Cette thèse contribue à l’analyse des relations entre santé, revenu et politiques de santé. Il m’a semblé nécessaire de mener cette recherche pour chaque direction de la relation. Ainsi, le 1er article étudie la solvabilité financière de différentes politiques de lutte contre le SIDA grâce à un modèle de microsimulation. La santé y est vue comme un facteur de production ; son amélioration génère des gains de productivité. Cette analyse montre que les programmes de traitement peuvent générer un surplus économique et ce net des coûts engendrés. Le 4ème article étudie la relation entre santé infantile et milieu social d’origine à partir d’une enquête internationale. Les analyses montrent que si un gradient socio-économique de santé s’impose à tous à travers le globe (les enfants issus de milieux pauvres sont en moins bonne santé), ce gradient varie selon le niveau de revenu et d’offre de soin du pays considéré. Les deux autres articles s’intéressent aux problèmes de mesures liés à la mise sous traitement des agents malades : le poids de ces derniers dans la population augmente. Au niveau macroéconomique, le PIB par habitant pourrait diminuer si les traitements ne permettent pas de maintenir un niveau de productivité suffisant. Les analyses dans le cadre du VIH montrent que cet effet pervers ne supplante pas les effets positifs. Cette problématique est élargie à la mesure du bien être dans le 3ème article de la thèse. En ne s’attachant qu’aux populations vivantes, les indicateurs traditionnels ne tiennent pas compte du fait que certains agents auraient pu être maintenus en vie (avec un bien être moindre). Les comparaisons inter-pays pourraient ainsi être faussées. / This dissertation aims at improving our understanding of the links between health and wealth, and between health programs and macroeconomic outcomes. Because the former might be bi-directional, it seemed sensible to tackle this issue for each direction of the causality. In the 1st paper, I examine using microsimulation the financial solvability of alternative policies against HIV. Health improvements at the individual level generate productivity gains which translate into an economic surplus that outweighs programs’ costs. In the 4th paper, I examine the relationship between child health and social background using an international survey. Analysis reveals a substantial gradient in health: across the globe, poorer children have worse health. Yet, the effect of wealth is moderated by country-level income and health-supply variables. The two other papers focus on rather methodological issues raised by the fact that curative programs save lives but increase the prevalence of the disease. One study highlights that average income could fall if treatments cannot guarantee a sufficient level of productivity among sick workers. Despite this adverse effect, the microsimulation model demonstrates that treatment policies can raise per capita income in the context of HIV. The 3rd paper of the thesis extends this message to welfare measurement. By restricting attention to the living population, standard indicators of welfare ignore the fact that individuals who would otherwise be dead can be kept alive through treatment, but with a lower than average welfare. Cross-country comparisons based on indicators that are made invariant to the population size may therefore be biased.

La compilation traditionnelle est confrontée à de nombreux défis face aux besoins d'optimisations de programmes pour architectures parallèles. Un défi particulier est la conception de langages et représentations intermédiaires (RIs) appropriés.Bien que différentes RIs aient été proposées pour repousser les limites de la compilation traditionnelle, la plupart ne sont toujours pas adaptées pour appliquer des transformations de programmes pertinentes.Différentes alternatives sont donc de plus en plus exploitées, telles que l'autotuning ou la compilation interactive. Ces dernières nécessitent l'usage de langages intermédiaires fondamentalement différents, par exemple, les méta-langages pour la transformation de programmes. Dans cette thèse, centrée sur les besoins en applications numériques, nous étudions ce type de meta-langages; nous adressons particulièrement quatre questions:(i) Comment introduire une expressivité spécifique à un domaine?(ii) Comment repenser leur conception pour améliorer leur flexibilité dans la composition de transformations et la génération de plusieurs variantes de programme?(iii) Jusqu'où pouvons-nous introduire du support pour le NUMA (Non-Uniform Memory Access)?(iv) En tant que nouvelle classe de méta-langages, comment formaliser leur sémantique? Nous répondons à ces questions au travers de la conception et la sémantique de TeML, un méta-langage pour l'optimisation d'applications tensorielles. / Traditional compilation faces numerous challenges with program optimizations for parallel architectures. A particular challenge is the design of proper intermediate languages and representations to enable the application of relevant optimization techniques.Various parallel intermediate representations and languages have been proposed.To overcome this issue, different alternatives are more and more exploitedsuch as empirical autotuning or interactive compilation. Such alernatives require fondamentally different typesof intermediates languages such as transformation meta-languages. In this thesis, we study transformation meta-languages for numerical applications: wa particularly address four questions:(i) How do we introduce domain-specific expressiveness?(ii) How do we rethink their design to enhance their flexibility in composing optimizations paths and generating multiple program variants?(iii) How far can we introduce NUMA (Non-Uniform Memory Access) awareness?(iv) As a new class of meta-languages, how do we formalize their semantics? We answer these questions through the design and semantics of TeML, a tensor optimizations meta-language.

