Healthy Cities/Communities (HC) is an experiment that addresses health from a non-medical perspective. It focuses on health as a phenomenon that is not amenable to conventional scientific investigation or discussion. HC emphasizes values of community, aestheticism, relativism and private behavior. Review of available material establishes that an existing understanding of the concepts underlying HC movement contributes to its successful application. No research appears on the attitudes of health care providers and public health officials on general beliefs about health. The importance of gauging the perceptions of these two sectors could determine the potential success of collaborative efforts for improving public health. Studies of health-related professionals, their perceptions for community health promotion and role of the administrative process, among others, will establish this potential in accordance with what the literature demonstrates. This study compares the attitudes and preferences of public health professionals and members of the hospital service category in Virginia concerning Healthy Communities concepts. The study concludes that the two sectors surveyed have similar attitudes and preferences on the issues that promote community health, thus showing potential for successful collaboration. Future research can explore the attitudes of other sectors, such as educational institutions, and their potential for engaging in collaborative efforts to create healthier communities. / Master of Urban and Regional Planning

Yes / Supermarkets, with vast product ranges and relatively low prices, are an established solution to problems of availability of healthy foodstuffs in areas of limited retail access. However, where they may indeed raise consumption of desirable goods they also open up new opportunities to buy less healthful items for less, a situation which potentially undermines their ability to improve diet. Using under-reported diary data from the Seacroft Intervention Study in the United Kingdom takes this paper beyond the extant fruit and vegetable focus, giving it scope to explore the full effect of supermarkets. Quantile regressions show existing behaviours are reinforced, and intervention stores may do little to improve diet. Switching to Tesco Seacroft is shown to increase the portions of unhealthy food consumed by almost 1 portion per day for the least healthy. Managing demand through promoting balanced diets and restricting offers on unhealthy items will be more effective than intervention, and is an essential accompaniment to new large format retailers if they are not to entrench dietary inequality further. Policymakers and practitioners alike should avoided being distracted by aggregate conclusions if food deserts are to be truly tackled.

A presente pesquisa busca verificar a constitucionalidade da aplicação da concessão administrativa para a contratação de particulares na atuação complementar junto ao Sistema Único de Saúde - SUS, assim como a sua conveniência, no plano teórico, para a máxima efetivação do direito fundamental à saúde. Para tanto, desenvolve um exame das transformações na concepção do Estado e de suas funções até o momento atual, destacando os novos papéis da Administração Pública e os seus reflexos no campo do direito administrativo e na evolução de seus institutos. Na sequência analisa a repercussão do modelo gerencial de Administração Pública nos sistemas mundiais de saúde e no brasileiro, com enfoque para a participação privada nos serviços públicos de saúde. Realiza um mapeamento do direito à saúde, a partir do conceito do bem jurídico \"saúde\" e dos seus princípios constitucionais. A partir de uma abordagem das diversas concepções de serviço público inclui nesta categoria os serviços de saúde prestados, direta ou indiretamente, pelo Estado no âmbito do SUS. Ainda, explora os mecanismos definidos na Constituição Federal para a participação privada complementar, os convênios e os contratos de direito público, além do contexto histórico em que estes ajustes foram inseridos no texto constitucional. Após, o estudo se direciona para as novas parcerias nos serviços públicos de saúde, criadas por leis posteriores à promulgação da Constituição Federal de 1988, verificando que os contratos de gestão (Lei nº 9.637/98) e as concessões administrativas (Lei nº 11.079/2004) são ajustes adequados para a transferência da gerência destes serviços à particulares. Na sequência, efetiva a contextualização da concessão gênero e da sua espécie concessão administrativa, por meio de uma síntese histórica da utilização destas ferramentas no Brasil e da averiguação dos regimes jurídicos das concessões translativas, em especial, os aspectos peculiares da concessão administrativa que a tornam conveniente para sua aplicação ao SUS. Por fim, conclui pela constitucionalidade desta modalidade de parceria público-privada (em sentido estrito) nos serviços públicos de saúde, assim como pela sua conveniência, no plano teórico, para a máxima efetivação do direito à saúde. / This study aims to analyses the constitutionality of using administrative concession to hire private sector in order to work in partnership with \"Sistema Único de Sáude - SUS\", it also analyses how this partnership can act to bring effective improvements in healthy fundamental rights. The paper describes the changes of State concept and its roles until now, highlighting the new roles of Public Management and its effect in Administrative Rights