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Evolu??o da cultura de seguran?a em hospitais antes e ap?s a implanta??o do programa nacional de seguran?a do pacienteAndrade, Luiz Eduardo Lima de 13 May 2016 (has links)
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Previous issue date: 2016-05-13 / Introdu??o: A promo??o de uma Cultura de Seguran?a do Paciente (CSP) nas organiza??es de sa?de tem sido recomendada como uma pr?tica que contribui para a redu??o do risco de danos desnecess?rios associados ao cuidado de sa?de, por?m n?o h? evid?ncias das interven??es em sa?de p?blica que devem ser implantadas. O sistema de sa?de brasileiro regulou uma s?rie de medidas para este objetivo, por?m sua efetividade ainda n?o foi avaliada. Objetivo: Analisar o efeito do Programa Nacional de Seguran?a do Paciente (PNSP) na Cultura de Seguran?a do Paciente. M?todo: Trata-se de um delineamento quase-experimental com abordagem descritivo-anal?tica. A CSP foi avaliada em tr?s hospitais com diferentes perfis, tr?s meses antes (n=215) e quinze meses ap?s (n=450) a implanta??o do programa nacional de seguran?a do paciente. Utilizou-se um instrumento validado e adaptado ? realidade brasileira (Hospital Survey On Patient Safety Culture). A evolu??o da CSP foi avaliada por meio de 14 indicadores simples e 2 compostos. Resultados: A CSP teve evolu??o positiva de forma consistente ap?s a implementa??o do PNSP. Os hospitais melhoraram a CSP em 14 dos 16 indicadores avaliados, que incluem 11 das 12 dimens?es avaliadas, a Porcentagem de Respostas Positivas total, a m?dia da nota para a seguran?a do paciente e o ?ndice de CSP. O hospital que apresentou maior melhoria foi o estadual seguido do federal e privado, isto demonstra que o PNSP foi um indutor da homogeneiza??o dos servi?os prestados no Brasil, pois esta ordem era inversa do n?vel de cultura antes do PNSP. Conclus?o: O estudo evidencia uma melhoria consistente da CSP em hospitais ap?s o PNSP, apontando para a efetividade da regula??o nacional externa, que por sua vez aparentam ser moduladas pela variabilidade do contexto interno. / Introdution: Promoting Patient Safety Culture (CSP) in health organizations has been recommended as a practice that contributes to reducing the risk of unnecessary harm associated with health care, but there is no evidence of public health interventions They should be deployed. The Brazilian health system has regulated a series of measures for this purpose, but its effectiveness has not been evaluated. Objective: To analyze the effect of Patient Safety National Program (PNSP) on Patient Safety Culture. Method: This is a longitudinal quase-exprimental design with descriptive and analytical approach. The CSP was evaluated in three hospitals with different profiles, three months before (n = 215) and fifteen months (n = 450) the implementation of national patient safety program. We used a validated instrument and adapted to the Brazilian reality (Hospital Survey On Patient Safety Culture). The development of CSP was evaluated by simple indicators 14 and 2 compounds. Results: The CSP had positive developments consistently following the implementation of PNSP. Hospitals improved CSP in 14 of the 16 indicators assessed, including 11 of the 12 dimensions evaluated, the total Positive Response Percent, the average score for patient safety and the CSP index. The hospital with the highest improvement was the state followed by federal and private, it shows that PNSP was an inducer of improving of services in Brazil, since this order was reversed culture level before PNSP. Conclusion: This study shows a consistent improvement of CSP in hospitals after PNSP, pointing to the effectiveness of external national regulation, which in turn appear to be modulated by the variability of the internal context.
