Doctor of Philosophy / Department of Hospitality Management and Dietetics / Deborah D. Canter / Junehee Kwon / Food allergies affect 1 in 25 school-aged children in the U.S., and Child Nutrition Professionals (CNPs) need more vigilance serving them. To assess CNPs’ knowledge, attitudes about food allergies including barriers to providing food allergy training, as well as current training practices; an online survey was conducted with randomly selected 1,500 CNPs nationwide. The survey instrument was developed based on focus groups, pilot-tested, and sent to the sample via email. About 24% or 340 CNPs completed the survey. Descriptive and inferential statistics including hierarchical and logistic regressions were calculated using SPSS. A majority of respondents currently provide allergen free meals in their districts (n=256). The mean food allergy knowledge score of CNPs was 31.9 (Standard Deviation=3.3) of 39. Respondents scored lowest on recognizing symptoms of food allergic reactions and understanding food allergen-related terminology. Years of managerial experience and previous food allergy training were positively associated with the knowledge scores. Most participants viewed food allergy as an important issue, but they faced challenges fulfilling last-minute allergen-free meal requests and purchasing allergen-free products. Sixty percent (n=200) did not provide any food allergy training. Of those who provided some sorts of training (n=140), the training was provided in groups (n=96), “one-on-one” basis (n=30), or combination of both methods (n=14). The employees were trained annually (n=76), once a year if they worked directly with the students with food allergies (n=52), and/or when they were newly hired (n=33). Lack of time and funding were barriers to providing food allergy training. Previous food allergic reactions and regulatory requirements served as cues to providing food allergy training. Previous food allergy training, knowledge, and self-efficacy were factors differentiating if food allergy training had or had not been provided in past 12 months. Systematic and regular food allergy training may be needed to ensure allergen-free meals are properly prepared. Food allergy training for CNPs to improve knowledge and self-efficacy may increase food allergy training at school food service establishments.

Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found. Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV). Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV). Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV). Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.

Dans cette recherche nous nous intéressons aux professionnels du domaine de la santé qui travaillent à la frontière Uruguay-Brésil. Cet espace est marqué non seulement par une culture « frontalière », mais aussi par le plurilinguisme car deux langues standard telles que l’espagnol et le portugais, ainsi que deux dialectes locaux étant le Portugais Gaúcho da Fronteira et Portugais de l’Uruguay (populairement appelé portugnol) son présents sur ce territoire. C’est exactement dans ce sens que nous cherchons à savoir comment les professionnels de santé travaillent dans un espace si singulier et si complexe. L’objectif de cette recherche est ainsi celui d’étudier l’activité professionnelle et les compétences mises en œuvre par les travailleurs de ce domaine dans le but de mieux répondre aux besoins des patients frontaliers. Nous nous demandons quelles compétences, autres que techniques, sont nécessaires afin d’assurer une prise en charge adéquate et efficace des patients dont le cadre de référence socio-économique, culturel et linguistique peut différer de celui du professionnel. Pour aborder ce sujet, nous avons choisi de travailler avec plusieurs approches, qui bien que différentes, s’avèrent pertinentes pour une compréhension plus holistique de notre objet d’étude. C’est ainsi que nous évoquerons les travaux de l’ergonomie francophone, la théorie des champs conceptuels proposée par Gérard Vergnaud, la didactique professionnelle, la clinique de l’activité et les travaux réalisés dans le domaine de l’interculturalité. En nous situant plus particulièrement dans la perspective historico-culturelle du psychisme, développée par l’école russe de psychologie, et notamment à travers les travaux de Vygotski et de Leontiev, nous étudierons davantage l’activité professionnelle et les compétences qui s’expriment à travers cette activité. Pour cela, nous avons mené cette étude auprès de 208 professionnels, aussi bien uruguayens que brésiliens, en utilisant cinq outils méthodologiques : des observations ethnographiques, un questionnaire, des entretiens informels, des entretiens dits d’instruction au sosie et des entretiens d’autoconfrontation simple. Les résultats de cette recherche montrent que les professionnels de santé travaillant dans cet espace frontalier semblent avoir développé des compétences, autres que techniques, afin de proposer une prise en charge plus adéquate et plus efficace. En outre, et à travers les résultats