“Off-label use” is defined as the use of medicine for indications other than recommended or registered for, e.g. the prescribing of a particular active substance for a patient younger than the substance is recommended or indicated for, or different formulations or dosages of a substance (Ekins-Daukes et al., 2004:349; Stedman’s medical dictionary, 2006). Off-label prescribing is common, and fluctuates by physician, patient and drug (Eguale et al., 2012:781). Drug classes most commonly prescribed off-label include anti-asthmatic, cardiovascular drugs and antidepressants. Lee et al. (2012:140) found that 9 out of 10 antidepressants prescribed were associated with unapproved usage of antidepressants. An antidepressant can be defined as a substance that prevents or relieves depression or depressive episodes (Mosby, 2009:115). There is paucity of information on the off-label prescribing practices of antidepressants in the South African private health sector. According to Eguale et al. (2012:781), the paucity of information on off-label prescribing practices may be, in part, ascribed to the difficulty in the establishment of reasons for treatment. The objective of this study was to determine the prescribing patterns of antidepressants as well as to identify off-label prescribing of antidepressants among adults in a section of the private health sector of South Africa by using a medicine claims database. A quantitative and observational, descriptive cross-sectional design was followed in this study. Data for a period of a year, from January to December 2010 were obtained for analysis. The data set consisted of medicine claims for a total number of 1 220 289 patients, containing a total of 8 515 428 prescriptions and 20 527 777 medicine items. The study population (patients receiving antidepressants 18 years and older) accounted for 14.8% (n = 1 220 289) of the total data set. The average age of patients receiving antidepressants was 56.1 ± 16.6 (median = 56.2) (Inter quartile range = 43.3–68.1). Results of the study showed that antidepressant prescriptions accounted for 8.3% (n = 8 515 428) of all prescriptions claimed during 2010. A total 3.5 % (n = 20 527 777) of antidepressants were claimed during the study period. Using the DU90% method it was established that the majority of antidepressant medicine items were prescribed by general practitioners (i.e. 75.7%, n = 702 285) and psychiatrists (14.9%, n = 702 285). Almost 72% (n = 702 885) of antidepressant medicine items claimed for the study population were for women. The most prescribed antidepressants (based on the DU90%) were amitriptyline (20.6%, n = 702 885), citalopram (19.2%), escitalopram (14.6%), fluoxetine (11.7%), venlafaxine (5.7%), paroxetine (5.2%), duloxetine (4.4%), sertraline (3.8%), bupropion (3.1%) and mirtazapine (2.6%). Amitriptyline accounted for 82.4% of off-label prescriptions (n = 2 635), whereas escitalopram and fluoxetine accounted for 4.2% and 3.8%, respectively. The tricyclic antidepressants (TCAs) were mostly prescribed off-label for migraine, headache and sleep disorders. The off-label prescribing of selective serotonin re-uptake inhibitors (SSRIs) included menopause, schizophrenia and headache. The off-label indicated prescriptions of the serotonin and noradrenaline re-uptake inhibitors (SNRIs) were mostly for schizophrenia and other anxiety disorders. Mirtazapine, a serotonin modulator/tetracyclic antidepressant, was mostly prescribed off-label for anxiety disorders. Off-label prescriptions for bupropion, a noradrenaline and dopamine re-uptake inhibitor mainly included other anxiety disorders and attention deficit hyperactivity disorder (ADHD). Furthermore, the prescribed daily dose (PDD) of each active antidepressant for all off-label indications was determined. In conclusion: This study investigated the off-label prescribing patterns of antidepressants among adults a section of the private health sector of a South Africa, using a large medicine claims database. Recommendations for future research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Revolutionary mobile technologies, such as high-speed packet access 3G (HSPA+) and LTE, have significantly increased mobile data rate over the radio link. While most of the world looks at this revolution as a blessing to their day-to-day life, a little-known fact is that these