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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
501

Avaliação assistencial da população atendida no ambulatório A2MG404 (Hepatite B) da Divisão de Gastroenterologia e Hepatologia Clínica do HC-FMUSP / Assistance assessment of the population served at the ambulatory A2MG404 (Hepatitis B) of the Division of Gastroenterology and Clinical Hepatology of HCFMUSP

Souza, Felipe Pereira de 22 May 2018 (has links)
Introdução: A infecção pelo vírus da Hepatite B (HBV) é um grande problema de saúde pública, uma vez que cerca de 257 milhões de pessoas em todo o mundo são acometidas pelo vírus. Mundialmente, devido ao grande movimento migratório, descrevem-se mudanças no perfil dos pacientes portadores de HBV. Desta forma, objetivamos caracterizar a população de pacientes portadores HBV atendidos no ambulatório A2MG404 de Hepatites Virais do HC-FMUSP. Métodos: Este foi um estudo retrospectivo descritivo de 617 novos pacientes com exames sorológicos positivos para HBV, em seguimento no ambulatório A2MG404 entre janeiro de 2005 e dezembro de 2015. Dados demográficos, epidemiológicos e clínicos foram obtidos de prontuários eletrônicos institucionais (SIGH-PRODESP, HCMED e ProntMed). A coleta e gerenciamento de dados foi realizada utilizando o software on-line REDCap (V6.16.4). A análise estatística foi realizada utilizando o software R (V3.3.0). O teste de Shapiro-Wilk foi utilizado para testar a normalidade dos dados; dados não paramétricos foram comparados utilizando-se o teste de Wilcoxon-Mann-Whitney; as proporções entre populações foram comparadas utilizando-se o Teste Z. Foram considerados estatisticamente significativos valores de p < 0,05. Resultados: Foi observada predominância do sexo masculino (60,9%); mediana de idade de 48 anos; raça branca (70,8%) e nível de escolaridade baixo [ensino fundamental completo (37,4%)] entre os pacientes. A maioria deles eram brasileiros (93,5%), residentes no estado de São Paulo (98,4%), principalmente na cidade de São Paulo (63,6%). Pacientes residentes em outros estados do Brasil também foram atendidos no serviço (1,6%), bem como estrangeiros (6,5%). Coinfecção por HCV foi identificada em 7,8% dos pacientes; e por HIV em 1,3% destes. De base, 109/617 (17,66%) pacientes eram AgHBe positivo [infecção crônica: 42/617 (6,8%); hepatite crônica: 67/617 (10,8%)]; 350/617 (56,72%) pacientes eram AgHBe negativo [infecção crônica: 290/617 (47,0%); hepatite crônica: 60/617 (9,7%)]; 104/617 (16,9%) pacientes eram Anti-HBc Total e Anti-HBs positivos; 49/617 (8,0%) pacientes eram Anti-HBc Total isolado; e 5/617 (0,8%) pacientes eram portadores de perfil sorológico anômalo da hepatite B. Entre o início e término de seguimento foram observados diminuição significativa dos valores de ALT, AST, APRI, carga viral (p < 0,001), hemoglobina (p=0,007) e bilirrubina total (p=0,011), bem como aumento significativo de bilirrubina direta e INR (p < 0,001). O FIB-4 não apresentou diferença estatisticamente significativa no mesmo intervalo. A análise mostra que 30,3% dos pacientes receberam tratamento com antivirais, sendo Tenofovir (28,3%) o mais prescrito, seguido de Lamivudina (19,8%), Tenofovir+Lamivudina (19,8%) e Entecavir (19,2%). Entecavir apresentou a maior taxa de soroconversão de AgHBe (6/9; 66,66%), enquanto que Lamivudina apresentou a maior taxa para AgHBs (5/30; 16,66%). Tenofovir possui maior potencial para redução de carga viral, aumento de plaquetas e melhora de enzimas hepáticas do que Lamivudina e Entecavir (p < 0,05). No total, foram realizadas 5412 consultas médicas, sendo a maioria delas do tipo \"seguimento\" (85,8%). Faltas foram registradas em 11,9% das consultas médicas agendadas no período. Conclusões: A população atendida no serviço é heterogênea, com representação de diferentes sexos, etnias, faixas etárias e nacionalidades; ao menos 14 nacionalidades representadas, refletindo o fenômeno da migração observado globalmente. São necessárias ações educacionais para promoção da adesão aos cuidados médicos adequados / Background: Hepatitis B virus (HBV) is a major public health problem with significant burden across all global regions, once they affect about 250 million people around the world. Worldwide, due to the great migratory movement, changes were described in the profile of patients with hepatitis B. In this way, we aimed to characterize the population of patients with chronic hepatitis B seen in the ambulatory A2MG404 of Viral Hepatitis of HC-FMUSP. Methods: This was a retrospective descriptive study of 617 new patients with positive serological tests results for HBV, followed up in the A2MG404 ambulatory between January 2005 and December 2015. Demographic, epidemiological and clinical data were obtained from institutional electronic medical records (SIGH-PRODESP, HCMED and ProntMed). Data collection and management was performed using REDCap online software (V6.16.4). Statistical analysis was performed using R software (V3.3.0). Shapiro-Wilk Test was used to test the normality of the data; non-parametric data were compared using Wilcoxon-Mann-Whitney Test; proportions among populations were compared using the Z-Test. Values of p < 0.05 were considered statistically significant. Results: Male predominance (60.9%); median age of 48 years; white race (70.8%) and low educational level (37.4%) was observed among the patients. Most of them were Brazilian (93.5%), living in the State of São Paulo (98.4%), mainly in the city of São Paulo (63.6%). Patients living in other Brazilian states were also assisted in the service (1.6%), as well as foreigners (6.5%). HCV coinfection were identified in 7.8% of patients; and HIV in 1.3% of these. At baseline, 109/617 (17.66%) patients were HBeAg positive [chronic infection: 42/617 (6.8%); chronic hepatitis: 67/617 (10.8%)]; 350/617 (56.72%) patients were HBeAg negative [chronic infection: 290/617 (47.0%); chronic hepatitis: 60/617 (9.7%)]; 104/617 (16.9%) patients were Total Anti-HBc and Anti-HBs positive; 49/617 (8.0%) patients were Anti-HBc Total isolated; and 5/617 (0.8%) patients had anomalous serological profile of hepatitis B. Significant decrease in ALT, AST, APRI, viral load (p < 0.001), hemoglobin (p = 0.007) and total bilirubin (p = 0.011); as well as significant increase of direct bilirubin and INR (p < 0.001) of patients were observed during the follow-up. FIB-4 score didn\'t present a statistically significant difference in the same interval. The analysis shows that 30.3% of the patients received antiviral treatment, being Tenofovir (28.3%) the most prescribed, followed by Lamivudine (19.8%), Tenofovir+Lamivudine (19.8%) and Entecavir (19.2%). Entecavir presented the highest HBeAg seroconversion rate (6/9; 66.66%), whereas Lamivudine presented the highest rate for HBsAg (5/30, 16.66%). Tenofovir has greater potential for viral load reduction, platelet increase, and hepatic enzymes normalization than Lamivudine and Entecavir (p < 0.05). In total, 5412 medical appointment were performed, most of them was classified as \"follow up\" type (85.8%). Absences were recorded in 11.9% of the medical appointments scheduled in the period. Conclusions: The population served in the service is heterogeneous, with representation of different genders, ethnicities, age groups and nationalities. In it, at least 14 nationalities are represented, reflecting the phenomenon of immigration observed worldwide. Educational actions are required to promote adherence to the necessary medical care for these patients
502

