Human life and maintainable advancement are still more combined and discusseable.Thus in this days much more attention is beeing concerntrated at the project titled as Healthy town.Under this title one can imagine a lot of its meanings.Someone might take it as injuries,others as clean parks, whereby the kids could play without any concern.As you notice, everyone under the title Healthy town is taking it differently, but altogerther it gives the same meaning as Healthy town. I have choosen this theme for its actuallity.This project Healthy town is completely dealing with the problems of the inhabitants,but does not forget for theire responsibilities and allows an active dialog amongst them and its leadership of the town.We should not forget, that healthy towns have got well worked out methods of public administration, which is well valued by the EU.This fact helps in requirements for grants from EU which is a privilege for healthy towns,which is the reality of today. In the theoritical part of the corrent state I have hilghlited the basic information of the WHO and its communual project Healthy town, which I have aquired through out my studies from special literatures, internet references,magayines,which I have listed in the used sources. In the practical part of the research I have added the information of the findings, which I have aquired wiith the help of my own findings.Initially I have conducted the secondary data analysis, which I have obtained from the database of the national net of healthy towns in CZ, Association of healthy towns in SR,of the Czech statistical office and Slovakian statistical office. Since the project Healthy town is part of the communal project is partially formed induvidually.As a result of this I have refered in the practical part of this work two case studyies of healthy towns,which serves as an exemplary of this project.

A segurança do paciente cirúrgico é problemática complexa e desafiadora em âmbito global. A presente pesquisa teve como objetivos (a) analisar as evidências disponíveis na literatura sobre o processo de implementação da lista de verificação de segurança cirúrgica da Organização Mundial da Saúde na prática dos serviços de saúde, e (b) analisar o processo de implementação e o uso diário da lista de verificação de segurança cirúrgica, segundo o relato de enfermeiros que atuavam em unidades de centro cirúrgico de hospitais de duas cidades localizadas no estado do Paraná. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta de 27 pesquisas agrupadas em três categorias, a saber: processo de implementação: estratégias para introdução da lista de verificação de segurança cirúrgica nos serviços de saúde (n=15); processo de implementação: estratégias para otimização do uso da lista de verificação de segurança cirúrgica nos serviços de saúde (n=9) e facilitadores e barreiras para implementação da lista de verificação de segurança cirúrgica nos serviços de saúde (n=3). A condução da revisão integrativa possibilitou compreender o processo de implementação da lista, as diferentes estratégias utilizadas para sua implantação, aspectos da implementação considerados bem-sucedidos ou pouco exitosos no alcance dos resultados esperados, facilitadores e barreiras deste processo. O estudo descritivo foi realizado em 25 hospitais de duas cidades que compõem a mesorregião do Norte Central Paranaense (Londrina e Maringá). Os participantes foram 91 enfermeiros que atuavam em centro cirúrgico dos hospitais selecionados. Para a coleta de dados elaborou-se dois instrumentos, os quais foram submetidos à validação aparente e de conteúdo. Os resultados evidenciaram que, na maioria dos hospitais investigados, a lista de verificação de segurança cirúrgica foi implementada, sendo que, para a maioria dos participantes, as estratégias adotadas na introdução da lista foram o planejamento prévio conduzido pelos enfermeiros, a adaptação com predominância do uso no formato impresso e programa educacional. Com relação ao uso diário da lista, a maioria dos enfermeiros apontou a utilização inadequada desta prática nos seguintes aspectos: adesão parcial ao uso pela equipe cirúrgica, diferença de adesão entre as etapas de checagem e entre as categorias profissionais e condutas inadequadas da equipe cirúrgica na checagem da lista em sala cirúrgica (equipe incompleta, desatenta e sem participação ativa de seus membros). Para a maioria dos participantes, o uso da lista trouxe benefícios ou tem potencial para produzir efeitos benéficos para o paciente, equipe cirúrgica e serviço de