Made available in DSpace on 2015-07-15T13:31:38Z (GMT). No. of bitstreams: 1 Antonia_Dissertacao_completa.pdf: 630942 bytes, checksum: 7d4824364a7517ab21ea6f7492f2757d (MD5) Previous issue date: 2006-08-27 / The fast aging of the Brazilian population produces great impact in its health and quality of life. In view of the permanence of traditional models of assistance that do not take care of this clientele in its especificity, a change of paradigm in the attention to the health of this population segment becomes urgent. Thus, the educative actions constitute as an important part of the actions of promotion of the health of the elderly as well as of the healthy aging. This work deals with the study of the social representations of eldery on the educative actions developed in the Family Health Program in Santo Antonio de Jesus, Bahia. It is a descriptive research of qualitative boarding, based on the Theory of the Social Representations of S?rge Moscovici, on the concept of education to the health and on the theoretical references on the pedagogical conceptions. Through the social representations of the elderly, we seek for understanding what they think about the educative actions, not as passive receivers, but, as citizens that have autonomy in communicating their ideas originated in the relations with the professionals in the health services. The objectives of this research are: to apprehend the social representations of the elderly on the educative actions developed by the team of the units of health of the Family Health Program of Santo Antonio de Jesus and to point limits and possibilities of the apprehended educative actions from the social representations of the elderly. Methodology: The citizens of the study have been consisted of 11 elderly users of four units of The Family Health Program in Santo Antonio de Jesus, Ba. The data have been collected by using the technique of the half-structuralized interview and they have been analyzed according to method of Analysis of Content of Bardin. After the analysis of the data, we apprehend the following categories: the boarded content in the educative action; the methodology used in the educative actions; limits and possibilities of the educative actions (re) guarded in the social representations of the elderly. Regarding the representations of the aged ones on the educative actions, the results point that these are focused in the illness, focused in the biomedical model. Thus, in the absence of a systematization of these actions related to the elderly in the individual searched units with emphasis in prescriptive, authoritarian, orientations, differentiating from that the current pedagogical theories state, also signaling that they can be limit/power for the transversality. As to the limits and possibilities, the study points that difficulties in the development of the educative actions exist when it comes to the methodology used, to the boarding of referring subjects to the aging process, to the opening for expression of knowing the other. Thus, it becomes necessary an organization of the educative actions directed toward the aged one in the USF, a reorganization in the pedagogical formation of the professionals of health to enable them to transpose it to their practice the theoretical references, basing the educative action on emergent pedagogical paradigms. / O r?pido envelhecimento da popula??o brasileira vem produzindo grande impacto na sua sa?de e qualidade de vida. Tendo em vista a perman?ncia de modelos tradicionais de assist?ncia que n?o atendem esta clientela em sua especificidade, torna-se urgente uma mudan?a de paradigma na aten??o ? sa?de deste segmento populacional. As a??es educativas se configuram como parte importante das a??es de promo??o da sa?de do idoso e do envelhecimento saud?vel. Este trabalho trata do estudo das representa??es sociais de idosos sobre as a??es educativas desenvolvidas no Programa Sa?de da Fam?lia em Santo Ant?nio de Jesus, Bahia. Constitui-se de uma pesquisa descritiva, de abordagem qualitativa, fundamentada na Teoria das Representa??es Sociais de S?rge Moscovici, no conceito de educa??o ? sa?de e nos referenciais te?ricos sobre as concep??es pedag?gicas. Atrav?s das representa??es sociais de idosos, procuramos compreender o que estes pensam sobre as a??es educativas, n?o como receptores passivos, mas como sujeitos que t?m autonomia em comunicar suas id?ias originadas nas rela??es com os profissionais nos servi?os de sa?de. Teve como objetivos: apreender as representa??es sociais de idosos sobre as a??es educativas desenvolvidas pela equipe das Unidades de Sa?de da Fam?lia de Santo Ant?nio de Jesus e apontar limites e possibilidades das a??es educativas apreendidas a partir das representa??es sociais dos idosos. Metodologia: os sujeitos do estudo constitu?ram-se de 11 idosos usu?rios de quatro Unidades de Sa?de da Fam?lia em Santo Ant?nio de Jesus, Ba. Para a coleta de dados utilizamos a t?cnica da entrevista semi - estruturada e para a an?lise o m?todo de An?lise de Conte?do de Bardin, resultando nas seguintes categorias: o conte?do abordado na a??o educativa; a metodologia utilizada na a??o educativa; limites e possibilidades das a??es educativas (re) velados nas representa??es sociais dos idosos. Com rela??o ?s representa??es dos idosos sobre as a??es educativas, os resultados apontam que estas est?o focalizadas na doen?a, pautadas no modelo biom?dico, n?o existindo uma sistematiza??o dessas a??es voltadas para o idoso nas unidades pesquisadas. S?o a??es individuais, com ?nfase em orienta??es prescritivas, autorit?rias, acr?ticas, divergindo do que preconizam as teorias pedag?gicas atuais, sinalizando tamb?m que podem ser limite/pot?ncia para a transversalidade. Quanto aos limites e possibilidades, o estudo aponta que existem dificuldades no desenvolvimento das a??es educativas quanto ? metodologia utilizada, quanto ? abordagem de temas referentes ao processo de envelhecimento e ? abertura para express?o do saber do outro. Neste sentido, faz-se necess?rio uma organiza??o das a??es educativas voltadas para o idoso nas Unidades de Sa?de da Fam?lia, uma re-estrutura??o na forma??o pedag?gica dos profissionais de sa?de para capacit?-los a transpor para a pr?tica os referenciais te?ricos, fundamentando a a??o educativa em paradigmas pedag?gicos emergentes.

