L'objectif principal de cette thèse était d'étudier la dynamique spatiale et temporelle de la structure des communautés de poissons du fleuve Mékong en aval et du grand lac Tonlé Sap au Cambodge. Les deux systèmes sont fortement liés et caractérisés par les systèmes d'inondation pulsés. À l'aide d'approches multivariées sur des bases de données piscicoles, environnementales et des traits fonctionnels des taxons étudiés, j'ai pu mettre en évidence : * les gradients longitudinaux des caractéristiques physicochimiques des eaux et l'importance relative des facteurs environnementaux dans la structuration des communautés de poissons à large échelle ; * la structure temporelle des communautés de poissons qui est fortement liée aux traits fonctionnels des taxons et déclenchée par les crues occasionnées du système * la structure de base du réseau trophique et l'état écologique du système d'inondation pulsé qui est perturbé par la pression anthropique. Ces résultats ont démontré leurs valeurs quant à leurs potentiels de transferts vers la compréhension écologique et la gestion durable des ressources de pêches dans le système d'inondation pulsé en Asie tropicale en relevant que : * la connectivité entre le fleuve Mékong et le lac Tonlé Sap est indispensable pour les poissons pour compléter leurs cycles de vie, et la conservation devrait prioritairement s'effectuer au milieu du Mékong où se trouve la plus forte diversité. * dans le système d'inondation pulsé, la structure temporelle des communautés dépend des dynamiques des crues, donc l'aménagement des cours d'eau est à éviter au maximum. * la compréhension bioécologique complète des communautés et leurs relations trophiques sont primordiales pour la mise en place des plans de gestion et de conservation à long terme. / The main objective of the thesis was to study the spatial and temporal dynamics of fish community structure in Lower Mekong river basin and Tonle Sap Great Lake in Cambodia. These two systems are strongly connected to each other and characterised by flood pulse system. By using the multivariate approaches on the fish, environmental and fish functional traits data sets, I am able to highlight: * the longitudinal gradients of physicochemical characteristics of water and the relative importance of environmental factors in explaining the large scale patterns of fish community; * the temporal structure of fish community, which is strongly linked to functional traits of fish and trigged by the pulse dynamics of the system; * the baseline trophic structure model and ecological health assessment of flood pulse system, which is disturbed by anthropogenic pressure. These results have demonstrated their values as well as their potentials to transfers toward an ecological understanding and sustainable fisheries resource management of the flood pulse system in tropical Asia by suggesting: * the connectivity between Mekong river and Tonle Sap lek is essential for fish to complete their life cycle and also the conservation should be done in the middle part of Lower Mekong river where containing the highest diversity; * in flood pulse system, the temporal structure of fish community strongly depend on the dynamics of pulses; therefore any river development must be strictly prohibited; * complete bio-ecological understanding of communities and their trophic relationships are crucial to the establishment of long-term management and conservation plans.

La prise en compte de la notion de la qualité de vie (QDV) du patient est révélatrice d'un changement profond dans la pratique médicale, notamment en néphrologie, pour les patients atteints d'insuffisance rénale chronique terminale (IRCT). Compte tenu de la prévalence, de l'incidence et de la mortalité de cette maladie en France, il paraissait important de pouvoir mesurer de façon pertinente et cohérente la QDV des patients atteints d'IRCT. La QDV liée à la santé constitue un indicateur pour apprécier les conséquences de cette maladie. En 2007, après une étude de revue de la littérature concernant les outils de mesure de la QDV des IRCT, il a été mis en évidence un manque de questionnaires spécifiques validés en langue française. Il existait donc un besoin réel d'évaluer la QDV de ces patients, et plus particulièrement celle des patients porteurs d'un greffon rénal fonctionnel.En 2008, une échelle spécifique a donc été développée et validée pour mesurer la QDV des patients greffés rénaux : le ReTransQol (ou RTQ). Après 5 années d'utilisation du RTQ dans diverses études nationales, cet outil a été amélioré et une nouvelle version a vu le jour: le RTQ V2. Après de nombreuses analyses, cette échelle présente actuellement de bonnes propriétés psychométriques et est validée auprès de diverses populations d'études. Le RTQ V2 sera d'ailleurs utilisé dans des études internationales (Brésil, Allemagne, Canada...), et une validation