Introdução: A Hipertensão Arterial - HA, doença crônica cujas taxas de morbidade atingem no Brasil aproximadamente 17 milhões de pessoas, é um dos principais fatores de risco para doenças do aparelho circulatório. Sua determinação multifatorial exige a adoção de estratégias de controle complexas, que deem conta dos fatores e condições de risco, o que remete a ações sobre estilo de vida e seus determinantes psicossociais, econômicos e ambientais. Nesse sentido, as práticas da Promoção da Saúde, fundadas em um conceito ampliado de saúde, colocam em pauta, juntamente com as ações de prevenção, a discussão sobre a qualidade de vida, relacionando-a às condições de vida e saúde da população. Objetivo: Identificar e analisar as práticas da Promoção de Saúde e sua utilização para reorientação dos serviços de saúde no município de Fortaleza com foco no controle da Hipertensão Arterial. Metodologia: Estudo de caso, contendo em seu desenho três fases: identificação através de análise documental de políticas, planos e ações no nível nacional, estadual e do município de Fortaleza, além de entrevistas em profundidade com gestores ligados ao controle da HA; aplicação de questionários semiestruturados com coordenadores dos Centros de Saúde do município sobre as estratégias de Promoção da Saúde utilizadas no controle da HA; entrevistas em profundidade com enfermeiros, médicos e agentes comunitários de saúde de algumas destas Unidades. Resultados e discussão: Apesar de o novo modelo ter modificado o padrão de atenção ao município, a visão biomédica centrada na clínica ainda predomina no atendimento dos Centros de Saúde. O controle dos fatores de risco está bastante relacionado a uma responsabilidade do usuário e as ações na maioria das vezes são pontuais, utilizando ainda a orientação prescritiva como maior ferramenta para mudança. A grande demanda por atendimento, assim como questões técnicas e políticas por parte da gestão, tornam esse processo de reorientação do serviço de saúde lento, porém desafiante. Alguns Centros de Saúde conseguem quebrar essa hegemonia biomédica e tendo uma visão mais abrangente de território. Realizam atividades em conjunto com a população e em prol de um fortalecimento da comunidade, fortalecendo o controle da HA, amenizando as desigualdades e iniquidades. Programas complementares, como NASF, Residências, Academia da Comunidade, Bombeiros, entre outros, provenientes de outras áreas do setor saúde ou de outros setores da administração municipal, têm contribuído para o desenvolvimento da iniciativa proposta pela Estratégia Saúde da Família. Conclusão: Apesar das inúmeras dificuldades encontradas foram observados alguns avanços em relação à mudança de paradigma na prestação de serviços de saúde no município de Fortaleza, contribuindo para a melhoria da qualidade de vida da população estudada / Introduction: Hypertension, a chronic disease with a morbidity rate in Brazil of circa 17 million people, is a leading risk factor for cardiovascular diseases. Its multifactorial determination requires the use of complex multifactor strategies of control, that could deal with the risk conditions and factors, which refers to actions on lifestyle and psychosocial, economic and environmental determinants. In this context, practices of health promotion, embracing a broader concept of health, discuss the quality of life and preventive actions, relating them with life and health conditions of the population. Objectives: Focusing the control of Hypertension, the aim of this thesis is to identify and analyze the health promotion practices and its use in the reorientation of health services in the city of Fortaleza, Brazil. Methodology: Case study, in three phases: identify, trough documental analysis, policies, plans and actions for the national, state, local (Fortaleza city) hypertension control and in-depth interviews with managers and directors relates to hypertension control; collect data on health promotion strategies used in the hypertension control, through semi-structured questionnaires with Coordinators of City Health Centers; interviews with nurses, doctors and community health agents from some of these Health Care Centers. Results and discussion: Although the new model has modified the City Health Care standards, the biomedical view focusing the clinic still predominates in Health Control Centers. The risk factors control is closely related to individual responsibility and actions in most cases are isolated and not very creative, still using the prescriptive guidance as a major tool for change. The great demand for health care as well as technical issues and management policies make this process of reorienting the health service slow but challenging. Some Health Care Centers are able to break this biomedical hegemonic point-of view and, through a closer and more realistic approach to their environment, carry out community oriented activities, strengthening hypertension control and mitigating inequalities and inequities. Although not well-disseminated, complementary programs, such as NASF, Home Care, Community Gym and Firemen, among others, related to other areas of the health care or other areas of city administration have contributed to the development of the initiative proposed by the Family Health Strategy. Conclusion: Despite many difficulties there is a clear progress achieved in the paradigm shift concerning the provision of health services and improvement of life quality