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Objective Structured Practical Examination (OSPE) como instrumento de avalia??o de habilidades no internato de cirurgia geral da Universidade Federal do Rio Grande do Norte - UFRNPaiva, Rodrigo Trigueiro Morais de 30 December 2015 (has links)
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Previous issue date: 2015-12-30 / Introdu??o: Objective Structured Practical Examination (OSPE), ? um m?todo de avalia??o de habilidades pr?ticas que utiliza de ambiente simulado e controlado, de efici?ncia comprovada no processo ensino-aprendizagem. O internato de Cirurgia Geral do curso de medicina da UFRN ainda necessita de adequa??es quanto ? avalia??o de habilidades em ambiente simulado, sendo essa uma demanda dos estudantes. A UFRN disp?e de Laborat?rio de Habilidades Cl?nicas, contudo observa-se que ainda ? pouco utilizado por docentes e discentes e a avalia??o estruturada de habilidades ainda n?o est? devidamente estruturada nas ?reas cir?rgicas. Metodologia: foi proposta a elabora??o de 10 protocolos contendo as listas de materiais para montagem de cen?rios e checklists de 10 esta??es de OSPE. A seguir foram selecionadas 04 esta??es e aplicadas a 32 estudantes do internato de Cirurgia Geral, onde estes al?m de serem avaliados, desempenharam, em algum momento da atividade, os pap?is de estudante ?avaliador? e ator/figurante. Um question?rio foi aplicado para avaliar este tipo de atividade na perspectiva destes estudantes do internato. Resultados: os10 protocolos referentes ?s esta??es de I a X, foram elaborados e ficar?o sob a responsabilidade da coordena??o do Laborat?rio de Habilidades da UFRN. Na atividade realizada, as notas dos checklists dos professores e estudantes ?avaliadores? mostraram uma associa??o moderada em duas esta??es (R = 0,70 e p=0,012) e (R = 0,44 e p=0,152) e uma ssocia??o forte nas outras duas esta??es (R = 0,79 e p=0,002) e (R = 0,78 e p=0,003). Os estudantes avaliaram positivamente a atividade nos tr?s blocos do question?rio: grau de satisfa??o em rela??o ? avalia??o, avalia??o com rela??o ?s esta??es e avalia??o sobre sua participa??o na atividade. Conclus?o: a realiza??o de avalia??o pelo m?todo OSPE apresenta requisitos estruturais favor?veis para sua implanta??o na avalia??o dos estudantes do curso de medicina da UFRN, reestruturando a avalia??o de habilidades no internato de cirurgia geral. / Introduction: Objective Structured Practical Examination (OSPE) is a method of assessment of practical skills using simulated and controlled environment, widely used in the teaching-learning worldwide. UFRN has Clinical Skills Laboratory, however the skills assessment is not yet properly structured in surgical areas, this is a demand of the students. Objectives: The general objective of this study is to implement the method Objective Structured Practical Examination (OSPE) as an evaluation tool in General Surgery of medical school UFRN, and to evaluate the use of the method from the perspective of students of the boarding school. Methodology: The strategy was divided into two stages: the first were prepared and / or revised 10 stations OSPE, including lists of material for assembly of each scenario and their checklists. A test with some stations was carried out with the boarding school teachers of general surgery, residents of surgical areas for adjustments. In the second stage, four stations were selected and applied to two groups of 16 students of General Surgery internship, on two separate occasions, where they were evaluated, also playing the role of evaluator of colleagues. At the end of the activity a questionnaire was used to evaluate the activity from the perspective of students. Results: 10 stations drawn up the list of materials will be under the responsibility of coordination of the Skills Laboratory of UFRN. In the seasons application stage, the marks awarded by teachers and students "evaluators" have shown a strong association in two seasons: intubation (R = 0.79 and p = 0.002) and exchange gastrostomy tube (R = 0.78 p = 0.003). This association was also observed, although moderate, in the thoracic puncture stations for decompression of tension pneumothorax (R = 0.70 and p = 0.012) and suture face and knowledge of materials needed for its realization. (R = 0.44 and p = 0.152). Students positively evaluated the activity questionnaire in the three blocks: degree of satisfaction with the assessment, as the seasons and evaluation of their participation in the activity. Conclusion: The use of OSPE, as proposed, has structural and technical favorable conditions and a faculty qualified for its implementation in the evaluation of skills in General Surgery of students of medical school UFRN, thereby qualifying the evaluation system in this area.
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Nise da Silveira e a sa?de mental no Brasil: um itiner?rio de resist?nciaFernandes, Sandra Michelle Bessa de Andrade 16 December 2015 (has links)
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Previous issue date: 2015-12-16 / O presente estudo teve como objetivo a reconstitui??o de um itiner?rio de resist?ncia de Nise da Silveira, no contexto da sa?de mental no Brasil, considerando suas contribui??es como uma cientista que inaugura um novo patamar na psiquiatria, psicologia, epistemologia dos estudos dos transtornos mentais. Partiu-se da seguinte quest?o norteadora: como foi poss?vel para Nise da Silveira, que escolheu a contracorrente do seu tempo, enfrentando logo no in?cio da vida profissional, estrutura de estado e o apogeu do tratamento cartesiano na ci?ncia m?dica psiquiatra, encontrar resist?ncia para - permanecendo na contra-hegemonia - inaugurar uma nova ci?ncia propositiva de novas modalidades de tratamento para os portadores de transtornos mentais graves, que reverberou na hist?ria? Como argumenta??o central da tese, destaca-se: Nise da Silveira percebeu