improvements over the radio access link results in demanding tremendous improvements in bandwidth on the backhaul network. Having said this, today's Internet Service Providers (ISPs) and Mobile Network Operators (MNOs) are intemperately impacted as a result of this excessive smartphone usage. The operational costs (OPEX) associated with traditional backhaul methods are rising faster than the revenue generated by the new data services. Building a mobile backhaul network is very different from building a commercial data network. A mobile backhaul network requires (i) QoS-based traffic with strict requirements on delay and jitter (ii) high availability/reliability. While most ISPs and MNOs have promised advantages of redundancy and resilience to guarantee high availability, there is still the specter of failure in today's networks. The problems of network failures in today's networks can be quickly but clearly ascertained. The underlying observation is that ISPs and MNOs are still exposed to rapid fluctuations and/or unpredicted breakdowns in traffic; it goes without saying that even the largest operators can be affected. But what if, these operators could now put in place designs and mechanisms to improve network survivability to avoid such occurrences? What if mobile network operators can come up with low-cost backhaul solutions together with ensuring the required availability and reliability in the networks? With this problem statement in-hand, the overarching theme of this dissertation is within the following scopes: (i) to provide low-cost backhaul solutions; the motivation here being able to build networks without over-provisioning and then to bring-in new resources (link capacity/bandwidth) on occasions of unexpected traffic surges as well as on network failure conditions for particularly ensuring premium services (ii) to provide uninterrupted communications even at times of network failure conditions, but without redundancy. Here a slightly greater emphasis is laid on tackling the 'last-mile' link failures. The scope of this dissertation is therefore to propose, design and model novel network architectures for improving effective network survivability and network capacity, at the same time by eliminating network-wide redundancy, adopted within the context of mobile backhaul networks. Motivated by this, we study the problem of how to share the available resources of a backhaul network among its competitors, with whom a Service Level Agreement (SLA) has been concluded. Thus, we present a systematic study of our proposed solutions focusing on a variety of empirical resource sharing heuristics and optimization frameworks. With this background, our work extends towards a novel fault restoration framework which can cost-effectively provide protection and restoration for the operators, enabling them with a parameterized objective function to choose desired paths based on traffic patterns of their end-customers. We then illustrate the survivability of backhaul networks with reduced amount of physical redundancy, by effectively managing geographically distributed backhaul network equipments which belong to different MNOs using 'logically-centralized' physically-distributed controllers, while meeting strict constraints on network availability and reliability

針對各國普遍面臨人口結構逐漸老化、退休人口增加問題，世界銀行曾提出應建立至少三層保障的養老制度之呼籲；而我國迄今尚未建構出一套全面性之老年經濟生活安全保障制度，現有退休制度係依國民職業身分作為區分基礎。近幾年政府財政日趨惡化，加以國內經濟景氣不佳，失業率節節升高，公務人員由於工作與薪資相對較為穩定，其退休給付亦較完備；因此，遂引起各界對公務人員退休給付及其條件之合理及公平性的諸多討論。而公務人員退撫基金管理良窳，除攸關公務人員退休權益，亦牽涉政府最後給付責任，在政府可用資源相對減少下，如何防範政治力介入，暨因應現有制度與管理上的若干缺失，避免未來發生嚴重財務危機，均為本研究之重點。 本研究採取文獻探討、比較研究法，並輔以德菲爾法（Delphi Method）、問卷調查等方法，就公平及管理角度檢視現行公務人員退休制度所存在之缺失及具體改進之道。研究結果發現大多數受訪者認為我國對老年經濟生活安全之保障，與個人從事職業別有很大關聯；除軍公教人員以外之其他職域與非工資勞動者的老年經濟生活保障普遍不足，故在制度比較上常衍生出差別性待遇公平性問題；而退撫基金經營決策又常有政治力介入，特別是政經情勢不穩定時，除非逐漸民營化，政府僅擔任監督者角色，否則既使修法明定政府干預、挪用基金等限制條文，只要仍維持現行制度精神，由政府管理，便很難防範政治力介入該基金之實際運作。 基此，本研究提出下述幾點建議：1.政府應致力提升其他職域（身分）人員之老年經濟生活安全保障；2.公務人員請領月退休金年齡條件應予以延後，並適度降低現行給付水準；3.研議增訂彈性退休規定，並研酌展期年金及減額年金之可行性；4.宜朝向「確定給付制」兼採「確定提撥制」混合制方向發展，並逐步提高「確定提撥制」比例及採個人退休金帳戶制；5.修法明確規範退撫基金提撥率之調整機制，以健全基金財務結構；6.宜逐步增加退撫基金國外投資配置比例；7.應研酌未達法定最低收益由國庫補足差額之規定，以免否對資產長期配置造成扭曲；8.對於有價證券之投資應改採市價法評價，以反映基金資產真實價值；9.加強退撫基金財務資訊公開，以利全體投保人之監督；10.現行基金管理與監理組織，可研酌精簡合併為一獨立專業監理機關。11.修法使退撫基金經營管理趨向私有化與自由化。 / To confront the ever growing ageing trend and consequent retirement tide, the World Bank has contended three pillars of old age security over the past few years. The ROC government, however, has not yet launched a national pension scheme to ensure the elderly economic security so far although the Plan has been worked out for some time. The country is currently adopting a retirement system based on people’s occupation. Civil servants all along enjoy relatively sound and stabilized retirement benefits even under the aggravating financial difficulties and the economy recession. Together with the increasing unemployment rate, this phenomenon has augmented a great deal of discussion with regard to its fairness. In addition, since the government has played significant role in terms of Pension Fund Management, how to prevent political intervention and avoid mismanagement particularly during economic crisis certainly deserve close scrutiny. In light of the aforementioned, this study, based on literature review, survey, and Delphi, focuses on the fairness and management perspectives of the existing pension system for civil servants. It is found that most interviewees agree that civil servants comparatively enjoy better retirement benefits than the rest of the population since the current pension system has been designed on occupational basis. It is further observed by the interviewees that political intervention does exist in terms of Pension Fund Management especially during economic recession. It is thus harbored that perhaps only through “privatization”, such intervention can come to its stop. The study, among other things, suggests the followings: 1.A national pension scheme covering all people is required. 2.Postponing the age of receiving annuity from the current 50 to a later age and reasonably cutting off some civil servants’ pension benefits need to be addressed. 3.Adding flexibility to current civil servants’ retirement system is worth pondering. 4.Working out a system blending together “defined benefit” and “defined contribution” in which the proportion of “defined contribution” should be gradually enlarged. Thoughts with regard to “individual account” should also be studied. 5.Adjusting the insurance fee for pension fund is necessary in order to ensure financial viability. 6.Bigger proportion of pension funds’ overseas investment should be allowed. 7.Investment in securities should be evaluated with market price to reflect the actual value of fund assets. 8.Pension funds management report should be released to the general public for supervision. 9.Professional pension fund supervision mechanism has to be established. 10.Law provisions as to privatize and liberalize the pension fund need to be worked out.

本文於確定提撥退休金制度下，探討基金經理人如何決定最適資產策略規避薪資所得及通貨膨脹之不確定風險，求得期末財富效用期望值極大化。本研究首先擴展Battocchio與Menoncin (2004)所建構之資產模型，我們不僅探討來自市場之風險，同時考量薪資所得、通貨膨脹與費用率之不確定性，研究其對最適資產配置行為的影響，建構隨機控制模型，以動態規劃方法求解Hamiltonian方程式，研究結果顯示，我們可利用五項共同基金分離定理來描述投資人之最適投資決策：短期市場基金、狀態變數避險基金、薪資所得避險基金、通貨膨脹避險基金與現金部位。數值結果顯示，股票持有部位中通貨膨脹避險基金佔有最大的成份，債券持有部位中通貨膨脹避險基金與狀態變數避險基金佔有最大的成份。 關鍵字：確定提撥、薪資的不確定性、通貨膨脹、隨機控制、動態規劃 / In this study, we investigate the portfolio selection problem in order to hedge the labor income and inflation uncertainties for defined contribution (DC) pension schemes. First, we extend the previous work of Battocchio and Menoncin (2004) that allowed the state variables (i.e., the risks from the financial market) and a set of stochastic processes to describe the inflation, labor income and expense uncertainties. A five-fund separation theorem is derived to characterize the optimal investment strategy for DC pension plans to hedge the labor income and the inflation risks. Second, by solving the Hamiltonian equation in the three-asset framework, we show that the optimal portfolio consists of five components: the myopic market portfolio, the hedge portfolio for the state variables, the hedge portfolio for the inflation risk, the hedge portfolio for the labor income uncertainty and the riskless asset. Then we explicitly solve the optimal portfolio problem. Finally, the numerical results indicate that the inflation hedge portfolio comprises the overwhelming proportion of stock holdings in the optimal portfolios. In addition, the inflation hedge portfolio and the state variable hedge portfolio constitute the overwhelming proportions of bond holdings. Keywords: defined contribution; salary uncertainty; inflation; stochastic control; dynamic programming.

