O objeto deste estudo são os grupos realizados pelas equipes de Núcleo de Apoio a Saúde da Família (NASF) na Atenção Primária a Saúde (APS) e a avaliação de seus resultados enquanto tecnologia de cuidado e modalidade assistencial prioritária destas equipes ofertada a usuários com condições crônicas de saúde. A sistematização do processo de avaliação pode auxiliar na validação do grupo como tecnologia de cuidado eficaz e capaz de ofertar respostas às necessidades de saúde destes usuários. Objetivos: caracterizar os usuários participantes e os profissionais que coordenam estes grupos; identificar os motivos dos usuários para estarem no grupo e suas expectativas; identificar o perfil e características dos grupos e suas formas de avaliação e/ou instrumentos atualmente aplicados e refletir com os profissionais sobre em que visão de saúde e educação os grupos se apoiam; levantar junto às equipes as dificuldades e possibilidades para a realização de avaliações de resultados dos grupos em seu cotidiano; propor e elaborar um instrumento de avaliação de resultados dos grupos a partir das reflexões emergentes do processo da pesquisa e condizente com a realidade e processos de trabalho das equipes de NASF. Metodologia: trata-se de uma pesquisa-ação, realizada em Unidades Básicas de Saúde (UBS) com Estratégia de Saúde da Família (ESF), no Município de São Paulo. Os sujeitos da pesquisa foram os participantes dos grupos e os profissionais que coordenam os grupos. Para tratamento dos dados foi utilizada a análise temática de conteúdo. Resultados: Os usuários dos grupos eram predominantemente mulheres com faixa etária entre 60 e 70 anos e os aposentados representavam uma parcela de 37,8% do total. A maioria não tinha o ensino médio completo e suas principais ocupações eram na área de serviços e que demandavam menos qualificação. A maioria dos usuários (51%) participava do grupo por um período de tempo entre 1 e 3 anos ou mais, denotando um perfil de grupo aberto e de uso para encontros e socialização. Os principais motivos de participação no grupo foram: necessidade de tratar doenças crônicas; atender à orientação médica; receber apoio e encorajamento para mudança por meio do compartilhamento de experiências; por ser bem tratado e acolhido e encontrar no grupo um espaço de escuta. As expectativas foram, em menor número, adquirir conhecimento, aprender coisas novas e receber orientações para o manejo da condição de saúde e em maior número, para obter a melhora da saúde e qualidade de vida e prevenir complicações. O tempo médio de formação dos coordenadores dos grupos foi de 13,7 anos e a média de tempo de trabalho em equipes de NASF foi de 5,5 anos. As principais linhas de cuidado identificadas nos grupos pesquisados foram: 1.promoção de saúde; 2.alimentação e nutrição; 3.reabilitação física; e 4.saúde mental. Os objetivos destes grupos eram: 1.promover qualidade de vida, promover saúde, controlar e prevenir doenças crônicas, estimular e promover mudança de estilo de vida, estimular a prática de atividade física; 2.promover reeducação alimentar; 3.reduzir a dor crônica e melhorar função para atividades de vida diária; 4.ofertar cuidado em saúde mental, estimular atividade cognitiva, fomentar participação social e em atividades ocupacionais, promover socialização, ampliar rede de apoio, ofertar espaço de aprendizado e convivência, orientar sobre direitos e cidadania. Não havia consenso em relação às formas de avaliação no que se refere ao tipo de instrumento, aplicabilidade, periodicidade e análise dos dados. A visão de saúde em que os profissionais baseiam o grupo transita entre o conceito ampliado de saúde e o da saúde como norma e parcialmente no modelo conceitual dos determinantes sociais da saúde. As vertentes educativas dos grupos se aproximam dos conceitos de educação em saúde e educação e saúde. As principais dificuldades apontadas pelos profissionais para a realização da avaliação de resultados de grupos foram relativas à forma de organização dos processos de trabalho, à habilidade profissional para o manejo em avaliações de grupos, a questões referentes às características dos participantes, e, por fim, a falta de um instrumento que abarque a avaliação de todos os objetivos, contemple as necessidades do grupo e se adeque às questões anteriores, permitindo seu uso e análise posterior dos dados de forma sistematizada. Foi elaborado um instrumento global para avaliar o resultado de todos os grupos nas quatro linhas de cuidado a partir das reflexões e considerações emergentes do processo das oficinas, de modo a responder as necessidades dos profissionais. Os indicadores foram propostos a partir da visão de saúde e educação em que os profissionais embasavam os grupos e levando em conta as expectativas dos participantes. Conclusões: O instrumento propõe a facilitação do processo avaliativo dos grupos nas principais linhas de cuidado dos profissionais do NASF. Contempla os objetivos dos grupos e as expectativas dos usuários. Não esgota o problema, mas configura-se em um ponto de partida para trazer novas respostas e possibilidades para a avaliação de grupos, permitindo a sua revisão e aperfeiçoamento constante. / The