qualitatifs et quantitatifs, nous avons remarqué que ce contexte culturellement et linguistiquement hybride ne viendrait pas tellement rendre difficile l’activité professionnelle. Au contraire, et dans certains cas, il aiderait même à développer d’autres compétences et à prendre des initiatives qui dépassent aussi bien ce qui est attendu par les prescriptions formelles que par les prescriptions propres au métier. / This research focuses on the study of health professionals who work on the border between Uruguay and Brazil. This area is characterized not only by a “culture of the borderlands”, but also by multilingualism because two standard languages (Spanish and Portuguese) as well as two local dialects (Portuguese Gaucho da Fronteira and Uruguayan-Portuguese - popularly called portuñol) are found in this territory. It is in this particular sense that we are trying to understand how healthcare professionals work in such a singular and complex area. The aim of this research is to study these workers’ professional activity and the competences they employ in their domain to better take care of the patients living in the border. We wonder which competences, other than technical, are necessary to these professionals to ensure a suitable and efficient care of the patients whose socio-economic, linguistic and cultural background may differ from theirs. We have chosen to work on this subject using a variety of techniques, which differ greatly but are all relevant in helping us achieve a holistic understanding of the topic we are studying. In this way, we will mention francophone ergonomics, the theory of conceptual fields developed by Gerard Vergnaud, the clinic of activity, and research from the domain of intercultural studies. More specifically using the historical-cultural theory of mind developed by the Russian school of psychology (in particular Vygotski and Leontiev’s work), we will study the professional activity and competences expressed through this activity. For this purpose, we have conducted this study with 208 Uruguayan and Brazilian professionals, using five methodological tools: ethnographic observations, a questionnaire, informal interviews, the so-called instruction to a double, and self-confrontation interviews. The results of this research show that the health professionals who work on that borderland seem to have developed a set of competences, other than technical, in order to provide more suitable and efficient care. Moreover, and in these quantitative and qualitative results, we have noticed that this culturally hybrid context is not an obstacle to their professional activity. On the contrary, in some cases, it is even likely to help them develop other skills and take initiatives that exceed what is demanded by technical requirements as well as their job's requirements.

Problem: While the multinational teams consisting of members from different nationalities,backgrounds and cultures have advantages of diversity in the workplace, the differencesbetween team members can also pose the challenges. Our study focuses on InformationTechnology (IT) project teams in organizations located in Sweden. The rapid growth oftechnology and IT sector, increasing demand in IT professionals, and the knowledge ofwriting universal code allow people to work internationally regardless of citizenship.Therefore, the workforce in the IT sector is rapidly growing and diversifying — it ischaracterized by teams consisting of different nationalities. However, these differences incultures, languages and nationalities can complicate the communication processes betweenthe team members. Therefore, efficient cross-cultural communication within a team isessential for team collaboration and performance. Purpose: The study aims to find the significant issues in the process of adaptation to the newculturally diverse environment faced by immigrant professionals in IT project teams. Thestudy mainly focuses on an individual level, consequently expanding it to a collective level,as the related challenges refer to collaboration among the team members. Method: The study was conducted by interviewing immigrant professionals who have beenworking in IT project teams in the companies, located in Sweden. The participants belong tosix different nationalities and have worked in Sweden for approximately 2-8 years. They areall male aged between 30-33 years old. After the interviews, we can present findings, whichdemonstrate the points of similarity and difference. Conclusion: Technology, which is a significant factor in IT projects, constantly changes, andtherefore, IT project teams that work with innovation require high adaptability to explore newopportunities. That makes effective coordination and communication essential. In theculturally diverse team, managers should manage global mindset and cultural intelligence forindividuals to help team members in adaptation process. Cross-cultural training should beprovided to the migrant professionals in the team to avoid miscommunication based oncultural differences, hence overcoming challenges.

