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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
161

Les savoirs d'expérience des aides-soignantes dans l'accompagnement de fin de vie en établissement d'hébergement pour personnes âgées dépendantes

Croyere, Nicole 20 September 2013 (has links) (PDF)
Le travail de recherche que nous présentons a pour but de mettre en évidence les savoirs d'expérience des aides-soignants et des aides-soignantes. Cette catégorie professionnelle dispense dans le cadre d'établissements d'hébergement, une aide à la vie quotidienne des personnes âgées dépendantes et participe à la mission d'accompagnement de fin de vie. Ces professionnels disposent de savoirs informels qui ne sont pas formalisés. Des entretiens narratifs ont permis la verbalisation de l'expérience. Grâce à des entretiens narratifs réalisés par les participants auprès de la chercheure, des récits sont co-construits qui mettent en avant des savoirs d'expérience. En référence à la théorie de la formation expérientielle, nous explorons l'expérience, tant dans le fait de vivre une nouveauté (mener une expérience) que le noyau central de l'apprentissage (apprendre de l'expérience) et que la mobilisation de vécus (avoir de l'expérience). L'étude a pu dégager l'importance du choix des mots, les traits de narration et les énoncés performatifs qui sont l'expression de valeurs et d'émotions qui explicitent le monde dans lequel évoluent les aides-soignants et les aides-soignantes. Les résultats ont pris la forme de récits phénoménologiques selon le langage des participants et des participantes et d'une typologie de savoirs d'expérience propre à cette catégorie professionnelle et au contexte de l'accompagnement de fin de vie en établissements d'hébergement pour personnes âgées dépendantes.
162

L'évolution des politiques du soutien l'innovation dans les PME en France : le cas de l'Anvar

Liu, Zeting 18 October 2011 (has links) (PDF)
La France, comme d'autres pays, cherche à valoriser son excellence scientifique et à augmenter la compétitivité de ses petites et moyennes entreprises (PME) pour tirer plein profit de l'innovation et soutenir la croissance économique et l'emploi. Il n'y a pas, ni en France ni ailleurs, une politique spécifique de soutien à l'innovation dans les PME mais des politiques scientifiques et de la recherche industrielle, en particulier en faveur des petites entreprises, et des politiques d'innovation, dans lesquelles peuvent être identifiées des mesures spécifiques visant à promouvoir le développement technologique et l'innovation dans les PME. Cette étude s'intéresse à la façon dont en France, à travers les différentes époques, ces politiques publiques sont définies et organisées et s'interroge sur l'efficacité et l'impact des interventions publiques dans le développement de capacité d'innovation des PME françaises. Elle se déroule en trois parties, en respectant une chronologie historique correspondant aux grandes étapes de l'évolution des politiques depuis les années 1960-1970 jusqu'à présent. Ces trois parties analytiques sont enrichies par l'analyse du cas de l'Agence nationale de valorisation de la recherche (Anvar). A la fin de ce travail, nous suggérons que la France entre dans une phase critique où des réformes structurelles doivent être menées pour assurer le développement de la compétitivité des PME et de l'innovation.
163

L’opération 5000/15000 logements sociaux et communautaires : une réponse au besoin en logements des ménages immigrants récents à Montréal, le cas de Côte-des-Neiges