object of this study are the groups conducted by the teams of the Family Health Support Center (Núcleo de Apoio a Saúde da Família - NASF) in Primary Health Care (PHC) and the evaluation of its results as a care technology and priority assistance mode of these teams offered to users with chronic health conditions. The systematization of the evaluation process to verify whether the objectives of the groups are being reached could assist in the validation of the group as a technology of effective care and be able to offer answers to the health needs of these users. Objectives: characterize the participating users and the professionals who coordinate these groups; identify users\' reasons for being in the group and their expectations; identify the profile and characteristics of the groups and their evaluation forms and/or instruments currently applied and reflect with the professionals about what idea of health and education the groups support; list, with help from the teams, the difficulties and possibilities for carrying out group results in their everyday reality; propose and develop an instrument to assess results of the groups from the reflections that emerge from the research process and consistent with the reality and work processes of the teams of NASF. Methodology: this is an action research, carried out in Basic Health Units - BHU (Unidades Básicas de Saúde - UBS) with the Family Health Strategy (FHS) in the Municipality of Sao Paulo. The research subjects were the participants of the groups and the professionals who coordinate the groups. Thematic content analysis was used for processing the data. Results: Users group were predominantly women, aged between 60 and 70 years-old and the retirees accounted for 37.8% of the total. The majority had not graduated from high school and their main occupations were in service areas and that required less qualification. The majority of users (51%) were in the group for a period of time between 1 and 3 years or more, denoting an open group profile and its use for meetings and socialization. The main reasons of participation in the group were: need to treat chronic diseases; to fill the medical advice; to receive support and encouragement to change through sharing of experiences; to be well treated and welcomed, and to find in the group a space for being heard. The expectations have been, in lesser number, to acquire knowledge, to learn new things and receive guidance for the management of health conditions, and in higher numbers, to improve health and quality of life and prevent complications. The average training time of the coordinators of the groups was 13.7 years and the average time working in NASF teams was 5.5 years. The main identified lines of care in the surveyed groups were: 1.health promotion; 2.food and nutrition; 3.physical rehabilitation; and 4.mental health. The objectives of these groups were: 1.to promote quality of life, to promote health, to control and prevent chronic diseases, to stimulate and promote lifestyle change, to encourage the practice of physical activity; 2. to promote nutritional education; 3.reduce chronic pain and improve function for every-day activities; 4.to offer mental health care, to stimulate cognitive activity, to promote social participation and in occupational activities, promoting socialization, expanding support network, to offer space for learning and living together, offer guidance about rights and citizenship. There was no consensus as to the forms of assessment regarding type of instrument, applicability, periodicity and data analysis. The health vision in which the professionals base the group transits between the \"extended concept of health and \"health as a norm, and partially on \"conceptual model of the social determinants of health. The educational aspects of the groups approach the concepts of \"health education and \"education and health. The main difficulties pointed out by the professionals to analyze the group\'s results were related to the structure of organization of the work processes, to the professional skill in managing group evaluations, to issues relating to the characteristics of the participants, and, finally, the lack of an instrument that encompasses the evaluation of all objectives, contemplating the needs of the group and adapting to earlier questions, allowing for its use and further data analysis in a systematic way. A global instrument was designed to assess the results of all groups in the four lines of care from the reflections and considerations that emerged from the workshops processes, in order to meet the needs of professionals. The indicators were considered from the understanding of health and education that the professionals had on the groups and taking into account the expectations of the participants. Conclusions: The instrument proposes the facilitation of the evaluation process of the groups in the main lines of care of NASF professionals. Covers the groups objectives and the expectations of the users. It does not extinguish the problem, but sets a starting point to bring new answers and possibilities for the group assessment, allowing its revision and improvement.