Made available in DSpace on 2014-12-17T15:38:35Z (GMT). No. of bitstreams: 1 AntonioAF_TESE.pdf: 1128829 bytes, checksum: c3a4628ae5adbd24f06b0562979b3e2d (MD5) Previous issue date: 2012-02-10 / This thesis studied the motivation to work among health professionals of the Basic Unities (BUH) in the health network of the city of Natal (RN). It was understood that the work motivation is a process. Then, the expectation theory was applied and motivation components (results of work, expectative, valence, instrumentality, and motivational force) were used to analyses. It s understanding the motivation as multifaceted phenomenon, the psycho sociological perspective was adopted. The research was developed in two phases: one with application of Work Motivation and Meaning Inventory (WMMI), and another with interview. In the first phases, the analysis of results revealed that the major factors contributing to increase the motivational force to health professionals in the BUH?s are: in valence, Self Expression and Personal Realization (VF2), Personal and Family Survival (VF3); in expectative, Self Expression and Work Justice (EF1), Safety and Dignity (EF2) and Responsibility (EF4); in instrumentality, Involvement (IF1) and Recognition and Economic Independence (IF4). In opposition, the factors that more contribute to reduce the motivational force are Wear and Dehumanization factors in valence (VF4), in expectative (EF3), and in instrumentality (IF4), behind the Work Justice Factor (IF2). Basing in content analysis of interviews, it was possible to associate by equivalence, the senses presented by health professionals with obtained results of first phase, indicating that the results of second phase corroborated and complemented those of first one. This possibility broadened the comprehension of the studied phenomenon. In speaking of the respondents, it was visible the presence of contents showing that they perceive the Health System and BUH?s in degradation. In the first phase, the participants? instruction also predict the results in motivation, and in the interviews can be saw that the instruction is associated with the opportunities in outside of system. As work motivation is a process, the impact of personal and occupational characteristics tend to interact with contextual aspects. It was concluded the majority of health professionals present the moderated motivational force, but it was falling because they experience and perceive a degrading context with work condition increasingly unfavorable. / A presente tese estudou a motiva??o para o trabalho dos profissionais de sa?de vinculados ?s Unidades B?sicas (UBS) da rede de sa?de do munic?pio de Natal (RN). Compreendeu-se a motiva??o para o trabalho como um processo e, para tanto, aplicouse a teoria das expectativas cujos componentes (resultados do trabalho, expectativa, val?ncia, instrumentalidade e for?a motivacional) serviram para assim analis?-la. Entendendo-se tamb?m a motiva??o como um fen?meno multifacetado, adotou-se a perspectiva psicossociol?gica. A pesquisa foi desenvolvida em duas etapas: uma com a aplica??o do Invent?rio da Motiva??o e Significado do Trabalho (IMST) e outra com entrevistas. As an?lises dos resultados obtidos com o IMST revelaram que os fatores que mais contribuem para aumentar a for?a motivacional dos profissionais de sa?de das UBS s s?o, em val?ncia, Autoexpress?o e Realiza??o Pessoal (FV2), Sobreviv?ncia Pessoal e Familiar (FV3); em expectativa, os fatores Autoexpress?o e Justi?a no Trabalho (FE1), Seguran?a e Dignidade (FE2) e Responsabilidade (FE4); em instrumentalidade, os fatores Envolvimento (FI1) e Reconhecimento e Independ?ncia Econ?mica (FI4). Em contrapartida, os fatores que mais contribuem para baixar a for?a motivacional s?o os fatores Desgaste e Desumaniza??o em val?ncia (FV4), em expectativa (FE3) e em instrumentalidade (FI4), al?m do fator Justi?a no Trabalho (FI2). Com base nas an?lises de conte?do das entrevistas, foi poss?vel, por equival?ncia, relacionar os sentidos apresentados pelos profissionais de sa?de aos fatores encontrados com o IMST, indicando que os resultados da segunda etapa corroboraram e complementam os da primeira favorecendo uma compreens?o mais ampla do fen?meno estudado. Na primeira etapa, a instru??o dos participantes tamb?m prediz os resultados em motiva??o e, nas entrevistas, pode ser visto que a instru??o est? relacionada com as oportunidades que t?m fora do sistema. Como a motiva??o para o trabalho ? processual, o impacto de caracter?sticas pessoais e ocupacionais tende a interagir com aspectos contextuais. Na fala dos entrevistados, obtidas na segunda etapa, ? vis?vel a presen?a de conte?dos que mostram que percebem o SUS e as UBS s em degrada??o. Conclui-se que a maioria dos profissionais de sa?de apresenta for?a motivacional moderada, por?m em queda, em fun??o de vivenciarem e perceberem um contexto deteriorado com condi??es de trabalho cada vez mais desfavor?veis.

