Human health is multidimensional: apart from physical, mental, and social aspects, it also incorporates subjective perceptions of health, and functional status (FS). Given that elderly persons have very distinctive health and social needs, multidimensional assessment (MA) of health proves particularly useful in this age group.¶ Aboriginal populations suffer poor health, and there are relatively few studies addressing the health problems of older Aboriginal Australians, mainly because of their distinctive demographic structure, and the low proportion of their elderly. Also, there is no prior information available on MA of health in this Australian population group.¶ This thesis offers a MA of health in older Aboriginal persons from two, urban and rural/isolated, locations in the NT, Katherine and Lajamanu (the NT survey).¶ This thesis specifically addresses the following questions: - what is the physical health, FS, subjective perception of health, and social functioning amongst the NT survey participants? - what are the possible similarities and differences in various dimensions of health between the two major survey locations, what age and gender patterns are observed, and what are the reasons for these patterns, similarities and differences? - how do various dimensions of health relate to each other, and why? - how do current findings relate to broader Aboriginal and non-Aboriginal populations, and why? - what can MA add to a better understanding of various aspects of morbidity and health care use? - what are its possible implications for health planning?¶ Findings from this work indicate poor physical health amongst participants in almost all investigated aspects, comparable to information available from other Aboriginal populations. These are accompanied by low levels of ability for physical functioning. Despite this, subjective perception of health is rather optimistic amongst participants, and levels of social functioning high. Use of health services is mainly related to available health infrastructure. Important health differences exist between Katherine and Lajamanu, and they became particularly visible when all dimensions of health are considered together.¶ The Main conclusions from the current work are that 1) poor physical health is not necessarily accompanied by similar level of deterioration in other dimensions of health: even though participants from the isolated community of Lajamanu experience most chronic diseases, their ability for physical functioning is better, self-perceived health (SPH) more optimistic and levels of social functioning highest 2) institutionalised participants from Katherine suffer by far the worst health of all sample segments in this study; at least some of the poor health outcomes are potentially avoidable, and could be improved by more appropriate residential choices for Aboriginal elderly 3) better health infrastructure does not necessarily bring better health in all its dimensions, suggesting that other factors (primarily socio-economic and cultural) should be addressed in conjunction with this in solving complex health problems of Aboriginal Australians, and 4) it provides strong support that MA can become a useful tool in comprehensive health assessment of older Aboriginals.

Made available in DSpace on 2014-12-17T14:13:33Z (GMT). No. of bitstreams: 1 RichardsonRSA_Tese.pdf: 1809117 bytes, checksum: 464fe0f4ad6e16db7d25aa3443366d02 (MD5) Previous issue date: 2009-12-18 / Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS / Objetivo: O prop?sito dessa investiga??o foi o de avaliar a aten??o ? sa?de de portadores de HIV/Aids no Centro de Refer?ncia para o tratamento da Aids em Natal/RN por profissionais e usu?rios do servi?o. M?todos: Trata-se de um estudo avaliativo, com abordagem quantitativa, realizada no servi?o ambulatorial do Hospital Giselda Trigueiro, em Natal (RN). A popula??o-alvo foi composta por 313 portadores de HIV e os 34 profissionais do referido centro. A coleta de dados ocorreu de agosto de 2007 a julho de 2008, com um formul?rio estruturado de entrevista, validado por meio de um estudo piloto. Os dados foram analisados pela estat?stica descritiva e inferencial. Resultados: A avalia??o do servi?o foi considerada insatisfat?ria por 85,6% usu?rios. No entanto, 58,8% dos profissionais consideraram-a satisfat?ria. Verificou-se diferen?a na avalia??o dos seguintes indicadores: relacionamento profissionais usu?rios, apoio oferecido, pontualidade dos profissionais, orienta??es sobre o tratamento. Observou-se semelhan?a nos seguintes indicadores: estrutura f?sica, respeito ? privacidade, oportunidade de fazer reclama??es, acolhimento, conveni?ncia dos hor?rios, disponibilidade de ARV e exames laboratoriais, e facilidade de acesso. Conclus?o: Os resultados apontaram para insatisfa??o dos usu?rios e a satisfa??o dos profissionais com a aten??o a sa?de de portadores de HIV/Aids no servi?o pesquisado. Constatou-se que os indicadores utilizados nesse estudo podem ser considerados pertinentes para avaliar o servi?o em quest?o, bem como, constituir par?metros de monitoramento aceit?veis da qualidade da aten??o ? sa?de pelo Programa Nacional de DST/Aids

