Introdução: As consultas de seguimento com o profissional fonoaudiólogo após a aquisição da prótese auditiva são de extrema importância para a garantia da manutenção do uso com qualidade. As dificuldades enfrentadas pelos usuários no comparecimento ao serviço de saúde impedem que esse processo ocorra de maneira adequada e impactam negativamente no processo de reabilitação auditiva do indivíduo ocasionando, inclusive, o abandono do uso. A incorporação da teleconsulta nesses seguimentos seria uma solução para impedir a ocorrência de tal fato, por permitir que as intervenções de orientações e aconselhamentos sejam realizadas remotamente. Objetivos: desenvolver um programa de seguimento semipresencial para novos usuários de prótese auditiva e verificar sua aplicabilidade. Método: estudo prospectivo (exploratório), no qual dez indivíduos adultos novos usuários de prótese auditiva bilateral, pertencentes a um serviço público de saúde, foram avaliados e submetidos a uma consulta inicial, seguido pela teleconsulta e novamente avaliados numa última etapa presencial. As intervenções realizadas foram classificadas em primárias e secundárias. O questionário para avaliação da satisfação foi aplicado nas etapas presenciais e os dados obtidos pelos registros foram enviados para análise estatística descritiva. Resultados: todos os indivíduos necessitaram de pelo menos uma intervenção na consulta presencial inicial. A maioria esteve relacionada a orientações e aconselhamentos referentes ao uso e manuseio da prótese auditiva (consideradas intervenções secundárias). Na etapa da teleconsulta, todos os indivíduos precisaram de intervenções secundárias, diminuindo sua ocorrência na consulta presencial final. O questionário utilizado para verificar a satisfação apresentou média de escore global com valores de 5,7 na consulta presencial inicial e 6,1 na consulta presencial final, o que correspondeu à satisfação dos participantes. Todos os participantes atribuíram nota máxima ao programa desenvolvido, o que representou a \"muito satisfeitos\". Conclusão: O estudo traz contribuições para a área da Telessaúde em Fonoaudiologia, pois a utilização das teleconsultas permitiu a resolução de problemas secundários no processo de adaptação à prótese auditiva. Apesar dessa amostra ser reduzida, o estudo inicial foi satisfatório para a continuidade do programa demonstrado ser aplicável. Ainda estudos com maior amostra em diferentes populações são necessários com intuito de validar novos protocolos / Introduction: Follow-up visits with the audiologist after the hearing aid fitting process are critical to ensure the maintenance of quality use. The difficulties faced by users in adhering to sequential return visits directly affect this process in an inadequate way and negatively impact on individual auditory rehabilitation process, even causing the use abandonment. The inclusion of virtual assistance in these follow-ups would be a solution to avoid this situation, allowing interventions of orientations and counseling by remote consultation. Objectives: to develop a follow-up program combining face-to-face appointments and telehealth for new hearing aid users as well as verifying its applicability. Methods: prospective (exploratory) study evaluated ten new bilateral hearing aid users, seen in a public health service. The first and the last appointments were face-to-face and five followed-ups by virtual assistance. The required interventions were classified as primary and secondary. The questionnaire for satisfaction evaluation were applied during the face-to-face assessments and all registered data was sent for descriptive statistical analysis. Results: all study subjects required at least one intervention during the initial face-to-face visit. Most were related to provide informative counseling and to clarify new users\' doubts regarding the use of the hearing aid (considered secondary interventions). At telehealth assistance stage, all subjects required secondary interventions, reducing their occurrence in the final face-to-face assistance. The questionnaire used to verify the satisfaction showed an average overall score of 5.7 in initial stage and 6.1 in the final stage, which proved subjects\' satisfaction. All subjects attributed the maximum score to the developed program, which represented \"very satisfied\". Conclusion: The study contributes to Telemedicine, since the use of virtual assistance allowed the resolution of secondary problems in the hearing aid fitting process. Although this sample was reduced, the initial study was satisfactory for the continuity of this program which has been shown to be applicable. Further studies with larger samples in different populations are needed to validate new protocols

