No decorrer da história humana, a hanseníase esteve atrelada ao imaginário social da lepra e do leproso, produzindo significados e sentidos relacionados ao isolamento dos acometidos, a caridade, ao estigma e preconceito. O que está em produção social e que regem as práticas profissionais não estão descritos apenas nos manuais e nas rotinas dos serviços de saúde, mas também são guiados pelos significados e sentidos do processo saúde-doença-cuidado. Para Vigotski significados e sentidos são construídos socialmente nas relações socioculturais, a partir da interação com o outro. Diante disso, buscamos responder a seguinte pergunta: Quais são os significados e sentidos da hanseníase para os trabalhadores da saúde de serviços ambulatoriais, de uma cidade no interior paulista, voltados ao tratamento de hanseníase? Nesse contexto, o objetivo deste estudo foi de analisar os significados da hanseníase para os trabalhadores da saúde. Utilizou-se a abordagem histórico-cultural, por meio da proposta da identificação dos Núcleos de Significação provenientes da análise das entrevistas com os trabalhadores. Ao todo, o estudo, contou com a participação de treze trabalhadores de diferentes disciplinas (enfermagem, medicina, serviço social e fisioterapia). Os resultados foram discutidos dentro de quatro capítulos. No capítulo 1 foi abordado os aspectos relacionados a vivência pessoal dos participantes (infância, formação, trabalho, família) em relação a hanseníase. Alguns trabalhadores contaram que tiveram algum familiar ou conhecido próximo com hanseníase e, relatam como essa experiência influenciou nas formas de significar a doença. Muitos relataram que tiveram uma formação deficiente ou até mesmo nula em relação a hanseníase. No segundo capítulo, identificou-se aspectos relacionados ao estigma e ao preconceito ainda presente na sociedade, mesmo após a descoberta da poliquimioterapia. Aspectos estes enraizados culturalmente e que vem sendo traduzidos nas ações das políticas públicas e do trabalho em saúde. O terceiro capítulo relaciona-se as dicotomias, desafios e potencialidades no cotidiano dos trabalhadores da saúde, o qual identificou o olhar e a postura dos profissionais atrelados ao sentimento de \"dó\", caridade, contrariando os princípios da política nacional de humanização. O último capítulo foi escrito buscando articular questões entre a hanseníase e a tuberculose, no contexto francês e brasileiro a partir da experiência da pesquisadora. Em suma, os significados e sentidos são produtos históricos e sociais e são construídos desde a infância, perpassam a vida profissional e continuam se modificando no decorrer do dia a dia do trabalho. / Throughout human history, Hansen\'s disease has been linked to the social imagery of leprosy and lepers, producing meanings and senses related to the isolation of those affected and to charity, stigma and prejudice. What is in social production and that govern professional practices are not only described in the manuals and routines of health services, but are also guided by the meanings and senses of the health-disease-care process. For Vygotsky meanings and senses are socially constructed in sociocultural relations, from the interaction with another. In view of this, we sought to answer the following question: What are the meanings and senses of Hansen\'s disease from the point of view of outpatient services health workers from a city in São Paulo state focused on this disease treatment? In this context, this study aimed to analyze the meanings of Hansen\'s disease for health workers. The historical-cultural approach was adopted, by means of the proposal of the meaning core identification from the analysis of the interviews with the health workers. In total, thirteen workers attended the study from different disciplines (nursing, medicine, social work and physiotherapy). The results were discussed within four chapters. In chapter 1, the aspects related to the personal experience of the participants (childhood, training, work, family) in relation to Hansen\'s disease were presented. Some workers reported having had a close family member or acquaintance with this disease, and described how that experience influenced the ways of meaning it. Many have reported that they have had a poor or even null training in Hansen\'s disease. In the second chapter, aspects related to the stigma and prejudice still present in society, even after the discovery of multidrug therapy, were pointed out. These aspects are culturally rooted and have been translated into public policies and health work. The third chapter concerns the dichotomies, challenges and potentialities in the daily routine of health workers, which identified the look and posture of professionals linked to the feeling of \"pitty\" and charity, contradicting the principles of the National Humanization Policy. The last chapter was written seeking to articulate questions between Hansen\'s disease and tuberculosis, in the French and Brazilian contexts, based on the researcher\'s experience. In sum, meanings and senses are historical and social products that are built from childhood passing through professional life and continue to change in the course of daily work.

Thesis (PhD)--University of South Australia, 2001.

