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O estudo refere-se a uma pesquisa que teve por objetivo discutir a implementação de atividades de Educação Nutricional em Serviços Públicos de Saúde, através da visão dos profissionais que tradicionalmente atuam nesses serviços: médicos e enfermeiros. Utilizou-se o método da pesquisa-ação descrito por Thiollent, o qual pressupõe uma intervenção do pesquisador na realidade e a proposta de aumentar o conhecimento e a consciência dos sujeitos pesquisados a respeito da problemática estudada. Os resultados descrevem: a construção do saber sobre Nutrição através das Instituições formadoras, Instituições profissionais e vivência profissional; a conduta adotada face aos problemas relativos à alimentação no cotidiano profissional em contraposição ao enfrentamento dos mesmos no cotidiano pessoal; a percepção dos profissionais acerca das atividades de Educação Nutricional, segundo a conceituação de educação/orientação, tipificação de papéis profissionais e processo de institucionalização; a visão dos profissionais relativa à Educação Nutricional frente a situações contraditórias: problema clínico versus problema alimentar, nutrição versus renda e problemas de saúde emergentes no Brasil: doenças crônico-degenerativas. Nas considerações finais são apresentadas propostas norteadoras de ações futuras visando a institucionalização da prestação deste serviço e o desenvolvimento da Educação Nutricional no âmbito do ensino e da pesquisa. / This work concerns a study that had as its objective the discussion of the implementation of Nutritional Education activities in Public Health Services by means of the point of view of the professionals who take part in these services: doctors and nurses. The action-research method described by Thiollent was used. This method presupposes an intervention of the researcher in reality and proposes increasing the understanding and awareness of the problem studied on the part of the subjects involved in the study. The results describe: the construction of knowledge about Nutrition by means of educational and professional institutions and professional life; the behaviour adopted in the face of problems relating to food practices in daily professional living in contrast to facing the same problems in daily pcrsonal living; the perception of professionals about activities of Nutritional Education according to education/orientation conceptualisation, typography of professional roles and the process of institutionalisation; the view of the professional regarding Nutritional Education when confronting contradictory situations like clinical problems versus alimentary problems, nutrition versus income and emerging health problems in Brazil such as chronic-degenerative illnesses. The final considerations present orientating proposals for futurc action seeking the institutionalisation of offering this service and the development of Nutritional Education in the sphere of teaching and research.

O estudo refere-se a uma pesquisa que teve por objetivo discutir a implementação de atividades de Educação Nutricional em Serviços Públicos de Saúde, através da visão dos profissionais que tradicionalmente atuam nesses serviços: médicos e enfermeiros. Utilizou-se o método da pesquisa-ação descrito por Thiollent, o qual pressupõe uma intervenção do pesquisador na realidade e a proposta de aumentar o conhecimento e a consciência dos sujeitos pesquisados a respeito da problemática estudada. Os resultados descrevem: a construção do saber sobre Nutrição através das Instituições formadoras, Instituições profissionais e vivência profissional; a conduta adotada face aos problemas relativos à alimentação no cotidiano profissional em contraposição ao enfrentamento dos mesmos no cotidiano pessoal; a percepção dos profissionais acerca das atividades de Educação Nutricional, segundo a conceituação de educação/orientação, tipificação de papéis profissionais e processo de institucionalização; a visão dos profissionais relativa à Educação Nutricional frente a situações contraditórias: problema clínico versus problema alimentar, nutrição versus renda e problemas de saúde emergentes no Brasil: doenças crônico-degenerativas. Nas considerações finais são apresentadas propostas norteadoras de ações futuras visando a institucionalização da prestação deste serviço e o desenvolvimento da Educação Nutricional no âmbito do ensino e da pesquisa. / This work concerns a study that had as its objective the discussion of the implementation of Nutritional Education activities in Public Health Services by means of the point of view of the professionals who take part in these services: doctors and nurses. The action-research method described by Thiollent was used. This method presupposes an intervention of the researcher in reality and proposes increasing the understanding and awareness of the problem studied on the part of the subjects involved in the study. The results describe: the construction of knowledge about Nutrition by means of educational and professional institutions and professional life; the behaviour adopted in the face of problems relating to food practices in daily professional living in contrast to facing the same problems in daily pcrsonal living; the perception of professionals about activities of Nutritional Education according to education/orientation conceptualisation, typography of professional roles and the process of institutionalisation; the view of the professional regarding Nutritional Education when confronting contradictory situations like clinical problems versus alimentary problems, nutrition versus income and emerging health problems in Brazil such as chronic-degenerative illnesses. The final considerations present orientating proposals for futurc action seeking the institutionalisation of offering this service and the development of Nutritional Education in the sphere of teaching and research.

