A distribuição geográfica de médicos é um problema com que se defrontam os sistemas nacionais de saúde e, no Brasil, tem se tornado um dos desafios para a consolidação do Sistema único de Saúde (SUS). A análise dos determinantes dessa distribuição está fundamentado em abordagens sobre o mercado de trabalho em saúde e no médico sua formação ou oferta inserido no contexto histórico, político, social e institucional em que são construídos. O referencial de análise proposto neste estudo tem como objetivo evidenciar os fatores e condicionantes que interferem na distribuição e fixação de médicos identificar possíveis estratégias de intervenção que podem ser aplicadas à realidade brasileira, no contexto das políticas públicas. O mote para essa discussão é a compreensão de que a forte concentração geográfica dos profissionais e dos serviços impede a concretização dos princípios que regem o Sistema Único de Saúde, particularmente no que se refere à universalização, à integralidade e à própria descentralização. As estratégias tentadas pelo governo brasileiro também são abordadas, mais especificamente, o Projeto Rondon, o Programa de Interiorização das Ações de Saúde e Saneamento (PIASS) e o Programa de Interiorização do SUS (PISUS). Essa análise é complementada com um estudo de caso sobre a experiência recente no campo da política pública em saúde destinada a minimizar a má distribuição de médicos no território nacional: o Programa de Interiorização do Trabalho em Saúde (PITS), implementado pelo Ministério da Saúde em 2001. Sua condição de estratégia inédita na política de recursos humanos em saúde em nosso país permitiu identificar aspectos relevantes para qualquer iniciativa que pretenda fortalecer a distribuição de profissionais de saúde, para além dos grandes centros urbanos. Por fim, o estudo oferece um referencial de análise para a distribuição e a fixação de médicos, construído a partir dos elementos contemplados na revisão da literatura, na discussão teórica, no aporte das experiências nacionais e internacionais e nos resultados obtidos no estudo de caso. / The medical geographical distribution is a matter that challenges the nationals systems of health and, Brazil, its becoming one of the main challenges to face to consolidate the SUS (Sitema Único de Saúde Unique System of Health). The analysis of the determinative ones of this distribution is based on approaches about the work market in health and the doctor his formation or offer inserted in the historical context, politician, economic, social and institutional where they are constructed. The referential of analysis considered in this study has as its objective to make evident the factors and conditioning matters that interfere with the distribution and retention of doctors and to identify possible strategies of intervention that they can be applied to the Brazilian reality, in the context of the public politics. The motto for this discussion is the understanding of that the strong geographic concentration of the professionals and of the services it obstructs the concretion of the principles that conduct the SUS (Unique System of Health), particularly as for the universalization, to the integrality and to the proper decentralization. The attempted strategies by the Brazilian government also are focused, emphasizing the Rondon Project, the PIASS (Program of Actions of health and Sanitation in the interior area of Brazil rural areas). This analysis is complemented with a case study on the recent experience in the field of the public health politics destined to minimize the bad distribution of doctors in the national territory: the PITS (a program to stimulate and increase work in the field of health in the interior area of Brazil), implemented by Ministry of Health in 2001. Its condition of unheard-of strategy in the politics of human resources in health in our country allowed identifying relevant aspects for any initiative that intends to fortify the distribution of health professionals towards out of the great urban centers. Finally, the study offers a referential of analysis for the distribution and retention of doctors, constructed from the elements contemplated in the bibliographic revision, in the theoretical discussion, in the related national and international experiences and in the results gotten in the case study.