Estudo quantitativo, descritivo, transversal, visando avaliação da estrutura, do processo e do resultado em diálise peritoneal domiciliar. Participaram 90 pacientes em diálise peritoneal domiciliar de municípios em Sergipe de novembro de 2011 a julho de 2012. Foi empregado o referencial teórico da Avaliação de Cuidados em Saúde proposta por Donabedian (1980). A coleta de dados foi realizada por meio de entrevista e observação sistematizada em domicílios com pacientes e cuidadores e por meio de consulta aos prontuários de saúde. Foram utilizados os programas Statistical Package for the Social Sciences (SPSS) versão 20 e Epi info versão 3.5.1 do Centers for Disease Control and Prevention- CDC e para a análise testes paramétricos e não paramétricos. Em relação ao componente estrutura o espaço predominante para a realização da diálise peritoneal foi o quarto (98,9%). Havia rachaduras nas paredes em 15,5% e infiltrações em 11,1% dos domicílios. A água era tratada em 87,7% das casas e com rede de esgotamento sanitário em 76,6%. Em 76,6% das residências constatou-se a existência de pia para higienização das mãos localizada no quarto. Quanto aos pacientes 41,1% estavam na faixa etária entre 60 a 79 anos, 56,7% do sexo masculino, baixa escolaridade 40,0% e renda per capta menor que um salário mínimo para 64,5%. As comorbidades mais prevalentes foram a hipertensão arterial e o diabetes mellitus. Quanto ao componente processo, faltas as consultas médicas foram de 38,9%. 51,1% pacientes realizavam DPA e 53,3% utilizavam o cateter Tenckhoff cuff duplo. Constatou-se a falta de registro nos prontuários da troca do equipo obedecendo a o prazo de validade para 43,3% dos pacientes. A solução dialítica em 26,7% das casas estava armazenada diretamente sobre o piso. 11,1% dos pacientes não tinham registro do dialisato efluente após o procedimento dialítico. Quanto ao componente resultado constatou-se que 42,1% apresentaram um ou mais episódios de peritonite. Pacientes com dois anos ou mais de tratamento apresentaram maior chance de peritonite (p = 0,01). A mediana de tempo da terapia foi de 23 meses. Houve associação entre ocorrência de peritonite e as variáveis integridade das paredes (p<0,026), troca do equipo fora da validade (p<0,049) e número de faltas nas consultas médicas, (p= 0,01). Quanto à infecção no orifício de saída do cateter peritoneal (IOS), 62,2% pacientes tiveram um ou mais episódios. Houve associação entre IOS e renda familiar (p< 0,019), não capacitação do cuidador ou paciente (p<0,028) e tempo de tratamento (p=0,015). 16,7% dos pacientes apresentaram como complicações mecânicas a drenagem inadequada. 88,9% dos pacientes referiram estar satisfeitos com a diálise peritoneal no domicílio. Os componentes relacionados à estrutura, processo e resultado mostraram que pacientes e cuidadores estão expostos a riscos que podem agravar o estado de saúde. Ressalta-se a importância da visita domiciliar e a educação permanente, como também o estabelecimento de parcerias com os profissionais da Estratégia de Saúde da Família sob a supervisão do enfermeiro da Clínica de Diálise, a fim de desenvolver ações de cuidado seguro para a prevenção de complicações no paciente em diálise peritoneal domiciliar. / This is a quantitative, descriptive and cross-sectional study, aimed at the assessment, the structure, the process and the outcome in peritoneal dialysis at home. The participants were 90 patients undergoing peritoneal dialysis at home in municipalities of the Sergipe State during the period from November 2011 to July 2012. The theoretical framework of the Health Care Assessment, proposed by Donabedian (1980), was employed. Data collection was performed through interviews and systematic observation in households with patients and caregivers and through consultations with medical records. We used the programs Statistical Package for Social Sciences (SPSS), version 20, and Epi Info, version 3.5.1, from the Centers for Disease Control and Prevention (CDC), and, for analysis, parametric and non-parametric tests. Regarding the component \'structure\', the predominant space for the accomplishment of peritoneal dialysis was the room (98,9%). There were cracks in the walls in 15,5% and infiltration in 11,1% of households. The water was treated in 87,7% of the houses and there was a sewage system in 76,6% of them. 76,6% of the surveyed households had a sink for hand -washing located in the room. As for patients, 41,1% were aged between 60 and 79 years, 56,7% were males, 40,0% had low schooling and 64,5% had a per capita income lower than a minimum wage. The most prevalent comorbidities were arterial hypertension and diabetes mellitus. Regarding the component \'process\', the absences to medical visits reached 38.9%. 51,1 % of patients performed APD and 53,3 % used the double Tenckhoff cuff catheter. It was found a lack of registration in the medical records of the exchange of the unit in line with the expiration date to 43,3 % of patients. The dialytic solution in 26,7 % of homes was directly stored on the floor. 