transculturelle est prévue. Le RTQ V2 est donc un outil de mesure spécifique de la QDV adapté pour une utilisation en routine auprès des patients porteurs d'un greffon rénal fonctionnel. / The inclusion of the concept of quality of life (QOL) is indicative of a profound change in the way of practicing medicine, particularly in the field of nephrology for patients with end stage renal disease (ESRD). Given the prevalence, incidence and mortality of this disease in France, it seemed important, even essential, to measure properly, appropriately and consistently, the QOL of patients with ESRD. Health related quality of life (HRQOL) is therefore an important indicator of results to evaluate the consequences of this disease, the effect of medical procedures, treatment effects, or the impact of health policies.In 2007, after a study of literature concerning the assessment of QOL's scales of patients with ESRD, it was revealed a certain lack, quantitative or qualitative, of specific questionnaires for measuring QOL for ESRD patients validated in French, especially for patients with a functioning kidney transplant.In 2008, a specific scale has been developed and validated to measure the QOL of renal transplant recipients: the ReTransQol (Renal Transplant Quality of life questionnaire). After 5 years of use and application of ReTransQol in different national studies, this tool has been improved and a new version was created: the ReTransQol V2 (or RTQ V2). After lots of analysis, this scale has currently good psychometric properties and has been validated in various populations. The RTQ V2 is also used in international studies (Brazil, Germany, Canada ...), and a cross-cultural validation of the scale is planned.The ReTransQol V2 is a specific tool to assess the HRQOL and is suitable for a routine use among renal transplant recipients.

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)

Os Núcleos de Apoio à Saúde da Família (NASF) foram criados em 2008 para ampliar a abrangência, o escopo e a resolubilidade das ações da Atenção Básica (AB). Passados 10 anos desde a sua criação, mecanismos de monitoramento, avaliação das ações e resultados alcançados pelo NASF ainda são insuficientes. O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), lançado em 2011, visa incentivar os gestores e as equipes de saúde para a melhoria da qualidade dos serviços oferecidos aos usuários do SUS e o fortalecimento da AB. O objetivo dessa pesquisa foi analisar a organização e a prática profissional do NASF no Brasil, com base nos dados coletados no segundo ciclo do PMAQ-AB (2013 - 2014). Para este estudo quantitativo e descritivo utilizou-se a base de dados secundários provenientes da avaliação externa das equipes de AB que participaram do PMAQ-AB. Foram utilizados dois instrumentos de avaliação externa: 1) Equipes de Atenção Básica (Saúde da Família e Equipe Parametrizada); e 2) Núcleos de Apoio à Saúde da Família – NASF. Do primeiro, foram escolhidos três domínios do Módulo II: Adequação da composição das equipes às necessidades do território; Acesso das equipes ao NASF; e Articulação das ações de apoio técnico-pedagógico e clínico-assistencial. Do segundo, os seguintes domínios: Educação permanente; Organização do apoio matricial às EAB; e Gestão da demanda e da atenção compartilhada. Para a análise dos dados utilizou-se o SPSS versão 22.0. Os resultados indicaram a inserção de novos profissionais na AB, em especial o Fisioterapeuta, o Profissional de Educação Física e o Médico Veterinário. Ficou evidente o planejamento de ações conjuntas entre o NASF e a eSF, embora a literatura aponte muitas dificuldades para essa atividade. Principais meios de contato entre as equipes: em dias programados ou pelo telefone, já o e-mail era pouco usual. Dentre as atividades realizadas em conjunto, as visitas domiciliares e as consultas individuais foram destaque para as eSF. Para os profissionais do NASF: discussão de casos e visitas com profissionais da sua equipe. Discussões sobre monitoramento e avaliação de resultados da atenção compartilhada tiveram um resultado pouco expressivo na rotina das equipes. Público-alvo atendido pelo NASF: adultos e idosos, destacando-se atividades voltadas para a atenção nutricional e atenção às pessoas com doenças crônicas. / The Family‟s Health Support Centers were created in 2008 to broaden the coverage, scope and solvability of Basic Attention‟s programs. Ten years after its creation, monitoring mechanisms, measurement of programs and results achieved by NASF are still scarce. The National Improvement Program of Access and Quality of Basic Attention (PMAQ-AB), launched in 2011, aims to motivate managers and health teams to improve quality of services offered to SUS‟ users and to strengthen Basic Attention. The goal of this research was to analyze the organization and the professional practice of NASF in Brazil, based