現行各國的退休金計畫逐漸地由確定給付制轉變為確定提撥制。這表示投資的風險由原本退休金計畫的發起者(雇主)轉移到了參與者(員工)的身上。為了減少每個確定提撥制計畫參與者的投資風險，本文中採用退休時所得替代率為預估的目標，藉由模擬與最適化的方法找到最適投資策略與最適提撥率。 能反映出時間性的隨機模型在精算科學的領域是日漸重要，本文試著藉由隨機性的變化來估計代替以往精算上各種假設下所求得的負債。本文藉由隨機模擬的方式，得到各種資產在市場上或者是經濟上的價值來建構相關投資標的之報酬率，並利用動態隨機規劃模型去改善財務上避險以及資產負債管理。此外，為了避免模擬分析時間過長的問題，本文採用了情境抽樣的方法去改善電腦模擬分析計算時的效率。 我們主要得到以下結論： (一)確定提撥制下的負債受薪資水準波動的影響，所以此時會持有較 多的指數連結型債券以反應薪資水準及通貨膨脹的影響。整體投 資的結果與Vigna & Haberman (2001) 文中的結果及實務上生命 週期型態(lifestyle)投資方式呈現相同的現象。 (二)考慮每期下跌風險(downside risk)時，期中的投資可能會偏向 於投資風險較高的股票。在每年觀察下跌風險的情況下其投資因 為必須考慮避免每一年的下跌風險，需要比每五年觀察下跌風險 的情況做風險較大的投資，以達到其目標。 (三)在本文的調整投資組合策略下，因為調整次數不多，所以在考慮 交易成本的情況，當交易成本很小時對於整體的最適化資產配置 與最適化提撥率的影響是很小的。在本文的調整投資組合策略 下，交易成本的影響只有在交易成本非常大的情況下才能看得出 來。 (四)均勻抽樣法抽出的400組情境幾乎可以完全的代替4000組情境， 其結果可以看出與未抽樣相同的生命週期型態(lifestyle)投資 方式。而隨機抽樣法的結果雖然也可看出趨勢，但準確性相對於 均勻抽樣法仍稍嫌不足，並不適合用來代替原先的4000組情境。 / A shift from defined-benefit pension plan towards defined-contribution pension plan is currently popular around the world. This means that a serious investment risk transfers from defined-benefit sponsors to the individual members of defined-contribution plans. In order to reduce the risk of individual DC member, we investigate the methodology of finding the optimal contribution rate and asset allocation to reach a certain target of the retirement replacement rate in this paper. Stochastic processes are getting more important to the field of actuarial science. Instead of trying to approximate liabilities by a single deterministic set of actuarial assumption, we seek to take account of market or economic valuation for both assets and liabilities using stochastic simulation. We applied dynamic stochastic programming models to improve financial hedging and asset liability management. Moreover, in order to avoid the problem of time-consuming, we use scenario sampling method to improve the efficiency of computer calculation. We draw four conclusions from our investigations： (1)We will hold more assets in indexed-linked bonds because the pension liability is highly related to the wage- index and inflation rate. The optimal investment strategy is very like the so called "lifestyle" investment strategy. (2)When we consider downside risk, we should hold more risky equities. The investment strategy is more risky when we consider downside risk every year than every 5 years. (3)Under our rebalancing strategy, if the transaction cost is small, the influence on the investment strategy and contribution rate is small. We can see the influence of the transaction cost in a situation that the transaction cost is very big only. (4)There are almost no different between uniform sampling scenarios and original simulation scenarios, so uniform sampling scenarios may replace the original simulation scenarios perfectly. And random sampling method is unsuitable to replace the original simulation scenarios.

