: 489bf8c299e3c543850c7b1898858eee (MD5) Previous issue date: 2010-04-16 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introdução: Entre 10% a 20% dos pacientes tratados em Atenção Primária à Saúde (APS) fazem uso de álcool em níveis considerados de risco. Para que ações de prevenção sejam desenvolvidas neste nível de atenção, é fundamental a capacitação das equipes, segundo o Ministério da Saúde. Porém muitas são as barreiras que podem impedir a adoção de um procedimento na prática de rotina. Objetivo: o presente estudo procurou avaliar práticas de prevenção ao uso de risco de álcool e outras drogas adotadas entre enfermeiros da APS capacitados em modalidades presencial, à distância e profissionais não capacitados, assim como os possíveis entraves neste processo. Método: Os dados foram coletados durante os meses de outubro e novembro de 2008, através de entrevistas com sete enfermeiras que atuam na APS, sendo a análise de conteúdo o procedimento analítico adotado, que nos possibilitou a eleição de seis temas: capacitação; práticas; atitudes; crenças sobre álcool e outras drogas; conhecimentos específicos sobre tratamentos para álcool e outras drogas; sentimentos envolvidos ao lidar com o tema álcool e outras drogas. Resultados: Os resultados nos remetem à necessidade de um espaço de discussão permanente subsequente às capacitações, que serviria de reforço, a médio prazo, para a capacitação, podendo contribuir para identificação das dificuldades dos profissionais, troca de experiências, aumentando o senso de autoeficácia para lidar com esta demanda. No entanto, um possível efeito positivo da capacitação foi sentido entre os grupos treinados, uma vez que estes não deram ao problema álcool e outras drogas a conotação moral dada pelo grupo não treinado, o que pode representar uma abertura a ações educativas futuras. Considerações finais: Ainda prevalece a subutilização de práticas baseadas em evidência no tocante a álcool e outras drogas entre as profissionais, corroborando a literatura que aponta, no Brasil, ações de saúde mental, como um todo, estando descontextualizadas com a prática sanitária. Assim como mostrou ser ainda prevalente a lógica de encaminhamentos, referência e contra-referência. / Introduction: Between 10-20% of patients treated in Primary Health Care (PHC) drink alcohol at levels considered risky. For preventive actions to be developed at this level, it is essential to train the teams, according to the Ministry of Health of Brazil. However, there are many barriers that may prevent the adoption of a procedure in routine practice. Objective: This study sought to evaluate practices of prevention against the risky use of alcohol and other drugs adopted amongst PHC nurses trained in different modalities – present and at a distance and also un-trained professionals, as well as possible obstacles in this process. Method: Data were collected during October and November 2008. Seven nurses were interviewed who were working in the PHC. For this study a content analysis was adopted as the analytical procedure. We followed a semi-structured model of interview which enabled us the analysis of six themes: training, practices, attitudes, beliefs about alcohol and other drugs; feelings involved in dealing with the topics of alcohol and other drugs. Results: The results suggest the need for a permanent forum for discussion subsequent to training that would serve to strengthen, at medium term, for training, contributing then to identification of difficulties of professional exchange of experiences, increasing the sense of self-efficacy for dealing with this demand. However, a possible positive effect of training was felt among the trained groups, since they did not give the problem alcohol and other drugs the moral connotation given by the non-trained group, which may represent an opening to future educative actions. Conclusion: The underutilization of evidence-based practice in relation to alcohol and other drugs is still prevailing among professionals, supporting the literature that points in Brazil, the mental health services as a whole, being decontextualised with the sanitary practice. The logic of referrals, reference and counter reference also proved to be still prevalent.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-03-02T19:11:12Z No. of bitstreams: 1 ritamariarodriguesbastos.pdf: 1524374 bytes, checksum: 8535080e6aa7b72c421e1b656a44a254 (MD5) / Rejected by Adriana Oliveira (adriana.oliveira@ufjf.edu.br), reason: Verificar se realmente ñ tem abstract on 2016-06-02T14:18:04Z (GMT) / Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-02T14:27:23Z No. of bitstreams: 1 ritamariarodriguesbastos.pdf: 1524374 bytes, checksum: 8535080e6aa7b72c421e1b656a44a254 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-02T13:09:48Z (GMT) No. of bitstreams: 1 ritamariarodriguesbastos.pdf: 1524374 bytes, checksum: 8535080e6aa7b72c421e1b656a44a254 (MD5) / Made available in DSpace on 2016-07-02T13:09:48Z (GMT). No. of bitstreams: 1 ritamariarodriguesbastos.pdf: 1524374 bytes, checksum: 8535080e6aa7b72c421e1b656a44a254 (MD5) Previous issue date: 2013-04-05 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A necessidade de se avaliar as políticas de saúde implementadas para a estruturação da atenção primária em todo o território nacional levou o Ministério da Saúde a institucionalizar indicadores de avaliação já utilizados em diversos países, entre eles, as Internações por Condições Sensíveis à Atenção Primária (ICSAP). Objetivo: Avaliar a atenção primária no Estado de Minas Gerais entre 2000 e 2011, com o uso do indicador ICSAP. Métodos: Trata-se de um estudo ecológico dos municípios mineiros, utilizando dados do Sistema de Informação Hospitalar, Sistema de Informação Ambulatorial, Departamento de Informática do Sistema Único Brasileiro, Censos 2000-2010 e dados do Instituto Brasileiro de Geografia e Estatística. A dimensão espacial correspondeu ao estado de Minas Gerais e a dimensão temporal teve como limites os anos de 2000 e 2011. Ambas foram submetidas a três recortes, para que a análise das ICSAP fossem realizadas sob diferentes perspectivas. Utilizou-se os municípios mineiros como unidades de análise, agregando-os por Regionais de Saúde (RS). Analisou-se as taxas de ICSAP quanto à permanência hospitalar, proporção de óbitos e relação com a cobertura pela Saúde da Família. Foram comparados os anos de 2000 e 2010. Posteriormente os municípios foram analisados no triênio 2009-2011, utilizando-se a análise das internações por infecções de rins e trato urinário sensíveis à atenção primária (IRTU-CSAP) em indivíduos enrte 40 e 59 anos, agregando-os por RS, porte populacional e cobertura pela saúde da família. As IRTU-CSAP foram analisadas, por sexo, quanto à permanência hospitalar, proporção de óbitos e os gastos com as internações. Por