Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-08T19:25:57Z No. of bitstreams: 1 Claudia Viviane de Castro.pdf: 178797 bytes, checksum: 1f498c465e5c6ddf6e72268f4d7d5495 (MD5) / Made available in DSpace on 2015-04-08T19:25:57Z (GMT). No. of bitstreams: 1 Claudia Viviane de Castro.pdf: 178797 bytes, checksum: 1f498c465e5c6ddf6e72268f4d7d5495 (MD5) Previous issue date: 2013-12-17 / Despite the low prevalence in the general population ( 0,5% to 1,0% ) , psychotic disorders represent high burden on society. These individuals require continuous depending on the severity and persistence of symptoms care, and these are not always available in the communities. Objective: To identify subjects with psychotic disorder within the population registered in the Health Unit Family Neighborhood Perequê city of Guaruja /SP and evaluate their use of the public health service available. Method: It is a cross-sectional study in two subsequent steps. In the first step, a questionnaire (SRQ - 30) was applied to 527 subjects between men and women older than 15 years, enrolled in the 12 team of the Family Health Unit Perequê neighborhood. Subjects with 03 or 04 positive responses to symptoms of psychosis (questions 21, 22, 23, 24) in this first stage, answered the clinical interview (LCRF) with information on the use they make of the public health service. Results: In the first stage, 51.4 % had at least one of the positive responses to psychotic disorder and 8.5 % (n = 45) had 03 or more positive responses. Of these, 34 participated in the second stage, mostly women, in a stable relationship with characteristics of low educational level, with an unemployment rate of 38,2 % and 85 % with per capita income up to minimum wage. Note - if current low use of specialized mental health services (5.9%), with an increased frequency of consultations with the general practitioner, either in PS or UBS. Fifty -nine percent of the subjects do not have or do not know their diagnosis, 50 % are drug treatment, most initiated by psychiatrist. There were 11,8% of cases of admissions to psychiatric hospital and 11,8 % of cases of suicide attempts. Conclusion: The study population has a high prevalence of subjects with psychotic symptoms of mental disorder and preferably seeking care in emergency rooms or primary care unskilled. This result reflects the lack of specialized mental health services and reinforces the importance of the preparation of the general practitioner and the whole team of family health for case identification, monitoring, family support and as a facilitator of social inclusion. / Apesar da baixa prevalência na população geral (de 0,5% a 1,0%), os transtornos psicóticos representam elevada sobrecarga para a sociedade. Estes indivíduos necessitam de cuidados contínuos em função da gravidade e persistência dos sintomas, e estes nem sempre estão disponíveis nas comunidades. Objetivo: Identificar sujeitos portadores de sintomas para transtorno psicótico dentro da população cadastrada na Unidade de Saúde da Família do Bairro Perequê, cidade de Guarujá/SP e avaliar o uso que fazem do serviço público de saúde disponível. Método: É um estudo de corte transversal em duas etapas subsequentes. Na primeira etapa, foi aplicado um questionário (SRQ-30) a 527 sujeitos entre homens e mulheres maiores de 15 anos, cadastrados na equipe 12 da Unidade de Saúde da Família do bairro Perequê. Os sujeitos que apresentaram 03 ou 04 respostas positivas para sintomas de transtorno psicótico (questões 21, 22, 23, 24) nesta primeira etapa, responderam a entrevista clínica (LCRF) com informações sobre o uso que estes fazem do serviço público de saúde. Resultado: Na primeira etapa, 51,4% apresentaram ao menos uma das respostas positivas para transtorno psicótico e 8,5% (n=45) apresentaram 03 ou mais respostas positivas. Destes, 34 participaram da segunda etapa, em sua maioria mulheres, em união estável, com características de baixo grau de escolaridade, com índice de desemprego de 38,2% e 85% deles com renda per capita até um salário mínimo. Nota-se utilização atual baixa dos serviços especializados em saúde mental (5,9%), sendo a maior frequência em consultas com o clínico geral, seja em PS ou UBS. Cinquenta e nove por cento dos sujeitos não têm ou não conhece sua hipótese diagnóstica, 50% fazem tratamento medicamentoso, a maioria iniciado por psiquiatra. Houve 11,8% de casos de internações em hospital psiquiátrico e 11,8% de casos de tentativas de suicídio. Conclusão: A população estudada apresenta elevada prevalência de sujeitos com sintomas para transtorno psicóticos e buscaram preferencialmente atendimento médico em pronto socorro ou em atenção básica não especializada. Este resultado reflete uma dificuldade na continuidade do acompanhamento a esses pacientes por parte dos serviços especializados em saúde mental e reforça a importância do preparo do clínico geral e de toda a equipe de saúde da família para suprir essa necessidade, auxiliando na identificação de caso, acompanhamento, suporte familiar e como facilitadora da inserção social.