Orientador: Rosana de Fátima Possobon / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T13:29:47Z (GMT). No. of bitstreams: 1 Menassi_AndreiaPerin_M.pdf: 1256716 bytes, checksum: 2be40efeb95b9fd3ca1018e6ca8f6a22 (MD5) Previous issue date: 2013 / Resumo: O aleitamento materno é a estratégia isolada que mais previne mortes infantis, além de promover a saúde física, mental e psíquica da criança e da mulher que amamenta. Desde 1981, o Brasil vem desenvolvendo programas (ex: Programa Nacional de Incentivo ao Aleitamento Materno - PNIAM, Banco de Leite Humano - BLH, Carteiro Amigo, Iniciativa Hospital Amigo da Criança, etc.) e normas como a Norma Brasileira de Comercialização de Alimentos para Lactentes - NBCAL e a Licença Gestante, a fim de garantir estratégias para promoção, apoio e proteção ao aleitamento materno. O Sistema único de Saúde (SUS), por meio das Unidades de Saúde da Família (USF), tem um papel fundamental na promoção do aleitamento materno, por ser uma de suas prioridades de atuação, que é dar assistência às crianças menores de dois anos de vida e a gestantes. Esse estudo propôs-se a identificar o perfil dos Agentes Comunitários de Saúde (ACS) atuantes nas USF da cidade de Piracicaba-SP e verificar seus conhecimentos e práticas em relação ao aleitamento materno. Trata-se de um estudo exploratório de corte transversal, envolvendo todas as USF do município de Piracicaba-SP. Foi utilizado um questionário estruturado, com informações relativas ao perfil sociodemográfico e relativas à atuação dos ACS, por meio de 20 afirmativas relacionadas ao conhecimento e às práticas de promoção e manejo da amamentação. A amostra foi composta por 193 ACS, sendo que 47% tinham mais de 34 anos de idade e atuavam havia menos de três anos na USF do município. A maioria (98%) havia estudado mais do que oito anos, mas somente a metade (49%) relatou possuir treinamento específico em amamentação. E mesmo assim, 94% da amostra, orientavam as mães usuárias das USF sobre a manutenção do aleitamento materno de forma exclusiva até o 6º mês de vida da criança, discorrendo sobre a qualidade do leite, sobre a não necessidade de utilização da chupeta e da mamadeira e sobre o alívio de dor no caso de ingurgitamento mamário e à prevenção de mastite. A maioria dos ACS participantes deste estudo orientava gestantes e puérperas. Dos profissionais com treinamento, 67% tinham conhecimentos insatisfatórios sobre o manejo do aleitamento, embora apresentassem bastante envolvimento em ações de saúde que constituem oportunidades de promoção do aleitamento materno. Houve diferença significativa entre os grupos que receberam e não receberam treinamento em relação ao oferecimento da orientação à gestante e à puérpera, mostrando que há uma maior freqüência de oferecimento de orientação por ACS que recebem treinamento específico sobre lactação / Abstract: Breastfeeding is the single strategy to prevent child deaths, in addition to promoting physical, mental and emotional health of children and breastfeeding women. Since 1981, Brazil has been developing programs (eg the National Breastfeeding Incentive - PNIAM, Human Milk Bank - HMB Friendly Postman, Baby Friendly Hospital Initiative, etc..) And standards such as the Brazilian Standard for Food Marketing for Infants - BNCIF and Pregnant License, to ensure strategies to promote, support and protect breastfeeding. The Unified Health System (SUS), through the Family Health Units (FHU) has a key role in the promotion of breastfeeding, to be one of its priorities for action, which is to care for children under two years Life and pregnant women. This study aimed to identify the profile of Community Health Agents (CHA) operating in the USF in Piracicaba-SP and verify their knowledge and practices in relation to breastfeeding. This is an exploratory cross-sectional, involving all USF from Piracicaba-SP. We used a structured questionnaire with information on the demographic profile and relative to the performance of the ACS through 20 statements related to knowledge and practice in the promotion and management of breastfeeding. The sample consisted of 193 ACS, of whom 47% were over 34 years old and had worked less than three years at USF. The majority (98%) had studied more than eight years, but only half (49%) reported having specific training in breastfeeding. And yet, 94% of the sample, oriented the mothers users of USF on the maintenance of breastfeeding exclusively until the 6th month of the child's life, discussing the quality of milk, about not needing the use of pacifiers and bottle and on the relief of pain in the case of breast engorgement and mastitis prevention. Most ACS study participants guided pregnant and postpartum women. Professionals with training, 67% had poor knowledge about the management of breastfeeding, although showing quite involvement in health activities that provide opportunities for the promotion of breastfeeding. There was significant difference between the groups receiving and not receiving training in relation to offering guidance to pregnant and postpartum women, showing that there is a higher frequency of offering guidance ACS who receive specific training on lactation / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

Master of Public Health - MPH / Health institutions in Zimbabwe often cannot fulfill their health care mandate due to lack of specialist health workers in different fields. Despite the effort by the Ministry in providing CPE opportunities, there is poor uptake of CPE by health workers in various provincial hospitals in Zimbabwe. This has resulted in severe staff shortages, particularly doctors (and more specifically specialists), as well as nurses and allied health workers.