fim, analisou-se as causas mais freqüentes de ICSAP por sexo e faixa etária no município de Juiz de Fora, comparando-se os quadriênios 2002-2005 e 2006-2009. Para as análises estatísticas foram utilizados o Teste t para dados pareados, Anova seguida do teste post hoc de Scheffe e Dunnett T3 e correlação de pearson. Resultados: As taxas gerais de ICSAP no estado diminuíram entre 2000 e 2010, mas não foram observadas correlação com a expansão da Estratégia de Saúde da Família. As RS que apresentaram maiores taxas foram as de Ubá e Leopoldina. As causas mais freqüentes das hospitalizações foram a Insuficiência Cardíaca e as Gastroenterites. Algumas causas apresentaram aumento das taxas, a exemplo das Infecções de Rim e Trato Urinário, tornando-se a terceira causa mais freqüente no estado, em 2010. A permanência hospitalar e a proporção de óbitos por ICSAP aumentaram no estado. Juiz de Fora se destacou por ser sede de uma das 7 duas únicas RS que apresentaram elevação das taxas de ICSAP no estado. Conclusão: As iniciativas governamentais, como a expansão da Estratégia de Saúde da Família e a Regionalização da Saúde, não foram efetivas para a diminuição das internações por condições sensíveis à atenção primária em Minas Gerais. As características dos municípios influenciaram de formas distintas no comportamento das taxas, permanência hospitalar e proporção de óbitos por ICSAP. Evidencia-se aumento das desigualdades entre algumas Regionais de Saúde, o que alerta para a necessidade de se priorizar a estruturação da atenção primária em regiões do estado onde as internações potencialmente evitáveis permanecem mais elevadas. / The need to evaluate the health policies implemented for the structuring of primary care nationwide prompted the Ministry of Health to institutionalize assessment indicators already in use in several countries, including the indicator Hospitalizations for Primary Health Care Sensitive Conditions (HPHSC). Objective: To evaluate the primary care in the State of Minas Gerais, between 2000 and 2011, using the indicator HSPHC. Methods: This is an ecological study of Minas Gerais municipalities, using data from the Hospital Informations System, Ambulatory Information System, Computing Department of System Unique of Healph, and 2000- 2010 Census data from the Brazilian Institute of Geography and Statistics. The spatial dimension corresponded to the state of Minas Gerais and the temporal dimension was limited to the years between 2000 and 2011. Both were subjected to three selections, so that an analysis of HPHSC were performed under different views. Used the Minas Gerais municipalities as units of analysis, aggregating them by Regionals Health (RH). HPHSC rates were analyzed regarding to hospital stay, proportion of deaths and the relation with coverage by Family Health. The years between 2000 and 2010 were compared. Subsequently, the cities were analyzed in the three-years period 2009-2011, using the analysis of hospitalizations for infections of the kidneys and urinary tract sensitive to primary health (IKUT-PH) in individuals from 40 to 59 years, aggregated by RH, population size and coverage by family health. The IKUT-PH were analyzed by sex, regarding to hospital stay, number of deaths and costs of hospitalizations. Finally, were analyzed the most frequent causes of HPHSC by sex and age in the city of Juiz de Fora, comparing the four-years periods 2002-2005 and 2006-2009. For statistical analyzes we used the t test for paired data, ANOVA followed by post hoc Dunnett T3 and Scheffe test and correlation of Pearson. Results: Overall rates of HPHSC in the state declined between 2000 and 2010, but were not verified any correlations with the expansion on the Family Health Strategy. The RH showed that the highest rates were in Ubá and Leopoldina. The most frequent causes of hospitalization were heart failure and gastroenteritis. Some causes had higher rates, such as infections of the Kidney and Urinary Tract, making it the third most frequent cause in the state in 2010. The hospital stay and the proportion of deaths for HPHSC increased in the state. Juiz de Fora is highlighted as home to one of only two RH in which the HPHSC rate increased in the State. Conclusion: The governmental actions, such as the expansion of the Family Health Strategy and the Health Regionalization, were not efective on decreasing the HPHSC in Minas Gerais. The characteristics of the municipalities affected in different ways in the behavior of rates, hospital stay and proportion of deaths by HPHSC. It is evidenced an increase in inequalities among the Regionals Health, what warns to the need of structuring the primary care in some regions of the State where the hospitalization due to potentially avoidable causes remains high.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The revised Infant and Young Child Feeding Policy (IYCFP) 2013 encourages HIV-positive mothers to also exclusively breastfeed for six months, and to continue breastfeeding for a year with introduction of appropriate complementary feeding, while their children receive antiretroviral treatment. The aim of this study was to determine knowledge and practices of the Primary Health Care Workers (PHCWs) related to the implementation of the revised IYCFP 2013 in the Blouberg Municipality of Capricorn District, Limpopo Province. Methods: A quantitative descriptive study was conducted on 103 PHCWs. The questionnaire was closed ended. The questionnaire was developed based on the contents of the revised IYCFP 2013. A simple random sampling technique was used to sample nurses irrespective of the category. Data were analyzed through SPSS Software v23.0. Results: Most participants were females (91.3%), category were Professional Nurses (44.7%), aged between 31 and 40 years (44.7%) and also mostly worked for >10 years (56.3%). The results revealed that 97.1% of the participants have good knowledge about infant and young child feeding, 68% of participants were not trained on the revised IYCFP 2013, resulting to only 32% of participants having a good practice of this policy. Also 44.7% of the participants reported that they were not aware if clinics had a copy of this policy. The results further revealed that 92.2% of the participants reported that clinics still receive, keep and issue infant formula to HIV positive mothers, which maybe the reason the dieticians still receive requests for Infant Formulas to be delivered to HIV-positive mothers. Conclusion: There is a need for monitoring and evaluation to ensure availability and vi implementation of the revised IYCFP 2013; and also the need for in-service training on this policy in order to improve the capacity to implement the revised IYCFP 2013. Key Concepts Revised IYCFP 2013; knowledge; practice; implementation; PHCWs; infant and young child feeding.