que o novo na ci?ncia s? se instala pela ousadia de constru??o de novas concep??es, novos m?todos e persist?ncia na pesquisa. Atentou que a abertura de novos paradigmas na ci?ncia torna-se mais vi?vel quando o pesquisador visita e se alimenta de outros campos de conhecimento que n?o s?o de sua especialidade, tendo ido ao encontro de outras regi?es de saberes fora do campo da psiquiatria, como arte, mitologia, literatura, religi?o, epistemologia, filosofia e psicologia. Elegeu guias do pensamento, mestres condutores de sua vida/obra. Exerceu a contra-hegemonia e, ancorando-se em profunda, rigorosa e obstinada pesquisa cient?fica, inaugurou um novo patamar na ci?ncia psiqui?trica. Para empreender a reconstitui??o desse itiner?rio, foram utilizadas as seguintes refer?ncias de an?lise, bases emp?ricas, que envolvem a vida/obra de Nise da Silveira: obras liter?rias, art?sticas, cient?ficas, entrevistas, filmes, jornais, document?rios. O texto foi tecido com a roupa de escafandro, foi tecido em mergulhos. Partiu-se do cen?rio ostensivo da ci?ncia m?dica psiqui?trica, no in?cio do s?culo XX; revisitou-se os nichos de origem da personalidade aguerrida e insubordinada; recontou-se a influ?ncia de alguns guias do pensamento, importantes para a constru??o da sua ci?ncia inaugural; adentrou-se nas conquistas da sua hist?ria de resist?ncia, a materializa??o da sua luta, presente em dois ?cones, a Casa das Palmeiras e o Museu de Imagens do Inconsciente; recordou-se alguns artistas e suas obras; narrou-se lembran?as de amigos e companheiros. E, por ?ltimo, quando a roupa do escafandrista era tirada, e restava a subjetiva??o do sujeito autor, o encontro sobreveio no caminho do meio, por interm?dio de cartas tecidas com a linha do afeto. / El estudio que se presenta a continuaci?n tiene como objetivo la reconstituci?n de un itinerario de resistencia de Nise da Silveira, en el contexto de la salud mental en Brasil, considerando sus contribuciones como una cient?fica que inaugura una nueva perspectiva en la psiquiatr?a, la psicolog?a y la epistemolog?a de los estudios de los trastornos mentales. Partimos del siguiente postulado: ?c?mo fue posible para Nise da Silveira, que escogi? el discurso de resistencia de su tiempo, enfrentando, inmediatamente, en el inicio de la vida profesional, la estructura del estado y el apogeo del tratamiento cartesiano en la ciencia m?dica psiqui?trica, encontrar un punto de resistencia para ?permaneciendo en la contra-hegemon?a? inaugurar una nueva ciencia propositiva de nuevas modalidades de tratamiento para los portadores de trastornos mentales graves, que reverber? en la historia? Como argumentaci?n central de la tesis, se destaca: Nise da Silveira percibi? que lo nuevo en la ciencia s?lo se instala por la osad?a de la construcci?n de nuevas concepciones, nuevos m?todos y persistencia en la investigaci?n. Llamo la atenci?n para la apertura de nuevos paradigmas en la ciencia y que se hace m?s viable cuando el investigador visita y se alimenta de otros campos de conocimiento que no son de su especialidad, habiendo ido al encuentro de otras regiones de saberes fuera del campo de la psiquiatr?a, como arte, mitolog?a, literatura, religi?n, epistemolog?a, filosof?a y psicolog?a. Eligi? gu?as del pensamiento, maestros conductores de su vida/obra. Ejerci? la contra hegemon?a y ancl?ndose en profunda, rigurosa y obstinada investigaci?n cient?fica inaugur? un nuevo horizonte en la ciencia psiqui?trica. Para emprender la reconstituci?n de ese itinerario fueron utilizadas las siguientes referencias de an?lisis, que envuelven la vida/obra de Nise da Silveira: obras literarias, art?sticas, cient?ficas, entrevistas, pel?culas, peri?dicos, documentales. El texto fue tejido con la ropa de escafandra, fue tejido en suaves zambullidas. Se parte del escenario ostensivo de la ciencia m?dica psiqui?trica, en el inicio del siglo XX; volvi? a visitar los nichos de origen de la personalidad aguerrida e insubordinada; se volvi? a contar el influjo de algunos gu?as del pensamiento, importantes para la construcci?n de su ciencia inaugural; se adentr? en las conquistas de su historia de resistencia, la materializaci?n de su lucha, presente en dos ?conos, a Casa das Palmeiras y o Museu de Imagens do Inconsciente; se recordaron algunos artistas y sus obras; se narraron recuerdos de amigos y compa?eros. Y, por ?ltimo, cuando la ropa de la escafandrista era retirada, le restaba la subjetivaci?n del sujeto autor, el encuentro sobrevino en el camino del medio, a trav?s de cartas tejidas con la l?nea del afecto.
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Situation Awareness, en jämförelse mellan SPL, MCPP och COPDMidenby, Johan January 2018 (has links)
Att utveckla och bibehålla situation awareness (SA) är en av de mest kritiska utmaningar i en stab i dagens konflikter. Det får avgörande betydelse för utgången av en konflikt. Om SA hanteras eller förstås felaktigt kan det leda till ökat mänskligt lidande i konfliktområden och förluster av människoliv. Det ökande internationella samarbetet gör att planeringsofficeren förutsätts kunna hantera flera olika processer. Syftet med uppsatsen var att jämföra och belysa skillnader hur SA skapas inom olika planeringsprocesser, samt vad försvårar utväxlingen av SA mellan processerna. Detta återspeglas i form av likheter och skillnader mellan planeringsmodellerna SPL, MCPP och COPD. Resultatet visar att det fanns stor likhet mellan processerna men det fanns också avgörande skillnader. I SA nivå 1 fanns en diskrepans mellan begreppen Centre of Gravity, caveats och gender. I SA nivå 2 skiljer bearbetningsprocesserna mellan planeringsmodellerna. I SA nivå 3 fanns den största och mest avgörande skillnaden där det kan konstateras att planeringsprocesserna inte utgår från samma byggstenar när det gäller att bygga planen. Medvetenhet och insikt för de olika planeringsprocessernas särart minskar risken för missförstånd.