Bahlouli, Abdelaziz 04 1900 (has links)
L’immigration dans les grandes métropoles comme Montréal est un phénomène qui prend de l’ampleur, ces dernières années. Or, si les ménages immigrants récents constituent un apport positif important dans la croissance démographique, sociale, culturelle et économique de notre société, l’amélioration de leur situation socioéconomique et des conditions des logements qu’ils occupent ne semble pas être la priorité des politiques d’habitation des pouvoirs publics. Malgré l’abondance des données statistiques sur l’immigration, il s’avère que l’on connaît peu sur les conditions de logement de ce type de ménages et de la qualité des aides publiques en matière de logements sociaux qui leur sont destinées. Notre recherche, par une méthode quantitative et une technique d’analyse statistique, a mené une recherche empirique sur la population de l’agglomération de Montréal, spécialement celle de Côte-des-Neiges, pour analyser la situation socioéconomique des ménages immigrants récents et leurs conditions de logement. Ceci pour connaître si les ménages immigrants récents ont un niveau socioéconomique inférieur à la moyenne des ménages de l’agglomération, pour constituer les ménages les plus démunis, et si leurs conditions de logement sont défavorables par rapport à celles de la moyenne des ménages de l’agglomération et ainsi figurent parmi les plus mal-logés. Dans un deuxième temps, notre recherche, par une méthode graphique et une technique de cartographie, a voulu illustrer puis comprendre la logique d’implantation des logements développés par l’opération 5000/15000 logements sociaux communautaires. Comprendre cette logique dans sa prise en considération du choix de logement initial des ménages immigrants récents et dans l’uniformité de la répartition de ses logements sur le territoire de l’agglomération de Montréal. / Immigration in big cities like Montreal is a phenomenon which is growing in recent years. However, if households recent immigrants are an important positive contribution in the population growth, social, cultural and economic development of our society, improving their socioeconomic situation and conditions of housing they occupy, do not seem to be the priority housing policies of the government. Despite abundance of statistical data on immigration, it turns out that we know little about the housing conditions of such households and Quality of public support for their social housing are intended. Our research, by a quantitative method and analysis technique Statistics conducted empirical research on population Greater Montreal, especially that of Côte-des-Neiges, for analyze the socioeconomic situation of households and recent immigrants their housing conditions. This to know if households Recent immigrants have a lower socioeconomic level than the average of households in the city, to constitute the poorest households poor, and if their housing conditions are unfavorable report to those of average households in the city and so are among the most poorly housed. In our search for a second time, by a graphical method and mapping technique, we want to illustrate and then understand the logic implementation of housing, developed by the operation 5000/15000 housing community. Understanding this logic in its decision considering the initial choice of accommodation of households recent immigrants and in its uniformity of distribution of its units on the agglomeration of Montreal. / Les cartes sur ce document ont été toutes conçues par l'auteur avec la logiciel ARCGIS version 9.3.
164

Developing a human resource profile for the nutrition workforce in the public health sector in the Western Cape province, South Africa

Goeiman, Hilary 12 1900 (has links)
Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Background: The crisis and study of health workforce has become more important in developed and developing countries. The relationship between human resource issues and health system effectiveness has been acknowledged. Human resources are seen to be one of the main constraints in achieving the millennium development goals. A number of changes have taken place within health services since 2003, including the promulgation of the new health Act 63 of 2003, restructuring processes in the Western Cape province and the development of a Comprehensive Service Plan (CSP) to implement Health Care 2010. Nationally and provincially nutrition is declared a priority, due to the documented beneficial impact of nutrition support on preventable diseases, disease of life-style, as well as the treatment of high priority disease groups, namely TB and HIV/AIDS. For appropriate planning of nutrition services, the Integrated Nutrition Programme (INP) in the Western Cape needed to review the status of the nutrition workforce in the province, towards developing a human resource plan to meet the nutrition service needs, in the provincial context, its service platforms and approved service implementation plan for public health sector. Objectives The study aimed to describe the current status of the nutrition workforce (staffing profile) in the Western Cape province in terms of staffing levels, personnel categories, location, placement, qualifications, skills, and personnel expenditure at all levels of the public health sector. Provincial maps were developed to indicate the density of personnel per category pictorially. Methods In this descriptive observational study, a targeted sampling approach was applied by developing master lists of the respective nutrition/dietetic/food service units and personnel within the geographical districts and hospitals at all levels of care. All nutrition personnel employed by the Western Cape Department of Health were included in the study. Quantitative data collection methods including coding sheets (per facility), self administered questionnaires and the official personnel database (Persal) of the Department of Health was used. Questionnaires were constructed according to the variability of services, settings, and job outputs. The respective personnel were grouped into 5 categories. Descriptive statistical methods were used to analyse data. Comparisons in terms of urban and rural distributions were also completed. Results A response rate of 86% was achieved (N = 647) with food service workers being the largest proportion of staff (N = 509), followed by dietitians (N = 64), managers (N = 31), auxiliary workers (N = 28) and administrative personnel (N= 15). Significant differences (p=0.0001- 0.05) were found amongst the respective personnel categories in terms of demographics, qualifications, training, experience, skills, competencies, time spent on the INP, and general human resource management areas. Training needs and areas of low skills were identified for the respective categories and key challenges and solutions in the nutrition workforce were highlighted. Conclusion The study indicates that the processes used to develop the workforce need to receive the same intensity as all other interventions. The results can be applied in providing evidence based information for the development of the Department of Health, Western Cape human resource plan and the integration of nutrition therein.
165

