Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / IntroduÃÃo: A Carta Magna de 1988 estabelece em seu art.196 que âa saÃde à um direito de todos e dever do Estadoâ, incluindo, ainda no campo de atuaÃÃo do Sistema Ãnico de SaÃde (SUS), a execuÃÃo de aÃÃes de assistÃncia terapÃutica integral, inclusive farmacÃutica. No Brasil, encontrar o meio de garantir efetivamente esse direito à saÃde tem sido um dos grandes desafios que os gestores do SUS tÃm enfrentado. Objetivo: Descrever os processos administrativos e judiciais de solicitaÃÃo de medicamentos a Secretaria de SaÃde do Estado do Cearà (SESA-CE) e discutir os seus aspectos crÃticos. Metodologia: Estudo descritivo, retrospectivo, realizado no NÃcleo de AssistÃncia FarmacÃutica (NUASF/SESA-CE). Foram coletados dados dos processos datados de 01 de janeiro de 2004 a 31 de junho de 2006. As principais informaÃÃes coletadas foram: tipo, condutor e motivo de instauraÃÃo do processo, doenÃas declaradas, unidade de atendimento e medicamentos solicitados. Resultados e DiscussÃo: No perÃodo foram pesquisados 841 processos entre administrativos e judiciais.Os tipos de processos mais frequentes foram os administrativos (84,9%). Os principais condutores foram a Promotoria da JustiÃa de Defesa da SaÃde PÃblica e o Grupo TÃcnico Social da SESA-CE (79,5%). O principal motivo para instauraÃÃo dos processos foi a falta de condiÃÃes financeiras para adquirir o medicamento (52,6%). As prescriÃÃes eram originÃrias principalmente de unidades pÃblicas (41,4%). As doenÃas mais declaradas foram: DoenÃa de Alzheimer (15,6%), e Diabetes mellitus insulino-dependente (7,5%). Durante o perÃodo estudado foram pleiteados 1.481 medicamentos, divididos em 400 especialidades farmacÃuticas (EF). Os medicamentos mais solicitados foram: rivastigmina (12,7%) e insulina glargina (6,4%). Dos medicamentos solicitados, 60% nÃo tinham financiamento definido, 23,0% eram medicamentos excepcionais e 10% da AtenÃÃo BÃsica. Dos medicamentos sem financiamento, os mais freqÃentes foram: insulina glargina (8,6%), clopidogrel (5,2%) e aripiprazol (5,2%). ConclusÃo: Os processos administrativos e judiciais para fornecimento de medicamentos mostraram grande variabilidade entre os medicamentos solicitados, o que leva a supor que as tendÃncias de utilizaÃÃo se devam à introduÃÃo de inovaÃÃes terapÃuticas, a ausÃncia de alguns medicamentos nas listas padronizadas pelo Estado e ao desconhecimento e descumprimento dos protocolos clÃnicos pelos prescritores.

Inquéritos nacionais de saúde bucal indicam que uma parcela da população brasileira nunca passou por uma consulta com o cirurgião-dentista. Os motivos são variados, desde a falta de percepção desta necessidade até mesmo a dificuldade de acesso aos serviços de saúde. No Brasil o atendimento odontológico predominante é através do Sistema Único de Saúde que tem nas unidades básicas de saúde a porta de entrada a diversos serviços. Através da consulta odontológica o paciente é referendado a especialidades, entre elas a endodontia. Esse estudo teve como objetivo avaliar a acessibilidade dos pacientes inscritos em fila de espera na especialidade de endodontia em duas unidades de saúde de Curitiba-PR. Foi realizado um estudo qualitativo e quantitativo, descritivo e exploratório com coleta de dados através de relatórios e também observada à movimentação do número de inscritos em tal especialidade numa determinada unidade de saúde e em outra realizada intervenção na fila de espera. Como resultado houve um redução de 95% no total de inscritos aguardando em fila de espera para a especialidade de endodontia, na unidade básica de saúde Pilarzinho e de 88% na unidade do programa de saúde da Família São Domingos, que tiveram intervenção na fila, no período de março a julho de 2008. Como conclusão, apontamos para a necessidade de melhorar a resolutividade dos profissionais que atuam na atenção básica, intervenção periódica na fila de espera, de triagem e agendamento da consulta especializada e da descentralização baseada na proximidade geográfica do Centro de Referência. / Oral health national inquiries indicate that a part of brazilian population has never been attended by a surgeon-dentist. The reasons are diverse, from lack of perception of this need to even difficulty in accessing health services. In Brazil the main dental care is provided by the SUS Sistema Único de Saúde (Health Exclusive System), which has the basic health units as the entrance to diverse systems. Through the dental consultation the patient is sent to a dental specialty, among which is Endodonthics. This study objective is to evaluate the accessibility of inscribed patients in the waiting line in Endodonthics specialty in two health units in Curitiba PR. It was developed a qualitative and quantitative study, descriptive and explorative with collection of data from reports. It was also observed the variation in inscription numbers to Endodonthics in one of the health units; an intervention in the waiting line was made in the other health unit. As a result there was a 95% reduction in the total number of inscribed patients expecting in the waiting line for endodonthic treatment in the health unit Pilarzinho; there was also an 88% reduction of the same aspect in the unit São Domingos (Family Health Program), which had suffered intervention in line from March to July 2008. As a conclusion we appoint the need of improvement in the optimization of professionals who work in basic services, the periodical intervention in the waiting lines as well as in the examinations and booking to specialty attendance, and also the decentralization based on geographical proximity from the reference center. Endodontics, Accessibility, Selection, Absenteeism