O Sistema Único de Saúde (SUS) pode ser traduzido em princípios constitucionais como acesso universal e igualitário às ações e serviços, e integralidade da atenção à saúde. É, portanto, um setor que carece de um processo de regulação eficiente das vagas e recursos. O SUS passou por um processo de reestruturação organizacional na última década e vem tentando se consolidar conforme proposto na Constituição de 1988. Uma das consequências foi a regionalização e a hierarquização da rede de serviços de saúde no que tange à estratégia de atendimento e ao encaminhamento de pacientes para os serviços especializados. Nesse sentido, os serviços de saúde foram organizados em diferentes níveis de complexidade (Rede de Atenção Básica, Rede de Média complexidade e Rede de Alta Complexidade) e, a regionalização no Estado de São Paulo ocorreu por meio da criação/organização de Departamentos Regionais de Saúde (DRS). Portanto, este projeto propõe analisar o processo de regulação de vagas de consultas eletivas do Departamento Regional de Saúde XIII do Estado de São Paulo verificando sua integração com os princípios propostos pelo SUS. Foi possível concluir que o processo atual de regulação de vagas eletivas do DRSXIII atende parcialmente os princípios propostos pelo Sistema Único de Saúde (SUS) e identificar oportunidades de melhorias. / The Public Health System (PHS) can be translated in constitutional principles as the egalitarian and universal access to the actions and services and integrality of attention to health. It is, therefore, a sector that needs an efficient regulation process of vacancies and resources. The PHS has passed by an organizational restructuration process in the last decade and has been trying to consolidate itself due to the proposal in the Constitution of 1988. One of the aftermaths was the regionalization and prioritization of the health networking services which refer to the public service strategy and to the patients forwarding to the specialized services. In this sense the health services were organized in different complexity levels (Basic Healthcare Network, Medium Complexity Healthcare Network and High Complexity Healthcare Network) and in the State of São Paulo the regionalization occurred through the creation/organization of the Regional Health Departments (RHD). Therefore, this project proposes to analyze the process of regulation of vacancies of elective consultations of the XIII Regional Health Department of the State of São Paulo verifying its integration with the principles proposed by PHS. It was possible to conclude that the current process of regulation of vacancies of elective consultations of the XIII Regional Health Department of the State of São Paulo meets partially the principles proposed by the Public Health System (PHS) and identify opportunities for improvement.

Em 2011, a Agência Nacional de Vigilância Sanitária inseriu como eixo estratégico de sua gestão o envolvimento com as macro políticas sociais brasileiras, especialmente as relacionadas ao desenvolvimento social, com foco na erradicação da extrema pobreza e no avanço da formalização das atividades econômicas relacionadas a produtos e serviços sujeitos à vigilância sanitária. Em 2013 a Agencia publicou uma regulação específica para o microempreendedor individual, para o empreendimento familiar rural e para o empreendimento econômico solidário (RDC n° 49) intitulada de \"Inclusão produtiva com segurança sanitária\". A construção da norma contou com a participação da sociedade, por meio da consulta pública n°37. Objetivos: Analisar criticamente a percepção e as expectativas dos atores sociais participantes da consulta sobre os impactos esperados acerca da RDC e discutir as possíveis convergências dessas expectativas com as ações propostas no I Plano Nacional de Segurança Alimentar e Nutricional (2012/2015). Metodologia: Trata-se de um estudo qualitativo que utilizou os métodos de análise documental e análise de conteúdo temática para analisar os dados secundários da consulta pública °37. Resultados: A partir da descrição das categorias identificadas, os atores sociais foram divididos entre \"grupo a favor\" e \"grupo contrário\", explicitando o caráter antagônico das expectativas dos participantes acerca dos impactos da norma. Além disso, a analise mostrou que existem vários pontos de convergência entre os impactos esperados pelos participantes e as ações propostas no I Plano de Segurança Alimentar e Nutricional (2012-2015). Conclusão: O tema \"Inclusão produtiva com Segurança Sanitária\" provocou uma discussão rica e complexa mostrando que é necessário haver um equilíbrio para que as normas sanitárias sejam coerentes com as especificidades existentes na pequena produção, garantindo, contudo, a segurança sanitária dos alimentos. / In 2011, the National Sanitary Surveillance Agency inserted as a strategic axis of its management the involvement with macro social policies in Brazil, especially those related with social development, focusing on eradication