Ihanteena vapaaehtoisuus : Diakoniatyö Porvoon hiippakunnan seurakunnissa, erityisesti Iitin ja Tampereen rovastikunnissa vuosina 1897-1923

The Ideal of Volunteerism. An institutional approach to social welfare work in the parishes of the Diocese of Porvoo especially in the deaneries of Iitti and Tampere, Finland, in the years 1897-1923 Social welfare work (also known as diakonia) has achieved a high status in the Evangelical Lutheran Church of Finland. Since 1944, provisions of the Finnish Church Act have obliged each parish to employ at least one deacon or deaconess. This study sets out to examine the background and development of social welfare work in the Evangelical Lutheran Church of Finland from the 1890s to the 1920s, by which time social welfare work had become an established practice in the Church. The study investigates the development of social welfare work on the level of parishes. The main source material was collected from sixteen parishes in the Diocese of Porvoo especially in the deaneries of Iitti and Tampere. In the 1890s, two approaches were used in church social work in Finland. The dioceses of Kuopio, Savonlinna and Turku pursued a congregational approach to social work, while the Diocese of Porvoo employed an institutional approach, mainly because of the influence of Bishop Herman Råbergh. This study charts the formation of church social work in Finnish parishes, which took place during a period of tension between the two approaches. The institutional approach to church social work adopted by the Diocese of Porvoo was based on the German system of Asisters= houses@, in which deaconess institutes sent parish sisters to serve congregations. The parish or, in many cases, a separate association dedicated to church social work paid an annual fee to the deaconess institute, which took care of the parish sisters in old age. In the institutional approach, volunteers were recruited to carry out church social work. It was considered as inappropriate to use tax revenue or other public funding for church social work, which was supposed to be based on Christian love for one=s fellow humans and the needy, and for which only voluntary financial contributions were supposed to be used. In the congregational approach, church social work was directly based on the efforts of the parish. The approach relied on the administrative bodies of parishes and the Church, and tax revenue collected by the parishes, as well as other forms of public funding, could be used to carry out the social welfare work. The parishes employed deacons and deaconesses and paid their salaries. The approaches described above were not pursued in their ideal forms; instead, many variations existed. However, in principle, the social welfare work undertaken by the parishes of the Diocese of Porvoo was based on the institutional approach, while the congregational approach was largely employed elsewhere in Finland. Both of the approaches were viable. Parishes began to employ deacons and deaconesses as of the 1890s. The number of parishes which had hired a deacon or deaconess increased particularly in the 1910s, by which time 60% of parishes had employed one. This level was maintained until 1944 when each parish in the Evangelical Lutheran Church of Finland was obliged to employ a deacon or deaconess. Deaconesses usually worked as travelling nurses. The autonomous status of Finland as part of the Russian Empire did not give Finns the right to develop legislation on social affairs and health care. Consequently, the legislation process did not begin until Finland gained its independence in 1917. The social welfare work carried out by parishes and a number of voluntary organisations satisfied the emerging need for medical treatment in Finnish society. Neither the government nor the municipalities had sufficient resources to provide this treatment. Based on the ideal of volunteerism, the institutional social work practiced in the Diocese of Porvoo ran into serious difficulties at the end of the First World War. Because of severe inflation, prices began to rise as of 1915 and tripled in 1917-1918. During the same period, Finnish society went through a deep crisis which escalated into Civil War in spring 1918. This period of economic and social turmoil marked a turning-point which led to a weakening of the status of institutional social work in parishes. Voluntary efforts were no longer sufficient to maintain the practice. In contrast, congregational social work, which was based on public funding, was able to cope with the changes and survived the crisis. The approach to social work adopted by the Diocese of Porvoo turned out to be no more than a brief detour in the history of social work in the Evangelical Lutheran Church of Finland. At the start of the 1920s, the two approaches were integrated into a common vision for establishing church social work as a statutory practice in parishes.