A pesquisa aborda a definição de políticas e processo de implantação das ações de saúde mental e da pessoa com deficiência em serviços municipais em São Paulo, na região de São Miguel Paulista, entre 1989-1995, não havendo anteriormente proposta assistencial organizada para esses grupos. Foi realizada através da análise de textos oficiais, de entrevistas com profissionais da assistência direta, gerentes e planejadores e com representantes do movimento social e da organização de banco de dados de pacientes atendidos, segundo idade, moradia, escolaridade e hipótese diagnóstica. Buscou-se descrever o processo de criação de serviços, conforme a proposta assistencial, identificar seus atores e os principais problemas, nos três distritos de saúde da região de São Miguel. No período pesquisado, a Secretaria Municipal de Saúde de São Paulo passou por transformações institucionais, desde a criação das Administrações Regionais e Distritos de Saúde para a construção do Sistema Único de Saúde - SUS (1989-92) até a proposição do Plano de Assistência à Saúde PAS em 1995. A proposta de saúde mental tinha como diretrizes o combate à cultura manicomial através da criação de serviços e da estruturação do sistema de atendimento e da mobilização de técnicos, usuários e população em geral, para a discussão dos temas do movimento da luta antimanicomial. A atenção à pessoa com deficiência dependeu mais da iniciativa de profissionais do que de uma proposta articulada institucionalmente. Em 1991 foi criado serviço pioneiro de fisioterapia nas enfermarias do Hospital Geral de Ermelino Matarazzo, que com a ampliação da equipe, torna-se referência para atendimento em reabilitação daqueles que passaram por internação. Por pressão do movimento de pessoas deficientes, a proposta de atenção a esse grupo foi apresentada em abril de 1992. Defendia-se a incorporação de ações em unidades básicas de saúde - UBS, hospitais gerais e a criação de centros de reabilitação regionais. As características assistenciais dos serviços definiram o perfil dos usuários atendidos por demanda espontânea. As mulheres, 52,9 por cento dos usuários, tinham idade média de 38 anos e os homens (47,1 por cento ) com idade média de 28 anos. Os homens mais jovens estavam nos Centros de Convivência e Cooperativa - CECCO e UBS. Os usuários mais velhos eram mulheres, na Unidade de Reabilitação e em algumas UBS. Os Hospitais-Dia - HD e a Enfermaria Psiquiátrica acompanhavam predominantemente psicóticos, as UBS, crianças com problemas de aprendizagem e adaptação à escola e, também, adultos psicóticos quando contavam com psiquiatra. A unidade de reabilitação caracterizava-se como serviço de fisioterapia para pessoas com disfunções traumato-ortopédicas. Os CECCO atendiam a grupos de jovens e adultos com deficiência mental, e psicóticos. Identificou-se como a maior dificuldade a estruturação da assistência nas UBS, serviços que historicamente priorizaram a assistência materno-infantil. Problemas como a falta de espaço e recursos materiais específicos para o trabalho dos profissionais eram constantes, mais graves entre 1993-95. Já nos serviços para grupos específicos (CECCO, HD, Enfermaria Psiquiátrica e Unidade de Reabilitação) as dificuldades estavam na organização do trabalho interdisciplinar e na capacidade dos profissionais aceitarem o desafio técnico de criar e gerir novas instituições. Esperava-se uma integração interinstitucional entre os serviços criados que, na prática, se mostrava impossível, dificultando a assistência a portadores de transtornos graves. Entre 1993 e 1995, com a mudança de governo houve o abandono de prioridades anteriores como política salarial, diretrizes de descentralização e autonomia dos serviços locais, provocando êxodo de profissionais e descaracterizando os serviços. Alguns técnicos que estavam em cargos de confiança na gestão anterior, permaneceram em função assistencial, na defesa da proposta, principalmente nos HD e nos CECCO. O curto período (1991-95) para definir e implantar políticas, a diversidade temporal para obtenção dos vários insumos necessários e as dificuldades de incorporação das propostas em vários níveis, além da ruptura para outra administração dificultaram a continuidade da experiência. A marca das propostas foi a defesa da universalização contribuindo para possíveis mudanças nas condições de exclusão social desses grupos, aumentando sua visibilidade social. A existência e permanência dessas experiências dependeram da sensibilidade e compromisso de gestores e do engajamento cotidiano dos profissionais e população na sua construção, mais do que da continuidade necessária na Administração Pública / This study approaches the definition of the polices and the process for the implementation of interventions in mental health and for people with disabilities in municipal services in Sao Paulo, in the region of Sao Miguel Paulista, between 1989-1995, whereas no assistance proposal was organized for these groups before this period. This study was accomplished by analyzing official documents, interviewing professional, managers and projectors, and representatives of the social movement, and organizing data bases of patients according to age, residence, scholarship and diagnosis hypothesis. This investigation describes the process of upbringing services, accordant to the assistance proposal, identifying role players and the main problems, em all three districts of health from Sao Miguel region. During the period of this research, the Municipal Secretary of Health of Sao Paulo went throw institutional changes, since the creation of Regional Administrations and Health Districts to construct Sistema Único de Saúde - SUS (1989-92) until the proposition of Plano de Assistência à Saúde PAS in 1995. The proposal for mental health was focused to combat the asylum culture by creating services and structuring the assistance system and with the mobilization of professionals, clients and the general population, to discuss the movement