on data collected in the second cycle of PMAQ-AB (2013-2014). To this quantitative and descriptive study, we used the secondary database from the external evaluation of AB teams that participated in PMAQ-AB. Two instruments were used for the external evaluation: 1) Attention Basic teams (Family‟s Health and Parameterized Teams); and 2) Family‟s Health Support Centers – NASF. From the first, we picked three domains from the II module: adjustment of team‟s composition to the territory needs; access from teams to NASF; and articulation of actions from technical-pedagogical support, as well as clinical-care. From the second, the following domains: Perennial education; organization of matrix support to the EAB; and demand and shared attention management. For data analysis we used SPSS version 22.0. Results pointed to the insertion of new professionals at AB, especially Physical Therapist, Physical Education professional and Veterinarian. It was evident the lack of joint action planning between NASF and eSF, although literature references many difficulties in this activity. The main points of contact between teams: in scheduled days or thought the phone, since e-mail was barely used. Among shared activities, residential visits and individual appointments were highlights for eSF. To NASF professionals: discussions of cases and visits with team professionals. Discussions about monitoring and evaluation of results from shared attention had a small impact in the team‟s routine. Target audience supported by NASF: adults and senior citizens, especially activities designed to nutritional attention and people with chronic diseases.

Studies in the USA have reported that species of meiobenthic copepods can be used as bioindicators of sediment-associated contaminants. The main objective of this research project was to develop and validate methods to assess the effects of estuarine pollution, using the marine benthic copepod Robertsonia propinqua as a bioindicator of environmental health in New Zealand intertidal / estuarine areas. Cultures of R. propinqua were set up and maintained in the laboratory and individuals used in 96h acute and full life-cycle chronic bioassays using the pre-selected contaminants atrazine and zinc sulphate. From the 96h acute experiments it was found that the lethal doses at which 50% mortality occurred (LC50) for exposed nauplii and adult individuals were 7.5 mg/L and 31.8 mg/L, respectively for atrazine and 1.7 mg/L and 2.7 mg/L, respectively for zinc sulphate. This indicated that the nauplii life stage was more sensitive than were the adult life stages for exposure to both contaminants. Based on the 'trigger' values reported (atrazine = 0.013 mg/L, zinc = 0.015 mg/L) in the Australian and New Zealand guidelines for fresh and marine water quality, which provide values at which concentrations of contaminants can occur in the environment before they begin causing effects on aquatic fauna, it is unlikely that the calculated LC50s in the current research will induce biological effects in exposed copepods in the short-term. The calculated LC50 results were then used to further investigate the effects of chronic exposure of sediment-associated contaminants on the complete life-cycle (egg-reproductive adult) of R. propinqua. In a laboratory-based full life-cycle toxicity test, field-collected sediments from polluted sites in the Auckland and Bay of Plenty regions reduced reproductive output (nauplii and copepodite production) of R. propinqua individuals, but the number of males and females, gravid females, clutch size per female and the number of eggs produced were not affected by either the polluted or non-polluted (reference) sediment samples from both field regions. Field investigations of meiofauna community composition in polluted and non-polluted field sites were carried out in 2004 in the Auckland and Bay of Plenty field regions in New Zealand. Greater sediment organic content and a correspondingly deeper redox potential discontinuity layer occurred in all polluted field sites compared with the non-polluted sites. However, species composition could not be used to characterise polluted and non-polluted sites, as there were no dominant taxa which were representative of these sites. The results presented in this thesis indicate that R. propinqua has strong potential to be a good candidate species as a bioindicator of environmental contamination. Furthermore, the full life-cycle toxicity test could be used as a rapid test to detect immediate changes in individual reproduction and development as well as long-term population effects. The technologies developed as part of this research may eventually provide additional tools for commercial environmental consultancies and may compliment existing standard operating procedures for environmental assessments involving pollution of estuarine ecosystems.

