<p>Objectives: To assess the knowledge and attitudes of doctors in relation to death certification and also assess whether an educational intervention can improve the accuracy of death certificate completion and thereby improve mortality information.</p>

<p>Objectives: To assess the knowledge and attitudes of doctors in relation to death certification and also assess whether an educational intervention can improve the accuracy of death certificate completion and thereby improve mortality information.</p>

Le risque contentieux est une incertitude prévisible. Il peut se définir comme la probabilité de survenance d’une cause contentieuse multipliée par l’ampleur des conséquences attachées à cette survenance. Le risque contentieux pèse d’abord sur le décideur public et les administrés. Son traitement s’effectue en deux phases. La première phase correspond au stade où le risque contentieux est éventuel, c’est-à-dire un risque connu mais non manifesté. Il s’agit alors de prévenir les causes contentieuses en sécurisant la décision publique. Pour y parvenir, la personne publique peut compter sur ses propres moyens ainsi que sur la compétence technique que les tiers peuvent lui apporter. Le risque contentieux devient probable au moment de l’introduction du recours contentieux. Il est alors un risque manifesté mais non encore concrétisé. Le procès est la phase où il convient de gérer le risque contentieux dans le contentieux, notamment par des actions curatives ou palliatives. Ces dernières ont pour objet d’éviter que le risque contentieux se réalise (par l’annulation d’un acte, une condamnation…) ou de limiter les conséquences contentieuses. Et le juge est loin d’être étranger à l’anticipation du risque contentieux. Il y est de plus en plus sensibilisé. Il prévient également les risques contentieux. In fine, ce risque conduit à faire supporter une charge sur la partie perdante et, corrélativement, à rétablir la partie adverse dans ses droits. / Litigation risk is a foreseeable uncertainty. It can be defined as the probability that a cause of action will occur, associated with the extent of the consequences attached to this occurrence. First, litigation risk hangs over policymakers and citizens. It is carried out in two-steps. The first step corresponds to stage when the litigation risk is potential. The risk is known but has not yet actualized. The issue is then to prevent litigation cause by securing public decision-making. To reach this goal, decision makers can, count on their own resources, but also on the expertise of third parties. When a court case is filed, litigation risk becomes probable. That is to say, litigation risk exists but it is not yet materialized. Secondly, the trial is the step in which litigation risk must be handled through remedial or mitigating actions. These actions aim at avoiding the realization of the litigation risk –quashing of an act, condemnation- or containing the consequences of the litigation. Furthermore, judges play a major role in the anticipation of litigation risk: not only are they increasingly aware of it, but also becoming more involved. Ultimately, the risk leads to burdening the losing party, and correlatively, to restoring the rights of the opposing party.

La tendance actuelle des organisations à développer des collaborations avec différentes parties prenantes a pour objectif de répondre à une complexité de plus en plus importante des produits et de favoriser l'innovation ; le tout sous de fortes pressions d'un environnement économique, liées aux exigences du développement durable, de l'accélération des cycles de vie, des normes qualité, etc. Les SIP tendent à garantir une transversalité entre l'ensemble des phases du cycle de vie produit ; répondant ainsi aux besoins d'amélioration de la qualité produit, de maîtrise des processus et de réduction des délais, tout en favorisant la collaboration. La complexité des processus collaboratifs liée à la gestion du cycle de vie du produit ne peut faire l’économie d’une réflexion sur les ressources engagées au regard des objectifs poursuivis, ni même d’une balance économique globale des coûts supportés. Ainsi les critères d’efficacité et d’efficience s’ajoutent aux critères les plus traditionnels du temps imparti et du degré de qualité visé. L'objectif de cette thèse consiste à définir une démarche méthodologique et applicative pour répondre à la question suivante : "Comment instrumenter le SIP pour analyser les activités menées au sein du système et déceler les freins au travail collaboratif ?". Ainsi, nous présentons dans cette thèse un cadre méthodologique et architectural permettant d'assurer un pilotage des processus collaboratifs dans les SIP. Il s'agit entre autre de mettre en place une expérience d'observation basée sur l’ingénierie des traces ; et de mener une réflexion sur la définition d'indicateurs permettant de mettre en place un contrôle de l'activité collaborative. La mise en œuvre effective de ces actions implique la définition d’une architecture complémentaire et générique adaptée à l'environnement du SIP. Finalement, le développement d'un prototype, intégré par la suite au SIP @udros, nous a permis de valider le cadre méthodologique et applicatif de cette thèse. / The current trend of organizations to develop partnerships with various stakeholders aims to respond to a rising complexity, of products and to foster innovation; all under great pressures of an economical environment, related to sustainability requirements, lifecycle acceleration, quality standards, etc. PLM systems tend to ensure the transversality within all the stages of product lifecycle; meeting the needs of product quality improvement, process control and delays reduction, while fostering collaboration. The complexity of collaborative processes related to the product lifecycle management cannot lean only on the engaged resources, or on the global balance between costs, budget, and receipts. Then efficacy and efficiency criterions come on top of the traditional ones (quality level, time, etc.). This thesis aims to propose a methodological and applicative approach responding to the following research question: “How can PLM System be « instrumented » in order to analyze the collaborative activities and to reveal the brakes causes?” We present in this thesis a methodological and architectural framework to ensure a collaborative process management in PLM System. The methodological framework leans on observation experiences based on tracks engineering (tracks generated by PLM system) and indicators definition supporting the control of the collaborative activity. The principal objective is to reduce risks by reacting in real time to the incidents or dysfunctions that may occur. The effective implementation of these actions involves the definition of a generic and complementary architecture suitable to the environment of the system. Finally, the development of a prototype, integrated then to the system @udros, allowed us to validate the methodological and architectural framework of this thesis.