against asylums. The attention for people with disabilities depended on professional initiative than an institutional proposal. In 1991 the first Physical Therapy service in infirmary was introduced in the General Hospital of Ermelino Matarazzo, that after enlarging the team, it became reference for rehabilitation of former inpatients. Due to pressure coming from the movement in favor to people with disabilities, the proposal for this group was presented in April of 1992. It defended the incorporation of interventions in primary health units, general hospitals and the creation of centers of regional rehabilitation. The assistance characteristics of each service defined the profile of their clients by spontaneous demand. The women, 52.9 per cent , had average age of 38 and men (47.1 per cent ) 28. The younger men were found in CECCO and UBS. The elderly women in Rehabilitation Units and in some UBS. The HD and the psychiatric infirmary accompany mainly psychotics, while UBS, children with learning disabilities and adults, psychotic where a psychiatrist was available. The rehabilitation unit is characterized as a Physical Therapy Service for people with trauma-orthopedics dysfunction. The CECCO assist groups of teenagers and adults with mental handicap and psychotic. The major difficulty was identified as being the structuring of UBS, service that historically gave priority to mother-infant assistance. Problems like lack of space and specific material for professionals to be able to work were constant, more severe between 1993-95. Em services for specific groups (CECCO, HD, Psychiatric Infirmary and Rehabilitation Unit) the difficulties was organizing the interdiscipline work and the capacity of professional to accept the technical challenge to create and generate new institutions. It was expected a interinstitutional integration between services created, which was considered impossible, making it difficult to assist severe disorders. Between 1993 and 1995, while the government changed there was an abandonment of former priorities like salary polices, decentralization and autonomy of local services, provoking exodus of professionals and discharacterizing the services. Some professionals from former management maintain their assistencial function, to defend the proposal, mainly in HD and CECCO. The short period (1991-95) to define and implement polices, the diversity to obtain whats necessary and the difficulty to incorporate the proposals in many levels, other than the rupture of the administration made it difficult to continue the experience. The demarcation of the proposals was the defense of universality contributing to possible changes of the social exclusion condition of these groups, increasing their social visibility. The existence and permanence of this experience depended on the sensibility and engagement of managers and the daily commitment of professional and population in its construction, more than in continuity necessary for Public Administration

La vérification à l’exécution est une méthode formelle légère qui consiste à vérifier qu’une exécution d’un système est correcte par rapport à une spécification. La spécification exprime de manière rigoureuse le comportement attendu du système, en utilisant généralement des formalismes basés sur la logique ou les machines à états finies. Alors que la verification a l’éxecution traite les systèmes monolithiques de manière exhaustive, plusieurs difficultés se présentent lors de l’application des techniques existantes à des systèmes décentralisés, c-à-d. des systèmes avec plusieurs composants sans point d’observation central. Dans cette thèse, nous nous concentrons particulièrement sur trois problèmes : la gestion de l’information partielle, la séparation du déploiement des moniteurs du processus de vérification lui-même et le raisonnement sur la décentralisation de manière modulaire et hiérarchique. Nous nous concentrons sur la notion de spécification décentralisée dans laquelle plusieurs spécifications sont fournies pour des parties distinctes du système. Utiliser une spécification décentralisée a divers avantages tels que permettre une synthèse de moniteurs à partir des spécifications complexes et la possibilité de modulariser les spécifications. Nous présentons également un algorithme de vérification général pour les spécifications décentralisées et une structure de données pour représenter l’exécution d’un automate avec observations partielles. Nous développons l’outil THEMIS, qui fournit une plateforme pour concevoir des algorithmes de vérification décentralisée, des mesures pour les algorithmes, une simulation et des expérimentations reproductibles pour mieux comprendre les algorithmes.Nous illustrons notre approche avec diverses applications. Premièrement, nous utilisons des spécifications décentralisées pour munir une analyse de pire cas, adapter, comparer et simuler trois algorithmes de vérification décentralisée existants dans deux scénarios: l’interface graphique Chiron, et des traces et spécifications générées aléatoirement. Deuxièmement, nous utilisons des spécifications décentralisées pour vérifier diverses propriétés dans un appartement intelligent: correction du comportement des capteurs de l’appartement, détection d’activité spécifiques de l’utilisateur (Activities of Daily Living, ADL) et composition de spécifications des deux catégories précédentes.En outre, nous élaborons sur l’utilisation de spécifications décentralisées pour la vérification décentralisée pendant l’exécution de programmes parallélisés. Nous commençons par discuter les limitations des approches et des outils existants lorsque les difficultés introduites par le parallélisme sont rencontrées. Nous détaillons la description de zones de parallélisme d’une unique exécution d’un programme et décrivons une approche générale qui permet de réutiliser des techniques de verification à l’éxécution existantes. Dans notre configuration, les moniteurs sont déployés dans