Thesis (LL.M)--York University, 2003. / Includes bibliographical references. Also available on the Internet.

Orientadores: Angelica Maria Bicudo Zeferino , Marco Aurelio Da Ros / Tese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T09:01:49Z (GMT). No. of bitstreams: 1 Souza_PatriciaAlvesde_D.pdf: 1385571 bytes, checksum: a743e125b5721c2bea34a94edea68547 (MD5) Previous issue date: 2010 / Resumo: O Programa de Incentivo às Mudanças Curriculares nos Cursos de Medicina (PROMED) pelo Ministério da Saúde (MS) em parceria com o Ministério da Educação (MEC) do Brasil foi criado para financiar as reformas curriculares nos cursos de medicina, a fim de que o médico seja formado para atender as reais necessidades de saúde da população atendida no Sistema Único de Saúde (SUS). O objetivo desta tese é avaliar as mudanças de tal programa nos cursos de medicina que receberam o financiamento, e, para isso, foi realizada uma pesquisa qualitativa e quantitativa com os coordenadores das mudanças curriculares. Foram entrevistados os 19 coordenadores de escolas médicas que receberam o PROMED e 12 destes responderam ao questionário. Foram utilizadas: a técnica da análise de conteúdo de Laurence Bardin, a base metodológica da pesquisa qualitativa de Cecília Minayo e a análise descritiva. Com os resultados pode-se observar que os cenários de práticas foram modificados e estiveram baseados na integração ao SUS e a inserção dos alunos em atividades na rede de saúde desde os primeiros anos. Percebeu-se a existência de resistências à mudança por alguns docentes e por profissionais da saúde, sendo que a estruturação de base do pensamento voltado ao processo saúde-doença não foi alterado. O PROMED facilitou as mudanças estruturais nas escolas que já possuíam alguma experiência com a comunidade e também contribuiu para demonstrar que uma mudança de fato e transformadora exige muito tempo e são necessárias novas iniciativas para que se consolidem essas novas reformas curriculares / Abstract: The Program for the Promotion of Changes in Medical School Curricula (PROMED), created by the Brazilian Ministry of Health (MS) and the Ministry of Education (MEC), was conceived to finance curricular changes in medical courses. It is based on the National Curricular Guides which assures the physician is educated to answer the real health needs of the population that have received treatment from the Brazilian National Healthcare System (SUS). The thesis aims to evaluate such changes taking into consideration the medical courses that received this financing. To accomplish this purpose, both a qualitative and quantitative survey was carried out involving the coordinators of the curricular changes, which consisted on nineteen interviews with the coordinators of medical schools that received PROMED and questionnaires that were answered by twelve of them. Concerning the methodological apparatus, it was used Laurence Bardin content analysis technique of Cecilia Minayo's qualitative research as well as a descriptive analysis. Results point out that the medical practice scenarios actually changed, based on two reasons: the interaction with SUS as well as the insertion of students in public health network activities since the very first years of the course. It is also possible to observe the resistance for changes by some of the professors and health professionals; however, the health-disease process framework has not been altered. As a result, it is possible to state that PROMED facilitated structural changes in schools that already had some experience with the community and also contributed to demonstrate that a real and transfomationalist change demands time. Therefore, new initiatives are necessary so as to consolidate these new curricular changes / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for the evaluation of the GMP by using a graphic flowchart depicting health outcomes prior to and after the implementation of the program. The review consisted of approximately 2,100 students from 9th to 12th grade, and out of those students there were 77 participants from 2010 and 89 participants from 2015 with diagnosis of diabetes. A t-test outcome evaluation found the updated GMP was associated with the lowering of hemoglobin A1c readings. Mean A1c in 2009 was 8.6% (180 - 190 mg/dl), with the mean decreasing to 7.2% (150 mg/d) in 2015. Changes in the program led to 1-to-1 care management based on children's individual needs and parental involvement. Findings show that the GMP improved glycemic management by empowering and individualizing care. This project contributes to positive social change by contributing to data from the Diabetes Prevention Program Research Group study showing that prevention of onset of Type II diabetes mellitus in adults and adolescents is successful through early detection of prediabetes in childhood.

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>