saúde. As evidências geradas trazem subsídios para os enfermeiros e demais profissionais de saúde na elaboração de protocolos relativos ao processo de implementação ou uso diário da lista mais adequados e compatíveis com as especificidades estruturais e organizacionais dos serviços de saúde nacionais, com o propósito de viabilizar a integração desta ferramenta no processo de trabalho, melhorar a adesão da equipe e alcançar os melhores resultados em prol da segurança do paciente / Surgical patient safety is a complex and challenging problem at the global level. This study aimed to analyze (a) the available evidence in the literature on the process of implementation of the surgical safety checklist of the World Health Organization in the practice of health services, and (b) the implementation process and the daily use of the surgical safety checklist, according to the report of nurses working in surgical center units of hospitals of two cities located in the state of Paraná. The research was conducted in two phases: integrative review and descriptive study. The search for primary studies was carried out in PubMed, CINAHL and LILACS databases. The sample of the integrative review consisted of 27 studies grouped into three categories, namely: implementation process: strategies for the introduction of the surgical safety checklist in the health services (n = 15); implementation process: strategies to optimize the use of the surgical safety checklist in health services (n = 9) and facilitators and barriers to the implementation of the surgical safety checklist (n = 3). Conducting the integrative review made it possible to understand the process of implementing the list, the different strategies used for its implementation, aspects of implementation considered successful or not very successful in achieving the expected results, facilitators and barriers of this process. The descriptive study was carried out in 25 hospitals of two cities that make up the mesoregion of Northern Central of Paraná state (Londrina and Maringá). Participants were 91 nurses who worked in the surgical center of the selected hospitals. For the data collection, two instruments were elaborated, which were submitted to the apparent validation and content. The results showed that, in most of the hospitals investigated, the surgical safety checklist was implemented, and, for most of the participants, the strategies adopted in the introduction of the list were the previous planning conducted by the nurses, the adaptation with predominance of the use in the printed format and educational program. Regarding the daily use of the list, most of the nurses pointed out the inadequate use of this practice in the following aspects: surgical team\'s partial adherence to the use of it, difference in adherence between the check-up stages, and between the professional categories and inadequate behavior of the surgical team in checking the list in the surgical room (incomplete, inattentive team, and members not taking part actively). For most participants, using the list has brought benefits or can potentially produce beneficial effects for the patient, surgical team, and health service. The evidence generated provides subsidies for nurses and other health professionals in elaborating protocols related to the implementation process or daily use of the list more adequate and compatible with the structural and organizational specificities of the national health services, in order to make feasible the integration of this tool into the work process, to improve team adherence and to achieve the best results for patient safety

Nas últimas décadas, verificou-se diferenças nas classificações da World Health Organization (WHO) de 2001 e da European Organization for Research and Treatment of Cancer (EORTC) de 1997 para os linfomas cutâneos primários. Em 2005, representantes dessas classificações se reuniram e em consenso estabeleceram a classificação WHO-EORTC que foi adotada pela última classificação da WHO de 2008. O presente estudo visa a avaliar a aplicabilidade dessa nova classificação em casuística retrospectiva de um único centro de referência no diagnóstico e tratamento de linfomas cutâneos. Assim, todos os casos de linfoma cutâneo de células T, excluindo-se micose fungóide (MF) e síndrome de Sézary (SS), no período de 1986 a 2009, foram analisados em relação aos aspectos clínicos, histopatológicos e imunofenotípicos, incluindo-se a realização de novas reações imunoistoquímicas. Os casos foram, então, classificados de acordo com critérios