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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
431

Interaktion och engagemang på digitala välgörenhetsplattformar : En kvalitativ studie om gränssnittdesignens roll för digitalt givande / Interaction and Engagement on Digital Charity Platforms : A Qualitative Study of the Role of Interface Design in Digital Giving

Fabricius Hultemark, Linda, Kahn, Elin January 2024 (has links)
Att bidra till välgörenhet sträcker sig flera århundraden tillbaka i tiden.  Världen står än i dag inför stora utmaningar som humanitära kriser, klimatförändringar och politiska konflikter, som kan behöva stöd i form av bidrag när  statliga medel inte räcker till. Här spelar välgörenhetsorganisationerna en viktig roll. Många av välgörenhetsorganisationerna är etablerade i dagens digitalisering, vilket också ökar konkurrensen om det digitala givandet från användarna.  Syftet med studien var att ta reda på vad som engagerar användare till att bidra digitalt till välgörenhet, samt identifiera vilka nyckelfaktorer som är viktiga för engagemanget i interaktionen med digitala välgörenhetstjänster.  Studien utfördes i samarbete med en etablerad svensk välgörenhetsorganisation och inkluderade användning av deras tjänst Gåvoshopen i den kvalitativa undersökningen. Välgörenhetsorganisationen riktar sig främst till individer som behöver humanitärt stöd. Genom kvalitativa metoder har semistrukturerade intervjuer utförts tillsammans med användartester av en tjänst för digitalt givande. Eftersom välgörenhet i sig inte är en tjänst utan ett beteende, har studiens arbete inspirerats av det teoretiska ramverket Theory of planned behavior, och kopplat den empiriska datan till teorins tre faktorer, attityd till beteende, subjektiva normer och uppfattad beteendekontroll.  Resultaten visade att visuella element så som bilder, textinnehåll och färg, hade en stor inverkan på empatin hos användarna. Designelement som är viktiga nyckelfaktorer till digitalt givande. Navigering och struktur på webbplatsen visade tydliga resultat över hur användarupplevelsen uppfattades, vilket i sin tur gav indikationer på om användarna ville fullfölja sitt digitala givande. Genom studiens resultat har rekommendationer för nya designprinciper tagits fram som kan inspirera andra välgörenhetsorganisationer i deras arbete att öka det digitala givandet från användarna. / Contributing to charity dates back several centuries. The world still faces significant challenges today, such as humanitarian crises, climate change, and political conflicts, which may require support in the form of donations when government funds are insufficient. This is where charitable organizations play an important role. A large part of charitable organizations are established in today's digitalization, which also increases competition for digital donations from users. The purpose of this study was to find out what engages users to contribute digitally to charity and identify the key factors that are important for engagement in interaction with digital charity services.  The study collaborated with a well-established Swedish charity organization that primarily focuses on individuals needing humanitarian support. The study performed a qualitative study by conducting user tests on one of their services that they offer on their website.  Through qualitative methods, semi-structured interviews were conducted along with user tests of a digital donation service. Since charity itself is not a service but a behavior, the study was inspired by the theoretical framework Theory of Planned Behavior and connected the empirical data to the theory's three factors: attitude toward behavior, subjective norms, and perceived behavioral control.  The results showed that visual elements such as images, text content, and color had a significant impact on users' empathy. Design elements that are important key factors for digital giving. Navigation and structure on the website showed clear results on how the user experience was perceived, providing indications on whether users wanted to complete their digital donation. Through the study's results, recommendations for new design principles have been developed that can inspire other charitable organizations in their efforts to increase digital donations from users."
432

Synthesis and properties of d6 metal complexes of bidentate and tridentate ‘super donor’ ligands