Incluir como ag?ncias financiadoras: Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG), Funda??o Diamantinense de Apoio ao Ensino, Pesquisa e Extens?o (FUNDAEPE). / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-01-09T21:32:26Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) elizeu_castro_pereira.pdf: 2314835 bytes, checksum: 338417e044a8319ff002f1ba8f047555 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-01-19T17:09:50Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) elizeu_castro_pereira.pdf: 2314835 bytes, checksum: 338417e044a8319ff002f1ba8f047555 (MD5) / Made available in DSpace on 2018-01-19T17:09:50Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) elizeu_castro_pereira.pdf: 2314835 bytes, checksum: 338417e044a8319ff002f1ba8f047555 (MD5) Previous issue date: 2017 / Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG) / Funda??o Diamantinense de Apoio ao Ensino, Pesquisa e Extens?o (FUNDAEPE) / O Programa Mais M?dicos para o Brasil foi implementado pelo Governo Federal nos Vales do Jequitinhonha e Mucuri de 2013 a 2016. V?rios fatores influenciam na satisfa??o dos profissionais m?dicos na presta??o de servi?o. A avalia??o desses fatores ? importante, pois pode trazer alternativas para a amplia??o da perman?ncia desses profissionais nas Unidades B?sicas de Sa?de, apontar lacunas importantes nas Estrat?gias Sa?de da Fam?lia e no Programa Mais M?dicos e, assim, subsidiar a??es efetivas no ?mbito da Aten??o Prim?ria em Sa?de, direcionadas ?s equipes de sa?de da fam?lia e equacionar as dificuldades apresentadas nas Unidades B?sicas de Sa?de do munic?pio de Diamantina, bem como dos demais munic?pios dos Vales do Jequitinhonha e Mucuri. O objetivo do presente projeto foi avaliar a satisfa??o dos m?dicos do Programa Mais M?dicos para o Brasil nos Vales do Jequitinhonha e Mucuri. Tratou-se de um estudo descritivo, o qual foi realizado por meio de uma estrat?gia de combina??o de abordagens quantitativas, denominada triangula??o de m?todos. A popula??o de estudo foi constitu?da por 90 m?dicos, distribu?dos nos 82 munic?pios dos Vales em quest?o. Dos 82 munic?pios investigados foi constatado que apenas 23, at? o momento, n?o fizeram ades?o ao Programa Mais M?dicos para o Brasil. Em rela??o ? satisfa??o dos profissionais m?dicos foi verificado, atrav?s da escala de Likert, que 63% (n=90) dos que responderam as perguntas relacionadas ? satisfa??o se encontram totalmente satisfeitos. Esses dados foram corroborados com outras an?lises estat?sticas como o dendograma e an?lise multicrit?rios. Foi observada a correla??o entre a satisfa??o dos m?dicos e o maior grau de escolaridade. Os resultados alcan?ados nessa pesquisa permitem visualizar quest?es importantes do Programa Mais M?dicos para o Brasil e, desta forma, subsidiar a??es efetivas no ?mbito da Aten??o Prim?ria ? Sa?de. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / More Doctors Program for Brazil was implemented by the Federal Government in the Jequitinhonha and Mucuri Valleys from 2013 to 2016. Several factors influence the satisfaction of medical professionals in the provision of services. The evaluation of these factors is important, since it can provide alternatives for the expansion of the permanence of these professionals in the Basic Health Units. It is believed that the results achieved so far may point to important shortcomings in the Family Health Strategies and the Medical Program and thus, subsidize effective actions in the scope of Primary Health Care directed to the family health teams and equate the difficulties presented in the Basic Health Units of the municipality of Diamantina and also of other municipalities of the Jequitinhonha and Mucuri Valleys. The objective of the present project was to evaluate More Doctors Program for the Brazilians in the Jequitinhonha and Mucuri Valleys. This was a descriptive study, which was carried out through a combination strategy of quantitative approaches, called method triangulation. The study population consisted of 90 physicians, divided among the 82 municipalities of the concerned Valleys. Of the 82 municipalities investigated, it was verified that only 23, untill now, they did not join More Doctor Program for Brazilians. Related to the satisfaction of medical professionals, 63% (n = 90) of those who answered the questions related to satisfaction they were found fully satisfied with the Likert scale. These data were corroborated with other statistical analyzes such as dendrogram and multicriteria analysis. Correlation between physician satisfaction and educational level was observed. The results obtained in this