To ask or not to ask? Investigating workers' flexibility requests and the phenomenon of discontented non-requesters

Flexible working arrangements have attracted growing attention in workplaces across Australia and in many other countries in recent years. This contribution utilises the results of two large Australian employee surveys to analyse who asks for flexibility, why, and with what effects on work-life interference. This analysis is set in the context of Australia’s ‘Right to Request’ (RTR) provisions which, at the time of the study, gave parents of preschool children and those with a disabled child aged up to 18 the RTR flexibility. The analysis also draws on a set of qualitative interviews of those we term ‘discontented non-requesters’ (that is, those who are not content with current arrangements but who do not ask for flexibility) to probe beneath the survey results to consider explanations about why some people do not ask for flexibility despite desiring different working arrangements. We conclude with the implications for policy and regulation.

Men´s health behaviour, health beliefs and need for health counselling : A study amongst 40-year-old males from one Helsinki City region

Tavoitteena oli tutkia 40-vuotiaiden miesten terveyskäyttäytymistä, terveysuskomuksia ja miesten saamaa terveysneuvontaa Helsingissä. 273 miestä vastasi kyselyyn ja osallistui terveystutkimuksiin. Terveydentilan perusteella miehet arvioitiin matalan (n=145) ja korkean (n=128) riskin ryhmiin. Khin neliö-testillä tutkittiin elämäntapa- ja riskitekijöitä koetun terveyden (hyvä, keskinkertainen/huono) luokissa ja verrattiin matalan ja korkean riskin ryhmiä em. tekijöiden osalta. Askeltavalla logistisella regressiomallilla analysoitiin tulosmuuttujia taustatekijöiden, terveyskäyttäytymisen, terveysuskomusten ja kliinisten riskitekijöiden avulla sekä arvioitiin oireiden ja vaivojen suhdetta koettuun terveydentilaan. Korkeassa riskissä olevien terveyttä seurattiin vuosina 2001–2004 analysoimalla mini-intervention vaikutusta terveysriskeihin ja elintapoihin varianssianalyysin avulla (ANOVA) (n=46). Matalasta vastausprosentista johtuen (39.6%), ei-vastanneiden aineistoa kerättiin käyttämällä syvähaastattelua (n=28) sekä puhelinkyselyä (n=40). Lopullinen aineisto koostui 341 miehestä. Tulokset osoittivat, että miehillä oli sydän- ja verisuonitautiriskejä. Kaksi kolmesta osallistuneista oli ylipainoisia tai lihavia, yli kolmanneksella vyötärönympärys oli ≥100 cm, ja yli 40%:llä oli diastolinen verenpaine ≥90 mmHg. Yli puolet tupakoi päivittäin ja 40% käytti alkoholia runsaasti. Ristiriitaisuutta ilmensi se, että huolimatta riskitekijöistä noin puolet miehistä koki terveydentilansa hyväksi. Sairauden tai vamman puute, hyvä suun terveydentila ja normaali vyötärönympärys olivat yhteydessä hyväksi koettuun terveydentilaan. Suora yhteys voitiin havaita omaisten tarjoaman neuvonnan ja vähäisen alkoholin käytön välillä. Masennus ja unettomuus olivat voimakkaasti yhteydessä loppuun palamiseen. Miehillä oli erilaisia fyysisiä ja psyykkisiä oireita, jotka korreloivat voimakkaasti masennuksen kanssa. Pieni määrä miehistä koki saaneensa terveysneuvontaa hoitohenkilökunnalta verrattuna perheenjäseniltä saatuun ohjaukseen. Korkeariskisten miesten (n=46) arvot parantuivat merkitsevästi lyhyellä aikavälillä. Kolesteroliarvoja lukuunottamatta ne palautuivat kolmen vuoden kuluttua alkumittausarvoja kohti. Laadullinen tutkimus osoitti, että “ei-vastanneet“ eivät osallistuneet projektiin, sillä he olivat oireettomia tai kiireisiä. Heillä todettiin samoja terveysriskejä kuin projektiin osallistuneilla. Syvähaastattelussa miehet toivat esille kokemuksiaan huolista, vihan tunteista, peloista ja yksinäisyydestä. Hoidonantajien on tärkeää ymmärtää ristiriidat miesten subjektiivisen ja objektiivisen terveydentilan välillä, mikä auttaa havaitsemaan esteitä terveyskäyttäytymiselle. Yhä enemmän tarvitaan yhteistyötä yksityisen ja julkisen terveydenhuollon välillä varmistamaan terveystottumusten jatkuminen miesten keskuudessa.