There is a need for research to understand change processes and knowledge management in health service organisations, and indeed public sector organisations in general. This research seeks to explain how knowledge becomes formulated and thereby mobile, and also how practice has come to be established, visibilised and thereby sustained in a specific context. Exploring practice within a health service organisation, and in particular a public health service organisation, is a particular feature of this research. The research demonstrates how collaboration becomes necessitated under pressure of enacting increasingly complex work activities, an outcome being changing practices and extended accountability relationships which enacts discipline while realising expertise. Using an ethnographic approach, the research explores how the practice of early childhood nursing in the South Western Sydney Area Health Service became a specialised expert undertaking. The research examines how change has occurred, whereby early childhood nursing was refined from being one part of the generalist community nursing practice to being a specialised practice through the increasing technologisation of practice. The technologisation of practice refers to the artefacts, conduct and the processes through which the conceptualisation and enactment of early childhood nursing has become increasingly standardised. Through the technologisation of practice explicit knowledge becomes distributed within the artefacts for practice and tacit knowing becomes distributed across, and is continually enacted by, the collaboration of the practice community. There are four interrelated aspects to the technologisation of practice. Firstly, the technologisation of practice involves standardising the conceptualisation and enactment of practice through constructing a multi-dimensional practice resource within a community of practice. Secondly, the technologisation of practice involves the mobilisation and refinement of the multi-dimensional practice resource to realise a practice network involving extended relationships of accountability. These relationships of accountability are within a profession and also with other professionals. Thirdly, the technologisation of practice involves the ongoing enactment of accountability in a collaborative community of practice. The research shows that a team can become a collaborative community by constructing an accountability context, reorganising and facilitating the team, and then amalgamating the organising and service delivery activities through integrating formal meetings and informal interactions. Fourthly, the technologisation of practice involves the collaborative community assemblage and/or appropriation of further technologies into practice thereby strengthening the local and extended relationships of accountability and expanding the boundaries of practice. The research describes how the technologisation of practice is the enactment of a number of mutually enabling practice dualities, which together simultaneously discipline and realise expertise. The interrelated practice dualities are individual-community, subjective-objective, local-global, formal-informal and governmentality-communal self-governance. The situatedness of practice is shown to necessitate a subjectivity-objectivity duality, whereby individual and communal experience is drawn upon to see through the otherwise opaque nature of statistics and information. The alignment of practice with the broader organisation and professional colleagues realises a local-global duality, whereby the community's local understandings are informed and shaped by distant issues. The formal-informal duality is a mechanism by which practice is increasingly collaboratively conceptualised and enacted, and thereby standardised. Individual and communal 'expertise' becomes realised through the assemblage and appropriation of organising and transforming tools and artefacts, or alternatively technologies. At the same time, the community in defining the use of such technologies as competent practice is disciplining their own conduct. Through this action a governmentality-communal self-governance duality is realised as the nursing community pursues expertise while disciplining themselves; by engaging in collaborative interactions and using standardised technologies the community constructs and makes visible their knowing, practice and expertise.

This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging. / This study attempts to investigate the issues of aging population in the context of Singapore through metaphorical approach and the potential of tapping on the collaborative characteristics of a health service cloud computing system to meet the needs in elderly care, hence allowing active aging. The use of electronic health records (EHR) in various countries, particularly the meaningful use of EHR in USA is examined to understand its current features and usage. By employing conceptual mapping and blending of metaphorical study, the concepts in cloud computing are probed to gain better understanding on the characteristics of the technology. Similarly, with concepts drawn from an eco-system blended with concepts in a health service system, the characteristics of EHR and finally the characteristics of a health service cloud computing system are illustrated. With understanding in aging population, present usage of EHR and potential of cloud computing in Singapore, multi-methods research consisting of intensive interviews and archival document collations are employed. Triangulation amongst the datasets collated using open coding via ATLAS.ti resulted in 6 issues of concern in aging population pertaining to the Singapore context to arise, namely (i) primary care, (ii) familial support, (iii) awareness in health maintenance and transparency in information, (iv) improved efficiency and accuracy in healthcare with seamless transfer of care and (v) intermediate care and (vi) collaboration between stakeholders. Further analysis of the results draws up the possibilities for enhancing meaningful use of health service cloud computing system for active aging, which criteria are: (i) empowerment and ownership, (ii) sustainable homecare and (iii) seamless transfer of care. Finally, a conceptual mapping of health service cloud computing system and the criteria for effective aging give rise to a model framework that is set for active aging.