Introduction: Palliative care is the approach to the care of patients with life-threatening illnesses. An important part of this is the rational use of a pharmacological approach to relieve suffering by addressing the symptom burden of the patient. Palliative care symptoms contribute a great deal to the suffering of the patient and affects quality of life. Different studies across several countries on the palliative care symptoms have identified common symptoms with pain being the most frequent. The WHO Public Health Strategy for palliative care outlines four components: policy, education, implementation and drug availability. These components interlink and each one affects the others. The drugs used for palliative care symptoms should be classified as essential medicines and be available to all patients who need this treatment. Factors influencing the effective pharmacological management of palliative care symptoms include drug availability, policy and the approach of the prescribers. Studies have shown that developing countries rank low in the use of the essential palliative care drugs especially morphine. Aim: The aim of this study was to describe the prevalence of palliative care symptoms and the prescribing and administration patterns in oncology and haematology patients at PGH, as well as exploring the health workers' opinions on the pharmacological approach to these symptoms. Methods: A mixed method approach was used to qualitatively look at the health workers' responses using inductive thematic analysis and quantitatively obtain information on palliative care symptom management from the health workers and patient records. Results: Pain was the commonest palliative care symptom identified by health workers, and evident in the patient records. A list of other palliative care symptoms, and the frequency at which they occurred was compiled in this study. The health workers highlighted drug availability, palliative care education and need to engage some nurses in prescribing some of the palliative care drugs. Fewer than half of the patient records assessed as being in need of palliative care (N = 247) were given medications from the recognized palliative care drug list (N = 101). Conclusion: This study showed that essential medicines for palliative care symptoms are not easily available in Zimbabwe for various reasons that include cost, policy, education and training. Pain and other palliative care symptoms are not adequately managed. Therefore, palliative care is not yet integrated into the health care system in Zimbabwe as mandated by the WHO. Recommendations to improve palliative care symptom treatment are suggested.

Philosophiae Doctor - PhD / National community health worker (CHW) programmes are to an increasing extent being implemented in health systems globally, mirrored in South Africa in the ward-based outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge impacting the performance and sustainability of scaled-up CHW programmes is ensuring adequate support from and supervision by the local health system. Supervisory systems, where they exist, are usually corrective and hierarchical in nature, and implementation remains poor. In the South African context, the absence of any guidance on CHW supportive supervision has led to varied practices across the country. Improved approaches to supportive supervision are considered critical for CHW programme performance. However, there is relatively little understanding of how this can be done sustainably at scale, and effective CHW supervisory models remain elusive. Research to date has mostly positioned supervision as a technical process rather than a set of relationships, with the former testing specific interventions rather than developing holistic approaches attuned to local contexts.

Food systems include food production, processing, distribution, marketing, access, preparation, consumption, and disposal and influences of social, economic, and environmental conditions. Virginia Cooperative Extension (VCE) has professionals, paraprofessionals, and volunteers with expertise in food systems dimensions integrated into Virginia communities. Current VCE programming has unequal reach for Black, Indigenous, and people of color (BIPOC) communities. Community health workers (CHWs) are lay outreach workers who are from the communities they serve and can be effective health educators within BIPOC communities who experience health disparities. The CHW model is underexplored in food systems, despite the importance of food systems for health. A scoping review of United States CHW educational food systems interventions found CHW reach to BIPOC communities primarily through education on food preparation and consumption. Garden-based programming educated on the highest number of food system processes, highlighting a potential role of CHWs within food systems. These results guided development of a feasibility evaluation for the CHW model for garden-based food systems programming for VCE, emphasizing reach to BIPOC communities. Semi-structured interviews were conducted with 29 VCE stakeholders representing several disciplines. The CHW model is feasible for VCE within the current focus on food systems, diversity, and inclusion. Participatory approaches for programming should be used to incorporate the cultural knowledge of the CHW and to create a welcoming environment for BIPOC communities. The CHW model can connect disciplines to provide accessible and culturally relevant programming to BIPOC communities, thus extending the reach of VCE and potentially creating more inclusive community food systems. / Master of Science / Food systems encompass all processes from food production to disposal and are influenced by social, economic, and environmental conditions in which food travels from farm to fork. Virginia Cooperative Extension (VCE) provides outreach to Virginia communities by disseminating research-based information through professionals and volunteers in educational programming for topics that include agriculture, gardening, nutrition, and more. Community health workers (CHWs) are public health educators who serve Black, Indigenous, and people of color (BIPOC) to mitigate health disparities that are exacerbated by unequal distribution of resources within food systems. CHWs are from the communities they serve and thus are uniquely positioned as culturally sensitive educators. This thesis aimed to explore the role of CHWs in food systems education and to evaluate the feasibility of the CHW model for garden-based food systems programming for VCE. A scoping review of U.S.-based food systems interventions found that CHWs have reached BIPOC communities for food systems education that focuses on preparation and consumption of food, but the CHW model has not been widely documented in broad-lens food systems educational programming. Garden-based programs educated on the greatest number of food systems processes. Interviews with 29 VCE stakeholders showed that the CHW model is feasible within the structure and values of VCE. The CHW model can connect traditionally separate disciplines to provide accessible and culturally relevant programming to BIPOC communities, thus extending the reach of VCE and potentially creating more inclusive community food systems.