Mehrebenen-Evaluation von Maßnahmen der betrieblichen Gesundheitsförderung

Fritz, Sigrun 18 December 2004 (has links) (PDF)
Die Dissertation beschreibt am Beispiel einer Längsschnittstudie in der Papierindustrie, wie Effekte von Maßnahmen der betrieblichen Gesundheitsförderung in geschätzten ökonomischen Nutzen übertragen werden können. Ausgangspunkt der Untersuchung ist das Variablen-Modell nach Locke und Latham (1990). Darauf aufbauend wurden geeignete Indikatoren und Messinstrumente ausgewählt und in mehreren Voruntersuchungen überprüft. Hauptinstrument ist ein Fragebogen, der im quasiexperimentellen Design zur Ist-Analyse und nach Umsetzung der Maßnahmen eingesetzt wurde. An der ersten Befragung im Oktober 2000 nahmen 320 Gewerbliche und Angestellte des Unternehmens (Rücklauf 89%), an der zweiten drei Jahre später 402 Mitarbeiter (Rücklauf 91%) teil. Für den Längsschnitt standen die Fragebögen von 118 Mitarbeitern zur Verfügung. Neben den Fragebogendaten wurden personbezogene Daten zum Krankenstand erhoben, die auf freiwilliger Basis mit den Fragebogendaten verknüpft wurden, worauf sich 71% der im Jahr 2000 Befragten und 80% der im Jahr 2003 Befragten einlassen konnten. Zur Absicherung der Validität kamen weitere Untersuchungsmethoden zum Einsatz: für 19 Tätigkeiten wurde eine objektive arbeitspsychologische Tätigkeitsanalyse (Pohlandt, Schulze, Jordan &amp;amp; Richter, 2002) durchgeführt, die beteiligten Bereiche wurden in einem Rankingverfahren durch betriebliche Experten eingeschätzt, die organisationale Einbindung der betrieblichen Gesundheitsförderung wurde zu beiden Untersuchungszeitpunkten mit Hilfe des Fragebogens von Breucker (Prävention online, 2000) erfasst, es fanden 22 strukturierte Interviews mit den Beschäftigten zur Einschätzung der durchgeführten Maßnahmen statt. Die Ergebnisse der ersten Mitarbeiterbefragung wurden zurückgemeldet, diskutiert und zu 12 Maßnahmen verdichtet. Diese 12 Maßnahmen wurden in die Zweitbefragung mit aufgenommen, wobei die aktive Beteiligung an ihnen und die Zufriedenheit mit ihrer Umsetzung eingeschätzt werden sollten. Zur Ermittlung der Effizienz wurden eine erweiterte Kosten-Nutzen-Analyse (nach Schmidt, Hunter &amp;amp; Pearlman, 1982) und eine Kosten-Nutzwert-Analyse (nach Rinza &amp;amp; Schmitz, 1992) durchgeführt. Fast alle im Fragebogen erfassten Variablen hatten sich zwischen der ersten und zweiten Befragung signifikant verbessert (Arbeitsintensität, Tätigkeitsspielraum, Motivationspotenzial der Tätigkeit, soziale Unterstützung, sozialen Stressoren, Commitment, Arbeitszufriedenheit, allgemeines Befinden, psychosomatische Beschwerden). Nicht signifikant waren die Änderungen beim (multimodal beeinflussten) Krankenstand, sowie bei der Einschätzung der Führung. Bezüglich der Effektstärke konnte bei 9 der 12 Maßnahmen mindestens ein positiver Unterscheidungseffekt aufgezeigt werden. Bei der Ermittlung des (subjektiv erlebten) Nutzwertes der Maßnahmen kamen alle 12 Maßnahmen in den positiven Bereich. Mit der Kosten-Nutzen-Analyse wurde ein positives Kosten-Nutzen-Verhältnis für 6 der 9 verbleibenden Maßnahmen (zwischen 1:71 und 1:1,5) ermittelt. Diese Ergebnisse wurden kritisch hinterfragt und durch Einbeziehung von Diskontierung, spezifischen Effizienzkriterien, Sensitivitätsanalysen und Worst-Case-Berechnung relativiert (vgl. Anforderungen nach Drummond, O´Brien, Stoddart &amp;amp; Torrance, 1987/1997). Im Vergleich zur Kosten-Nutzen-Analyse wurden bei der Kosten-Nutzwert-Analyse deutlich andere Rangreihen ermittelt. Die kritische Gesamtschau der Ergebnisse ermöglicht spezifische Empfehlungen für fünf Maßnahmengruppen. Es zeigte sich, dass die gemeinsame Erörterung von Kosten-Nutzen-Analyse und Nutzwert zusätzliche und bisher nicht erfasste Aspekte beim Umgang mit den