A Reforma Sanitária Brasileira (RSB) tem sido bastante estudada pelo campo científico da Saúde Coletiva. Recentemente, novos estudos retomam sua trajetória e, assim, têm estimulado discussões sobre seu futuro. Este trabalho buscou valorizar este tema e o pensamento de uma de suas pesquisadoras e personagens, a socióloga Amélia Cohn. Devido à relevância de suas contribuições teóricas e a inexistência de trabalhos sobre esta autora, o objetivo desta dissertação foi compreender o pensamento de Amélia Cohn sobre a Reforma Sanitária Brasileira, a partir de um conjunto de seus textos, publicados ao longo de 24 anos. Para tanto, elaboraram-se as seguintes temáticas para análise dos quatro textos principais: a \"definição\" construída por Amélia Cohn sobre a RSB, o protagonismo político no interior do movimento da RSB, as características das estratégias políticas do movimento da RSB, os objetivos da RSB e o alcance de suas propostas, a produção de conhecimentos do campo da RSB, e a questão democrática para o campo da RSB. Concluiu-se que a autora buscou analisar esse tema de modo amplo, avaliando diferentes aspectos e priorizando em sua avaliação sobre os rumos da RSB a relação concomitante entre a produção de conhecimentos do campo e suas propostas e ações políticas. Além disso, ela considerou a RSB das décadas de 1960, 1970 e 1980, como a experiência de referência para suas reflexões. Dessa forma, elaborou em 1992 sua tese principal sobre o esgotamento da reforma sanitária e, em 2013, a tese sobre a renúncia do campo a um projeto de saúde para o país. Portanto, entende-se que Amélia Cohn buscou identificar pluralidade teórico-política no movimento e no pensamento da RSB, incluindo-se o campo da Saúde Coletiva, e propôs a autoconfrontação dos projetos do campo em suas análises. / The Brazilian Sanitary Reform (BSR) is a common object of research within the Public Health scientific field. Long-lasting questions about its path have been discussed in recent studies, opening doors to think about its future. This study highlights this theme by reflecting on the sociologist Amélia Cohn\'s theoretical contributions upon the BSR. Due to the relevance of her theoretical contributions and the absence of studies about her scholarly works, this dissertation seeks to understand Amélia Cohn\'s thought about the BSR through published works over a 24-year-period. In order to do so, the following themes guide through the analysis of four main readings: Amelia Cohn\'s \'definition\' of the BSR, the political role within the BSR, the characteristics of the political strategies of the RSB movement, the goals of the BSR and the extent of its propositions, the production of knowledge from the BSR field, and the understanding of the democratic question to the BSR field. The author sought to analyze the BSF in a broad spectrum by evaluating its diverse aspects and prioritizing the concomitant relationship between the production of knowledge of the field and its proposals and political actions in order to evaluate the BSR\'s paths. Furthermore, she considered the 60\'s, 70\'s and 80\'s as time reference for her reflections on the development of the BSR. Accordingly, in 1992 she developed her main thesis on the collapse of sanitary reform, and, in 2013, theorized about the resignation of the BSR to a health project for the country. Therefore, Amélia Cohn sought to identify theoretical and political plurality in the movement and thought of the BSR, which includes the field of Public Health. The author has clearly proposed the confrontation between the projects carried out by the field in her analytical frameworks.

