Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption. Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted. Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior. In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful. Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.

Oportunidades is a Conditional Cash Transfer (CCT) that uses a proxy means-test targeting model to select eligible households for the programme. According to the Income and Expenditure Household Survey of 2008, approximately two in every three eligible rural households participate in Oportunidades, whereas only one in every three eligible urban households receives the Oportunidades cash transfer. This research explores the factors behind this lack of take-up, the costs of participation and the implications of targeting inefficiency on the programme’s impact on income poverty. It argues that a sample selection model is a pertinent tool of analysis as it informs on the distribution of cash transfers conditional on household eligibility. This conditional distribution is also used to understand the costs of participation as a latent variable. Eligible households are less likely to invest in human capital and neither the cash transfer nor the income forgone by children and teenagers are sufficient to overcome these costs of participation. By identifying a method to quantify behavioural change of households, I associate the costs of participation to the difficulties of inducing health-related behavioural change among recipients and eligible non-recipients. At an aggregate state level, targeting inefficiency is not fully explained by only looking at the budget constraints of the programme. In fact, targeting efficiency is positively associated to aggregate behavioural change and negatively associated to aggregate costs for participation at state level. Yet, targeting efficiency does not guarantee impact on income poverty and Oportunidades’ highest impact on income poverty also associated with the inclusion of non-eligible households in the programme. This research reconsiders the importance of the context in which CCTs are implemented and informs on the conflicting aims of CCTs: providing income poverty relief via cash transfers and incentivizing behavioural change by conditioning the cash transfer in health and education investment.

The unprecedented scale of health sector reform in the course of radical political transformation in post-apartheid South Africa is well-documented. This thesis examines child health policy reform as a crucial part of this process. The goals of broader health sector reform were to improve the overall health status of citizens, in particular those most vulnerable, and eliminate inequities in health service provision and health status outcomes. Although children were accorded explicit prioritisation during this time, child health indicators remain poor and some have worsened. Amidst the documented explanations for the poor progress with child health indicators, the specific role and contribution of child health policies had not been interrogated. The thesis examines the development, design and implementation of national child health policies, with particular focus on equity. The National School Health Policy serves as a case-study for the analysis. Three complementary policy analysis frameworks guide the enquiry. Findings are based on a documentary analysis of key policies and 81 qualitative interviews with national policy makers and managers, provincial and district managers, and service providers in three socioeconomically different provinces of South Africa. The common assertion by South African health system analysts, that "policies are good, but implementation is poor", is refuted by this research. The findings show that child health policies have many deficiencies in their design and development. These "poor policies" contribute to inadequate child health service provision, which in turn have a bearing on poor child health outcomes. In particular the failure in clearly defining and conceptualising equity in policy development and design contributed to the absence of equity considerations in the implementation phase. The explanations for these policy failures include: lack of strategic direction for child health services; poor policy making capacity; a lack of clear policy translation; and the diverse politics, power and passion of policy actors. Broader health system factors, such as an immature and poorly functioning district health system, compound these policy failures. The thesis deepens the understanding of child health policy reform through a retrospective policy analysis and so contributes to the body of knowledge on policy reform in South Africa and in low- and middle-income countries more generally.

M.A. / Because of the high incidence of hypertension amongst South African blacks, many hypothesis have been forwarded to account for the relative higher index of hypertension amongst South African blacks when compared to whites. Because of the virtue lack of endemic proportions of hypertension in South African blacks at the beginning of this century, the often - quoted genetic hypothesis that hypertension is genetically determined would seem not to hold for South African situation. However, this was not yet tested as one of the risk factors or precursors to hypertension, namely the higher indices of cardiovascular reactivity had not been compared in the South African group between white and black subjects. This study investigated the hypothesis that the offspring of black hypertensive parents would show greater cardiovascular reactivity than those of black non-hypertensive parents, and also show greater cardiovascular reactivity than the children of white hypertensive parents as well as the children of white non-hypertensive parents. These hypotheses were partially supported. As expected the children of black hypertensives did show greater indices of cardiovascular reactivity when compared to both children of white hypertensives and the children of black non-hypertensives. An interesting finding however, was that the children of white hypertensives had shown greater indices of the psychological construct of state anxiety than the children of black hypertensive and black non-hypertensive subjects. Whereas this study supported the hypothesis that an inherited cardiovascular reactivity would and could account for the greater index of hypertension amongst South African blacks, it is also possible that the non-psychological expression of tension or cardiovascular reactivity in the form of state anxiety could partially account for the results herein obtained.

Thesis (M.A.)--University of Toronto, 2006. / Source: Masters Abstracts International, Volume: 44-06, page: 2521.