A distribuição geográfica de médicos é um problema com que se defrontam os sistemas nacionais de saúde e, no Brasil, tem se tornado um dos desafios para a consolidação do Sistema único de Saúde (SUS). A análise dos determinantes dessa distribuição está fundamentado em abordagens sobre o mercado de trabalho em saúde e no médico sua formação ou oferta inserido no contexto histórico, político, social e institucional em que são construídos. O referencial de análise proposto neste estudo tem como objetivo evidenciar os fatores e condicionantes que interferem na distribuição e fixação de médicos identificar possíveis estratégias de intervenção que podem ser aplicadas à realidade brasileira, no contexto das políticas públicas. O mote para essa discussão é a compreensão de que a forte concentração geográfica dos profissionais e dos serviços impede a concretização dos princípios que regem o Sistema Único de Saúde, particularmente no que se refere à universalização, à integralidade e à própria descentralização. As estratégias tentadas pelo governo brasileiro também são abordadas, mais especificamente, o Projeto Rondon, o Programa de Interiorização das Ações de Saúde e Saneamento (PIASS) e o Programa de Interiorização do SUS (PISUS). Essa análise é complementada com um estudo de caso sobre a experiência recente no campo da política pública em saúde destinada a minimizar a má distribuição de médicos no território nacional: o Programa de Interiorização do Trabalho em Saúde (PITS), implementado pelo Ministério da Saúde em 2001. Sua condição de estratégia inédita na política de recursos humanos em saúde em nosso país permitiu identificar aspectos relevantes para qualquer iniciativa que pretenda fortalecer a distribuição de profissionais de saúde, para além dos grandes centros urbanos. Por fim, o estudo oferece um referencial de análise para a distribuição e a fixação de médicos, construído a partir dos elementos contemplados na revisão da literatura, na discussão teórica, no aporte das experiências nacionais e internacionais e nos resultados obtidos no estudo de caso. / The medical geographical distribution is a matter that challenges the nationals systems of health and, Brazil, its becoming one of the main challenges to face to consolidate the SUS (Sitema Único de Saúde Unique System of Health). The analysis of the determinative ones of this distribution is based on approaches about the work market in health and the doctor his formation or offer inserted in the historical context, politician, economic, social and institutional where they are constructed. The referential of analysis considered in this study has as its objective to make evident the factors and conditioning matters that interfere with the distribution and retention of doctors and to identify possible strategies of intervention that they can be applied to the Brazilian reality, in the context of the public politics. The motto for this discussion is the understanding of that the strong geographic concentration of the professionals and of the services it obstructs the concretion of the principles that conduct the SUS (Unique System of Health), particularly as for the universalization, to the integrality and to the proper decentralization. The attempted strategies by the Brazilian government also are focused, emphasizing the Rondon Project, the PIASS (Program of Actions of health and Sanitation in the interior area of Brazil rural areas). This analysis is complemented with a case study on the recent experience in the field of the public health politics destined to minimize the bad distribution of doctors in the national territory: the PITS (a program to stimulate and increase work in the field of health in the interior area of Brazil), implemented by Ministry of Health in 2001. Its condition of unheard-of strategy in the politics of human resources in health in our country allowed identifying relevant aspects for any initiative that intends to fortify the distribution of health professionals towards out of the great urban centers. Finally, the study offers a referential of analysis for the distribution and retention of doctors, constructed from the elements contemplated in the bibliographic revision, in the theoretical discussion, in the related national and international experiences and in the results gotten in the case study.

By applying the theory of compensating differentials on a self-compiled data set on the 67 sites in Sweden that offer medical internships, I seek to identify the factors of an internship that determine its salary. Because prospective interns tend to queue for popular internships, I use an estimated equilibrium salary that incorporates the opportunity cost of delaying the internship. I find a significant independent correlation between the travel time to the nearest major city and salary that is suggestive of a compensating differential. The results imply that a larger salary differentiation can mitigate the widespread phenomena of maldistribution of physicians.