11,1% of patients had no record of the effluent dialysate after the dialysis procedure. Regarding the component \'outcome\', it was found that 42,1% showed one or more episodes of peritonitis. Patients with two or more years of treatment showed a higher chance of peritonitis (p=0,01). The median of therapy time was of 23 months. There was an association between the occurrence of peritonitis and the variables \'integrity of walls\' (p<0,026), \'exchange of unit out of date\' (p<0,049) and \'number of absences in medical consultations\' (p = 0,01). Regarding infections in the exit orifice of the peritoneal catheter (IOS), 62,2 % of patients had one or more episodes. There was an association between \'IOS\' and \'family income\' (p<0,019), \'lack of training of the caregiver or the patient\' (p<0,028) and \'treatment time\' (p= 0,015). 16,7% of patients showed inadequate drainages as mechanical complications. 88,9% of patients reported being satisfied with peritoneal dialysis at home. The components related to the structure, process and outcome showed that patients and caregivers are exposed to risks that may aggravate the health condition. It should be emphasized the importance of home visits and continuing education, as well as the establishment of partnerships with professionals of the Family Health Strategy, under the supervision of the Dialysis Clinic\'s nurse, in order to develop actions for safe care to prevent complications in patients undergoing peritoneal dialysis at home.

O setor da saúde no Brasil passa por uma difícil situação no que tange ao financiamento e ao atendimento das demandas sociais. O estrangulamento orçamentário do setor público vem aumentando os desafios encontrados na área da saúde. Neste sentido, o desenvolvimento de iniciativas que apresentam impactos sócio econômicos positivos, ou seja, que cooperam no atendimento das demandas básicas de saúde da população brasileira passam a ser importante para a sociedade. Entretanto, o financiamento de tais iniciativas também se apresenta como um desafio para sua implementação. Assim, os negócios sociais ou investimentos de impacto, que conciliam oportunidades de investimentos com impacto social, representam uma via alternativa para incremento no atendimento de demandas sociais, possibilitando maior alcance da assistência na saúde, mesmo considerando a restrição pública orçamentária de curto prazo. Neste contexto, o presente estudo propõe avaliar o impacto de um programa de atendimento gratuito na área de saúde, considerando uma iniciativa de investimento, analisada sobre o modelo de avaliação de impacto e da teoria de mudança. Como resultado, observou-se que o modelo de negócio estudado gerou contribuição significativa para a sociedade local, apresentando impacto econômico direto de R$ 507.678,48, somente no ano de 2016. Destaca-se a relevância do estudo para o desenvolvimento de iniciativas de impacto socioeconômicos para direcionamento dos esforços públicos e privados, auxiliando nas ações e formulações de estratégias no setor da saúde / The health sector in Brazil faces a difficult situation in terms of financing and meeting social demands. The public-sector budget bottleneck has been increasing the health challenges. In this sense, the development of initiatives that have positive socio-economic impacts, that is, that cooperate in meeting the basic health demands of the Brazilian population are important for society. However, funding for such initiatives is also a challenge for their implementation. Thus, social businesses or impact investments, which reconcile investment opportunities with social impact, represent an alternative way to increase social assistance, allowing a greater reach of health care, even considering the public short-term budget constraint. In this context, the present study proposes to evaluate the impact of a free health care program, considering an investment initiative, analyzed by impact investment model and theory of change. As a result, it was observed that the business model studied generated a significant contribution to the local society, with a direct economic impact of R$ 507.678,48, only in 2016. It is worth highlighting the relevance of the study for the development of socioeconomic impact to guide public and private efforts, assisting in the actions and formulations of strategies in the health sector

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-04-12T14:09:13Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Maria_Carolina_Pinheiro_Meirelles.pdf: 12582888 bytes, checksum: 7f15bb6109e4317d5e9e9159b77a7ded (MD5) / Made available in DSpace on 2018-04-12T14:56:25Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Maria_Carolina_Pinheiro_Meirelles.pdf: 12582888 bytes, checksum: 7f15bb6109e4317d5e9e9159b77a7ded (MD5) Previous issue date: 2016-12-16 / Sem bolsa / Na presente tese avaliaram-se os processos de gestão de uma rede de atenção psicossocial (RAPS) à luz da Teoria da Ação Comunicativa. Estudo de avaliação qualitativa, realizado em um município da Região Sul do Rio Grande do Sul. A coleta de dados incluiu 19 entrevistas individuais semiestruturadas com participantes do Colegiado Gestor e 20 horas de observação participante em oito reuniões do colegiado,de maio a setembro de 2015. A análise foi de abordagem