des fils d’exécution spécifiques et échangent de l’information uniquement lorsque des points de synchronisation définis par le programme lui-même sont atteints. En utilisant les points de synchronisation existants, notre approche réduit les interférences et surcoûts résultant de la synchronisation, au prix d’un retard pour déterminer le verdict. / Runtime Verification (RV) is a lightweight formal method which consists in verifying that a run of a system is correct with respect to a specification. The specification formalizes the behavior of the system typically using logics or finite-state machines. While RV comprehensively deals with monolithic systems, multiple challenges are presented when scaling existing approaches to decentralized systems, that is, systems with multiple components with no central observation point. We focus particularly on three challenges: managing partial information, separating monitor deployment from the monitoring process itself, and reasoning about decentralization in a modular and hierarchical way. We present the notion of a decentralized specification wherein multiple specifications are provided for separate parts of the system. Decentralized specifications provide various advantages such as modularity, and allowing for realistic monitor synthesis of the specifications. We also present a general monitoring algorithm for decentralized specifications, and a general datastructure to encode automata execution with partial observations. We develop the THEMIS tool, which provides a platform for designing decentralized monitoring algorithms, metrics for algorithms, and simulation to better understand the algorithms, and design reproducible experiments.We illustrate the approach with two applications. First, we use decentralized specifications to perform a worst-case analysis, adapt, compare, and simulate three existing decentralized monitoring algorithms on both a real example of a user interface, and randomly generated traces and specifications. Second, we use decentralized specifications to check various specifications in a smart apartment: behavioral correctness of the apartment sensors, detection of specific user activities (known as activities of daily living), and composition of properties of the previous types.Furthermore, we elaborate on utilizing decentralized specifications for the decentralized online monitoring of multithreadedprograms. We first expand on the limitations of existing tools and approaches when meeting the challenges introduced by concurrency and ensure that concurrency needs to be taken into account by considering partial orders in traces. We detail the description of such concurrency areas in a single program execution, and provide a general approach which allows re-using existing RV techniques. In our setting, monitors are deployed within specific threads, and only exchange information upon reaching synchronization regions defined by the program itself. By using the existing synchronization, we reduce additional overhead and interference to synchronize at the cost of adding a delay to determine the verdict.

Les systèmes critiques basés sur l’arithmétique flottante exigent un processus rigoureux de vérification et de validation pour augmenter notre confiance en leur sureté et leur fiabilité. Malheureusement, les techniques existentes fournissent souvent une surestimation d’erreurs d’arrondi. Nous citons Arian 5 et le missile Patriot comme fameux exemples de désastres causés par les erreurs de calculs. Ces dernières années, plusieurs techniques concernant la transformation d’expressions arithmétiques pour améliorer la précision numérique ont été proposées. Dans ce travail, nous allons une étape plus loin en transformant automatiquement non seulement des expressions arithmétiques mais des programmes complets contenant des affectations, des structures de contrôle et des fonctions. Nous définissons un ensemble de règles de transformation permettant la génération, sous certaines conditions et en un temps polynômial, des expressions pluslarges en appliquant des calculs formels limités, au sein de plusieurs itérations d’une boucle. Par la suite, ces larges expressions sont re-parenthésées pour trouver la meilleure expression améliorant ainsi la précision numérique des calculs de programmes. Notre approche se base sur les techniques d’analyse statique par interprétation abstraite pour sur-rapprocher les erreurs d’arrondi dans les programmes et au moment de la transformation des expressions. Cette approche est implémenté dans notre outil et des résultats expérimentaux sur des algorithmes numériques classiques et des programmes venant du monde d’embarqués sont présentés. / Critical software based on floating-point arithmetic requires rigorous verification and validation process to improve our confidence in their reliability and their safety. Unfortunately available techniques for this task often provide overestimates of the round-off errors. We can cite Arian 5, Patriot rocket as well-known examples of disasters. These last years, several techniques have been proposed concerning the transformation of arithmetic expressions in order to improve their numerical accuracy and, in this work, we go one step further by automatically transforming larger pieces of code containing assignments, control structures and functions. We define a set of transformation rules allowing the generation, under certain conditions and in polynomial time, of larger expressions by performing limited formal computations, possibly among several iterations of a loop. These larger expressions are better suited to improve, by re-parsing, the numerical accuracy of the program results. We use abstract interpretation based static analysis techniques to over-approximate the round-off errors in programs and during the transformation of expressions. A tool has been implemented and experimental results are presented concerning classical numerical algorithms and algorithms for embedded systems.