Comprehending adverbs of doubt and certainty in health communication: A multidimensional scaling approach

This research explored the feasibility of using multidimensional scaling (MDS) analysis in novel combination with other techniques to study comprehension of epistemic adverbs expressing doubt and certainty (e.g., evidently, obviously, probably) as they relate to health communication in clinical settings. In Study 1, Australian English speakers performed a dissimilarity-rating task with sentence pairs containing the target stimuli, presented as "doctors' opinions". Ratings were analyzed using a combination of cultural consensus analysis (factor analysis across participants), weighted-data classical-MDS, and cluster analysis. Analyses revealed strong within-community consistency for a 3-dimensional semantic space solution that took into account individual differences, strong statistical acceptability of the MDS results in terms of stress and explained variance, and semantic configurations that were interpretable in terms of linguistic analyses of the target adverbs. The results confirmed the feasibility of using MDS in this context. Study 2 replicated the results with Canadian English speakers on the same task. Semantic analyses and stress decomposition analysis were performed on the Australian and Canadian data sets, revealing similarities and differences between the two groups. Overall, the results support using MDS to study comprehension of words critical for health communication, including in future studies, for example, second language speaking patients and/or practitioners. More broadly, the results indicate that the techniques described should be promising for comprehension studies in many communicative domains, in both clinical settings and beyond, and including those targeting other aspects of language and focusing on comparisons across different speech communities.

Dancing into the second phase of creative industries

As we enter the second phase of creative industries there is a shift away from the early 1990s ideology of the arts as a creative content provider for the wealth generating ‘knowledge’ economy to an expanded rhetoric encompassing ‘cultural capital’ and its symbolic value. A renewed focus on culture is examined through a regional scan of creative industries in which social engineering of the arts occurs through policy imperatives driven by ‘profit oriented conceptualisations of culture’ (Hornidge 2011, p. 263) In the push for artists to become ‘culturpreneurs’ a trend has emerged where demand for ‘embedded creatives’ (Cunningham 2013) sees an exodus from arts-based employment through use of transferable skills into areas outside the arts. For those that stay, within the performing arts in particular, employment remains project-based, sporadic, underpaid, self-initiated and often self-financed, requiring adaptive career paths. Artist entrepreneurs must balance creation and performance of their art with increasing amounts of time spent on branding, compliance, fundraising and the logistical and commercial requirements of operating in a CI paradigm. The artists’ key challenge thus becomes one of aligning core creative and aesthetic values with market and business considerations. There is also the perceived threat posed by the ‘prosumer’ phenomenon (Bruns 2008), in which digital on-line products are created and produced by those formerly seen as consumers of art or audiences for art. Despite negative aspects to this scenario, a recent study (Steiner & Schneider 2013) reveals that artists are happier and more satisfied than other workers within and outside the creative industries. A lively hybridisation of creative practice is occurring through mobile and interactive technologies with dynamic connections to social media. Continued growth in arts festivals attracts participation in international and transdisciplinary collaborations, whilst cross-sectoral partnerships provide artists with opportunities beyond a socio-cultural setting into business, health, science and education. This is occurring alongside a renewed engagement with place through the rise of cultural precincts in ‘creative cities’ (Florida 2008, Landry 2000), providing revitalised spaces for artists to gather and work. Finally, a reconsideration of the specialist attributes and transferable skills that artists bring to the creative industries suggests ways to dance through both the challenges and opportunities occasioned by the current complexities of arts’ practices.

Psychosocial processes of health behaviour change in a lifestyle intervention : Influences of gender, socioeconomic status and personality