Maßnahmen eröffnet. / The thesis illustrates a longitudinal study in the paper industry. It shows how effects resulting from measures of occupational health promotion may be translated into an estimated economic advantage. The starting point of the study is the high performance cycle (Locke &amp;amp; Latham: 1990). Proceeding from that, appropriate indicators and measuring instruments were selected and tested in several pre-studies. The main instrument is a questionnaire, used in a comparative design before and after the translation of the measures into practice. 320 white- and blue-collar workers took part in the first survey in October 2000 (response rate 89%), whereas 402 workers participated in the second survey which was conducted three years later (response rate 91%). After all, complete data sets for the longitudinal analysis were available from 118 participants. Apart from that personal data concerning absenteeism were used, which were then connected to the questionnaire data on a voluntary basis. Whereas in 2000, in the first survey, 71% of the participants agreed to the connection of their personal data with the questionnaire, 80% agreed to it in the second survey, in 2003. To guarantee the questionnaire?s validity an array of additional methods was used: an objective occupational job analysis (Pohlandt, Schulze, Jordan &amp;amp; Richter, 2002) of 19 different occupations was carried out and the company?s experts evaluated the branches involved by ranking. Furthermore the organizational embedding of occupational health promotion measures was investigated in both surveys with the help of Breucker?s questionnaire (Prevention online, 2000) and additionally 22 structured interviews with the employees took place in order to evaluate the acceptance of the measures conducted. The results of the first employee survey were reported back, discussed and condensed into 12 measures. These 12 measures were then included in the second survey when the employees? active participation in the measures? implementation and their satisfaction with the measures? effects should be evaluated. To determine the measures? actual efficiency an extended cost-benefit-analysis (with reference to Schmidt, Hunter &amp;amp; Pearlman: 1982) and a cost-utility-analysis (with reference to Rinza &amp;amp; Schmitz: 1992) were conducted. Nearly all variables investigated in the questionnaire had significantly improved between the first and the second survey (indicators of job demands, occupational scope, motivational potential of occupation, social support, social stressors, commitment, job satisfaction, well-being, psychosomatic complaints). Changes in (multi-modally influenced) absenteeism and in the evaluation of the management?s style of leadership were not significant. Referring to the effects? impact 9 out of 12 measures proved to be positively significant in at least one criterion, whereas referring to (subjectively felt) utility all 12 measures turned out to be positively significant. In six of the remaining nine measures the cost-benefit-analysis resulted in a positive cost-benefit-relation (between 1:71 and 1:1,5). These results were critically discussed and taking into account discounting, specific result-criteria, sensitivity analyses and worst case assessment (see quality principles by Drummond, O´Brien, Stoddart &amp;amp; Torrance, 1987/1997) finally adjusted. Comparing the cost-benefit and cost-utility analyses resulted in significantly different rankings. The critical overall view allows for specific recommendations for five measure-groups. Finally, the joint discussion of the cost-benefit analysis and utility turned out to open up additional aspects of how to conduct the measures in future, which have not been described so far.
503