hermenêutica-dialética com auxílio do Ethnograph V6. Os resultados apontaram uma complexa rede de atenção psicossocial, com vários pontos de atenção e equipes multiprofissionais de diversas formações. Identificaram-se ações de planejamento e avaliação de estruturas, práticas e políticas de saúde mental,em reuniões de equipe,do colegiado e Seminários, que auxiliam tomadas de decisão;ações de produção de cuidado em rede que promovem integração, articulação da rede, e compartilhamento do cuidado, destacando-se o Apoio Matricial da Atenção Básica; e ações de Educação Permanente em Saúde—seminários, eventos culturais, reuniões de equipe, colegiados, matriciamento, cursos de residência multiprofissional e de psiquiatria —e o percurso formativo de redes. Nas categorias de análise apontou-se relação com o agir instrumental nas discussões sobre a utilização rígida de fluxos, normas e protocolos, as ações prescritivas sem negociação coletiva e sem inclusão do usuário, e a medicalização baseada apenas em critérios técnicos. Quanto ao agir comunicativo observou-se predominância sobre o agir instrumental,apontando pactuação de fluxos, discussões e encaminhamento de casos, pactuações com o judiciário, e ênfase nas deliberações do colegiado sobre questões da gestão ou da singularidade dos casos, próprias do mundo da vida, que não se resolvem somente com o tecnicismo. Destaca-se a relevância de manter e fortalecer os espaços de comunicação e de encontro entre os sujeitos que operam a rede - as reuniões de equipe, os seminários e principalmente as reuniões semanais do colegiado-, ampliando a participação da rede intersetorial e de usuários. Os processos de gestão da RAPS lourenciana são possivelmente produtores de cuidado em rede,coordenando e promovendo a integração de diversos pontos de atenção, à medida que operam de modo participativo e democrático mediante ação comunicativa linguisticamente mediada, buscando um poder criativo, protagonista e emancipatório dos sujeitos e da produção do trabalho em saúde. Processos de gestão de uma Rede de Atenção Psicossocial são ações do mundo da vida, orientados por um agir comunicativo, e ainda que pautados também pelo mundo do sistema, requerem a superação de um agir capturado por ações estratégicas ou instrumentais. / The aim of this thesis was to evaluate the management processes of a psychosocial care network (RAPS) in the light of the Theory of Communicative Action. A qualitative evaluation study was carried out in a municipality in the Southern Region of Rio Grande do Sul. Data collection included 19 individual semi-structured interviews with participants from the Colegiado Gestor and 20 hours of participant observation at 8 meetings of the collegiate from May to September 2015. The analysis was hermeneutic-dialectical with the help of the Ethnograph V6. The results pointed to a complex network of psychosocial attention, with several points of attention and multiprofessional teams of diverse formations. It was identified actions of planning and evaluation of structures, practices and mental health policies in team meetings,collegiate and Seminars, that help in decision making; Actions for the production of care in a network that promote integration, network articulation, and sharing of care, highlighting the Matrix Support of Primary Care; And actions of Permanent Educationin Health, such as seminars, cultural events, team meetings, collegiate, matriciamento, multiprofessional and psychiatry residency courses and the formative course of networks. In the categories of analysis, it was pointed out a relation with the instrumental action in the discussions on the rigid use of flows, norms and protocols, prescriptive actions without collective negotiations and without inclusion of the user, and medicalization based only on technical criteria. As far as communicative action was concerned, it was observed a predominance of the instrumental act, pointing to the agreement of flows, discussions and referrals of cases, agreements with the judiciary, and emphasis on the deliberations of the collegiate on management issues or the uniqueness of cases, specific to the world of life, Which are not only solved with technicality. It is important to maintain and strengthen the communication and meeting spaces between the individuals who operate the network, such as team meetings, seminars and especially the weekly meetings of the collegiate, increasing the participation of the intersectoral network and users. The management processes of RAPS Lourenciana are possibly network care producers, coordinating and promoting the integration of several points of attention, as they operate in a participatory and democratic way through a linguistically mediated communicative action, seeking a creative power, protagonist and Emancipation of the subjects and the production of health work. Management processes of a Psychosocial Attention Network are actions of the world of life, guided by a communicative action, and although also guided by the system world, require by a communicative action, and although also guided by the system world, require the overcoming of an action captured by strategic or instrumental actions.

