Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-09-11T18:38:59Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-09-19T14:00:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) / Made available in DSpace on 2017-09-19T14:00:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_QualidadeVidaPacientes.pdf: 2921092 bytes, checksum: 9e31e5b8c539077daa663ef07bbb8ddd (MD5) Previous issue date: 2014-11-20 / A Hanseníase é uma doença infecciosa que atinge pele, nervos periféricos, provoca dor, sequelas físicas e psicológicas. Pouco estudos descrevem a qualidade de vida (QV) em pacientes com dor neuropática hansênica (DNH), presente na doença. O objetivo desta pesquisa foi avaliar a QV de pacientes acometidos pela hanseníase utilizando os questionários WHOQOL-Bref e SF-36 e, investigar a influência da atividade física na QV de pacientes com DNH. Trata-se de um estudo Transversal e de Intervenção Self-control, em que foram selecionados 80 pacientes a partir de amostra de conveniência da Unidade Básica de Saúde da Vila Santo Antônio do Prata (Igarapé Açú/Pará) e Ambulatório de Dermatologia do Núcleo de Medicina Tropical da Universidade Federal do Pará (Belém/Pará). Os pacientes responderam aos questionários de avaliação de QV propostos e os casos diagnosticados com DNH participaram pelo período de 90 dias de um protocolo de Exercício Físico. No dia zero e após o período da intervenção, foram aferidas a força da preensão palmar e a flexibilidade de membros superiores e inferiores. Os resultados mostram maiores médias de QV em pacientes com ausência de DNH. Houve melhora significativa nos domínios da QV do grupo com DNH após o período de intervenção. O exercício físico deve ser incentivado enquanto proposta terapêutica para prevenção de sequelas físicas e de DNH crônica. A avaliação da QV relacionada à saúde de pacientes hansenianos pode ser uma estratégia preponderante para melhor prevenir, tratar e curar a doença nas regiões endêmicas do Brasil. / Leprosy is an infectious disease that affects the skin, peripheral nerves, causes pain, physical and psychological consequences. Some studies describe the quality of life (QOL) in patients with leprosy neuropathic pain (DNH) in this disease. The objective of this research was to evaluate the QL of patients affected by leprosy using the WHOQOL-Bref questionnaire and SF-36 and investigate the influence of physical activity on QL in patients with DNH. This is a Transversal study and intervention Self-control, in which 80 patients were selected from a convenience sample of Basic Health Unit of Vila Santo Antonio do Prata (Igarapé Açú / Pará) and the Dermatology Clinic of the Center for Tropical medicine, from Federal University of Pará (Belém / Pará). The patients answered evaluation questionnaires of QL proposed and diagnosed cases with DNH attended by 90 days of physical activity protocol. On zero day and after the intervention period were measured the power of palmar prehension and flexibility of upper and lower limbs. The results show higher averages of QL in patients with absence of DNH. There were significant improvements in the dominion of QL with DNH group after the intervention period. Physical activity should be encouraged as a therapeutic proposal for the prevention of chronic physical consequences and DNH and the evaluation of QL associated with health of leprosy patients can be a predominant strategy to better prevent, treat and cure the disease in endemic regions of this country.

[pt] O estudo da resistência à fratura dos materiais é de grande importância para desenvolvimentos de projetos, seleção de materiais e avaliação do comportamento dos materiais perante a presença de um defeito no componente. Há inúmeras normas que envolvem geometrias padronizadas para determinação desta propriedade mecânica, no entanto nem todo componente em serviço possui as mesmas condições encontradas nas geometrias padronizadas, como é o caso de materiais dúcteis empregados em estruturas com espessuras de paredes finas e elevada pressão interna. Nesta dissertação foram estudados dois materiais com diferentes limites de escoamento confeccionados conforme geometria tipo SEN(T) de fixação por garras, a qual não é padronizada pela ASTM. Com isso, foi realizada uma pesquisa com o emprego desta geometria com variação de 0,2 a 0,8 da relação entre a dimensão idealizada inicialmente para a trinca e a largura do corpo de prova, e entalhes laterais com redução de 20 porcento foram confeccionados nos corpos de prova do material mais dúctil. Após, foi realizada a pré-trinca de fadiga e iniciado o ensaio de tenacidade à fratura. Este último foi desenvolvido adotando o método compliance, o qual permite que com apenas um corpo de prova seja realizado descarregamentos parciais permitindo assim a determinação de J e incremento de trinca em cada posição, possibilitando plotar a curva-R Os resultados obtidos determinaram que mesmo com a/W diferente daqueles indicados por norma para levantamento da curva-R, é possível obter uma curva-R para a/W=0,2. Existe uma limitação em aplicar a geometria SEN(T) que não possuem extensa ductilidade. / [en] The study of resistance to fracture of the materials is very important for developing new projects, making materials specifications and also for evaluating materials behaviour under presence of a crack in a component. There are uncountables standards which apply normalized specimens due to determine this mechanical property, however some components in service doesn t act under same conditions as the specimen chosen, for instance ductile materials applied in components with thin thickness and high intern pressure. In this dissertation was studied two diferente of materials with distinct yield limits fabricated according to SEN(T) geometry with clamped fixing, which one is not acceptable by ASTM. Thus, a research has been carried out using this geomerty with a variation of 0,2 to 0,8 of the relation between the idealized initially for the crack and the width of the proof body ratio and side-grooves with 20 percent reducted were made in the specimens with higher ductility. After that, the procedure for doing fatigue pre-crack was initialized, followed by fracture toughness test. This last one was developed adopting the unloading compliance technique, which one allows that more than one aplications of force and displacement can be realized in only one specimen then the value of J and crack extension can be calculated and the R-curve will be plotted. The results obtained showed even with a a/W ratio diferente of those indicated by standards, is possible to constructo a qualified R-curve for a/W=0,2. In additon to the results, there is a limitation in applying a SEN(T) geometry in materials that don t present extensive ductility.