Asset allocation is the most influential factor driving investment performance. While researchers have made substantial progress in the field of asset allocation since the introduction of mean-variance framework by Markowitz, there is little agreement about appropriate portfolio choice for multi-period long horizon investors. Nowhere this is more evident than trustees of retirement plans choosing different asset allocation strategies as default investment options for their members. This doctoral dissertation consists of four essays each of which explores either a novel or an unresolved issue in the area of asset allocation for individual retirement plan participants. The goal of the thesis is to provide greater insight into the subject of portfolio choice in retirement plans and advance scholarship in this field. The first study evaluates different constant mix or fixed weight asset allocation strategies and comments on their relative appeal as default investment options. In contrast to past research which deals mostly with theoretical or hypothetical models of asset allocation, we investigate asset allocation strategies that are actually used as default investment options by superannuation funds in Australia. We find that strategies with moderate allocation to stocks are consistently outperformed in terms of upside potential of exceeding the participant’s wealth accumulation target as well as downside risk of falling below that target by very aggressive strategies whose allocation to stocks approach 100%. The risk of extremely adverse wealth outcomes for plan participants does not appear to be very sensitive to asset allocation. Drawing on the evidence of the previous study, the second essay explores possible solutions to the well known problem of gender inequality in retirement investment outcomes. Using non-parametric stochastic simulation, we simulate iv and compare the retirement wealth outcomes for a hypothetical female and male worker under different assumptions about breaks in employment, superannuation contribution rates, and asset allocation strategies. We argue that modest changes in contribution and asset allocation strategy for the female plan participant are necessary to ensure an equitable wealth outcome in retirement. The findings provide strong evidence against gender-neutral default contribution and asset allocation policy currently institutionalized in Australia and other countries. In the third study we examine the efficacy of lifecycle asset allocation models which allocate aggressively to risky asset classes when the employee participants are young and gradually switch to more conservative asset classes as they approach retirement. We show that the conventional lifecycle strategies make a costly mistake by ignoring the change in portfolio size over time as a critical input in the asset allocation decision. Due to this portfolio size effect, which has hitherto remained unexplored in literature, the terminal value of accumulation in retirement account is critically dependent on the asset allocation strategy adopted by the participant in later years relative to early years. The final essay extends the findings of the previous chapter by proposing an alternative approach to lifecycle asset allocation which incorporates performance feedback. We demonstrate that strategies that dynamically alter allocation between growth and conservative asset classes at different points on the investment horizon based on cumulative portfolio performance relative to a set target generally result in superior wealth outcomes compared to those of conventional lifecycle strategies. The dynamic allocation strategy exhibits clear second-degree stochastic dominance over conventional strategies which switch assets in a deterministic manner as well as balanced diversified strategies.

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Made available in DSpace on 2018-06-04T19:14:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-02-17 / Repensar estratégias efetivas para o controle e prevenção das doenças crônicas não transmissíveis (DCNT) tem sido um desafio para os sistemas de saúde. Segundo a OMS, as DCNT respondem por 73% dos óbitos no mundo, com destaque para doenças cardiovasculares (31,3%). No Brasil, as doenças cardiovasculares (DCV) constituem a primeira causa de morte em todas as regiões brasileiras. O presente estudo teve como campo de pesquisa o município de Praia Grande-SP, com objetivo de avaliar o desempenho da rede de atenção à saúde ao paciente portador de DCV. A pesquisa foi realizada em duas fases. A primeira, de caráter quantitativo, buscou identificar a evolução das taxas de mortalidade por doenças do aparelho circulatório (doenças isquêmicas do coração, doenças cerebrovasculares e doenças hipertensivas) no período entre 1996 e 2012, antes e após a criação do Serviço de Verificação de Óbitos regional no município de Praia Grande. A segunda parte do estudo, de caráter qualitativo, buscou conhecer, por meio de coleta de informações orais, o circuito do atendimento em rede à pessoa que procura os serviços de saúde do município de Praia Grande na perspectiva do usuário com doença cardiovascular, desde o diagnóstico até a ocorrência do óbito, com o objetivo de reconstruir as formas de acesso aos serviços de saúde e continuidade do cuidado. Com essa finalidade realizamos uma seleção aleatória de 17 óbitos por