O presente estudo aborda a introdução de ações de regulação na gestão de saúde de um município do interior do estado do Rio de Janeiro, de 2009 a 2012. Mais especificamente, são analisadas a responsabilização sanitária do ente municipal a partir da aquisição da gestão plena do sistema (Pacto de Gestão) e as ações desencadeadas pela implantação do Controle, Avaliação e Auditoria, e pela criação do Complexo Regulador, tendo como referência a Política Nacional de Regulação. A metodologia empregada envolveu análise documental e entrevistas com informantes-chave. Os resultados demonstram o desenvolvimento de ações em todas as dimensões da regulação e o amadurecimento da função reitora da secretaria municipal de saúde sobre o sistema, através do direcionamento qualitativo e quantitativo dos prestadores privados. / The present study focus on the introduction of regulatory actions on health management in a municipality of the state of Rio de Janeiro, 2009-2012. More specifically, it analyses the new health responsibility taken by the municipal administration after acquiring the full management of the system (Management Pact) and the actions triggered by the implementation of control, evaluation and auditing, as well the creation of a regulatory complex, with reference to regulation national policy. The methodology included documental analysis and interviews with key informants. The results demonstrated the implementation of actions in all aspects of regulation and the progress of the local health system stewardship function at the municipal health department through the qualitative and quantitative guidance on the private providers.

Thesis (MSc.) Zoology)) -- University of Limpopo, 2019 / In South Africa, a high anthropogenic demand of water for domestic, recreational, agricultural, urbanisation and industrial purposes has placed enormous pressure on freshwater resources and has led to a decline in water quality. In addition to measuring water quality variables, the health assessment index (HAI) advocated by AvenantOldewage and Swanepoel (1993), and modified by Crafford and Avenant-Oldewage (2009) by incorporating the inverted parasite index (IPI), and adapted further by Madanire-Moyo et al. (2012) who excluded the white blood cells counts, has been used as a rapid and inexpensive means of assessing and monitoring fish health and, in turn, the state of aquatic ecosystems. However, few studies have evaluated the latter approach in conjunction with other biomonitoring indices to assess the water quality of impoundments. Thus, the aim of this study was twofold. The first was to evaluate the HAI adapted by Madanire-Moyo et al. (2012) as a means to establish the health status of Oreochromis mossambicus (Peters, 1852) sampled from various impoundments based on a once-off survey. The second was to establish if the adapted HAI, in conjunction with selected biomonitoring indices and environmental variables, could describe monthly and seasonal fluctuations of O. mossambicus health. Once-off surveys were conducted between April and May 2016 at five impoundments. The Luphephe-Nwanedi Dam located in the upper catchment of the Limpopo River System and Rhenosterkop Dam situated in the Elands River, a tributary of the Olifants River System, served as control sites due to little or no anthropogenic activities occurring in their catchment areas. In addition, surveys were conducted at Loskop and Flag Boshielo dams and Phalaborwa Barrage situated in the main stem of the Olifants River for comparison purposes. The latter three impoundments were selected because they vary in water quality and pollution levels. Monthly surveys were carried out at Flag Boshielo Dam from February 2016 to February 2017 to establish if the biomonitoring tools and the quantification of water and sediment quality variables, could describe and predict seasonal fluctuations in the health of O. mossambicus. To this end, water quality variables were measured during each survey. Water and sediment samples were collected for analysis of nutrients and metals. Oreochromis mossambicus were collected using gill nets. Fish health was assessed using the adapted HAI that was based on observing parasite burden, haematocrit determination and anomalies in body tissues and organs in conjunction with determining gonad and iv hepato-somatic indices, the condition factor, blood glucose levels, microscopy analyses of fish gills and metal concentrations in fish muscle tissues. Water quality in terms of pH, total dissolved solids and electrical conductivity, nutrients and some aqueous and sediment metals exhibited significant differences (p ˂ 0.05) between impoundments surveyed with water quality from good to poor being in the order of: Luphephe-Nwanedi Dams ˂ Rhenosterkop Dam ˂ Loskop Dam ˂ Phalaborwa Barrage ˂ Flag Boshielo Dam. The HAI scores varied significantly (p ˂ 0.0001) between impoundments and substantiated water quality variables results during once off surveys, indicating that the health of fish from Flag Boshielo Dam were most affected when compared to the health of fish surveyed from the other impoundments. Findings from monthly surveys conducted at Flag Boshielo Dam indicated better conditions in terms of water quality variables during a period of high inflow as opposed to periods of low inflow. The HAI scores obtained for fish exhibited significant (p ˂ 0.0001) differences between the months surveyed and were found to be in agreement with the water quality findings, indicating that flow regimes and water quality of an impoundment