estabelecidos na classificação WHO de 2008. Houve, assim, 33 casos de linfomas cutâneos de células T não-MF e não-SS, sendo 08 (24,2%) de linfoma cutâneo de grandes células anaplásicas, 05 (15,2%) de papulose linfomatóide, 06 (18,1%) de linfoma extranodal de células NK/T tipo nasal, 05 (15,2%) de neoplasia de células dendríticas plasmocitóides blásticas, 05 (15,2%) de linfoma/leucemia de células T do adulto e 04 (12,1%) de linfoma de células T periféricas, sem outra especificação. Portanto, a classificação WHO de 2008 é aplicável à maioria dos casos de linfoma cutâneo de células T não-MF e não-SS. Entretanto, permanecem casos não classificáveis, alguns dos quais com curso clínico agressivo / Recent years have witnessed differences between the World Health Organization (WHO) 2001 and the European Organization for Research and Treatment of Cancer (EORTC) 1997 classification systems of primary cutaneous lymphomas (PCLs). In 2005, a joint WHO-EORTC classification system for PCLs has been reached and was adopted by last WHO 2008 classification. This study was performed to assess the applicability of this new classification to a single referral center. All cutaneous T-cell lymphoma (CTCL) cases, excluding mycosis fungoides (MF) and Sezary syndrome (SS), who were referred from 1986 to 2009 were included. The clinical features, histological and immunohistochemical stainings were reviewed, and additional stains were performed as needed. The cases were then reclassified according to the WHO 2008 classification. There were 33 cases of non-MF and non-SS CTCL, included 08 (24.2%) CD30+ anaplastic large-cell lymphomas, 05 (15.2%) cases of lymphomatoid papulosis, 06 (18.1%) extranodal NK/T-cell lymphoma nasal type, 05 (15.2%) blastic plasmacytoid dendritic cell neoplasm, 05 (15.2%) adult T-cell lymphoma/leukemia and 04 (12.1%) peripheral T-cell lymphomas, unspecified. The new WHO 2008 classification is applicable to most nonMF and non-SS CTCL cases. However, there is still a substantial subset of T-cell PCLs which cannot be classified beyond the unspecified peripheral T-cell category, some of which may have an aggressive course

Submitted by Marcelo de Andrade Pinheiro (m-pinheiro@outlook.com) on 2018-06-23T20:53:29Z No. of bitstreams: 1 Tese-MAP-versão-final-maio-2018.pdf: 1624122 bytes, checksum: 58571623f2d60deba1a21c18cf6dc014 (MD5) / Approved for entry into archive by Debora Nunes Ferreira (debora.nunes@fgv.br) on 2018-06-25T12:57:02Z (GMT) No. of bitstreams: 1 Tese-MAP-versão-final-maio-2018.pdf: 1624122 bytes, checksum: 58571623f2d60deba1a21c18cf6dc014 (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-06-25T16:20:15Z (GMT) No. of bitstreams: 1 Tese-MAP-versão-final-maio-2018.pdf: 1624122 bytes, checksum: 58571623f2d60deba1a21c18cf6dc014 (MD5) / Made available in DSpace on 2018-06-25T16:20:15Z (GMT). No. of bitstreams: 1 Tese-MAP-versão-final-maio-2018.pdf: 1624122 bytes, checksum: 58571623f2d60deba1a21c18cf6dc014 (MD5) Previous issue date: 2018-05-14 / Conforme relatórios sobre o panorama dos transtornos mentais nos ambientes de trabalho, produzidos pela Organização Mundial da Saúde (OMS), agência das Nações Unidas especializada em saúde pública mundial, há evidências crescentes do impacto dos transtornos mentais nas Organizações (WHO, 2000, 2005, 2010, 2013). A partir de 2000, duas ideias centrais acerca da saúde mental passaram a ser divulgadas em tais relatórios: 'que a saúde mental gera capital mental, e que não há saúde sem saúde mental' (WHO, 2000, 2005, 2010, 2013). A perspectiva econômica atrelada à saúde mental, expressa como capital mental, implica a proposição de que uma boa saúde mental permitiria um bom estado cognitivo e emocional, essenciais para as habilidades sociais e para a resiliência frente às situações de estresse, além de ser imprescindível para o funcionamento saudável (PRINCE, 2007). Segundo Lok Sang-Ho, economista que cunhou o termo, 'capital mental engloba a capacidade de reflexão e do grau de eficiência com o qual o indivíduo resolve os problemas e as restrições da vida cotidiana' (SANG-HO, 2001, p.24). Em uma abordagem pragmática associada à psicologia, o capital mental foi associado com habilidades psicológicas como a esperança, a auto eficácia, o otimismo e a resiliência (LUTHANS et al., 2004), fatores subjetivos que podem ser verificados por meio dos comportamentos dos indivíduos e passíveis de serem desenvolvidos. Dessa forma, a eficácia e a produtividade de um indivíduo no ambiente de trabalho passam a depender de seu capital mental, associado à sua condição