This study develops quality evaluation criteria that consider both service provider satisfaction and patient perspective in assessing e-Health services; additionally, it evaluates the impact of these criteria on the performance of e-Health services. Utilizing data from the Tele Care Center in National Taiwan University Hospital (NTUH), one of the largest hospitals in Taiwan, this research framework extends the service-profit chain by integrating service triangle concept and emphasizing the relationships among three stakeholders: the firm, the customer, and the employee. The results suggest that the positive relationships among hospital’s business value, physicians’ value, and patients’ value can contribute to customer retention. In sum, this study expects to contribute to literature by providing an e-Health service performance assessment framework, which systematically develops a scale to evaluate e-Health service quality that concerns multiple stakeholders’ perspectives.

No description available.

This thesis focused on factors contributing to improved work environment in small-scale enterprises and sustainable health for the entrepreneurs. In Study I, implementation of the provision of Systematic Work Environment Management (SWEM) with and without support was investigated. Two implementation methods were used, supervised and network method. The effect of the project reached the employees faster in the enterprises with the supervised method. In general, the work environment improved in all enterprises. However, extensive support to small-scale enterprises in terms of advice and networking aimed at fulfilling SWEM regulations had limited effect – especially considering the cost of applying these methods. Studies II, III, and IV focused on entrepreneurs’ health, work conditions, strategies for maintaining good health, and utilisation of Occupational Health Service (OHS). A closed cohort of entrepreneurs in ten different trades responded to two self-administered questionnaires on health and work conditions, with five years between the surveys: at baseline, 496 entrepreneurs responded, and 251 entrepreneurs responded at follow-up. Differences were tested by Chi2-test, and associations estimated with logistic regression analyses. Qualitative interviews on entrepreneurs’ strategies for maintaining good health were included. In Study II, the most frequently reported complaints, musculoskeletal pain and mental health problems, were associated with poor job satisfaction and poor physical work environment. In Study III, consistent self-reported good health, i.e. good health both at baseline and at follow up, was associated with self-valued good social life when adjusted for physical work conditions and job satisfaction. Entrepreneurs’ strategies for maintaining good health included good planning and control over work, flexibility at work, good social contact with family, friends and other entrepreneurs, and regular physical exercise. Study IV concerned entrepreneur’s utilisation of OHS. Entrepreneurs affiliated to OHS had either better or more adverse work conditions than non-affiliated entrepreneurs. Medical care and health check-ups were the services most utilised. Affiliation to OHS correlated with use of specific information sources and active work environment management. The entrepreneurs were not consistently affiliated to OHS over the five-year-period.

Due to changes in UK and Scottish policy and NHS directives, there have been many changes and improvements in the way information is provided to patients affected by cancer and their families over the last decade. The information provided should be accurate, detailed and tailored to the individual’s needs across the whole of their cancer trajectory. People affected by laryngeal cancer could be classed as a “Cinderella” group as there is a lack of research with this group of patients and their families, in comparison to other types of cancer, even though the impact of treatment can have a profound and debilitating effect on the individual and their family’s quality of life. How this group of patients and their families use and source information to help them make sense of their experiences across their trajectory is unknown, therefore this study explored the role of information based on the experiences of people affected by laryngeal cancer across their cancer trajectory. The study adopted an interpretive prospective longitudinal approach, using two in-depth qualitative interviews with twenty patients and eighteen carers from across the main treatment pathways associated with this type of cancer. The data were analysed using Framework Analysis and influenced by Dingwall’s Illness Action Model. Four broad thematic headings were developed to explain the role of information: “Search for Normality”, “Illusion of Certainty”, “Reality of Uncertainty” and “Culture of Caring”. Relationships were identified between these headings at four key stages across the cancer trajectory. The ii broad theme “Search for Normality” overarched the whole of the cancer trajectory explaining how information was sourced and used to help this group understand their experience of symptoms. The main findings from the study show that two broad categories of information are used: information from health professionals and experiential information from one’s own and others’ experiential knowledge of health and illness. Both categories of information are sourced and used in different ways at different stages over the course of the trajectory and become inextricably linked over time. The study shows that information is not an entity that can be studied on its own but needs to be studied and explained in the ways it is situated, used and experienced within the context of the complex needs and experiences of this group of patients and their families. This study is the first longitudinal study to provide an explanation of the role of information with people affected by laryngeal cancer across their cancer trajectory. The findings show how the different types of information used from the various sources influence how people affected by laryngeal cancer perceive and understand their diagnosis, treatment and the outcome of treatment. The study findings suggest that health professionals need to situate information in the context of the individual’s understanding and prior knowledge of health and illness to ensure that it does not set unrealistic expectations, with a clear need for continuity and supportive care identified in the post-treatment and follow-up phases.