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The influence of exogenously applied 'anti-stress' agents in the upregulation of the drought response in Iraqi wheat varietiesKareem, Fakhriya Mohammed January 2017 (has links)
Bread wheat (Triticum aestivum L.) is one of the most important cereal crops grown in the world. It has great importance because it constitutes a major source of carbohydrate for more than one third of the world’s population (Budak et al., 2013). In the last three decades, drought conditions are becoming more widespread in wheat production areas including Europe, Australia and Asia, and it is considered a major cause of reduced wheat growth and productivity in most developing countries with semi-arid climates. Drought constitutes the most important threat for wheat production in Iraq and especially for the Kurdistan Regional Governate owing to the limited source of water during at least some part of the growing period. Because wheat is considered a staple food and has economic importance for the Kurdistan Regional Government research is needed to determine the production capacity of Iraqi wheat varieties under drought stress and the potential for the maximization of the drought tolerance response. The soil moisture holding capacity of the intended growing medium was measured gravimetrically in pots with and without wheat plants and correlated with the soil capacitance measured using a TDR Theta Probe (Delta-T Devices). This was used to determine the available water content of the soil (AWC) and to control and manage the watering regimes during drought studies. The results of a study of the response of different cultivars of Iraqi wheat (Triticum aestivum L.) to watering regimes of 70% and 50% showed that drought stress had a significant effect on the biomass and yield traits especially tiller number and stem bundle weight compared to normal conditions. The highest significant difference was observed for cv. Tamooz 2 in comparison to Adana 99, but there was a little difference between cvs. Rizgary and Sham 6. The effect of the exogenous application of salicylic acid (SA) and molybdenum (Mo) on drought tolerance of cvs. Tamooz 2 and Adana 99, showed that Tamooz 2 had higher values for growth characteristics and higher yield potential when sprayed with a lower concentration of SA (1.44 mM) under well-watered conditions in comparison with Adana 99. The effect of spraying variety Tamooz 2 with SA at different growth stages indicated that biomass production and yield components (the number of spikes/pot, grain dry weight and average 1000 grain dry weight) significantly increased at both stem+flower as well as leaf+stem+flower sprayings for plants subjected to drought. Also, SA treatments at stem extension and flowering had a positive effect on the up-regulation of the drought response gene CBF/DREB under drought stress conditions. These findings indicate that agronomic treatments with exogenous applications of salicylic acid and molybdenum could help to reduce the effects of drought in the field.
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A qualitative exploration of the South African cricket development environmentEnglish, Cedric Vaughan January 2017 (has links)
It may be argued that there are fewer sporting environments where politics and sport are so intertwined, however having undergone significant socio-political changes and development, South Africa (SA) remains a strong sporting nation with a rich and complex sporting history. After 28 years of sporting isolation, following SA's re-entry to international competition in 1992, the country has since competed at international level and immediately reasserted itself as one of the top cricketing nations in the world. With very little non-politicised literature on the subject, the question of what SA's talent development environment looks like in order to produce internationally competitive teams, after 28 years of isolation, remains relatively un-reviewed. In light of this, the SA cricket development environment offers a unique opportunity to explore one of SA's oldest and most established sports. The focus of this thesis will provide a pragmatic and holistic picture of the South African cricket development environment across four features, Organisational Culture, Structural Change, Coach Development and Coach-Administrator Relationships. Consequently, the aims of this thesis are fourfold: 1. To explore the use of an existing organisational framework, the Cultural Web, from the domain of organisational culture management to investigate organisational culture within SA cricket development environment. 2. To gather an understanding of the development pathway of SA cricketers and investigate if the changes made to the provincial structure in 2004 have impacted on the pre-2004 development trajectory of a SA cricketer. 3. To explore the learning and development environment of SA cricket coaches and their career progression. 4. To explore and illuminate the operational relationship between the coach and the administration within the context of SA cricket.