Den ökande globaliseringen bidrar till en kulturell mångfald i vården. Det finns få tidigare studier om ledarskap från mångkulturella arbetsplatser i Sverige och för att möjliggöra ett hållbart ledarskap av en hållbar mångkulturell arbetsplats behöver framgångsfaktorer i ledarskapet identifieras. I syfte att undersöka vilka upplevelser och erfarenheter vårdens chefer har av att leda mångkulturella medarbetargrupper har en kvalitativ intervjustudie genomförts. Totalt intervjuades 8 chefer från två olika sjukhus. Det insamlade materialet har transkriberats, analyseras och kategoriseras genom innehållsanalys (Elo & Kyngäs 2008). Resultatet visar att ledarskapet anpassades både utifrån individen och medarbetarens kulturella bakgrund. Det var främst språket som de intervjuade cheferna anpassade, men även på vilket sätt de kommunicerade med medarbetarna. Fördelar identifierades med en mångkulturell arbetsplats då personalen kunde tolka åt patienter och förmedla kunskap om kultur i medarbetargruppen. Informanterna upplevde inte att konflikter i medarbetargruppen härrörde från kulturella aspekter men däremot att missförstånd relaterade till språkförståelse kunde skapa konflikter. En förklaring till detta resultat kan vara att informanterna upplever det mer socialt accepterat att diskutera språkliga orsaker till konflikter än kulturella orsaker. Cheferna saknade stöd och utbildning i mångkulturellt ledarskap och uppgav att de fått kunskap genom erfarenhet och lärt av tidigare misstag. Författarna tror att cheferna kan få stöd genom mentorskap för att utveckla ett hållbart ledarskap och att färre misstag då skulle behöva begås. En organisatorisk tydlighet med regler och värdegrund ses också som viktiga för ett hållbart ledarskap.

The specific aims of this study were determined on a conceptual appreciation that management of information assets and services in some government agencies was deficient in meeting both existing and developing demands. This appreciation manifested itself in a commitment to investigate the principles and processes intrinsic to existing management methodologies, to relate these processes to the needs of users, and to determine a strategy which could more ably meet the information provision requirements of those users. The achievement of these aims predicated the use of the case study research method, selecting as the first case study the Department of Human Services and Health (DHSH), an agency that had recognised that a problem existed in the provision of information services, and had initiated action to address that problem. As a counter, the Department of Defence, an agency which adrmts to a problem, but which had yet to initiate an active, global program for its resolution, was chosen as the second case study. A theoretical model, which reflects extant international thinking and practice, was initially constructed in order to establish a basis on which to ascertain and evaluate the information management circumstances of the two case study departments. This model specified the objectives considered to be fundamental to effective information management in a public service environment. It included studying the foundation repositories of information services from which information in the portfolio domains of government are sought. These services are the traditional records centres or registries, the library services which provide a repository of published and grey material in printed, image and magnetic formats, and the computerised networks holding electronic records at varying levels of development. An analysis of findings was carried out separately on each case study agency before bringing the data together for cross-case analysis. In order to maximise the veracity and validity of the data collected and its subsequent interpretation by the researcher, the draft analysed case study findings were submitted to the respective agencies for review and critique. All matters of substance received have been incorporated in the final version. The findings from the two case studies and the cross-case analysis confm that, despite significant advances in some specific agencies, the initial hypothesis that government agencies are still deficient in providing optimum services to meet the information needs of users, is demonstrated. The advances that have been made, however, similarly support the other thesis hypotheses that the implementation of an integrated information management strategy in any government agency will provide a foundation for improved information provision and the timely delivery of relevant available information to the user. Finally, a model of optimum processes involved in such a strategy, derived from the theory and practical products of this study, is offered. This could be the subject for future evaluation and testing for realistic and functional application.

Title from first page of PDF document. Includes bibliographical references (p. 41-45-Xx).

