Estrategias de intervención desde el trabajo social frente al suicidio en la adolescencia

La presente monografía; “Estrategias de intervención desde el Trabajo Social frente al suicidio en la adolescencia” aborda, entre otras, las siguientes temáticas; definiciones y tipos desuicidio; factores que influyen en el suicidio de la adolescencia y las causas que generan este problema de salud pública. El “sujeto” central de la investigación es la adolescencia, grupo etario donde el suicidio se ha convertido en la tercera causa de muerte. La conducta suicida,también es abordada; considerando los cambios y características psicológicas que es determinante para detectarestos comportamientos y poder prevenirlos e intervenir desde diferentes perspectivas profesionales, en donde el trabajo multidisciplinario es la base de la intervención especializada. En este escenario de multidisciplinariedad la tarea del Trabajador Social es caracterizada, en la monografía, como la del profesional que dinamiza armónicamente la acción de los profesionales involucrados, apoyándose en lopsicoeducativo y en la definición del escenario social. Finalmente se plantean estrategias y alternativas conceptuales y metodológicas, para prevenir el suicidio en la adolescencia y como intervenir con sus familias y allegados. La propuesta metodológica que se enfatiza como estrategia, para prevenir el suicidio, es el trabajo de equipo multidisciplinario,en dónde; psicólogos, médicos, psiquiatras, enfermeras, educadores, orientadores familiares y trabajadores sociales, aúnan esfuerzos para prevenir este flagelo y con la finalidad de relacionar lo conceptual y metodológico desde la práctica profesional se transcribe una entrevista a profundidad con un médico psiquiatra de uno de los hospitales de la localidad.

Unionization : a necessary strategy to arrest professional decline?

This article examines contemporary social work and why it is under serious threat, ideologically and economically, in a rapidly changing world that no longer highly values its social mandate, methods, and outcomes. Within this hostile environment we investigate the low salaries and high student debt that beginning social workers experience, which might otherwise drive them into unions. Instead, the profession resists unionization, preferring to remain focused on its ideals rather than the disquieting marketplace realities. We then examine the general elements of a hybrid union model that can assist social workers to organize and thus arrest their long-standing professional and fiscal decline.

How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care

Aboriginal and Torres Strait Islander people experience higher levels of psychological distress and mental ill health than their non-Indigenous counterparts, but underuse mental health services. Interventions are required to address the structural and functional access barriers that cause this underuse. In 2012, the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care employed a psychologist and a social worker to integrate mental health care into its primary health care services. This research study examines the impact of this innovation.

Es war einmal 1882-1902

Childhood in Berlin; cultural life in fin-de-siecle Berlin; voyages and travels; marriage with physician Ernst Gustav Levin; contains newspaper clippings on author's mother, the social worker Hermine Lesser, copies of letter by the author from 1942, poems by Ernst Ludwig Levin

Cecilia Razovsky papers, undated, 1913-1971.

The papers consist of correspondence and reports of Cecelia Razovsky (married name: Davidson), noted social worker specializing in immigration and resettlement of refugees. The collection includes information about her work with the National Council of Jewish Women in the 1920's, and with the National Refugee Service (and predecessor organizations) in the 1930's. Information is included about her work as a Resettlement Supervisor in the post-World War II DP camps in Europe, and as a field worker in the southwestern U.S. for the United Service for New Americans in 1950. The collection contains reports and correspondence from her trips to South America, primarily Brazil: to explore possibilities of refugee settlement in 1937 and 1946; as a representative for United HIAS Service to aid in settling Egyptian and Hungarian refugees in 1957-58; and as a pleasure trip and evaluation of the changes in the Jewish community of the country in 1963. Also included in the collection are many of Razovsky's articles, plays, and pamphlets.

Reduced visual function and its association with physical functioning in the Finnish adult population : Prevalence, causes, and need for eye care services

