Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system. My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis. I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments. / Ph. D.

Admite-se que o uso dos serviços de saúde, inclusive os odontológicos, deve ser considerado em três dimensões: a capacitação, a predisposição e a necessidade. Acreditando que as necessidades vão além daquelas confirmadas pela presença de doenças bucais no momento do exame epidemiológico, este trabalho verificou as percepções sobre a satisfação com a vida, o corpo e a saúde bucal de adolescentes, cujas práticas se refletem na saúde. Por meio de pesquisa qualitativa, os discursos de adolescentes do município de Barueri, na Grande São Paulo, foram levantados em entrevistas pela técnica do grupo focal nos diferentes gêneros. Foram analisados segundo a análise de conteúdo. A percepção sobre a satisfação com a vida, corpo e saúde demonstrou que a alimentação desses jovens é pouco balanceada; o emprego é entendido como um problema para o futuro, embora muitos já tenham experienciado alguma vivência com o trabalho; as relações afetivas são o grande conflito desta faixa etária; o cuidado com o corpo é tido como sinônimo de banho e esportes e o cuidado com higiene oral foi limitado à escovação, muitos relataram fazer uso dos serviços do convênio odontológico uma vez que o posto de saúde é muito demorado. O conhecimento da percepção dos jovens sobre esses eixos pode contribuir para o aprimoramento das ações em saúde bucal, em que se consideram os determinantes sociais da saúde e a forma de articular o acesso aos meios de prevenção, tratamento e manutenção da saúde bucal. / It is accepted that the use of health services, including dental, should be considered in three dimensions: the training, the willingness and necessity. Believing that the needs go beyond those confirmed by the presence of oral diseases at the time of the epidemiological survey, this study examined the perceptions of satisfaction with life, body and oral health of adolescents, whose practices are reflected in health. Through qualitative research, the discourse of adolescents in the city of Barueri, in Greater São Paulo, were collected in interviews by the focus group technique in different genera. Were analyzed using content analysis. The perception of satisfaction with life, body and health showed that the feeding of young is poorly balanced, employment is seen as a problem for the future, although many have already experienced any experience with the work, the affective relations are the great conflict of this age group, the care of the body is seen as synonymous with sports and bathing and oral hygiene care was limited to brushing, many reported use of the services of dental plan since the health post is too long. Knowledge of the kids\' perceptions of these aspects can contribute to the improvement of oral health practices, which consider the social determinants of health and how to articulate the access to means of prevention, treatment and maintenance of oral health.

Admite-se que o uso dos serviços de saúde, inclusive os odontológicos, deve ser considerado em três dimensões: a capacitação, a predisposição e a necessidade. Acreditando que as necessidades vão além daquelas confirmadas pela presença de doenças bucais no momento do exame epidemiológico, este trabalho verificou as percepções sobre a satisfação com a vida, o corpo e a saúde bucal de adolescentes, cujas práticas se refletem na saúde. Por meio de pesquisa qualitativa, os discursos de adolescentes do município de Barueri, na Grande São Paulo, foram levantados em entrevistas pela técnica do grupo focal nos diferentes gêneros. Foram analisados segundo a análise de conteúdo. A percepção sobre a satisfação com a vida, corpo e saúde demonstrou que a alimentação desses jovens é pouco balanceada; o emprego é entendido como um problema para o futuro, embora muitos já tenham experienciado alguma vivência com o trabalho; as relações afetivas são o grande conflito desta faixa etária; o cuidado com o corpo é tido como sinônimo de banho e esportes e o cuidado com higiene oral foi limitado à escovação, muitos relataram fazer uso dos serviços do convênio odontológico uma vez que o posto de saúde é muito demorado. O conhecimento da percepção dos jovens sobre esses eixos pode contribuir para o aprimoramento das ações em saúde bucal, em que se consideram os determinantes sociais da saúde e a forma de articular o acesso aos meios de prevenção, tratamento e manutenção da saúde bucal. / It is accepted that the use of health services, including dental, should be considered in three dimensions: the training, the willingness and necessity. Believing that the needs go beyond those confirmed by the presence of oral diseases at the time of the epidemiological survey, this study examined the perceptions of satisfaction with life, body and oral health of adolescents, whose practices are reflected in health. Through qualitative research, the discourse of adolescents in the city of Barueri, in Greater São Paulo, were collected in interviews by the focus group technique in different genera. Were analyzed using content analysis. The perception of satisfaction with life, body and health showed that the feeding of young is poorly balanced, employment is seen as a problem for the future, although many have already experienced any experience with the work, the affective relations are the great conflict of this age group, the care of the body is seen as synonymous with sports and bathing and oral hygiene care was limited to brushing, many reported use of the services of dental plan since the health post is too long. Knowledge of the kids\' perceptions of these aspects can contribute to the improvement of oral health practices, which consider the social determinants of health and how to articulate the access to means of prevention, treatment and maintenance of oral health.

