Facteurs contextuels dans l'évaluation d'une politique de santé maternelle au Burkina Faso

Cette thèse s’intéresse à l’influence des facteurs contextuels sur la mise en œuvre et les effets d’une politique de santé maternelle au Burkina Faso. Cette politique nommée la subvention SONU vise à faire augmenter la couverture des accouchements dans les établissements de santé publics en agissant sur l’accessibilité économique des ménages. La thèse propose une évaluation des processus de cette politique. Le cadre d’analyse repose sur des propositions théoriques issues du champ de l’étude des politiques sanitaires (les acteurs et leurs relations de pouvoir) et de l’anthropologie médicale critique (les représentations). L’étude s’est déroulée dans le district sanitaire de Djibo, situé dans la région du Sahel. Il s’agit d’une étude de cas multiples où chaque centre de santé représentait un cas. L’approche méthodologique employée était qualitative. Une enquête de terrain, des entretiens, des groupes de discussion, des observations non participantes et une analyse documentaire ont été les méthodes de collecte de données utilisées. Les résultats préliminaires de l’étude ont été présentés aux parties prenantes. Le premier article évalue l’implantation de cette subvention SONU au niveau d’un district et rend compte de l’influence des rapports de pouvoir sur la mise en œuvre de cette dernière. Les résultats indiquent que toutes les composantes de cette subvention sont mises en œuvre, à l’exception du fond d’indigence et de certaines composantes relatives à la qualité technique des soins telles que les sondages pour les bénéficiaires et l’équipe d’assurance qualité dans l’hôpital du district. Les professionnels et les gestionnaires de la santé expliquent les difficultés dans l’application de politique de subvention par un manque de clarté et de compréhension des directives officielles. Les relations de pouvoir entre les différents groupes d’acteurs ont une influence sur la mise en œuvre de cette politique. Les rapports entre gestionnaires du district et agents de santé sont basés sur des rapports hiérarchiques. Ainsi, les gestionnaires contrôlent le travail des agents de santé et imposent des changements à la mise en œuvre de la politique. Les rapports entre soignants et patients sont variables. Dans certains centres de santé, les communautés perçoivent positivement cette relation alors que dans d’autres, elle est perçue négativement. Les perceptions sur les relations entre les accoucheuses villageoises et les agents de santé sont également partagées. Pour les agents de santé, ces actrices peuvent être de potentielles alliées pour renforcer l’efficacité de la politique SONU en incitant les femmes à utiliser les services de santé, mais elles sont aussi perçues comme des obstacles, lorsqu’elles continuent à effectuer des accouchements à domicile. Les difficultés de compréhension des modalités de remboursement entrainent une rigidité dans les rapports entre agents de santé et comités de gestion. Le deuxième article vise à comprendre la variation observée sur la couverture des accouchements entre plusieurs centres de santé après la mise en œuvre de cette politique SONU. Les facteurs contextuels et plus spécifiquement humains ont une influence sur la couverture des accouchements assistés. Le leadership des agents de santé, caractérisé par l’initiative personnelle, l’éthique professionnelle et l’établissement d’un lien de confiance entre les populations et l’équipe sanitaire expliquent la différence d’effets observée sur la couverture des accouchements assistés après la mise en œuvre de cette dernière. Le troisième article analyse l’usage stratégique des référentiels ethnoculturels par certaines équipes sanitaires pour expliquer l’échec partiel de la politique SONU dans certains centres de santé. La référence à ces facteurs vise essentiellement à normaliser et légitimer l’absence d’effet de la politique sur la couverture des accouchements assistés. Elle contribue également à blâmer les populations. Enfin, le recours à ces référentiels tend à écarter les interprétations socioéconomiques et politiques qui sous-tendent la problématique des accouchements dans les établissements de santé publics. Sur le plan pratique, cette thèse permet de mieux comprendre le processus de mise en œuvre d’une politique de santé maternelle. Elle montre que les dimensions relatives à l’équité et à la qualité des soins sont négligées dans ce processus. Cette recherche met en lumière les difficultés auxquelles sont confrontés les agents de santé dans la mise en oeuvre de cette politique. Elle met également en exergue les facteurs qui expliquent l’hétérogénéité observée sur la couverture des accouchements assistés entre les centres de santé après la mise en œuvre de cette politique. Sur le plan théorique, cette thèse montre l’importance d’identifier les rapports de pouvoir qui s’exercent entre les différents acteurs impliqués dans les politiques sanitaires. Elle rappelle l’influence considérable des facteurs contextuels sur la mise en œuvre et les effets des politiques. Enfin, cette recherche révèle le poids des représentations sociales des acteurs dans la compréhension des effets des politiques. Cette thèse contribue au développement des connaissances dans le champ des politiques publiques sur le plan des thématiques abordées (mise en œuvre, rapports de pouvoir) et de l’approche méthodologique (enquête de terrain) utilisée. Elle participe aussi aux réflexions théoriques sur le concept de leadership des professionnels de la santé en Afrique.