Pal, Amlan Kumar 03 1900 (has links)
La polyvalence de la réaction de couplage-croisé C-N a été explorée pour la synthèse de deux nouvelles classes de ligands: (i) des ligands bidentates neutres de type N^N et (ii) des ligands tridentates neutres de type N^N^N. Ces classes de ligands contiennent des N-hétérocycles aromatiques saturés qui sont couplés avec hexahydropyrimidopyrimidine (hpp). Les ligands forment de cycles à six chaînons sur la coordination du centre Ru(II). Ce fait est avantageux pour améliorer les propriétés photophysiques des complexes de polypyridyl de Ru(II). Les complexes de Ru(II) avec des ligands bidentés ont des émissions qui dépendent de la basicité relative des N-hétérocycles. Bien que ces complexes sont électrochimiquement et photophysiquement attrayant, le problème de la stereopurité ne peut être évité. Une conception soigneuse du type de ligand nous permet de synthétiser un ligand bis-bidentate qui est utile pour surmonter le problème de stereopurité. En raison de la spécialité du ligand bis-bidentate, son complexe diruthénium(II,II) présente une grande diastéréosélectivité sans séparation chirale. Alors que l'unité de hpp agit comme un nucléophile dans le mécanisme de C-N réaction de couplage croisé, il peut également agir en tant que groupe partant, lorsqu'il est activé avec un complexe de monoruthenium. Les complexes achiraux de Ru(II) avec les ligands tridentés présentent des meilleures propriétés photophysiques en comparason avec les prototypes [Ru(tpy)2]2+ (tpy = 2,2′: 6′, 2′′-terpyridine). L’introduction de deux unités de hpp dans les ligands tridentates rend le complexe de Ru(II) en tant que ‘absorbeur noir’ et comme ‘NIR émetteur’ (NIR = de l’anglais, Near Infra-Red). Cet effet est une conséquence d'une meilleure géométrie de coordination octaédrique autour de l'ion Ru(II) et de la forte donation sigma des unités hpp. Les complexes du Re(I) avec des ligands tridentates présentent un comportement redox intéressant et ils émettent dans le bleu. L'oxydation quasi-réversible du métal est contrôlée par la donation sigma des fragments hpp, tandis que la réduction du ligand est régie par la nature électronique du motif N-hétérocycle central du ligand lui-même. Cette thèse presente également l'auto-assemblage des métal-chromophores comme ‘métallo-ligands’ pour former des espèces supramoléculaires discretes utilisant des complexes neutres. Les synthèses et propriétés des métaux-chromophores précités et les supramolécules sont discutées. / The versatility of C-N cross coupling reactions has been explored for the synthesis of two novel classes of ligands : (i) neutral bidentate N^N ligands and (ii) neutral tridentate N^N^N ligands. Both classes of ligands contain saturated aromatic N-heterocycles coupled with the unsaturated hexahydropyrimidopyrimidine (hpp) unit. The ligands form six-membered chelate rings upon coordination to a Ru(II) center. This fact is advantageous to improve the photophysical properties of Ru(II)-polypyridyl complexes. Ru(II) complexes of bidentate ligands can act as red-emitters. The red-emission is dependent on the relative basicity of the N-heterocycles. While these complexes are electrochemically and photophysically appealing, the problem of stereopurity can not be avoided. Careful ligand design affords bis-bidentate ligand that is useful to overcome the problem of stereopurity. Due to the speciality of this bis-bidentate ligand, its diruthenium(II,II) complex exhibits high diastereoselectivity without any chiral separation. While the hpp unit acts as a nucleophile in the mechanism of C-N cross coupling reaction, it can also act as a leaving group when activated as a monoruthenium complex. Achiral Ru(II) complexes of the tridentate ligands display improved photophysical properties over the prototype complex [Ru(tpy)2]2+ (tpy = 2,2’:6’,2’’-terpyridine). Introduction of two hpp units in the tridentate ligands renders the Ru(II) complex into a ‘black absorber’ and a ‘NIR emitter’ (NIR = Near Infra-Red). This fact is a consequence of better octahedral geometry around the Ru(II) ion and strong sigma-donation from the hpp units. The blue-emitting Re(I) complexes of the tridentate ligands also exhibit interesting redox behavior. The metal-based quasi-reversible oxidation is controlled by the sigma-donation from the hpp moieties, while the ligand-based reduction is governed by the electronic nature of the central N-heterocycle of the same ligand moiety. This thesis also incorporates self-assembly of metal-chromophores as ‘metallo-ligands’ to form discrete supramolecular species using neutral metal-complexes. The syntheses and properties of the aforesaid metal-chromophores and the supramolecules are discussed.
433