Introdução: A densidade energética (DE) de alimentos e dietas é apontada como importante fator na regulação do peso corporal e está intimamente relacionada ao consumo energético. Objetivos: Estimar a DE de refeições ofertadas em amostra de empresas inscritas no Programa de Alimentação do Trabalhador (PAT), e analisar a DE da dieta de trabalhadores da cidade de São Paulo e sua associação com características sócio-demográficas. Métodos: A dissertação é composta por dois manuscritos, que analisaram a DE utilizando como métodos de cálculo: a inclusão de todos os alimentos sólidos e das bebidas, excluindo apenas água (DE1); inclusão de todos os alimentos sólidos e bebidas calóricas que contém, no mínimo, 5 kcal/100g (DE2); e a inclusão de todos os alimentos sólidos e exclusão de todas as bebidas (DE3). O primeiro manuscrito avaliou refeições de 21 empresas, pelos métodos DE1 e DE3. Os valores para energia e peso dos alimentos/bebidas foram obtidos pela avaliação do cardápio do almoço em três dias consecutivos. Utilizaram-se testes não-paramétricos nas análises estatísticas. O segundo manuscrito avaliou a dieta de 852 trabalhadores, por meio de recordatório de 24 horas, considerando os três métodos de cálculo da DE. Na análise da relação entre DE e variáveis sócio-demográficas utilizou-se regressão linear. Resultados: Para as refeições oferecidas, a mediana da DE1 foi 1,10 kcal/g e da DE3 foi 1,43 kcal/g. Para a dieta dos trabalhadores, os valores observados foram 1,18 kcal/g (+0,08), 1,22 kcal/g (+0,08) e 1,73 kcal/g (+0,16), considerando os métodos de cálculo DE1, DE2 e DE3, respectivamente. Nos modelos múltiplos de regressão, apenas a variável idade apresentou associação negativa com todos os métodos de DE. Para a DE3, houve incremento da DE para indivíduos não-brancos. Conclusão: Observou-se que a densidade energética das refeições oferecidas pelas empresas estudadas, assim como a dieta dos trabalhadores, em especial dos mais jovens, apresentaram valores elevados. Esses achados sinalizam a necessidade de intervenções nutricionais para promoção de dietas com menor densidade energética, a fim de prevenir a obesidade entre trabalhadores / Introduction: Energy density (ED) of food and diets is considered as an important factor in the regulation of body weight and is intimately tied to energy intake. Aims: To estimate ED of meals offered in a sample of companies enrolled in the Workers Food Program (WFP), and to analyze ED of the diet of workers from the city of São Paulo and its association with socio-demographic characteristics. Methods: The dissertation consists in two manuscripts, which have analyzed ED utilizing as methods of calculation: including all solid food and beverages, excluding water (ED1); including all solid food and beverages containing at least 5 kcal/100g (ED2); including all solid food and excluding all beverages (ED3). The first manuscript evaluated meals from 21 companies, using methods ED1 and ED3. The values for energy and weight of food/beverages were obtaining through the evaluation of the lunch menu during three consecutive days. Non-parametric tests were used for the statistical analyses. The second manuscript evaluated the diet of 852 workers using a 24-hour recall, taking into account the three methods for calculating ED. In the analysis of the relation between ED and socio-demographic variables linear regression was used. Results: For the meals the median of ED1 was 1.10 kcal/g and ED3 1.43 kcal/g. For the workerss diet the ED values observed were 1.18 kcal/g, 1.22 kcal/g and 1.73 kcal/g, considering respectively ED1, ED2, ED3 methods. In the multiple regression models only the age variable was maintained in the final model and showed inverted association with all methods of ED. For ED3 there was an increase of ED for non-white individuals. Conclusion: It was observed that both the energy density of the meals offered by the companies as well as the energy density of the workerss diet, in special the younger ones, showed high values. These findings point out to the necessity of nutritional interventions for promoting diets with lower energy density in order to prevent workerss overweight

A pesquisa aborda a definição de políticas e processo de implantação das ações de saúde mental e da pessoa com deficiência em serviços municipais em São Paulo, na região de São Miguel Paulista, entre 1989-1995, não havendo anteriormente proposta assistencial organizada para esses grupos. Foi realizada através da análise de textos oficiais, de entrevistas com profissionais da assistência direta, gerentes e planejadores e com representantes do movimento social e da organização de banco de dados de pacientes atendidos, segundo idade, moradia, escolaridade e hipótese diagnóstica. Buscou-se descrever o processo de criação de serviços, conforme a proposta assistencial, identificar seus atores e os principais problemas, nos três distritos de saúde da região de São Miguel. No período pesquisado, a Secretaria Municipal de Saúde de São Paulo passou por transformações institucionais, desde a criação das Administrações Regionais e Distritos de Saúde para a construção do Sistema Único de Saúde - SUS (1989-92) até a proposição do Plano de Assistência à Saúde PAS em 1995. A proposta de saúde mental tinha como diretrizes o combate à cultura manicomial através da criação de serviços e da estruturação do sistema de atendimento e da mobilização de técnicos, usuários e população em geral, para a discussão dos temas do movimento da luta antimanicomial. A atenção à pessoa com deficiência dependeu mais da iniciativa de profissionais do que de uma proposta articulada institucionalmente. Em 1991 foi criado serviço pioneiro de fisioterapia nas enfermarias do Hospital Geral de Ermelino Matarazzo, que com a ampliação da equipe, torna-se referência para atendimento em reabilitação daqueles que passaram por internação. Por pressão do movimento de pessoas deficientes, a proposta de atenção a esse grupo foi apresentada em abril de 1992. Defendia-se a incorporação de ações em unidades básicas de saúde - UBS, hospitais gerais e a criação de centros de reabilitação regionais. As características assistenciais dos serviços