Made available in DSpace on 2014-12-17T15:38:41Z (GMT). No. of bitstreams: 1 VanessaABMG.pdf: 453215 bytes, checksum: 24ae84f6ac14ea21a38c45ddaeeb8fed (MD5) Previous issue date: 2008-06-11 / Violence is a complex and multifarious phenomenon that has convoked the government to think about strategies to face the question. This work is about one of these strategies proposed by brazilian Health Minister: the Individual notification/investigation Card - Domestic Violence, Sexual and/or others Interpersonal Violences . This instrument is a notification protocol which is been implanted in all of the country. This process is in course in Natal/RN. This work is a report of one research realized in five units of basic health care network of Natal/RN concerning this process about the implementation of the violence notification card. The study aims to cartography all the process of card implantation, discussing the used strategies, the drawn course, difficulties and possibilities as well as how the researcher intended to map subjective process involved at health professional acting at violence case and the propose to use the card. Meetings were held at each unit and a daily fieldwork report was used as research instrument. In this investigation it was observed that notifying violence involves a complexity that is not present in other kinds of notification as consequence of the phenomenon characteristic and health workers are invited to act in different perspective that knowledge and instruments of traditional health fieldwork available does not work. It was observed that the notification card, as a possible instrument of intervention, are considered important detectors from process of work at health basic care and health policies. Depending the way the instrument is used, it may incentive different discussions and manners to offer health care or in other way it can reproduce control and vigilance logics. Consequently it is necessary to consider some factors pointed out at this experience, implanting instruments like this, thinking about these limits and possibilities / A viol?ncia ? um fen?meno complexo e multicausal que tem convocado o poder p?blico a desenvolver estrat?gias para o seu enfrentamento. O presente estudo versa sobre uma dessas estrat?gias propostas pelo Minist?rio da Sa?de: a Ficha de Notifica??o/Investiga??o Individual Viol?ncia Dom?stica, Sexual e/ou outras Viol?ncias Interpessoais . Tal instrumento se trata de um protocolo de notifica??o que vem sendo implantado em todo o pa?s. Este processo encontra-se em andamento no munic?pio de Natal/RN. Este trabalho ? o relato de uma pesquisa realizada em cinco unidades da rede b?sica de sa?de do munic?pio acerca do processo de implanta??o da ficha de notifica??o da viol?ncia. Teve como objetivos realizar uma cartografia de todo o processo envolvido na implanta??o da ficha, problematizando as estrat?gias utilizadas, o percurso tra?ado, as dificuldades e possibilidades, bem como pretendeu mapear os processos subjetivos que atravessam a atua??o dos profissionais de sa?de frente ?s demandas da viol?ncia e ? proposta de uso deste instrumento. Metodologicamente, foram realizados encontros com cada um dos servi?os e se fez uso de um di?rio de campo. Nessa investiga??o percebeu-se que notificar a viol?ncia envolve complexidades n?o presentes em outros tipos de notifica??es pelas pr?prias caracter?sticas do fen?meno viol?ncia, pois os profissionais s?o convocados a assumirem posturas para as quais os conhecimentos e instrumentos tradicionais em sa?de n?o respondem satisfatoriamente. Percebeu-se que a ficha de notifica??o, enquanto instrumento poss?vel de interven??o, configura-se como um analisador importante dos processos de trabalho da aten??o b?sica e das pol?ticas da ?rea. Dependendo de como for manejado, esse instrumento pode ter a pot?ncia de suscitar novas discuss?es e modos de ofertar sa?de, mas tamb?m de reproduzir uma l?gica de controle e vigil?ncia. Faz-se necess?rio, ent?o, considerar alguns fatores apontados nessa experi?ncia quando da implanta??o de instrumentos como esse, problematizando seus limites e suas potencialidades

Made available in DSpace on 2014-12-17T15:38:48Z (GMT). No. of bitstreams: 1 FabianaLS.pdf: 655458 bytes, checksum: e94bc91d973d0c27aac0a995d1542a52 (MD5) Previous issue date: 2004-05-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The model of attention to health has been suffering alterations due to the difficulty faced to put into practice its universal, democratic and institutional layout. Since the movement of Sanitary Reform, which focused in the demands of a new health context and the process of work in the area of health, one seeks uninterruptedly, to find a way which leads to the execution of the principles of SUS. Despite having tried, the model of Sanitary Vigilance centered within the work of a multi-professional team has shown fragmentation and little adequacy to the necessity of health in the population. Whilst inserting himself in the field of health, the psychology professional has taken with him his clinic way of attending to individuals being one more in the team to act in a de-contextualised and little critical way. In virtue of this framework, the Ministry of Health invests in the Family Health Program as a new guide in the health system, restructuring the basic attention at a new logic of action. In this way, the municipality of Natal-RN implants, in the year 2002, the PSF in the Northern Sanitary District, a context in which professional teams are created