The purpose of this study was to estimate the prevalence and distribution of reduced visual acuity, major chronic eye diseases, and subsequent need for eye care services in the Finnish adult population comprising persons aged 30 years and older. In addition, we analyzed the effect of decreased vision on functioning and need for assistance using the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) as a framework. The study was based on the Health 2000 health examination survey, a nationally representative population-based comprehensive survey of health and functional capacity carried out in 2000 to 2001 in Finland. The study sample representing the Finnish population aged 30 years and older was drawn by a two-stage stratified cluster sampling. The Health 2000 survey included a home interview and a comprehensive health examination conducted at a nearby screening center. If the invited participants did not attend, an abridged examination was conducted at home or in an institution. Based on our finding in participants, the great majority (96%) of Finnish adults had at least moderate visual acuity (VA ≥ 0.5) with current refraction correction, if any. However, in the age group 75–84 years the prevalence decreased to 81%, and after 85 years to 46%. In the population aged 30 years and older, the prevalence of habitual visual impairment (VA ≤ 0.25) was 1.6%, and 0.5% were blind (VA < 0.1). The prevalence of visual impairment increased significantly with age (p < 0.001), and after the age of 65 years the increase was sharp. Visual impairment was equally common for both sexes (OR 1.20, 95% CI 0.82 – 1.74). Based on self-reported and/or register-based data, the estimated total prevalences of cataract, glaucoma, age-related maculopathy (ARM), and diabetic retinopathy (DR) in the study population were 10%, 5%, 4%, and 1%, respectively. The prevalence of all of these chronic eye diseases increased with age (p < 0.001). Cataract and glaucoma were more common in women than in men (OR 1.55, 95% CI 1.26 – 1.91 and OR 1.57, 95% CI 1.24 – 1.98, respectively). The most prevalent eye diseases in people with visual impairment (VA ≤ 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%), and DR (7%). One-half (58%) of visually impaired people had had a vision examination during the past five years, and 79% had received some vision rehabilitation services, mainly in the form of spectacles (70%). Only one-third (31%) had received formal low vision rehabilitation (i.e., fitting of low vision aids, receiving patient education, training for orientation and mobility, training for activities of daily living (ADL), or consultation with a social worker). People with low vision (VA 0.1 – 0.25) were less likely to have received formal low vision rehabilitation, magnifying glasses, or other low vision aids than blind people (VA < 0.1). Furthermore, low cognitive capacity and living in an institution were associated with limited use of vision rehabilitation services. Of the visually impaired living in the community, 71% reported a need for assistance and 24% had an unmet need for assistance in everyday activities. Prevalence of ADL, instrumental activities of daily living (IADL), and mobility increased with decreasing VA (p < 0.001). Visually impaired persons (VA ≤ 0.25) were four times more likely to have ADL disabilities than those with good VA (VA ≥ 0.8) after adjustment for sociodemographic and behavioral factors and chronic conditions (OR 4.36, 95% CI 2.44 – 7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95% CI 2.38 – 9.76 and OR 5.37, 95% CI 2.44 – 7.78, respectively) and self-reported mobility limitations were three times as likely (OR 3.07, 95% CI 1.67 – 9.63) as in persons with good VA. The high prevalence of age-related eye diseases and subsequent visual impairment in the fastest growing segment of the population will result in a substantial increase in the demand for eye care services in the future. Many of the visually impaired, especially older persons with decreased cognitive capacity or living in an institution, have not had a recent vision examination and lack adequate low vision rehabilitation. This highlights the need for regular evaluation of visual function in the elderly and an active dissemination of information about rehabilitation services. Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limited functioning. Thus, continuous efforts are needed to identify and treat eye diseases to maintain patients’ quality of life and to alleviate the social and economic burden of serious eye diseases.

Caution, helping may be hazardous: Client abuse, threats and assaults

The shooting of a social worker by a client on the Gold Coast in 1991 graphically illustrated the issue of physical assaults and violence by service users against social workers. In this article we look at the incidence of physical assault, threats of violence, abuse of agency property and verbal abuse to social and other welfare workers by clients, using data from a survey in Melbourne. We then look at probable causes of menacing behaviour, such as issues involved in work with involuntary clients' and we discuss options for preventing and coping with violence and abuse in the welfare work place.

Los derechos de las niñas, niños y adolescentes en situación de desahucio. El caso de Gipuzkoa

[ES] La crisis económica ha agravado la situación de pobreza y precariedad en las familias españolas y vascas. Ejemplo de ello es el aumento de las familias que han sufrido o están sufriendo un proceso de desahucio. Con esta investigación, además de contextualizar este fenómeno de la pérdida de vivienda, queremos analizar los derechos de la infancia que se vulneran; cómo actúan los distintos agentes encargados de salvaguardar los derechos humanos de las/os menores cuando éstos están inmersos en un proceso de desahucio. En el marco teórico exponemos el fenómeno del desahucio de los derechos de la infancia. La metodología utilizada es cualitativa, y para ello nos basaremos en entrevistas en profundidad y semi-estructuradas a diferentes agentes implicados (dos familias que están viviendo un proceso de desahucio, dos abogadas y una trabajadora social). A partir de las conclusiones del estudio, hemos elaborado unas propuestas de mejora de la situación de las y los menores y la defensa de sus derechos.