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-06-14T19:40:40Z No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-28T07:54:58Z (GMT) No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-28T07:55:11Z (GMT) No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) / Made available in DSpace on 2017-06-28T08:01:35Z (GMT). No. of bitstreams: 1 DissJFS.pdf: 1537912 bytes, checksum: 5c0bc9f181d07163e84cc47cb09da0fb (MD5) Previous issue date: 2016-12-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The historical path of the attention to the mental health of children and adolescents accompanied, in a particular and late way, the paths taken in the care of the adult population with psychic suffering, so that from the beginning of the nineteenth century there is recognition of the needs of care to the child and adolescent population, being, at first, the historical care delegated to the educational and social assistance sectors. However, from a few milestones, such as the Brazilian psychiatric reform and the declaration of human rights, it became possible to develop a new conception for childhood and adolescence, as well as the recognition of child and adolescent psychosocial care in the public policy arena. However, literature in the area has pointed to the scarcity of research that focuses on the assistance to Mental Health of adolescents, since they have presented significant indexes of psychic suffering, and indicate the need for more research that can subsidize the actions and policies aimed at this population. Thus, the present study aimed to identify how psychosocial attention has been given to the adolescent from the perspective of professionals linked to a service of Strategic Psychosocial Care (CAPS) and to Basic Health Care services (UBS and USF). In order to respond to the proposed objectives, a qualitative, descriptive and exploratory research was developed. The study was attended by 19 professionals from the Strategic Psychosocial Attention Service (CAPSij) and Basic Health Care (UBS and USF) and located in a medium-sized municipality in the interior of the State of São Paulo. Four data collection instruments were developed, two forms for characterization of professionals and services, and two semi-structured interviews for professionals. The data coming from the forms were analyzed in a descriptive way and those of the interviews were investigated by the Thematic Analysis, one of the techniques foreseen in the Content Analysis Method. The main results of the interviews with CAPSij professionals indicated that it acts as a gateway to the mental health demand of adolescents in the municipality, which is perceived as a challenge, considering the role of the service in the definition of eligible cases or not for the CAPSij. In addition, the participants also reported on the difficulties that the team faces with regard to the adherence of the adolescents users to the service, indicating the need for more strategies that facilitate the linkage of the same and the effectiveness of the work, as well as in relation to the users' families. The difficulty in enabling RAPS in the municipality was also a challenge pointed out by professionals. On the other hand, the data show the commitment of the participants in care actions focused on the premises of policies and the search for network articulation, especially with the Basic Health Care. The results of the interviews with the professionals of Basic Health Care Pointed out the challenges in the care and follow-up of the adolescent population in general, especially those who experience the psychological suffering that, according to the statements, hardly reach the service and, when they arrive, are referred to CAPSij. It was also observed that the activities carried out in adolescent ABS services are fundamentally curative, and health promotion and prevention actions are rare, as well as those of a network of care that, when they occur, are triggered by the CAPSij. Therefore, it was possible to verify with the present study that the psychosocial attention of adolescents in the investigated context is a field under construction and, currently, it occurs in CAPSij. It is hoped that the findings obtained may provide more subsidies for reflection and planning of policies and more effective interventions directed at the population of adolescents in psychological distress. / O percurso histórico da atenção à saúde mental de crianças e adolescentes acompanhou, de maneira particular e tardiamente, os caminhos trilhados no cuidado com a população adulta com sofrimento psíquico, de modo que, a partir do início do século XIX, há o reconhecimento das necessidades de cuidado à população infantojuvenil, sendo, a priori, o histórico assistencial delegado aos setores educacionais e de assistência social. Entretanto, a partir de alguns marcos, como a reforma psiquiátrica brasileira e a declaração dos direitos humanos, tornou-se possível o desenvolvimento de uma nova concepção para a infância e a adolescência, bem como o reconhecimento da atenção psicossocial infantojuvenil no cenário das políticas públicas. No entanto, a literatura da área tem apontado sobre a escassez de pesquisas que focalizem a assistência à Saúde Mental de adolescentes, visto que estes têm apresentado índices significativos de sofrimento psíquico, e indicam a necessidade de mais investigações que possam subsidiar as ações e políticas voltadas a essa população. Assim, o presente estudo objetivou identificar como tem ocorrido a atenção psicossocial ao adolescente sob a ótica de Profissionais vinculados a um serviço de Atenção Psicossocial Estratégica, no caso o Centro de Atenção Psicossocial Estratégica Infantojuvenil (CAPSij), e a serviços da Atenção Básica em Saúde referentes à Unidade Básica de Saúde (UBS) e à Unidade de Saúde da Família (USF). Para responder aos objetivos propostos, foi desenvolvida uma pesquisa qualitativa, de caráter descritivo e exploratório. O estudo contou com a participação de 19 profissionais de serviços de Atenção Psicossocial Estratégica (CAPSij) e Atenção Básica em Saúde (UBS e USF) localizados em um município de médio porte do interior do Estado de São Paulo. Foram desenvolvidos quatro instrumentos de coleta de dados, sendo dois formulários para caracterização dos profissionais e dos serviços, e dois roteiros de entrevistas semiestruturados destinados aos profissionais. Os dados advindos dos formulários foram analisados de forma descritiva e os das entrevistas foram tratados por meio da Análise Temática, uma das técnicas previstas no Método da Análise do Conteúdo. Os principais resultados das entrevistas com os profissionais do CAPSij indicaram que o órgão atua como porta de entrada da demanda de saúde mental de adolescentes no município, o que é percebido como um desafio, considerando o papel solitário do serviço na definição dos casos elegíveis ou não para o CAPSij. Além disso, os participantes relataram, também, sobre as dificuldades que a equipe enfrenta no que se refere à adesão dos adolescentes usuários ao serviço, indicando a necessidade de mais estratégias que facilitem a vinculação deles e a efetivação do trabalho, assim como em relação às famílias dos usuários. A dificuldade em viabilizar a RAPS no município também foi um desafio apontado pelos profissionais. Por outro lado, os dados mostram o empenho dos participantes nas ações de cuidado voltadas às premissas das políticas e a busca de articulação em rede, em especial com a Atenção Básica em Saúde. Os resultados advindos das entrevistas com os profissionais da Atenção Básica em Saúde apontaram os desafios no cuidado e acompanhamento da população adolescente de forma geral, especialmente aquela que vivencia o sofrimento psíquico que, segundo as falas, dificilmente chegam ao serviço e, quando chegam, são encaminhadas para o CAPSij. Observou-se, ainda, que as atividades realizadas nos serviços de ABS junto aos adolescentes são fundamentalmente curativas, sendo raras as ações de promoção e prevenção em saúde, bem como aquelas de articulação de rede de atenção que, quando ocorrem, são disparadas pelo CAPSij. Portanto, foi possível verificar, com o presente estudo, que a atenção psicossocial de adolescentes no contexto investigado é um campo em construção e, atualmente, dá-se no CAPSij. Espera-se que os achados obtidos possam fornecer mais subsídios para reflexão e planejamento de políticas e intervenções mais efetivas direcionadas à população de adolescentes em sofrimento psíquico.