subjetiva. Porém, as próprias organizações estão sujeitas a transformações frequentes, sendo a mais recente delas denominada Racionalismo de Mercado, ancorado na afirmação de que para sobreviver nos mercados globais, as empresas devem se ajustar às novas demandas crescentes de clientes que esperam gratificação instantânea, de baixo custo e personalizada (DAVIDOW; MALONE 1992). As consequências para os indivíduos são a instabilidade no emprego, pressão excessiva e permanente por resultados crescentes, associadas a efeitos negativos na saúde mental (DEKKER; SCHAUFELI, 1995), evocando o termo burnout para captar as realidades desgastantes das experiências dos indivíduos no local de trabalho. Assim, leva-se à ideia que para uma conduta se transformar em capital, deve ser transformada em benefícios econômicos e sociais. Para compreender como esta racionalidade que valoriza a eficácia, produtividade e rentabilidade influenciou na própria conceptualização do que considera atualmente saúde mental, esta tese procurou identificar e discutir, a partir de uma análise crítica de discurso do relatório da OMS (WHO, 2000) e de relatórios subsequentes produzidos pela mesma instituição (WHO, 2000, 2005, 2010, 2013) um dos conceitos fundamentais no discurso atual da saúde mental promulgado por meio dos relatórios da OMS – o 'capital mental', via Análise Crítica do Discurso (em inglês, Critical Discourse Analysis) de Fairclough, criada no ambiente da linguística aplicada e análise de discurso como uma forma de sistematicamente abordar os relacionamentos entre a linguagem e a estrutura social (FAIRCLOUGH, 2011). A posição ontológica sobre a qual se fundamenta a OMS em suas conceitualizações teóricas e proposições práticas, marcam a noção de respeito pelos seres humanos, definida por meio do princípio de se tratar os indivíduos como um fim em si mesmos, buscando condições de bem-estar mental nos ambientes organizacionais. Contudo, essa proposição imperativa conflita com os princípios de gestão sobre os quais se baseiam as diretrizes organizacionais. A ideologia do Racionalismo de Mercado considera os empregados como um fator de produção passível de ser medido com base em desempenhos atrelados a resultados financeiros, desconsiderando as necessidades subjetivas da força de trabalho. Há, portanto, um antagonismo entre as ideologias organizacionais fundadas no crescimento contínuo e da busca incessante pela maximização dos resultados financeiros e os valores éticos defendidos pela OMS. A gestão da subjetividade via conceito de capital mental adentra em um mundo à imagem dos mercados financeiros, a partir de uma dinâmica cuja finalidade é a maximização permanente dos recursos visando o êxito econômico. / According to reports on the status of mental disorders in the workplace, produced by the World Health Organization (WHO), a specialized United Nations agency concerned with global public health, there is increasing evidence of the global impact of mental disorders at the organizations (WHO, 2000, 2005, 2010, 2013). Since 2000, two key ideas about mental health have been disclosed in such reports: 'mental health generates mental capital, and there is no health without mental health' (WHO, 2000, 2005, 2010, 2013). The economic perspective linked to mental health, expressed as mental capital, implies the proposition that good mental health would allow a good cognitive and emotional state, essential for social skills and for resilience to stressful situations, besides being required for a healthy functioning (Prince, 2007). According to Lok Sang-Ho, economist who created the term, 'mental capital encompasses the capacity for reflection and the degree of efficiency with which the individual solves the problems and constraints of daily life' (SANG-HO, 2001, p. 24). In a pragmatic approach to psychology, mental capital was associated with psychological abilities such as hope, self-efficacy, optimism, and resilience (LUTHANS et al., 2004), subjective factors that can be verified from the behaviors of individuals and likely to be developed. In this way, the effectiveness and productivity of an individual in the work environment depends on their mental capital, associated with their subjective condition. However, organizations themselves are subject to frequent transformations, the most recent of which is called Market Rationalism, anchored in the claim that to survive in global markets, companies must adjust to the everincreasing demands of customers expecting instant, downward and personalized gratification (DAVIDOW; MALONE, 