Etude de l'impact des aides à l'innovation sur l'exportation des firmes / The impact of public innovation support on firm export activity

Liabot, Michael 04 April 2017 (has links)
Cette thèse étudie l’impact des aides publiques en faveur de l’innovation sur l’activité d’exportation des firmes. Jusqu’ici, les évaluations empiriques des aides à l’innovation se sont principalement intéressés à l’existence d’un effet sur l’investissement des firmes en R&D (effet additionnel). Si ce critère constitue logiquement le principal indicateur de l’efficacité des aides à l’innovation, il conduit à adopter une vision très partielle de la firme. Les impacts potentiels sur ses décisions stratégiques, en particulier l’exportation, sont largement ignorés. Ce travail de recherche combine deux littératures distinctes qui n’ont pas été mobilisées ensemble à ce jour. D’une part, la littérature visant à évaluer l’efficacité des aides montre que ces dispositifs peuvent induire les firmes à intensifier leurs investissements en R&D. D’autre part, les travaux de Constantini et Melitz, (2007) et Aw et al. (2008 ; 2011) mettent en évidence l’interdépendance entre les décisions d’innovation et d’exportation prises par les firmes. De plus, une attention particulière est portée sur les spécificités des aides fiscales en faveur de l’innovation. La méthodologie empirique mise en place combine deux méthodes économétriques, bi-variée récursive d’une part, et par appariement d’autre part. Trois résultats principaux sont mis en évidence.Tout d’abord, (1) les aides à l’innovation impactent la relation causale entre innovation de produit et exportation, sur le court terme. Ce résultat est également observé lorsque l’analyse se concentre sur l’effet des aides fiscales à l’innovation. Ensuite, (2) les aides à l’innovation impactent directement l’activité d’exportation des firmes, indépendamment de la réussite du projet d’innovation. Cet effet est observé pour les firmes ayant bénéficié uniquement d’incitations fiscales. En revanche, bénéficier à la fois d’aides directes et fiscales à l’innovation n’induit pas de décisions simultanées en innovation et en exportation. Enfin, (3) considérer le rôle central de la R&D permet de montrer que l’impact des aides à l’innovation sur l’exportation constitue une extension de l’efficacité des politiques d’innovation. Ces résultats conduisent à formuler des recommandations en matière de politiques publiques, afin d’améliorer le soutien public des activités d’innovation et d’exportation. / This thesis investigates the impact of public subsidies for innovation on firms’ export activity. Previous research has focused mainly on understanding the effects of innovation support on investment in R&D (additional effect). While R&D investment is logically the primary indicator of innovation aid effectiveness, this approach ignores potential impact on strategy, particularly on export. Our research framework draws on two distinct streams of literature that have not been mobilized so far. First, the literature which evaluates the impact of aid shows that these devices can induce strategic R&D decisions in firms. Secondly, the work of Constantini and Melitz (2007) and Aw, Roberts and Xu, (2008) emphasizes the interdependence between firms' innovation and export decisions. Particular attention is paid in this study on the effect of innovation tax credits. The empirical methodology utilizes two econometric methods, bi-varied recursive and propensity score matching, generating three main results:First, (1) innovation support impacts the causal relationship between product innovation and export in the short term. This result is also observed when the analysis focuses on the effect of tax incentives. Then, (2) innovation subsidies impact the export activity of firms directly and simultaneously This effect occurs for firms that have benefited only from tax incentives. However, benefiting from both direct and tax subsidies for innovation does not affect? joint decisions regarding innovation and export. Finally, (3) considering the central role of R&D investments reveals that the impact of innovation subsidies on exports is an extension of the effectiveness of innovation policies. These results lead to several policy recommendations that can be used to improve public support effectiveness for both innovation and export activities.
166