Privatização, desestruturação organizacional e da força de trabalho: o caso de uma empresa de energia

Este trabalho tem como objetivo caracterizar o processo de privatização, como parte do projeto da reestruturação produtiva e de reforma do Estado, no contexto da crise do setor energético brasileiro nos anos 90. Para isto, é tomado, como caso exemplar, uma empresa do setor elétrico, para investigação das implicações ocorridas para a organização e para os seus trabalhadores. Entende-se aqui que a reforma do setor elétrico é parte integrante de mudanças mais amplas, remetidas à reforma do Estado, a qual adotou como ideologia as políticas neoliberais a partir dos anos 1990 no Brasil. É neste contexto que entendemos a privatização das empresas de utilidade pública no Programa Nacional de Desestatização (PND). Tomamos para o estudo de caso uma empresa do setor elétrico, tendo em vista que a energia representa um insumo essencial para o desenvolvimento de um país. Foi a partir também do desenvolvimento das formas de energia que ocorreram as revoluções industriais e, com isso, o desenvolvimento do capitalismo industrial. Além de revisão teórica e bibliográfica, o estudo contou com pesquisa documental dos relatórios anuais, do planejamento estratégico e da pesquisa de clima organizacional realizados pela empresa investigada. Contribuiu, para a análise, ainda, o processo de observação da autora como participante do cotidiano organizacional, na medida em que é trabalhadora e assistente social da empresa. A pesquisa revela que o período de sete anos em que a empresa permaneceu incluída no PND, acarretou a sua des/reestruturação tanto para a identidade empresarial da empresa quanto para os seus recursos humanos. Diante, da reestruturação, a empresa elaborou seu Planejamento Estratégico, buscando, segundo os padrões empresariais vigentes, ser referência mundial, ter excelência empresarial e rentabilidade. Ao mesmo tempo, estabeleceu abstratamente a valorização das pessoas, a transparência, a ética e a responsabilidade sócio-ambiental. Porém, ao analisar o seu Planejamento Estratégico e a pesquisa de Clima Organizacional, constatamos as contradições existentes na empresa. Entre as contradições, verificamos ser a gestão de recursos humanos, o principal desafio a ser superado nesse processo de reestruturação.

Entre o princípio da emancipação e o fardo da institucionalização: dilemas do projeto ético-político profissional na busca de caminhos para intervenção

O objetivo desse estudo é refletir sobre questões pertinentes aos limites e às possibilidades que permeiam o exercício profissional de assistentes sociais comprometidos com o que se convencionou chamar, no meio profissional, de Projeto Ético-Político do Serviço Social brasileiro. O que, em nossa compreensão, requer considerar os impactos da intervenção profissional em relação aos diferentes projetos societários. Para a realização desse estudo, retomamos debates que consideramos centrais para pensarmos a intervenção do assistente social, enfatizando os dilemas e pretensões postos a esse profissional, partindo dos interesses burgueses que conformaram o Projeto institucional que lhe traz requisições. Buscamos pensar a tensão presente entre esse Projeto Institucional e o referido Projeto Ético-Político, considerando as relações de oposição e poder, e possíveis negociações estabelecidas entre ambos, pois, assim, pudemos mergulhar nesse universo e avaliarmos o conceito de autonomia profissional, em busca de possibilidades interventivas pertinentes à materialização (ainda que relativa) do Projeto Ético-Político do Serviço Social brasileiro. Para enriquecer esse debate, realizamos uma pesquisa empírica que recorreu instrumentalmente a questionários e a entrevistas. O primeiro teve a finalidade de contribuir para a escolha dos profissionais a serem entrevistados e enriquecer alguns dados de análise. A entrevista foi realizada com assistentes sociais que atuam na área da saúde, empregados pelo Estado, em processo de formação continuada e que alegaram compromisso com o referido Projeto Ético-Político Profissional.