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-07-20T21:40:33Z No. of bitstreams: 1 DISSERTA??O VER?NICA GAMBOA cd.pdf: 3654035 bytes, checksum: bb1f7c26524d7edc5944ae2c6c8482b4 (MD5) / Made available in DSpace on 2018-07-20T21:40:33Z (GMT). No. of bitstreams: 1 DISSERTA??O VER?NICA GAMBOA cd.pdf: 3654035 bytes, checksum: bb1f7c26524d7edc5944ae2c6c8482b4 (MD5) Previous issue date: 2018-03-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Integrative Review Study, with a qualitative approach, based on a critical analytical perspective, aiming to understand the meanings of Health Promotion in the context of PHC in Brazil and in other countries of the world; to analyze the practices of Health Promotion in the context of PHC in Brazil and in other countries of the world and to discuss the concreteness between the areas of action established in the International Conferences on Health Promotion on Health Promotion practices in the context of Primary Care in Brazil and in the world. For the production of the empirical data, we cover the six (6) steps performed in the Integrative Review, delimiting the corpus of the study to 18 articles with peer review conditions published between January 2016 and July 2017 in different countries of Asia, Europe and America. As a method of analysis, we adopt Hermeneutics-dialectics. The results are organized in four empirical categories: Characterization of the corpus of the study: a reality to be achieved; Meanings of Health Promotion in the context of PHC: confluences and dissonances between theory and practice; Health Promotion in the context of PHC: contradictions, fragilities and challenges in the health work process; confrontations between the areas of action of the International Conferences on Health Promotion on practices in the context of PHC. We understand that Health promotion implies a 'new' and 'polysemic' practice that still generates theoretical and philosophical tensions, which has been associated with concepts such as lifestyles-healthy habits-health behaviors, empowerment, social participation, autonomy, intersectoriality, however there is a conflict, even reinforced by several authors, related to the conceptual misconception about health education, and more worrying about its differential character as approaches and practices to primary prevention. In the work process of Health Promotion, the purpose was to 'improve people's quality of life' as well as 'generate empowerment in users'; as the instruments were considered the theoretical models as fundamentals of practice, as well as the combination of strategies, practical guides and various educational materials; activities were related to health education, the use of online technologies, health advisory services and counseling; the agents were identified under the figure of collective agents, such as nurses and doctors with different training areas, health visitors, psychologists, social workers, as well as other professionals from the health service and the community itself; as for the interpersonal relationship, it was possible to see the strengthening of the links between users and health teams with a certain potentiality in the practice of Health Promotion. The evaluation emerged as a topic that presents weaknesses in the practice of Health Promotion and which represents a challenge to be conquered. In the confrontation of the areas of action of Health Promotion with its practice evidenced in the corpus of the study. In relation to the development of healthy policies was reinforced the importance of support for decision makers and joint responsibility of the State, health services with their professionals and community. The creation of favorable environments was invisible, even when it is considered relevant, since it could be of ?little importance? given to them in the practice and actions of Health Promotion. Community empowerment had a direct relation with the processes of empowerment and social participation, emphasizing the intersectoriality as key in this process. The development of personal skills was the area most studied in the articles analyzed, focusing on health education activities and once again the emergence of prevention as a conflicting concept in the understanding and practice of Health Promotion; finally, the reorientation of health services was visible when considering the paradigm shift and the strengthening of professional training in Health Promotion. We consider that Health Promotion contributes from its innovative, differentiated approach and with a positive approach to health services and specifically PHC. The protagonism of the professional with a profile in Health Promotion is significant in the development of strategies and corresponding actions with the areas of action, as well as to dispel conflicts by the conceptual misconceptions of Health Promotion in relation to the concepts of health education and prevention. / Estudo de Revis?o Integrativa, com abordagem qualitativa, fundamentado na perspectiva cr?tico anal?tica, com os objetivos de compreender os sentidos e significados da Promo??o da Sa?de