Quality online health information/knowledge is globally in high demand. Achieving such quality necessitates a multi-disciplinary requirements engineering approach that enables elicitation, analysis and representation of the viewpoints from a broad variety of related sources. These sources include health and health education/promotion professionals, health informaticians and application design experts, and health consumers, the primary users of such knowledge. In addition, maintaining and improving quality over time requires such a large set of viewpoints to be updated regularly. This dissertation endeavors to provide an enabling methodology to address the above needs specifically in the field of eHealth. This research was conducted in two steps. In the first step, the existing methods of requirements engineering applicable into our particular scope of eHealth applications, aimed at health promotion/education, were reviewed to develop a framework for knowledge requirements engineering. In the second step, the usability and usefulness of the proposed framework were evaluated throughout a four-phase study (0-III). During this study, knowledge requirements engineering was used to specify the pieces of information that should be included in a quality health Web site targeting university students. Within the established framework, requirements data was gathered from various sources, including literature, existing Web sites, and interviews with local health professionals and university students. The evaluation results showed that the pieces of information and health topics specified using the framework consistently matched those the subjects preferred. In addition, the findings provided evidence that such information, when used by health search engines to index and retrieve online health resources, helped the subjects choose the resources that actually matched their interest. Finally, the data showed a higher satisfaction of the subjects with the health Web site that was built based on the knowledge requirements specified, as compared to the other selected health Web sites. This dissertation makes significant contributions to the fields of health informatics, health promotion, and requirements engineering. It contributes to the field of health informatics by expanding the scope of requirements engineering to include the field of eHealth and knowledge provision. The approach presented illustrates how various viewpoints related to requirements knowledge should be elicited, analyzed, and reasoned to build valid knowledge requirements specifications representing viewpoints of all sources consulted. It also illustrates how such specifications can be used as a basis to build quality eHealth applications. In the field of health promotion, this dissertation demonstrates a knowledge provision methodology that is grounded in the models of health behaviour change. This methodology allows health educators to rationally and accurately specify not only the health topics of high interests to health consumers, but also the type of knowledge they would prefer to be provided in the related knowledge artifacts. More particularly, this research has specified the health knowledge content of preference to adolescent consumers. These specifications highlight the particular knowledge needs of this age group, which can be used as a basis for local to national health promotion activities targeting these consumers. Finally, the research contributes to the field of requirements engineering by illustrating an integrated requirements engineering approach that accommodates multiple viewpoints and allows transparent reasoning and representation of requirements. It is anticipated that the concept of knowledge requirements engineering introduced and discussed in this dissertation will open a new area of research and practice for health informaticians. Subsequently, the methodology demonstrated can be improved and further advanced to address the needs of other domains of health and health-related knowledge.

Made available in DSpace on 2014-12-17T14:20:27Z (GMT). No. of bitstreams: 1 JoselitoS_TESE.pdf: 2216695 bytes, checksum: 31c3393eaa7120982ec5feb0be12aca7 (MD5) Previous issue date: 2012-04-27 / The assistance to women who have breast cancer is studied in a Reference Center in Paraiba and also the way this assistance is performed in a School Hospital maintained by SUS (Single Health System) is questioned. Breast cancer demands institutional organization, provision of financial, material and human resources, requiring, from the health system, effective assistance with new technologies which make it possible for the population their access to specialized medical services although it not always is able to guarantee those services nor the rights which the legislation granted them, inhibiting a proper relationship between the health professional and the patient. The theme is discussed through a transdisciplinary knowledge view and has as its theoretical referential the contribution of classical and contemporary authors from the human and social sciences and, as an empirical research strategy, the structured interview. The objectives of the research were: identify how the assistance to women with breast cancer is carried on at a Reference Center on Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction with the received assistance; draw up a profile of the women with breast cancer who were assisted in this Reference Center; understand their gynecological and obstetric antecedents, life styles, age group and stage of the disease when the treatment started; check their knowledge about their rights and which benefits they had received. Most women ranged between 40 and 59 years old (63%), which corresponds to the risk range of developing breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose family income was among those who received between less than a minimum salary and one minimum salary (58.2%). This population was mainly constituted of married women (60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and complete elementary school (24.1%), which added up to 51.6%. It was observed that the majority of the women seemed to be satisfied with the assistance received, noting that a minimum care was enough to define this satisfaction, although it is perceived that the access to the health system does not ensure the ideal attention conditions they need; it was verified that the availability of the services and the assistance itself are seen (in the local culture) as a favor and not as a right. It is also observed that only 30% of the women mentioned that they knew about their rights and the most mentioned ones were the disease assistance (13%), the medicines (13%) and the treatment (12%), which represent the most important triad to face the disease and around which the oncologic assistance most focus on. It is concluded that the condition of the users? minimum existential of a public health unit and the condition of belonging to a lower social stratum were variables that influenced the respondents? satisfaction in relation to the assistance received but the importance of the Reference Center for the women with breast cancer?s assistance for the whole region cannot be denied as well as the need to broaden the way the policy of the oncologic assistance in Brazil in the local realm is seen / Estuda-se a assist?ncia a mulheres com c?ncer de mama, em um Centro de Refer?ncia da Para?ba, indagando-se como se d? a assist?ncia em oncologia, oferecida por um Hospital- Escola, que o mant?m atrav?s do Sistema ?nico de Sa?de (SUS). O c?ncer de mama exige organiza??o institucional, provimento de recursos materiais, humanos e financeiros, demandando ao sistema de sa?de assist?ncia eficiente e com novas tecnologias que possibilitem o acesso da popula??o aos servi?os m?dicos especializados, mas nem sempre consegue garantir esses servi?os, nem os direitos que a legisla??o conferiu ? popula??o, inibindo a adequada rela??o entre sistema de sa?de, profissional e paciente. Discute-se o tema em uma vis?o transdisciplinar do conhecimento, tendo como referencial te?rico aportes de autores cl?ssicos e contempor?neos das ci?ncias humanas e sociais em sa?de e, como estrat?gia de pesquisa emp?rica, a entrevista estruturada. Delimitaram-se como objetivos: identificar como ? realizada a assist?ncia a mulheres com c?ncer de mama em um Centro de Refer?ncia em Cancerologia, no munic?pio de Campina Grande, PB, identificando suas dificuldades e satisfa??o com a assist?ncia recebida; elaborar o perfil das mulheres com c?ncer de mama assistidas nesse Centro; conhecer seus antecedentes ginecol?gicos e obstetr?cios, estilos de vida, faixa et?ria e est?gio da doen?a quando iniciou o tratamento; verificar seus conhecimentos acerca dos seus direitos e quais os benef?cios recebidos. A maioria das mulheres encontrava-se na faixa et?ria entre 40 e 59 anos (63,1 %), correspondente ? faixa de risco para desenvolvimento do c?ncer de mama. Quanto ? ocupa??o, 38,3 % eram do lar e 30,1 % aposentadas, cuja renda familiar se concentrava entre aquelas que ganhavam menos de um sal?rio e um sal?rio m?nimo (58,2 %). Essa popula??o era constitu?da em sua maioria por mulheres casadas (60,2 %), com n?vel de escolaridade mais frequente no ensino fundamental incompleto (27,6 %) e fundamental completo (24,1 %), perfazendo um total de 51,6 %. Constatou-se que a maioria das mulheres mostrou-se satisfeita com a assist?ncia recebida, observando-se que um m?nimo de cuidado lhes foi suficiente para definir essa satisfa??o, embora se perceba que o acesso ao sistema de sa?de n?o garante as condi??es ideais para a aten??o de que necessitam; constatase que a disponibilidade de servi?os e de atendimento ? vista (na cultura local) como favor e n?o como direito. Observa-se ainda que apenas 30 % das mulheres mencionaram conhecer os seus direitos, sendo os mais citados o aux?lio doen?a (13 %), o medicamento (13 %) e o tratamento (12 %), que se apresentam como a tr?ade mais importante para o enfrentamento da doen?a, e em torno dos quais mais se foca a assist?ncia ?s mulheres no ?mbito da assist?ncia oncol?gica. Conclui-se que a condi??o de m?nimo existencial das usu?rias de uma unidade p?blica de sa?de e a condi??o de pertencimento a um baixo estrato social foram vari?veis que influenciaram a satisfa??o das entrevistadas com rela??o ? assist?ncia recebida, mas n?o se pode negar a import?ncia do Centro de Refer?ncia para a assist?ncia ?s mulheres com c?ncer de mama para toda a regi?o, bem como a necessidade de se ampliar o olhar em torno da pol?tica de assist?ncia oncol?gica no ?mbito local