field and its entities evolution. After that, the analysis is focused on the repercussion of Public Management model in healthy system over the world and Brazil, detailing the private sector participation in healthy public services. The study analyses the right to healthy from the juridical concept of \"healthy\" and its constitutional principles. Also it approaches the different concepts of public services including the healthy services provided, direct or indirect, by the State though SUS. The paper analyses the mechanisms defined in Federal Constitution to guide private sector complementary participation, agreements, and public right contracts; it also describes the historical context in which these mechanisms were included in Federal Constitution. After that, the study approaches the new partnerships in healthy public services originate by laws created after 1988 Federal Constitution, it verifies that the management contracts (Law nº 9.637/98) and administrative concessions (Law nº 11.079/2004) are correct changes in law to guarantee the properly transfer of services management to private sector. There is a description of concession and administrative concession concepts based on historical resume of the utilization of these juridical tools in Brazil and on checking the juridical aspects of transmission concessions, mainly the peculiar aspects of administrative concession that are key factors for using this tool in SUS. At the end, the paper concludes for the constitutionality of this model of public/private partnership (strict concept) in healthy public services, as its convenience to bring effective improvements in healthy fundamental rights.

O objetivo deste trabalho é analisar os processos participativos em cidades brasileiras que desenvolvem projetos de acordo com o ideário por Cidades Saudáveis. O movimento Cidades Saudáveis fomentado pela Organização Mundial de Saúde desde 1986, objetiva o estabelecimento de políticas públicas urbanas, voltadas à melhoria da qualidade de vida, com ênfase na intersetorialidade e na participação social. O presente estudo é qualitativo, realizado com base na coleta e análise de dados secundários, de entrevistas e de grupos focais, o que permitiu caracterizar, em primeiro lugar, a situação dos projetos Cidades Saudáveis no Brasil, seus processos de implantação e desenvolvimento, e, em segundo lugar, verificar os avanços e retrocessos na relação sociopolítica estabelecida entre o poder público e os grupos sociais envolvidos nesses projetos. Pode-se observar que os projetos Cidades Saudáveis vêm se desenvolvendo no Brasil de diferentes maneiras, e seus avanços são bastante restritos. As propostas são frágeis e estão relacionadas a dificuldades de implementar novas formas de gestão, participativas, não setorizadas, capazes de alterar as estruturas políticas, sociais e econômicas. Esta fragilidade faz com que os projetos não se sustentem nas mudanças administrativas. Os estudos de caso, nas cidades de Jundiaí, Estado de São Paulo, e Maceió, capital do Estado de Alagoas, mostraram que as condições gerais políticas das cidades não favorecem a participação efetiva dos cidadãos nas questões que envolvem as condições de vida. O aspecto contraditório das relações Estado/sociedade civil fica evidenciado. A participação existe, é reconhecida pelo Estado que abre um espaço institucional para que ela ocorra, no entanto, os grupos sociais não têm conseguido penetrar nos espaços de poder, o que aponta uma série de limites relacionados desde à cultura institucional marcada por estruturas tradicionais e autoritárias que dificultam a participação, até os conflitos próprios do processo de organização da sociedade civil. / The aim of this work was to analyse the process of participation in the project Healthy Cities developed in Brazilian cities. This kind of project has been fostered by WHO since 1986, to promote public urban policies able to improve the quality of life by emphasizing the intersectoral action and social participation. This is a qualitative study based on data collection and analysis from interviews and focal groups which allowed identifying the implementation, process of development as well as the present situation of the project Healthy Cities in Brazil, to evaluate the progress and hindrances in the social political relationship among the public sphere and the social groups involved. The projects Healthy Cities have been developed in different ways in Brazil and there has been very little progress in the direction of changing the political, social and economical structures. The proposals are flimsy, usually related to the difficulties of implementing new participant and intersectoral models of management. As a consequence of such a fragility the projects are interrupted when administrative changes occur. The case studies developed in two Brazilian cities, Jundiaí in the state of São Paulo, and Maceió, capital of the state of Alagoas, showed that the general political conditions in the cities do not stimulate the effective community participation in issues related to life conditions. The contradictory aspect in the State/community relations becomes evident. Although the State offers institutional conditions for the community participation, the social groups are not granted the power, and that shows their limits related to institutional culture rooted in traditional and authoritarian structures hampering participation as well as the conflicts related to the process of civil organization.