Potencialidades terapéuticas del juego de rol

Esta investigación cualitativa-cuantitativa tiene como objetivo explorar las potencialidades terapéuticas del Juego de Rol, las cuales no han sido objeto de estudio. Se realizó con cinco estudiantes de colegio y cuatro de universidad, aplicándoles las escalas 16PF, SASS, ocho sesiones de juego de rol (Dungeons and dragons) y Grupos de Discusión. Se concluyó que no hay diferencia entre la adaptación pre y post. Los estudiantes de Colegio tienen características de personalidad similares en escala de Autosuficiencia, Apertura al Cambio y Aprensión, los universitarios en Atrevimiento, Vigilancia, Abstracción y Aprensión y dimensión global de Ansiedad. El Juego de Rol mejora las relaciones interpersonales dentro y fuera del grupo de juego, la expresión de sentimientos repercute fuera del Juego, la principal diferencia entre la experiencia de juego y la Vida Real es la libertad para romper las normas sociales. El trabajo en Equipo es una enseñanza primordial, contribuye a la toma de decisiones, proyección como mecanismo de defensa, capacidad Imaginativa inherente, desarrollo de la empatía, socialización, potenciación de habilidades no explotadas, encuentro de intereses, toma de conciencia, responsabilidad y sublimación de aspectos reprimidos de la personalidad.

La mejora de la calidad de vida de las personas con lesión medular: la transición del centro rehabilitador a la vida cotidiana desde la perspectiva de los usuarios

El retorno a la vida cotidiana para una persona con lesión medular después del periodo de rehabilitación en régimen hospitalario, es un proceso difícil no exento de dificultades y nuevos retos personales. En este trabajo nos planteamos identificar aquellos factores más relevantes que contribuyen a mejorar su calidad de vida, desde la perspectiva de las propias personas afectadas. Hemos realizado dos grupos de discusión: uno formado por 12 personas con paraplejia y otro formado por 6 personas con tetraplejia. El análisis de contenido realizado indica que, para los participantes existen dos dimensiones relacionadas con su percepción de calidad de vida una vez salen del centro de rehabilitación: a) necesidad de atención al entorno más próximo y b) preparación para el mundo real. Concluimos señalando la importancia de realizar programas de rehabilitación integral, que incluyan, rehabilitación física, aprendizaje de habilidades que posibiliten el máximo de independencia y autonomía personal y trabajo de apoyo a la familia

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Preparadurías estudiantiles como proceso de aprendizaje colaborativo entre estudiantes de ingeniería de la UNEXPO, Vicerectorado de Puerto Ordaz