Exploring the causes of low grade 12 pass rate in two Umlazi District schools, KwaZulu-Natal / Exploring the causes of low grade twelve pass rate in two Umlazi District schools, KwaZulu-Natal

Ngcongo, Piuson Hluphani Muntu January 2016 (has links)
The purpose of this study was to explore the causes of low Grade 12 pass rate in two Umlazi District Schools, KwaZulu-Natal. It is hoped that the study would contribute to the understanding of the causes and factors of low Grade 12 pass rate and provide solutions of improving learners’ performance. This is qualitative study conducted in the area of Umbumbulu focusing on exploring the causes of low Grade 12 pass rate in two Umlazi District Schools, KwaZulu-Natal. The methodology used was qualitative. A case study method was adopted. Data was gathered through focus group interviews with two principals, twelve Grade12 learners aged between 18 and 21, and six teachers between 15 and 22 years teaching experience in secondary schools. Drawing from the findings of the interviews conducted, the study highlights the factors that have negative impact to low Grade 12 pass rate, and it revealed the possible solutions to alleviate the trend of low performance. The data reveals that there are numerous factors that affect the performance of Grade 12 learners such as poverty, child headed families, sporadic absenteeism, questionable assessment methods, overcrowded classes, lack of discipline in schools, corporal punishment, violence in schools, teenage pregnancy, curriculum reforms, lack of parental involvement, and cultural background. In this study I argue that the trend of low Grade 12 pass rate is not only limited to Umbumbulu Circuit in Umlazi District, but is the overall trend in most rural schools in South Africa. Therefore, the study recommended that all stakeholders should play their roles to overcome the crises of low Grade 12 performance. Again, it was recommended that the introduction of an advanced integrative approach in training programmes of future teachers is needed in which attention to rural -FET band schools will be considered as an integral part of the training, whereby teachers will be trained to teach inclusive education. / Inclusive Education / M. Ed. (Inclusive Education)
504