.../... / “Standards make a positive contribution to the world we live in. They facilitate trade, spreadknowledge, disseminate innovative advances in technology, and share good management andconformity assessment practices”7. There are a multitude of standard and standard consortiaorganizations producing market relevant standards, specifications, and technical reports in thedomain of Information Communication Technology (ICT). With the number of ICT relatedstandards and specifications numbering in the thousands, it is not readily apparent to users howthese standards inter-relate to form the basis of technical interoperability. There is a need todevelop and document a process to identify how standards inter-relate to form a basis ofinteroperability in multiple contexts; at a general horizontal technology level that covers alldomains, and within specific vertical technology domains and sub-domains. By analyzing whichstandards inter-relate through normative referencing, key standards can be identified as technicalcenters of gravity, allowing identification of specific standards that are required for thesuccessful implementation of standards that normatively reference them, and form a basis forinteroperability across horizontal and vertical technology domains. This Thesis focuses on defining a methodology to analyze ICT standards to identifynormatively referenced standards that form technical centers of gravity utilizing Data Mining(DM) and Social Network Analysis (SNA) graph technologies as a basis of analysis. As a proofof concept, the methodology focuses on the published International Standards (IS) published bythe International Organization of Standards/International Electrotechnical Committee; JointTechnical Committee 1, Sub-committee 36 Learning Education, and Training (ISO/IEC JTC1 SC36). The process is designed to be scalable for larger document sets within ISO/IEC JTC1 that covers all JTC1 Sub-Committees, and possibly other Standard Development Organizations(SDOs).Chapter 1 provides a review of literature of previous standard analysis projects and analysisof components used in this Thesis, such as data mining and graph theory. Identification of adataset for testing the developed methodology containing published International Standardsneeded for analysis and form specific technology domains and sub-domains is the focus ofChapter 2. Chapter 3 describes the specific methodology developed to analyze publishedInternational Standards documents, and to create and analyze the graphs to identify technicalcenters of gravity. Chapter 4 presents analysis of data which identifies technical center of gravitystandards for ICT learning, education, and training standards produced in ISO/IEC JTC1 SC 36.Conclusions of the analysis are contained in Chapter 5. Recommendations for further researchusing the output of the developed methodology are contained in Chapter 6.

<p>Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT).</p><p>Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients. </p><p>Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once.</p><p>Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.</p>

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>

The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed. Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used. Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate. Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension. Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.

Abdominal aortic aneurysm (AAA) is a common problem with life-threatening consequences and was suspected to be a serious health problem in Norsjö, a municipality in northern Sweden. A screening study was undertaken to investigate the prevalence, risk factors associated with AAA and the effect of screening on quality of life (QoL). All men and women, aged 65-75 years, were invited to an ultrasonography (US) examination, 91% attended and 92 subjects were also evaluated with computed tomography (CT). Depending on diagnostic criteria, the AAA prevalence was 3.6-16.9% in men and 0.8-9.4% in women. Seventy-five percent of the differences between US- and CT anteroposterior measurements were less than 5 mm. A decrease in mental health was observed among AAA patients with low baseline SF-36 scale scores. Elevated cholesterol at age 60 years were associated with screening detected AAA after 12 years of follow-up. Smoking, atherosclerosis and having a first degree relative with AAA were associated with AAA at screening. Compared to blood samples obtained 12 years prior to screening an elevation of hsCRP over time was observed among AAA patients. Based on a systematic review of the literature, different screening strategies were analysed in a Markov cohort model. The cost per life year gained ranged from $8 309 to $14 084 and was estimated to $10 474 when 65 year old men were screened once. Conclusions: The highest prevalence of AAA ever reported, in a population-based screening program, was found in Norsjö. The risk of having an AAA at screening showed a strong but complex association with atherosclerosis and its risk factors, genetic and inflammatory mechanisms may also be important. Screening 65-year-old men for AAA may be cost-effective, but QoL aspects on the cost-effectiveness of AAA screening merits further investigation.