Orientador: Helenice Bosco de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T18:38:51Z (GMT). No. of bitstreams: 1 FerreiraJunior_Sergio_M.pdf: 747663 bytes, checksum: a25726e53762dc99adb1adc720db49d8 (MD5) Previous issue date: 2011 / Resumo: Este estudo analisou comparativamente o conhecimento, atitudes e práticas dos detentos e dos funcionários da unidade prisional III do Complexo Penitenciário e Rede Pública de Saúde do município Hortolândia-SP sobre tuberculose e HIV/aids. Trata-se de um estudo seccional que utilizou o questionário KAP, do inglês, Knowledge, Attitudes and Practices, instrumento de pesquisa utilizado em vários estudos para coleta de dados a respeito do conhecimento, práticas e atitudes de uma determinada população em relação à saúde. Participaram do estudo de 506 indivíduos: 141 detentos, 115 funcionários do presídio e 250 funcionários da rede pública de saúde. Para a análise das variáveis foi utilizado o programa epi-info versão 6.4. Para as variáveis dependentes foi utilizado o teste do qui-quadrado e considerado com significância estatística o valor de p<0,05. Os resultados demonstraram muitos conceitos equivocados sobre a transmissão, sintomas, tratamento e cura da TB, bem como na transmissão do HIV/AIDS entre os três grupos pesquisados. O restrito acesso dos detentos às várias fontes de informação como T.V. rádio, e internet, permite que estes tomem conhecimento sobre a tuberculose apenas por meio dos poucos folhetos e cartazes que chegam até as celas. Os funcionários do presídio, apesar de terem amplo acesso às várias fontes de informação, bom nível de escolaridade e trabalharem na unidade prisional por longo tempo, não tiveram um bom desempenho nesta pesquisa. Com relação à rede pública de saúde, os resultados apontam erros conceituais básicos sobre o conhecimento dos sinais e sintomas da TB e sobre as formas de transmissão, infecção e prevenção da doença, informações que poderiam ser acessadas em qualquer manual de controle da tuberculose. Os resultados indicam haver falhas nos treinamentos replicados na rede pública e a falta de multidisciplinaridade, intersetorialidade e demandam a necessidade de reavaliação da metodologia e logística utilizadas nestas capacitações. Sobre a utilização do questionário KAP, o instrumento mostrou ser eficaz na coleta de dados gerais sobre o conhecimento e dados sociodemográficos, que podem colaborar para o planejamento das ações dos programas de tuberculose e serem utilizados nas ações de Advocacy Controle e Mobilização Social, entretanto mostrou limitação e fragilidade na validação dos resultados sobre práticas e atitudes. Este estudo pode colaborar para a discussão e validação do roteiro KAP como método adequado para explorar o conhecimento, atitudes e práticas na saúde de diferentes populações / Abstract: This study analyzed comparatively the knowledge, attitudes and practices of the prisoners, employees from the prison unit III of the Penitentiary Complex and health care workers of Hortolândia city, in São Paulo state, Brazil about tuberculosis and HIV/aids. It is about of a sectional study that used the KAP questionnaire, research instrument used in various studies for the gathering of data about the knowledge, attitudes and practices of a certain population in relation to health. On the study participated 506 Individuals: 141 prisoners, 115 prison employees and 250 health care workers. For the variables analysis was used theprogram Epi-info version 6.4. For the dependent variables was used the qui-square and considered a significant statistic the value of p<0,05. The results have demonstrated many wrong concepts about the transmission, symptoms, treatment and cure of TB, as on the transmission of HIV/aids among the three researched groups. The restricted access of the prisoners to various sources of information like T.V., radio and internet have made possible that these take knowledge about the tuberculosis only through a few flayers and posters that got to the cells. The prison employees, despite having great access to information sources, a nice education level and work on the prison for a long time, they have not had a good performance on this research. In relation to the health care workers, the results point basic conceptual mistakes about the knowledge of the signs and symptoms of TB and yet, wrong ideas about the ways of transmission, infection and prevention from the disease, information that could have been accessed in any tuberculosis control manual. The results still pointed to have imperfections on the replicated trainings on the public health and the lack of multidisciplinary and inter sectional and demand the necessity of methodological and logistic re-evaluation used for the realization of these capabilities. About the use of the KAP questionnaire has shown to be a very effective instrument on the data gathering that can collaborate for the planning of actions on the programs of tuberculosis and DST/aids to be used also on the actions of Advocacy Control and Social Mobilization. The results still can instigate the discussion about the validation of this instrument to the Portuguese language and the using of it as an adequate methodology to explore the knowledge, attitudes and practices of different health populations / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Doctor Pharmaceuticae - DPharm / The effect of industrialisation has thrust the pharmaceutical profession into a clinical paradigm where the approcah to pharmaceutical decisions is more disease and patient orientated. Consequently, South African community pharmacies are inundated with requests from the public for advice and treatment on a wide range of medical conditions, including sexually transmitted infections (STI's). Although community pharmacies are often the first port of call for undiagnosed STI, limited diagnostic skills and legally-imposed prescribing restrictions preclude pharmacists from providing the necessary clinical management. The overarching goal of this dissertation was to present objective arguments and evidences (new and existing) around an expanded role for pharmacists in STI partner management. / South Africa