no contexto da APS no Brasil e em outros pa?ses do mundo; analisar as pr?ticas de Promo??o da Sa?de no contexto da APS no Brasil e em outros pa?ses do mundo e discutir a concretude entre as ?reas de a??o estabelecidas nas Confer?ncias Internacionais de Promo??o da Sa?de sobre as pr?ticas de Promo??o da Sa?de no contexto da Aten??o Prim?ria no Brasil e no mundo. Para a produ??o de dados emp?ricos percorremos as seis (6) etapas realizadas na Revis?o Integrativa delimitando-se o corpus do estudo a 18 artigos com condi??o de peer review, publicados entre janeiro de 2016 e julho de 2017, em diversos pa?ses da ?sia, Europa e Am?rica. Como m?todo de an?lise adotamos a Hermen?utica-dial?tica. Os resultados encontram-se organizados em quatro categorias emp?ricas: Caracteriza??o do corpus do estudo: uma realidade a ser conquistada; Sentidos e Significados da Promo??o da Sa?de no contexto da APS: conflu?ncias e disson?ncias entre teoria e pr?tica; Promo??o da Sa?de no contexto da APS: contradi??es, fragilidades e desafios no processo de trabalho em sa?de; confrontos entre as ?reas de a??o das Confer?ncias Internacionais da Promo??o da Sa?de sobre as pr?ticas no contexto da APS. Compreendemos que a Promo??o da Sa?de implica uma pr?tica ?nova? e ?poliss?mica? que ainda gera tens?es te?ricas e filos?ficas, a qual esteve associada a conceitos como estilos de vida-h?bitos saud?veis-comportamentos em sa?de, empoderamento, participa??o social, autonomia, intersetorialidade, abordagem populacional, por?m, existe um conflito, refor?ado por diversos autores, diante do equ?voco conceitual em rela??o ? educa??o em sa?de e, mais preocupante pelo seu car?ter diferenciado enquanto a abordagens e pr?ticas, ? preven??o prim?ria. No processo de trabalho da Promo??o da Sa?de, foi destacada como finalidade ?melhorar a qualidade de vida das pessoas? assim como ?gerar empoderamento nos usu?rios?; como os instrumentos foram considerados os modelos te?ricos como fundamentos da pr?tica, assim como a combina??o de estrat?gias, as guias pr?ticas e diversos materiais educativos; j? as atividades estiveram relacionadas ? educa??o em sa?de, o uso de tecnologias online, as assessorias e os aconselhamentos em sa?de; os agentes constitu?ram-se nas figuras de agentes coletivos, como as enfermeiras e os m?dicos com diferentes ?rea de forma??o, os visitadores sanit?rios, os psic?logos, os assistentes sociais, assim como outros profissionais do servi?o de sa?de e a pr?pria comunidade; quanto a rela??o interpessoal, foi vis?vel o fortalecimento dos v?nculos entre usu?rios e as equipes de sa?de com certa potencialidade ? pr?tica de Promo??o da Sa?de. A avalia??o surgiu como um tema que apresenta fragilidades na pr?tica da Promo??o da Sa?de e que representa um desafio a ser conquistado. No confronto das ?reas de a??o da Promo??o da Sa?de com a sua pr?tica evidenciada no corpus do estudo, em rela??o ao desenvolvimento de pol?ticas saud?veis foi refor?ada a import?ncia do apoio aos respons?veis ?s decis?es e responsabiliza??o conjunta do Estado, dos servi?os de sa?de com seus profissionais e da comunidade. A cria??o de ambientes favor?veis ficou invis?vel, apesar da sua relev?ncia, uma vez que poderia estar associada ? ?pouca import?ncia? dada a eles na pr?tica e nas a??es de Promo??o da Sa?de. O fortalecimento comunit?rio teve rela??o direta com os processos de empoderamento e de participa??o social, ressaltando a intersetorialidade como chave nesse processo. O desenvolvimento de habilidades pessoais foi a ?rea mais trabalhada nos estudos analisados, focando em atividades de educa??o em sa?de e surgindo mais uma vez a preven??o como um conceito conflituante na compreens?o e na pr?tica da Promo??o da Sa?de; finalmente, a reorienta??o dos servi?os de sa?de foi vis?vel a necessidade de mudan?a de paradigmas e o fortalecimento da forma??o profissional em Promo??o da Sa?de. Consideramos que a Promo??o da Sa?de vem contribuir desde a sua abordagem inovadora, diferenciada e com um enfoque positivo aos servi?os de sa?de e especificamente de APS. O protagonismo do profissional com perfil em Promo??o da Sa?de ? significante no desenvolvimento de estrat?gias e a??es correspondentes com as ?reas de a??o, assim como para dissipar os conflitos pelos equ?vocos conceituais da Promo??o da Sa?de em rela??o aos conceitos de educa??o em sa?de e de preven??o principalmente.