Absenteeism of adult learners at the Sekgosese West Circuit in Limpopo Province : a critical reflection

Mello, Masefora Victoria 02 1900 (has links)
The purpose of the study was to find out why adult learners absent themselves from adult basic education programmes and to devise strategies to encourage them to attend classes. In order to achieve the aim of the study, the objective of the study were to investigate the economic and social reasons why adult learners do not attend classes. The research focus on a critical issue of absenteei(sm by adult learners at SEKGOSESE West Circuit adult centre in Limpopo Province. Literature review was engaged in the field of Adult Education and related to the research problem. The literature review presented an insight into theoretical frameworks and conceptual frameworks about causes of adult learner’s absenteeism. The researcher used sources which included journals, books, articles and dissertations. To collect information. This qualitative study explored the causes of adult learner absenteeism and came with strategies to reduce adult learner absenteeism. Critical theory was used as a theoretical framework. The theory deals with social economic factors and conditions under which people live. Data was collected through focus group interviews. There were sixteen participants who attend classes at Mosima adult learning centre, and they were selected homogeneously. It was discovered that adult learner absenteeism is caused by lack of motivation, lack of support from departmental officials, lack of adult learner commitment, lack of facilities, lack of qualified adult educators, lack of respect amongst adult learners and adult educators as a serious matter, lack of parental support for those who are still under parental care and lack of transport for adult learners who stay far from the centre. Based on the causes of adult learner absenteeism, recommendations are made for the Department of Education to address these causes in order to elevate adult learner absenteeism and further research efforts are recommended. It is recommended that the department of education include stationery material in their budget for adult basic education. Adult Basic education educators should also receive adequate training s o that they can be able to teach adult learners effectively. / ABET and Youth Development / M. Ed. (Adult Education)
505

Managing the phenomenon of Sexual harassment in the manufacturing industry

Kölkenbeck-Ruh, Rudolph Karl 30 June 2003 (has links)
All companies have strategic assets comprising financial capital, physical capital, human capital and organisational capital which, when effectively utilised, contribute to the competitive advantage necessary to survive in a globalised economy. The manifestation of adverse factors in a company will impact detrimentally on the performance of these strategic assets. Since the 1980s, one factor has become prominent in the management of a company’s human capital, namely sexual harassment. Sexual harassment constitutes behaviour of a sexual nature that leads to, and perpetuates, a working environment in which it becomes unpleasant to work, and if allowed to go unchecked, will lead to the underperformance of the company’s human capital. Besides the cost of litigation associated with sexual harassment, companies are confronted with the more troubling and subtle costs arising out of the psychological and physiological harm to both victims and co-workers. The psychological and physiological effects manifest themselves in symptoms such as depression, frustration, decreased self-esteem and fatigue which, in turn, lead to decreased productivity and increased absenteeism. Accordingly, in an effort to gain the competitive advantage to survive in a globalised economy, companies must manage the phenomenon of sexual harassment in the workplace. The existing theoretical principles relating to the management of sexual harassment in the workplace have been analysed in depth and a model developed to satisfy this need. This model was subsequently used to determine to what extent sexual harassment management is taking place within companies affiliated to the Steel and Engineering Industries Federation of South Africa (SEIFSA). Various informative findings resulted from the investigation, amongst which were the lack of a proper sexual harassment policy within companies, the lack of proper training of employees regarding the occurrence of this phenomenon in the workplace, and the absence of proper formal/informal complaints procedures. It thus became evident that the management of sexual harassment in these companies – despite the Government’s Code of Good Practice on the Handling of Sexual Harassment Cases – had not been fully established and that there is a need for guidelines in this regard. / Business Management / D. Comm. (Business Management)
506