En quoi peut-on définir un individu compétent en éthique ? Si la compétence éthique se caractérise par une capacité à adopter la manière d’agir la plus ajustée à la situation vécue, la confrontation aux réalités de terrain doit mettre en évidence les débats de normes sous-jacents à cette compétence éthique. Nous nous proposons de la rendre plus lisible et de la réactualiser en repérant les éléments qui constituent l’activité de travail, notamment celle des professionnels de santé à l’œuvre dans les hôpitaux publics de Marseille (APHM). Comment être compétent en éthique dans des services accueillant un public hétérogène du point de vue des maladies, de la culture et des valeurs ? Dans la lignée des travaux en ergologie, cette étude propose d’appréhender la compétence éthique en donnant la parole au travail et en analysant les savoirs et les « usages de soi » des soignants. / How can we define a competent individual in ethics ? If ethical skill is characterized by an ability to adopt the way to act as fairas possible to the lived situation, the confrontation with realities must highlight debates of standards underlying the ethical skill. We propose to make it more readable and to update it by identifying the elements that constitute the work activity, in particular that of healthcare professionals at work in the public hospitals of Marseille (APHM). How to be competent in services welcoming a heterogeneous public from the point of view of the diseases, of the culture and the values ? In the line with Ergologie’s work, this study proposes to perceive ethical skill with language exists in work and analyzing the knowledge and the « uses of one » of the nursing staff.

Bakgrund: Cirka 130 000-150 000 personer i Sverige har en demenssjukdom. Demens är en obotlig sjukdom som kan leda till exempelvis minnessvårigheter, svårigheter att kommunicera, svårigheter att sköta sin personliga hygien. På grund av dessa symtom kan omvårdnaden av personer med demenssjukdom vara en svårighet för vårdpersonalen och de kan ställas inför olika utmaningar. Syfte: Att beskriva vårdpersonalens erfarenheter kring utmaningar i omvårdnad av personer med demenssjukdom. Metod: Litteraturöversikt där resultatet är baserat på arton vetenskapliga artiklar. Resultat: I resultatet har författarna till denna litteraturöversikt studerat vårdpersonalens erfarenheter av utmaningar kring omvårdnad av personer med demenssjukdom. Vid olika situationer i omvårdnaden av personer med demenssjukdom identifierades svårigheter och utmaningar för vårdpersonalen. Utmaningar som urskiljes: Bevara integritet eller förebygga skada, personlig hygien, administrera läkemedel, måltidssituationer, att undanhålla sanning för att lugna, teknisk övervakning och kommunikation. Slutsats: Det finns flera utmaningar inom omvårdnad av personer med demenssjukdom, där vårdpersonalen ställs inför valet att främja individens självbestämmande och integritet eller att förebygga skador genom att gå emot individens vilja. / Background: Around 130 000-150 000 people in Sweden is suffering from dementia. Dementia is a terminal illness which can lead to memory loss, difficulty in communication and difficulties to manage their personal hygiene. Due to these symptoms, the care of people with dementia can be challenging and healthcare professionals are often faced with problematic questions. Aim: Describe healthcare professionals experiences concerning care of people affected by dementia. Method: A literature review, including eighteen scientific articles. Results: The authors to this systematic review has been studying the health care professionals experiences with different challenges within the healthcare of people with dementia. In different situations difficulties and challenges could be identified for the healthcare professionals. These challenges could include: maintain integrity or prevent injuries, personal hygiene, administration of medicinal products, meal situations, withhold the truth to keep the calm, technical monitoring, communication. Conclusion: Within the healthcare of people with dementia it occurs several dilemmas. The healthcare professionals are facing the choice between the individuals right to autonomy and integrity or provide against injury by acting against the patients individual will.