where there is not an inclusion of a psychologist. Consequently, this professional is excluded of his work space in the previous Basic Unities of Health. This piece of work constitutes in the investigation of the implementation and instrumentalization of the Northern Sanitary District PSF of Natal-RN, having as its objective to analyze the implications of this execution for the structuring of the health network services and more specifically the alterations that this implementation could be making to the practice of the Psychology Professionals, emphasizing its advances, obstacles and limitations. To make this work feasible it was necessary to search for data and information from the implementation and execution of the PSF in the DSN, carrying interviews from a semi-structured guide, with 21 institutional actors (members of the team, coordinators and directors of the unities and psychologists) / O modelo de aten??o ? sa?de vem sofrendo altera??es em face da dificuldade enfrentada para p?r em pr?tica seu desenho institucional universalista e democr?tico. Desde o Movimento da Reforma Sanit?ria, que p?s em pauta a exig?ncia de um novo contexto de sa?de e o pr?prio processo de trabalho em sa?de, busca-se, ininterruptamente, encontrar um caminho que leve ? efetiva??o dos princ?pios do SUS. Embora o modelo da vigil?ncia sanit?ria - centrada na atua??o de uma equipe multiprofissional - tenha tentado, mostrou-se fragmentado e pouco adequado ?s necessidade de sa?de da popula??o. Ao inserir-se no campo da sa?de, profissional de psicologia levou consigo seu modelo cl?nico de atendimento, sendo mais um - na equipe - a atuar de forma descontextualizada e pouco cr?tica. Em virtude dese quadro, o Minist?rio da Sa?de investe no Programa Sa?de da Fam?lia enquanto novo orientador do sistema de sa?de, resstruturando a aten??o b?sica sob uma nova l?gica de a??o. Nesse sentido, o munic?pio de Natal-RN, implanta, no ano de 2002, PSF no Distrito Sanit?rio Norte, contexto em que s?o criadas equipes de profissionais nas quais n?o h? inclus?o do psic?logo. Conseq?entemente, esse profissional ? exclu?do de seu espa?o de trabalho nas antigas Unidades B?sicas de Sa?de.Este trabalho constitui-se na investiga??o da implanta??o e instrumentaliza??o do PSF no Distrito Sanit?rio Norte de Natal-RN, tendo como objetivo analisar as implica??es dessa efetiva??o para a estrutura??o da rede de servi?os e mais especificamente as altera??es que essa implanta??o possa estar imprimindo ? pr?tica dos profissionais de Psicologia, destacando seus avan?os, entraves e limites. Para realizar tal estudo se fez neces?rio buscar dados e informa??es da implanta??o e efetiva??o do PSF no DSN, realizandoainda entrevistas, a partir de um roteiro semi-estruturado, com 21 atores institucionais (integrantes de equipes, coordenaodres e diretores de unidades de sa?de e psic?logos)

Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 FatimaRRM_TESE.pdf: 870071 bytes, checksum: 0013fd8d1569e1ed87bf96b26d2cfa3f (MD5) Previous issue date: 2010-02-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema ?nico de Sa?de SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Ara?jo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens / As pr?ticas em sa?de relacionadas ao processo gestacional tendem a se organizar de acordo com o contexto e os espa?os assistenciais, os quais s?o dependentes das condi??es socioecon?micas e da estrutura f?sica e funcional dos servi?os. A elevada morbimortalidade nesse processo desencadeou, desde 1986, a reflex?o pela Organiza??o Mundial de Sa?de (OMS) quanto aos aspectos t?cnicos e ?s iniquidades sociais que influenciam essa situa??o em diferentes contextos, culminando nas recomenda??es que propunham a reorienta??o da din?mica assistencial com foco na maternidade segura. O Brasil adota, no ano 2000, as sugest?es da OMS, enfatizando a humaniza??o como eixo orientador das a??es. Contudo, essa discuss?o tende a desconsiderar os problemas das iniquidades locais e os condicionantes epidemiol?gicos e sociais que definem as a??es no Sistema ?nico de Sa?de (SUS). Nesse sentido, esta pesquisa objetivou analisar as pr?ticas discursivas nas a??es de trabalhadores e usu?rias da Maternidade de Felipe Camar?o em face da organiza??o do cuidado na perspectiva da humaniza??o do parto e do nascimento no contexto institucional de uma maternidade p?blica. Ent?o, al?m da an?lise dos documentos p?blicos que lidam com essa tem?tica, foi desenvolvido um estudo etnogr?fico em uma maternidade em Natal (RN), considerada modelo para a humaniza??o ap?s ter recebido o pr?mio Galba de Ara?jo, em 2002. Nessa etapa, as estrat?gias metodol?gicas foram a observa??o participante, o grupo focal e a pr?tica da entrevista individual com trabalhadores e usu?rias do servi?o. Na an?lise dos dados, evidenciou-se que os diferentes atores, os profissionais e as mulheres em parturi??o, tendem a mostrarem-se alheios aos contextos que delimitam a produ??o e reprodu??o das pr?ticas em sa?de, o que favorece a aus?ncia de uma postura cr?tica diante das a??es destinadas ? popula??o. Al?m disso, ficou evidente que as dificuldades institucionais, associadas ?s quest?es econ?micas, culturais, pol?ticas e de gest?o, tamb?m dificultam o envolvimento e a reflex?o dos trabalhadores em favor de mudan?as assistenciais para o processo. H? tamb?m a utiliza??o de uma perspectiva prescritiva da humaniza??o no fazer cotidiano desses atores sociais, sem uma reflex?o cr?tica acerca do seu significado. Alguns trabalhadores apresentam em seus