Probability distortion in clinical judgment : field study and laboratory experiments / Distorsion de probabilité dans le jugement clinique : étude de terrain et expériences en laboratoire

Hainguerlot, Marine 21 December 2017 (has links)
Cette thèse étudie la distorsion de probabilité dans le jugement clinique afin de comparer le jugement des médecins à des modèles statistiques. Nous supposons que les médecins forment leur jugement clinique en intégrant une composante analytique et une composante intuitive. Dans ce cadre, les médecins peuvent souffrir de plusieurs biais dans la façon dont ils évaluent et intègrent les deux composantes. Cette thèse rassemble les résultats obtenus sur le terrain et en laboratoire. À partir de données médicales, nous avons constaté que les médecins n'étaient pas aussi bons que les modèles statistiques à intégrer des évidences médicales. Ils surestimaient les petites probabilités que le patient soit malade et sous­-estimaient les probabilités élevées. Nous avons constaté que leur jugement biaisé pourrait entraîner un sur­-traitement. Comment améliorer leur jugement? Premièrement, nous avons envisagé de remplacer le jugement du médecin par la probabilité de notre modèle statistique. Pour améliorer la décision, il était nécessaire d'élaborer un score statistique qui combine le modèle analytique, la composante intuitive du médecin et sa déviation observée par rapport à la décision attendue. Deuxièmement, nous avons testé en laboratoire des facteurs qui peuvent influencer le traitement de l'information. Nous avons trouvé que la capacité des participants à apprendre la valeur de la composante analytique, sans feedback externe, dépend de la qualité de leur composante intuitive et de leur mémoire de travail. Nous avons aussi trouvé que la capacité des participants à intégrer les deux composantes dépend de leur mémoire de travail, mais pas de leur évaluation de la composante intuitive. / This thesis studies probability distortion in clinical judgment to compare physicians’ judgment with statistical models. We considered that physicians form their clinical judgment by integrating an analytical component and an intuitive component. We documented that physicians may suffer from several biases in the way they evaluate and integrate the two components. This dissertation gathers findings from the field and the lab. With actual medical data practice, we found that physicians were not as good as the statistical models at integrating consistently medical evidence. They over­estimated small probabilities that the patient had the disease and under­ estimated large probabilities. We found that their biased probability judgment might cause unnecessary health care treatment. How then can we improve physician judgment? First, we considered to replace physician judgment by the probability generated from our statistical model. To actually improve decision it was necessary to develop a statistical score that combines the analytical model, the intuitive component of the physician and his observed deviation from the expected decision. Second, we tested in the lab factors that may affect information processing. We found that participants’ ability to learn about the value of the analytical component, without external feedback, depends on the quality of their intuitive component and their working memory. We also found that participants’ ability to integrate both components together depends on their working memory but not their evaluation of the intuitive component.
167

L’application du droit européen des aides d’État aux mesures de protection de l’environnement / The application of European State aid law to environmental protection measures