The impact of the education management system on the effectiveness of secondary schools in Lesotho

Lekhetho, Mapheleba 11 1900 (has links)
The primary purpose of the study was to investigate the factors that cause most Lesotho secondary schools to perform poorly in the Cambridge Overseas School Certificate examinations. The findings of the study show that the problems that contribute to the ineffectiveness of most secondary schools are multiple and interrelated. These problems can be identified at the macro or policy-making level at the Ministry of Education, and at the micro or the individual school level. At macro level, there appears to be a lack of adequate capacity among the senior management staff to perform the management and governance functions effectively, so that substantive improvement could be realised in the day-to-day operations, and academic results of schools. An upshot of this is that the professional support that the Ministry of Education provides to secondary schools is inadequate. Furthermore, despite the deepening poverty in Lesotho, the state does not provide textbooks to learners in secondary schools. Consequently, many learners do not have all the textbooks, and this affects their learning negatively. At micro level, the problems that contribute to the ineffectiveness of most secondary schools include teacher tardiness, teacher absenteeism and a lack of learner determination. It is contended that these factors indicate that the management of the school principals is weak. Moreover, because of poverty, many parents fail to pay school fees for their children on time. As a result, many learners are frequently sent back home by the principals to fetch money, and this reduces their academic learning time. The study also revealed that prior academic achievement of learners in primary schools is, to a large extent, a major predictor of their achievement in secondary schools. In this regard, the highly effective schools, which have selective admission policies and accept mainly Form A applicants, tend to consistently outperform the average and less effective schools, which have open admission policies. In order to improve the academic performance of secondary schools, it is recommended that the Ministry of Education officials, principals, teachers and learners should work more diligently and refocus their efforts on the core business of schools, namely, teaching and learning. / Teacher Education / D. Ed. (Education Management)
507

Identification of health needs and problems of Black employees in the Germiston City Health Department

Poho, Petronella Tryzina 11 1900 (has links)
The aim of this study was to identify the health needs and problems of black employees within the Germiston City Health Department in order to indicate a possible relationship between such needs and problems and a high rate of absenteeism. Although the findings could relate to all employees, this study was limited to black employees only. Data was collected by means of observation, perusal of health records and personal interviews with personnel as well as with the selected sample. The results of the study highlighted the specific health needs and problems of employees as well as factors which could influence their health status and which could contribute to the problem of absenteeism. The main factors identified included interalia poor working conditions and unsatisfactory methods of solving employees problems. Relevant recommendations were made ;· to address the problem of absenteeism in the Germiston City Health Department / Health Studies / M.A. (Nursing Science)
508

Factors related to school refusal of black adolescents in the Impendle area

Chemane, Bonginkosi Reginald 11 1900 (has links)
The specific aim of this research study was to identify, explore, describe and interpret the factors related to school refusal of black adolescents. An overview of literature was used to arrive at a broader appreciation of issues pertaining to school refusal phenomenon and also to black adolescents. Ten subjects participated in this study. Data were gathered qualitatively using ethnographic interviews. The following factors were found to be contributory to the problem of school refusal: School refusers who stay with grandparents instead of staying with biological parents; fear of something specific at school; lack of insight into the refusal problem; lover plays a role in refusal behaviour; protective parents; poor social relationships; fathers that play a marginal role in the family; parents' worldview; emotional problems and weak or no attempts to stop behaviour. The emphasis was on the understanding of the refusal phenomenon rather than on cause and effect. / Educational Studies / M. Ed. (with specialisation in Guidance and Counselling)
509

Absenteeism, an indicator of the health status of school children in the middle schools of the Molopo region in the North-West Province