DCV de residentes na Praia Grande ocorridos no período de janeiro a maio de 2013. Os prontuários foram localizados nas Unidades de Saúde da Família e usados para coleta de dados, realizada por meio de questionário semiestruturado. Os familiares e profissionais dos serviços de saúde acessados para o atendimento do evento que levou ao óbito foram entrevistados para recompor a rede de assistência Resultados: Verificamos uma forte correlação positiva entre aumento da mortalidade proporcional por doenças cardiovasculares e número de óbitos investigados por necropsia no Serviço de Verificação de Óbito sugerindo que a investigação da causa de morte e o preenchimento correto da declaração de óbito pode ter sido um fator importante na modificação do perfil de mortalidade do município de Praia Grande no período 2006-2012. A observação do comportamento em espelho das tendências das mortalidades proporcionais por causas mal definidas e doenças cardiovasculares permite supor que o aumento de participação das últimas no obituário se deu à custa do declínio das primeiras. No ano de 2013, este estudo indicou que apenas o aumento quantitativo de equipes da Estratégia de Saúde da Família não se mostrou suficiente para o enfrentamento da DCV de forma efetiva e contínua, embora a rede de atenção básica do município de Praia Grande contasse com uma cobertura de mais de 56 % da população local com a Estratégia de Saúde da Família. Os nós dificultadores identificados neste circuito de serviços de saúde no município de Praia Grande são constituídos pelo desafio de trabalhar em rede, com comunicação entre os pares e transpondo barreiras locais, além do protagonismo fundamental do agente comunitário de saúde na questão do conhecimento, do monitoramento e da vigilância da população moradora em seu território, seja ela usuária do SUS ou da rede de saúde suplementar. À época da pesquisa, as unidades da atenção básica não pareciam ser uma porta aberta quando da agudização da sua condição crônica de saúde, o que leva o usuário a procurar primeiramente por serviços de urgência e emergência, continuando o fluxo para os serviços de internação, cujos procedimentos de alta complexidade também são dificultadores para uma boa evolução antes da ocorrência do óbito por DCV. / Rethinking effective strategies for prevention and control of chronic non-communicable diseases (NCD) has been a challenge for health care systems. According to the WHO, NCDs account for 73% of deaths worldwide, especially cardiovascular diseases (31.3%). In Brazil, cardiovascular diseases (CVD) are the leading cause of death in all Brazilian regions. This study’s research field was the municipality of Praia Grande -São Paulo, and its goal was to evaluate the performance of the health care network for the patient with CVD. The survey was conducted in two phases. The first, of quantitative character, sought to identify the evolution of mortality rates from cardiovascular diseases (ischemic heart disease, cerebrovascular disease and hypertensive disease) in the period between 1996 and 2012, before and after the creation of Regional Coroner's Service in Praia Grande’s municipality. The second part of the study, qualitative, sought to know, through collecting oral information, the path along the service network of the person seeking health services on the Praia Grande’s municipality in the perspective of the patient with cardiovascular disease until death occurred, in order to reconstruct the forms of access to health services and the continuity of care. The authors conducted a random selection of 17 CVD deaths of residents in Praia Grande that occurred in the period from January to May 2013. The records were located on the Family Health Units and used for data collection, carried out through semi-structured questionnaire. Family members and health services’ professionals that had been accessed during the event that led to the death were interviewed to recompose the service network. Results: We found a strong positive correlation between increased proportional cardiovascular mortality and number of deaths investigated by necropsy in the Coroner's Service suggesting that the investigation of the cause of death and the correct completion of death certificates may have been an important factor in mortality profile modification of Praia Grande municipality in the period 2006-2012. The behavioral observation using mirror of the trends of proportional mortality from ill-defined causes and cardiovascular disease suggests that the increase in participation in recent obituary occurred at the expense of the decline of the first. In the year 2013, this study indicated that the quantitative increase of teams of the Family Health Strategy alone was not enough to manage effectively and continuously the CVDs, although the primary care network of Praia Grande municipality had more than 56% of the local population covered with the Family Health Strategy. The knots within the health care circuit in the city of Praia Grande are the challenge to network, to communicate between peers, to transpose local walls and the fundamental role of the Community Health Agent in the matter of knowledge, monitoring and surveillance of the population living in his territory, whether SUS user or of the private healthcare services. At the time of the survey, the primary care units did not seem to be an open door at the moment that their chronic health condition worsens. This lead the user to look first for urgency and emergency services, continuing the flow for inpatient services, whose highly complex procedures are also hindering for a good outcome instead the occurrence of death from CVD. / BV UNIFESP: Teses e dissertações