Introdução – A partir de 1999, os coeficientes anuais de mortalidade por tuberculose no Estado de São Paulo apresentam declínio, segundo dados do Centro de Vigilância Epidemiológica da Secretaria Estadual de Saúde (CVE). Para caracterizar os óbitos e entender a tendência, explora-se o fato de o óbito por tuberculose possuir características que possibilitam estudos com enfoque em causas múltiplas, podendo a doença ser causa básica ou causa associada da morte. Objetivo – Traçar o perfil da mortalidade relacionada à tuberculose no Município de São Paulo, segundo causas múltiplas de morte e suas inter-relações com outras causas básicas e verificar se os casos de tuberculose estão notificados ao banco de dados do CVE. Metodologia – Estudo descritivo utilizando dados secundários. Foram estudados todos os óbitos de pessoas residentes no Município de São Paulo, ocorridos entre 2002 e 2004, que tiveram, na declaração de óbito, tuberculose como causa básica ou causa associada, ou seqüela de tuberculose como causa básica (N=2.325). Causa básica e causas associadas de morte foram caracterizadas segundo as disposições da Organização Mundial de Saúde. Pesquisaram-se os registros do CVE para verificar se os casos de tuberculose estavam notificados. As fontes de dados foram o Programa de Aprimoramento das Informações de Mortalidade no Município de São Paulo (PRO-AIM) e o banco de dados do CVE. Os dados de população provieram da Fundação SEADE. Resultados – A utilização de causas múltiplas de morte aumentou o número de óbitos em 82,6%. A tuberculose foi selecionada como causa básica de morte em 1.212 óbitos (54,8%), tendo sido mencionada como causa associada em 1.001 óbitos (45,2%). Destes, 676 (30,5%) foram devidos à aids e 325 (14,7%), a outras causas. A seqüela de tuberculose foi causa básica de morte em 112 óbitos. As formas clínicas mais freqüentes, quando a tuberculose foi causa básica, foram a pulmonar e a miliar. O sexo masculino foi o mais atingido (1.690 óbitos, ou 72,7%). Em 46,3% dos óbitos que tinham tuberculose como causa básica, a declaração de óbito foi fornecida pelo Serviço de Verificação de Óbitos ou pelo Instituto Médico Legal, indicando dificuldades para fazer o diagnóstico ou falha na assistência aos casos. Os óbitos não encontrados no banco de dados do CVE, portanto desconhecidos pelo Sistema de Vigilância, foram 1.200 (51,6%). Conclusões – A análise segundo causas múltiplas de morte revelou óbitos em que a tuberculose estava presente mas não aparecia nas estatísticas de mortalidade por causa única. As notificações de casos de tuberculose ao CVE não foram satisfatórias, necessitando ter seus fluxos e procedimentos reavaliados. / Background – According to data from CVE – Centro de Vigilância Epidemiológica da Secretaria de Saúde do Estado de São Paulo (Epidemic Control Center / State Dept), yearly death rates caused by tuberculosis have declined in the state of São Paulo. In order to characterize deaths and understand the mentioned decrease, the issue death related to tuberculosis will be investigated whilst presenting certain characteristics that might enable studies to be taken over, by focusing on multiple causes. Moreover, the tuberculosis might be regarded as an underlying cause of death or as death-associated cause. Objective – The outlining of tuberculosis mortality, as a result from multiple causes and its relations with other underlying causes, and to verify if patients were underreported to CVE. Methodology – Secondary data descriptive study. Deaths occurring between 2002 and 2004 were considered for this study, from people living in São Paulo. The people died, as stated by their death certificate, from tuberculosis as an underlying or associated cause, or tuberculosis sequel as an underlying cause (N=2.325). Both underlying and associated causes of death were characterized according to the World Health Organization guidelines. The study searched tuberculosis cases on CVE’s database. Data were supplied by Programa de Aprimoramento das Informações de Mortalidade no Município de São Paulo (PRO-AIM) and CVE’s database. Results – Studies focusing on multiple causes increase deaths (82,6%). Tuberculosis was selected as an underlying cause of death in 1.212 deaths (54,8%). In 1.001 deaths (45,2%) it was regarded as associated cause: in these deaths, the underlying cause was AIDS (676 deaths – 30,5%) or other causes (325 deaths – 14,7%). Tuberculosis sequel was underlying cause in 112 deaths. The most frequent clinical forms observed, having tuberculosis as an underlying cause, were the pulmonary and the miliary types. Male sex was inflicted the most (1.690 deaths – 72,7%). Either Serviço de Verificação de Óbitos or Forensics issued death certificates where tuberculosis was selected as underlying cause of death in 46,3% of total deaths, denoting deficient diagnosis and poor assistance to cases. Death records – 1.200 (51,6%) – are not to be found in CVE’s database, so tuberculosis cases are underreported. Conclusion – Analyses that use multiple-cause data brings to view other deaths where tuberculosis was present, in spite of not being observed in statistics of mortality resulting from underlying causes. The flow of information to CVE must be inspected.