Donation vivante de rein: trajectoire de transplantation, expérience relationnelle et enjeux éthiques et méthodologiques d’une recherche qualitative impliquant des dyades donneur-receveur

Ummel, Deborah 06 1900 (has links)
La présente thèse poursuit l'objectif général de mieux comprendre l'expérience de la transplantation d'organe de la perspective de dyades comprenant un donneur et un receveur d'une donation vivante de rein. Pour ce faire, nous proposons une exploration en profondeur de la trajectoire de transplantation et des enjeux relationnels des donneurs et des receveurs. Un second objectif, qui s'est développé au cours de la recherche, est de contribuer à une meilleure compréhension des enjeux entourant la recherche qualitative impliquant des dyades. Cette thèse est présentée sous la forme de trois articles. Le premier article vise, par le biais de la méthode du méta-résumé, à dresser un portrait le plus complet possible du processus de donation tel qu'il avait été examiné à ce jour par les écrits empiriques qualitatifs disponibles, et à mettre en lumière les aspects qui avaient encore peu été appréhendés par les chercheurs, notamment l'importance de considérer conjointement au sein d'une même recherche des donneurs et des receveurs d'une donation vivante de rein. Le deuxième article a pour but d'explorer en profondeur l'expérience vécue pour des dyades de donneurs et de receveurs en contexte de donation vivante de rein, et en particulier la trajectoire de transplantation ainsi que les enjeux relationnels. Des entrevues qualitatives ont été menées auprès de cinq dyades (donc cinq donneurs et cinq receveurs). L'analyse phénoménologique interprétative des données recueillies propose un portrait de la trajectoire de transplantation, soit (a) l'expérience de la maladie du receveur, (b) l'expérience d'offrir et d'accepter un rein, (c) la période des tests, (d) la transplantation d'organe à proprement parler et finalement (e) la période post-transplantation. Un apport particulièrement significatif de l'analyse et de l'interprétation de nos données est la mise en relief que le processus de transplantation est mieux compris lorsque l'on considère le contexte social et interpersonnel plus large dans lequel évolue chaque dyade donneur-receveur, et en ce sens, la décision de donner ou d'accepter un rein peut être appréhendée comme un prolongement du rôle social auquel la personne adhère par rapport à autrui dans sa vie quotidienne. Le troisième article, qui a émergé des leçons acquises en réalisant la recherche effectuée dans l'article précédent, vise à décrire et discuter des défis éthiques et des impacts des décisions méthodologiques dans le cadre de recherches qualitatives impliquant des dyades de personnes se connaissant. Sur la base de nos propres défis empiriques et des écrits scientifiques disponibles, des réflexions et recommandations sont suggérées à différents stades d'un processus typique de recherche qualitative, soit (a) le recrutement, (b) le consentement à participer, (c) la collecte de données, (d) la validation des transcriptions par les participants, (e) l'analyse de données, et (f) la dissémination des résultats. Une réflexion en amont des enjeux entourant ces étapes est susceptible de faciliter l'entreprise de recherches qualitatives impliquant des dyades. En conclusion, les résultats de notre analyse soulignent l'importance du rôle social et du