Background: The onset of many chronic diseases such as type 2 diabetes can be delayed or prevented by changes in diet, physical activity and obesity. Known predictors of successful behaviour change include psychosocial factors such as selfefficacy, action and coping planning, and social support. However, gender and socioeconomic differences in these psychosocial mechanisms underlying health behaviour change have not been examined, despite well-documented sociodemographic differences in lifestyle-related mortality and morbidity. Additionally, although stable personality traits (such as dispositional optimism or pessimism and gender-role orientation: agency and communion) are related to health and health behaviour, to date they have rarely been studied in the context of health behaviour interventions. These personality traits might contribute to health behaviour change independently of the more modifiable domain-specific psychosocial factors, or indirectly through them, or moderated by them. The aims were to examine in an intervention setting: (1) whether changes (during the three-month intervention) in psychological determinants (self-efficacy beliefs, action planning and coping planning) predict changes in exercise and diet behaviours over three months and 12 months, (2) the universality assumption of behaviour change theories, i.e. whether preintervention levels and changes in psychosocial determinants are similar among genders and socioeconomic groups, and whether they predict changes in behaviour in a similar way in these groups, (3) whether the personality traits optimism, pessimism, agency and communion predict changes in abdominal obesity, and the nature of their interplay with modifiable and domain-specific psychosocial factors (self-efficacy and social support). Methods: Finnish men and women (N = 385) aged 50 65 years who were at an increased risk for type 2 diabetes were recruited from health care centres to participate in the GOod Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. The programme aimed to improve participants lifestyle (physical activity, eating) and decrease their overweight. The measurements of self-efficacy, planning, social support and dispositional optimism/pessimism were conducted pre-intervention at baseline (T1) and after the intensive phase of the intervention at three months (T2), and the measurements of exercise at T1, T2 and 12 months (T3) and healthy eating at T1 and T3. Waist circumference, an indicator of abdominal obesity, was measured at T1 and at oneyear (T3) and three-year (T4) follow-ups. Agency and communion were measured at T4 with the Personal Attributes Questionnaire (PAQ). Results: (1) Increases in self-efficacy and planning were associated with three-month increases in exercise (Study I). Moreover, both the post-intervention level and three-month increases (during the intervention) in self-efficacy in dealing with barriers predicted the 12-month increase in exercise, and a high postintervention level of coping plans predicted the 12-month decrease in dietary fat (Study II). One- and three-year waist circumference reductions were predicted by the initial three-month increase in self-efficacy (Studies III, IV). (2) Post-intervention at three months, women had formed more action plans for changing their exercise routines and received less social support for behaviour change than men had. The effects of adoption self-efficacy were similar but change in planning played a less significant role among men (Study I). Examining the effects of socioeconomic status (SES), psychosocial determinants at baseline and their changes during the intervention yielded largely similar results. Exercise barriers self-efficacy was enhanced slightly less among those with low SES. Psychosocial determinants predicted behaviour similarly across all SES groups (Study II). (3) Dispositional optimism and pessimism were unrelated to waist circumference change, directly or indirectly, and they did not influence changes in self-efficacy (Study III). Agency predicted 12-month waist circumference reduction among women. High communion coupled with high social support was associated with waist circumference reduction. However, the only significant predictor of three-year waist circumference reduction was an increase in health-related self-efficacy during the intervention (Study IV). Conclusions: Interventions should focus on improving participants self-efficacy early on in the intervention as well as prompting action and coping planning for health behaviour change. Such changes are likely to be similarly effective among intervention participants regardless of gender and educational level. Agentic orientation may operate via helping women to be less affected by the demands of the self-sacrificing female role and enabling them to assertively focus on their own goals. The earlier mixed results regarding the role of social support in behaviour change may be in part explained by personality traits such as communion.