A elevada frequência de óbitos por causas mal definidas e por diagnósticos incompletos compromete a validade de indicadores de mortalidade por causas, constituindo obstáculo para a alocação racional dos recursos de saúde com base em perfil epidemiológico. O presente trabalho avalia a qualidade da informação da causa básica de morte na região do Médio Paraíba, estado do Rio de Janeiro, Brasil, nos anos de 2005 a 2009 para toda a população. Os dados provieram do Sistema de Informações sobre Mortalidade (SIM) disponibilizados pelo DATASUS/MS. A análise baseou-se em dois indicadores de mortalidade proporcional, por causas mal definidas (CMD - todos os óbitos cuja causa básica esteja incluída no capítulo XVIII da CID-10) e por diagnósticos incompletos (DI), segundo classificação apresentada no Projeto Carga de Doença do Brasil, 2002. As associações entre a qualidade da informação e variáveis demográficas, socioeconômicas e relacionadas à ocorrência do óbito foram investigadas por meio do cálculo das razões de chances de mortes por CMD e por DI, em relação às demais causas de morte. Observou-se na região do Médio Paraíba uma proporção de CMD de 4,54% no período de 2005 a 2009. A proporção de diagnósticos incompletos na região do Médio Paraíba no mesmo período mostrou-se elevada (20,59%). Somados os óbitos por CMD e DI na região do Médio Paraíba no quinquênio avaliado, chega-se a uma proporção de causas inadequadamente definidas (25,13%) bem acima do valor mediano de 12% estimado para a população mundial. As chances de CMD e DI decrescem quanto maior o grau de instrução. Quanto à variável raça, os óbitos de indivíduos da raça negra apresentaram maiores chances de ter CMD. Entre os óbitos de indivíduos de cor branca observaram-se maiores chances de constar um DI como causa básica. Nos óbitos sem assistência médica as chances de CMD e DI foram superiores em relação aos óbitos com assistência. Os óbitos em unidade hospitalar apresentaram menores chances de CMD e maiores chances de DI. As variáveis ignoradas ou não informadas apresentaram-se associadas a maiores chances de CMD e DI. Os resultados sugerem que na região do Médio Paraíba a qualidade dos dados de mortalidade no que concerne CMD está bem superior à nacional, assemelhando-se aos valores dos países desenvolvidos. Ainda assim, a proporção de causas residuais encontra-se bastante elevada, evidenciando que não obstante a expressiva melhora do SIM, persistem limitações que restringem a utilização mais ampla do sistema e impedem que os avanços nas políticas e programas na área da saúde sejam maiores. / A high frequency of deaths due to ill-defined causes and incomplete diagnoses compromise the validity of cause specific mortality indicators, constituting an obstacle to the rational allocation of health resources based on epidemiological profile. This study evaluates the quality of information regarding the underlying cause of death in the Médio Paraíba region, state of Rio de Janeiro, Brazil, in the years 2005 to 2009 for the entire population. Data were obtained from the Mortality Information System (SIM) provided by DATASUS / MS. The analysis was based on two indicators of proportional mortality, the proportion of deaths due to ill-defined causes (IDC - Chapter XVIII, ICD-10) and incomplete diagnosis (ID) according to the classification presented in the Burden of Disease Project in Brazil, 2002. The association between quality of information of the underlying cause of death and demographic, socioeconomic and related to the occurrence of deaths covariates was assessed by calculating odds ratios of deaths due to IDC and ID in relation to the remaining causes of death. Proportional mortality due to IDC in the Médio Paraíba was found to be 4.54% in the period 2005-2009, values similar to those expected in developed countries. However, following a national trend, the proportion of incomplete diagnosis in the Médio Paraíba region, in the same period was high (20.59%). Together, the proportions of deaths from IDC and ID in the Médio Paraíba region in the quinquenium from 2005 to 2009, reached 25.13%, above the median value of 12% estimated for the world population. The odds of deaths due to IDC and ID decreased at higher levels of education. As for the variable race, the deaths of the black subjects had higher odds of having IDC. Deaths of white individuals were more likely to be listed as the underlying cause ID. Among deaths without medical assistance chances of IDC and ID were higher in relation to deaths with assistance. The deaths in hospital had lower odds of IDC and greater chances of ID. The variables had ignored or not reported were associated with higher odds of IDC and ID. The results suggest that in the Médio Paraíba quality of mortality data regarding IDC is well above the national level, resembling the values of developed countries. Still, the proportion of residual causes is quite high, showing that despite the significant improvement of SIM persist limitations that restrict the wider use of the system and prevent that advances policies and programs in health are greater.