research allow to visualize important issues of More Doctor Program for Brazilians and thus subsidize effective actions in the ambit of the Primary Healthy Care. / El Programa M?s M?dicos para Brasil (PMMB) fue implementado por el Gobierno Federal en los Valles del Jequitinhonha y Mucuri de 2013 a 2016. Varios factores influencian en la satisfacci?n de los profesionales m?dicos en la prestaci?n de servicio. La evaluaci?n de estos factores es importante, pues puede traer alternativas para la ampliaci?n de la permanencia de esos profesionales en las Unidades B?sicas de Salud, se?alar lagunas importantes en las Estrategias Salud de la Familia y en el Programa M?s M?dicos y, as?, subsidiar acciones efectivas en el ?mbito de la Atenci?n Primaria en De la Salud, dirigidas a los equipos de salud de la familia y abordar las dificultades presentadas en las Unidades B?sicas de Salud del municipio de Diamantina, as? como de los dem?s municipios de los Valles del Jequitinhonha y Mucuri. El objetivo del presente proyecto fue evaluar la satisfacci?n de los m?dicos del Programa M?s M?dicos para Brasil en los Valles del Jequitinhonha y Mucuri. Se trat? de un estudio descriptivo, el cual fue realizado por medio de una estrategia de combinaci?n de abordajes cuantitativos, denominada triangulaci?n de m?todos. La poblaci?n de estudio fue constituida por 90 m?dicos, distribuidos en los 82 municipios de los Valles en cuesti?n. De los 82 municipios investigados se constat? que s?lo 23, hasta el momento, no hicieron adhesi?n al PMMB. En cuanto a la satisfacci?n de los profesionales m?dicos se verific?, a trav?s de la escala de Likert, que el 63% (n = 90) de los que respondieron las preguntas relacionadas a la satisfacci?n se encuentran totalmente satisfechos. Estos datos fueron corroborados con otros an?lisis estad?sticos como el dendograma y an?lisis multicriterios. Se observ? la correlaci?n entre la satisfacci?n de los m?dicos y el mayor grado de escolaridad. Los resultados alcanzados en esta investigaci?n permiten visualizar cuestiones importantes del PMMB y, de esta forma, subsidiar acciones efectivas en el ?mbito de la APS.

The study was done to assess the information and care the men and women have on PCC and develop strategies that could improve provision of PCC that could advance maternal and newborn outcome after pregnancy in Malawi. Most for the interventions to improve pregnancy outcome are done too late in Malawi but there is an opportunity during preconception period to plan to improve the health of the couple so that the goal of a healthy mother and baby is attained. The objectives were to: explore and describe the knowledge men and women of childbearing age have on HTSP and PCC, identify variables that influence men and women to acquire appropriate knowledge on PCC and finally to develop strategies that could assist provision of PCC in developing countries like Malawi. Adverse issues that affect the couples could be addressed promptly before the occurrence of pregnancy. A quantitative non-experimental descriptive-correlation design method was used to determine the knowledge men and women of childbearing have on HTSP and PCC. A structured questionnaire was used to collect data from 300 men and women of childbearing age. The target population for the study was prospective parents that are couples that have an intention to conceive, women of childbearing age that could be accessible at family planning, gyneacological and under-five clinics between the ages of 18-35 years. A questionnaire was adapted from a study conducted in Texas. SPSS version 20 was used to analyse the data by generating frequencies and chi- square. Kruskal Wallis test was used to determine relationship between variables and knowledge on preconception care. The constructs examined were psychological preparation, reproductive health care and the physical care that are provided to ensure a healthy pregnancy outcome. With a 100% response rate the findings indicated a gap of information and care on PCC.Services on PCC were not available in the clinics which indicated a great need to empower health care providers on PCC that could reduce maternal and neonatal mortality rate. The findings were used to develop relevant preconception strategies that would assist health providers to give PCC that would improve maternal and newborn outcomes in Malawi. / D. Litt. et Phil. (Health Studies)

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)