Fazendo o caminho de volta: análise do exercício profissional dos assistentes sociais em emergência de grande porte do Rio de Janeiro

O trabalho que ora apresentamos tem como objetivo analisar o exercício profissional dos Assistentes Sociais em uma emergência de grande porte da cidade do Rio de Janeiro. A importância desta análise se inscreve na centralidade alcançada pela saúde na constituição da cidadania brasileira, após a Carta Constitucional de 1988. Este documento assegurou a saúde como direito de todos e dever do Estado, contudo a conjuntura política e econômica iniciada nos anos 90 e aprofundada nos anos 2000, capitaneada pela Contrarreforma do Estado, imporá limites à materialização da política de saúde preconizada pelo Sistema Único de Saúde, impossibilitando que esta seja implementada de acordo com a nova concepção. O que percebemos nos anos 2000 é uma política de saúde focalizada no atendimento emergencial, que abandonou a dimensão da prevenção e da promoção da saúde e que se distancia, progressivamente, do principio da universalidade. Neste contexto de adversidade e limitação do acesso e do atendimento se insere o Assistente Social. Nosso objetivo é delinear o exercício profissional, por nós analisado, a fim de identificar as possibilidades de materialização do projeto ético-político profissional em condições tão adversas e contrárias àquelas que nortearam a interlocução entre o Serviço Social e a saúde nos anos 80. Para tanto este trabalho busca oferecer elementos que nos permitam compreender não somente a dinâmica interna do Hospital por nós analisado, como também a política de saúde em sua totalidade, além de identificar as potencialidades da rede do entorno. Nessa perspectiva, buscamos compreender a dinâmica dos Conselhos de Saúde e a configuração adquirida por estes em tempos de restrição de direitos, sucateamento e desmonte da saúde pública. Nossos estudos indicam que possibilidades de atuação profissional congruentes com o Projeto Ético-Político Profissional estão colocadas na realidade, imiscuídas nas dificuldades impostas pela conjuntura e somente podem ser apreendidas sob a perspectiva de um trabalho coletivo em saúde.

Wykluczenie społeczne wyzwaniem dla współczesnego świata

Społeczeństwo, w którym egzystuje współczesny człowiek, jest nie tyle trudne, ile bardzo złożone. Dlatego też wielu ludzi nie radzi sobie z różnymi problemami natury osobistej i społecznej. Wielu z nich doświadcza wykluczenia społecznego definiowanego jako efekt różnego rodzaju upośledzeń społecznych, wobec czego jednostka lub grupa nie może w pełni uczestniczyć w życiu gospodarczym, społecznym, ekonomicznym i politycznym społeczeństwa, do którego należy. Podmiotem wykluczenia społecznego jest przede wszystkim jednostka, która na drodze realizacji własnego humanitas została wykluczona w sposób przez siebie zawiniony lub doznała wykluczenia z powodu niewłaściwej polityki państwa. Do najważniejszych problemów lokujących się w obrębie wykluczenia autor zalicza: niepełnosprawność, bezrobocie, bezdomność, uzależnienia, samotność i ubóstwo. Scharakteryzowano przywołane powyżej obszary wykluczenia oraz podjęto próbę wskazania sposobów pomocy jednostkom, które stały się ofiarami wykluczenia. Podstawową instytucją pomagającą tym osobom jest pomoc społeczna, której pierwszym i podstawowym celem jest ulepszanie życia społecznego. Ważne miejsce zajmują w niej pracownicy socjalni, którzy jako jednostki wykształcone i kompetentne mogą wpływać na lepsze życie człowieka. Niestety, współcześnie nie zawsze w wystarczający sposób zaspokajane są podstawowe potrzeby zagubionych osób. Najsilniej dotykają one grupy i jednostki najsłabsze. Wskutek owych braków w polityce społecznej oraz w jej przedmiotowych zakresach: w polityce ludnościowej, rodzinnej, edukacyjnej, mieszkaniowej, polityce podziału dochodu, zabezpieczenia społecznego, zatrudnienia, następuje erozja najsłabszych ogniw systemu społecznego. Konieczne zatem wydaje się otwarcie polityki państwa na różne problemy społeczne, nie zawsze zawinione przez jednostkę, ale przez system, w którym się ona znalazła.

Panning for Gold: The Standardizing Work of Filling “Autistic” Shells – Using institutional ethnography to explore textually mediated health relations in the diagnostic process of autism.