of extreme poverty and on advancing formalization for economic activities related to products and services subject to health surveillance. In 2013 the Agency published a specific regulation for individual microentrepreneur, family farmer and solidarity economic enterprise (RDC n°49) entitled \"Productive Inclusion with Health Security\". The construction of the standard was attended by civil society, through the public consultation n° 37. Objectives: To critically analyze perception and expectations of social actors participants of the consultation on expected impacts of RDC and to discuss the possible convergences of these expectations with the actions proposed in the 1st National Plan for Food and Nutrition Security (2012/2015). Methodology: This is a qualitative study that used the methods of document analysis and the analysis of thematic content to analyze the secondary data of the public consultation n° 37. Results: From the description of categories identified, the social actors were divided between \"favor group\" and \"opposing group\", clarifying the antagonistic character of participants\' expectations about impacts of the norm. In addition, the analysis showed there are several points of convergence between the expected impacts of participants and actions proposed in the I Food and Nutrition Security Plan (2012-2015). Conclusion: The theme \"Productive Inclusion with Sanitary Safety\" has provoked a rich and complex discussion, showing that a balance needs to be struck in order to ensure that health standards are consistent with the specificities of small production, while guaranteeing food safety.

O desenho coletivo é utilizado como objeto mediador da intervenção institucional, de maneira semelhante ao squiggle game da consulta terapêutica, o desenho produzido pelo grupo facilita a comunicação entre os membros, promove associações livres verbais e gráficas, apresenta fantasmas, desejos e medos, comuns e compartilhados; informa sobre aspectos individuais e da instituição na associação discursiva e na produção pictográfica. A hipótese norteadora é que o desenho coletivo quando usado em um contexto de intervenção institucional, seja de diagnostico ou de tratamento, é um objeto mediador do diálogo no grupo. Devido ao acesso à representação e projeção de conteúdos inconscientes, o desenho manifesta conteúdos recalcados, aparentemente desconhecidos. Apresenta-se um histórico do desenho como linguagem nos primórdios da humanidade e a utilização e reflexão desde a medicina, pedagogia e psicologia. Valorizado para conhecer a alma infantil, posteriormente à psicanálise considera-o substituto da associação livre. Freud não aprofunda sobre o desenho como recurso terapêutico, mas mostra como usar o método psicanalítico na presença da imagem. De maneira semelhante ao sonho analisa o que se reitera, se condensa e desloca na imagem pictográfica. O primeiro desenho produzido no contexto vincular é descrito na Analise de uma fobia de uma criança de 5 anos, quando, da mesma maneira como Winnicott faz na brincadeira do squigglel game, Hans o pequeno paciente- introduz um traço para completar a idéia que deseja transmitir a respeito do tamanho do pênis da girafa. Na psicanálise de crianças, Winnicott e Dolto mostram caminhos para usar o desenho no processo terapêutico. Em contextos vinculares, poucos autores empregam o desenho no grupo como um recurso mediador do diálogo e do trabalho psicanalítico. Apresentam-se as contribuições teóricas para a psicanálise de grupo e instituição de autores como J. Bleger, E. Pichon Rivière, D. Anzieu e René Kaës. Identifica-se que no desenho é figurada a queixa, o inédito; detectam-se o aparecimento de traços, formas que enunciam e denunciam aspectos a serem destacados, trabalhados e elaborados pelo grupo no primeiro encontro. Um dos grupos apresentados era uma instituição que vivia várias queixas entre elas a equipe dividida, no encontro enquanto desenham surge uma ponte que une o que estava separado por um grande tronco: a equipe técnica da instituição de um lado e de outro o grupo de crianças e seus cuidadores. Outro caso descreve a intervenção da equipe de manutenção de uma empresa, que desenha um campo de futebol e no meio uma caveira, simbolizando o perigo de morte; o diálogo com os membros remete ao medo a serem demitidos. Os desenhos coletivos permitem que o psicólogo conduza e aborde, com facilidade, aspectos silenciados a partir de apontamentos de aspectos díspares, estranhos, repetitivos. / The collective drawing is used as the institutional interventions mediating object, in a similar way as the squiggle game of the therapeutic consultations; the drawing produced by the group facilitates communication among the members, improves free verbal and graphic associations, shows common and shared phantoms, desires and fears; informs about the individual and institutional aspects