contexte interpersonnel plus large dans lequel évoluent les donneurs et les receveurs dans la façon dont ils parviennent à donner une signification à leur expérience. Enfin, si la recherche qualitative impliquant des dyades est en émergence, des défis éthiques et des décisions méthodologiques rigoureuses doivent être considérés en amont. / The global objective of this thesis is to help develop a better understanding of how living kidney transplantation donors and recipients experience the donation process as an interactive dyad. To address this objective, we suggest an in-depth exploration of the transplant trajectory and of the relational issues at play between donors and recipients in the context of a living kidney donation. A secondary objective, which developed along the way, is to contribute to a better understanding of how to conduct qualitative research with dyads. This thesis is comprised of three articles. The first article is a meta-summary that aimed at aggregating results pertaining to both donors and recipients of a living kidney donation to offer a complete picture of the donation process and to highlight avenues that warrant further research, namely looking at both donors and recipients as an interactive dyad within the same study. The objective of the second article was to provide a better understanding of how living kidney transplantation donors and recipients experience the donation process as an interactive dyad, and in particular the transplant trajectory and the relational issues involved. In-depth qualitative interviews were conducted with five dyads (five donors and five recipients). An interpretative phenomenological analysis of the data suggests that the transplant process can be naturally broken down into five phases of the transplant process: (a) the experience of the disease, (b) the experience of offering and accepting a kidney, (c) the screening period, (d) the surgery, and (e) the post-transplantation period. We found that for each donor-recipient dyad, the transplantation process reflects the unique larger social and interpersonal context within which the dyad evolves, and in this sense, the decision to donate or accept a kidney becomes a reflection of the social role one adheres to with respect to another being in everyday life. The third article emerged from the lessons we learned in conducting the research described in the second article and describes both the ethical challenges and methodological decisions involved in conducting qualitative research with dyads who have shared a common experience. Based on our experience and on the available literature, we offer reflections and recommendations that follow the typical chronology of the research process: (a) recruitment, (b) consent to participation, (c) data collection, (d) transcript validation by participants, (e) data analysis, and (f) result dissemination. Reflecting ahead upon issues at each of these stages is likely to be beneficial in conducting rigorous qualitative research involving dyads. In conclusion, our results underline the importance of the unique larger social and interpersonal context within which dyads evolve and achieve a sense of meaning with respect to their own experience of the donation process. Last, as qualitative research involving dyads continues to evolve, ethical challenges and rigorous methodological decisions should be reflected upon ahead of time.
434