Submitted by Fernando Souza (fernandoafsou@gmail.com) on 2017-09-11T14:27:45Z No. of bitstreams: 1 arquivototal.pdf: 9093282 bytes, checksum: cd80d4f337e9b1e518bce8eb1deb0f47 (MD5) / Made available in DSpace on 2017-09-11T14:27:45Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 9093282 bytes, checksum: cd80d4f337e9b1e518bce8eb1deb0f47 (MD5) Previous issue date: 2017-08-30 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Introduction: As association of the orientation degree of the structural and procedural components of the attributes in the child´s Primary Health Care (APS) regarding the results of the infantile population health condition, that identify the adequacy of the provision of services. In Brazil, different models of APS coexist in several municipalities, either through the Family Health Strategy (EFS) or the Basic Unit of Traditional Health (UBS). While comparing these different scenarios in the viewpoint of children´s caregivers, the actions developed for solving the children´s care are analyzed. Objective: To evaluate the effectiveness of the structure and process of primary care services in child´s health in different care models. Method: It is an evaluative and cross-sectional research of quantitative approach. The total of 875 family members of children using João Pessoa´s Family Health Strategy (ESF) or Cascavel´s Basic Unit of Traditional Health (UBS) took part in the sample. Data collection took place between 2012 and 2013 by means of a socio-demographic survey of the families and the PCATool Instrument (Primary Care Assessment Tool) Brazil - child version. Data wereanalyzed by using Excel and the SPSS version 13. The profile of the children´s families, that were seen in the mentioned services, was attained by descriptive statistics of frequency, comparative statistical tests and descriptive measures of essential and derived scores for the measured attributes using for evaluation the results: the parametric t-test for comparing the means of two independent groups. In all statistical tests, was used the significance level of alpha α = 0.05 and for the evaluation of significant results, the use of significance was p-value <0.05. For association with the infantile health condition, the documental research of reports of the Municipal Health Departments wasused. The study followed the Resolution No. 466/12 of the National Health Council, with the assent of the Research Ethics Committee No. 044/2012 and the Certificate of Presentation for Ethical Consideration (CAAE) No. 01295412.2.1001.0107.Results: Assessing the essential attributes, the two municipal health services had an average score higher than expected (6.6). In the joint analysis by comparing the APS overall score, no significant difference waspresented between the overall mean scores, but both services of primary care had the same score (6.4). Correlated to the results of the indicators related to child health status in relation to mortality, births, immunization, food and nutrition surveillance and notifiable diseases Conclusion: At the end of the evaluation, it can be stated that the two health services had as result an APS orientation referring to the essential attributes and in the APS overall score, they presented a performance unsatisfactory. This evaluation result of the APS orientation, with the PCATool Brazil- child version, identified the weaknesses and the potentialities of the two models of basic health care, and the correlation with the results of the health indicators enabled the evaluation of health services as health care system entry in the perspective of the child's caregiver, in relation to health management results. / Introdução: A avaliação da efetividade em saúde, como uma associação do grau de orientação dos componentes estrutural e processual dos atributos na Atenção Primária à Saúde (APS) da criança aos resultados do estado de saúde da população infantil, identifica a adequação da prestação dos serviços na APS. No Brasil, diferentes modelos de APS coexistem nos diversos municípios, sejam através da Estratégia de Saúde da Família (ESF) ou da Unidade Básica de Saúde tradicional (UBS). Ao comparamos, na visão dos cuidadores de crianças, esses distintos cenários analisam-se as ações desenvolvidas para a resolutividade do cuidado das crianças. Objetivo: Avaliar os atributos da dimensão processual e estrutural da atenção primária na saúde da criança comparando aos resultados dos estados de saúde infantil nos serviços de saúde municipais. Método: Pesquisa avaliativa, transversal de abordagem quantitativa. Participaram da amostra total 875 familiares de crianças usuárias da USF de João Pessoa ou da UBS de Cascavel. A coleta de dados ocorreu entre 2012 a 2013, com levantamento sóciodemográficos das famílias e o