O objetivo deste trabalho é analisar os processos participativos em cidades brasileiras que desenvolvem projetos de acordo com o ideário por Cidades Saudáveis. O movimento Cidades Saudáveis fomentado pela Organização Mundial de Saúde desde 1986, objetiva o estabelecimento de políticas públicas urbanas, voltadas à melhoria da qualidade de vida, com ênfase na intersetorialidade e na participação social. O presente estudo é qualitativo, realizado com base na coleta e análise de dados secundários, de entrevistas e de grupos focais, o que permitiu caracterizar, em primeiro lugar, a situação dos projetos Cidades Saudáveis no Brasil, seus processos de implantação e desenvolvimento, e, em segundo lugar, verificar os avanços e retrocessos na relação sociopolítica estabelecida entre o poder público e os grupos sociais envolvidos nesses projetos. Pode-se observar que os projetos Cidades Saudáveis vêm se desenvolvendo no Brasil de diferentes maneiras, e seus avanços são bastante restritos. As propostas são frágeis e estão relacionadas a dificuldades de implementar novas formas de gestão, participativas, não setorizadas, capazes de alterar as estruturas políticas, sociais e econômicas. Esta fragilidade faz com que os projetos não se sustentem nas mudanças administrativas. Os estudos de caso, nas cidades de Jundiaí, Estado de São Paulo, e Maceió, capital do Estado de Alagoas, mostraram que as condições gerais políticas das cidades não favorecem a participação efetiva dos cidadãos nas questões que envolvem as condições de vida. O aspecto contraditório das relações Estado/sociedade civil fica evidenciado. A participação existe, é reconhecida pelo Estado que abre um espaço institucional para que ela ocorra, no entanto, os grupos sociais não têm conseguido penetrar nos espaços de poder, o que aponta uma série de limites relacionados desde à cultura institucional marcada por estruturas tradicionais e autoritárias que dificultam a participação, até os conflitos próprios do processo de organização da sociedade civil. / The aim of this work was to analyse the process of participation in the project Healthy Cities developed in Brazilian cities. This kind of project has been fostered by WHO since 1986, to promote public urban policies able to improve the quality of life by emphasizing the intersectoral action and social participation. This is a qualitative study based on data collection and analysis from interviews and focal groups which allowed identifying the implementation, process of development as well as the present situation of the project Healthy Cities in Brazil, to evaluate the progress and hindrances in the social political relationship among the public sphere and the social groups involved. The projects Healthy Cities have been developed in different ways in Brazil and there has been very little progress in the direction of changing the political, social and economical structures. The proposals are flimsy, usually related to the difficulties of implementing new participant and intersectoral models of management. As a consequence of such a fragility the projects are interrupted when administrative changes occur. The case studies developed in two Brazilian cities, Jundiaí in the state of São Paulo, and Maceió, capital of the state of Alagoas, showed that the general political conditions in the cities do not stimulate the effective community participation in issues related to life conditions. The contradictory aspect in the State/community relations becomes evident. Although the State offers institutional conditions for the community participation, the social groups are not granted the power, and that shows their limits related to institutional culture rooted in traditional and authoritarian structures hampering participation as well as the conflicts related to the process of civil organization.