Peiffert, Olivier 05 December 2013 (has links)
Les politiques de la protection de l’environnement des États membres de l’Union européenne donnent lieu généralement à des aides publiques. Elles tombent de ce fait sous le coup des règles des traités constitutifs de l’Union interdisant par principe les aides d’État et organisant leur contrôle. De l’application de ces règles émerge un cadre juridique autonome qui soumet les politiques de la protection de l’environnement au respect de la libre concurrence. Le champ de ce cadre juridique dépend de la qualification des mesures de la protection de l’environnement au regard de la catégorie juridique d’aide d’État. Cette opération se réalise principalement au moyen d’éléments objectifs, certes imparfaits, mais révélant que seuls les instruments dits « économiques » de la protection de l’environnement sont soumis au contrôle des aides. La détermination précise du champ de la catégorie d’aide est toutefois hypothéquée par l’intervention périodique d’éléments subjectifs permettant aux institutions d’opérer des choix au stade de la qualification.La portée de ce cadre juridique doit être appréciée en rapport avec la législation environnementale de l’Union. En théorie, cette dernière pourrait être la source d’une harmonisation des conditions de concurrence dans le marché intérieur. Néanmoins, en pratique, son contenu concret déclenche l’application du droit des aides d’État, engendrant des relations complexes et parfois conflictuelles entre ces deux strates de règles, tandis que l’exercice extensif par la Commission de son pouvoir de définition du régime juridique des aides d’État produit une quasi-harmonisation du domaine environnemental. / Environmental protection policies for European Union members usually create a need for public subsidies. They therefore fall within the scope of the rules of the founding treaties of the EU which prohibits state aid and organizes their control. In applying these rules an independent legal framework arises that subject the policies of the environmental protection to the open and free competition.The scope of this legal framework depends on the qualification of the measures of environmental protection with regards to the legal concept of state aid. This qualification is based on objective criteria, which, though not perfect, concludes that only market-based instruments for environmental protection are relevant for the control of the subsidies. The precise determination of the scope of the category of aid is, however, superseeded by the regular intervention of subjective factors allowing the institutions to choose when it comes to qualification.The impact of the legal framework needs to be considered against the environmental legislation of the EU. In theory this later could lead to harmonisation of competition in the internal market. In practice, however, its content triggers the law of state aid leading to a complex and sometimes conflicting relationship between those two sets of rules, while the discretionary exercise of the EU Commission’s power for the definition of the legal regime leads to a quasi-harmonisation of the environmental sector.
168

Agente Comunitário de Saúde (ACS): construção do percurso identitário a partir da história de vida / Community Health Agent (CHA): Construction of pathway identity from life history

Cristiane Otoni Gomes 26 April 2013 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa busca compreender a construção do percurso identitário do Agente Comunitário de Saúde (ACS) a partir da história de vida. Os objetivos colocados neste estudo foram analisar as formas como se constituíram os princípios e valores que orientam as práticas de cuidado do ACS e de construir uma narrativa que contemplasse como as contingências e os acasos produziram os sentidos para o seu percurso identitário. Para isto, utilizou-se a metodologia qualitativa heterogênea através da abordagem da História de Vida e da Análise de Conteúdo. A primeira - História de Vida, segundo Becker (1994) é a expressão de uma forma de vida, de conhecer crenças, valores e desejos de uma população estudada dentro do contexto da vida destes sujeitos. Para tanto, foram realizadas entrevistas com seis ACS que atuam há pelo menos dois anos no município do Rio de Janeiro. As entrevistas foram gravadas e, parcialmente, transcritas após o aceite e a assinatura do termo de consentimento. Acredito que os agentes podem operar entre si diferentes modos de fazer, uma vez que afetam e sofrem afetamentos, atravessam e ao mesmo tempo são atravessados por diferentes micro redes que geram solidariedade ou individualismo, humanidade ou animosidade nas inter-relações. Neste contexto, o estudo conclui que ainda que a maioria dos entrevistados não escolhesse a carreira de ACS, houve uma disponibilidade para aprender o ofício e um compromisso com as atribuições definidas para o exercício profissional. Aliado a isso, constatou-se também, que a inserção na profissão foi uma forma de conseguir um emprego formal que garanta uma renda fixa mensal. Não há o desejo de permanecer por muito tempo nesta profissão pelo desgaste físico e emocional que é fortemente sentido já no primeiro ano de trabalho. Em relação à construção dos sentidos para o percurso identitário dos ACS, os depoimentos apresentam uma identificação com as ações de ajuda e solidariedade presentes na vida dos sujeitos. E, dentre os valores ou princípios que constituíram a formação de um caráter ou identidade pessoal, que são determinantes para a atuação no cuidado à saúde das pessoas, destacam-se a sensibilidade, a escuta, o afeto, o acolhimento, a ética, a amizade e alteridade. Na discussão sobre a necessidade deste profissional ser morador da área que vai atuar, observou-se, a partir das narrativas, que esta exigência pode facilitar a abordagem. Contudo, a qualidade do cuidado não está diretamente relacionada a este critério que pode gerar distanciamento e desconfiança dos outros moradores. Logo, estudos como este se justificam para que se possa reafirmar a importância de trabalhadores do SUS, em especial, o ACS. Estes representam hoje mais de 200 mil trabalhadores da saúde pública e se espera que sejam profissionais responsáveis por um cuidado em saúde que respeitem as diferenças entre as pessoas, que não sobreponham a doença ao sujeito e não minimizem o sofrimento em função do cumprimento de metas e produção de dados a serem planilhados. Lutem, acima de tudo, pela defesa de qualquer vida.
169