MPM / Oliver Tambo Institute of Governance and Policy Studies

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Late antenatal care (ANC) booking delays treatment and management of high-risk pregnancies, which may result to maternal deaths. Early ANC booking has been found to be effective in most of the pregnancy related risk factors that can be detected and managed at early stages of pregnancy. Aim: The aim of the study was to investigate the prevalence and factors contributing to late ANC booking amongst pregnant women in primary health care facilities at Dikgale-Mamabolo local area. Methods: Quantitative cross-sectional research approach was used. The study was conducted at Dikgale-Mamabolo local area, which consists of seven clinics at Polokwane, Limpopo province in South Africa. Only three clinics were purposefully selected for the study. The population of the study included pregnant women who were 18 years and above. The sample size consisted of 238 pregnant women who came for ANC services in primary health care facilities during the period of the study. Convenience sampling method was used to select pregnant women from the population. Data was collected using an adapted questionnaire. Data was analysed using Statistical Package for Social Sciences (SPPS) version 25. Results: The results indicated that 86% of pregnant women booked antenatal care before five months gestational age and 14% booked after five months gestational age. Factors contributing to late ANC booking amongst pregnant women were marital status, educational level, employment status, mode of transport to clinic, lack of information, cultural beliefs, long distance to the clinic, long waiting time in the clinic and clinic operating hours. Conclusion: Late ANC booking remains a major public health issue. The study showed that lack of information and cultural beliefs are major contributing factors to late ANC booking. It is recommended that awareness campaigns should be conducted in the community and schools to empower women with knowledge about ANC services.