have an impact on fish health. The condition and somatic indices findings did not seem to be sensitive enough to discriminate between the impoundments during the once off surveys. While during monthly surveys, these indices were significantly (p ˂ 0.0001) different between the months, showing to be affected by seasonal fluctuations. Knowledge of the HAI in conjunction with blood glucose levels, gill histopathology and the arithmetic mean thickness of gill epithelium (Har) best described the health of fish in both the once off and monthly surveys. In conclusion, the findings of this study emphasised the HAI premise that fish from more polluted sites would be more impacted as opposed to less impacted sites, making the HAI adapted by Madanire-Moyo et al. (2012) an effective and rapid biomonitoring tool that can be used in the field. Furthermore, this study proved that the HAI can be used either solely or in association with the parasite index (PI) or IPI depending on the objectives of the study, as no pronounced differences were evident when using HAI, HAI with PI and HAI with IPI. / National Research Foundation (NRF) and Water Research Commission (WRC)

The dissertation deals with the accounting aspects of assessing the financial health of a company with a focus on agriculture. The main objective of this study is to assess individual methods designed to evaluate the financial health of a company, to determine their sensitivity to risk data in accounting. The study is focused on the field of agriculture mainly as a result of knowledge about the difficult process of compiling and using agricultural accounting. Agriculture fall within the primary sector of the economy, is very important for landscaping and a lot of subsidies flow from the budget of state and the European Union. Due to the specifics and stated problematic areas, which cannot be fully captured by legislation, incomplete or distorted information is transmitted, being also transferred to the methods of the financial health assessment of the company. Attention is also paid to the influence of legislative changes on the values in accounting as well as creative accounting. Following the findings from the theoretical basis, the application part analyses the impact of different accounting solutions on the financial statements. A paired t-test, used for the analysis, was preceded by data normality testing using the histogram and Shapiro-Wilk test. According to these tests, statistically significant differences were found com-paring the current method of accounting used for investment subsidies and leases with the IFRS accounting, between the accounting of changes in inventories and capitalization before and after 1 January 2016, and in land valuation using historical cost and market price. All these areas influence the values of all the analysed methods of financial health assessment. Only the CH-index showed no statistically significant difference in land valuation and accounting solution of inventory activation and changes. Furthermore, the reliability and controllability of the selected methods used for the evaluation of financial health in the field of agriculture is assessed. According to the results, none of the evaluated models can be used in its original variant, but it is possible to use them to compare the company with similar enterprises or over time thanks to the proven dependence of partial indicators and even the whole models on the productivity. Another type of analysis is designed to determine the indicators that have a statistically significant impact on the actual financial situation of businesses. The method of generalized linear models - multinomial linear regression - is used for this test. To determine whether an enterprise is at risk or not, it would be possible to use the stock / income and short-term liabilities / income indicators, and the cash flow / assets indicator to determine the type of threat.

Psychological evaluations administered by forensic psychologist in personal injury cases are surrounded by complex issues. Although empirically-based research has legitimized that psychological damages do exist in personal injury cases there is a missing link in the way forensic psychologists are conducting these evaluations. Prior researchers suggested that some personal injury evaluations had been dismissed or overlooked due to a lack of a standard of care. Addressing the current literature, this study examined how a diverse group of 14 licensed forensic psychologists, operating in different judicial jurisdictions (Daubert, Frye, and Independent) were conducting personal injury evaluations and their perspectives on the implementation of a standard of care. A qualitative thematic analysis design was used to gain a more in-depth understanding of this phenomenon. Systems theory was the conceptual framework that informed this study and guided the methodology employed. The identified themes were organized into steps reflected in an adapted version cube model. The study promotes positive social change by fostering confidence in the field of psychology and personal injury evaluations with regard to bolstering the overall credibility, reliability, and validity of the practice and processes involved. Further, positive change can occur through the development of framework that assists in leveling the practice by keeping evaluations flexible, but consistent; basing the decision regarding implementing a standard of care on the utility of the framework, along with future findings and developments in the field.