1992). The consequences for individuals are job instability, excessive and permanent pressure for increasing results, associated with negative effects on mental health (DEKKER; SCHAUFELI, 1995). The evocative power of the term burnout to capture the exhausting realities of individuals' experiences in the workplace has emerged from the various research as a psychological syndrome in the response to chronic interpersonal stressors at work. From this notion, in order a conduct to turn into capital, it must be transformed into economic and social benefits. To understand how this rationality that values efficacy, productivity and profitability, influenced the conceptualization of what mental health is currently considered, and what are its theoretical components and their implications in the world of work, this thesis sought to identify and discuss, a critical analysis of WHO reports (WHO, 2000, 2005, 2010, 2013) one of the fundamental concepts in the current discourse of mental health promulgated through such reports - 'mental capital', via the Critical Discourse Analysis (Critical Discourse Analysis) from Fairclough, created in the context of applied linguistics and discourse analysis as a way to systematically address the relationships between language and social structure (FAIRCLOUGH, 2011). The ontological position on which the WHO is founded in its theoretical conceptualizations and practical propositions marks the notion of respect for human beings, defined from the principle of treating individuals as an end in themselves, seeking conditions of mental well-being in organizational settings. However, this imperative proposition conflicts with the management principles upon which organizational guidelines are based. The ideology of Market Rationalism views employees as a production factor that can be measured based on performance tied to financial results, disregarding the subjective needs of the workforce. There is, therefore, an antagonism between organizational ideologies based on continuous growth and the endless search for maximization of financial results and ethics values advocated by the WHO. The management of subjectivity via the concept of mental capital enters a world in the image of the financial markets, whose purpose is the permanent maximization of resources for economic success.

Orientador: Fabio Ramoa Pires / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T19:21:56Z (GMT). No. of bitstreams: 1 Azevedo_RebecadeSouza_D.pdf: 3976330 bytes, checksum: c8e93167e95f91aad2f31f4a0a284024 (MD5) Previous issue date: 2009 / Resumo: O objetivo deste trabalho foi avaliar a freqüência relativa e os aspectos demográficos, clínicos, radiográficos e histopatológicos de uma série de tumores odontogênicos (TO) oriundos dos arquivos de 3 serviços de histopatologia bucal e 1 de histopatologia geral da cidade do Rio de Janeiro no período entre 1970 e 2008, após adequação de seu diagnóstico aos critérios da classificação elaborado pela Organização Mundial da Saúde (OMS) em 2005. Foram revisados 568 TO, representando 3,8% do total das amostras de biópsia da região oral e maxilofacial. A idade média dos pacientes foi de 32,4 anos, com variação entre 3 e 83 anos e maior distribuição na 2ª e 3ª décadas de vida. A relação homen-mulher foi de 1:1.2 e a maioria dos pacientes tinha cor de pele branca (57,9%). Do total, 559 tumores localizavam-se no interior dos ossos gnáticos, 393 na mandíbula (70,3%) e 147 na maxila (26,3%), especialmente na região posterior e anterior, respectivamente. A distribuição dos 568 TO encontrados indicou 191 tumores odontogênicos queratocísticos, 174 ameloblastomas, 76 odontomas, 31 tumores odontogênicos císticos calcificantes, 26 mixomas/fibromixomas odontogênico, 13 cementoblastomas, 11 fibromas odontogênicos, 10 tumores odontogênicos adenomatóides, 7 fibro-odontomas ameloblásticos, 6 tumores odontogênicos epiteliais calcificantes, 4 fibromas ameloblásticos, 3 tumores odontogênicos escamosos, 3 tumores dentinogênicos de células fantasmas, e 6 carcinomas odontogênico, incluindo 3 carcinomas espinocelulares intraósseos primários, 2 carcinomas ameloblásticos e 1 carcinoma odontogênico de células claras. Foram ainda encontrados 7 tumores odontogênicos não-classificáveis. Os TO são lesões incomuns nesta população brasileira, em que as lesões malignas são extremamente raras. O paciente é mais freqüentemente do gênero feminino, de cor de pele branca entre 10 e 29 anos de idade, e as lesões envolvem principalmente a região posterior da mandíbula como uma imagem radiolúcida