Les rapports patrimoniaux entre concubins et leur liquidation. Etude comparative des droits français et polonais / Property relations between cohabitants and their settlement. A comparative study of French and Polish law

Pfeifer-Chomiczewska, Katarzyna 12 June 2015 (has links)
Après avoir quitté le monde de la réprobation, le concubinage a intégré l'ordre social et par suite, l'ordre juridique. Le concubinage est devenu l'une des conjugalités. Contrairement au législateur français, le législateur polonais n'a pas donné de définition du concubinage. Nonobstant cette différence, les éléments constitutifs du concubinage dans les deux systèmes légaux se ressemblent. Le concubinage se caractérise tant en France qu'en Pologne par: l'absence de lien juridique entre les concubins, la monogamie, la stabilité et la continuité et la communauté de vie. Dans les deux pays, le concubinage n'est pas juridiquement inorganisé. Le concubinage ne fait naître aucun droit ni obligation entre concubins, que ce soit sur le plan personnel ou patrimonial. / After leaving the world of disapproval, concubinage has integrated the social order and consequently the legal order. In French law, cohabitation is legally defined. In Poland, a legal definition of cohabitation does not exist. Notwithstanding this difference, the elements of cohabitation in the two legal systems are similar. Cohabitation is characterized in France and in Poland by the absence of a legal relationship between partners, monogamy, stability and continuity, and community of life. In both countries, concubinage is not legally organized. Cohabitation does not create any rights or obligations between the cohabitants, whether in a personal, property or financial sphere. Property relationships of cohabitants and their liquidation pose many difficulties. In order to legally qualify the economic acts of the cohabitants, it is necessary to retrospectively analyse the facts.
435