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

The basis of my study is the belief that governance of the local delivery of health could usefully include full and wide community representation and participation by the stakeholders and the larger community. The study was initially carried out in 2003 and now the same clinic has been targeted to carry out an update to see whether the perceptions have changed; if so why and if not what the status is. This study investigates the proposition that if communities do not participate in policy formulation processes, implementation is crippled. The case study is of free health-care policy in a small area of Pietermaritzburg, the Mpumuza area. This area is chosen because it has a local clinic that is being used by the local people to get free primary health care services, covered by the national policy. My interest in the study is influenced by the role I played as a public servant within the district Department of Health one and a half years ago. I dealt, on a daily basis, with service delivery (with a focus on facilitation of the process of service delivery). My interest is to know how the processes of policy development unfold in practice. The study will be examining what the different writers allude to in relation to policy formulation and implementation, the legislative framework pertaining to health policy, the actual case study and finally the conclusions drawn and recommendations, which are open for further exploration in other studies. The study looks at the impact of lack of involvement of the community members (who are at the receiving end) and the role of service providers (who for the purposes of this study will be confined to the nurses that offer the health services at the specific local clinic). Basically the study found that the subject of involving communities in policy formulation is a crucial one if the policy is to be successfully implemented and these are detailed later in the document. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

The last few years have seen an increase in the infection rate not only of HIV but also TB. The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub- Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and HIV exert increased pressure on health service delivery thus reflecting the serious problem in the country with regard to health service delivery to people co-infected with TB and HlV/AlDS. Health service delivery is also hindered by negative attitudes of health workers that have been reported towards people living with HIV/AIDS. They entertain a biased view of their own risk, considering risk only from occupational exposure and denying the possibility of infection in their private life. These attitudes of health workers decreases the quality of care and support delivered to patient co-infected with TB and HIV. This result in people not disclosing their illness even in cases were treatment is available like TB for the fear of stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the patient co-infected with TB and HIV. Therefore these patients tend to shy away from health services and isolate themselves due to fear of being stigmatised twice. The need to address TB and HIV together in the light of this dimension is urgent so as to improve the utilization of the health services by people co-infected with Ti3 and HIV. The purpose of this research was to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, to explore and describe the attitudes of health workers towards patients co-infected with TB and HIV, and to formulate guidelines for health workers that will facilitate the health service utilization by patients co-infected with TB and HIV in the Potchefstroom district. The research was conducted in the Potchefstroom district in the North West province of South Africa. A qualitative research design was used to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, and to explore and describe the attitudes of health workers toward co-infected patients. A purposive voluntary sampling method was used to select participants who met the set criteria. Two populations were used, that is the patients co-infected with TB and HIV, and the health workers who were involved in their care. In depth unstructured interviews were conducted with the patient population and semi structured interviews with the health worker population using an interview schedule that was formulated from the background literature. Data was captured on an audiotape, and transcribed verbatim. Field notes were taken immediately after each interview. The researcher and a co-coder did data analysis after data saturation was reached and a consensus was reached on the categories that emerged. From the findings of this research it appeared that there were general perceptions by the patients co-infected with TB and HIV that indicated stigmatisation by the health workers. This perceived stigmatisation was reported as being perpetrated by all categories of health workers. Negative behaviours such as the health workers not having time for the patients and being impatient were reported. Lack of sufficient knowledge was related to these behaviours especially amongst lower categories or non-professional health workers. In spite of the above, the researcher also observed that there was a limited number of health workers who were still being perceived as committed and caring by the patients co-infected with TB and HIV. The researcher concluded that the relationship between the health workers and the patients co-infected with TB and HIV was characterised by conflict. The health workers seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse alcohol, manipulative and not taking responsibility of their illness. These perceptions lead the health workers to have a negative attitude towards these patients and occasionally came across as unsympathetic towards them. On the other hand the researcher observed that there were other health workers who did not present with negative behaviours towards these patients and tried to understand the reasons for their sometimes-unacceptable behaviours. Recommendations are made for the field of nursing education, community health nursing practice and nursing research with the formulation of guidelines for health workers so as to facilitate the utilization of the health services by the patients co-infected with TB and HIV. The guidelines are discussed under three main categories, namely guidelines for the health workers to facilitate the utilization of the health services by the patients co-infected with TB and HIV, guidelines to improve the utilization of the health services more efficiently and adequately by the patients co-infected with TB and HIV, and guidelines to improve the attitudes of the health workers towards the patients co-infected with TB and HIV with the intention of improving the utilization of the health services by these patients. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2006.