unilocular de limites precisos. A freqüência relativa e a distribuição das informações demográficas, clínicas, radiográficas e histopatológicas dos subtipos histológicos mostraram semelhanças com a encontrada na literatura revisada de diferentes países, excluindo-se o tumor odontogênico queratocístico. / Abstract: The aim of this study was to evaluate the relative frequency and demographical, clinical, radiological and pathological features of a series of odontogenic tumors (OT) from the files of 3 oral histopathology services and 1 general histopathology service from the city of Rio de Janeiro in the period from 1970 to 2008, after reviewing their final diagnosis according to the diagnostic criteria elaborated by the World Health Organization in 2005. A total of 568 OT was reviewed, representing 3,8% of all oral and maxillofacial biopsy samples. Mean age of the patients was 32.4 years-old, ranging from 3 to 83 years, with most cases in the 2nd and 3rd decades of life. The male-female ratio was 1:1.2 and most patients were Caucasians (57.9%). From the total, 559 OT were centrally located on maxillary bones, being 393 in the mandible (70.3%) and 147 in the maxilla (26.3%), especially in the posterior and anterior regions, respectively. Distribution of the 568 OT revealed 191 keratocystic odontogenic tumors, 174 ameloblastomas, 76 odontomas, 31 calcifying cystic odontogenic tumors, 26 odontogenic myxomas/fibromyxomas, 13 cementoblastomas, 11 odontogenic fibromas, 10 adenomatoid odontogenic tumors, 7 ameloblastic fibro-dontomas, 6 calcifying epithelial odontogenic tumors, 4 ameloblastic fibromas, 3 squamous odontogenic tumors, 3 dentinogenic ghost cell tumors and 6 odontogenic carcinomas, including 3 cases of primary intraosseous squamous cell carcinomas, 2 ameloblastic carcinomas and 1 clear cell odontogenic carcinoma. Also, 7 OT were considered non-classifiable. OT are uncommon lesions in this Brazilian population, and malignant lesions are extremely rare. The patient is more commonly female, Caucasian, between 10 and 29 years-old, and the lesions occur in the posterior mandible as a well-defined unilocular radiolucency. The relative frequency and distribution of the demographical, clinical, radiological and pathological information obtained from each histological subtype showed similarities to the revised literature from different countries, excluding the keratocystic odontogenic tumor. / Doutorado / Patologia / Doutor em Estomatopatologia

Institution spécialisée du système des Nations Unies créée à la sortie de la Seconde guerre mondiale, l'Organisation mondiale de la santé (OMS) s'est vu confiée, par l'article premier de sa Constitution, le but « d'amener tous les peuples au niveau de santé le plus élevé possible ». Pour atteindre cet objectif, les États membres lui ont conféré vingt-deux fonctions dont une normative. Cette dernière lui permet, en théorie, d’adopter à la fois des instruments de santé non contraignants et d'autres contraignants. L'étendue du champ d'application de cette fonction permet à l'OMS d'élaborer des normes au contenu très divers et varié dès lors qu'elle agit dans le cadre de son objectif sanitaire. Parallèlement, en raison de difficultés internes, propres à son organisation régionalisée et à une concurrence externe accrue par la multiplication d'acteurs de santé mondiale, l'OMS est à un tournant de son histoire comme en atteste l'envergure de la réforme qui est toujours en cours depuis 2010. Dans ce contexte, il s'agit de comprendre et d'analyser l'influence du rôle normatif de l'OMS dans les systèmes de santé nationaux. D'abord, une évaluation de son autorité normative, qui apparaît affaiblie, est proposée afin de présenter des évolutions pour la renforcer et ainsi améliorer la protection de la santé mondiale au sein d'un droit international de la santé consolidé. Ensuite, l'étude approfondie de son activité normative est envisagée pour délimiter la conception de la norme de l'OMS par le prisme de son efficacité. L'objectif in fine est de proposer une réflexion sur l'avenir du rôle normatif de l'OMS. / The World health organization (WHO), as a specialized agency, was created, after the Second world war with the objective of, according to article 1 of its Constitution, the "attainment by all peoples of the highest possible level of health”. For that purpose, the WHO was granted twenty two functions by the Member States including a normative one. This normative function allows, in theory, the WHO to adopt both binding and non binding health instruments. The extent