Health reform practices in Canada and elsewhere have restructured the purpose and use of diagnostic labels and the processes of naming such labels. Diagnoses are no longer only a means to tell doctors and patients what may be wrong and indicate potential courses of treatment; some diagnoses activate specialized services and supports for persons with a disability and those who provide care for them. In British Columbia, a standardized process of diagnosis with the outcome of an autism spectrum disorder gives access to government provided health care and educational services and supports. Such processes enter individuals into a complex of text mediated relations, regulated by the principles of evidence-based medicine. However, the diagnosis of autism in children is notoriously uncertain. Because of this ambiguity, standardizing the diagnostic process creates a hurdle in gaining help and support for parents who have children with problems that could lead to a diagnosis on the autism spectrum. Such processes and their organizing relations are problematized, explored and explicated below. Grounded in the epistemological and ontological shift offered by Dorothy E. Smith (1987; 1990a; 1999; 2005), this article reports on the findings of an institutional ethnographic study that explored the diagnostic process of autism in British Columbia. More specifically, this article focuses on the processes involved in going from mothers talking from their experience about their childrens problems to the formalized and standardized, and thus “virtually” produced, diagnoses that may or may not give access to services and supports in different systems of care. Two psychologists, a developmental pediatrician, a social worker – members of a specialized multidisciplinary assessment team – and several mothers of children with a diagnosis on the autism spectrum were interviewed. The implications of standardizing the diagnosis process of a disability that is not clear-cut and has funding attached are discussed. This ethnography also provides a glimpse of the implications of current and ongoing reforms in the state-supported health care system in British Columbia, and more generally in Canada, for people’s everyday doings.

Política(s) de saúde no trabalho : um inquérito sociológico às empresas portuguesas