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-16T17:52:38Z No. of bitstreams: 1 Natasha Dejigov Monteiro da Silva.pdf: 2789563 bytes, checksum: 4802430c85976463fb4fa4d5130e4bc1 (MD5) / Made available in DSpace on 2015-07-16T17:52:38Z (GMT). No. of bitstreams: 1 Natasha Dejigov Monteiro da Silva.pdf: 2789563 bytes, checksum: 4802430c85976463fb4fa4d5130e4bc1 (MD5) Previous issue date: 2014-12-04 / Considering patient safety one of the critical points that reflect the performance of a hospital organization, this study aimed to identify how patient safety is included in the organizational culture of hospital organizations in São Paulo, different in their administrative nature: public hospitals of direct administration, public hospitals operated by management contract, and private hospitals. The methodological strategy used was the multiple-case study, applying a self-assessment questionnaire from the Emergency Care Research Institute (ECRI), translated for the Portuguese language. The questionnaire was applied both to leaders who work directly with patient care and administrative leaders that ensure assistance is not prevented or interrupted, and thus indirectly reflect on patient safety. Qualitative and quantitative questions were graded using a Likert scale and consolidated according to seven dimensions, namely: expectations and safety promotion, support and investment from hospital management, security environment, openness to communication and non-punitive response, organizational learning, teamwork, and feedback (information and communication feedback about errors). Data analysis was performed using the statistical programSTATATM 12.1, whose response sample was subjected to linear regression for analysis of variance (ANOVA), having an F test of joint statistical significance as decision rule , in which the p-value is zero. The analysis of mean values of the groups in the studied organizations, as perceived by the respondents, showed a gradation among organizations, with higher values concentrating in private institutions. However, when assessing the specifics among the dimensions of safety culture used for the data analysis, it was found that, as perceived by the participants of the study, the most significant dimensions are Security Environment and Organizational Learning, with an explanatory power of 80%. In addition, also as perceived by the agents, the correlation between the above-mentioned dimensions is stronger in direct administration organizations, followed by the institutions under governmental autonomous administration. / Considerando que a segurança do paciente é um dos pontos críticos que refletem no desempenho de uma organização hospitalar, o presente estudo teve como objetivo identificar como a segurança do paciente se insere na cultura organizacional de organizações hospitalares do município de São Paulo, de diferentes naturezas administrativas: hospitais públicos de administração direta, hospitais públicos administrados por contrato de gestão e hospitais privados. A estratégia metodológica utilizada foi o estudo de casos múltiplos, com aplicação do questionário de autoavaliação do Emergency Care Research Institute (ECRI), traduzido para a língua portuguesa. Procedeu-se a aplicação do instrumento com as lideranças que atuam diretamente com a assistência aos pacientes e com as lideranças administrativas que garantem que a assistência não seja inviabilizada ou interrompida, e, assim, refletem indiretamente na segurança dos pacientes. As questões, qualitativas e quantitativas, utilizaram uma escala de Likert para sua gradação e foram consolidadas segundo sete dimensões, a saber: expectativas e ações de promoção da segurança, apoio e investimento da gestão hospitalar, ambiente de segurança, abertura para comunicações e respostas não punitivas, aprendizado organizacional, trabalho em equipe e feedback (retorno da informação e comunicação a respeito de erros). Para análise dos dados utilizou-se o programa de estatística STATATM 12.1, cuja amostra de resposta foi submetida a regressão linear para análise de variância (ANOVA), considerando como base decisória um teste F, de relevância estatística conjunta, em que p-valor é igual a zero. A análise das médias de respostas obtidas nos grupos das organizações estudadas, segundo a percepção dos respondentes, evidenciou uma gradação entre as organizações com maiores valores se concentrando nas de natureza privada. Entretanto, ao serem avaliadas as especificidades entre as dimensões da cultura de segurança utilizadas para a análise dos dados, verificou-se que, segundo a percepção dos participantes do estudo, as dimensões significativas foram a do Ambiente de Segurança e Aprendizado Organizacional, com um poder explicativo de 80%. Além disso, também segundo a percepção dos agentes, a correlação entre as dimensões citadas acima foi mais forte nas organizações de administração direta, seguida pelas instituições sob administração autárquica.

Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T19:00:22Z No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) / Made available in DSpace on 2015-12-09T19:00:22Z (GMT). No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo objetivou avaliar os custos e consequências do tratamento da pseudartrose com aplicação de células-tronco. A metodologia correspondeu à avaliação econômica parcial do custo e das consequências desse tratamento. O cenário do estudo foi o Hospital Universitário Antonio Pedro e os sujeitos foram oito pacientes operados entre setembro de 2008 e maio de 2009. A perspectiva do estudo foi a do Sistema Único de Saúde, principal fonte de financiamento da assistência médica no Brasil. Para o tratamento estatístico dos dados foram utilizados o software STATISTICA 6.0 e o teste não paramétrico de Spearman. A análise estatística apresentou resultados satisfatórios dentro de uma margem aceitável. O custo total médio do tratamento foi de R$ 1243.199 e o tempo de consolidação foi em média 14.71429 semanas. Observamos através do teste não paramétrico de Spearman que a correlação entre o custo total e o tempo de consolidação é - 0, 5078, uma indicação fraca de que o custo total é inversamente proporcional ao tempo de consolidação. A partir deste estudo, podemos concluir que o custo com o tratamento não foram exorbitantes. O pequeno tamanho da amostra não afetou os resultados de forma significativa, sendo que os achados em relação à idade são parecidos com os de outros estudos, o que nos leva a concluir que a população acometida pela pseudartrose é a economicamente ativa. A criação de um protocolo foi primordial para o levantamento do custo com o tratamento, possibilitando a consolidação dos dados e nos permitindo visualizar de forma mais abrangente o tratamento. O tempo de consolidação foi igual aos melhores resultados vistos em estudo internacionais e o procedimento se mostrou seguro e eficaz. Constatamos que o questionário SF36 é um instrumento de fácil aplicação e foi de confiabilidade no acompanhamento ambulatorial de pacientes submetidos ao tratamento. / The purpose of this study was to evaluate the costs and consequences of the use of stem cells in the treatment of pseudarthrosis. The methodology involved a partial economic assessment of the cost and consequences of this treatment. The study scenario was the Hospital Universitário Antonio Pedro and the subjects were eight patients operated between September 2008 and May 2009. The study perspective was that of the Sistema Único de Saúde, the main financial resource for medical assistance in Brazil. Statistical treatment of the data was performed using the STATISTICA 6.0 application and the Spearman nonparametric test. The results were statistically significant within an acceptable margin of error. The average treatment cost was R$ 1.247,21 and the average time for consolidation was 12.875 weeks. The Spearman nonparametric test showed that the correlation between the total cost and the time for was -0.25, a weak indication that the total cost is inversely proportional to the time for consolidation. From this study, we can conclude that the treatment costs were not prohibitive. The small size of the sample had no significant influence on the results; the agerelated findings are similar to those of other studies and lead to the conclusion that population affected by pseudarthrosis is economically active. The creation of a protocol was essential for cost evaluation, providing a framework for data consolidation and yielding a more general view of the treatment. The time for consolidation was about the same as for the best results reported in the international literature and the procedure was observed to be safe and effective. We concluded that the SF36 questionnaire is an easily applied tool that can be reliably used in the post-treatment follow-up of the patients.