Study of the work of the Hungarian Baptist Aid with a special stress on the relationship between the social responsibility and evangelism

Nagy-Ajtai, Erzsébet 02 1900 (has links)
In this study we studied how holistic mission should be accomplished. May we speak about social and evangelical mandates? This search is done through the examination of a Christian relief organisation, the Hungarian Baptist Aid. Our main research question was: Is the work of this service holistic? Although we concluded in the light of David Bosch's mission interpretation that their mission is not yet holistic, the model of Hungarian Baptist Aid is encouraging how we could multiply our resources that are placed in God's hand. How we can see a commission that seemed impossible can become possible, and how we can find our way in God's mission. / Christian Spirituality, Curch History and Missiology / M. Th. (Missiology)
436

Perceptions of the relatives of patients suffering from chronic renal failure regarding kidney donation

Mbeje, Nthombithini Pretty 06 1900 (has links)
1 electroninc resource (ix, 86 leaves) / This study aimed at exploring and describing the perceptions of relatives of patients with chronic renal failure regarding kidney donation. The number of patients suffering from chronic renal failure awaiting kidney transplantation is on the increase, while the treatment they get in the interim is not cost effective. The researcher used qualitative descriptive and exploratory research using the Potter and Perry’s Health Belief Model. She applied purposive sampling and used semi structured interviews to collect data from 45 participants who were all relatives of patients coming for haemodialysis at a selected hospital in KwaZulu-Natal. Data analysis identified participants’ perceptions regarding chronic renal failure and kidney donation. Findings of the study revealed that most relatives were fully aware of kidney donation, but fear and lack of knowledge regarding kidney transplantation were the main barriers to them offering themselves for kidney donation. The researcher recommends that the Renal Transplant Multidisciplinary Committee should ensure the public is informed about kidney donation and more intensive education should be given to the relatives of patients suffering from chronic renal failure at an early stage in the illness to give them more time to come to terms with the concept of kidney donation. / Health Studies / M.A. (Health Studies)
437

Les représentations médiatiques de la mort cérébrale : perspectives publiques, débats d’experts et enjeux éthiques

Daoust, Ariane 06 1900 (has links)
Domaine de recherche: Bioéthique / Bien que largement accepté dans la communauté médicale, le concept de mort cérébrale est encore mal compris par certains professionnels de la santé et par le public en général. Il est au centre de débats et demeure une source de controverses. Malgré la confusion et les variations de pratiques documentées, les sources d’incertitudes et de confusion entourant le concept n’ont pas encore été étudiées en profondeur. Pourtant, cette confusion est à même d’influencer les débats et les décisions de fin de vie et de don d’organes, et soulève ainsi de sérieuses considérations tant éthiques que médicales. Ce mémoire de maîtrise propose d’abord une revue de la littérature discutant des origines, de l’évolution et des débats en lien avec le concept de mort cérébrale et les enjeux éthiques associés. Les approches méthodologiques utilisées pour la réalisation de cette recherche sont ensuite décrites. Les résultats découlant de l’analyse de contenu qualitative de médias canadiens et américains des différentes représentations de la mort cérébrales qu’on y retrouve suivent. Ces résultats décrivent l’utilisation du terme de « mort cérébrale » dans des contextes de don d’organes, de définitions de la mort cérébrale, de détermination de la mort, d’enjeux de fin de vie, d’enjeux légaux ainsi que des usages familiers du terme. Finalement, une discussion générale quant au rôle de la terminologie utilisée pour parler du concept de mort cérébrale puis celui des professionnels de la santé impliqués dans sa détermination et les pratiques de don d’organes, ainsi que des recommandations pour le futur concluront ce mémoire. / Despite being widely accepted by the medical community, the concept of brain death is still misunderstood by healthcare providers and the general public. It is central to several debates and remains a source of controversy. In spite of documented practice variations and conceptual confusion surrounding brain death, the upstream sources of variability and uncertainty have not been extensively investigated. This confusion is likely to influence debates and decisions about end-of-life and organ donation, and thus raises serious medical and ethical considerations. This thesis first proposes a review of the literature discussing the origins, the evolution and the debates related to the concept of brain death, as well as the ethical issues associated with brain death. The methodological approaches used for the realization of this research are then described. The results obtained from the qualitative content analysis of Canadian and American media about the different depictions of brain death follow. These results describe the use of the term “brain death” in contexts of organ donation, definitions of brain death, determination of death, end-of-life issues, legal issues and also colloquial uses of the term. Finally, a general discussion about the role of the terminology used to discuss the concept and that of healthcare professionals involved in its determination and organ donation practices, as well as recommendations for the future will conclude this thesis.
438