Intervenção educacional em grupo para promoção do consumo de frutas e hortaliças de Agentes Comunitários de Saúde do município de Porto Feliz-SP / Educational group intervention to promote the consumption of fruits and Non-starchy vegetables by Community Health Agents from the municipality of Porto Feliz-SP

Alcalá Garcia, Carina [UNESP] 20 August 2014 (has links) (PDF)
Made available in DSpace on 2015-06-17T19:33:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-08-20. Added 1 bitstream(s) on 2015-06-18T12:48:03Z : No. of bitstreams: 1 000831020.pdf: 1578746 bytes, checksum: e3f5d6af5706db515dbf0f62db5cf4ef (MD5) / Foi realizado um estudo de intervenção, com grupo controle, para avaliar o impacto de uma atividade educativa em grupo (AEG) sobre o consumo de frutas e hortaliças (FH) de agentes comunitários de saúde (ACS) de um município de pequeno porte do interior do estado de São Paulo. Foram constituídos dois grupos: grupo intervenção (n=16), formado por agentes que participaram de cinco sessões de grupo e uma oficina culinária; e grupo controle (n=30), formado por agentes não participantes. Para aferir o consumo de FH, em gramas e em porcentagem da energia da dieta, foram aplicados, antes e 90 dias após a intervenção, um recordatório de 24h e dois registros de consumo em 24 horas; um destes, referente a um fim de semana. O impacto da intervenção foi avaliado mediante análises de medidas repetidas com ANOVA seguida de teste Tukey ou gama seguida de teste de comparação múltipla, caso a distribuição das variáveis fosse, ou não, simétrica. Foram também comparadas as distribuições dos indivíduos dos dois grupos de acordo com os estágios de mudança de comportamento segundo o Modelo Transteorético, antes e após a intervenção, mediante teste qui-quadrado de tendência. Também houve avaliação de processo e do efeito da intervenção na visão dos ACS participantes. O incentivo ao consumo de FH realizado pelos ACS dos dois grupos, juntos às famílias assistidas por eles, também foram comparados, três meses após a intervenção. Todas as análises foram feitas utilizando o programa SAS for Windows, versão 9.3. Em todos os testes foi fixado o nível de significância de 5%, ou o p-valor correspondente. O grupo que participou da intervenção aumentou significativamente o consumo de hortaliças (em gramas e percentual calórico) quando comparado com o grupo controle, efeito não observado para o consumo de frutas. Em relação aos estágios de mudança de comportamento, 60% dos ACS do grupo intervenção modificaram... / This intervention study assessed the impact of a group education activity on the consumption of produce (fruits and non-starchy vegetables) by community health agents from a small municipality in the state of São Paulo. The intervention group (n=16) consisted of agents who participated in five group sessions and a cooking workshop, and the control group consisted of agents (n=30) who did not participate in those activities. Produce intake in grams and percentage of total energy intake was investigated by one 24-hour dietary recall and two 24- hour food records(one weekday and one weekend day). The three instruments were administered before and 90 days after the intervention. The impact of the intervention was assessed by repeated measures analysis of variance (ANOVA) followed by the Tukey's test or gamma followed by multiple comparison test depending on variable distribution (symmetric or not). The chi-square test for trend compared the distributions of the individuals in the two groups before and after the intervention according to the stages of change of the transtheoretical model. The participants also assessed the intervention and its effect. The study also investigated the impact of the two groups on the produce intake of the families they visited. The data were treated by the software SAS for Windows version 9.3 with a significance level of 5% or corresponding p-value. The non-starchy vegetable intake (in grams and percentage of total energy intake) of the intervention group increased significantly, but not the fruit intake. The produce intake in grams and percentage of total energy intake also did not change. Sixty percent of the intervention group increased their produce intake against 25% of the control group. All participants in the intervention group reported positive repercussions associated with the intervention, citing greater awareness of the importance of healthy food habits most. The intervertion group ...
170