Instrumento PCATool (Primary Care Assessment Tool) Brasil-versão criança. Os dados foram analisados usando o Excel e o SPSS versão 13. O perfil das famílias de crianças atendidas nos serviços foi por estatística descritiva de frequência, testes estatísticos comparativos e medidas descritivas dos escores essenciais e derivados para os atributos mensurados. Em todos os testes estatísticos, utilizou-se nível de significância alfa α=0,05 e para a avaliação de resultados significativos o uso de significância p-valor<0,05. Para a associação com o estado de saúde infantil usou-se a pesquisa documental de relatórios das Secretárias Municipais de Saúde. O estudo seguiu a Resolução nº 466/12 do Conselho Nacional de Saúde, com parecer favorável do CEP nº 044/2012 e CAAE nº 01295412.2.1001.0107. Resultados:Na avaliação dos atributos essenciais, os dois serviços de saúde municipais tiveram um escore médio superior ao esperado (6,6). Na análise conjunta de comparação do Escore Geral da APS, não foi apresentada diferença significativa entre os escores médios gerais, mas ambos os serviços da atenção básica tiveram o mesmo valor de escore (6,4).Correlacionou-se aos resultados dos indicadores referente ao estado de saúde infantil em relação à mortalidade, nascimentos, imunização, vigilância alimentar e nutricional e agravos de notificação obrigatória.Conclusão: Ao final da avaliação pode-se afirmar que os dois serviços de saúde tiveram como resultado uma orientação à APS nos atributos essenciais e, no escore geral da APS, apresentaram um desempenho insatisfatório. Este resultado de avaliação da orientação a APS, com o PCATool Brasil-versão criança, permitiu identificar as fragilidades e potencialidades dos dois modelos de atenção básica em saúde, e a correlação aos resultados dos indicadores de saúde possibilitou a avaliação dos serviços em saúde enquanto porta de entrada da rede de atenção em saúde, na perspectiva do cuidador da criança, numa relação com os resultados da gestão em saúde.

Made available in DSpace on 2014-12-17T15:30:58Z (GMT). No. of bitstreams: 1 LidianyVL_DISSERT.pdf: 1294064 bytes, checksum: a82c4b5ecb809f1a845083c8b4a7ce40 (MD5) Previous issue date: 2012-05-16 / As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine / Como resultado do incentivo financeiro estabelecido pela Portaria GM/MS n? 1.444, desde 2000, o Brasil tem apresentado um aumento substancial do n?mero de equipes de sa?de bucal na Estrat?gia Sa?de da Fam?lia. H?, no entanto, evid?ncias de que essas equipes v?m produzindo experi?ncias qualitativamente diferentes que n?o se traduzem, necessariamente, em melhorias na qualidade de vida e sa?de da popula??o. Desse modo, pesquisas avaliativas assumem grande relev?ncia. Este estudo se prop?e a avaliar o impacto da Estrat?gia Sa?de da Fam?lia na sa?de bucal da popula??o natalense numa perspectiva longitudinal dos anos 2006 e 2009. Trata-se de um estudo de interven??o cujo desenho ? um ensaio comunit?rio em paralelo, quase randomizado. A amostra constou de setores censit?rios cobertos pelas Equipes de Sa?de Bucal na Estrat?gia Sa?de da Fam?lia e pelo Modelo Tradicional (Unidades B?sicas de Sa?de com e sem ESF, com Programa de Agentes Comunit?rios de Sa?de e ?reas n?o cobertas). A amostra foi definida por sorteio de dez setores censit?rios para compor o grupo experimental e outros dez setores para o grupo controle atrav?s de emparelhamento intencional baseando-se no perfil s?cio-econ?mico e geogr?fico. Para verificar o efeito l?quido da interven??o foi realizada an?lise multivariada atrav?s da Regress?o de Poisson. Como resultado da an?lise transversal do ano 2009, verificou-se que os efeitos da ESF em Natal foram satisfat?rios apenas para as vari?veis de agravos sendo sem efeitos para as demais e com impacto negativo na cobertura de a??es recuperadoras. Contudo a an?lise longitudinal revelou que as ESB/ESF melhoraram seu desempenho nas quest?es relativas aos agravos, acesso e tipo de cobertura das a??es e este fato independe da idade, sexo e condi??es sociais e econ?micas. Em ouras palavras, est?o relacionadas com a presen?a da Estrat?gia Sa?de da Fam?lia na regi?o. Todavia ainda n?o cabe afirmar que ambos os modelos em estudo (Estrat?gia de Sa?de da Fam?lia e Modelo Tradicional) s?o diferentes do ponto de vista da atua??o. Desse modo, ? pertinente a reflex?o sobre a necessidade de elabora??o de mais estudos avaliativos que utilizem outras abordagens capazes de esclarecer as din?micas do processo cujos resultados possam chegar ao conhecimento dos atores respons?veis pela condu??o da ESF e motiv?-los a incorporar a avalia??o no seu cotidiano