Food and nutrition are an integral part of daily life and can have an effect on social, cognitive, and physical development as well as the prevention of negative health outcomes. The development of the School Food and Beverage Policy was targeted to both elementary and secondary schools in Ontario as a proactive approach to health and wellbeing by eliminating the sale of foods that do not meet nutrition criteria. School food policies can play an important role in students’ overall health and well-being, but little is known about schools’ readiness for implementing these policies. The purpose of this study was to examine schools’ readiness to implement the policy with an organizational readiness lens. This study consisted of a policy analysis and qualitative interviews with 8 administrators who were directly involved in the planning and preparation for the policy and 4 teachers who were recommended by their respective principals as key stakeholders in assisting in the process. Policy analysis uncovered the inconsistencies within the policy, while interview data revealed emergent themes surrounding: pre-implementation planning, policy technicalities, and challenges of confronting implementation. The variability in perspectives of readiness illustrates the complexity of preparing for policy implementation across schools and even within schools. Findings suggest that there is a need for more effective dissemination, in-service training, and education for school stakeholders in order to engage and stimulate interest and compliance of the nutrition standards. Having appealing and nutritious foods that students will enjoy is an area that requires more work. Developing supportive partnerships within and outside the school to reinforce consistent messages to students is also an area that needs attention. The results of this research serve as a framework for potential solutions to school nutrition policies, strategies, and interventions and may also inform key stakeholders and policy makers in adapting and refining policies as a means of supporting the implementation process for successful outcomes. / Thesis (Master, Education) -- Queen's University, 2012-05-25 15:28:52.064

Darbo tikslas: įvertinti Kauno miesto X ir Y mokyklose vykdomos sveikos mitybos programos „Pienas vaikams“ organizavimo ir įgyvendinimo ypatumus tėvų ir mokyklos vadovų požiūriu. Darbo uždaviniai: 1. Išanalizuoti sveikos mitybos programų įgyvendinimo ypatumus X ir Y bendrojo lavinimo mokyklose. 2. Atskleisti tėvų požiūrį į sveikos mitybos programos „Pienas vaikams“ bendrojo lavinimo mokyklose įgyvendinimą. 3. Atskleisti mokyklos vadovų požiūrį į sveikos mitybos programos „Pienas vaikams“ įgyvendinimą ir programos tobulinimo būdus. Tyrimo metodika: tyrimui atlikti pasitelktas mišrus kiekybinis ir kokybinis tyrimas. Tyrime dalyvavo dvi Kauno miesto X ir Y mokyklos, kuriuose buvo atliekamas tyrimas. Iš viso abiejose mokyklose buvo išdalinta 188 anketos. Anketinėje apklausoje dalyvavo pradinių mokyklų, 4 klasių mokinių tėvai X mokykloje (n=56), Y mokykloje (n=110). Bendras dalyvavusių tėvų skaičius abiejose mokyklose (n=166). Atsako dažnis Y mokykloje – 92,43 proc., X mokykloje – 81,15 proc. Tyrimo duomenų statistinė analizė atlikta naudojant SPSS 14 statistinių duomenų analizės paketą. Ryšiai tarp požymių buvo vertinami naudojant Chi kvadrato kriterijų (χ2). Tyrime gauti kokybiniai (interviu) duomenys apdoroti turinio analizės principu, grupuojant interviu metu gautus duomenis į atitinkamas temas ir potemes. Tyrimo rezultatai: tyrimu atskleista, kad tirtose mokyklose programos įgyvendinimas skiriasi. Remiantis interviu metu gautais iš mokyklų vadovų duomenimis išaiškėjo, kad X... [toliau žr. visą tekstą] / Task of the paper: to evaluate various aspects of the management and implementation of the healthy nutrition program Milk for Children in general education schools X and Y located in Kaunas City from the point of view of parents and school management. Objectives of the paper: 1. To research the peculiarities of the implementation of healthy nutrition programs in general education schools X and Y. 2. To discover the attitude of parents to the implementation of the healthy nutrition program Milk for Children in general education schools X and Y. 3. To reveal the attitude of the school management to the implementation of the healthy nutrition program Milk for Children and the ways of improving this program. Research methodology: when conducting the research, a mixed qualitative and quantitative research method was selected. Two general education schools X and Y located in Kaunas City participated in the research. In the two schools, 188 questionnaire sheets were distributed in total. Parents of 4th grade students of primary school took part in the research; n=56 in school X and n=110 in school Y. The total number of participating parents in both schools is n=166. The response rate in school Y was 92.43% and in school X it was 81.15%; the cumulative response rate in both schools was 88.29%. Statistical analysis of the research data was conducted by employing the SPSS 14 statistical data analysis package. The interrelation between the criteria was evaluated with the chi-square... [to full text]