Made available in DSpace on 2016-04-29T13:31:33Z (GMT). No. of bitstreams: 1 Maria Dionisia do Amaral Dias.pdf: 1536747 bytes, checksum: bdab9975783e6fb15639087507a739ac (MD5) Previous issue date: 2007-06-14 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present research, guided by the Social-historical Psychology developed by the Núcleo de Estudos Psicossociais da Dialética Exclusão/Inclusão (NEXIN Nucleus of Psychosocial Studies of the Exclusion/Inclusion Dialetics), aimed to analyze the interlacement among work, exclusion/inclusion and health through a case study with young workers from the garment industry in a city in the interior of São Paulo state. In order to do so, the objective conditions of work to which youths are submitted were mapped and a profile of common diseases of the city s working young population was drawn and, focusing the singularity, the study aimed at understanding the subjects history of the process health/disease, as well as their sufferings, dreams, desires, conception of themselves, social insertion and the sense that work and health acquire to them. Health is understood as potency to action, in an enlarged conception which incorporates the ethical and affective dimensions. In order to guide such conception, the study was based on Espinosa s reflections on happiness, joy and power and on Vygotsky s reflections about the adolescent s health. Health is an indicative of the quality of social insertion made possible by work, which means that the health/disease process is a concrete expression on the human body of the exclusion/inclusion process in which the individual is inserted. Health becomes an indicator of the ethical-political quality of the society and not only of the individuals' health condition. The youth s job became today a world-wide social subject, particularly due to the global reduction of workstations, which hinders the youths insertion in the work world. This situation constitutes a present social problem and worries population and governments everywhere, since it is a matter that can commit not only the future of individuals, but the future of societies. Therefore, forms of guaranteeing opportunities of access for youths to work are looked for. In this scenery, it was considered relevant to know the youths reality for those who are already inserted in the job market, relating this experience to the question of health and formation for their future, considering the importance of that phase of human development, in which the individual forms his conceptions about the world, about the society, about the people and about himself. The analysis of the data demonstrated that work, in a tayloristic system, is configured as a perverse inclusion, for when the youth needs conditions for the opening of horizons, of new conquests, to exercise his creativity and so live and apprehend the world, he has this transition process blocked by several social institutions, among which work and the connections it establishes with other institutions stand out / A presente pesquisa, orientada pela Psicologia Sócio-Histórica desenvolvida pelo Núcleo de Estudos Psicossociais da Dialética Exclusão/Inclusão (NEXIN), buscou analisar o entrelaçamento entre trabalho, exclusão/inclusão e saúde por meio de estudo de caso com jovens trabalhadoras de indústrias de confecção em uma cidade do interior paulista. Para tanto, mapearam-se as condições objetivas de trabalho a que as jovens estão submetidas e traçou-se um perfil de adoecimento da população jovem trabalhadora na cidade e, focando a singularidade, buscou-se compreender a história do processo saúde/doença dos sujeitos, bem como seus sofrimentos, sonhos, desejos, concepção de si, inserção social e sentido que o trabalho e a saúde adquirem para eles. A saúde é entendida como potência de ação, numa concepção ampliada que incorpora as dimensões ética e afetiva. Para orientar tal concepção baseia-se nas reflexões de Espinosa sobre felicidade, alegria e potência e de Vigotski sobre a saúde do adolescente. A saúde é indicador da qualidade de inserção social que o trabalho possibilita, o que significa que o processo saúde/doença é expressão concreta no corpo humano do processo de exclusão/inclusão no qual o indivíduo está inserido. A saúde torna-se um indicador da qualidade ético-política da sociedade e não só do estado de saúde de indivíduos. O emprego do jovem tornou-se hoje questão social mundial, particularmente em função da redução global de postos de trabalho, o que dificulta a inserção dos jovens no mundo do trabalho. Essa situação vem se configurando como um problema social da atualidade e preocupa a população e governos de todo o mundo, pois é uma questão que pode comprometer o futuro não só de indivíduos, mas das sociedades. Por isso, buscam-se formas de garantir oportunidades de acesso dos jovens ao trabalho. Neste cenário, considerou-se relevante conhecer a realidade dos jovens que já estão inseridos no mercado de trabalho, relacionando esta experiência às questões de saúde e de formação para seu futuro, considerando-se a importância dessa fase do desenvolvimento humano, em que o indivíduo forma suas concepções do mundo, da sociedade, das pessoas e de si mesmo. A análise dos dados demonstrou que o trabalho, num sistema taylorista, configura-se como uma inclusão perversa, pois no momento em que o jovem necessita condições para a abertura de horizontes, de novas conquistas, para exercer sua criatividade e assim viver e apreender o mundo, tem esse processo de transição bloqueado por diversas instituições da sociedade, entre as quais se destaca o trabalho e os nexos que ele estabelece com as demais