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-04-12T12:54:47Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Caroline_Vasconcellos_Lopes.pdf: 3209821 bytes, checksum: 2a990dd25e528479ec56858ce46dafc7 (MD5) / Made available in DSpace on 2018-04-12T14:55:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Caroline_Vasconcellos_Lopes.pdf: 3209821 bytes, checksum: 2a990dd25e528479ec56858ce46dafc7 (MD5) Previous issue date: 2016-09-15 / Sem bolsa / A perspectiva cultural com ênfase nas contribuições da antropologia foi a base para se conhecer, nesta pesquisa, a utilização das plantas medicinais no cuidado realizado pelas interlocutoras do sistema informal de saúde, com a pretensão de aproximar estes saberes com a enfermagem. Desse modo, buscou-se descrever o cuidado sob o enfoque cultural realizado pelas interlocutoras com as plantas medicinais. Trata-se de uma pesquisa qualitativa de orientação etnográfica. As interlocutoras do estudo foram duas mulheres referência no conhecimento das plantas medicinais. Além delas, participaram vizinhos, voluntários da Organização Não Governamental (ONG) e as pessoas que procuravam o cuidado das interlocutoras. As duas mulheres foram abordadas nos locais onde realizavam o cuidado à saúde: a interlocutora IC1, no seu domicílio, localizado na zona rural (3º distrito de Pelotas); e a interlocutora IC1, na ONG, da qual é líder. O projeto de pesquisa foi aprovado pelo Comitê de Ética e Pesquisa, da Faculdade de Enfermagem da UFPel, sob o parecer nº 705.696. Foi assegurado o anonimato dos participantes da pesquisa, sendo utilizadas as iniciais dos seus nomes. O trabalho de campo ocorreu de julho a setembro de 2014, e de março a agosto de 2015. Desse modo, foram utilizados um conjunto de técnicas e instrumentos de pesquisa tais como: entrevista, observação participante, diário de campo, levantamento etnobotânico e registros fotográficos do contexto de cuidado e das plantas medicinais utilizadas ou indicadas. Além disso, foram coletadas amostras das plantas observadas que estavam com inflorescência no dia do levantamento etnobotânico para a confecção de exsicatas e a determinação taxonômica. As entrevistas foram gravadas e transcritas. As entrevistas e os diários de campo, foram categorizados pela pesquisadora no software NVivo 10. Na investigação qualitativa, o pesquisador analisa e codifica seus próprios dados, por meio de um processo dinâmico e criativo. Os resultados e a discussão foram dispostos em três capítulos: “A contextualização dos cenários investigados para o entendimento da integralidade do cuidado”; “O cuidado à saúde realizado pelas interlocutoras: um enfoque cultural”; e “O cuidado com as plantas medicinais para a saúde”. Esse estudo pretendeu contribuir no combate de posturas e atitudes etnocêntricas. O reconhecimento das práticas populares de cuidado à saúde se torna importante, no contexto da enfermagem e de outras profissões da área da saúde, no instante em que esse saber é preservado e interage com o conhecimento científico, considerando o contexto cultural. / In this research, the cultural perspective with emphasis on anthropological contributions was the base to know the use of medicinal plants in the practices of health care performed by interlocutors of the informal health system, in order to approximate this type of knowledge to nursing. In this system, the medicinal plant is the guiding axis to the performed care. The general objective is to describe the care performed by interlocutors from the informal health system (folk), with medicinal plants, under cultural focus. This is an ethnographic qualitative research, which was developed in Pelotas, in two places, in the rural and urban zones. The start point of this study was two women, considered Key Informants. Thus, they were identified as IC1 and IC2, who perform the health care to the informal health system, which is reference to knowledge on medicinal plant to ecological farmers. From them, other people participated in this research, such as persons cared by them, neighbors and volunteers at the NGO in the period of this work. Eight interlocutors participated. The fieldwork happened from July to September 2014, and from March to August 2015. Therefore, a set of techniques and tools of research were used, such as: interviews, participant observation, field notes, photographs from the care context and used or indicated medicinal plants. In order to make exsiccates and the taxonomical determination, samples of plants with inflorescence during the ethnobotanical data survey date were collected. The interviews and field dairy were categorized by the researcher in the software NVivo 10. The analysis developed was the Hermeneutic described by Hammersley and Atkinson (2014), which begins comparing the problem of research, the objectives, and the initial scope of data, generalizing concepts of different type until the development of typologies and theories. The Ethics Committee and Research from the nursing school of UFPel, under the umber 705.696, approved the research project. The participants’ anonymity was assured, and only their initials were used. The results and discussion were disposed in three chapters: “The contextualization of investigated scenarios to the understanding of whole care”; “O cuidado à saúde realizado pelas interlocutoras: um enfoque cultural”; and “The care performed with medicinal plants to health”. In the last, the ethnobotanical data survey was organized, and the knowledge of interlocutors related to ecology, management and use of medicinal plants were systematized, according to therapeutic characteristics in health care. The acknowledgment of popular practices of health care becomes important in the context of nursing and other health professions, when it is preserved, and interact with science, and the cultural context is considered. / La