Submitted by Milena Rubi (milenarubi@ufscar.br) on 2017-10-09T14:35:22Z No. of bitstreams: 1 FRATE_Marcelo-2017.pdf: 8466810 bytes, checksum: 9438c26c84ebe90cd741672c8c04d726 (MD5) / Approved for entry into archive by Milena Rubi (milenarubi@ufscar.br) on 2017-10-09T14:35:33Z (GMT) No. of bitstreams: 1 FRATE_Marcelo-2017.pdf: 8466810 bytes, checksum: 9438c26c84ebe90cd741672c8c04d726 (MD5) / Approved for entry into archive by Milena Rubi (milenarubi@ufscar.br) on 2017-10-09T14:35:45Z (GMT) No. of bitstreams: 1 FRATE_Marcelo-2017.pdf: 8466810 bytes, checksum: 9438c26c84ebe90cd741672c8c04d726 (MD5) / Made available in DSpace on 2017-10-09T14:35:53Z (GMT). No. of bitstreams: 1 FRATE_Marcelo-2017.pdf: 8466810 bytes, checksum: 9438c26c84ebe90cd741672c8c04d726 (MD5) Previous issue date: 2017-02-23 / Não recebi financiamento / Since the emergence of the Software-Defined Networking (SDN), and, more precisely, since the development of an open interface in 2008 called OpenFlow protocol, it is being observed that this new networking paradigm is deeply remodeling the IP-protocol- based networks. It means that new mechanisms of provision services are being possible, which ensures scalability and reduces costs. Although this new paradigm has been created to centralize the control logic, there is the possibility of decentralizing it through the parceling of control tasks between two or more controllers. In this scenario, the subdivision of administrative domain in smaller subdomains in order to have each of them being controlled by one single controller has been an alternative to ensure scalability in SDN. The OpenFlow protocol allows communication among switches and controllers to another controller. However, the protocol does not define how this communication between one controller to other should be done. It is mandatory, therefore, the development of protocol independent solutions able to distribute this logic inside the same administrative domain. New proposals have been arisen, but their applications either use equal controllers or demand the development of new controllers specifically designed. This master’s research aims to offer the fundamentals to the development of an architecture here so called Orch Flow, able to receive application demands and organize them in a way it provides requested services through an OpenFlow network designed with two or more different implementation controllers. The OrchFlow architecture that is being proposed accomplishes its task through handling multiple OpenFlow controllers hierarchically and providing network access through three distinct modes: Proactive, Reactive and Hybrid. / Desde o surgimento das Redes Definidas por Software e mais especificamente à partir de 2008 com o desenvolvimento de uma interface aberta, o protocolo OpenFlow, é possível observar que este novo paradigma de redes está revolucionando as redes baseadas no protocolo IP, possibilitando a criação de novos mecanismos de aprovisionamento de serviços, garantindo a escalabilidade e reduzindo custos. Embora este novo paradigma tenha sido criado para a centralização da lógica de controle, existe a possibilidade de descentralizá-la através da divisão das tarefas de controle entre dois ou mais controladores. Neste cenário, subdividir o domínio administrativo em subdomínios menores e fazer com que cada subdomínio seja controlado por um controlador tem sido uma alternativa para garantir escalabilidade em Software-Defined Networking (SDN). O protocolo OpenFlow permite a comunicação entre switches e controladores, entretanto ele não define como deve ser feita a comunicação de um controlador para outro controlador. Faz-se necessário, portanto, o desenvolvimento de soluções independentes do protocolo, capazes de distribuir essa lógica dentro de um mesmo domínio administrativo. Neste cenário, novas propostas vão surgindo, porém as aplicações desenvolvidas ou fazem uso de controladores iguais ou são criados novos controladores especificamente para essa finalidade. Esta pesquisa de mestrado tem como objetivo o desenvolvimento de uma arquitetura, aqui denominada de OrchFlow, capaz de receber solicitações de aplicações, orquestrando as requisições a fim de prover os serviços solicitados numa rede OpenFlow com dois ou mais controladores de implementações diferentes. A arquitetura OrchFlow, desenvolvida para esta pesquisa de mestrado, realiza essa tarefa através da orquestração de múltiplos controladores OpenFlow atuando de forma hierárquica, provendo o acesso à infraestrutura da rede através de três modos distintos: o Proativo, o Reativo e o Híbrido.