published_or_final_version / Social Work / Master / Master of Social Sciences

All governments aim to ensure better health and nutrition to children. The Rajasthan state (India) has implemented a unique frontline coordination model where Accredited Health Social Activist (ASHA) Sahyoginis are expected to support two other frontline workers (FLWs) i.e. the Anganwadi Workers from the Integrated Child Development Services and the Auxiliary Nurse Midwives from the Health department to improve child health. This thesis focuses on examining the existing coordination between the three groups of FLWs in Rajasthan by exploring FLWs' participation in child immunisation and Vitamin A supplementation (two common activities), service coverage and beneficiary's' knowledge (expected outcomes), and the challenges faced and areas that need improvement for better frontline coordination. A mixed methods design was used. Sixteen villages from two blocks (tribal and non-tribal) of Udaipur district (Rajasthan) were selected using multistage purposive sampling. The formative stage included 12 FLWs' in-depth interviews (IDIs) as well as a review of FLWs' job descriptions to understand the process and government expectations on their participation in routine childhood immunisation, polio camps, routine Vitamin A supplementation and Vitamin A campaigns. The next stage included data collection from the 16 selected villages i.e. structured questionnaire survey of FLWs (46), observations of Maternal and Child Health and Nutrition Day (16), review of FLWs' immunisation and Vitamin A registers (32) and a structured questionnaire survey of registered infants' mothers (321)-all to ascertain the actual participation of FLWs in these four activities and the outcomes. IDIs with FLWs (46) and FLWs' line managers (17) were conducted to understand their experience, issues and solutions for better frontline coordination. The participation of FLWs in three of the four activities (except Polio Camps) was found to be limited. The FLWs and their line managers were also dissatisfied with coordination between FLWs. Poor outcomes also indicated unsatisfactory coordination. Overall, frontline participation and outcomes were better in tribal than non-tribal villages. A variety of factors (i.e. personal, professional, organisational, and geo-socio-cultural) appeared to affect coordination between FLWs. Appropriate recruitment, training, monitoring and supervision and rewards to the FLWs along with greater political commitment for coordinated approached and addressing intra-departmental challenges are proposed to improve frontline coordination and child health in Rajasthan.