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa tem como objetivo geral, compreender as práticas desenvolvidas no cuidado realizado por enfermeiros nos Programas Nacionais de Saúde em uma unidade da rede básica de saúde no município do Rio de Janeiro. Este estudo corresponde ao desdobramento do projeto Práticas de cuidado no SUS: o papel do enfermeiro na Atenção Básica, apoiado por bolsa de produtividade em pesquisa da Universidade do Estado do Rio de Janeiro (UERJ/ Prociência). A presente dissertação trata-se de um estudo de caso realizado no âmbito da Atenção Básica, e, possui como cenário o Centro Municipal de Saúde (CMS) Milton Fontes Magarão. Os sujeitos da pesquisa corresponderam a oito enfermeiros, sendo sete entrevistas e um depoimento. Os instrumentos de coleta de dados utilizados, durante o período de julho a setembro de 2011, foram: observação sistemática, entrevista semi-estruturada, depoimento, formulário e pesquisa em fontes documentais. Para a avaliação dos resultados utilizou-se a técnica de análise temática, proposta por Minayo. No plano metodológico a análise foi qualitativa, no entanto, no tratamento dos dados, a análise aplicada se apropriou de elementos da abordagem quantitativa, com o objetivo de encontrar os núcleos de sentido contextualizados nas entrevistas. A partir dos resultados alcançados foi possível elaborar três categorias. A primeira categoria focou uma abordagem temática sobre as práticas desenvolvidas no cuidado realizado por enfermeiros nos Programas Nacionais. A segunda categoria buscou descrever a visão do enfermeiro sobre o desenvolvimento de suas práticas e do cuidado realizado, no qual, foram discutidas duas temáticas centrais: noções acerca das atividades realizadas pelos enfermeiros e noções dos enfermeiros acerca dos princípios e diretrizes para atenção à saúde. A terceira categoria direcionou-se para os fatores que interferem nas práticas e no cuidado realizado pelos enfermeiros. A prática e o cuidado realizados pelos enfermeiros foram analisados e discutidos, a partir dos relatos dos profissionais sobre suas vivências. Sendo assim, não coube a expressão de uma única forma de prática ou de uma única dimensão do cuidado, visto que essas práticas parecem estar entrelaçadas a diversos aspectos subjetivos, epistemológicos, culturais e sócio-econômicos. As práticas realizadas, independente do Programa Nacional de atuação dos enfermeiros, estão voltadas principalmente para a consulta de enfermagem, a prática educativa, a organização do fluxo de entrada, o sistema de referência e a visita domiciliar. Pôde-se inferir que diversos são os fatores que influenciam, de forma positiva ou negativa, o desenvolvimento das atividades diárias. Por fim, cabe ressaltar a necessidade de novos estudos sobre a temática a fim de estimular a construção de saberes teórico-práticos e a formulação de uma visão crítica sobre o cuidado profissional realizado pelo enfermeiro no âmbito da Atenção Básica. / This research has as a general goal to understand the practices developed in care performed by nurses in Health National Programs at a Basic Health Care unit in Rio de Janeiro city. This study corresponds to the unfolding of the project named Practices of care at SUS: the role of the nurse on Health Care, supported by research productivity grants from University of the State of Rio de Janeiro (UERJ/ Prosciences). The current dissertation is a case study performed at the scope of Health care, and the site is the Municipal Health Center (MHC) Milton Fontes Magarão. The research subjects were eight nurses, providing seven interviews and one testimony. Data sample tools used, during the period from July to September, 2011, were: systematic observation, semi-structured interview, testimony, form and research at documental sources. To the assessment of results the theme analysis technique was used, proposed by Minayo. Methodologically, the analysis was qualitative, however, in treatment of data, the analysis applied used elements from quantitative approach, in which the objective was to find meaning cores contextualized in the interviews. From the results achieved it was possible to elaborate three categories. First category focus was on the thematic approach about the practices which have been developed by nurses at National Programs. The second one aimed at describing the nurses view on the development of their practices as well as the care performed, in which, two core themes were discussed: notions about activities performed by nurses and their notions about principles and guidelines to basic Health Care. The third category was directed to factors that interfere on the practice and the care performed by nurses. Practice and care were analysed and discussed from the professionals reports about their life experiences. Thus, it was not suitable to structure a single form of practice or single care dimension, once such practices seem overlapped to diverse subjective, epistemological, cultural and socio-economic factors. Nurses performance practices, apart from the National Program are turned mainly to the nursing consultation, educational practice, organization of input, reference system and home visit. It can be inferred that a lot of factors influence - positively or negatively - on the development of daily activities. Finally, it is important to highlight the need of new studies on the subject in order to stimulate theoretical-practical knowledge and the formulation of a critical thinking about professional care from the nurse at the scope of basic Health Care.