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?Saber ser, saber conhecer, saber saber?: compreendendo as viv?ncias, saberes e as pr?ticas pedag?gicas de preceptores em um Programa de Resid?ncia Multiprofissional em Sa?de da Fam?liaSilva Junior, Ren? Ferreira da 31 January 2018 (has links)
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Previous issue date: 2018 / A resid?ncia em sa?de surge como padr?o ouro para forma??o em servi?o, caracterizada pela educa??o no trabalho, relaciona teoria e pr?tica, o ensino e o servi?o, sendo importante para a forma??o dos profissionais para o Sistema ?nico de Sa?de. Nesse contexto, destaca-se o papel do preceptor, essencial para a forma??o do residente. Assim, esse estudo tem como objetivo principal compreender a atua??o docente de preceptores enfermeiros em um programa de resid?ncia multiprofissional em sa?de da fam?lia da Universidade Estadual de Montes Claros e como objetivos espec?ficos: descrever a constru??o das pol?ticas e organiza??o da sa?de no Brasil e a Reforma Sanit?ria Brasileira; compreender as principais pol?ticas p?blicas e programas interministeriais de forma??o em sa?de no Brasil; descrever a resid?ncia em sa?de; compreender o ser professor; conhecer o significado de ser preceptor e descrever seus processos formativos. Nortearam o estudo os seguintes problemas: Como ocorre ? atua??o docente dos preceptores? Qual sua identidade? E quais experi?ncias docentes formam essa identidade? O estudo foi explorat?rio, descritivo, qualitativo e os procedimentos metodol?gicos articulam entrevistas orais tem?ticas, desenvolvido durante o ano de 2017, al?m de busca bibliogr?fica e documental para embasamento do corpus da disserta??o. Para o processo de an?lise de dados foi utilizado ? an?lise de conte?do de Bardin. Os participantes foram preceptores enfermeiros atuantes no programa de resid?ncia em sa?de da fam?lia, a amostra foi por conveni?ncia, sendo selecionadas tr?s preceptoras de acordo com a disponibilidade para participar da pesquisa e o maior e menor tempo de atua??o. Utilizou-se um roteiro semi-estruturado para coleta de dados, que ocorreu nos p?los de atua??o dos preceptores, durante o turno vespertino, nos meses de novembro e dezembro de 2017, os depoimentos foram gravados e transcritos na ?ntegra. O projeto de pesquisa foi aprovado com parecer 2.425.790/2017. O estudo est? organizado em cinco cap?tulos, na qual buscou-se tra?ar a linha hist?rica da sa?de no Brasil, em especial, o movimento de reforma sanit?ria, a constru??o do Sistema ?nico de Sa?de e o desenvolvimento e implementa??o das principais pol?ticas e programas direcionados ? forma??o em sa?de no pa?s. Nessa perspectiva, deu se ?nfase nas Resid?ncias Multiprofissionais em Sa?de e o papel docente, finalizando com as vozes dos preceptores. Conclui-se que o estudo possibilitou a compreens?o da evolu??o da sa?de no Brasil, o que resultou no Sistema ?nico de Sa?de, sendo criadas por meio dele estrat?gias de forma??o voltadas ao atendimento e aos seus princ?pios, assim, a resid?ncia multiprofissional em sa?de ? um espa?o privilegiado de produ??o de ensino e sa?de. Ressalta-se que o papel do preceptor ? essencial para a forma??o de profissionais cr?ticos e reflexivos, com mudan?as na vis?o do residente sobre si e quais caminhos ele quer seguir. Percebe-se tamb?m fragilidades acerca da forma??o em doc?ncia dos preceptores e aus?ncia de preparo espec?fico pr?vio para desenvolvimento desse papel, no qual foi desempenhado inicialmente por oportunidade/convite de exercer o of?cio docente. Evidenciou-se por fim que o papel docente do preceptor ? secundarizado em detrimento as fun??es administrativas e/ou assistenciais, e a sua identidade enquanto educador ? perdida. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. / The residence in health is gold standard for in-service training, characterized by education at work, relating theory and practice, teaching and service, and it is important for the training of professionals to the single Health System. In this context, we highlight the role of the tutor, essential for the formation of the resident. Thus, this study aims to understand the teaching performance of main tutors nurses in a program of multidisciplinary residency in family health at the State University of Montes Claros and as specific objectives: describe the construction of the policies and organization of health in Brazil and the Brazilian health reform; understand the main public policies and Interministerial programmes of training in health in Brazil; describe the residence in health; understand the teaching; know the meaning of being tutor and describe their formation processes. Guided the study the following issues: How does the teaching performance of the tutors? What is your identity? And what experiences teachers form this identity? The study was exploratory, descriptive, qualitative and methodological procedures articulate thematic oral interviews, developed during the year 2017, in addition to bibliographical and documental search for basement of the corpus of the dissertation. For the data analysis process was used to analysis the content of Bardin. The subjects were tutors nurses operating in residency program in family health, the sample was for convenience, being selected three governesses according to availability to participate in the research and the larger and shorter acting. We used a semi-structured data collection script, which occurred at the poles of expertise of tutors, during the evening shift, in the months of November and December 2017, the interviews were recorded and transcribed in full. The research project was approved with 2,425,790 opinion/2017. The study is organized into five chapters, in which he sought to trace the historical line of health in Brazil, in particular, the health reform movement, the construction of the health system and the development and implementation of key policies and programs targeted to health training in the country. In this perspective, gave emphasis on Multiprofessional Health Residences and the teaching role, ending with the voices of tutors. It is concluded that the study allowed understanding the evolution of health in Brazil, which resulted in the unified Health System, being created through training strategies geared to the service and to their principles, so the multi-professional residence in health is a space privileged education and health production. It should be noted that the role of the tutor is essential to the formation of critical and reflective professionals, with changes in resident's vision about you and what ways he wants to follow. You can see also weaknesses concerning the teaching training of tutors and the absence of specific preparation prior to development of this paper, which was played initially by chance/invitation to pursue the craft. It was finally the teaching role of the tutor is secundarizado over administrative functions and/or assistance, and your identity as an educator is lost.