in the discourse association and in the pictographic production. The guiding hypothesis is that the collective drawing when used in a context of institutional intervention, whereas of diagnosis or treatment, it is a mediating object of the dialog in the group. Because of the access to the representation and projection of unconscious contents, the drawing expresses repressed contents, apparently unknown. We show a historical record of the drawing like the language in the beginnings of humanity, its used and thinking from Medicine, Pedagogy and Psychology. Initially Psychoanalysis valued it to know the childs psyche, after it considered a substitute of the free association. Freud doesnt deeper on the drawing as a therapeutic resource, but He shows how to use the psychoanalytic method with the image. As in a similar way like in a dream, Freud analyses what comes again, condenses and dislocates in the pictographic image. The first drawing produced in a bind context is describe in Analysis of a phobia of a child under 5 years, when, as in the same way like Winnicott does in the squiggle game, Hans the young patient- introduces a trace to complete the idea he wants to transmit in relation to the size of the giraffe\'s penis. In children psychoanalysis, Winnicott and Dolto show paths to use the drawing in the therapeutic process. In binding contexts, few authors utilize the drawing in the group like a mediating resource of the dialog and the psychoanalytic work. We show theoretical contributions for group and institutional psychoanalysis from authors like J. Bleger, E. Pichon Rivière, D. Anzieu and René Kaës. We identify that the complaint is figured in the drawing, the novel; we detect the emerging of traces, forms that enounce and denounce aspects to be underline, worked and elaborated by the group in the first encounter. One of the groups shown was an institution that experienced different complaints, among them the divided team, in the encounter while they draw it emerges a bridge that joins with a big trunk what was separated: the institutions technical team, by one side and a group of children and their care takers by the other. Another case describes an intervention in a companys maintenance team, that draws a football field with a skull in the middle of it, symbolizing the danger of death; the dialog with the members remits to the fear of being dismissed. The collective drawings permit that the psychologist lead and address in an easy way, silenced aspects by the pointing of despair, strange and repetitive aspects.

Orientador: Nemre Adas Saliba / Banca: Doris Hissako Sumida / Banca: Symone Cristina Teixeira / Resumo: Introdução: A rede de atenção à saúde maternoinfantil foi instituída em 2011 com a finalidade de promover melhorias na eficiência da gestão dos serviços, porém ainda se apresenta como um grande desafio para os gestores. Objetivo: Analisar a rede regional de atenção à saúde da gestante no SUS. Método: Trata-se de pesquisa de caráter transversal, quanti-qualitativa, tipo inquérito. Foram realizadas entrevistas com gestores de 28 municípios, do Ambulatório de Especialidades Médicas (AME) e do Departamento Regional de Saúde (DRS) II do estado de SP, totalizando 86 entrevistados. As variáveis pesquisadas foram: realização de atividade educativa no pré-natal, existência de protocolo de atendimento e encaminhamento, organização da atenção à saúde bucal e geral à gestante, pactuação das referências e funcionalidade do sistema de referência e contrarreferência. Realizou-se análise de conteúdo para as questões discursivas e triangulação entre as respostas obtidas nos municípios, AME e DRS. Resultado: Observou-se que 78,57% dos municípios realizam atividade educativa com gestantes; 42,86% não possuíam protocolo de atendimento implantado e em 57,14% não havia critérios de encaminhamento estabelecidos. Do total de gestores municipais, 53,57% afirmaram realizar testes rápidos para detecção de HIV, Sífilis e Hepatite B e C; 46,43% teste rápido de gravidez e 39,28% relataram avaliar a situação vacinal. Quanto à atenção odontológica primária, não havia protocolo instituído em 71,43% dos munic... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The maternal and child health care network was established in 2011 with the purpose of promoting improvements in the efficiency of service management, but still presents a great challenge for managers. Objective: To analyze the regional health care network of pregnant women in SUS. Method: This is a cross-sectional, quantitative-qualitative research type survey. Interviews were carried out with managers from 28 municipalities, from the Ambulatory of Medical Specialties (AME) and from the Regional Department of Health (DRS) II of the state of São Paulo, totaling 86 interviewees. The variables studied were: performance of prenatal educational activity, existence of a referral protocol, organization of oral and general health care for the pregnant woman, agreement of references and functionality of the referral and counter-referral system. Content analysis was performed for the discursive questions and triangulation between the responses obtained in the municipalities, AME and DRS. Result: It was observed that 78.57% of the municipalities carry out educational activities with pregnant women; 42.86% did not have an implanted care protocol and in 57.14% there were no established referral criteria. Of the total of municipal managers, 53.57% affirmed to carry out rapid tests for the detection of HIV, Syphilis and Hepatitis B and C; 46.43% rapid pregnancy test and 39.28% reported evaluating the vaccine situation. Regarding primary dental care, there was no protocol esta... (Complete abstract click electronic access below) / Mestre

This study was conducted to comparatively examine child specific expulsion rates and parent satisfaction of children who received early childhood mental health consultation (ECMHC) services delivered in 2 states for the 2012 program year: Maryland (unlicensed) and Delaware (licensed) . This current study examined secondary data to determine whether unlicensed (Maryland) ECMHC professionals are equally or more effective than licensed (Delaware) ECMHC professionals. Of the total number of child specific consultations or cases referred for services in Maryland (unlicensed), N = 370, n = 266 children avoided expulsion and were able to remain at their childcare placements while n = 17 children were expulsed. Of the total number of child specific consultations or cases referred for services in Delaware (licensed), N = 135, n = 119 children were able to remain in their childcare placements while n = 3 children were expulsed. The results of this study revealed that there is no statistically significant difference in expulsion rates between Unlicensed (Maryland) professionals and Licensed (Delaware) professionals. Results suggest that licensure status of ECMHC professionals has no affect on expulsion rate outcomes and should receive further examination. Additionally, results could support policy changes that could lead to a national credentialing process that would address the current gap in ECMHC services due to the shortage of qualified ECMHC professionals. This study was unable to determine the outcome of parent satisfaction due to missing data. Future direction should include replication using a mixed longitudinal study.

The present study attempted to answer two questions: do academic library users have a distinctive and useful input to make to library strategic planning? If they do, what mechanisms will permit them to participate effectively in this planning process? To address these questions research was carried out in two stages at a single institutional site, the Canberra College of Advanced Education. The first of these utilised a structured group discussion process, Nominal Group Technique (NGT). This was used both as an indicator of user planning priorities and as a pilot research technique contributing to the design of a subsequent survey. This survey obtained a response rate of over 90 percent from a sample of 379. The study attempted to establish that academic staff and students do have a worthwhile input to make to planning by testing for congruence between the rankings of library planning priorities of these user groups and the rankings of planning priorities of Library staff. No strong positive correlations were established between the priorities of student groups and Library staff, although in the survey the priorities of academic staff and Library staff were found to be related. These results suggest users do have a worthwhile input to make to library strategic planning. Other tests for congruence were also applied between and within respondent groups, because if a group was found to have different priorities there would be a prima facie case for consulting members of that group as part of the planning process. Both mechanisms used in the present study were considered successful. User surveys have been employed for planning in previous studies with a future-oriented component. However, it appears that this may have been the first formally reported application of NGT to library management. Experience in the present study suggests it is a highly suitable technique for situations such as strategic planning, where generation of ideas or comment on priorities is required. However, an attempt to establish congruence between the results obtained using NGT and those obtained from the survey yielded inconclusive results. It is believed that major changes in the institutional environment were principally responsible for this, although a methodological limitation may also have contributed. The study concludes with suggestions for further research.