Resumo Política(s) de saúde no trabalho: um inquérito sociológico às empresas portuguesas A literatura portuguesa sobre políticas, programas e actividades de Segurança, Higiene e Saúde no Trabalho (abreviadamente, SH&ST) é ainda escassa. Com este projecto de investigação pretende-se (i) colmatar essa lacuna, (ii) melhorar o conhecimento dos sistemas de gestão da saúde e segurança no trabalho e (iii) contribuir para a protecção e a promoção da saúde dos trabalhadores. Foi construída uma tipologia com cinco grupos principais de políticas, programas e actividades: A (Higiene & Segurança no Trabalho / Melhoria do ambiente físico de trabalho); B (Avaliação de saúde / Vigilância médica / Prestação de cuidados de saúde); C (Prevenção de comportamentos de risco/ Promoção de estilos de vida saudáveis); D (Intervenções a nível organizacional / Melhoria do ambiente psicossocial de trabalho); E (Actividades e programas sociais e de bem-estar). Havia uma lista de mais de 60 actividades possíveis, correspondendo a um índice de realização de 100%. Foi concebido e desenhado, para ser auto-administrado, um questionário sobre Política de Saúde no Local de Trabalho. Foram efectuados dois mailings, e um follow-up telefónico. O trabalho de campo decorreu entre a primavera de 1997 e o verão de 1998. A amostra (n=259) é considerada representativa das duas mil maiores empresas do país. Uma em cada quatro é uma multinacional. A taxa de sindicalização rondava os 30% da população trabalhadora, mas apenas 16% dos respondentes assinalou a existência de representantes dos trabalhadores eleitos para a SH&ST. A hipótese de investigação principal era a de que as empresas com um sistema integrado de gestão da SH&ST seriam também as empresas com um (i) maior número de políticas, programas e actividades de saúde; (ii) maior índice de saúde; (iii) maior índice de realização; e (iv) maior percentagem dos encargos com a SH&ST no total da massa salarial. As actividades de tipo A e B, tradicionalmente associadas à SH&ST, representavam, só por si, mais de 57% do total. Os resultados, correspondentes às respostas da Secção C do questionário, apontam, para (i) a hipervalorização dos exames de medicina do trabalho; e por outro para (ii) o subaproveitamento de um vasto conjunto de actividades (nomeadamente as de tipo D e E), que são correntemente levadas a cabo pelas empresas e que nunca ou raramente são pensadas em termos de protecção e promoção da saúde dos trabalhadores. As actividades e os programas de tipo C (Prevenção de comportamentos de risco/Promoção de estilos de vida saudáveis), ainda eram as menos frequentes entre nós, a seguir aos Programas sociais e de bem-estar (E). É a existência de sistemas de gestão integrados de SH&ST, e não o tamanho da empresa ou outra característica sociodemográfica ou técnico-organizacional, que permite predizer a frequência de políticas de saúde mais activas e mais inovadores. Os três principais motivos ou razões que levam as empresas portuguesas a investir na protecção e promoção da saúde dos seus trabalhadores eram, por ordem de frequência, (i) o absentismo em geral; (ii) a produtividade, qualidade e/ou competitividade, e (iii) a filosofia de gestão ou cultura organizacional. Quanto aos três principais benefícios que são reportados, surge em primeiro lugar (i) a melhoria da saúde dos trabalhadores, seguida da (ii) melhoria do ambiente do ambiente de trabalho e, por fim, (iii) a melhoria da produtividade, qualidade e/ou competitividade.Quanto aos três principais obstáculos que se põem, em geral, ao desenvolvimento das iniciativas de saúde, eles seriam os seguintes, na percepção dos respondentes: (i) a falta de empenho dos trabalhadores; (ii) a falta de tempo; e (iii) os problemas de articulação/ comunicação a nível interno. Por fim, (i) o empenho das estruturas hierárquicas; (ii) a cultura organizacional propícia; e (iii) o sentido de responsabilidade social surgem, destacadamente, como os três principais factores facilitadores do desenvolvimento da política de saúde no trabalho. Tantos estes factores como os obstáculos são de natureza endógena, susceptíveis portanto de controlo por parte dos gestores. Na sua generalidade, os resultados deste trabalho põem em evidência a fraqueza teóricometodológica de grande parte das iniciativas de saúde, realizadas na década de 1990. Muitas delas seriam medidas avulsas, que se inserem na gestão corrente das nossas empresas, e que dificilmente poderão ser tomadas como expressão de uma política de saúde no local de trabalho, (i) definida e assumida pela gestão de topo, (ii) socialmente concertada, (iii) coerente, (iv) baseada na avaliação de necessidades e expectativas de saúde dos trabalhadores, (v) divulgada, conhecida e partilhada por todos, (vi) contingencial, flexível e integrada, e, por fim, (vii) orientada por custos e resultados. Segundo a Declaração do Luxemburgo (1997), a promoção da saúde engloba o esforço conjunto dos empregadores, dos trabalhadores, do Estado e da sociedade civil para melhorar a segurança, a saúde e o bem-estar no trabalho, objectivo isso que pode ser conseguido através da (i) melhoria da organização e das demais condições de trabalho, da (ii) participação efectiva e concreta dos trabalhadores bem como do seu (iii) desenvolvimento pessoal. Abstract Health at work policies: a sociological inquiry into Portuguese corporations Portuguese literature on workplace health policies, programs and activities is still scarce. With this research project the author intends (i) to improve knowledge on the Occupational Health and Safety (shortly thereafter, OSH) management systems and (ii) contribute to the development of health promotion initiatives at a corporate level. Five categories of workplace health initiatives have been identified: (i) Occupational Hygiene and Safety / Improvement of Physical Working Environment (type A programs); (ii) Health Screening, Medical Surveillance and Other Occupational Health Care Provision (type B programs); (iii) Preventing Risk Behaviours / Promoting Healthy Life Styles (type C programs); (iv) Organisational Change / Improvement of Psycho-Social Working Environment (type D programs); and (v) Industrial and Social Welfare (type E programs). A mail questionnaire was sent to the Chief Executive Officer of the 1500 largest Portuguese companies, operating in the primary and secondary sectors (≥ 100 employees) or tertiary sector (≥ 75 employees). Response rate has reached about 20% (259 respondents, representing about 300 companies). Carried out between Spring 1997 and Summer 1998, the fieldwork has encompassed two direct mailings and one phone follow-up. Sample is considered to be representative of the two thousand largest companies. One in four is a multinational. Union membership rate is about 30%, but only 16% has reported the existence of a workers’ health and safety representative. The most frequent workplace health initiatives were those under the traditional scope of the OSH field (type A and B programs) (57% of total) (e.g., Periodical Medical Examinations; Individual Protective Equipment; Assessment of Working Ability). In SMEs (< 250) it was less likely to find out some time-consuming and expensive activities (e.g., Training on OSH knowledge and skills, Improvement of environmental parameters as ventilation, lighting, heating).There were significant differences in SMEs, when compared with the larger ones (≥ 250) concerning type B programs such as Periodical medical examinations, GP consultation, Nursing care, Other medical and non-medical specialities (e.g., psychiatrist, psychologist, ergonomist, physiotherapist, occupational social worker). With regard to type C programs, there were a greater percentage of programs centred on Substance abuse (tobacco, alcohol, and drug) than on Other health risk behaviours. SMEs representatives reported very few prevention- oriented programs in the field of Drug abuse, Nutrition, Physical activity, Off- job accidents, Blood pressure or Weight control. Frequency of type D programs included Training on Human Resources Management, Training on Organisational Behaviour, Total Quality Management, Job Design/Ergonomics, and Workplace rehabilitation. In