Este trabalho foi desenvolvido como subprojeto integrante da pesquisa A Interface Entre a Ocorrência e o Atendimento de Violência de Gênero Entre Mulheres Usuárias dos Serviços de Saúde da Rede Pública de Ribeirão Preto. A violência contra a mulher é uma das expressões mais perversas da subordinação feminina e gera graves conseqüências para as pessoas que vivenciam o seu ciclo. Mulheres nessa situação buscam frequentemente os serviços de saúde, que possuem um alto poder de detecção da violência. Porém, há uma série de dificuldades por parte dos profissionais, médicos e enfermeiros, em identificar e prestar assistência adequada a essas mulheres. O objetivo deste estudo foi analisar comparativamente as percepções de médicos e enfermeiros que atuam na rede de saúde de Ribeirão Preto acerca da violência contra a mulher buscando formas de aprimorar a assistência prestada. Para isso, realizamos uma pesquisa qualitativa, utilizando um banco de dados de 14 entrevistas com médicos e 10 com enfermeiros, realizadas por meio de um roteiro semi-estruturado. Por meio de análise de conteúdo temático foram identificadas as seguintes categorias: 1) Percepções sobre gênero; 2) Percepções sobre a violência contra a mulher; 3) Sobre atuação profissional; e 4) Sobre a rede de proteção. Tais categorias foram divididas em diversas subcategorias que foram analisadas a partir do referencial de gênero. Os resultados mostraram que há muitas semelhanças nas percepções relativas às questões de gênero, que são ainda bastante tradicionais. Os profissionais entendem que a violência contra a mulher ocorre devido às desigualdades perpetuadas pelo sistema social e que acabam por justificar a violência. Eles reconhecem os tipos de violência existentes e estão aptos a identificar e acolher as mulheres nos serviços de saúde, reconhecendo tais ações como suas responsabilidades. Porém, muitas vezes não o fazem por barreiras como a própria estrutura dos serviços, a falta de capacitação e aspectos emocionais, que dificultam o acolhimento e a orientação adequados. Também identificamos que a rede de apoio existente ainda é desconhecida por muitos dos profissionais e, diversas vezes, está estruturada de forma inadequada para atender às demandas existentes. Assim, é fundamental o desenvolvimento de capacitações para os profissionais da área de saúde com o objetivo de prepara-los para uma melhor assistência às mulheres em situação de violência e para o conhecimento da rede de proteção existente. Além disso, é urgente que a estrutura dos serviços seja repensada em diversos aspectos para que os princípios do SUS e as ações de humanização possam, de fato, ser colocadas em prática. / This study was conducted as part of the larger research project \"The interface between the occurrence and treatment of gender violence among women who are users of public health care in Ribeirão Preto. Violence against women is one of the most perverse forms of female subordination and leads to serious consequences to those affected by it. Women in such conditions frequently seek health care services, which are highly capable of detecting violence. However, there are a number of obstacles faced by professionals, doctors and nurses, in order to identify and provide proper assistance to these women. The objective of this study was to comparatively analyze how doctors and nurses who work in the public health care system in Ribeirão Preto perceive violence against women with a view to improving the quality of services. To attain this goal, this qualitative study made use of a database of 14 interviews with doctors and 10 with nurses following a semistructured script. Following thematic content analysis, the following categories have been established: 1) Perceptions about gender; 2) Perceptions about violence against women; 3) About the jobs; and 4) About the protection network. These categories were further divided into subcategories that were analyzed by taking gender as a reference. The findings show that there are many similarities across perceptions concerning gender issues, which are still quite traditional. Professionals believe that violence against women occurs as a result of inequalities that have been perpetuated by the social system and that ultimately justify such violence. They recognize the existing types of violence and are ready and able to identify women and offer them assistance within the health care system, which they regard to be part of their responsibilities. However, they frequently cannot do that due to barriers such as how the services are structured, lack of training, and emotional aspects, which make both reception and counseling difficult. It has also been found that the existing support network is still unknown to many professionals and, very often, that it is inadequately organized to meet current demands. Thus, it is essential to develop the skills of health care professionals in order to prepare them both to provide better assistance to women who have been affected violence and to know about the existing protection network. In addition, there is the urgent need to rethink the organization of services at various levels so that the principles of SUS - the universal health care system - and humanization actions can actually be put into practice.