This thesis is concerned with assessment of the health risks of lifestyle of basic school children. The topic of the healthy nutrition, the healthy lifestyle and the healthy eating habits has been more and more popular. The healthy eating habits influence the whole human life and the term health has to be understood as a constant value that we have to protect and develop. Nutrition of children and youth is one of the most pronounced matter nowadays all over the world. First part of the thesis is focused on the lifestyle of basic school children, it´s parts and results too (especially the part about nutrition). Then it is focused on work of pediatric´s nurse who takes care about them. In my thesis I found two goals: to assess the specific lifestyle risks of basic school children and to find if basic school children keep the rules of healthy eating. Based on these goals four hypotheses were set: the H1 - Children eat more fruit than vegetables. H2 - Children drink sweet drinks more than water. H3 - Children don´t keep healthy eating habits. H4 - Children prefer fast-food meals to school meals. The hypotheses number H1, H3 and H4 were accepted. The H2 wasn´t accepted because the statistic showed that children drink more water than sweet drinks. The quantitative research was done to reach the goals and confirm the hypotheses via anonymous questionnaire for children from 13-15 years old. This research was given to approximately 310 pupils of primary school. The results were put into charts and tables and statistically assessed with Pearson chi square test. The results of research of my thesis were used for a booklet about healthy eating habits for children and their parents. The material should be ready for use for pediatric´s nurses who work for general practitioner for children and adolescents. The brochure can serve for gaining more information about healthy nutrition.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Dentre as políticas públicas de alimentação e nutrição no Brasil, o Programa Nacional de Alimentação Escolar (PNAE) se apresenta como um espaço privilegiado para promoção de alimentação saudável. Sendo assim, o presente estudo tem por objetivo compreender as concepções de "alimentação saudável" e "promoção da alimentação saudável" dos atores que estão diretamente envolvidos na gestão e execução do PNAE. Realizaram-se entrevistas individuais com 22 representantes do PNAE de 11 municípios do estado do Rio de Janeiro. Os resultados encontrados mostram que o discurso sobre "alimentação saudável" dos gestores e responsáveis técnicos (RT) tem forte influência do saber técnico de nutrição, apesar de associarem outras dimensões como a cultura, a economia e a agricultura. Para os gestores a promoção da alimentação saudável ultrapassa as questões relacionadas à aquisição de conhecimento, e levantam os aspectos relacionados ao acesso à alimentação saudável, aos serviços públicos de saúde e a renda. Já no discurso dos RT, a promoção da alimentação saudável está predominantemente relacionada à transmissão do conhecimento técnico no intuito de provocar mudanças de hábitos à nível individual. Tanto os gestores quanto os RT quando exemplificam a promoção da alimentação saudável, remeteram ao PNAE como um espaço que possibilita a execução dessas ações. Finalmente, pontua-se o desafio de ampliação do conceito de alimentação saudável e promoção da alimentação saudável no discurso e prática desses atores incorporando noções de direito à alimentação adequada, cidadania, entre outros. / Among public policies of food and nutrition in Brazil, the universal and free school feeding program (Programa Nacional de Alimentação Escolar, or PNAE) presents itself as a privileged space for promotion of healthy eating. Thus, the objective of this study was to understand the view of the actors who directly involved in managing and implementing of the Program about healthy eating and promotion of healthy eating. For this interview 22 representatives of the PNAE of 11 municipalities in the state of Rio de Janeiro. The results show that the speech on "healthy eating" of the managers and technical managers (RT) has strong influence of technical knowledge of nutrition, associating although other dimensions such as culture, economy and agriculture. For managers to promote healthy eating beyond issues related to acquisition of knowledge, and raise the aspects related to access to food healthy, to public healthy and income. In the discourse of RT, the promotion of healthy eating is predominantly knowledge related to the transmition technician in order to cause changes habits at the individual level. Both managers and RT illustrate the PNAE as the space that allows the implementation these actions. Finally, we points to the challenge expansion of the concept of eating healthy and promotion of eating healthy discourse and practice of these actors incorporating notions of human right to adequate food, citizenship, among others.