Registrovaná partnerství osob stejného pohlaví z pohledu etiky a práva / Partnerships of record of individuals of the same sex from ethics and law point of view

Zaplatílková, Simona January 2014 (has links)
This thesis is looking at the issue of registered partnerships from the perspective of ethics and law. The main objective of this thesis is to provide a comprehensive perspective on registered partnership problematic and on other current issues related to this topic. The work is divided into two parts. The theoretical part deals with the history of homosexuality from ancient Greece to modern times, furthermore it focuses on the actual registered partnership and the regularization process of the necessary law in the Czech Republic. It covers a topic of religion perspective on homosexuality, the issue of child adoptions by homosexual couples and not least the blood donation problematic. The practical part deals with the social investigational survey, its processing and reporting the results. The aim of the social survey was to obtain a view on the homosexual minority from the society and get their opinions about the questions analyzed in the theoretical part. Powered by TCPDF (www.tcpdf.org)
439

Générativité : nouvelle conceptualisation et examen du rôle médiateur de l'imagerie mentale et de la générativité situationnelle dans le processus persuasif prosocial : application au don du sang placentaire / Generativity : new conceptualization and examination of the mediator role of mental imagery and situational generativity in the persuasive prosocial process : application to the umbilical blood cord donation

Assaf, Cynthia 06 December 2018 (has links)
De nombreux facteurs environnementaux et/ ou de santé publique amènent à se poser aujourd’hui la question du devenir des générations futures. Plusieurs fléaux touchent notre société et sont de nature à affecter les générations suivantes à l’instar de nombreuses maladies dégénératives, de cancers, de maladies génétiques et diverses maladies de sang et de la moelle osseuse. Cependant, un élément d’optimisme a vu le jour grâce à la possibilité de prélever le sang placentaire et de conserver les cellules souches du cordon ombilical du nouveau-né à des fins de greffes ultérieures, beaucoup moins lourdes que celles de moelle osseuse. Des actions de communication seraient donc utiles pour informer les parents de cette possibilité, les sensibiliser et les encourager à prendre la décision de conserver les cellules souches du cordon pour le bien des générations futures. Ce besoin de communication et la nécessité de se préoccuper des générations futures ont attiré notre attention sur un concept issu de la psychologie sociale et introduit récemment en marketing : la générativité, définie par son auteur pionnier comme étant « la préoccupation quant à l’établissement et au conseil des générations futures » (Erikson, 1950). Par conséquent, la problématique centrale de cette recherche s’articule comme suit : Comment construire des messages prosociaux incitatifs, favorables aux générations futures, - en l’occurrence de conservation des cellules souches du sang du cordon ombilical -, efficaces pour agir sur les attitudes et intentions des femmes enceintes par une stimulation de leur générativité situationnelle ? Les objectifs de cette recherche imposent avant tout de mener une phase primordiale de meilleure compréhension du concept de générativité et de sa mesure. À cet effet, deux études préliminaires (étude qualitative suivie d’une étude quantitative) ont permis de mieux cerner ce concept du point de vue de ses conceptualisation, opérationnalisation et mesure. Une nouvelle conceptualisation de la générativité fondée sur une générativité situationnelle, venant compléter l’unique vision dispositionnelle de préoccupation générative, est proposée. Ensuite, une expérimentation auprès de femmes enceintes, cible de la décision de don du sang placentaire, souligne le rôle de l’imagerie mentale et de la générativité situationnelle dans le processus persuasif, confirmant la pertinence de cette nouvelle conceptualisation. Enfin, les résultats sont discutés ; des voies de recherches sont développées, notamment pour pallier les limites de la présente recherche. / Many environmental and/ or public health factors lead to questioning the future of generations. Many plagues affect our society and are likely to influence future generations such as numerous degenerative or genetic diseases, cancers, blood and bone marrow disorders. However, an optimistic element has emerged due to the ability to collect placental blood and to preserve the umbilical cord stem cells of the newborn for subsequent grafts, less heavier than those of bone marrow. Communication actions would therefore be useful to inform parents of this possibility, raise awareness and encourage them to decide to conserve cord stem cells for the benefit of future generations. This need for communication as well as the concern toward future generations have drawn our attention to a concept that emerged from social psychology and has been recently introduced into marketing: generativity. Erikson (1950), its pioneer, defined it as « primarily the concern in establishing and guiding the next generation ». Our central research question is articulated as follows: How to construct incentive prosocial messages, favorable to future generations, - in our case the conservation of umbilical cord stem cells -, effective in influencing the attitudes and intentions of pregnant women by stimulating their situational generativity? The objectives of this research require, first and foremost, a crucial phase of better understanding the concept of generativity and its measurement. To this end, two preliminary studies (qualitative followed by a quantitative study) made possible to perceive the conceptualization, operationalization and measurement of this concept. A new conceptualization of generativity based on a situational vision, in addition to the dispositional vision of generative concern, is proposed. Afterwards, an experiment among pregnant women, potential decision makers in donating placental blood, highlights the role of mental imagery and situational generativity in the persuasive process, confirming the relevance of this new conceptualization. Finally, the results are discussed ; research perspectives are developed, particularly to overcome the limitations of this research.
440

Transplante de córnea no Brasil: progresso e dificuldades em 16 anos / Corneal transplantation in Brazil: progress and difficulties in 16 years