La planification des infrastructures routières est marquée par une crise au plan de l'acceptabilité sociale. En quelques décennies, les grands projets routiers ont cessé de représenter des monuments du progrès, pour devenir des objets de débat. Dès les années 1970, le ministère des Transports du Québec (MTQ) faisait face à un contrecoup important de sa politique de développement des routes. Le morcellement des tissus urbains par les réseaux routiers a été fortement dénoncé et plusieurs projets ont connu de fortes oppositions de la société civile. Ces grands projets s'imposent encore aujourd'hui difficilement dans un contexte sociétal où la mise en rapport des différentes représentations véhiculées par les acteurs du territoire peine à mener à des consensus ou à des solutions intégrées. Parallèlement, l'institutionnalisation du débat public (notamment à travers le BAPE) et la mise en place d'un cadre juridique viennent encadrer davantage les projets. En mobilisant le concept d'apprentissage organisationnel, la présente thèse répond à une double interrogation. Elle cherche d'abord à comprendre comment se déploient les projets routiers du MTQ dans leurs rapports aux territoires et à leurs acteurs. Ensuite, elle tente de cerner comment évoluent les pratiques planificatrices de ce promoteur face aux contraintes actuelles de la territorialisation des projets. Le terrain d'étude est formé de l'analyse de quatre études de cas, tous des grands projets routiers planifiés par le MTQ, puis de la recension des grands changements organisationnels liés à la planification des projets routier. Par la confrontation du contenu des projets à chaque étape de leur planification, aux requêtes et représentations mobilisés par les acteurs, les effets du rapport au territoire sur la configuration des projets peuvent être constatés. Il ressort de la thèse que les controverses qui se déploient autour des grands projets routiers témoignent d'une nouvelle forme de territorialisation. Les projets se définissent beaucoup plus dans un enchevêtrement de rapports d'acteurs, que dans l'application de paramètres rationnels prédéfinis. Aux choix tranchants d'un acteur hégémonique se substitue une gouvernance des projets axée sur une imbrication et une pluralité d'acteurs. Les conduites de projet répondent d'un rapport au territoire plus complexe, qui vient remettre en question l'héritage technique et le rôle traditionnel conféré au MTQ. De manière transversale, la thèse fait ressortir une série d'apprentissages au sein des pratiques planificatrices du MTQ face à cette nouvelle territorialisation des projets routiers.

<p>The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. </p><p>The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. </p><p>The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. </p><p>In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness. </p>

The aim of this dissertation is to examine inter-ethnic relations between organizationally active people with different ethnic backgrounds. I focus on relations that are based on a mutual interdependence between parties, mutual respect, common procedural rules, real opportunities that expressly approve or reject a proposal in a decision or deliberation situation free from compulsion, where people, who have different ethnic backgrounds, strive after insight and understanding in their relations. In this dissertation I present three empirical cases about cooperation, consultation and participation as forms of inter-ethnic relations from the organizational fields in the society. These cases are examples of what I characterize as “organizing inter-ethnicity”, or organizing people with different ethnic backgrounds around common concerns. Organizing inter-ethnicity is in turn a part of organizing and integrating diversity in society. Drawing on the results of three case studies, I distinguish between opportunities and barriers. My case studies clearly illustrate that the tensions that influence the patterns of and variation in opportunities and barriers have sources that reach well beyond ethnicity. Tensions between old and new organizations, between working immigrant organizations and refugee organizations, between organizations from same group or between organizations that have conflicts from their members’ countries of origin provide some examples of the difficulties that generate barriers to broad interest constellations between organizations.