Unauthorized reproduction of this article is prohibited. Objective: The role of local health departments (LHDs) as a clinical service provider remains a salient topic of discussion. As local and state health departments continue to migrate away from clinical services, there is need to understand the impact on these transitions on access to care in a given community. The purpose of this study was to examine the impact of clinical capacity reductions in LHDs on receipt of annual family planning visits among South Carolina women. Design: A rolling panel of women eligible for Medicaid between 2001 and 2012 was created. Receipt of an annual visit for each year of Medicaid eligibility was tracked over time. A typology reflecting changes in county capacity for clinical services was used as the independent variable. We estimated multivariate generalized estimating equation models, which examined changes in population-averaged probabilities (marginal means) of annual family planning visits over time by level of county typology. Results: Approximately 325 269 unduplicated women were included in the panel, with 25.18% receiving an annual visit in a given year. On average, receipt of annual visits in counties with notable reductions in LHD clinical capacity tended to be fewer over time (-0.022; 95% CI [confidence interval],-0.028 to-0.017) as among counties with reduced capacity that included a specific clinic closing (-0.032; 95% CI,-0.037 to-0.028). However, the magnitude of observed differences between county typologies was relatively small. Conclusions: Evidence of service discontinuity was present. However, differences occurred later in the study period following the economic recession. Our findings suggest that counties that reduced capacity did not lose ground but were unable to meet increasing demand from the economic recession relative to those that did not reduce capacity even when closing a clinic. As LHDs discontinue or significantly reduced clinical services, fulfilling the assurance role is important for transitioning women to other sources of care.

The structure and systems of state health departments (SHD) may affect reporting of foodborne disease outbreak (FBDO) hospitalizations. Evaluation of SHD by investigating the contributions of structural capacity elements (SCE) will provide an accurate measure of performance and highlight areas for development of effective strategies for improvement. This study investigated the relationship between organizational and structural characteristics of SHD and systems for FBDO reporting, and included three manuscripts designed to address seven hypotheses, as well as a conclusion chapter interpreting the findings as they relate to the overall research question. Study findings identified consistently higher reports of hospitalization due to foodborne illness from third party payers compared to SHDs between 2006 and 2009 in 30 of the 31 states analyzed. Furthermore, significantly different rates of reporting among states with mixed governance classification were seen when compared to those with centralized and decentralized governance; associations between total laboratory expenditures and total food-related hospitalizations reported were also identified when analyzing healthcare claims data. This dissertation contributes to the current knowledge base for public health services and systems research, as well as food safety surveillance and reporting, and provides an innovative approach to using secondary databases to investigate food safety issues. Findings support the conclusion that collaboration between public and private agencies would support improvements in data collection and foodborne illness surveillance. / Public Health

Patients with mental illness experience dissatisfaction with their care due to lack of understanding and ignorance from the nurses. The nurses’ approach might influence these patients' experience of their care. The purpose of the literature review was to describe nurses' approach in care of patients with mental illness. The literature review is based on an inductive approach and the result is based on 14 scientific papers, of which eight used a qualitative design and sex used a quantitative design. A simpler form of content analysis was used, which resulted in four themes: the importance of knowledge, preconceived perceptions, neglect and feelings of responsibility. Nurses' attitudes to mental illness are both positive and negative. Positive approaches include feelings of responsibility for patient care. Negative approaches include neglect and negative feelings such as distrust and fear. The result of the literature review indicates a need for more education about mental illness in order to reduce stigma and knowledge gaps among registered nurses in public health services. As many results articles were related to abuse problems the area seems limited, therefore more research directed toward other mental illnesses, is recommended. / Patienter med psykisk ohälsa upplever missnöje med sin omvårdnad på grund av brist på förståelse och negligering från sjuksköterskorna. Sjuksköterskorna kan påverka dessa patienters upplevelser av omvårdnaden genom sitt förhållningssätt. Syftet med litteraturstudien var att beskriva sjuksköterskors förhållningssätt i omvårdnaden av patienter med psykisk ohälsa. Litteraturstudien grundas på en induktiv ansats och resultatet baseras på 14 vetenskapliga artiklar, varav åtta artiklar är kvalitativa och sex artiklar är kvantitativa. En enklare form av innehållsanalys användes, vilket resulterade i fyra teman: kunskapens betydelse, förutfattade uppfattningar, negligering samt känslor av ansvar. Sjuksköterskors förhållningssätt till psykisk ohälsa är både positiv och negativ. Positiva förhållningssätt inkluderar känslor av ansvar för patienternas omvårdnad. Negativa förhållningssätt inbegriper bland annat negligering samt negativa känslor som misstro och rädsla. Litteraturstudiens resultat påvisar ett behov av mer utbildning om psykisk ohälsa för att reducera stigmatisering och kunskapsluckor hos legitimerade sjuksköterskor i den allmänna hälso- och sjukvården. Området upplevdes begränsat då många funna resultatartiklar berör missbruksproblematik, därför rekommenderas mer forskning riktad mot andra psykiska sjukdomar.