Se trata de una investigación que se realizó en la Universidad Nacional Experimental Politécnica "Antonio José de Sucre" (UNEXPO), Vicerrectorado Puerto Ordaz, Venezuela, referida al estudio e intervención educativa en el programa de preparadurías (mecanismo de asesoramiento académico entre estudiantes de ingeniería), en el ámbito de matemática I (asignatura crítica), que desarrolló procesos participativos de enseñanza-aprendizaje en aula fundamentados en una metodología colaborativa, de cara a la promoción de un cambio educativo. La investigación tiene como propósito promover la mejora de los procesos de enseñanza aprendizaje que se desarrollan en este programa, facilitando la participación de los preparadores en un proceso de intervención. Las acciones que orientaron la intervención en el aula, se fundamentan en una concepción constructivista y sociocultural de los procesos de enseñanza-aprendizaje, que otorgan un papel preponderante a la actividad del alumno mediada por factores de su contexto educativo. Desde el punto de vista metodológico, estamos frente a un tipo de investigación interpretativa, sustentada operacionalmente por la metodología cualitativa. Para llevarla a cabo, se definieron tres fases interconectadas en el proceso investigativo: descriptiva, de intervención y valoración; destacando que la fase intervención en el aula, se inspiró en la investigación-acción, como mecanismo indagatorio y propulsor de la transformación en la práctica. En estas fases, fue predominante la identificación de informantes clave de acuerdo a momentos y ámbitos de actuación y combinaciones que relacionaban técnicas narrativas como los grupos de discusión, entrevistas cualitativas y la observación, entre otras. Los resultados más resaltantes, tienden a realizar una caracterización exhaustiva de las preparadurías, describir de forma pormenorizada la experiencia vivida con los preparadores, la cual trata de aportar una estrategia pedagógica en matemática I, traducida en el aprovechamiento de las relaciones simétricas entre alumnos en ambientes colaborativos. La investigación permite a la UNEXPO, otras universidades y a la comunidad educativa, evaluar la posibilidades que ofrece una propuesta innovadora de enseñanza-aprendizaje en matemática I, que puede orientar las acciones pedagógicas en una de las asignaturas con más bajo porcentaje de promoción; combinando la colaboración, participación; explorando y aprovechando las relaciones entre iguales en ambientes alternativos de aprendizaje como las preparadurías.

Soil fertility management in the mid-hills of Nepal: Practices and perceptions

Sustaining soil fertility is essential to the prosperity of many households in the mid-hills of Nepal, but there are concerns that the breakdown of the traditional linkages between forest, livestock, and cropping systems is adversely affecting fertility. This study used triangulated data from surveys of households, discussion groups, and key informants in 16 wards in eastern and western Nepal to determine the existing practices for soil fertility management, the extent of such practices, and the perception of the direction of changes in soil fertility. The two principal practices for maintaining soil fertility were the application of farmyard manure (FYM) and of chemical fertilizer (mainly urea and diammonium phosphate). Green manuring, in-situ manuring, slicing terrace risers, and burning plant residues are rarely practiced. FYM usage was variable with more generally applied to khet land (average 6053 kg fresh weight manure ha(-1)) than to bari land (average 4185 kg fresh weight manure ha-1) with manure from goats and poultry preferred above that from cows and buffaloes. Almost all households (98%) apply urea to khet land and 87% to bari land, with 45% applying diammonium phosphate to both types of land. Application rates and timings of applications varied considerably both within and between wards suggesting poor knowledge transfer between the research and farming communities. The benefits of chemical fertilizers in terms of ease of application and transportation in comparison with FYM, were perceived to outweigh the widely reported detrimental hardening of soil associated with their continued usage. Among key informants, FYM applied in conjunction with chemical fertilizer was the most popular amendment, with FYM alone preferred more than chemical fertilizer alone - probably because of the latter's long-term detrimental effects. Key informant and householder surveys differed in their perception of fertility changes in the last decade probably because of differences in age and site-specific knowledge. All key informants felt that fertility had declined but among households, only about 40% perceived a decline with the remainder about evenly divided between no change and an increase. Householders with small landholdings (< 0.5 ha) were more likely to perceive increasing soil fertility while those with larger landholdings (> 2 ha) were more likely to perceive declining fertility. Perceived changes in soil fertility were not related to food self-sufficiency. The reasons for the slow spread of new technologies within wards and the poor understanding of optimal use of chemical fertilizers in conjunction with improved quality FYM may repay further investigation in terms of sustaining soil fertility in this region.