Sosiaaliturvan ulkopuolella - kokemuksia kansalaisuuden reunalta

Muuttaessaan maasta toiseen ihminen kohtaa useita rajoja. Ylittäessään kohdemaan valtion rajan hän kulkee läpi ensimmäisestä maahanmuuton portista. Toinen raja erottaa tilapäiset asukkaat pysyvistä: tämän maahanmuuton toisen portin läpikulkemisen myötä yksilö pääsee osalliseksi sosiaalisista oikeuksista. Maahanmuuton viimeisestä portista kuljettuaan yksilö saavuttaa kyseisen valtion kansalaisuuden. (Hammar 1990, 21.) Tässä pro gradu -tutkielmassa tarkastelen toisen maahanmuuton portin aukeamista ja sosiaaliturvan piiriin pääsyä odottavien maahan-muuttajien kokemuksia. Käytän tarkastelussa sosiaalisen kansalaisuuden ja marginaalisuuden käsitteitä. Tutkielmassa selvitän, miten sosiaali- ja terveyspalveluiden sekä toimeentuloturvan ulkopuolelle jääminen vaikuttaa maahanmuuttajien arkeen ja miten he kokevat osallisuutensa ja jäsenyytensä yhteiskunnassa. Tutkimus on lähtökohdiltaan fenomenologis-hermeneuttinen ja sovellan lähestymistapana ko-kemuksiin keskittyvän narratiivista tutkimusta. Tutkimusaineisto on koottu kevään 2011 aikana ja se koostuu 10 teemahaastattelusta. Haastateltavien maahanmuuton keinot ja syyt vaihtelivat: he olivat saapuneet Suomeen perhesyistä, työn vuoksi tai hakeakseen turvaa. Haastateltavat tavoitettiin Helsingin Diakoniaopiston, Pro-tukipisteen, Kansainvälisen seurakunnan ja tuttava-verkostojen kautta. Aineiston analyysi toteutettiin sisällönanalyysillä Atlas-ohjelman avulla syksyn 2011 aikana. Toisen maahanmuuton portin aukeamisen odottaminen oli raskaaksi: tuota aikaa leimasi epä-varmuus, tyhjyys ja yksinäisyys. Sosiaaliturvan ulkopuolella jääminen aiheutti osalle haastatel-tavista taloudellisia vaikeuksia sekä ongelmia terveydenhuollon palveluiden piiriin pääsemisessä. Toisaalta apua hakeneet haastateltavat olivat sitä lopulta saaneet. Auttamistyön ammattilaiset ja maistraatti saivat haastateltavien kertomuksissa portinvartijan aseman. Kaikille sosiaaliturvan ulkopuolelle jääminen ei ollut ongelma vaan he kokivat sosiaaliturvan puutetta suuremmaksi ongelmaksi työnteko-oikeuden puuttumisen. Kuulumisen ja ulkopuolisuuden kokemus voivat olla läsnä samanaikaisesti, ja kuulumisesta neuvotellaan jatkuvasti esimerkiksi sosiaalisessa kanssakäymisessä tai palveluita hakiessa. Insti-tutionaaliset käytännöt ja poiskäännyttämisen kokemukset tuottavat marginaalisia identiteettejä. Tasavertainen oikeus sosiaaliturvaan vahvistaa kokemusta kuulumisesta ja kodista. Sosiaaliturva ei kuitenkaan yksin määritä kuulumisen ja kodin kokemusta vaan siihen vaikuttavat myös muut tekijät. Näistä tärkeimmät ovat kehon fyysinen sijoittuminen Suomeen, perhe- ja ystä-vyyssuhteet, työ, asunto ja rasismin kokemukset.

La deshumanización en la atención profesional : ¿vulnera el derecho a la intimidad?

Resumen: El problema de la deshumanización de la atención médica sido enfocado desde ópticas diferentes (y en diversos momentos históricos), ya sea desde la perspectiva del paciente, de los familiares o del propio equipo de salud que presta los servicios, pero no hay un estudio de las causas y de las posibles soluciones. Al realizar un recorrido de la atención profesional en el mundo de la salud observamos que solo podemos re humanizar esa atención con el compromiso directo de todos los participantes del equipo de salud para promover actos y condiciones que tengan como finalidad el respeto de los derechos humanos que se afirman en la dignidad de cada persona enferma. Creemos que esta presentación puede llevar a tomar conciencia sobre la vulnerabilidad de la intimidad en el proceso, hoy deshumanizante, de la atención profesional en el ámbito de la salud y desde este punto de partida asumiendo las responsabilidades subjetivas, sin anular la moralidad objetiva del hecho, comprometiéndonos a denunciar estas situaciones injustas y a trabajar día a día para humanizar la atención y de esta forma respetar el derecho a la intimidad.

Saturated duration of rectangular pressure pulse applied to rectangular plates with finite-deflections

The inequities in health care and housing access experienced by low-income women in the United States are a continuing concern. This article addresses the interrelationships between housing and health as experienced by low-income clients so that health care practitioners can begin to build active and effective health-promoting partnerships with clients, their families, and their communities. A case study is presented that describes the actual experience of a woman living in a low-income housing development and its effect on her health and access to health care. The importance of the role of midwives in addressing the health care and advocacy needs of women in substandard housing is highlighted.