Thesis (MA (Sociology and Social Anthropology))--Stellenbosch University, 2008. / In recent years the World Heath Organisation (WHO) has recomended standardising HIV/AIDS treatment. Standardisation is based upon a particular model of what occurs within the relationship between a doctor and a patient and is propogated through the application of protocols. This thesis aims to illustrate how a doctor deals with a protocol in the face of contexts over-laden with contingency and excess which the protocol does not account for and which standardisation excludes. In other words, it explores how doctors deal with the failures and restrictions of standardised medicine. The central question this thesis aims to answer is: How do doctors on the ground deal with the standardising demands of global, as well as national, institutions in the face of highly contingent daily realities? I aim to answer this question by critically analysing the relationship between global institutions and the effects of their policies on the ground level. I argue that global organisation such as the WHO attempt to limit the particularities and contingency of local contexts in order to ensure the internal coherence of their own policies. This is made possible through ‘interpretive communities’ of experts, as well as, the relative opacity of ground level actions. However, I also illustrate how doctors applying these protocols are not merely pawns in the state’s and global health organisations schemes but rather depend upon the opacity at ground level in order to ensure the well-being of those marginalised by protocols.

Στην Ελλάδα ο όρος “γενόσημα” φάρμακα έχει γίνει ευρέως γνωστός τον τελευταίο καιρό, παρ’ό,τι στην Ευρώπη και σε άλλες χώρες του κόσμου η χρήση γενοσήμων είναι γνωστή εδώ και δεκαετίες. Η παρούσα διπλωματική εργασία έχει σκοπό να μελετήσει τους παράγοντες που επηρεάζουν τη στάση ασθενών-καταναλωτών και επαγγελματιών υγείας ως προς τα γενόσημα φάρμακα. Πιο συγκεκριμένα, μελετώνται διάφοροι παράγοντες που βρέθηκαν μέσα από τη βιβλιογραφική ανασκόπηση ότι επηρεάζουν τις πεποιθήσεις των ασθενών-καταναλωτών και των επαγγελματιών υγείας. Αρχικά, έγινε μια βιβλιογραφική ανασκόπηση σε μελέτες της διεθνούς βιβλιογραφίας σχετικά με το θέμα των γενόσημων φαρμάκων. Στη συνέχεια, κατασκευάστηκαν δύο ερωτηματολόγια, ένα που απευθυνόταν σε ασθενείς-καταναλωτές και ένα που απευθυνόταν σε επαγγελματίες υγείας. Το πρώτο ερωτηματολόγιο συμπλήρωσαν 364 ασθενείς-καταναλωτές. Το δεύτερο συμπλήρωσαν 95 επαγγελματίες υγείας (ιατροί και φαρμακοποιοί). Τα στοιχεία που συλλέχθηκαν από τα ερωτηματολόγια αναλύθηκαν στη συνέχεια με τη βοήθεια του προγράμματος SPSS. Από τις αναλύσεις που έγιναν, διαπιστώσαμε πως στους περισσότερους πλέον ασθενείς ο όρος «γενόσημα φάρμακα» είναι γνώριμος αλλά, υπάρχει έλλειψη σωστής πληροφόρησης. Παρόλα αυτά, οι μισοί σχεδόν ασθενείς έχουν θετική στάση προς τα γενόσημα φάρμακα και είναι διατεθειμένοι να τα χρησιμοποιήσουν μετά από σύσταση του ιατρού κυρίως, ή και του φαρμακοποιού. Επίσης, οι πιο σημαντικοί λόγοι που τους ωθούν να αγοράσουν ένα φάρμακο είναι η ασφάλεια και η αποτελεσματικότητά του. Από τις αναλύσεις των απαντήσεων των επαγγελματιών υγείας διαπιστώσαμε πως υπάρχει έλλειψη γνώσεων και σωστής πληροφόρησης. Ενώ είναι πρόθυμοι να συνταγογραφήσουν/χορηγήσουν γενόσημα φάρμακα, παρόλα αυτά, προτιμάται η χρήση πρωτότυπων φαρμακευτικών σκευασμάτων, πιθανότατα λόγω της έλλειψης εμπιστοσύνης προς τον ΕΟΦ. Πιστεύεται πως η βελτίωση της αξιοπιστίας του Οργανισμού και η καλύτερη ενημέρωση των επαγγελματιών υγείας θα συμβάλει στην αύξηση χρήσης των γενοσήμων. Το κράτος έχει θεσπίσει ήδη αρκετά μέτρα για την αύξηση χρήσης των γενοσήμων. Προτείνεται όμως, να γίνει μια πιο ολοκληρωμένη προσπάθεια μέσα από τα κανάλια των επαγγελματιών υγείας, της φαρμακευτικής βιομηχανίας αλλά και των ασθενών-καταναλωτών, ώστε να αποδώσει η προσπάθεια αυτή και επιτευχθεί ο σκοπός της. / In Greece the term "generic" drugs has become widely known lately, although in Europe and other countries of the world, generics are known for decades. This thesis aims to study the factors that affect the attitude of patients-consumers and health professionals to generics. More specifically, it examines various factors found through the literature to influence the beliefs of patients, consumers and healthcare professionals. Initially, there was a literature review on studies of the literature on the subject of