Intervenção educacional em grupo para promoção do consumo de frutas e hortaliças de Agentes Comunitários de Saúde do município de Porto Feliz-SP /

Alcalá Garcia, Carina. January 2014 (has links)
Orientador: Maria Antonieta de Barros Leite Carvalhaes / Coorientador: José Eduardo Corrente / Banca: Silvia Justina Papini / Banca: Betzabeth Slater Villar / Resumo: Foi realizado um estudo de intervenção, com grupo controle, para avaliar o impacto de uma atividade educativa em grupo (AEG) sobre o consumo de frutas e hortaliças (FH) de agentes comunitários de saúde (ACS) de um município de pequeno porte do interior do estado de São Paulo. Foram constituídos dois grupos: grupo intervenção (n=16), formado por agentes que participaram de cinco sessões de grupo e uma oficina culinária; e grupo controle (n=30), formado por agentes não participantes. Para aferir o consumo de FH, em gramas e em porcentagem da energia da dieta, foram aplicados, antes e 90 dias após a intervenção, um recordatório de 24h e dois registros de consumo em 24 horas; um destes, referente a um fim de semana. O impacto da intervenção foi avaliado mediante análises de medidas repetidas com ANOVA seguida de teste Tukey ou gama seguida de teste de comparação múltipla, caso a distribuição das variáveis fosse, ou não, simétrica. Foram também comparadas as distribuições dos indivíduos dos dois grupos de acordo com os estágios de mudança de comportamento segundo o Modelo Transteorético, antes e após a intervenção, mediante teste qui-quadrado de tendência. Também houve avaliação de processo e do efeito da intervenção na visão dos ACS participantes. O incentivo ao consumo de FH realizado pelos ACS dos dois grupos, juntos às famílias assistidas por eles, também foram comparados, três meses após a intervenção. Todas as análises foram feitas utilizando o programa SAS for Windows, versão 9.3. Em todos os testes foi fixado o nível de significância de 5%, ou o p-valor correspondente. O grupo que participou da intervenção aumentou significativamente o consumo de hortaliças (em gramas e percentual calórico) quando comparado com o grupo controle, efeito não observado para o consumo de frutas. Em relação aos estágios de mudança de comportamento, 60% dos ACS do grupo intervenção modificaram... / Abstract: This intervention study assessed the impact of a group education activity on the consumption of produce (fruits and non-starchy vegetables) by community health agents from a small municipality in the state of São Paulo. The intervention group (n=16) consisted of agents who participated in five group sessions and a cooking workshop, and the control group consisted of agents (n=30) who did not participate in those activities. Produce intake in grams and percentage of total energy intake was investigated by one 24-hour dietary recall and two 24- hour food records(one weekday and one weekend day). The three instruments were administered before and 90 days after the intervention. The impact of the intervention was assessed by repeated measures analysis of variance (ANOVA) followed by the Tukey's test or gamma followed by multiple comparison test depending on variable distribution (symmetric or not). The chi-square test for trend compared the distributions of the individuals in the two groups before and after the intervention according to the stages of change of the transtheoretical model. The participants also assessed the intervention and its effect. The study also investigated the impact of the two groups on the produce intake of the families they visited. The data were treated by the software SAS for Windows version 9.3 with a significance level of 5% or corresponding p-value. The non-starchy vegetable intake (in grams and percentage of total energy intake) of the intervention group increased significantly, but not the fruit intake. The produce intake in grams and percentage of total energy intake also did not change. Sixty percent of the intervention group increased their produce intake against 25% of the control group. All participants in the intervention group reported positive repercussions associated with the intervention, citing greater awareness of the importance of healthy food habits most. The intervertion group ... / Mestre

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