Almeida, Hirlana Gomes 15 June 2018 (has links)
Introdução: As doenças da córnea são responsáveis por cerca de 5% da cegueira reversível no mundo e o transplante de córnea (TC) é importante para o tratamento dessas enfermidades. A partir de fontes de dados oficiais e públicas, foram analisados o progresso e as dificuldades relacionados ao TC no Brasil nos últimos 16 anos, bem como desigualdades regionais, gastos do Sistema Único de Saúde (SUS) e indicadores de qualidade dos bancos de tecido ocular (BTOs). Métodos: Estudo retrospectivo e analítico com dados sobre TCs e BTOs no Brasil, no período de janeiro de 2001 a dezembro de 2016, divulgados pelo Sistema Nacional de Transplantes (SNT), pela Associação Brasileira de Transplante de Órgãos (ABTO) e pela Agência Nacional de Vigilância Sanitária (ANVISA). Para verificação de existência de tendência, comparação de médias entre as regiões e verificação da diferença de médias, foram utilizados o teste de Cochran-Armitage, a Análise de Variância e as comparações múltiplas de Duncan, respectivamente. Em todos os testes foi utilizado um nível de significância de 5%. Resultados: No Brasil, houve aumento: de 2,4 vezes no número de TCs (de 6.193 - 35,2 pmp para 14.641 - 71,0 pmp - p < 0,001); de 50,7% na eficácia do atendimento à demanda populacional por TCs (de 35,3% para 53,2% - p < 0,001); de 27,8% no número de globos e córneas in situ doados (de 24.608 - 127,1 pmp para 31.450 - 152,6 pmp - p < 0,001); de 31,7% nas córneas preservadas (de 21.012 para 27.674); de 2,4 vezes no gasto financeiro total com TCs (de R$ 9.179.688 para R$ 22.060.973); e de 2,2 vezes no gasto unitário com TC (de R$ 716 para R$ 1.603). A fila de espera para TC reduziu em 45,4% (de 23.549 - 123,0 pmp para 12.865 - 62,4 pmp - p < 0,001). As duas principais causas para a não doação foram as contraindicações médicas (média de 42,5%) e a recusa familiar (média de 36,6%). As principais causas de descarte de córneas foram a sorologia positiva para hepatite B (média de 33%), validade tecidual (média de 30,9%) e qualidade imprópria do tecido (16,8%). A Eficácia na Preservação de Córnea (EPC), o Coeficiente de Descarte de Córnea (CDC) e a Eficácia no Fornecimento de Córnea para Transplante (ECT) foram em média 88%, 37% e 63% ao longo dos anos, respectivamente. Os melhores índices foram apresentados nas regiões Sul, Centro-Oeste e Sudeste e os piores no Norte e Nordeste. Conclusão: No Brasil, o pequeno número de doações e a grande taxa de descarte de córneas são as principais dificuldades ao adequado atendimento à demanda populacional por TCs. Contudo, o país aumentou a capacidade de transplantar córneas e reduziu as filas de espera em 16 anos / Introduction: Corneal diseases account for about 5% of reversible blindness in the world and Corneal Transplantation (CT) is important for the treatment of these diseases. From official and public data sources, the progress and difficulties related to CT in Brazil in the last 16 years were analyzed, as well as regional inequalities, expenses for the Unified Health System (SUS) and quality indicators of ocular tissue banks (OTBs). Methods: A retrospective and analytical study with data on CT and OTB in Brazil, from January 2001 to December 2016, published by the National Transplantation System (SNT), the Brazilian Organ Transplantation Association (ABTO) and the National Surveillance Agency Sanitary (ANVISA). The Cochran-Armitage test, the Analysis of Variance and the Duncan\'s multiple comparisons were used to verify the existence of trend, comparison of means between regions and verification of the mean difference, respectively. A significance level of 5% was used in all tests. Results: In Brazil, there was an increase: of 2.4 times in the number of CTs (from 6,193 - 35.2 pmp to 14,641 - 71.0 pmp - p < 0.001); of 50.7% in the efficacy of meeting the population demand for CTs (from 35.3% to 53.2% - p < 0.001); of 27.8% in the number of donated globes and corneas in situ (from 24,608 - 127.1 pmp to 31,450 - 152.6 pmp - p < 0.001); of 31.7% in preserved corneas (from 21,012 to 27,674); of 2.4 times in the total finance expense with CTs (from R$ 9,179,688 to R$ 22,060,973); and 2.2 times the unit expense with CT (from R$ 716 to R$ 1,603). The waiting list for CT decreased by 45.4% (from 23,549 - 123.0 pmp to 12,865 - 62.4 pmp - p < 0.001). The two main causes for non-donation were medical contraindications (mean of 42.5%) and family refusal (mean of 36.6%). The main causes of corneal discard were positive serology for hepatitis B (mean of 33%), tissue validity (mean of 30.9%) and inadequate tissue quality (16.8%). Efficacy in Corneal Preservation (EPC), Corneal Discarding Coefficient (CDC) and Efficacy Supply of Corneas for Transplantation (ECT) averaged 88%, 37%, and 63% over the years, respectively. The best indexes were presented in the South, Midwest and Southeast regions and the worst in the North and Northeast. Conclusion: In Brazil, the small number of donations and the high rate of discard of corneas are the main difficulties to the adequate attendance to the population demand by CTs. However, the country increased the ability to transplant corneas and reduced waiting lists in 16 years

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