posicionamentos uma preocupa??o com os aspectos sociais e econ?micos que afetam as pr?ticas em sa?de e com as limita??es do discurso humanizador, que desarticula as necessidades dos envolvidos nesse contexto. Todavia, possivelmente por quest?es culturais e relacionadas ao processo de forma??o, logo tendem a retornar ao discurso da humaniza??o enquanto pr?tica caridosa caracterizada pela minimiza??o das a??es intervencionistas. J? as usu?rias mostram-se passivas diante da din?mica dos servi?os, submetendo-se ao que lhes ? oferecido enquanto assist?ncia, sem questionar e/ou refletir acerca das suas car?ncias usuais. Assim, pensar em mudan?as no saber/fazer em sa?de destinadas ao parto e ao nascimento implica refletir a produ??o cotidiana dessas pr?ticas e os contextos sociais que influenciam o processo assistencial em sa?de. Dessa forma, seria poss?vel antever a apropria??o, pelos diferentes atores, dos seus anseios e necessidades, fazendo-os ativos na busca pelos seus direitos de cidadania

Made available in DSpace on 2014-12-17T15:43:48Z (GMT). No. of bitstreams: 1 MatheusSM_DISSERT.pdf: 826650 bytes, checksum: 41c585f7d1d37e8e9af7b5caa4e9f50f (MD5) Previous issue date: 2012-12-21 / Investments in health have controversial influence on results of the health of populations, besides being subject rarely explored in literature. Moreover, from the 1970s, the social determinants of health have been consolidated in the disease process as multifactorial factors (social, economic, cultural, etc.) that directly or indirectly influence the occurrence of health problems of populations, as well as mortality rates. This study aimed to evaluate the influence of these investments and the social determinants of health on infant mortality and its neonatal and post-neonatal mortality. This is an ecological study, in which the sample was composed of Brazilians cities with over 80,000 inhabitants, avoiding fluctuations in mortality rates for common small populations, and ensure greater coverage of information systems on mortality and births Brazilians and, therefore, increase data consistency. To isolate the effect of investments in health, we used multiple linear regression. The socioeconomic indicators (p <0.001, p = 0.004, p <0.001), the inequality index (p <0.001, p = 0.001, p = 0.006) and coverage of prenatal visits (p <0.001, p <0.001; p = 0.005) were associated with infant mortality rate total, neonatal and post-neonatal, and the Gross Domestic Product per capita only influenced the overall infant mortality rate and neonatal (p=0.022; 0.045). Investments in health, in this model, lost statistical significance, showing no correlation with mortality rates among children under one year. We conclude that the social determinants of health has an influence on the variation in mortality rates of Brazilian cities, however the same was not observed for indicators of health investment / Os investimentos em sa?de possuem controversa influ?ncia nos resultados em sa?de das popula??es, al?m de serem temas pouco recorrentes na literatura. Por outro lado, a partir da d?cada de 1970, os determinantes sociais em sa?de se consolidaram no processo sa?dedoen?a como fatores multifacet?rios (sociais, econ?micos, culturais entre outros) que influenciam direta ou indiretamente a ocorr?ncia de agravos ? sa?de das popula??es, bem como as taxas de mortalidade. Esse estudo buscou avaliar a influ?ncia desses investimentos e dos determinantes sociais em sa?de sobre a taxa de mortalidade infantil e seus componentes neonatal e p?s-neonatal. Trata-se de um estudo ecol?gico, no qual a amostra foi composta por munic?pios brasileiros com mais de 80 mil habitantes, evitando-se, assim, flutua??es nas taxas de mortalidade comum para pequenas popula??es, al?m de garantir maior cobertura dos sistemas de informa??o sobre mortalidade e sobre nascidos vivos brasileiros e, com isso, aumentar a consist?ncia dos dados. Para isolar o efeito dos investimentos em sa?de, utilizouse a regress?o linear m?ltipla. Os indicadores socioecon?micos (p<0,001; p=0,004; p<0,001), o ?ndice de desigualdade (p<0,001; p=0,001; p=0,006) e a cobertura de consultas pr?-natal (p<0,001; p<0,001; p=0,005) apresentaram rela??o com a taxa de mortalidade infantil total, neonatal e p?s-neonatal, sendo que o Produto Interno Bruto per capita influenciou apenas a taxa de mortalidade infantil total e neonatal (p=0,022; 0,045). Os investimentos em sa?de, nesse modelo, perderam signific?ncia estat?stica, n?o apresentando correla??o com os ?ndices de mortalidade entre as crian?as menores de um ano. Conclui-se que os determinantes sociais de sa?de tem influ?ncia na varia??o das taxas de mortalidade dos munic?pios brasileiros, no entanto o mesmo n?o foi observado para os indicadores de investimento em sa?de