Selected topics in probiotics and prebiotics: meeting report for the 2004 international scientific association for probiotics and prebiotics

On August 2931, 2004, 84 academic and industry scientists from 16 countries gathered in Copper Mountain, Colorado USA to discuss certain issues at the forefront of the science of probiotics and prebiotics. The format for this invitation only meeting included six featured lectures: engineering human vaginal lactobacilli to express HIV inhibitory molecules (Peter Lee, Stanford University), programming the gut for health (Thaddeus Stappenbeck, Washington University School of Medicine), immune modulation by intestinal helminthes (Joel Weinstock, University of Iowa Hospitals and Clinics), hygiene as a cause of autoimmune disorders (G. A. Rook, University College London), prebiotics and bone health (Connie Weaver, Purdue University) and prebiotics and colorectal cancer risk (Ian Rowland, Northern Ireland Centre for Food and Health). In addition, all participants were included in one of eight discussion groups on the topics of engineered probiotics, host-commensal bacteria communication, 'omics' technologies, hygiene and immune regulation, biomarkers for healthy people, prebiotic and probiotic applications to companion animals, development of a probiotic dossier, and physiological relevance of prebiotic activity. Brief conclusions from these discussion groups are summarized in this paper.

Percepção ambiental de crianças em ambientes naturais protegidos

This study aimed at exploring and describing children s perceptions in threatened natural settings, specifically, the Rain Forest in Brazil. Several studies point to the significance of perceptions for people s pro-environmental attitudes and actions. We try to understand the person-environment interaction from an ecological perspective, and we present theoretical references for the understanding of how crucial nature is for psychological development and well-being. The children s drawings, individual interviews, discussion groups, photographies and informal and indirect sources, as teachers, brought material for the analysis. Participated in our study, carried on through a multi-method strategy, 209 children from six to eleven years old, living in the neighborhood of the Biological Reserve of Una, State of Bahia, created to protect Rain Forest fragments. The Rain Forest landscape is well portrayed in children s drawings, the vegetal elements prevailing over artificial and human elements. The figured plants and trees, however, are pointed with no precision as to their species. Most of the defined species are eatable. The children seem to be aware of the environment degradation, and of the importance of its conservation, but they describe episodes of hunting and feeding wild threatened animals. Our results indicate a utilitarian trend in the perception of living beings, in terms of their immediate usefulness for people. The multimethod approach seems to be appropriate to the complexity of the theme; the methodological strategies were well accepted by the children, offering them opportunities to express themselves. We observed how children, in different life phases, organize natural elements and processes in their drawings, and how these images relate to the local landscape. We discuss the results in the light of theoretical references of personenvironment studies and from previous investigations about children s perceptions of natural environment

Diabetes auto-referido em idosos: prevalência, fatores associados e práticas de controle

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Multilateral rules on competition policy: an overview of the debate

Includes bibliography

Informática e ensino de química: investigando a experiência de um grupo de professores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O movimento negro e o processo de elaboração das diretrizes curriculares nacionais para a educação das relações étnico-raciais