Yes / Inequities in access to diabetic retinopathy (DR) services particularly in rural and remote Fiji is concerning. This is because DR when left undiagnosed and untreated for long, can lead to vision loss and permanent blindness. Appropriate channels must be explored to strengthen services and ensure equitable access to healthcare for everyone. This study describes the development and implementation of DR awareness training for community health workers (CHWs) and their subsequent engagement to raise awareness and scale-up DR screening for communities throughout Fiji. As part of a programme to reduce the incidence of avoidable blindness due to diabetes amongst people living in the Pacific, DR training for primary level nurses was developed and implemented. As these primary level nurses were already inundated by clinical duties and competing health priorities, a shifting of the task was proposed to engage the CHWs who would instead educate communities on diabetes and DR and make referrals for DR screening. A one-day DR awareness training was developed and implemented by the Pacific Eye Institute with funding from the Fred Hollows Foundation New Zealand. At the end of the DR programme in 2019, the team had achieved their target and trained a total of 823 CHWs giving an 81.32% coverage of the total 1012 registered CHW in the MHMS register. Anecdotal evidence showed a spike in DR referrals and screenings recorded at health facilities. Three key themes emerged related to the involvement of CHWs which include engagement of CHWs, benefits of the engagement, and health system-related challenges. The use of CHWs who are already integrated into the health system was considered a sustainable intervention to strengthen diabetes and DR services at the primary level of care, particularly if it involves community awareness, health education, and health services facilitation The future of the CHWs will depend on their being integrated more systematically into local health services with strengthened management and supervision. / We acknowledge Fred Hollows Foundation New Zealand for granting this project.

Numerous studies have focused on the effectiveness of community health worker (CHW) programs in producing positive health behaviors and health outcomes for the clients CHWs serve; however, there has been a gap in the literature regarding how the health of HIV + CHWs is impacted by their jobs. A phenomenological design was used to gain insight into the lived experiences of HIV+ CHWs (HIVCHW) who provided services to HIV positive clients. Fifteen HIVCHW were recruited using criteria and snowball techniques. Data were collected via audio recorded personal interviews regarding respondents' perceptions of their work and how it impacted their own health and wellbeing. The data were organized by hand creating charts with pen and paper. Lazarus's theory of stress and coping was used to understand the data and aided in the analysis. The key findings indicated that while the majority of participants had an overall positive perception of the experience of being HIVCHWs, they also indicated that being a CHW impacted their health and well-being. Stress and stressful situations were among the impacts most often referenced by the study participants. The study is socially significant because it may offer the workforce of HIVCHWs empowerment to self-advocate for tools such as stress and time management training and mentors to support healthy work-life balance. In addition, this study may help to prevent or reduce rates of adverse health outcomes such as pain and burnout that HIVCHWs reported experiencing.

<p>This research investigates the nature and extent of community participation and involvement in the recruitment and selection processes for Community Health Workers (CHWs), primarily through detailed case studies of three CHW programmes, one in the Western Cape, another in KwaZulu-Natal, and a third which operates in the Western Cape and KwaZulu-Natal. The first utilizes CHWs in health education and home-based care in Khayelitsha and Nyanga. The second specializes in the training, management and supervision of home-based care CHWs in the rural areas of KwaZulu-Natal. The third utilizes CHWs in addressing maternal and child health issues in targeted peri-urban and rural areas in the three provinces. The mini-thesis is organized into five chapters: the first chapter provides the introduction and background as well as the methodological design of the mini-thesis / the second chapter focuses on providing a detailed literature review of relevant materials that cover the subject matter / the third chapter provides the descriptive background of the history of CHWs, CHW policies and community participation in South Africa, as well as a description of the three case study organizations / the fourth chapter describes and discusses the findings and the last and fifth chapter provides a summary of the findings as well as recommendations and conclusions.</p>