Made available in DSpace on 2014-12-17T15:43:51Z (GMT). No. of bitstreams: 1 JanmilleVS_DISSERT.pdf: 924305 bytes, checksum: f63a120cee4f02a246910cfb885de7a3 (MD5) Previous issue date: 2012-12-07 / Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity?s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water?s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations / Apesar da melhoria das condi??es de vida dos brasileiros nas ?ltimas d?cadas, esta ocorreu de forma polarizada entre grupos de melhor posi??o social. Assim, persiste um panorama de iniquidades em sa?de no Brasil que abrange, inclusive, a situa??o de sa?de bucal. Tal panorama instigou a realiza??o deste estudo ecol?gico que visou avaliar a rela??o das condi??es socioecon?micas (SE), bem como de pol?ticas de sa?de p?blica com as condi??es de sa?de bucal nas capitais brasileiras. Para tanto, foram realizadas an?lise fatorial e de regress?o linear utilizando indicadores de sa?de bucal coletados do SB Brasil 2010, de condi??es socioecon?micas do Censo Brasileiro 2010 e relativos ? fluoreta??o das ?guas de abastecimento do Sisagua. A An?lise fatorial com os indicadores de condi??es de vida revelou dois fatores comuns; depriva??o econ?mica e condi??o s?cio-sanit?ria. Depriva??o econ?mica apresentou correla??o positiva estatisticamente significativa com o CPO-D 12 anos (p=0,03) e m?dia de dentes perdidos (p=0,002) e correla??o negativa com popula??o livre de c?rie (p=0,012). Condi??o s?cio-sanit?ria mostrou correla??o negativa com CPO-D (p<0,0001) e correla??o positiva com popula??o livre de c?rie (p=0,002). ?gua de abastecimento fluoretada teve associa??o significativa com CPO-D (p<0,0001), m?dia de dentes perdidos (p<0,0001) e popula??o livre de c?rie (p<0,0001). An?lise de regress?o linear m?ltipla para o CPO-D das capitais foi estimado pelas condi??es s?cio-sanit?rias e fluoreta??o, ajustado pela depriva??o econ?mica; enquanto que o modelo para a m?dia de dentes perdidos foi estimado apenas pela fluoreta??o e depriva??o econ?mica, e por fim, o modelo para a taxa da popula??o livre de c?rie nas capitais brasileiras foi estimado pela condi??o econ?mica e s?cio-sanit?ria ajustadas pelo abastecimento de ?gua fluoretada. Portanto, quest?es relativas ?s condi??es de vida e ?s pol?ticas p?blicas est?o intrinsecamente associadas ? c?rie dent?ria. Assim, ? preciso desenvolver a??es, para al?m da assist?ncia odontol?gica, para impactar positivamente nas condi??es econ?micas e sociais, sobretudo, das popula??es mais vulner?veis

Made available in DSpace on 2014-12-17T15:43:51Z (GMT). No. of bitstreams: 1 NeumaLO_DISSERT.pdf: 3127072 bytes, checksum: 9bb62caa6ed83de2685de95ce84d5932 (MD5) Previous issue date: 2013-06-27 / Universidade Estadual do Rio Grande do Norte / Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camar?o II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camar?o II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations / Na Aten??o Prim?ria em Sa?de, sobretudo, na Estrat?gia Sa?de da Fam?lia, espera-se que ocorra articula??o das a??es assistenciais e de promo??o da sa?de. O Minist?rio da Sa?de (BRASIL, 2007) define a educa??o em sa?de como uma estrat?gia potencializadora das a??es de preven??o e promo??o, fundamentada em pr?ticas reflexivas, que possibilitem ao usu?rio sua condi??o de sujeito hist?rico, social e pol?tico, sob a vis?o de uma cl?nica ampliada por parte dos profissionais de sa?de. Nesse sentido, h? diretrizes para que profissionais desenvolvam a??es educativas e que estas possam interferir no processo de sa?de-doen?a da popula??o, na perspectiva do desenvolvimento de autonomia dos sujeitos. Esta pesquisa teve como objetivo compreender, ? luz da integralidade do cuidado, como se d? a produ??o das pr?ticas de educa??o em sa?de, no ?mbito da Estrat?gia Sa?de da Fam?lia a partir de estudo etnogr?fico em uma Unidade de Sa?de da Fam?lia (USF). O local da pesquisa foi a Unidade de Sa?de Felipe Camar?o II, no Distrito Sanit?rio Oeste, no munic?pio de Natal, RN, Brasil, selecionada a partir de mapeamento preliminar de pr?ticas educativas implantadas nas unidades de sa?de da fam?lia deste munic?pio, com base em crit?rios entre os quais tempo de implanta??o da USF e sustentabilidade das a??es existentes. A imers?o em campo constou de observa??o participante com registro em di?rio, realizada durante o per?odo de agosto de 2012 a janeiro de 2013, em que a pesquisadora acompanhou processos de trabalho das equipes em a??es clinico-assistenciais, na pr?pria USF, em domic?lios e em a??es educativas de car?ter grupal. Os resultados apresentados na descri??o etnogr?fica foram analisados com base nos eixos propostos por Ayres (2009) para identifica??o da integralidade nas pr?ticas de sa?de: o eixo das necessidades; o eixo das finalidades; o eixo das articula??es; e o eixo das intera??es. As evid?ncias descritas a partir da observa??o apontam presen?a de cada eixo acima nas pr?ticas de educa??o em sa?de desenvolvidas pelas equipes, mesmo que de forma incipiente, quais sejam: articula??o e valoriza??o de saberes e pr?ticas da cultura popular com iniciativas locais (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); integra??o da cl?nica com as a??es de promo??o da sa?de e articula??o de saberes multiprofissional, com v?nculo profissional-usu?rio (Curso para Gestantes). No entanto, alguns desafios foram identificados a serem enfrentados para se avan?ar nessas pr?ticas numa perspectiva do cuidado integral: necessidade de ruptura com a fragmenta??o das a??es; fortalecimento do trabalho em equipe; necessidade de maior sustentabilidade pol?tica das a??es coletivas; trabalho intersetorial com vistas a uma melhor atua??o do Estado no enfrentamento do processo sa?de-doen?a, somando-a ? a??o dos indiv?duos-sujeitos. A an?lise produzida a partir da observa??o dos processos vivenciados indica haver necessidade de um melhor reconhecimento por parte dos gestores locais de que a??es semelhantes as que ocorrem na USF Felipe Camar?o possibilitam avan?os na integralidade ? medida que permite inclus?o dos atores implicados nos processos de trabalho em sa?de, e estimulam participa??o e corresponsabiliza??o no enfrentamento de situa??es de sa?de-doen?a