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2020 / The integration of mental health care (MHC) into primary health care (PHC) has been identified as a practical intervention to: increase accessibility to mental health care; reduce stigma and discrimination against people living with mental illnesses; improve the management of chronic mental illness; and, to reduce the burden of comorbidity of mental illnesses with other chronic illnesses. In the South African context, integrating MHC into PHC also seeks to respond to numerous legislative reforms, with the aim of providing comprehensive health care, particularly to previously disadvantaged populations. The aim of the present study was to explore the perceptions of facility managers in the Tshwane District (Gauteng Province) towards the integration of mental health into PHC. Fifteen participants from the Tshwane district facilities participated in the study. The participants were selected through a non-probability purposive sampling method. Data was collected through in-depth interviews using a semi-structured questionnaire, and analysed using the thematic coding approach. Significant findings suggested that the major hindrances to the realisation of the policy objectives may be due to: the lack of rehabilitation and psychotherapeutic services; insufficient skill and knowledge of mental health on the part of staff; insufficient or unsuitable practice space in the facilities; and, poor cooperation between South African Police Services, Emergency Medical Services and Primary Health Care. Inter-facility communication, district implementation support and policy knowledge has notably increased over the years and were deemed to be amongst the biggest enablers.

The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed. / <p>S. 1-82: sammanfattning, s. 85-199: 7 uppsatser</p> / digitalisering@umu

The purpose of this study was to describe and compare the perceptions of the registered nurses and the nurse managers regarding the role of the registered nurse in integrated primary health care. Quantitative, descriptive research was conducted to determine if there were any discrepancies between role perceptions and role expectations. Data collection was done using structured questionnaires. Two groups of respondents participated in the study. The registered nurse group (n=40) provided direct clinical care in integrated primary health care settings. The second group was composed of nurse managers (n=20) managing integrated primary health care services. The findings revealed that there are some areas where there is lack of congruence between the perceptions of registered nurses and nurse managers regarding the functions that registered nurses perform. These differences may result in confusion and role conflict among registered nurses, which can ultimately impede the attainment of integrated primary health care goals. / Advanced Nursing Sciences / M.A.(Nursing Science)

Submitted in fulfilment of the requirements for D.Tech: Nursing in the Faculty of Health Sciences, Durban University of Technology, 2009. / BACKGROUND In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization by increasing the accessibility of all services at Primary Health Care (PHC) level. However, the problem with the policy arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. Hence, there is a need for shared views on this phenomenon. METHODS A cross-sectional study, using a qualitative approach was employed in this study in order to analyze IPHC in KwaZulu-Natal (KZN). A grounded theory approach was selected as it is a method known for its ability to make the greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews was comprised of 38 participants. RESULTS It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop. Based on the findings of the study, it was concluded that the phenomenon, IPHC meant different things in different contexts. / Durban University of Technology, Research Post Grad Development and Support Departments

Thesis (MA (Psychology))--University of Stellenbosch, 2009. / The importance of delivering psychological services, particularly in disadvantaged communities is acknowledged by policy makers. Yet, little information exists about how communities view psychologists and psychological services. This study explores how key informants and primary health care service users in a peri-urban community in the Western Cape perceive psychologists and their profession. Focus groups were conducted with primary health care service users and in-depth interviews were conducted with key informants. Results were content analysed. These results indicate that this community’s conceptualisation of psychology incorporates both Western and indigenous notions and concepts which are utilised simultaneously. Psychology is viewed positively as a profession that can aid individuals and groups in dealing with and resolving intra- and interpersonal problems and conflicts. Those with mental health problems are still subject to a great deal of stigmatisation. The fear of being labelled makes the utilisation of the services of a psychologist or other mental health professional highly unlikely in several instances. This problem is exacerbated by issues related to the availability of and access to such services, as well as the quality of available care. Nonetheless, these participants state that psychologists themselves can make a positive contribution to addressing these issues, starting with active involvement in communities and providing information regarding the nature and value of the work they do. This information is critical if we are to design and implement comprehensive intervention strategies that allow for meaningful and informed participation within communities.