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Comportamento l?dico como indicador de desempenho infantil: influ?ncia da fam?lia, ambiente escolar e condi??es de trabalho das professoras de creches p?blicas de Diamantina (MG) / Play of preschool children: family influence, school environment and working conditions of teachers of public day care centers in Diamantina (MG)Lemos, Ang?lica Carvalho 01 September 2017 (has links)
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Previous issue date: 2017 / Introdu??o: Na medida em que se reconhece a import?ncia das creches no desenvolvimento
integral de crian?as at? cinco anos de idade, ? evidente a preocupa??o com o impacto do
trabalho prec?rio dos professores na garantia da oferta de oportunidades de estimula??o das
crian?as frequentes em creche. Objetivo: Examinar associa??es entre o comportamento
l?dico de crian?as de creches p?blicas e fatores individuais da crian?a, est?mulos do ambiente
familiar, ambiente creche e condi??es de trabalho das professoras que atuavam nas turmas das
respectivas crian?as. M?todo: A amostra aleat?ria e representativa incluiu 131 crian?as com
faixa et?ria 18 a 36 meses e 14 professoras, frequentes em seis creches p?blicas. O brincar foi
avaliado pela Escala L?dica Pr?-escolar de Knox- revisada, adaptada culturalmente para o
Brasil e nas quatro dimens?es: dom?nio espacial, dom?nio material, faz-de-conta/jogo
simb?lico e participa??o; para as oportunidades de estimula??o do ambiente familiar adotou o
question?rio Affordances in the Home Enviroment for Motor Development (AHEMD); o
ambiente creche foi avaliado pela Infant/Toddler Environment Rating Scale ? Revised Edition
(ITERS-R); ainda de question?rio estruturado elaborado exclusivamente para pesquisa para
professoras de creche contendo quest?es sociodemogr?ficas, condi??es de trabalho e fatores
psicossociais do trabalho. A an?lise multivariada adotou o modelo Generalized Estimating
Equations (GEE) com entrada hier?rquica das vari?veis. Resultados e Discuss?o: A
preval?ncia de defasagem no comportamento l?dico foi de 18 % (n = 24 crian?as) com
desvantagens em crian?as com idade inferior a 24 meses. O comportamento l?dico apresentou
m?dia de 70,3 (desvio padr?o [DP]=19,9), a dimens?o participa??o apresentou menor m?dia
de 60,4 (desvio padr?o [DP=27]. As vari?veis faixa et?ria da crian?a, escolaridade paterna,
escolaridade materna, n?mero de cursos realizados pelas professoras e estresse ocupacional
permaneceram associadas ao comportamento l?dico. A associa??o entre estresse ocupacional
e o comportamento l?dico ? preocupante, uma vez que a precariza??o do trabalho docente
pode comprometer o brincar de crian?as de 18 a 36 meses que frequentam creche.
Adequa??es na organiza??o de trabalho e atua??es interdisciplinares entre profissionais da
sa?de e educa??o faz-se necess?rias. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Reabilita??o e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / Introduction: As you get to know the importance of kindergartens in full-time education of
children up to six years old, it gets evident the concern about the impact of the weak work
from the teachers on the assurance of development. Objective: Examine associations between
performance of children?s playing in municipal daycare and encouragement in family?s
environment, environment in daycare and tutor?s work conditions in educational centers for
children in Diamantina. Method: The random and representative sample included 131
children aged 18 to 36 months and 14 female teachers, attending six public day care centers.
The play was evaluated by the Knox-Revised Preschool Play Scale, culturally adapted to
Brazil and in the four dimensions: spatial domain, material domain, make-believe / symbolic
play and participation; for the opportunities of stimulation of the family environment adopted
the questionnaire Affordances in the Home Enviroment for Motor Development (AHEMD);
the nursery environment was evaluated by the Infant / Toddler Environment Rating Scale -
Revised Edition (ITERS-R); yet a structured questionnaire elaborated exclusively for research
for daycare teachers containing sociodemographic questions, working conditions and
psychosocial factors of work. The multivariate analysis adopted the Generalized Estimating
Equations (GEE) model with hierarchical input of the variables. Results and Discussion: The
prevalence of gaps in play behavior was 18% (n = 24 children) with disadvantages in children
less than 24 months old. The participation rate presented a mean of 60.3 (standard deviation
[SD = 27].) The participation rate presented a mean of 60.3 (standard deviation [SD = 27].)
The variables age range of the child, paternal schooling, maternal schooling, number of
courses performed by teachers and occupational stress remained associated with playful
behavior. The association between occupational stress and play behavior is worrisome, since
the precariousness of the teaching work can compromise the play of children from 18 to 36
months attending day care. Adequations in the organization of work and interdisciplinary
actions among health professionals and education are necessary.