Made available in DSpace on 2014-12-17T15:43:53Z (GMT). No. of bitstreams: 1 GerlieneMSA_DISSERT.pdf: 1373192 bytes, checksum: ae98ef68760a45b957ffea40dff5d730 (MD5) Previous issue date: 2013-02-22 / Many surveys are conducted comparing oral health conditions with individual variables, such as socioeconomic and demographic factors. However, in the same way that individuals differ among themselves, the groups also have their own characteristics and the effects of this differentiation must be researched. Brazil, despite being one of the major economic powers of the world and shows an improvement in the average value of its health indicators, is also one of the most unequal and remains among the countries with the greatest health inequities. The purpose of this study was to investigate the importance of social determinants on the contextual level oral health among Brazilian adolescents, population not much researched by the literature. The research was made using an ecological approach in order to identify possible inequalities between cities and capitals. Using data from SBBrasil 2010 it was evaluated less common outcomes (loss of first molar, dental care index and T-Health) which provide information on the degree of morbidity of caries and health level of dental tissues, in addition to analyze the related services. The association of these oral health indicators with socioeconomic factors such as income, employment, education and inequality, collected from Census 2010, was analyzed by simple and multiple linear regressions. The study included the 27 state capitals and four clusters representing the municipalities of the country. It was possible to see better access to services in locations with better income distribution. However, the strong association of contextual factors related to poverty, low levels of education and poor housing and jobs with poorer levels of oral health in adolescents seems to overshadow the effects of income inequalities on dental caries in the country. In some locations, particularly within the North and Northeast, whichever one keeps dentistry mutilating, whose effects are already noticeable in its adolescent population. Access to restorative services in Brazil remains limited and unequal. The results of this study highlight the inequities in oral health in the country and show the need of the inclusion of new perspectives on the traditional approach of Preventive Dentistry and education models in Dentistry. Tackling health inequalities in oral health in the country requires the cooperation of various actors involved in the process and the inclusion of oral health in the context of overall health. The social determinants approach, as well as evaluating the distribution of oral diseases in the country and its inclusion in the context of overall health, should guide the implementation of programs and oral health practices in order to contribute to the reduction of inequalities / Muitas pesquisas s?o realizadas confrontando condi??es de sa?de bucal com vari?veis individuais, como fatores socioecon?micos e demogr?ficos. No entanto, da mesma forma que os indiv?duos divergem entre si, os grupos tamb?m possuem caracter?sticas pr?prias e os efeitos dessa diferencia??o precisam ser pesquisados. O Brasil, apesar de ser uma das maiores pot?ncias econ?micas do mundo e vir apresentando uma melhoria no valor m?dio de seus indicadores de sa?de, ? tamb?m um dos mais desiguais e permanece entre os pa?ses com maiores iniquidades em sa?de. A proposta deste estudo foi pesquisar a import?ncia dos determinantes sociais a n?vel contextual na sa?de bucal de adolescentes brasileiros, popula??o pouco pesquisada na literatura. A pesquisa foi feita atrav?s de uma abordagem ecol?gica, no intuito de identificar poss?veis desigualdades entre munic?pios e capitais. Utilizando dados do SBBrasil 2010, foram avaliados desfechos menos comuns (perda do 1? molar, ?ndice de cuidados odontol?gicos e T-Health) que fornecem informa??es sobre o grau de morbidade da c?rie e o n?vel de sa?de dos tecidos dent?rios, al?m de abordar aspectos relacionados aos servi?os. A associa??o destes indicadores de sa?de bucal com fatores socioecon?micos como renda, emprego, educa??o e desigualdade, coletados do CENSO 2010, foi analisada por meio de regress?o linear simples e m?ltipla. Os dom?nios do estudo inclu?ram as 27 capitais brasileiras e 4 clusters representativos dos munic?pios do interior do pa?s. Foi poss?vel constatar um melhor acesso aos servi?os em localidades com melhor distribui??o de renda. No entanto, a forte associa??o de fatores contextuais relativos ? pobreza, baixos n?veis de educa??o e m?s condi??es de moradia e emprego com piores n?veis de sa?de bucal em adolescentes parece ofuscar os efeitos das desigualdades de renda sobre os agravos bucais no pa?s. Em algumas localidades, em especial no interior das regi?es Norte e Nordeste, continua prevalecendo uma odontologia mutiladora, cujos efeitos s?o percept?veis j? em sua popula??o adolescente. O acesso aos servi?os restauradores no Brasil ainda permanece limitado e desigual. Os resultados deste estudo evidenciam as iniquidades em sa?de bucal no pa?s e mostram a necessidade da inclus?o de novas perspectivas na abordagem tradicional da Odontologia Preventiva e nos modelos de educa??o em Odontologia. O combate a essas iniquidades requer a coopera??o dos v?rios autores envolvidos no processo e a inclus?o da sa?de bucal no contexto da sa?de geral. A abordagem dos determinantes sociais, bem como a avalia??o da distribui??o das doen?as bucais no territ?rio brasileiro e sua inclus?o no contexto da sa?de em geral, devem nortear a implementa??o de programas e a??es em sa?de bucal, de forma a contribuir para a redu??o das desigualdades