of the scope of this function offers a wide and diverse content to theses norms with the only limit that it pursues a health purpose. At the same time, the WHO shows internal difficulties, in part, due to its regional structure and overall lack of financing. Further, the increase number and diversity of actors of global health result in potential external competition with the WHO. The reform initiated in 2010 and still ongoing proves that the WHO is a turning point in its history. In this context, this research seeks to understand and analyze the influence of the normative role of the WHO on national health systems. First, we study the normative authority of the WHO which appears weakened. With the objective of increasing health protection based on a reinforced global health law paradigm, our proposals aim at strengthening the normative authority of WHO. Then, our in-depth analysis of the normative activity of the WHO allows to the define the conception of norm by the WHO using effectiveness as our analytical frame. Finally, this research offers an opportunity to reflect on the future of the normative role of the WHO.

>Magister Scientiae - MSc / Physiotherapy services for disabled children and their families have conventionally been received at a hospital or school for children with special educational needs in the main towns and cities of South Africa. Community-Based Rehabilitation (CBR) programmes were proposed and established as an additional approach to Institutional-Based Rehabilitation to address the need for accessible resources for these families. In this study the author evaluated two CBR programmes for disabled children and their main caregivers in two separate low socioeconomic peri-urban areas of Cape Town. The programme, a weekly group meeting, included physiotherapy interventions to assist the development and functional abilities of the children by means of activities that the caregivers could include in daily home care. They handled their own children following demonstrations and correction of handling skills by the author. The majority of the caregivers were mothers. Their children, less than 13 years old, were severely intellectually impaired. Some with concomitant physical disabilities. The author implemented the interventions of the CBR programme and she required to understand the impact on the particpants in a study using qualiative research methods. In the pilot programme the attendant members were individually interviewed, after her withdrawal, for their opinions of the outcomes. Evaluation documentation.ofjheir children and CBR programme records were related to the caregivers' responses. From the pilot study experiences the author felt that additional methods of data collection would result in a greater understanding of the impacts of the interventions. Expanded methods of research were utilised in the study of the second group. During the interventions at group meetings the author used field notes to record observations. Participant observation allowed the author to analysis the responses of the participants. Focus group interviews assisted in understanding external factors influencing the participants as well as their needs. Individual interviews, after the closure of the CBR programme, allowed the participants to express their views of the interventions. Documentation of the individual evaluation of each child was related to the views expressed by the caregivers. Common meanings and themes were explored in the analysis of the various data collected. Analysis revealed that interventions of education and training for the caregivers improved their knowledge and understanding of the impairments and disability of their children. The children benefited functionally from their families increased skills and knowledge. Through discussion with other families at group meetings, the caregivers had an understanding of other disabilities in children and developmental outcomes possible for their own child. The caregivers were more confident to address the negative perceptions of disability in their communities. It is recommended that physiotherapists implementing any interventions for disabled children should ensure that the caregivers are partners in planning and selection of interventions and that their needs are addressed. Community participation in Community-Based Rehabilitation programmes was required for the participants to become self-reliant and solve their own needs as well as for the programme to be sustainable. This was demonstrated in only one of the programmes.