Hlonipho, Maria Molebogeng 01 1900 (has links)
Health related absenteeism was identified as a problem in the schools in the Molopo region, needing a multi-disciplinary approach which included the parents. A conceptual framework on absenteeism was used as a guideline for the descriptive research design. Using a convenience sampling technique 426 absentees, 22 teachers and 2 school nurses filled in three separate questionnaires in ten schools selected to determine the extent of absenteeism due to health related and other problems, the control measures taken and the awareness of school personnel. Health problems were identified as the main reasons for absenteeism. Inadequate communication between the schools and parents as well as lack of guidelines on the control of absenteeism, were other problems identified. Recommendations made related to the provision of school health services that promote the health status of the pupils based on Primary Health Care principles, parental involvement in school health matters and the formulation of policies aimed at controlling absenteeism in schools. / Health Sciences / M.A. (Nursing Science)
510

Avaliação assistencial da população atendida no ambulatório A2MG404 (Hepatite B) da Divisão de Gastroenterologia e Hepatologia Clínica do HC-FMUSP / Assistance assessment of the population served at the ambulatory A2MG404 (Hepatitis B) of the Division of Gastroenterology and Clinical Hepatology of HCFMUSP

Felipe Pereira de Souza 22 May 2018 (has links)
Introdução: A infecção pelo vírus da Hepatite B (HBV) é um grande problema de saúde pública, uma vez que cerca de 257 milhões de pessoas em todo o mundo são acometidas pelo vírus. Mundialmente, devido ao grande movimento migratório, descrevem-se mudanças no perfil dos pacientes portadores de HBV. Desta forma, objetivamos caracterizar a população de pacientes portadores HBV atendidos no ambulatório A2MG404 de Hepatites Virais do HC-FMUSP. Métodos: Este foi um estudo retrospectivo descritivo de 617 novos pacientes com exames sorológicos positivos para HBV, em seguimento no ambulatório A2MG404 entre janeiro de 2005 e dezembro de 2015. Dados demográficos, epidemiológicos e clínicos foram obtidos de prontuários eletrônicos institucionais (SIGH-PRODESP, HCMED e ProntMed). A coleta e gerenciamento de dados foi realizada utilizando o software on-line REDCap (V6.16.4). A análise estatística foi realizada utilizando o software R (V3.3.0). O teste de Shapiro-Wilk foi utilizado para testar a normalidade dos dados; dados não paramétricos foram comparados utilizando-se o teste de Wilcoxon-Mann-Whitney; as proporções entre populações foram comparadas utilizando-se o Teste Z. Foram considerados estatisticamente significativos valores de p < 0,05. Resultados: Foi observada predominância do sexo masculino (60,9%); mediana de idade de 48 anos; raça branca (70,8%) e nível de escolaridade baixo [ensino fundamental completo (37,4%)] entre os pacientes. A maioria deles eram brasileiros (93,5%), residentes no estado de São Paulo (98,4%), principalmente na cidade de São Paulo (63,6%). Pacientes residentes em outros estados do Brasil também foram atendidos no serviço (1,6%), bem como estrangeiros (6,5%). Coinfecção por HCV foi identificada em 7,8% dos pacientes; e por HIV em 1,3% destes. De base, 109/617 (17,66%) pacientes eram AgHBe positivo [infecção crônica: 42/617 (6,8%); hepatite crônica: 67/617 (10,8%)]; 350/617 (56,72%) pacientes eram AgHBe negativo [infecção crônica: 290/617 (47,0%); hepatite crônica: 60/617 (9,7%)]; 104/617 (16,9%) pacientes eram Anti-HBc Total e Anti-HBs positivos; 49/617 (8,0%) pacientes eram Anti-HBc Total isolado; e 5/617 (0,8%) pacientes eram portadores de perfil sorológico anômalo da hepatite B. Entre o início e término de seguimento foram observados diminuição significativa dos valores de ALT, AST, APRI, carga viral (p < 0,001), hemoglobina (p=0,007) e bilirrubina total (p=0,011), bem como aumento significativo de bilirrubina direta e INR (p < 0,001). O FIB-4 não apresentou diferença estatisticamente significativa no mesmo intervalo. A análise mostra que 30,3% dos pacientes receberam tratamento com antivirais, sendo Tenofovir (28,3%) o mais prescrito, seguido de Lamivudina (19,8%), Tenofovir+Lamivudina (19,8%) e Entecavir (19,2%). Entecavir apresentou a maior taxa