O risco de agressões a profissionais da área de saúde mental tem sido evidenciado devido ao número crescente de ocorrências. Assim surgem algumas questões: A violência aos profissionais de saúde mental apresenta especificidade e sinais de alerta? Esse profissional está preparado para as variabilidades de suas atribuições? Como agir a um comportamento inesperado? Em busca de resposta a essas questões, este estudo objetiva entender as atividades realizadas por estes profissionais, identificando as dificuldades e variabilidades encontradas e os determinantes de risco. Como metodologia foram utilizadas observação das atividades e entrevistas e a aplicação do Modelo de Analise e Prevenção de Acidente do Trabalho (MAPA) em três casos de acidentes do trabalho selecionados em um Centro de Atenção Integrada em Saúde Mental (CAISM). Os resultados demonstraram que existem vários determinantes de agressão relacionados às características do paciente com TMC e a presença de comorbidades. A existência ou não de planos, programas e equipe direcionados à gestão da segurança e saúde no trabalho adequado às características dos pacientes atendidos e a falta de capacitação dos profissionais quanto ao agir diante de comportamento agressivo inesperado representam fatores fundamentais na ocorrência ou não deste evento indesejado. / The risk of aggression to mental health professionals has been evidenced due to the increasing number of occurrences. Thus, some questions arise: Does violence to mental health professionals show specificity and warning signs? Is this professional prepared for the variability of his / her duties? How to act on unexpected behavior? In order to answer these questions, this study aims to understand the activities performed by these professionals, identifying the difficulties and variabilities encountered and the determinants of risk. The methodology used was the observation of the activities and interviews and the application of the Work Accident Analysis and Prevention Model (MAPA) in three cases of occupational accidents selected in an Integrated Mental Health Care Center (CAISM). The results demonstrated that there are several determinants of aggression related to the characteristics of the patient with TMC and the presence of comorbidities. The existence or not of plans, programs and staff directed to the management of safety and health at work adequate to the characteristics of the patients attended and the lack of capacity of the professionals to act in the face of unexpected aggressive behavior represent fundamental factors in the occurrence or not of this undesired event .

A literatura científica biomédica tem apontado que pessoas em intenso sofrimento psíquico encontram no consumo de drogas um modo de lidar com esse sofrimento. Assim, o consumo de drogas tem alta prevalência entre pessoas que apresentam algum quadro clínico psiquiátrico e este aparece muitas vezes como uma estratégia de lidar com os sintomas. Em contrapartida, este consumo aparece descrito como causador de pior prognóstico, colocando o usuário em situações de maior vulnerabilidade. Esta pesquisa teve como objetivo compreender a perspectiva de profissionais de um serviço de saúde mental sobre o consumo de drogas por pessoas em tratamento psiquiátrico. O estudo tem caráter qualitativo, descritivo e exploratório e foi aprovado por Comitê de Ética em Pesquisa. Foram realizadas entrevistas semi-estruturadas com 16 profissionais de um Centro de Atenção Psicossocial III (CAPS) do interior de São Paulo. Para a análise dos dados, considerou-se o papel da linguagem como construtora da realidade. Foi realizada análise de conteúdo temática, sendo construídas quatro categorias: Especificidades do contexto; O fenômeno da droga; O uso de drogas durante o tratamento psiquiátrico; e Fronteira entre a saúde mental e o uso de drogas. Os profissionais destacaram a presença do uso de drogas em pacientes do serviço, apesar da disposição da rede local em dividir o cuidado às duas demandas. Os participantes compreendiam que o sofrimento era o principal motivador para o uso de drogas nesta população. A identificação do consumo foi tema relevante para os profissionais não havendo, porém, protocolo específico para isto. O vínculo estabelecido com o paciente foi apontado como principal estratégia para identificação. O uso de drogas em pacientes do CAPS foi relatado como fomentando preconceito por parte de alguns profissionais, influenciados pelo discurso moral na construção de sentidos sobre os usuários de drogas. O tabaco não era descrito como uma droga, sendo algumas vezes compreendido inclusive como parte do tratamento no CAPS. Os discursos moral e biomédico construindo sentidos sobre o uso de drogas concorrem nas falas dos profissionais para explicar o fenômeno da droga. Da mesma forma, estratégias de cuidado dividem-se entre aquelas voltadas à redução de danos ou em busca da abstinência, sendo mais prevalentes as voltadas à abstinência. O papel central atribuído ao medicamento no tratamento suscitou questionamentos a respeito do lugar ocupado por este como