Introdução: A proporção de óbitos classificados como de causa básica mal definida é um dos principais indicadores da qualidade das estatísticas de mortalidade, de grande importância na avaliação da situação e na orientação das políticas de saúde. Estudos preliminares encontraram uma evolução temporal discrepante na comparação da mortalidade proporcional por causa mal definida no Brasil, no Estado de São Paulo, na Baixada Santista e no Município do Guarujá. Este estudo foi realizado com o objetivo de tentar compreender tais diferenças. Métodos: A evolução temporal da proporção de óbitos por causa mal definida foi analisada no período de 1980 a 2002, dividindo-se o Estado de São Paulo em grupos de municípios com e sem o Serviço de Verificação de Óbitos (SVO) e a Baixada Santista. Além da mortalidade proporcional, a classificação do óbito por causa mal definida foi estudada com base no que se convencionou chamar de ?primeiro médico? a avaliar a causa de morte. Ou seja, o profissional que preenche a Declaração de Óbito ou encaminha o caso ao SVO ou ao Instituto Médico Legal (IML). Exclui os médicos do SVO e do IML que preenchem a declaração. A qualidade do preenchimento foi avaliada nos óbitos ocorridos em hospitais e em domicílios, baseada nas informações do tipo de atestante. Resultados: Observou-se um aumento na proporção de óbitos por causa mal definida pelo primeiro médico avaliador da causa de morte em todas as áreas do Estado de São Paulo. Em 1980, na Baixada Santista, a mortalidade proporcional por causa mal definida (MPCMD) era muito baixa, pois mais de 90% dos casos classificados como de causa mal definida pelo primeiro médico avaliador da causa de morte eram encaminhados aos IMLs da região ou ao SVO do Guarujá, onde a maioria dos casos era reclassificada para óbito de causa definida sem a realização de necropsia. A partir de 1984, progressivamente, os casos deixaram de ser encaminhados aos IMLs e passaram a ser classificados como de causa mal definida, com aumento da mortalidade proporcional de mais de nove vezes. A MPCMD no Estado de São Paulo manteve-se estável no período analisado em virtude do aumento da proporção de óbitos em serviços de saúde e de realização de necropsias. No Brasil, onde se observou uma queda de 36,4% da MPCMD, pode-se atribuir ao aumento dos óbitos hospitalares mais de 50% da redução desse indicador. O aumento do encaminhamento dos casos aos SVOs e aos IMLs foi fator importante na redução da mortalidade por causa mal definida nos óbitos domiciliares. Na Baixada Santista, no Estado de São Paulo e nos óbitos hospitalares do país, verificou-se uma piora na qualidade do preenchimento da Declaração de Óbito. Conclusão: A despeito da melhoria dos recursos diagnósticos, observou-se no período estudado uma piora na qualidade do preenchimento da Declaração de Óbito no Estado de São Paulo e nos óbitos hospitalares do país. Para enfrentar o problema da elevada mortalidade proporcional por causa mal definida, sugere-se rediscutir o modelo do fluxo de preenchimento das declarações de óbito, com redefinição das atribuições dos SVOs e dos IMLs. / Introduction: The proportion of deaths classified as due to ill-defined causes is one of the major indicators of the quality of mortality statistics, and is of great value for evaluating and orienting public policies. Preliminary studies indicate discrepant time trends in the evolution of the proportion of deaths due to ill-defined causes between Brazil as a whole, the state of Sao Paulo, the Baixada Santista region, and the municipality of Guarujá. The present study was designed as an attempt to understand these discrepancies. Methods: We analyzed the temporal evolution in the proportion of deaths due to illdefined causes between 1980 and 2002, dividing the state of Sao Paulo into three groups of municipalities: those with Death Verification Service (DVS), those without DVS, and those located in the Baixada Santista. In addition to proportional mortality, we also studied the classification of ill-defined deaths based on what was defined as the ?first physician? to evaluate cause of death. This consisted either of the professional who completed the Death Certificate or who referred the case to the DVS or medical examiner. This definition excludes any DVS or Medical Examiner physicians who filled certificates. The quality of the information in the certificate was evaluated for deaths occurred in hospitals and at home based on information on the type of physician. Results: There was an increase in the proportion of deaths due to ill-defined causes as defined by the first physician to evaluate cause of death in all areas of the State of Sao Paulo. In 1980, in the Baixada Santista, proportional mortality due to ill-defined causes (PMIDC) was very low, with over 90% of cases considered as due to illdefined causes by the first physician being referred to the region?s Medical Examiners or to the Guarujá DVS, where the majority of cases was assigned to a defined cause without need for autopsy. Beginning in 1984, the number of cases referred to Medical Examiners began to fall, leading to a 9-fold increase in PMIDC. PMIDC in the State of Sao Paulo remained stable throughout the period as a consequence of the increase in the proportion of autopsies and of deaths occurred within healthcare facilities. In the country as a whole, there was a 36.4% decrease in PMIDC, of which more than 50% can be attributed to the increase in the number of hospital deaths. Increased referral of cases to DVSs and medical examiners was an important factor in the reduction of mortality due to ill-defined causes among athome deaths. The quality of information in Death Certificates decreased in the Baixada Santista, in the State of Sao Paulo, and among hospital deaths in Brazil as a whole. Conclusion: Despite improvements in diagnosis, quality of information in Death Certificates decreased during the studied period in the State of Sao Paulo and among hospital deaths in the country as a whole. In order to tackle the issue of high proportional mortality due to ill-defined causes, we suggest a reevaluation of the flow of information in Death Certificates, with a redefinition of the role of medical examiners and DVSs.