>Magister Scientiae - MSc / This thesis is a quantitative and qualitative study, reflecting the health promotion I needs of individuals with lower limb amputation in Rwanda. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, and this may be exacerbated by poor choices of lifestyle. Rehabilitation services have been traditionally designed for those experiencing sudden on-set, traumatic disabling conditions. Although physically disabled persons desire to engage in wellness-enhancing activities, limited programs based on their health promotion needs' assessment have been developed. In this study, participants' health promotion needs and factors that influence their health-related behaviours were examined using a questionnaire survey and in-depth face-to-face interviews. Data analysis, using SPSS version 10.0, was used to obtain frequency tables and histograms. Chi-square tests, Fisher's exact Tests and Pearson's correlation coefficient were utilized to test for associations between several variables. Audiotape recordings and process notes were translated, and then transcribed verbatim. Strong themes that ran through the data were identified. In order to qualify for between method triangulation used in the study, complementally strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. Participants were 334, comprising more males (8O%) than females (20%). The most frequently reported cause of amputation was land mines injuries (44.6%). Most participants were either unilateral below-knee (40.7%) or above-knee (40.1%) amputees. The. majority of participants led physically inactivity lifestyles (64.7%), others consumed alcohol (60.5%), used tobacco (33.5%) and drugs (9.6%). In-depth interviews revealed that participants' low psycho-social status and self-perception led to depression and frustration. Negative peer influence and lack of access to relevant information predisposed them to involvement in risky health behaviours. Further interviews indicated that the participants' perceived health-related needs included access to relevant information and new lifestyle habits to improve their health. Participants also desired job opportunities, particularly vocational training programmes and the formation of support groups, to enhance various programmes. The study findings are extremely challenging. Over 50% of participants were engaged in health-risk behaviours, which would certainly result in the deterioration of their health status. This places a greater demand on rehabilitation services, increasing morbidity and mortality rates, thus further straining the national health -- budget. There is therefore an urgent need to develop, encourage and promote - wellness-enhancing behaviours and activities, to improve the participants' health status and ultimate quality of life. Finally, further studies need to focus on barriers and determinants of health-promoting behaviours, and to explore more about issues related to self-perception and risky health behaviours.

This thesis aims to describe how the International Federation of Red Cross and Red Crescent Societies (IFRC) tends to maternal health care in floodings and whether it should be deemed sufficient. Floodings in Pakistan (2010), Bangladesh (2017) and Sudan (2013) are used as units of analysis when conducting a content analysis. The theoretical framework consists of critical success factors for disaster response based in the emergency management literature. A big part of the theoretical framework revolves around the importance of expertise and rationality in disaster response planning and implementation. The three floodings received relief efforts from IFRC which are presented in emergency appeal reports. Lists on essential maternal health care interventions in combination with the theoretical framework create analysis questions that are posed to the appeals. Results are presented in a table naming the prevalence of each intervention in each report. The findings show that maternal health care was seen to and deemed sufficient in only one of the three cases: Pakistan. The conclusion is that the discourse on maternal health care in natural disasters should be developed and that further research on the subject needs to be conducted.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-1Oand DSM-IlI-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.