Report of the Sea Turtle Health Assessment Workshop, 2-3 February 1998, Part I: Background and information needs

A two day workshop was convened on February 2-3, 1998 in Charleston, SC with 20 invited experts in various areas of sea turtle research. The goal of this workshop was to review current information on sea turtles with repect to health and identify data gaps. The use of a suite of health assessment indicators will provide insight on the health status of sea turtle populations. Since the relationship of health factors of sea turtles is limited, a seconde workshop was planned. Using a tiered approach, the first workshop we identified and reviewed the available, pertinent baseline information and data gaps. The second workshop will focus on developing the framework for the research plan. The workshops will address the use of integrated set of health parameters; specific objectives are: 1) Identify reliable indicators of health in sea turtles: assess advantages and disadvantages; determine new indicators/biomarkers which may be useful; 2) Review existing sea turtle field sampling projects; 3) Identify field projects suitable for inclusion for health assessment sampling; 4) Identify data gaps, particularly environmental characterization; 5) Identify new health assessment sampling sites, including reference site(s); and 6) Develop integrated five-year research plan, with focus on health assessment of environmental characterization. (PDF contains 174 pages)

Sexualidade, corpo e saúde masculinos: transformações e permanências nos discursos de homens e da revista Mens Health.

O estudo analisa os discursos de homens e da revista Mens Health acerca do corpo, saúde e sexualidade. Para a construção dos discursos dos homens, realizamos entrevistas semi-estruturadas com 19 homens leitores e nove não leitores. E dois eventos de grupos focais que reuniram 11 homens no total. Foi entrevistado também o editor da revista. Os principais conceitos norteadores deste trabalho foram os de gênero, sexualidade, poder e masculinidades hegemônicas e subalternas. Evidenciou-se que a revista está fortemente atrelada à sociedade de consumo ao estimular a inserção dos homens em um mercado de produtos e serviços até então estranhos a esse gênero. E que suas concepções sobre saúde estão relacionadas a de bem-estar e de individualização que se articulam com os discursos hegemônicos que vêm dando sentido às concepções de saúde e doença atualmente. A publicação investe fortemente na ideia de um corpo musculoso que proporcionará ganhos sociais, sexuais e profissionais aos sujeitos, nem sempre atrelado às questões de saúde. Ela ratifica a heterossexualidade do leitor projetado, expondo o corpo feminino e o sexo heterossexual e silenciando sobre outras formas de sexualidade. Por isso consideramos que a revista se vincula a uma concepção tradicional da masculinidade. Seus discursos, no entanto, não são monolíticos ou isentos de contradição, e também manifestam nuances relativas a um modelo mais contemporâneo de masculinidade, como quando apresenta a ideia de uma nova pedagogia da sexualidade e a valorização dos cuidados estéticos e de saúde com o corpo, aspectos considerados pouco próximos da masculinidade tradicional. Com relação aos discursos dos homens, evidenciou-se que a classe social e a geração são as variáveis mais importantes nas suas concepções sobre corpo, saúde e sexualidade masculina. Que, entre os não leitores, de modo geral, há evidências mais fortes de flexibilização com relação aos padrões mais tradicionais entre os homens mais jovens e/ou de classes mais altas. Enquanto os homens com idade acima dos 30 anos e das classes populares estão mais atrelados às concepções tradicionais. Entre os leitores, observou-se uma grande reflexividade com relação aos discursos da revista demonstrando que eles vêm se apropriando de forma importante dos discursos da revista e ressignificando suas concepções e práticas sobre os três temas da pesquisa a partir desses discursos. E, assim como os discursos da revista, os discursos dos homens, leitores ou não, também apresentaram aspectos contraditórios, ora demonstrando mais afiliação a um novo modelo de masculinidade, ora ao modelo mais tradicional.