general, implementation of this type of programs (Organisational Change / Improvement of Psychosocial Working Environment) is not largely driven by health considerations. Concerning Industrial and Social Welfare (Type E programs), the larger employers are in a better position than SMEs to offer to their employees a large spectrum of health resources and facilities (e.g., Restaurant, Canteen, Resting room, Transport, Infra-structures for physical activity, Surgery, Complementary social protection, Support to recreational and cultural activities, Magazine or newsletter, Intranet). Other workplace health promotion programs like Training on Stress Management, Employee Assistance Programs, or Self-help groups are uncommon in the Portuguese worksites. The existence of integrated OSH management systems, not the company size, is the main variable explaining the implementation of more active and innovative workplace health policies in Portugal. The three main prompting factors reported by employers for health protection and promotion initiatives are: (i) Employee absenteeism; (ii) Productivity, quality and/or competitiveness; and (iii) Corporate culture/management philosophy. On the other hand, (i) Improved staff’s health, (ii) Improved working environment and (iii) Improved productivity, quality and/or competitiveness were the three main benefits reported by companies’ representatives, as a result of successful implementation of workplace health initiatives. (i) Lack of staff commitment; (ii) Lack of time; and (iii) Problems of co-operation and communication within company or establishment (iii) are perceived to be the main barriers companies must cope with. Asked about the main facilitating factors, these companies have pointed out the following ones: (i) Top management commitment; (ii) Corporate culture; and (iii) Sense of social responsibility. This sociological research report shows the methodological weaknesses of workplace health initiatives, carried out by Portuguese companies during the last ‘90s. In many cases, these programs and actions were not part of a corporate health strategy and policy, (i) based on the assessment of workers’ health needs and expectancies, (ii) advocated by the employer or the chief executive officer, (ii) planned and implemented with the staff consultation and participation or (iv) evaluated according to a cost-benefit analysis. In short, corporate health policy and action were still rather based on more traditional OSH approaches and should be reoriented towards Workplace Health Promotion (WHP) approach. According to the Luxembourg Declaration of Workplace Health Promotion in the European Union (1997), WHP is “a combination of: (i) improving the work organisation and environment; (ii) promoting active participation; (iii) encouraging personal development”.Résumée Politique(s) de santé au travail: une enquête sociologique aux entreprises portugaises Au Portugal on ne sait presque rien des politiques de santé au travail, adoptés par les entreprises. Avec ce projet de recherche, on veut (i) améliorer la connaissance sur les systèmes de gestion de la santé et de la sécurité au travail et, au même temps, (ii) contribuer au développement de la promotion de la santé des travailleurs. Une typologie a été usée pour identifier les politiques, programmes et actions de santé au travail: A. Amélioration des conditions de travail / Sécurité au travail; B. Médecine du travail /Santé au travail; C. Prévention des comportements de risque / Promotion de styles de vie sains; D. Interventions organisationnelles / Amélioration des facteurs psychosociaux au travail; E. Gestion de personnel et bien-être social. Un questionnaire postal a été envoyé au représentant maximum des grandes entreprises portugaises, industrielles (≥ 100 employés) ou des services (≥ 75 employés). Le taux de réponse a été environ 20% (259 répondants, concernant trois centaines d’entreprises et d’établissements). La recherche de champ, conduite du printemps 1997 à l’été 1998, a compris deux enquêtes postales et un follow-up téléphonique. L´échantillon est représentatif de la population des deux miles plus grandes entreprises. Un quart sont des multinationales. Le taux de syndicalisation est d’environ 30%. Toutefois, il y a seulement 16% de lieux de travail avec des représentants du personnel pour la santé et sécurité au travail. Les initiatives de santé au travail les plus communes sont celles concernant le domaine plus traditionnel (types A et B) (57% du total): par exemple, les examens de médecine du travail, l’équipement de protection individuelle, les tests d’aptitude au travail. En ce qui concerne les programmes de type C, les plus fréquents sont le contrôle et la prévention des addictions (tabac, alcool, drogue). Les interventions dans le domaine de du système technique et organisationnelle du travail peuvent comprendre les courses de formation en gestion de ressources humaines ou en psychosociologie des organisations, l’ergonomie, le travail posté ou la gestion de la qualité totale. En général, la protection et la promotion de la santé des travailleurs ne sont pas prises en considération dans l’implémentation des initiatives de type D. Il y a des différences quand on compare les grandes entreprises et les moyennes en matière de politique de gestion du personnel e du bien-être (programmes de type E, y compris l’allocation de ressources humaines ou logistiques comme, par exemple, restaurant, journal d’entreprise, transports, installations et équipements sportifs). D’autres activités de promotion de la santé au travail comme la formation en gestion du stress, les programmes d’ assistance aux employés, ou les groupes de soutien et d’auto-aide sont encore très peu fréquents dans les entreprises portugaises. C’est le système intégré de gestion de la santé et de la sécurité au travail, et non pas la taille de l’entreprise, qui aide à prédire l’existence de politiques actives et innovatrices dans ce domaine. Les trois facteurs principaux qui encouragent les actions de santé (prompting factors, en anglais) sont (i) l’absentéisme (y compris la maladie), (ii) les problèmes liés à la productivité, qualité et/ou la compétitivité, et aussi (iii) la culture de l’entreprise/philosophie de gestion. Du coté des bénéfices, on a obtenu surtout l’amélioration (i) de la santé du personnel, (ii) des conditions de travail, et (iii) de la productivité, qualité et/ou compétitivité.Les facteurs qui facilitent les actions de santé au travail sont (i) l’engagement de la direction, (ii) la culture de l’entreprise, et (iii) le sens de responsabilité sociale. Par contre, les obstacles à surmonter, selon les organisations qui ont répondu au questionnaire, seraient surtout (i) le manque d’engagement des travailleurs et de leur représentants, (ii) le temps insuffisant, et (iii) les problèmes de articulation/communication au niveau interne de l’entreprise/établissement. Ce travail de recherche sociologique montre la faiblesse méthodologique des services et activités de santé et sécurité au travail, mis en place par les entreprises portugaises dans les années de 1990, à la suite des accords de concertation sociale de 1991. Dans beaucoup de cas, (i) ces politiques de santé ne font pas partie encore d’un système intégré de gestion, (ii) il n’a pas d’évaluation des besoins et des expectatives des travailleurs, (iii) c’est très bas ou inexistant le niveau de participation du personnel, (iv) on ne fait pas d’analyse coût-bénéfice. On peut conclure que les politiques de santé au travail sont plus proches de la médecine du travail et de la sécurité au travail que de la promotion de la santé des travailleurs. Selon la Déclaration du Luxembourg sur la Promotion de la Santé au Lieu de Travail dans la Communauté Européenne (1997), celle-ci « comprend toutes les mesures des employeurs, des employés et de la société pour améliorer l'état de santé et le bien être des travailleurs » e « ceci peut être obtenu par la concentration des efforts dans les domaines suivants: (i) amélioration de l'organisation du travail et des conditions de travail ; (ii) promotion d'une participation active des collaborateurs ; (iii) renforcement des compétences personnelles ».