definiram o perfil dos usuários atendidos por demanda espontânea. As mulheres, 52,9 por cento dos usuários, tinham idade média de 38 anos e os homens (47,1 por cento ) com idade média de 28 anos. Os homens mais jovens estavam nos Centros de Convivência e Cooperativa - CECCO e UBS. Os usuários mais velhos eram mulheres, na Unidade de Reabilitação e em algumas UBS. Os Hospitais-Dia - HD e a Enfermaria Psiquiátrica acompanhavam predominantemente psicóticos, as UBS, crianças com problemas de aprendizagem e adaptação à escola e, também, adultos psicóticos quando contavam com psiquiatra. A unidade de reabilitação caracterizava-se como serviço de fisioterapia para pessoas com disfunções traumato-ortopédicas. Os CECCO atendiam a grupos de jovens e adultos com deficiência mental, e psicóticos. Identificou-se como a maior dificuldade a estruturação da assistência nas UBS, serviços que historicamente priorizaram a assistência materno-infantil. Problemas como a falta de espaço e recursos materiais específicos para o trabalho dos profissionais eram constantes, mais graves entre 1993-95. Já nos serviços para grupos específicos (CECCO, HD, Enfermaria Psiquiátrica e Unidade de Reabilitação) as dificuldades estavam na organização do trabalho interdisciplinar e na capacidade dos profissionais aceitarem o desafio técnico de criar e gerir novas instituições. Esperava-se uma integração interinstitucional entre os serviços criados que, na prática, se mostrava impossível, dificultando a assistência a portadores de transtornos graves. Entre 1993 e 1995, com a mudança de governo houve o abandono de prioridades anteriores como política salarial, diretrizes de descentralização e autonomia dos serviços locais, provocando êxodo de profissionais e descaracterizando os serviços. Alguns técnicos que estavam em cargos de confiança na gestão anterior, permaneceram em função assistencial, na defesa da proposta, principalmente nos HD e nos CECCO. O curto período (1991-95) para definir e implantar políticas, a diversidade temporal para obtenção dos vários insumos necessários e as dificuldades de incorporação das propostas em vários níveis, além da ruptura para outra administração dificultaram a continuidade da experiência. A marca das propostas foi a defesa da universalização contribuindo para possíveis mudanças nas condições de exclusão social desses grupos, aumentando sua visibilidade social. A existência e permanência dessas experiências dependeram da sensibilidade e compromisso de gestores e do engajamento cotidiano dos profissionais e população na sua construção, mais do que da continuidade necessária na Administração Pública / This study approaches the definition of the polices and the process for the implementation of interventions in mental health and for people with disabilities in municipal services in Sao Paulo, in the region of Sao Miguel Paulista, between 1989-1995, whereas no assistance proposal was organized for these groups before this period. This study was accomplished by analyzing official documents, interviewing professional, managers and projectors, and representatives of the social movement, and organizing data bases of patients according to age, residence, scholarship and diagnosis hypothesis. This investigation describes the process of upbringing services, accordant to the assistance proposal, identifying role players and the main problems, em all three districts of health from Sao Miguel region. During the period of this research, the Municipal Secretary of Health of Sao Paulo went throw institutional changes, since the creation of Regional Administrations and Health Districts to construct Sistema Único de Saúde - SUS (1989-92) until the proposition of Plano de Assistência à Saúde PAS in 1995. The proposal for mental health was focused to combat the asylum culture by creating services and structuring the assistance system and with the mobilization of professionals, clients and the general population, to discuss the movement against asylums. The attention for people with disabilities depended on professional initiative than an institutional proposal. In 1991 the first Physical Therapy service in infirmary was introduced in the General Hospital of Ermelino Matarazzo, that after enlarging the team, it became reference for rehabilitation of former inpatients. Due to pressure coming from the movement in favor to people with disabilities, the proposal for this group was presented in April of 1992. It defended the incorporation of interventions in primary health units, general hospitals and the creation of centers of regional rehabilitation. The assistance characteristics of each service defined the profile of their clients by spontaneous demand. The women, 52.9 per cent , had average age of 38 and men (47.1 per cent ) 28. The younger men were found in CECCO and UBS. The elderly women in Rehabilitation Units and in some UBS. The HD and the psychiatric infirmary accompany mainly psychotics, while UBS, children with learning disabilities and adults, psychotic where a psychiatrist was available. The rehabilitation unit is characterized as a Physical Therapy Service for people with trauma-orthopedics dysfunction. The CECCO assist groups of teenagers and adults with mental handicap and psychotic. The major difficulty was identified as being the structuring of UBS, service that historically gave priority to mother-infant assistance. Problems like lack of space and specific material for professionals to be able to work were constant, more severe between 1993-95. Em services for specific groups (CECCO, HD, Psychiatric Infirmary and Rehabilitation Unit) the difficulties was organizing the interdiscipline work and the capacity of professional to accept the technical challenge to create and generate new institutions. It was expected a interinstitutional integration between services created, which was considered impossible, making it difficult to assist severe disorders. Between 1993 and 1995, while the government changed there was an abandonment of former priorities like salary polices, decentralization and autonomy of local services, provoking exodus of professionals and discharacterizing the services. Some professionals from former management maintain their assistencial function, to defend the proposal, mainly in HD and CECCO. The short period (1991-95) to define and implement polices, the diversity to obtain whats necessary and the difficulty to incorporate the proposals in many levels, other than the rupture of the administration made it difficult to continue the experience. The demarcation of the proposals was the defense of universality contributing to possible changes of the social exclusion condition of these groups, increasing their social visibility. The existence and permanence of this experience depended on the sensibility and engagement of managers and the daily commitment of professional and population in its construction, more than in continuity necessary for Public Administration