Análise do cuidado em saúde na atenção básica em Piraí - RJ

A Estratégia de Saúde da Família é um dos movimentos adotados pelo Brasil para o alcance da universalidade de acesso aos serviços de saúde em todos os níveis de assistência, integralidade da atenção, preservação da autonomia, igualdade da assistência, direito à informação e participação da comunidade. Com a reorganização da prática assistencial, são esperados maior resolubilidade, vínculo, acesso e continuidade da atenção, através de equipe multidisciplinar. Diversos autores vêm-se debruçando na análise da adequação desse modelo com o cuidado em saúde e sua contribuição para o bom êxito do atendimento aos indivíduos, aliviando seus sofrimentos. O município de Piraí adotou esse modelo para 100% de sua população, em 2002. Este estudo tem por objetivo analisar o cuidado oferecido no município, na perspectiva teórica da integralidade, utilizando como condição traçadora o diabetes mellitus, descrevendo o desenvolvimento do atendimento e analisando o processo de trabalho à luz dos protocolos e normas recomendadas, assim como o cuidado na perspectiva do usuário. Foram realizadas entrevistas com profissionais que atuam há pelo menos três anos na mesma unidade e com usuários cadastrados minimamente por um ano, excluindo-se aqueles com quadros mais graves. Foi utilizado instrumento padronizado e elaborado com intenção de promover relatos sobre acesso, acolhimento, vínculo-responsabilização, coordenação de cuidado, uso de protocolos, resolubilidade, autonomia e percepção de cuidado pelo paciente em três unidades da estratégia de Piraí. A partir da análise dos resultados, observamos que o acesso aos serviços de saúde qualifica a atenção, por meio do atendimento personalizado e acolhedor, percebido a partir de relatos sobre o agendamento de 1 consulta, consulta subsequente, atendimento de emergência, acesso via telefone e priorização da população que reside em locais mais distantes da unidade. Com relação ao vínculo, os usuários reconhecem as profissionais que trabalham nas unidades, o que aproxima a equipe dos usuários e contribui para o estabelecimento de relações de longa duração e efetividade da atenção. Percebe-se a responsabilidade com a vida do paciente e o foco do trabalho no indivíduo. Os usuários mantêm uma relação de confiança. Buscar autonomia destes através da promoção de trabalhos em grupos e visitas domiciliares é uma realidade, muito embora nos pareça que existe uma dificuldade de superar a transmissão de informações, pela troca de experiências, ou mesmo de entender a forma de pensar do paciente em relação a sua condição de saúde, buscando habilidades para lidar com a situação. Isso faz com que o desenvolvimento de uma organização rotineira de grupos seja algo em que a equipe encontra dificuldades. À luz dos protocolos, são constatadas a busca ativa e a realização adequada com relação ao número e aprazamento das consultas médicas. No entanto, o registro no prontuário foi um problema detectado. O cuidado ao paciente, a partir dos registros, é desenvolvido principalmente pelo profissional médico. A avaliação por parte de outras categorias profissionais de nível superior é pouco expressa. Do ponto de vista biológico, as metas estabelecidas em protocolo para os usuários são atingidas por um número restrito de usuários. Essas situações demonstram a necessidade de investimentos que favoreçam a superação desses desafios.

Analysis and evaluation of public health policy in Cuba : progress on millennium development goals

[EN] The main objective of this project is to analyze Cuban public health policy and the Millennium Development Goals, especially those linked to the issue of health, presenting their potential and strengths with a well-defined time horizon (2000-2015). The Millennium Development Goals are the international consensus on development and was signed as an international minimum agreement, with which began the century. The MDGs promote various goals and targets, with the corresponding monitoring indicators, which should be achieved by all countries for the present year. Health is an area that is at the center of the Millennium Development Goals, which reinforce each other to get a true human development itself. The research was done through theoretical frameworks of social production of health and disease, social justice and the power structure. A retrospective analysis of Cuban economic and social context is performed in order to study whether health-related MDGs are likely to be completed by the deadline on the island and likewise, the main parameters related to health compared with those of the neighboring countries in the Americas.