droga ou como tratamento. Ações que proporcionem aos profissionais mais espaços para construção de sentidos a respeito do tema, seja de mais ajuda do que apenas uma divisão arbitrária (e aparentemente impossível de ser implementada na prática) entre as duas demandas. O momento das entrevistas foi uma oportunidade para a construção destes sentidos. / Biomedical scientific literature has showed that people under severe mental suffering conditions usually consume drugs as a coping strategy. Therefore, the drug consumption has high prevalence in psychiatric patients and is frequently described as a coping strategy to deal with theirs symptoms. On the other hand, this drug consumption is described as causing poorer prognosis, including putting the users in vulnerable situations. This research aimed to understand the perspective of professionals from a mental health service about the patients drug use during psychiatric treatment. This study is qualitative, descriptive and exploratory and was approved by the Research Ethics Committee. Sixteen semi-structured interviews were conducted with professionals of a Psychosocial Care Center (CAPS- 3) in a medium city in the countryside of São Paulo state. For data analysis, we consider the role of language as a constructor of reality. A thematic content analysis was performed, resulting in four categories: Particularities of the context; the drug phenomena; drug use during psychiatric treatment; and the boundaries between mental health and drug use. The professionals highlighted a perceived presence of drug use in patients, despite of the local network willingness in offering care for both demands. Participants understood that suffering was the main motivator for the use of drugs in this population. Identifying the drug consumption was a relevant issue for professionals, however, there was no specific protocol to address this issue. Establishing bonding with the patient was pointed out as the main strategy for drug use identification. The drug use in CAPS patients was reported as contributing to the stigma by some professionals, mostly influenced by the moral discourse on meaning making attributed to drug users. Tobacco was not described as a drug, and sometimes was even understood as part of treatment in CAPS. Both moral and biomedical discourses constructed meanings about the use of drugs compete in the professionals´ speeches to explain the drug phenomena. Similarly, care strategies were divided between those aiming to reduce damage or seeking withdrawal, and the most prevalent ones were those focused on drug abstinence. The central role assigned to medication in the treatment raised questions about the place occupied by the medication as drug or as a treatment tool. Actions providing professionals more opportunities for meaning making about this subject can be more helpful than the currently arbitrary division (and seemingly impossible to implement in practice) for addressing both demands. The interviews offered the professionals an opportunity for the construction of these meanings and senses.

A Incontinência Urinária (IU) é um sintoma multifatorial associado ao estilo de vida, sendo uma disfunção anatomopatológica que interfere, principalmente, na saúde da mulher. Objetivo: O estudo teve como objetivo analisar a prevalência de incontinência urinária e fatores associados em profissionais de enfermagem que atuam em um Hospital Universitário de Ribeirão Preto-SP. Materiais e Método: Trata-se de uma pesquisa descritiva e exploratória de corte transversal com abordagem quantitativa, sobre a prevalência e fatores associados à incontinência urinária entre estes profissionais. A população foi composta por 119 profissionais das unidades de Clínica Médica (CM),Clínica Cirúrgica (CC),Ginecologia (GO) e Obstétricia (OBST), nas categorias de enfermeira, técnica de enfermagem e auxiliar de enfermagem; o período de coleta de dados foi de Junho a Outubro de 2010 .Foi solicitada a autorização da Divisão de Enfermagem do HCFMRP-USP e , posteriormente, enviado o projeto para análise do Comitê de Ética em Pesquisa (CEP) da mesma instituição. Este procedimento visa a preservação dos aspectos éticos relacionados à pesquisa envolvendo seres humanos, segundo a resolução 196/96. Resultados: Das 91 mulheres entrevistadas a maioria estava na média de 40 anos e 58 (65,17%) eram de raça branca apresentaram uma prevalência de incontinência urinária de 30,94%. As categorias profissionais que apresentaram sintomas de incontinência urinária foram as técnicas e auxiliares de enfermagem (25,48%), as enfermeiras (5,46%). Entre os tipos de sintomas de perdas de urina mais prevalentes foram perdas pelo menos uma vez ao mês com 34,12%, as perdas por algum motivo 20,24%%, perdas antes de chegar ao banheiro 20,24%. Os sintomas IU causaram algumas alterações na vida das mulheres, tais como, alterações nas atividades ocupacionais, falta de concentração, baixa produtividade, estresse e fadiga, o aumento da perda urina devido às atividades executadas, a não realização de algumas atividades no trabalho para evitar