generic drugs. Then, we constructed two questionnaires, one aimed at patients-consumers and one that was aimed at health professionals. The first questionnaire was completed by 364 patient-consumers. The second was completed by 95 health professionals (doctors and pharmacists). The data collected from the questionnaires were then analyzed using the SPSS program. From the analyzes, we found that among most patients the term "generic" is familiar, but there is a lack of proper information. However, almost half patients have positive attitude towards generics and are willing to use them with the recommendation of a physician primarily, or a pharmacist. Also, the most important reasons that make them buy a drug is knowing it’s safe and effective. The analyzes of the responses of health professionals found that there is lack of knowledge and correct information among them. While they are willing to prescribe/dispense generics, however, original drugs are preferred, probably due to lack of confidence in the regional EMEA. According to them, improvement of the reliability of the Agency and better information of the health professionals will help increase the use of generics. The state has already adopted several measures to increase the use of generics. But it is proposed that a more integrated effort, through the channels of health professionals, pharmaceutical industry and patients and consumers should take place so that to this effort and purpose are achieved.

Tikslas – Įvertinti Kauno medicinos universiteto rezidentų, rezidentų vadovų ir gydytojų, baigusių Kauno medicinos universitetą 2003-2008 m. požiūrį į rezidentūros kokybę. Uždaviniai: 1. Įvertinti rezidentų, rezidentų vadovų ir gydytojų, baigusių Kauno medicinos universitetą 2003-2008 m. požiūrį į rezidentūros studijų proceso organizavimą. 2. Išsiaiškinti svarbiausias rezidentų darbo problemas. 3. Aptarti svarbiausius rezidentūros kokybės elementus rezidentų, rezidentų vadovų ir gydytojų, baigusių KMU rezidentūrą 2003 – 2008 m. požiūriu. 4. Ištirti rezidentų savarankiškumą bei aktyvumą rezidentūros metu ir išsiaiškinti jų ateities planus. Tyrimo metodika. KMU rezidentų, rezidentų vadovų ir 2003 -2008 m. baigusių studijas gydytojų anoniminė anketinė apklausa. Per apklausą buvo išdalinta 400 anketų rezidentams, iš jų gauta 266 atsakymų (66,5 proc.), apklausta 40 rezidentų vadovų ir 40 studijas jau baigusių gydytojų. Apklausoje naudota 10 balų Likerto skalė (1 balas žemiausias, o 10 aukščiausias), specifiniams klausimams buvo individualūs atsakymai. Anketų duomenys buvo apdoroti ir išanalizuoti naudojant statistinį duomenų analizės paketą SPSS 15,0. Rezultatai. Rezidentai susipažinimą su rezidentūros studijų programa, rezidentūros studijų vykdymą atsižvelgiant į programą, teorinių žinių ir praktinių įgūdžių kokybę įvertino palankiai (atitinkamai : 7,36; 6,36; 6,53; ir 7,07 balais). Rezidentų vadovai rezidentūros studijų vykdymą atsižvelgiant į programą įvertino 7,5 balais... [toliau žr. visą tekstą] / Aim – To evaluate the opinion of residents, supervisors of residents and doctors of Kaunas University of Medicine who graduated from Kaunas University of Medicine in 2003 – 2008 about the quality of the residency. Tasks: 1. To evaluate the opinion of residents, supervisors of residents and doctors, who graduate from Kaunas University of Medicine in 2003 – 2008, about the organization of process of residency studies. 2. To find out the most important problems of residents’ work. 3. To discuss the most important elements of the quality of residency according to the opinion of residents, supervisors of residents and doctors, who graduated from residency of Kaunas University of Medicine. 4. To explore the self-sufficiency and activeness of the residents during their residency and to find out their future plans. Methodology of the research. The anonymous questionnaire of residents, supervisors of residents and doctors, who graduated from Kaunas University of Medicine in 2003 – 2008. During the research 400 questionnaires were given to the residents, and 266 answers (66.5%) were got back, there were also questioned 40 supervisors of residents, and 40 doctors who had already finished their studies. The questionnaire included 10 points Likert scale (1 point is the lowest, 10 points is the highest), the specific questions had individual answers. The data of the questionnaires was processed and analysed using the package SPSS 15,0 of statistical data analysis. Results. The... [to full text]