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Inova????o institucional no contexto do federalismo brasileiro p??s-1988: a emenda constitucional no. 29 de 2000 e os governos estaduaisFortes, F??tima Beatriz Carneiro Teixeira Pereira January 2008 (has links)
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Previous issue date: 2008 / Funda????o Jo??o Pinheiro / O objetivo desta tese ?? investigar os efeitos da Emenda Constitucional n. 29, de 2000 (EC n.29) nas decis??es alocativas dos governadores estaduais relativas aos gastos com sa??de, buscando identificar os seus condicionantes. Dois argumentos anal??ticos principais guiaram a an??lise. O primeiro foi o de que as institui????es, entendidas como regras formais, orientam o c??lculo e a intera????o dos atores. O segundo foi o de que, para investigar seus impactos ?? preciso considerar a import??ncia da ag??ncia humana e que as escolhas refletem a intera????o entre institui????es e condi????es. De fato, ap??s a aprova????o da Emenda a grande maioria dos estados aumentou o percentual da receita aplicada na sa??de, diferentemente do que se observou no per??odo imediatamente anterior. Constatou-se, tamb??m, que o comportamento dos estados variou significativamente. Essa variabilidade das respostas dos governadores instigou a investiga????o dos poss??veis condicionantes de seus comportamentos
Mesmo reconhecendo que a rela????o condicionantes???tomada de decis??es seja extremamente complexa, o pressuposto foi o de que, a partir da associa????o entre vari??veis capazes de refletir a diversidade dos estados brasileiros nos aspectos pol??tico, econ??mico e social e as respostas dos governadores em termos do gasto com sa??de, fosse poss??vel responder ?? indaga????o principal proposta. Os resultados do modelo ajustado mostraram que a vari??vel indicadora emenda para a aprova????o da EC n. 29 mostrou-se altamente significativa, confirmando que a sua aprova????o induziu os governadores a elevarem o percentual da receita aplicado na sa??de. Entre as vari??veis de contexto, apenas a receita l??quida per capita e o perfil ideol??gico do partido do governador mostraram-se significativas. No entanto, os resultados encontrados permitem afirmar que tais vari??veis condicionam apenas marginalmente o efeito substantivo da Emenda nos estados. O que se pode concluir ?? que a introdu????o de uma regra como a EC n.29 foi capaz de induzir os governadores a adotarem comportamentos independentemente das vari??veis de contexto aqui consideradas. Ainda que as vari??veis selecionadas possam compor o contexto das escolhas, as suas influ??ncias, mediadas pelos mais diversos interesses e circunst??ncias, n??o puderam ser captadas numa abordagem dessa natureza.
O estudo buscou chamar a aten????o ainda para o fato de que, ao mesmo tempo em que induziu o aumento dos gastos com sa??de, a EC n.29 passou a estimular outros jogos envolvendo disputas relacionadas ao conceito de ???a????es e servi??os de sa??de??? e quanto ?? base de c??lculo para a defini????o da participa????o da Uni??o. Nesse sentido, o estudo confirmou a pertin??ncia do argumento neo-nstitucionalista de que as institui????es n??o podem ser consideradas apenas como ???coer????es herdadas??? e, portanto, ex??genas ao processo pol??tico, mas que atores racionais tendem a buscar participar da elabora????o/altera????o das regras, de modo a favorecer suas escolhas. A investiga????o tamb??m lan??ou luzes sobre os desafios postos ao compartilhamento de responsabilidades pela engenharia federativa. Embora a Emenda tenha sido, de certa forma, bem sucedida no sentido de impor uma dada dire????o aos gastos com a sa??de, constatou-se que alguns estados reduziram o percentual da receita aplicado na sa??de quando deveriam t??-lo aumentado e que poucos estados conseguiram atingir o percentual m??nimo de 12% em 2004, conforme estipulado. Portanto, ainda que a a????o coletiva em pa??ses federativos possa ser favorecida por meio de regras, seus efeitos plenos podem ser retardados ou, mesmo, n??o serem atingidos caso o consenso em torno delas mostre-se fr??gil. No caso da EC n.29, essa fragilidade manifesta-se nos percal??os enfrentados pela sua regulamenta????o e implementa????o. / The purpose of this thesis is to investigate the effects of Constitutional Amendment 29 (EC n.29), of 2000, on the decisions of state governors related to the allocation of funds for the health sector, aiming at identifying its conditioning factors.
Two main analytical arguments guided the analysis. The first: institutions, understood as formal rules, orientate the calculations and the interaction of actors. The second: in order to investigate its impacts, it is necessary to consider the importance of human agency and that choices reflect the interaction between institutions and conditions.
In fact, after the passing of Amendment 29, the great majority of the states increased their revenue percentage invested in the health sector, differently from what was seen in the previous period. It was also a fact that the behavior of the states significantly varied. Such variability regarding the governors?? responses instigated the investigation into the possible factors that condition their behavior.
Even recognizing that the relation between conditioning factors and decision-making is extremely complex, the assumption was that, based on the association between variables capable of reflecting the diversity of Brazilian states concerning political, economical and social aspects and the governors?? responses regarding expenditures on health, it would be possible to answer the main proposed question.
The results of the adjusted model showed that the variable amendment indicating the passing of EC n.29 was highly significant, confirming that its passing induced governors to raise the revenue percentage invested in the health sector. Among context-related variables, just the net per capita revenue and the ideological profile of the governor??s party were significant. However, the overall results allow to state that such variables only marginally condition the substantial effect of the Amendment on the states. What can be concluded is that the introduction of a rule such as EC n.29 was capable of inducing governors to adopt behaviors despite the context-related variables considered herein. Although the selected variables may compose the context of choice, their influences, mediated by all sorts of interests and circumstances, could not be captured in such an approach.