This study investigates the relationship between community psychology and social policies, seeking to determine which contextual conditions, institutional and interaction of actors help to explain the form and structure of the technical field of the psychologists that work in social intervention in the General Social or Community Services as part of the Spanish Social Services Systems. As a methodological framework, we use the Strauss & Corbin (2002) approach known as Grounded Theory, and also the Coller (2000) multidimensional multiple cases. We study five General Social Services, trough twenty-four interviews to professionals, members and managers of these services, town hall and autonomous community managers and external agents, representatives of professional associations and academics concerned with the issue. As a result, we observe that the integration process of the psychologists that work with social interventions and the components of their field are explained in the context of three major sets of conditions: in first place, the institutional conditions arising from the legal-regulatory bodies and their impact on the technical, management and administration framework. Second, the actor’s interaction processes around reflection dynamics, training and definition of perspectives and frameworks of intervention, all of them developed in negotiations and alliances between the experts, politicians, leaders of the professional associations and academics. And finally, the conditions of the amount and type of problems, the multidimensionality and complexity that are involved in social problems which demand attention and that affect the technical requirements of response / En aquest estudi s’investiga la relació entre la psicologia comunitària i les polítiques socials, buscant determinar quines condicions contextuals, institucionals i de interacció dels actors permeten explicar la forma i estructuració del camp tècnic dels psicòlegs de la intervenció social en els Serveis Socials Generals o Comunitaris que formen part dels Sistemes de Serveis Socials espanyols. Com marc metodològic s’utilitza la proposta de Strauss & Corbin (2002), coneguda com Grounded Theory, i l’estudi de casos múltiples multidimensional de Coller (2000). S’estudien aquí cinc Serveis Socials Generals, mitjançant entrevistes a vint-i-quatre professionals, membres i encarregats dels equips d’aquests serveis, directius a nivells d’ajuntament i comunitat autònoma i agents externs, representants de col•legis professionals i acadèmics relacionats amb la temàtica. Com resultat, s’observa que el procés de inserció dels psicòlegs de la intervenció social i els components del seu camp tècnic s’expliquen en el context de tres conjunts de condicions principals: en primer lloc, las condicions institucionals que sorgeixen dels cossos normatiu-legals i que incideixen sobre el marc tècnic i de gestió i administració. En segon terme, els processos de interacció d’actors al voltant de dinàmiques de reflexió, formació i definició de perspectives i enfocaments de intervenció, desenvolupades en negociacions i aliances entre tècnics, polítics, dirigents gremials i acadèmics. I, finalment, les condicions que intervenen segons la quantitat, tipus de problemàtiques, multidimensionalitat i complexitat que presenten els problemes socials pels quals es demana atenció, que repercuteixen en les exigències tècniques de resposta

La tesis supone un exhaustivo análisis acerca de una realidad hasta ahora desconocida: la participación ciudadana en los procesos de construcción de las Políticas Sociales locales de la Región a través de los Consejos e Institutos Municipales de Servicios Sociales. Analiza la realidad de la participación en la vida pública local social desde una posición crítica, pero también optimista respecto a las innumerables posibilidades y mecanismos participativos que se pueden implantar en los Servicios Sociales municipales.Los resultados ofrecen un conocimiento real y actual sobre la situación de la participación ciudadana en los Servicios Sociales en el ámbito geográfico de la Región de Murcia, contrastando y comparando sus resultados con realidades y tendencias observadas en otros estudios y experiencias de ámbito nacional e internacional / This thesis means an exhaustive analysis about a reality unknown up to now: The citizen participation in the construction process of local Social Policy, through the Local Commitees and Institutes. It analyses the reality of participation in the local social public life from a critical position, but also from and optimistic one, with regard to the countless posibilities and parcipative mechanismes that we could introduce. The results offer a real and current knowledge about the situation of citizen participation in Social Services in the geographique Murcia Region, constracting and comparing their results with realities and trends observed in others estudies and experiencies in a national and international frame.

El trabajo de investigación se ha centrado en conocer cuáles son las estrategias puestas en marcha por los Planes Municipales de Drogodependencias (PMD) de algunos municipios clave de la Región de Murcia, así como conocer las repercusiones de la aplicación de estas estrategias a nivel educativo, ya que, por sus características éste ámbito es uno de los privilegiados para abordar el fenómeno de las drogodependencias. Para desarrollar este trabajo hemos propuesto alcanzar dos objetivos generales:o Analizar los Planes Municipales de Drogodependenciaso Analizar los Programas escolares de prevención en drogodependenciasUna vez analizada la información obtenida de los PMD, a través de una metodología predominantemente cualitativa, e interpretada a partir del modelo de evaluación de Stufflebeam, hemos realizado una serie de propuestas de mejora de los PMD que pasan por revisar las políticas sobre intervención en drogodependencias. / The investigation work has centred on knowing which are the strategies put in march by the Municipal Plans of the drug additions (PMD) of some key municipalities in the Region of Murcia, as well as to know the repercussions of the application of these strategies in the educational field, since, for its characteristics this area is one of thefavoured to approach the phenomenon of the drug additcions.To develop this work we have proposed to reach two general aims:· To analyze Municipal Plans of the drug addictions.· To analyze the school Programs of prevention in drug addictions.Once analyzed the information obtained of the PMD, using a predominantly qualitative methodology, and interpreted from the model of Stufflebeam evaluation, we have realized some proposals of improvement of the PMD that happen for checking the intervention policies in drug addiction.