Magister Public Health - MPH / Objectives: To assess the knowledge and attitudes of doctors in relation to death certification and also assess whether an educational intervention can improve the accuracy of death certificate completion and thereby improve mortality information. / South Africa

This thesis concerns with effectiveness of cause related marketing, the promotion tool, by which the firm tries to positively influence relations with consumers. In first three chapters the tool of cause related marketing is presented, some examples of successful foreign and also home campaigns are given, and facts about perception and attitudes of American consumers especially the Millenial generation members toward the cause related marketing are placed here. In next four chapters the thesis concerns with own research of attitudes of Czech millenials, analyses the outcomes and compares the differences in answers according to sex, age and the place of living. At the end some contrasts in the attitudes of Czech and American consumers are studied.

The thesis deals with the impact of cause related marketing campaigns on the customers in the Czech Republic. The thesis is divided into theoretical and practical parts. Within the theoretical part, the attention is paid to the determination of CRM, as well as to the CSR concept, on whose grounds CRM is based on. For the findings about the situation on the Czech market regarding CRM, chosen CRM campaigns were analyzed together with its particular campaign characteristic, which cause the campaign to be un/successful. Because commercial subjects evaluate the campaigns according to the gathered amount of money, it is difficult to find out the real impact of CRM campaigns. Therefore, the own survey became a part of the practical part of the thesis with the aim to find out this impact directly from the customers. The results were compared with the American studies and are summed up into the ideal campaign, which is introduced on the chosen bank company.

Au sein de cette thèse, j’examine l’influence de l’identité du consommateur (ex. matérialisme, construction de soi) sur les stratégies marketing ciblant les jeunes consommateurs (millénaire).Dans l’Essai 1, j’explore comment les consommateurs matérialistes peuvent être encouragés à agir de manière pro-sociale en actionnant leur motivation de recherche de prestige pendant la consommation de produits de luxe et comment les marques de luxe peuvent maximiser la participation des consommateurs via des campagnes de cause-related marketing centrées sur le produit.Dans l’Essai 2, je déploie la théorie des coûts d’interaction sociale plus bas pour étudier les effets de l’individualisme (vs. collectivisme) sur le choix de répondre à son besoin d’appartenance via l’interaction sociale digitalement-médiée. / In this dissertation, I examine the influence of consumer identity (e.g., materialism, self-construal) on marketing strategy targeting young consumers (i.e., millennials).In Essay 1, I explore how materialistic consumers can be nudged to act prosocially by leveraging their status-seeking motivations in the context of luxury consumption, and luxury brands will maximize participation of consumers by utilizing product-linked cause-related marketing (CRM) campaigns.In Essay 2, I investigate the effects of individualism (vs. collectivism) on preferences for meeting belonging needs through digitally mediated social interaction, through the lens of lower social interaction costs.