perspectiva cultural con énfasis en las contribuciones de antropología fue la base para conocer en esta pesquisa la utilización de plantas medicinales en prácticas de cuidado a la salud realizado por interlocutores del sistema informal de salud, con la pretensión de aproximar estos saberes con la enfermería. En este sistema, la planta medicinal es el principio rector de todo el cuidado realizado. Con el objetivo general de describir el cuidado realizado por las interlocutoras del sistema informal de salud (folk) con las plantas medicinales, baja un enfoque cultural. Se trata de una pesquisa cualitativa de orientación etnográfica, que fue desarrollado en Pelotas, en dos localidades, en el área rural y urbana. El punto de partida de este estudio fueron dos mujeres, consideradas informantes clave, y dese modo, fueron identificadas como IC1 e IC2, que realizan cuidado a salud en el sistema informal de salud que es referencia en el conocimiento de plantas medicinales para agricultores ecológicos. A partir de ellas, otras personas participaran de esta investigación, como las personas cuidadas por ellas, vecinos y voluntarios de la ONG en el periodo de realización de este trabajo. En el total, ocho interlocutoras participaran. El trabajo de campo ocurrió de julio hasta septiembre de 2014, y de marzo hasta agosto de 2015. De este modo, fueron utilizados un conjunto de técnicas e instrumentos de pesquisa, tales como: entrevista, observación participante, notas de campo, registros fotográficos del contexto de cuidado y de plantas medicinales utilizadas o indicadas. Para la confección de exsiccatae y determinación taxonómica, fueron colectadas amuestras de pantas con inflorescencia en el día de colecta etnobotánica. Las entrevistas y diarios de campo fueron categorizados por la investigadora en el Software NVivo 10. El análisis desarrollado fue la Hermenéutica descripta por Hammersley y Atkinson (2014), la cual se inicia comparando el problema de pesquisa, objetivos y cuerpo inicial de datos, haciendo generalización de conceptos de distintos tipos hasta el desarrollo de tipologías y teorías. El proyecto de pesquisa fue aprobado por el comité de ética y pesquisa de la facultad de enfermería de UFPel, baja el número 705.696. Fue asegurado el anonimato de los participantes de la pesquisa, siendo utilizadas las iniciales de sus nombres. Los resultados y discusión fueron dispuestos en tres categorías: “La contextualización de senarios investigados para el entendimiento de la integralidad del cuidado”; “El cuidado a la salud realizado por las interlocutoras: un enfoque cultural”; y “El cuidado con las plantas medicinales para la salud”. En este último, fue organizado el levantamiento etnobotánico y sistematizado el conocimiento de las interlocutoras relacionado a la ecología, maneo y uso de plantas medicinales, de acuerdo con las características terapéuticas en el cuidado a la salud. El reconocimiento de las prácticas populares de cuidado a la salud tornase importante en el contexto de enfermería y de otras profesionales del área de salud, en el instante en que ese saber es preservado e interactúan con el conocimiento científico, considerando el contexto cultural.

Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.

Content removed due to copyright restrictions: Paper titled, "Practitioner characteristics with comparison of counselling and psychotherapy practices between New Zealand and Singapore mental health practitioners" was presented and published in the proceedings of The Inaugural International Asian Health Conference, at the University of Auckland, 4-5 November 2004. 2. Workshop cum paper titled, " A modified cognitive behavioural therapy model for working with Chinese people" was also presented and published in the above Conference. 3. Abstract on paper titled, "Integrating homework assignments based on culture: Working with Chinese patients" was accepted in April 2006 for publication in the Cognitive and Behavioral Practice. 4. Paper titled, "Cultural considerations in using cognitive behaviour therapy with Chinese people: A case study of an elderly Chinese woman with generalised anxiety disorder", was published in November 2006 in the New Zealand Journal oj Counselling, Volume 35(3), 1 53- 1 62, and presented at the 29th National Conference of the Australian Association for Cognitive Behaviour Therapy, 1 8- 20 October 2006, under the title "Cultural considerations for Chinese people: Implications for CBT". 5. Abstract on paper titled, "Cognitive behaviour therapy in New Zealand and S ingapore : From a doctoral study and personal experience" was presented and published (in a book of abstracts) at the 1 st Asian Cognitive Behaviour Therapy (CBT) Conference: Evidence-based Assessment, Theory and Treatment, at The Chinese University of Hong Kong, 28-30 May 2006. 6. Paper titled, "CounsellinglPsychotherapy with Chinese Singaporean clients" was published in 2006 in the Asian Journal oj Counselling, Volume 1 3(2), 27 1 -293 . / This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2673. Adviser: Linda Lloyd. Includes bibliographical references.

La loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de soins donne une définition unique des réseaux de santé. Ils représentent aujourd’hui une forme organisationnelle inscrite dans les politiques régionales de santé et sont soutenus financièrement par les agences régionales de santé (ARS). La recherche menée a pour objet la participation des personnes malades au fonctionnement et à l’activité d’un réseau de santé. En effet, si les textes législatifs consacrent la place de l’usager dans le système de soins et si la politique de santé proclame sa participation, qu’en est-il dans la réalité quotidienne des pratiques au sein d’un réseau de santé ? Cette recherche s’intéresse ainsi de manière plus spécifique aux interactions entre les professionnels et les usagers en envisageant le réseau comme un espace de coopération. L’étude comparative de deux réseaux de santé diabète montre comment – face à une double contrainte, celles des politiques de santé et celle d’une régulation économique dominante - ce dispositif est soumis à une logique gestionnaire le conduisant à devenir une réponse instrumentale aux dysfonctionnements du système de santé, tel que les cloisonnements multiples du système de santé, une pénurie démographique de professionnels médicaux ou encore une spécialisation technique croissante des activités en santé. Mais en même temps, ces réseaux constituent un espace expérimental propice à la mise en œuvre d’une pratique communautaire en santé. Le corpus de données a été constitué principalement à partir de 31 entretiens biographiques auprès des personnes diabétiques, d'entretiens thématiques auprès des professionnels salariés des réseaux et d’observations des pratiques d’éducation thérapeutique, une prestation de service proposée par les réseaux. Cette prestation de service interroge les modalités possibles d’un travail ensemble dans la gestion d’une maladie chronique entre les professionnels et les personnes malades. En fonction des conceptions en santé des professionnels et des logiques d’action en présence, l’étude montre deux tendances : une personne malade partenaire des soins et un patient auxiliaire de soins. Par ailleurs, les réseaux étudiés présentent des modalités organisationnelles différentes, un modèle linéaire et un modèle satellitaire où la coordination d’acteurs occupe une place majeure. Derrière ce terme de coordination se cache, dans les deux cas, un principe de rationalisation des activités en santé propre au système sanitaire actuel. Les réseaux sont ainsi soumis à une instrumentalisation économique, ils deviennent des prestataires de l’offre de soins sur un territoire. Cette instrumentalisation des réseaux de santé est mise en œuvre principalement par des procédures d’évaluation. Celles-ci s’appuient sur des données épidémiologiques et reposent sur une approche quantitative de résultats en santé. Dans une logique gestionnaire, la personne malade doit adopter des comportements conformes aux normes de santé pour permettre l’atteinte des objectifs organisationnels planifiés dans le cadre d’une politique de santé publique. Face au développement des maladies chroniques, le champ de la santé s’est modifié, mais le système de santé français reste organisé selon une logique biomédicale. L’évaluation prend appui sur des savoirs normatifs, et les pratiques des professionnels sont très imprégnées par cette logique biomédicale. Néanmoins, l’étude montre que les réseaux créent un espace propice à une pratique communautaire en santé par la création d’une proximité sociale. Les deux réseaux mettent en perspective une appropriation par les usagers des questions concernant leur santé. Une mise en mouvement des patients et des professionnels s’opère en marge des objectifs opérationnels affichés d’un réseau de santé. Ainsi, les réseaux constituent tout à la fois des espaces démocratiques réflexifs et un outil au service d’un processus de rentabilisation des activités en santé. / The law of March 4th 2002 concerning patients' rights and the quality of the care system formalizes health networks and provides a single definition. They now account for an organizational form registered in regional politics of public health and are financially supported by the regional health agencies (RHA). The conducted research is about the sick's participation in a health network operation and activity. Indeed, if the legislation grants the user a thorough place in the health care system and if health policy proclaims his participation, what happens in the daily reality of practices within a health network? So this research deals more specifically with the interactions between professionals and users by considering the network as an area of cooperation. The comparative study of two Burgundy diabetes health networks shows how - facing a double constraint, those of public health policies and that of a dominant economic regulation - this device is subject to a managing logic leading to become an instrumental response to health system dysfunctions, such as multiple barriers of the health system, a demographic shortage of health professionals or even an increasing medical specialization of health activities. But even these networks constitute an experimental space favorable to the implementation of a community health practice.The data base has mainly been formed from 31 biographical interviews of diabetic people, thematic interviews of professionals employed in networks and observations of the patient's therapeutic education practices, a service offered by the two networks. This service examines the possible ways of working together in the management of chronic illness between professionals and the sick. According to the conceptions of health among professionals and logic of action involved, the study shows two trends: a sick person, either partner in patient care or in care giving.Moreover, the studied networks present two different organizational terms, a linear model and a satellite model where the coordination of actors plays a major role. Behind this term of coordination lies, in both cases, a principle of rationalization of health activities specific to the current health system. Networks are thus subject to an economic exploitation; they become providers of the offer of health care in a given territory. This instrumentation of health networks is mainly implemented by assessment procedures. It relies on epidemiological data and is based on a quantitative approach about health outcomes. In a managerial logic, the sick person should behave in accordance with health standards to enable the achievement of organizational goals planned as part of a public health policy.With the development of chronic diseases, the field of health has changed, but the French health system is still organized on a biomedical logic. The evaluation is based on normative biomedical knowledge, and professional practices are also very much imbued with biomedical logic. Nevertheless, the study shows that networks create a favorable space for a community health practice by creating a social proximity. Both networks put into perspective the idea that users have a hold on questions concerning their health. Patients and professionals become actors besides operational objectives displayed in a health network. Thus, networks are simultaneously democratic spaces of thought and a tool dedicated to the efficiency of health activities.