No final da década dos 70 e início da década dos 80, em diferentes regiões do Brasil, os serviços públicos - tanto aqueles existentes quanto aqueles começando a se estruturar - passam a utilizar pessoal de nível elementar e médio para auxiliar nas ações de atenção à saúde bucal. No Estado de São Paulo, embora inúmeros sistemas locais de saúde (SILOS) venham empregando pessoal auxiliar odontológico (PAO), existe pouca informação disponível sobre a contribuição dada por estes trabalhadores à essas ações. O objetivo desta investigação foi de analisar a participação do PAO em dez SILOS de cinco municípios do Estado de São Paulo, em 1994. Um questionário foi respondido por 248 (76,3 por cento) dos 325 auxiliares e técnicos em higiene dental empregados nos municípios de ltú, Embú, Penápolis, São José dos Campos e Campinas. Os resultados indicaram que a maioria do PAO é jovem, do sexo feminino, possui 2° grau completo, curso de qualificação profissional, tem vínculo municipal e trabalha 40 horas/semana, sendo que, recebem entre US$ 119,00 e US$ 330,00 no exercício da função de ACD e entre US$ 162,00 e US$ 232,00 como THD. Sua participação em atividades de promoção da saúde bucal é relativa e varia conforme o SILOS em estudo: nos SILOS do Embú e das regiões norte e leste de S. José do Campos, o PAO vem dedicando sua jornada de trabalho mais para ações coletivas que para ações de assistência individual, contribuindo para a transformação das práticas da odontologia em saúde coletiva e para a mudança do modelo assistencial conforme as diretrizes de saúde bucal e os princípios do SUS. A participação do PAO é mais frequente em atividades de evidenciação de placa bacteriana seguida de escovação supervisionada (ES), bochechos fluorados e atividades educativas. A participação em ações coletivas é maior quando se trata da realização dessas atividades em escolas ou outros espaços sociais. Entretanto, em ltú, Embú e Penápolis, o pessoal auxiliar desenvolve de forma significativa atividades de ES em unidades básicas de saúde, atingindo com atividades de promoção da saúde bucal grupos populacionais que as frequentam. Excetuando-se os três SILOS de Campinas e o de ltú, é baixa a proporção do PAO que trabalha à quatro-mãos rotineiramente. Os SILOS de ltú, Embú e Penápolis apresentam maior grau de delegação de funções ao PAO na assistência individual que os SILOS dos municípios de São José dos Campos e Campinas. Segundo o pessoal auxiliar, a população-usuária reage positivamente e aceita bem os seus serviços. Além disso, os cirurgiões-dentistas têm um relacionamento profissional bom ou muito bom com eles, prestam-lhes orientações sempre que necessário e, na opinião deles, devem manter o grau de orientação corrente. / At the end of the seventies and begining of the eighties, dental public services from different areas of Brazil started to introduce basically and intermediately trainned personnel to assist dental care activities. This happened both in services in operation at the time and in those which were begining to be structured. In São Paulo State, although several health local systems are employing dental auxiliary personnel, we know there is a small number of studies in this field and also little information about this personnel. The purpose of this survey was to document the role and extent of dental auxiliary personnel in some state public health programmes in São Paulo State, 1994. A questionnaire requested information from 248 (76,3 per cent) auxiliarias of 325 dental assistants and dental hygienists employed in the health municipal systems of ltú, Embú, Penápolis, São José dos Campos and Campinas (towns in São Paulo State). The results indicated that most of them are young, female sex, went through high school and professional qualification course, work forty hours a week and receive between US$ 119,00 and US$ 330,00 in dental assistant function and between US$ 162,00 and US$ 232,00 in dental hygienist function. Their participation in oral healh promotion activities is relative and varies according to each town reality: in Embú and in the north and east health local systems of São José dos Campos, the working time of auxiliary personnel is spent more in oral health promotion activities than in dental clinic activities, contributing to the transformation of public health dentistry practice according to the principies of health systems in Brazil. This \' participation occurs more often in fluoride mouthrinse, dental plaque staining followed by supervised brushing and oral health education activities. The participation in oral health promotion activities happens more often in schools than in health centers. However, in ltú, Embú and Penápolis, the auxiliarias provide expressively dental plaque staining followed by supervised brushing in health centers, reaching population groups who use them. Excluding the health local systems of Campinas and ltú, the proportion of them who practice four-handed dentistry daily is low. ltú, Embú and Penápolis present high grade of expanded functions to auxiliary personnel in dental clinic activities. According to the auxiliary personnel, the aided population answer positively and accept their services well. Besides, dentists have a good or very good professional relationship with them, give them orientation everytime it is necessary; also, in their opinion, dentists ought to keep up the corrent levei of supervision.

