How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A partir da formalização do Programa de Agentes Comunitários de Saúde e do Programa Saúde da Família pelo Ministério da Saúde (anos 90), as discussões sobre a reorientação dos modelos assistenciais ganham destaque. O Programa Saúde da Família passa a ser visto por boa parte dos profissionais de saúde coletiva como um modelo capaz de imprimir mudanças não apenas na atenção em si como também na dinâmica dos processos. Ao propor a substituição das estratégias tradicionais, voltadas para a doença e centradas no hospital, a nova proposta voltase, entre outros aspectos, para a ação preventiva e para a promoção da saúde. Busca contemplar também a atenção às necessidades de saúde da população adscrita, a família e seu território, ações intersetoriais e tem na equipe multiprofissional pilar importante no cuidado. O Agente Comunitário de Saúde se apresenta como ator importante na possibilidade de mudança de modelo assistencial; atuando intensamente na produção do cuidado assim como na organização de tal assistência. Criam-se conflitos acerca da percepção de potencialidades e da possibilidade de interação entre os diversos aspectos envolvidos neste contexto. Este trabalho buscou investigar a percepção de Agentes Comunitários de Saúde do município de Petrópolis RJ acerca dos saberes envolvidos na sua prática. A estratégia metodológica utilizada para coleta de dados em campo foi a de entrevistas semi estruturadas. O corpo textual gerado pelas entrevistas foi analisado com base na teoria da Análise do Discurso. Este estudo concluiu que o saber do Agentes Comunitários de Saúde aponta para uma posição que vai além de ser ponte ou de fazer ponte. Argumenta que a potencialidade deste saber é a de ser como a linha de costura entre comunidade e as propostas de cuidado. Esta imagem indica que ao pertencer em algum momento a ambos tecidos, e ao fazer o movimento de pertencer ora ao tecido comunidade e hora ao tecido UBS, o ACS pode aproximar essas partes na busca da construção de algo mais unificado. Como em uma colcha de retalhos, onde cada tecido mantém suas características e padronagens iniciais, mas aos serem costurados, formam algo único, inteiro. / The debate about a new orientation of health assistance models is highlighted after Brazilian Health Ministry developed Community Health Agents Program and Family Health Program (late 90s). Family Health Program then begins to be seen by health workers as a model that is able to make changes not only in health care itself but also in processes dynamics. This new model aims preventive actions and health promotion. It substitutes traditional strategies, which are more related to disease and hospitals. This model also aims to address attention to the target population health necessities, families and their territory and intersectional actions. Health workers from different professions form the teams and this fact is one of the most important features regarding health care. The Community Health Agent plays a very important role helping the model change, working intensively to provide care and organization of such assistance. Some conflicts come up as one gets aware of potentials and interaction possibilities among the several aspects this agent can offer in the health care context. This research has aimed to investigate the perception from Community Health Agents of the city of Petropolis, RJ Brazil, about the knowledges involved in their practice. The methodology used for data collection was semistructured interview. The text generated by the interviews was analysed based on Discourse Analysis Theory. Through this study one can come to the conclusion that the Community Health Agents knowledge appears to be more than only being a link or to make links. The study discusses that the potential of that knowledge plays a sewing cord between the community and the health care proposals. This image indicates that, as sometimes the Community Health Agents belongs to both fabrics, and by switching the position, from the community fabric to Heath Unit fabric, the Agent can bring those parts together, looking for a sort of unification. As a patchwork sheet, where each part keeps its root design and patterns, but when they are sewed together, they form one whole thing.