The study also attempted to call attention to the fact that, while inducing the increase in the expenditures on health, EC n.29 started to stimulate other games involving disputes related to the concept of ???health actions and services??? and concerning the calculation basis that define the participation of the federal entity. In this regard, the present study confirmed the pertinence of the neo-institutionalism argument which states that institutions can not be considered only as ???inherited coercions??? and, thus, exogenous to the political process, but that rational actors tend to seek the participation in the elaboration/alteration of rules, so as to favor their choices. The investigation brought light as well to the challenges of responsibility sharing set by federative engineering. Although the Amendment was, in a way, well-succeeded in the sense that it imposed a certain direction to expenditures on health, it was possible to see that some states reduced the revenue percentage invested in the health sector when it should have been increased, and that only a few states managed to reach the established minimum of 12% in 2004. Therefore, even though collective actions in federative countries can be favored by means of rules, their full effects may be delayed or even not be reached if consensus on them turns out to be fragile. In case of EC n.29, such fragility is manifested by the drawbacks faced in its regulation and implementation. / Governo e Pol??tica
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A??es educativas de promo??o da sa?de relacionadas ? atividade f?sica nas unidades b?sicas de sa?de do munic?pio de Diamantina-Minas GraisS?, Paulo Henrique Vilela Oliveira de 25 July 2013 (has links)
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Previous issue date: 2013 / O presente trabalho teve como objetivo estudar o entendimento de profissionais e estudantes respons?veis por a??es educativas de promo??o da sa?de relacionadas ? atividade f?sica para idosos, realizadas nas Unidades B?sicas de Sa?de (UBS) da ?rea urbana de Diamantina,Minas Gerais. Trata-se de um estudo quali-quantitativo do tipo transversal, realizado com 28 respons?veis por tais a??es. Os dados foram coletados atrav?s de um instrumento de pesquisa fechado do tipo Likert, como uma primeira aproxima??o do objeto do estudo. Os dados foram analisados de forma descritiva e anal?tica pelo programa Epi Info vers?o 6.04 for Windows. Foram encontradas 11 a??es educativas de promo??o da sa?de relacionadas ? atividade f?sica para idosos nas seis UBS estudadas. Cinco a??es eram de responsabilidade dos professores e alunos da Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM) e seis a??es de responsabilidade dos profissionais do servi?o de sa?de. As a??es observadas foram ?grupo de caminhada e exerc?cios (alongamentos)?, ?grupo de coluna? e ?Qigong?. Dentre os respons?veis pelas a??es, nove (32,1%) eram agentes comunit?rios de sa?de (ACS), nove (32,1%) acad?micos do curso de fisioterapia, cinco (17,9%) enfermeiros, dois (7,1%) t?cnicos de enfermagem, um (3,6%) fisioterapeuta do N?cleo de Apoio ? Sa?de da Fam?lia (NASF), um (3,6%) professor do curso de Fisioterapia e um (3,6%) professor do curso de Educa??o F?sica. Todos os participantes demonstraram seu entendimento sobre o conceito de atividade f?sica, os benef?cios dessas atividades para idosos, o impacto dessas a??es na sa?de p?blica e a necessidade de permanente capacita??o ao responder as 28 quest?es do instrumento tipo Likert. Os respons?veis por a??es educativas de promo??o da sa?de relacionadas ? pr?tica de atividade f?sica para idosos percebem essas a??es como uma importante ferramenta de gest?o, educa??o em sa?de e promo??o da sa?de. Entretanto, relatam necessidade de educa??o permanente para melhor operacionaliza??o e desenvolvimento dos seus conhecimentos e habilidades. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2013. / ABSTRACT
This paperintended to study the understanding of professionals and students of responsible for educational activities of health promotion related to physical activity for elderly, conducted in the Health Care Units (HCU) of the urban area of Diamantina, Minas Gerais. This is a qualitative and quantitative cross-sectional study, conducted with 28 responsible for these activities. Data were collected with the use of a research instrument closed Likert-type, as a first approximation of the object of study.Data were analyzed in the descriptive and analytical using Epi Info version 6.04 for Windows.Were found 11 educational activities of health promotion related to physical activity for elderly in the six HCU studied.Five activities were responsibility of the teachers and students of the Federal University of the Jequitinhonha and Mucuri (UFVJM) and six activitiesof responsibility healthcare service professionals.Actions observed were ?walking group and exercises (stretching)?, ?spine group? and ?Qigong?.Among those responsible for the actions, nine (32.1%) were community health agents (CHA), nine (32.1%) physiotherapy students, five (17.9%) nurses, two (7.1%) nursing technicians, one (3.6%) Family Health Support Centers (FHSC) physiotherapist, one (3.6%) course teacher of physiotherapy and one (3.6%) course teacher of physical education. All participants demonstrated their understanding of the concept of physical activity, the benefits of these activities for elderly, the impact of these activities on public health and the need for permanent qualification to the answer the 28 questions the Likert-type instrument.Those responsible for educational activities of health promotion related to physical activity for elderly perceive these activities as an important management tool, health education and health promotion. However, report need for permanent education for the better operationalization and development of their knowledge and abilities.
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