as perdas de urina, o manejo para facilitar as trocas de roupa, o uso de absorvente ou ir ao banheiro, as dificuldades para interromper as atividades para ir ao banheiro. Os sintomas de incontinência urinária foram associados a diversas variáveis qualitativas como hipertensão, menopausa, intestino preso, atividade física e categoria profissional. Indicou que hipertensão (0,049) e menopausa (0,022). Estão associados às perdas de urina quando tossem, espirram ou fazem algum esforço. Os sintomas de incontinência urinária foram associados às diversas variáveis quantitativas como idade, IMC, ingestão de café (número de copos), número de gravidez, peso médio do recém-nascido (RN), tabaco e paridade, e indicou que as pessoas que perdem urina pelo menos uma vez no mês são as que apresentaram maiores índices de massa corporal (0,001) e ingeriam mais café diariamente ( 0,027). Quanto as que perdiam urina quando tossiam, espirravam, levantavam peso ou faziam algum tipo de esforço são as que apresentaram idade (0,036), IMC (0,029), gravidez (0,003) e paridade (0,009). Entre as mulheres que apresentaram perda de urina antes de chegar ao banheiro e as que não apresentaram tal perda quando comparadas às variáveis, estavam associadas ao IMC (0,029) e ingestão de café (0,001). Conclusão: Foi observada uma grande prevalência de sintomas de incontinência urinária entre os profissionais de enfermagem; também, os fatores associados podem influenciar tanto no desenvolvimento de IU quanto na piora dos sintomas. A maioria destas mulheres encontra algumas dificuldades para o manejo das perdas de urina devido às suas atividades laborais. / The Urinary Incontinence (UI), anatomopathological dysfunction, is a multifactorial symptom associated to the lifestyle that interferes, mainly, in the woman\'s health. Objective: This study aimed at analyzing the prevalence of urinary incontinence and factors associated with nursing professionals that wok at a University Hospital of Ribeirão Preto-SP. Materials and Method: This is a descriptive, exploratory, cross-sectional study with quantitative approach, about the prevalence and associated factors to the urinary incontinence among these professionals. The population comprised 119 professionals from the Medical Clinics (MC), Surgery Clinics (SC), Gynecological Clinics (GC) and Obstetrics (OBST) units. These professional categories were: nurse, nursing technician and nursing auxiliary. Data collection was in the period from June to October 2010. The authorization from of the Nursing Division of HCFMRP-USP was requested and, later, the project was sent to its Research Ethics Committee for informed consent to preserve the ethical aspects related to the research involving human beings, according to the resolution 196/96. Results: Out of the 91 interviewed women; most of them was the mean age of 40 years, and 58 (65.17%) were white race; they presented a 30.94%-urinary incontinence prevalence. The professional categories that presented symptoms of urinary incontinence were the nursing technicians and auxiliaries (25.48%), the nurses (5.46%). The most prevalent types of symptoms of urine losses were: losses at least once a month (34.12%), losses for some reason (20.24%%), losses before arriving to the bathroom (20.24%). The UI symptoms have caused some alterations in the women\'s life, such as, alterations in the occupational activities, lack of concentration, low productivity, stress and fatigue, the increase of the urine loss due performed activities, the non accomplishment of some activities in the work to avoid the urine losses, the handling to ease cloth changes, the absorbent use or to go to the bathroom, the difficulties to interrupt the activities to go to the bathroom. The symptoms of urinary incontinence were associated to several qualitative variables as hypertension, menopause, intestine constipation, physical activity and professional category. indicated that hypertension (0.049) and menopause (0.022). They are associated to the urine losses when they cough, sneeze or make some effort. The symptoms of urinary incontinence were associated to the several quantitative variables as age, IMC, Coffee intake (number of glasses), number of pregnancy, the newborn´s medium weight (NB), tobacco and parity, and it pointed out that the women losing urine at least once in a month were the ones that presented higher indexes of body mass (0.001).moreover, they drink more coffee daily (0.027). While the ones that lost urine when they coughed, sneezed, lifted weight or made some type of effort are the ones aged (0.036), IMC (0.029), pregnancy (0.003) and parity (0.009). The women with urine loss before arriving to the bathroom were associated with BMI (0.029) and coffee intake (0.001). Conclusion: A great prevalence of symptoms of urinary incontinence among the nursing professionals was observed; also, the associated factors can influence either in the UI development or in the worsening of symptoms. Most of these women have found some difficulties to handle the urine losses due to their working activities.