ABSTRACT Lifestyle factors related to overweight, obesity, and Type 2 diabetes are currently in the forefront of health issues affecting children and adolescents. Schools have been considered important venues for disseminating health education and promotion programs. Some investigators, however, contend that school-based programs have only seen modest success over the last two decades. Typically short-term, school-based interventions do not address program sustainability or larger social issues such as socioeconomic status (SES). A growing body of literature suggests there is value in collaborative efforts between university researchers and communities as these relationships can help build the capacity of the school and community. The Coordinated School Health Program (CSHP) model was developed as a mechanism to build the organizational capacity of schools to facilitate, integrate and sustain health education and promotion efforts to improve the health of youth in our nation. The purpose of the current study was to assess a mid-western middle school's capacity to sustain a previously implemented Type 2 diabetes prevention program. An instrumental case study design was utilized. A total of 19 interviews were conducted. Additionally, observations and documents related to school policies and procedures were reviewed. The four infrastructures of the CSHP framework were used as predetermined categories into which data were coded. This study found that there was potential for the school to sustain the Type 2 diabetes program within the framework of the CSHP Model. The school already had in place five of the eight CSHP components. The three remaining components could be implemented if several issues were addressed. First, there were many myths and misconceptions regarding the purpose and costs of a CSHP. Education for district administrators, school faculty and staff, as well as the community, would be vital. Concerns regarding personnel to implement a CSHP were expressed. A dedicated health course would also need to be implemented. When planning health related interventions that will be implemented in school-based settings researchers should seriously consider implementing a CSHP prior to employing their short-term programs. If programs can be planned with sustainability in mind, there is potential for greater health outcomes for school-aged children and adolescents.

This diploma thesis deals with kindergartens with a health promotion program. It describes the care of children in these kindergartens, what is the difference from kindergartens that do not have a health promotion program, and why the parents choose it. The theoretical part contains chapters dealing with the general definitions of health and its support as well as the origin and development of kindergartens in our country and in the world. The practical part describes the methods of qualitative research used and presented the results. There are also described individual kindergartens with a program supporting health.

A efetividade da Estratégia Saúde da Família (ESF) está demonstrada em grandes municípios quanto ao processo de cuidado e impacto em saúde, mas pouco se estudou sobre sua qualidade em pequenos municípios ou como ela é influenciada pela presença de hospitais ou de equipes com modelo de Atenção Básica (AB) tradicional em conjunto com a ESF no mesmo local. O presente estudo avaliou a percepção de médicos e enfermeiros de 100 equipes da ESF sobre a qualidade do processo de cuidado e as características de suas Unidades Básicas de Saúde (UBS) em 32 municípios do interior do Rio Grande do Sul participantes do Projeto Telessaúde RS. A análise das 77 UBS onde se localizavam as 100 equipes da ESF mostrou mediana de 2800 habitantes e média de 1,7 médicos por equipe da ESF, presença de profissionais de outras áreas da saúde de nível superior em 71% das UBS e AB tradicional ou hospitais junto a 20% das unidades. A partir do instrumento PCATool-Brasil foram construídos escores de orientação do cuidado aos atributos da Atenção Primária à Saúde. Entre os 195 profissionais, 71% atribuíram aos seus serviços um alto escore de APS (>=6,6/10). A percepção de capacitação nas habilidades específicas da APS incluindo trabalho multidisciplinar, visita domiciliar, abordagem familiar e comunitária estiveram estatisticamente associados com alto escore de orientação para APS (p<0,05).. A disponibilização e avaliação de programas de treinamento em habilidades específicas da APS podem ser úteis para atingir-se maior orientação de profissionais ao padrão-ouro de cuidado em APS. / The Family Health Strategy (FHS) effectiveness was already demonstrated in large municipalities in Brazil and both health processes and impacts were tested. Nevertheless, there are few studies that focus on the quality of FHS teams in small municipalities and the way they are affected by the presence of the "Basic Attention" traditional model of care or hospitals. This study