Philosophiae Doctor - PhD / Modern day leaders are faced with a complex globalised environment that has resulted in intense competition, ever-changing government rules and regulations, stakeholder demands, environmental policies and much more. In order to not only survive but thrive, they need to lead and motivate a diversified group of employees with different economic, cultural, and socio-political values. Today’s leaders need to develop effective managerial strategies, learn to inspire those both inside and outside of the organisation, and guide change. This study aimed to provide insight into change-oriented leadership and examine its effect on psychological capital (PsyCap) and psychological empowerment as antecedents of work engagement and change-oriented organisational citizenship behaviour (changed-oriented OCB). For purposes of this study, a quantitative research design was employed using both paper and pencil and electronic questionnaires. Data was gathered by using a probability sample of employees within a manufacturing organisation in South Africa (N = 736). The measurement instruments were revalidated for the South African sample through both confirmatory factor analysis (CFA) and partial least squares structural equation modelling (PLS-SEM). All the measuring instruments retained its original factor structures and reported acceptable reliabilities of change-oriented leadership (α= .908), PsyCap (α= .848), psychological empowerment (α= .860), work engagement (α= .883) and changed-oriented OCB (α= .897).

En France et au Québec, la littérature pour la jeunesse fut longtemps négligée par les enseignants du secondaire ou exclue des cours de français. Or, en 1996, elle apparaît dans des listes ministérielles qui lui sont exclusivement consacrées et qui sont destinées aux professeurs du collège. Un an auparavant, les enseignants québécois sont invités à l’inclure dans des pratiques de lecture. Elle était jusqu’alors considérée comme relevant de la lecture personnelle des élèves. L’objectif de cette recherche est d’identifier les œuvres de littérature pour la jeunesse qui ont été sélectionnées pour l’enseignement secondaire français et québécois, puis de connaître les finalités que les prescripteurs leur confèrent et les pratiques pédagogiques que les enseignants mettent en œuvre lorsqu’ils l’introduisent dans leurs classes. La première partie retrace l’histoire de la littérature pour la jeunesse à travers celle des premiers supports, créés pour instruire, éduquer ou divertir les enfants dans les lieux divers qui leur sont ouverts (périodiques et livres variés). La deuxième partie évoque la place que l’enseignement secondaire a accordée à la littérature pour la jeunesse, dans ses différents programmes. Enfin, la troisième partie aborde les textes pour la jeunesse et les pratiques que les enseignants proposent à leurs élèves actuellement. Notre recherche appartient au champ de la didactique du français et touche aux domaines spécifiques des didactiques de la littérature et de la lecture. À visée descriptive, elle consiste à interroger des corpus figés, destinés aux enseignants (instructions officielles, notes de lecture et documents issus de revues pédagogiques), dans une perspective diachronique et synchronique. / In France and in Quebec, youth literature has been neglected for a long time by the secondary teachers or discorded from french lessons. Nevertheless, in 1996, it appeared in ministerial lists exclusively dedicated to it and intended to the high school teachers. One year before, the Quebec teachers were invited to include it in reading practices. It has been considered as a matter for pupils’ personal reading. The aim of this research is to identify youth literature works that have been selected for French and Quebec secondary teaching, then to know the purposes given by the teachers and their pedagogical practices when they introduce it in their classes. The first part relates the history of youth literature through the first teaching aids’ one, created to teach, to educate or to entertain children in the different places that are opened to them (periodicals and various books). The second part is about the place that the secondary teaching gave to youth literature, in its different programs. At last, the third part moves on the texts for the youth and the practices that nowadays teachers propose to their pupils. Our research belongs to the sphere of French language didactics and affects the specific fields of literature and reading didactics. It has a descriptive purpose and it asks questions to fixed corpus, intended to teachers (official instructions, reading notes and documents extracted from pedagogical reviews), in a diachronic and synchronic view.