In recent times, public engagement has become an increasingly prominent feature of modern public service provision. Contemporary Public Engagement (CPE) has been characterized by the proliferation of new and innovative mechanisms with which to engage and involve the public in any process in which their input is either desired or legally required. This thesis takes a qualitative approach to exploring CPE within the context of local public services in Scotland, with the explicit aim of contribution to the development of conceptual understanding and theory. The design of this project was based on a case study of the Clackmannanshire Community Health Partnership (CHP). The key empirical instruments were semi-structured interviews, a focus group, analysis of key CHP documents and participant observation by the researcher at CHP Committee meetings. This study makes three main contributions to existing knowledge. They are: a Conceptual Framework for explaining CPE within Scottish local public service provision, a Conceptual Model which is based on the Conceptual Framework and presents it at a higher level of abstraction, and the generation of substantive theory rooted in the case study data. The thesis makes two main recommendations. The first is that further comparative research should be undertaken in order to further develop and confirm the validity of Conceptual Model and substantive theory. The second is that meta-analysis should be undertaken to assist in the development of the proposed formal theory of Public Sector Reform.

Treating chronic health conditions consumes a significant portion of the health care resource. Two–thirds of UK hospital admissions consist of people with chronic conditions (Singh, 2005). To date, health management has tended to focus on service redesign, rather than focusing on the patients, as a way to facilitate improved outcomes and control costs. Typically, these management approaches are premised on the patient as a consumer/end user. An alternative view to the patient being a consumer is that of the patient being a co–producer of the service. Co–production recognises the client (patient) as a resource, in that value cannot easily be created or delivered, unless the patient actively contributes to the service (Alford, 1998). Patients gain health value when they are well and are independent of the health care system and its costs. Health care organisations gain economic value, when chronic patients require less health care. This thesis examines co–production, in the context of contemporary patient involvement and heath services management. ‘Knowing the People Planning’ (KPP), an innovative health management method, is evaluated for its patient management co–production potential. KPP is based on ten key features of service provision. Four of the key features relate to the patient, whilst the remaining six features relate to the organisation. It is the management of these patient and organisation features that better facilitates chronic long-term mental health patients as co–producers. The empirical findings, from this evaluation of KPP provide evidence for the efficacy of co–productive health management theory and practice. Patient health value and health care organisation economic value are created, when both the organisation and the patient co–produce the health service. KPP was initially implemented by eight of New Zealand’s 21 District Health Boards. Socio-ecological action research methodology was used to evaluate KPP — by taking a ‘people-in-environments’ approach. The evaluation covers fourteen action research cycles for 2,021 chronic long-term patients over four years. Measurements include the amount of time these long-term patients spent in hospital and employment rates. The integration of the action research cycles, using the socio-ecological method supported the generation of (what I have called) ‘co–productive health management theory’. Analyses of secondary data, across organisational and patient domains, supplement the action research findings, in order to assess for confounding factors. The organisation outcomes relate to costs and staff turnover. Patient outcomes relate to service utilisation measures, for approximately 60,000 adult patients per year, who access New Zealand’s secondary mental health services. A pivotal finding of this research was that, as the rate of patients with treatment plans increased from 50% to 90%, inpatient bed use decreased by 26%. However, increased funding for mental health services had only a minor impact on decreasing inpatient bed use. Patient employment rates increased, whilst the number of patients who required access to general practitioners and changes to their housing situation, decreased. The patient management co–production view offers a significant opportunity for health care managers and researchers to significantly improve both patient and organisation value. Co–production views the patient as a resource, who contributes to her/his health outcome, rather than a person who simply consumes services. The better patients can co–produce their health outcome the better their health, and the lower their demand for health services.

Thesis (Ph.D.)--University of Melbourne, School of Social Work and Department of Psychiatry, 2001. / Typescript (photocopy). Includes bibliographical references (leaves 262-311).

Thesis (Ph.D.)--Yale University, 2004. / Presented to the Faculty of the Graduate School of Yale University in candidacy for the degree of Doctor of Philosophy. Includes bibliography. Preview available online at: http://proquest.umi.com/pqdlink?did=765029031&Fmt=7&clientId%20=43258&RQT=309&VName=PQD.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 29, 2009). Includes bibliographical references (p. 88-97).

Thesis (M.S.P.H.)--University of Michigan, 1942.