focus on the perceptions of 195 FHS physicians and nurses from the countryside of Rio Grande do Sul state about their Primary Health Care (PHC) services organization and performance in 32 municipalities participating in Telehealth RS Project. Looking at the 77 PHC services (total of 100 FHS teams), it was found the median of 2.800 people and the mean of 1.7 physicians per ESF team. There were other graduated health professionals besides physicians, nurses and dentists in 71% of the FHS teams. The Basic Attention traditional services or hospitals were in the same place as the FHS team in 20% of the PHC services. The Primary Care Assessment Tool-Brazil was applied to physicians and nurses. According to these professionals, 72% of PHC services obtained scores higher than 6.6/10. Their self perception of their ability to work in teams with different professionals, to do home visits, to work with educational or therapeutic groups, to work with familiar and community approaches were statistically associated with higher Primary Care Assessment Tool score. The availability and assessment of training programs regarding PHC specific abilities may be useful for the FHS workers to reach the golden standard level of PHC. / Teleducação

p. 1-184 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T20:05:10Z No. of bitstreams: 3 Gilka%20Parte%201.pdf: 38647 bytes, checksum: 09b3df0d357381c502253361418b8e27 (MD5) GILKA%20PARTE%202.pdf: 368828 bytes, checksum: a62f67b971d3a89834406553f1971558 (MD5) GILKA%20PARTE%203.pdf: 580562 bytes, checksum: 49ea1a3b8ae194523fd311a1f9c4b910 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T16:52:14Z (GMT) No. of bitstreams: 3 Gilka%20Parte%201.pdf: 38647 bytes, checksum: 09b3df0d357381c502253361418b8e27 (MD5) GILKA%20PARTE%202.pdf: 368828 bytes, checksum: a62f67b971d3a89834406553f1971558 (MD5) GILKA%20PARTE%203.pdf: 580562 bytes, checksum: 49ea1a3b8ae194523fd311a1f9c4b910 (MD5) / Made available in DSpace on 2013-05-04T16:52:14Z (GMT). No. of bitstreams: 3 Gilka%20Parte%201.pdf: 38647 bytes, checksum: 09b3df0d357381c502253361418b8e27 (MD5) GILKA%20PARTE%202.pdf: 368828 bytes, checksum: a62f67b971d3a89834406553f1971558 (MD5) GILKA%20PARTE%203.pdf: 580562 bytes, checksum: 49ea1a3b8ae194523fd311a1f9c4b910 (MD5) Previous issue date: 2007 / As diversas concepções de saúde e doença estão envolvidas em dualismos como o do Corpo X Mente e o de Indivíduo X Sociedade. No entanto, a saúde e a doença integram corpo,mente, emoção, espírito e relações sociais suscitando uma abordagem integral ou biopsicossocial, que no caso, estamos sugerindo contribuições da psicologia analítica de Jung diante da concepção holística do sujeito. A dimensão psicossocial envolve questões psicológicas, sócio-afetivas e sócio-econômicas, além das questões culturais e espirituais. Esta dimensão deve ser assimilada no atendimento médico que visa esta abordagem biopsicossocial, estimulando a participação do sujeito numa prática de acolhimento, onde são reforçados a escuta, o diálogo e a narrativa da experiência e significados, envolvendo a família e a comunidade, figurando num contexto propiciador da ação educativa dialógica. O PSF situa-se na proposta de reorientação do modelo assistencial que figura no princípio da integralidade, onde estimula-se a atenção integral ou biopsicossocial, além do incentivo de aspectos preventivos aliados aos curativos, atendimento interdisciplinar e intersetorial. O presente estudo teve como objetivo a compreensão da percepção de 10 médicos professores de uma instituição-escola nos moldes do PSF sobre a dimensão psicossocial. Nesta proposta realizou-se análise do discurso das entrevistas coletadas seguindo a hipótese de que não há uma sistematização e integração de conceitos do que seja esta dimensão nem criação de um roteiro claro e conciso para melhor orientação dos alunos nesta investigação psicossocial que foi incluída na anamnese do atendimento local. Para tanto, além das entrevistas foram observados prontuários preenchidos pelos alunos. A importância da localização da história da doença na história de vida do paciente, contextualizando sua queixa e considerando seu ponto de vista sobre a enfermidade em questão despontam nesta abordagem biopsicossocial, a qual necessita de uma melhora na atual relação médico-paciente, a fim de poder se criar melhores condições para realização desta investigação psicossocial. Acredita-se na importância de uma melhor formação médica para estímulo desta integração biopsicossocial no atendimento que inclui a sistematização da dimensão psicossocial para inclusão na anamnese e assimilação desta dimensão na condução da consulta, além de maior oferta de atendimentos psicológicos para encaminhamentos no sistema de referência (inclusive da atenção básica) e a presença do psicólogo na equipe para trabalho interdisciplinar dentro do PSF, inclusive no caso desta instituição, para complementaridade da consulta de abordagem biopsicossocial. / Salvador