A violência sexual provoca sofrimento e produz consequências de ordem física e psicológica que se fazem escutar no espaço clínico. É preconizado pelo Ministério da Saúde que a assistência se faça por meio de abordagem interdisciplinar capacitada, porém, nota-se que existe uma carência na literatura a respeito de atendimentos psicológicos realizados e seus resultados, principalmente na abordagem psicanalítica. É dado clínico que a violência sexual se repete em muitos casos, que mulheres adultas que relatam ter vivido essa experiência na infância mantenham segredo, e que a manutenção desse segredo resulta em consequências, muitas vezes sobrecarregando os serviços públicos de saúde. Temos percebido que o segredo vem sendo justificado em função do vínculo afetivo existente entre agredido e agressor, entretanto a clínica nos mostra que apesar da presença dessas características, nem sempre esse silenciamento se dá em função disso e que frequentemente o segredo vem ocupar uma função de possível manutenção de uma posição subjetiva que talvez não possa ser revelada. Assim, essa justificativa engessada poderia impossibilitar que essas mulheres fossem tratadas. Acreditando na relevância da compreensão clínica da função do segredo no tratamento psíquico de cada mulher, tanto do ponto de vista conceitual quanto da manutenção de uma posição subjetiva, apresentamos uma investigação teórica a respeito da violência sexual e do conceito de segredo nas obras de Freud e de Lacan, bem como uma revisão da literatura científica especializada. Abordamos também conceitos psicanalíticos como silêncio, não-dito, complexo de édipo e constituição de sujeito, trauma, repetição e fantasia, para discutir questões relacionadas às articulações da violência sexual e o segredo com a psicanálise, enfatizando a escolha pelo segredo como algo que tem a função de resguardar a fantasia. Refletimos também a importância de serviços à violência sexual para o sistema de saúde brasileiro no que se refere a possível contribuição para a diminuição da sobrecarga nas instituições públicas, bem como caminhos para que psicólogos que trabalhem ou pretendam trabalhar em instituições de saúde e/ou consultórios particulares com pacientes que apresentam histórico de violência sexual, possam pensar em possibilidades de prevenção, direção de tratamento do sofrimento psíquico e interlocução com os demais saberes da área da saúde, corroborando para novos projetos de serviços interdisciplinares e novas pesquisas / The Sexual violence causes suffering and produces physical and psychological consequences that can be listened in the clinical space. The Brazilian health department recommends that social assistance should be provided by specialized interdisciplinary approach; however, there is a lack of literature about psychological services and results performed, especially in the psychoanalytic approach. The clinical observation testifies that sexual violence can be a repetition in many cases, that the adult women who have suffered abuse during their childhood keep the that as a secret, and that the maintenance of such secrecy results in consequences, that often overload the public health services. We realized along the studies that the secret has been justified by the emotional connection between the abused and the abuser, however the clinic experience shows us that despite the presence of these characteristics, this silencing is not always related to the emotional relationship described above but is often related to the possibility of maintaining a subjective position which may not be revealed. Therefore, this \"assumed\" reason could make it impossible for these women to be treated. Based on the belief that clinically the secrecy has its function on the way we can conduct the treatment of each women from the theoretical point of view as well as the maintenance of a subjective position we present a theoretical research about sexual violence and the concept of secrecy in the Freud and Lacan literature, as well as review of the specialized scientific researches. We analyzed psychoanalytic concepts such as silence, the unsaid, the Oedipus complex and the psychic constitution, trauma, repetition and fantasy. We discussed the issues related to the links of sexual violence and secrecy with the psychoanalysis, emphasizing the \"choice\" for the secrecy as something that has the function of protecting the fantasy. We also considered the importance of multidisciplinary services supporting treatments of sexual violence victims in the Brazilian health system in order to reduce the overload on public institutions, as well as, the possibility of finding ways for psychologists to work with patients who have sexual violence history. At last, we discussed the possibilities of prevention, the treatment of psychological suffering and the dialogue among the health fields such as medical and social services, corroborating for new projects of interdisciplinary services and new researches

Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory&ndash;based, case study&ndash;supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies &ndash; one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework &ndash; the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.