O objeto deste estudo são as práticas que favorecem a participação social, realizadas por enfermeiros na Atenção Básica, em Unidade de Saúde da Família (USF). As práticas dos enfermeiros na Atenção Básica têm sido orientadas pelas diretrizes das políticas públicas de saúde, por isso devem adotar a concepção do processo-saúde doença sancionada no Sistema de Saúde brasileiro, a de que esse processo tem determinantes e condicionantes associados às formas de vida dos indivíduos e grupos sociais. Portanto, as práticas devem ser planejadas para responder necessidades de saúde ampliadas. Contudo, os protocolos que orientam práticas de enfermeiros privilegiam o enfoque da clínica médica, limitando o objeto dessas práticas a agravos e doenças. A literatura registra a descrição de práticas preponderantemente ancoradas nos saberes da clínica médica, centradas em agravos, doenças, processos característicos de determinadas fases da vida; ou seja, práticas que respondem principalmente necessidades de preservação da vida. Defende-se que a inclusão da participação social como uma das finalidades das práticas de saúde permite respostas a necessidades de saúde ampliadas, considerando-se que essa participação está nas raízes das necessidades de saúde, na medida em que possibilita o aprimoramento das condições de reprodução social. Referencial teórico: necessidades de saúde são reconhecidas como necessidades de reprodução social, portanto, determinadas pela inserção social dos indivíduos e grupos sociais, e se conformarão de forma distinta nas diferentes classes sociais. Portanto, necessidades de saúde não são respondidas apenas em serviços de saúde. Para respondê-las é necessário que se considere as necessidades de reprodução social - originadas nas formas de trabalhar e de viver, que estão na base dos processos saúde-doença; a necessidade da presença do Estado, que garante direitos para viabilizar respostas a necessidades de reprodução social e as necessidades de participação social, que possibilitam colocar em jogo necessidades acima de interesses, possibilitando o aprimoramento das necessidades de reprodução social. Participação neste estudo é compreendida como processos de lutas sociais voltadas para a transformação de condições da realidade social, de carência econômica e/ou opressão sociopolítica e cultural. Objetivo geral: apreender características das práticas operacionalizadas por enfermeiros, na AB, que tenham como uma das finalidades o estímulo à participação social de usuários do serviço e de grupos sociais. Objetivos específicos: identificar as práticas realizadas por enfermeiros de uma USF; identificar e analisar as práticas realizadas por enfermeiros que favorecem mobilização e participação social; analisar as práticas que efetivam a participação social, realizadas por enfermeiros. Finalidade: subsidiar as práticas de saúde na AB, com ênfase nas do enfermeiro, para que sejam operacionalizadas como respostas a necessidades de saúde ampliadas. Procedimentos metodológicos: estudo qualitativo, do tipo estudo de caso, realizado em uma USF da Supervisão de Saúde do Butantã com todos os enfermeiros que atuavam na Estratégia de Saúde da Família. Primeiro foram realizadas entrevistas e depois observação participante de práticas que favoreciam a participação social. Necessidades de saúde e participação social foram as categorias analíticas. O projeto foi aprovado por Comitês de Ética em Pesquisa e respeitou os preceitos éticos recomendados. Resultados: Foram identificadas, nos processos de trabalho de enfermeiras da USF, práticas pautadas na concepção dos determinantes sociais do processo saúde-doença; portanto, práticas ampliadas, tanto voltadas a atendimento individual ao usuário quanto ao coletivo, a grupos sociais. Essas práticas incorporavam a associação entre condições de reprodução social e processos saúde-doença; ou seja, respondiam a necessidades de saúde ampliadas, para além daquelas concretizadas no corpo bio-psíquico. Ao construir com os sujeitos do cuidado a compreensão desse nexo, essas práticas possibilitavam a mobilização, inerente à participação social, com vistas ao aprimoramento das condições de trabalho e vida e, consequentemente, de saúde. Portanto, os espaços de respostas a necessidades de saúde ampliadas não eram restritos ao cuidado individual e os de mobilização para a participação social não eram restritos, nem exclusivos do Conselho Gestor. Essas práticas participativas estavam incorporadas nos processos de trabalho das enfermeiras da USF; portanto, legitimadas pela gerente da USF, também enfermeira, em sintonia com características de gestão democrática dessa USF. Considerações finais: para que as práticas de saúde respondam a necessidades de saúde, a participação social deve ser incorporada às finalidades dos processos de trabalho de todos os trabalhadores de saúde. Acredita-se que essa é a forma de garantir que as necessidades de saúde dos moradores sejam reconhecidas e possam ser tomadas como objeto, não só dos processos de trabalho da USF, mas também dos processos de participação social, uma vez que essa participação possibilita a modificação da realidade concreta dos grupos sociais, pela via do aprimoramento das condições de reprodução social que estão, por