Self-reported health needs and use of primary health care services by adolescents enrolled in post-mandatory schools or vocational training programmes in Switzerland.

BACKGROUND: The second Swiss Multicenter Adolescent Survey on Health (SMASH02) was conducted among a representative sample (n = 7428) of students and apprentices aged 16 to 20 from the three language areas of Switzerland during the year 2002. This paper reports on health needs expressed by adolescents and their use of health care services over the 12 months preceding the survey. METHODS: Nineteen cantons representing 80% of the resident population agreed to participate. A complex iterative random cluster sample of 600 classes was drawn with classes as primary sampling unit. The participation rate was 97.7% for the classes and 99.8% for the youths in attendance. The self-administered questionnaire included 565 items. The median rate of item non-response was 1.8%. Ethical and legal requirements applying to surveys of adolescent populations were respected. RESULTS: Overall more than 90% of adolescents felt in good to excellent health. Suffering often or very often from different physical complaints or pain was also reported such as headache (boys: 15.9%, girls: 37.4%), stomach-ache (boys: 9.7%, girls: 30.0%), joint pain (boys: 24.7%, girls: 29.5%) or back pain (boys: 24.3%, girls: 34.7%). Many adolescents reported a need for help on psychosocial and lifestyle issues, such as stress (boys: 28.5%, girls: 47.7%) or depression (boys: 18.9%, girls: 34.4%). Although about 75% of adolescents reported having consulted a general practitioner and about one-third having seen another specialist, reported reasons for visits do not correspond to the expressed needs. Less than 10% of adolescents had visited a psychiatrist, a family planning centre or a social worker. CONCLUSIONS: The reported rates of health services utilisation by adolescents does not match the substantial reported needs for help in various areas. This may indicate that the corresponding problems are not adequately detected and/or addressed by professionals from the health and social sectors.