Promoção de Segurança Alimentar e Nutricional na Estratégia Saúde da Família: uma aproximação a partir da escuta de diferentes atores sociais

A garantia de Segurança Alimentar e Nutricional (SAN) remete à necessidade de ações intersetoriais que articulem as dimensões alimentar e nutricional, além da questão contemporânea da sustentabilidade e da perspectiva do direito humano à alimentação adequada. O setor saúde tem funções específicas e importantes que contribuem para o conjunto das políticas de governo voltadas para a garantia da SAN a população. Desta forma, ações promotoras de SAN devem ser desenvolvidas em todos os níveis de atenção do Sistema Único de Saúde, sendo a Atenção Básica à Saúde, por meio da Estratégia Saúde da Família (ESF), um campo privilegiado de implementação dessas ações, uma vez que está configurada como a porta preferencial de entrada dos usuários no sistema de saúde e como o centro norteador da rede de assistência. Este é um estudo exploratório e descritivo de abordagem qualitativa que teve como objetivo conhecer o que profissionais de equipes de saúde da Família, gestores dos âmbitos federal e municipal ligados à ESF, além de representantes de organizações da sociedade civil atuantes no campo da SAN entendem sobre SAN e sobre práticas promotoras de SAN na ESF. A construção das informações ocorreu por meio de entrevistas semi-estruturadas e grupos focais. Os profissionais referiram-se a SAN como a garantia de uma alimentação que atenda às necessidades nutricionais e que seja segura para o consumo, enquanto que entre os representantes da sociedade civil organizada e gestores predominou uma compreensão mais ampla da SAN. Os diferentes atores identificaram a ESF com um espaço promotor de SAN a partir do levantamento de ações já desenvolvidas ou que possam vir a ser desenvolvidas, porém as ações citadas encontram-se majoritariamente ligadas à dimensão nutricional da SAN. Os atores referiram um conjunto de problemas estruturais que desencadeiam dificuldades no cotidiano da organização dos serviços e das práticas dos profissionais e consequentemente na execução de ações promotoras de SAN nessa estratégia. Este trabalho levantou a necessidade de difundir a interdependência entre saúde e SAN entre gestores e profissionais ligados à ESF para que estes possam identificar melhor nas ações dos serviços de saúde elementos promotores da SAN, e desta forma compreender seu papel de agentes promotores de saúde e SAN.

Sociedade Contemporânea e Cuidados Paliativos: a morte e o morrer no campo da saúde

Este trabalho refere-se a uma pesquisa qualitativa exploratória que tem por objetivo geral investigar alguns aspectos que marcam a experiência da morte na modernidade, como sua crescente desqualificação e ocultamento social, e mais recentemente, no período denominado de contemporâneo, a sua maior visibilidade no campo dos saberes especializados, a fim de avaliar como tais questões se materializam no campo da assistência em saúde. Essa discussão servirá de base para a reflexão sobre o novo modelo de assistência denominado de cuidados paliativos, o qual tem significado uma tentativa de humanizar o cuidado dispensado a pacientes portadores de doença avançada, sem possibilidades de cura ou em fase de terminalidade da vida.Para tal, parte-se de uma análise da panorâmica histórica sobre os modos como a questão da morte se apresenta no século XX, além do processo de emergência do novo modelo assistencial, sendo abordados os conceitos de morte moderna - que reflete uma objetivação da morte pelo conhecimento técnico científico no campo da medicina - e morte contemporânea ou neomoderna - surgida como reação a esta última, caracterizada principalmente pela reivindicação ao direito de morrer com dignidade. Para cumprir os objetivos específicos, quais sejam, conhecer um serviço de cuidados paliativos no cotidiano de um hospital, mapear suas principais características e coletar dados sobre a dinâmica e organização do serviço foi realizada uma breve observação através de visitas ao Programa de Tratamento da Dor e Cuidados Paliativos do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Os resultados mostraram que nos últimos 40 anos houve uma mudança notável das atitudes e das representações associadas ao fim da vida.Isso promoveu o surgimento de novas filosofias e formas alternativas para lidar com a morte e o morrer, de que os cuidados paliativos são o representante maior neste início de século, tornando-se hegemônicos no cuidado ao fim da vida nos domínios profissionais, associativos e políticos. Mostraram que os cuidados paliativos têm sido integrados ao sistema público de saúde em nosso país a partir das políticas nacionais voltadas para a realidade do câncer, com desenvolvimento especialmente no contexto hospitalar de alta complexidade, ainda circunscritos exclusivamente ao domínio do especialista, fato indicado pelo desconhecimento da clientela sobre a existência e natureza do serviço.