Esta pesquisa situa-se no campo de estudo sobre currículo e versa sobre a atuação do movimento negro no processo de elaboração das Diretrizes Curriculares Nacionais para a Educação das Relações Étnico-Raciais (DCNERER). Esta Diretriz é uma das ações promovidas pelo governo brasileiro decorrente da atual política curricular adotada pelo Estado. A abordagem metodológica adotada foi de cunho qualitativo e teve como técnicas de coleta de dados a pesquisa documental e aplicação de questionários aos ex -conselheiros, membros da comissão responsável pelo Parecer 03/2004 do Conselho Nacional de Educação (que fundamenta as Diretrizes) e a militantes do movimento negro que participaram do processo de elaboração das DCNERER. O envio dos questionários aos militantes negros foi feito pela internet, para grupos de discussão sobre as relações raciais e educação e a uma lista de endereços eletrônicos de entidades do movimento negro de todo o Brasil. As resposta s dos questionários foram devolvidas por militantes representantes de grupos e entidades do movimento, que têm experiência de militância expressiva e que em suas atividades, são professores e desenvolvem projetos que tratam da questão racial na escola. Os resultados da pesquisa apontam que o movimento negro foi um importante ator do processo de elaboração das Diretrizes Curriculares, tendo o mesmo participado ativamente, apresentando propostas gerais e reafirmando proposições históricas. A atuação do movime nto negro foi importante na elaboração das Diretrizes, pois demarcou politicamente o espaço e as propostas do movimento. Defendo que ao fazer uma avaliação positiva das DCNERER, o movimento negro não consegue analisar a estratégia ideológica de formação de identidades subjacente na política curricular do qual estas Diretrizes fazem parte.

Relações sociais na escola: representações de alunos negros sobre as relações que estabelecem no espaço escolar

Este trabalho faz uma abordagem do tema educação e relações raciais, tendo como objeto de investigação as relações sociais que os alunos negros estabelecem dentro do espaço escolar, a partir de suas representações. Para tal intento, adotamos, além das formulações de Pierre Bourdieu (1980, 1982, 1983,1998, 1999,2002) sobre as relações sociais, um diálogo com a teorização de Roger Chartier (1991, 1994) na discussão das representações como classificações responsáveis pela organização e apreensão do mundo social (CHARTIER, 1991). Tais aportes serão lidos em correlação com os estudos contemporâneos sobre as relações raciais e a educação (CAVALLEIRO, 2000, 2001, 2005; COELHO, 2003, 2006, 2007, 2009; GOMES, 2001, 2003, 2005, 2006). A partir das relações que permeiam o universo das representações e da proposição de Telles (2003) - ao considerar as escolas como os locais mais importantes para examinar a discriminação racial - pretendemos desenvolver uma análise objetivando investigar que representações os alunos negros possuem acerca das relações sociais que estabelecem em sua escola. A efetivação desse estudo ocorreu junto a alunos de 7a e 8a séries, em duas escolas de Ensino Fundamental, situadas no município de Ananindeua, integrante da região metropolitana de Belém. Para o tratamento dos dados obtidos por meio da observação, aplicação de questionários e reuniões de Grupos de Discussão no lócus de investigação, adotamos algumas técnicas da Análise de Conteúdo (BARDIN, 1977) dada a possibilidade da obtenção de uma leitura que realce outros sentidos que estão subjacentes às mensagens, atendendo assim ao objetivo deste trabalho.

Alimentação escolar e agricultura familiar: a viabilidade da aplicação da lei federal 11.947 de 2009 sob o ponto de vista de diferentes atores sociais

Pós-graduação em Geografia - IGCE

O apoio institucional como uma das faces da função apoio no Núcleo de Apoio à Saúde da Família (NASF): para além das diretrizes

The aim of this study was to add to the debate about Family Health Support Centers (FHSCs), starting from reflections about the support function. Support is generally presented, in official documents from the Ministry of Health and in academic-scientific publications, accompanied by descriptors that characterize it. Differences in terminology are commonly encountered: “institutional support”, “managerial support”, “matrix support” and so on. With regard to FHSCs, published papers have highlighted the central role played by matrix support. However, we pose the question: what are the faces that the support function has been taking on in implementing such programs? To reflect on this and other issues, we developed a study of qualitative nature within a FHSC team in Paraná, outside of the state capital, using the methodological tools of participant observation, semi-structured interviews and discussion groups. We sought to demonstrate that the dynamics of the support function in FHSCs make it possible for both matrix support and institutional support to emerge.