de soroconversão de AgHBe (6/9; 66,66%), enquanto que Lamivudina apresentou a maior taxa para AgHBs (5/30; 16,66%). Tenofovir possui maior potencial para redução de carga viral, aumento de plaquetas e melhora de enzimas hepáticas do que Lamivudina e Entecavir (p < 0,05). No total, foram realizadas 5412 consultas médicas, sendo a maioria delas do tipo \"seguimento\" (85,8%). Faltas foram registradas em 11,9% das consultas médicas agendadas no período. Conclusões: A população atendida no serviço é heterogênea, com representação de diferentes sexos, etnias, faixas etárias e nacionalidades; ao menos 14 nacionalidades representadas, refletindo o fenômeno da migração observado globalmente. São necessárias ações educacionais para promoção da adesão aos cuidados médicos adequados / Background: Hepatitis B virus (HBV) is a major public health problem with significant burden across all global regions, once they affect about 250 million people around the world. Worldwide, due to the great migratory movement, changes were described in the profile of patients with hepatitis B. In this way, we aimed to characterize the population of patients with chronic hepatitis B seen in the ambulatory A2MG404 of Viral Hepatitis of HC-FMUSP. Methods: This was a retrospective descriptive study of 617 new patients with positive serological tests results for HBV, followed up in the A2MG404 ambulatory between January 2005 and December 2015. Demographic, epidemiological and clinical data were obtained from institutional electronic medical records (SIGH-PRODESP, HCMED and ProntMed). Data collection and management was performed using REDCap online software (V6.16.4). Statistical analysis was performed using R software (V3.3.0). Shapiro-Wilk Test was used to test the normality of the data; non-parametric data were compared using Wilcoxon-Mann-Whitney Test; proportions among populations were compared using the Z-Test. Values of p < 0.05 were considered statistically significant. Results: Male predominance (60.9%); median age of 48 years; white race (70.8%) and low educational level (37.4%) was observed among the patients. Most of them were Brazilian (93.5%), living in the State of São Paulo (98.4%), mainly in the city of São Paulo (63.6%). Patients living in other Brazilian states were also assisted in the service (1.6%), as well as foreigners (6.5%). HCV coinfection were identified in 7.8% of patients; and HIV in 1.3% of these. At baseline, 109/617 (17.66%) patients were HBeAg positive [chronic infection: 42/617 (6.8%); chronic hepatitis: 67/617 (10.8%)]; 350/617 (56.72%) patients were HBeAg negative [chronic infection: 290/617 (47.0%); chronic hepatitis: 60/617 (9.7%)]; 104/617 (16.9%) patients were Total Anti-HBc and Anti-HBs positive; 49/617 (8.0%) patients were Anti-HBc Total isolated; and 5/617 (0.8%) patients had anomalous serological profile of hepatitis B. Significant decrease in ALT, AST, APRI, viral load (p < 0.001), hemoglobin (p = 0.007) and total bilirubin (p = 0.011); as well as significant increase of direct bilirubin and INR (p < 0.001) of patients were observed during the follow-up. FIB-4 score didn\'t present a statistically significant difference in the same interval. The analysis shows that 30.3% of the patients received antiviral treatment, being Tenofovir (28.3%) the most prescribed, followed by Lamivudine (19.8%), Tenofovir+Lamivudine (19.8%) and Entecavir (19.2%). Entecavir presented the highest HBeAg seroconversion rate (6/9; 66.66%), whereas Lamivudine presented the highest rate for HBsAg (5/30, 16.66%). Tenofovir has greater potential for viral load reduction, platelet increase, and hepatic enzymes normalization than Lamivudine and Entecavir (p < 0.05). In total, 5412 medical appointment were performed, most of them was classified as \"follow up\" type (85.8%). Absences were recorded in 11.9% of the medical appointments scheduled in the period. Conclusions: The population served in the service is heterogeneous, with representation of different genders, ethnicities, age groups and nationalities. In it, at least 14 nationalities are represented, reflecting the phenomenon of immigration observed worldwide. Educational actions are required to promote adherence to the necessary medical care for these patients

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