The aim of this study was to determine the information-seeking behaviour, needs and preferences of doctors, specifically with reference to Evidence Based Medicine (EBM) in the UK. This is particularly relevant during the current IT and resource development currently being undertaken in the NHS. Mixed methods research techniques were utilised to gather and analyse the data collected to meet the aims and objectives of this study. Three data collection methods have been utilised. The first utilised Clinical Librarians to count the information needs (questions) of doctors (Clinical Librarians Logs). The second data collection method gathered clinical questions from clinical librarians (specialists), medical librarians (generalists) and from websites hosting clinical questions (such as http://www.attract.wales.nhs.uk). These were analysed using the taxonomy developed by Ely et al. 2000. Finally an online questionnaire was used to gather data on doctors' awareness and use of electronic EBM resources. The major finding is that research undertaken on the information needs in the healthcare sector in the USA cannot be readily utilised in the NHS. This research utilised a unique data collection technique, the Clinical Librarian as a data collector. This enabled the quantification of doctors unperceived information needs. This research identified that doctors in the UK asked roughly one question for every four patients seen. Despite the advances and ease of use of electronic resources, the preferred information source was colleagues. Time continues to be the major barrier for accessinge lectronici nformation to aid clinical decision making.

In recent years, there has been an increasing demand to study the information needs and information-seeking behaviour of doctors as an essential element in developing successful clinical information systems and improving the quality of healthcare services. This doctoral thesis focuses on exploring the information needs and information seeking behaviour of doctors in Kuwait government hospitals (KGH). The aims are to investigate the internal and external information sources used by doctors in Kuwait government hospitals and to analyse whether the existing clinical information sources meet their needs. A strategy of sequential, mixed-method procedures was followed to gather the research data using focus groups, a paper-based questionnaire and semi-structured telephone interviews. The participants of the research included all categories of doctors (consultants, senior specialists, specialists, senior registrar, registrar, assistant registrar and trainees), working in four government hospitals: Mubarak AI Kabeer, AI Sabaha, AI Farwania and AI Amiri in Kuwait. The findings of the study show that the most frequently mentioned need for information was to keep up-to-date to maintain good practice. It was found that interpersonal communication and a doctor's personal collection, consisting primarily of electronic resources, were the sources most frequently reported as used by the doctors. However, the degree of use of clinical information sources showed that doctors' information seeking varied depending on the clinical scenario. Doctors' knowledge and patient data were the doctors' most frequently used sources of information in the three clinical scenarios: outpatients, wards and the emergency department. There was a low use of knowledge-support resources such as the Internet and library resources in the outpatient and emergency rooms. However, use of the knowledge-support resources was highest in the wards. The results showed some contextual factors either supported or hindered doctors in seeking the information they need. The factors were categorised in the following contexts: a) Organisation context, b) Socio-cultural context; c) Information sources context and d) Scenarios context. Doctors made a number of suggestions for effective information communication and improving the information provision system in KGH. Two conceptual models result from the study findings: a clinical decision-making model scenario· and the overall conceptual model of information seeking by doctors in Kuwait government hospitals. The thesis concludes with recommendations and practical implications to enhance the information provision in KGH. Suggestions for further research are also given.