sua vez, nas raízes das necessidades de saúde. No entanto, esse processo deve ser reconhecido pelos trabalhadores, a começar pela gerência dos serviços, para não serem esporádicos, eventuais. / The objects of the present study are the practices that favor social participation, performed by primary health care nurses working in Family Health Units (FHU). Primary health nurses practices have been guided by public health policies, and should, therefore, adopt the concept of the health-diseases process as sanctioned by the national health system, which states that there are determining and conditioning factors associated with the life styles of individuals and social groups. For this reason, nurses must plan their practices aiming to meet broader health needs. However, the protocols guiding nurses practices focus mainly on clinical medicine, thus limiting the objects of these practices to illness and disease. Literature records the description of practices based predominantly on clinical medicine knowledge, centered on illness, disease, and processes characteristic of specific life phases; i.e., practices that meet mainly the needs for the preservation of life. It is believed that including social participation as one of the goals of health care would allow achieving responses for the broader health needs, since that participation stands in the roots of health needs, as it permits to enhance the conditions of social reproduction. Theoretical framework: health needs are recognized as the needs of social reproduction, hence, they are determined by the social insertion of individuals and social groups, and will emerge in different ways in the different social classes. Therefore, health needs are not met exclusively at health services. In order to meet health needs, it is necessary to consider the needs of social reproduction which originate in the different ways of working and living, and stand at the basis of health-diseases processes; the need for the presence of the State, which assures the rights to meeting the needs of social reproduction and of social participation, which permit to attend to needs before interests, thus allowing an enhancement of the social reproduction needs. Participating in this study is understood as the processes of social battles aimed at transforming the conditions of social reality, economic needs and/or sociopolitical and cultural oppression. Overall objective: to identify the characteristics of the practices conducted by primary health care nurses, which aim to encourage the social participations of patients and social groups. Specific objectives: to identify the practices conducted by the nurses of a FHU; identify and analyze the nurses practices that benefit mobilization and social participation; analyze the nurses practices that make social participation effective. Purpose: to support primary health care practices, focused on nurses practices, so they are conducted as responded to broader health needs. Methodological procedures: qualitative case study, performed with all nurses working with Family Health Strategy at the FHU of the Butantã Health Division. First, interviews were conducted. After, were made the participant observation of practices that favor social participation. Health needs and social participation were the analytical categories. The project was approved by Research Ethics Committees and complied with all ethical principles. Results: It was identified, in the FHU nurses working processes, practices based on the concept of the social determinants of the health-disease process; hence, broader practices, aiming at the health care to individuals as well as to social groups. Those practices incorporated the association between the conditions of social reproduction and health-disease processes; in other words, they answered broader health needs, beyond those of the bio-psyche-body. By achieving an understanding of that nexus with the subjects of care, those practices allowed for mobilization, inherent to social participation, with a view to improving ones work, life, and, thus, health conditions. Therefore, the spaces for answering broader health needs were not restricted to individual care, and those of mobilization for social participation were not restricted nor exclusive of the Administration Committee. These participative practices were incorporated in the working processes of FHU nurses; however, legitimated by the FHU manager, who was also a nurse, in harmony with the characteristics of the democratic administration of the referred FHU. Final remarks: in order for health practices to meet health needs, social participation must be incorporated to the purposes of the working processes of all health care workers. This is the way of assuring that the health needs of the local population will be recognized and made the object not only of the work at the FHU, but also of processes of social participation, as the latter allows making a change in the concrete reality of the social groups, by improving the conditions of social reproduction, which, on their hand, stand within the roots of the health needs. Nevertheless, workers, particularly and firstly the management, must acknowledge that process, so it does not become periodic, sporadic.