Submitted by Verena Bastos (verena@uefs.br) on 2015-08-04T00:42:15Z No. of bitstreams: 1 Disserta??o Am?lia Ivine Costa Santana.pdf: 2199413 bytes, checksum: c8afd67767cc43a2e0a711b88cf742f4 (MD5) / Made available in DSpace on 2015-08-04T00:42:15Z (GMT). No. of bitstreams: 1 Disserta??o Am?lia Ivine Costa Santana.pdf: 2199413 bytes, checksum: c8afd67767cc43a2e0a711b88cf742f4 (MD5) Previous issue date: 2015-03-02 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The importance of work in people's lives has been consistently reported in the literature. However, the work may also contribute to changes in physical and mental health of the individuals. Mental disorders related to work, has reached a significant portion of the Brazilian population, in this context, it is highlight common mental disorders (CMD), which under the health work are configured as a highly relevant problem because imply commitment of care provided to the user. In the field of occupational health, psychosocial aspects of work have been the subject of numerous studies, showing that there is at work risk factors invisible capable of causing suffering and illness. Among the tools to evaluate the psychosocial aspects of work is the demand-control model (MDC) and the model of effort-reward imbalance (effort-reward imbalance model - ERI), both widely used in the literature and whose proposals are to show different work stressors and their relationship to outcomes on health. This study has the following objectives: evaluate the contribution of analysis models combined psychosocial work stress and its association with TMC and highlight the interaction between psychosocial aspects of work and the occurrence of TMC. This was a cross-sectional study conducted with a representative sample of primary care workers in five counties of the state of Bahia. The outcome variable was the TMC measured by SRQ-20 and exposure models were demand-control-support social and effort-reward imbalance. We evaluated the performance of partial and complete models and combination of partial models, the interaction was verified by the departure from additivity of effects for the factors studied by calculating the excess risk due to interaction, proportion of cases attributed to the interaction and synergy index. The adjusted prevalence ratios with 95% confidence limits were obtained by Poisson regression with robust variance method. The overall prevalence of CMDs was 21.0% and was associated with high strain and effort-reward imbalance high and showed greater magnitude in the combined exposure group. The results showed better performance than full effort-reward imbalance model and the combination of partial models to predict the event, showed still exist interaction between psychosocial aspects of work and TMC, directed to the synergy of effects. / A influ?ncia do trabalho na vida das pessoas tem sido consistentemente apontada na literatura. No entanto, o trabalho tamb?m pode contribuir para altera??es da sa?de f?sica e mental dos indiv?duos. Os transtornos mentais relacionados ao trabalho t?m atingido uma parcela significativa da popula??o trabalhadora brasileira, nesse contexto, cabe evidenciar os transtornos mentais comuns (TMC), que no ?mbito do trabalho em sa?de se configuram como um problema de grande relev?ncia, pois implicam em comprometimento do cuidado prestado ao usu?rio. No campo da sa?de ocupacional, os aspectos psicossociais do trabalho t?m sido objeto de estudos que demonstram haver no trabalho fatores de risco invis?veis capazes de gerar sofrimento e adoecimento. Dentre os instrumentos capazes de avaliar os aspectos psicossociais do trabalho est? o modelo demanda-controle (MDC) e o modelo de desequil?brio esfor?o-recompensa (effort-reward imbalance model - ERI), ambos largamente utilizados na literatura e cujas propostas consistem em evidenciar diferentes estressores laborais e sua rela??o com desfechos sobre a sa?de. OBJETIVOS: avaliar a contribui??o da an?lise de modelos combinados de estresse psicossocial no trabalho e sua associa??o com TMC e evidenciar a intera??o entre os aspectos psicossociais do trabalho e a ocorr?ncia de TMC. M?TODOS: Tratou-se de estudo transversal conduzido com amostra representativa de trabalhadores da aten??o b?sica de cinco munic?pios do estado da Bahia. A vari?vel desfecho foram os TMC mensurados pelo SRQ-20 e as de exposi??o foram os modelos demanda-controle-apoio social e desequil?brio esfor?o-recompensa. Foram avaliados os desempenhos dos modelos parciais e completos e a combina??o dos modelos parciais, a intera??o foi verificada atrav?s do afastamento da aditividade dos efeitos para os fatores estudados a partir do c?lculo do excesso de risco devido ? intera??o, propor??o de casos atribu?da ? intera??o e ?ndice de sinergia. As raz?es de preval?ncia ajustadas com 95% de confian?a foram obtidas pelo m?todo de regress?o de Poisson com vari?ncia robusta. RESULTADOS: A preval?ncia global de TMC foi de 21,0% e esteve associada ? alta exig?ncia e ao alto desequil?brio esfor?o-recompensa e apresentou maior magnitude no grupo de exposi??o combinada. CONCLUS?O: Os resultados demonstraram melhor desempenho do modelo de desequil?brio esfor?o-recompensa completo e da combina??o dos modelos parciais para predizer o evento. Evidenciaram ainda, existir intera??o entre os aspectos psicossociais do trabalho e TMC, com dire??o para a sinergia dos efeitos.