Diploma thesis "Female Overseers and Doctors in the Concentration and Extermination Camps of Nazi Germany" deals with life and deeds of these women before and during World War 2. In my thesis I would therefore like to address the possible causes of the Holocaust, I want to think about how we can from the relatively recent past World War 2 learn, or whether there are any options to prevent similar incidents. It will try to hold on to the role of women in the extermination camps, which were the main venue of the program extermination of Jews and other minorities. I will focus on the phenomenon of "bad women" in the death camps, thus nazi women or female doctors. I would like this type of women looked at from a sociological point of view. If possible, a description of their origin, family background, education, interpersonal relationships, behavior in the camp and the like. It is clear that there are more reasons why some individuals become a cruel figure. Of course, some tendencies to violence inside each and every one must be encoded. I believe, however, that the main role is played by education, whether at home or at school.

Notre thèse s’intéresse au changement dans le contexte hospitalier. Il s’agit de l’étude du changement par l’approche néo-institutionnelle. Nous tentons d’expliquer et de décrire comment depuis une nouvelle structuration les effets organisationnels opèrent à la fois sur les comportements, les modes de pensée et les actions des acteurs peu ou prou impactés par ces modifications. 5 établissements hospitaliers publics en France sont analysés au travers d’une étude comparative de cas. Nous mobilisons une méthodologie de type qualitative pour mettre en lumière les déterminants de ce changement où les acteurs jouent un rôle central. Nous étudions plus précisément en quoi le travail identitaire des médecins chefs de pôle favorise l’institutionnalisation du pôle. Nous mobilisons le concept de travail identitaire issu de deux courants théoriques et proposons un modèle d’analyse du travail identitaire intégrateur. Nous percevons le travail identitaire comme un antécédent favorisant l’action entrepreneuriale du chef de pôle et par là-même l’institutionnalisation du pôle. Notre travail met en lumière le lien entre travail identitaire opéré et institutionnalisation du pôle dans deux cas sur cinq. Dans trois cas le travail identitaire n’est pas expérimenté. Nous décrivons à travers un modèle d’analyse quels facteurs favorisent le travail identitaire du chef de pôle. L’accompagnement du chef de pôle et l’expérience de ce dernier expliquent d’une manière importante pourquoi la transition identitaire opère dans deux cas sur cinq étudiés. / Our thesis aims to understand the change in French public hospital. Since the implementation of a new organizational structure, hospitals have to find a new way of handling care and collaboration among medical and administrative worlds. Then we ask how and why change is possible in some cases whereas in others it doesn’t occur? We use neo-institutionalist theory to seize micro events enabling institutionalization of the medical cluster. This theoretical stream puts that change can occur with entrepreneurial action lead by an institutional entrepreneur. We wonder if a change in role has an impact on the change itself. Particularly, we question the impact of identity work as an antecedent of institutionalization in so far as identity and role are components of the same individual structure. Hence, we propose an integrated identity model to describe identity work. Then we suggest the impacts between identity work and institutionalization. We measure institutionalization with its impacts on behavior, cognitive, and activity dimension. Thus, we tend to highlight the impact of identity work on institutionalization. We use a qualitative methodology as we try to understand the meaning for actors of this change. We study 5 cases as a unique case and compare them to stress their commonalities and differences in a generalization attempt. Our results show how identity work experienced by the medical chief enables institutionalization of the medical cluster. Identity work is experienced in two cases whereas in other three cases medical chiefs adopt an avoidance strategy and do not participate to institutionalize the cluster.