The purpose of this quantitative study was to examine whether the post-deployment screening instrument currently utilized to assess active-duty Marines for symptoms of PTSD upon their return from a combat deployment can be solely relied upon to accurately assess for PTSD. Additionally, this study sought to compare the number of Marines who have sought trauma-related mental health treatment based on their answers on the Post-Deployment Health Assessment (PDHA) to the number who have sought trauma-related mental health treatment based on their answers on their PTSD Checklist - Military Version (PCL-M). The participants in this study were comprised of a sample of active-duty Marines that had recently returned from a combat deployment. A quantitative secondary data analysis used Item Response Theory (IRT) to examine the answers provided by the participants on both the PDHA and PCL-M. Both instruments proved to be effective when assessing symptoms of PTSD and the participants identified as having symptoms of PTSD were referred for mental health services as required. According to the results, more Marines were identified as having symptoms of PTSD using both assessment instruments (PDHA and PCL-M) compared to those identified using just the PDHA. The result was a better understanding of predictors of Marines who may later develop PTSD. The results of this study can also assist the Marine Corps with its post-deployment screening for symptoms of PTSD which in turn can provide appropriate mental health referrals for Marines if deemed appropriate.

In European countries, people, whatever the socio-economic group or nationality they belong to, men or women, the young or the elderly without distinction, should be guaranteed the right to health as well as its promotion and support measures (Javtokas, 2009). Personal health promotion reflects the general idea stating that in order to enhance health it is necessary to change the way of life (Tones, Tilford, 1994; Donev et al., 2007). In this era of radical modernity related to the increased personal anxiety and uncertainty, there appear new alternative ways to enhance a person’s health: taking a variety of medications, trying different diets, engaging in traditional and non-traditional forms and ways of physical education (Cavill et al., 2006). In turn, physical education specialists and health educators bring out the importance of exercise encouraging a person to understand the social value and significance of their health promotion and physical development (Schneider and Becker, 2005; Netz et al., 2005). It is widely recognized that a major health risk factor associated with a person’s lifestyle, is low physical activity, the importance of which for human health has been shown in numerous scientific studies. They have emphasized the positive interface between active leisure time physical activity and a range of health indicators (Kalėdienė et al., 1999; Domarkienė, 2000; Borodulin, 2006; Kallings, 2008; Klumbienė, 2008, Gill et al., 2010; Weiler et al., 2010). The... [to full text] / Visuotinai pripažįstama, kad esminis sveikatos rizikos veiksnys, susijęs su asmens gyvensena, yra mažas fizinis aktyvumas, kurio svarba žmogaus sveikatai yra įrodyta daugelyje mokslinių studijų. Jose pabrėžiama pozityvi aktyvios fizinės veiklos laisvalaikiu sąsaja su įvairiais sveikatos rodikliais (Kalėdienė ir kt., 1999; Domarkienė, 2000; Borodulin, 2006; Kallings, 2008; Klumbienė, 2008; Gill et al., 2010; Weiler et al., 2010). Nekelia abejonių faktas, kad dažnai deklaruojama sveikatos stiprinimo idėja yra tiesiogiai susijusi su gyvensenos ypatumais, kuriuos lemia tiek atskiro individo požiūris į savo sveikatą, tiek įvairūs išoriniai veiksniai, visų pirma gyvenimo sąlygos. Savaime suprantama, daugiausia dėmesio stiprinant žmonių sveikatą turėtų būti skiriama įvairiose sveikatos ugdymo (sveikatinimo) programose. Šių programų pagrindinis tikslas turėtų būti asmens elgesio keitimas panaudojant žiniasklaidos ir individualaus poveikio priemones (Van der Bij et al., 2002; Rise, 2004; Roux et al., 2008). Reiškiama nuomonė, kad supažindinus gyventojus su aktyvaus gyvenimo būdo principais, propaguojant ir skatinant pastovų jų realizavimą, tobulinant fizinę parengtį, pagerėtų ir žmonių gyvenimo kokybė (Aхвердова, Maгин, 2002; Taylor et al., 2002; Netz et al., 2005; Kallings, 2008; Miller, Miller, 2010). Kita vertus, kada kalbama apie fizinį aktyvumą laisvalaikiu kaip apie asmens visapusiškos gerovės sąlygą bei ligų profilaktikos veiksnį labiau akcentuojama jo reikšmė vaikystės ir... [toliau žr. visą tekstą]