Orientador: Luísa Andréia Gachet Barbosa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Tecnologia / Made available in DSpace on 2018-08-24T15:19:21Z (GMT). No. of bitstreams: 1 Santos_VaniaReginaFerreirados_M.pdf: 1698251 bytes, checksum: acb74baaabcae217648c5433fbcfcde1 (MD5) Previous issue date: 2014 / Resumo: As questões de acessibilidade reduzem as desigualdades e promovem a inclusão social. Embora, no Brasil, nas últimas décadas as políticas públicas relacionadas à mobilidade urbana vem sendo incrementadas para assegurar a todos o direito constitucional de ir e vir, a realidade apontada no Censo Demográfico de 2010 do Instituto Brasileiro de Geografia e Estatística ¿ IBGE sobre população residente por tipo de deficiência, enfatiza a importância da atenção à questão da acessibilidade e de assegurar os direitos das pessoas com deficiência. Com a crescente demanda de execução de calçadas com padrões de acessibilidade, levantou-se a problemática da escassez de estudos sobre a dosagem quando pretende-se produzir pisos táteis intertravados de concreto com fibras de aço, utilizando o Resíduo de Construção Civil ¿ RCC reciclado como matéria prima visando uma solução ambiental adequada para a disposição final desses RCC, contribuindo ainda, para a preservação dos recursos naturais. Frente ao exposto, com o intuito de colaborar com o meio técnico na resolução desses problemas e auxiliar na minimização do impacto ambiental causado pela extração do agregado natural e disposição irregular dos RCC e ainda fornecer maior autonomia e qualidade de vida da pessoa com deficiência visual, esta pesquisa tem como principal objetivo produzir pisos táteis intertravados de concretos com fibras de aço substituindo em massa porcentagens de agregados miúdos naturais por reciclados. Inicialmente foram selecionados os materiais e realizada a caracterização, e posteriormente, feito uma pesquisa bibliográfica para escolher um traço de partida para a produção dos pisos. Foram realizados alguns ensaios experimentais para adequá-lo, uma vez que foi adicionado fibras e também realizado um estudo para a relação água/cimento, devido a substituição do agregado natural pelo reciclado de cor cinza. Foram moldados pisos táteis, corpos-de-prova prismáticos e placas de concreto, com cinco traços, o primeiro utilizado como concreto de referência com fibras de aço e os demais com adição de RCC nas proporções de 15%, 20%, 25% e 50%. Foram analisadas as propriedades: resistência à compressão, absorção de água, resistência à abrasão, tenacidade e resistência à tração e feitas comparações do resultado obtido com de outros autores nacionais e internacionais e com as normas da Associação Brasileira de Normas Técnicas ¿ABNT. Os resultados encontrados comprovam a viabilidade de produzir pisos táteis de concreto com fibras de aço utilizando RCC / Abstract: Accessibility matters reduce inequalities and promote social inclusion. Although, over the last decades, public policies related to urban mobility have been implemented in Brazil to ensure to everybody the constitutional right of coming and going, The reality according to the demographic census of 2010 of Brazilian Institute of Geography and Statistics ¿ IBGE about the residents for type of disability, points up the importance of providing accessibility and ensuring the rights of disabled people. The demand for this kind of paving increases to be used in sidewalks with accessibility standards, the problem of lack of studies about dosage for the production of interlocked steel fiber floors raises, using recycled Construction Waste as raw material. The production would provide an appropriate environmental solution for the final disposal of Construction Waste, contributing for the preservation of natural resources. In view of this, aiming to collaborate with the technical area in solving these problems, assist in minimizing the environmental impact caused by the extraction of the natural aggregate and irregular Construction Waste disposal and offer more autonomy and quality of life to the visual impaired person, this research main objective is to produce interlocked floors made of concrete and steel fiber replacing in mass percentages small natural aggregates to recycled aggregates. First it was selected the materials and performed characterization tests. Later a review of the literature was performed to choose a starting trait for the paving production. We also had experimental tests for adjusting it since we had added fiber to it and a study was made to determine the relation between water/cement due to the replacement of the natural aggregate to the grey recycled one. Some tactile floors, prismatic sample parts and concrete plaques were molded with 5 traces: the first used as concrete reference with steel fibers and the others with addition of Civil Construction Waste in the following proportions: 15%, 20%, 25% and 50% in mass replacement. It was then analyzed the properties: resistance compression, water absorption, abrasion, tearing and traction. It was made comparisons between this work and other national and international authors and with the ABNT standards - Associação Brasileira de Normas Técnicas and the findings proved the viability in producing tactile concrete and steel fibers floors using Civil Construction Waste / Mestrado / Tecnologia e Inovação / Mestra em Tecnologia

Orientador: Núbia Bernardi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo / Made available in DSpace on 2018-08-23T17:00:09Z (GMT). No. of bitstreams: 1 Martin_ClaudiaMaria_M.pdf: 137646573 bytes, checksum: b6bfa7e878949686c21ad73ffef90d02 (MD5) Previous issue date: 2013 / Resumo: A necessidade de uma arquitetura acessível tem sido cada vez mais solicitada e torna-se importante ao arquiteto compreender a diferença entre o conceito de projeto de arquitetura "acessível" e o conceito de projeto de arquitetura "universal". Enquanto o projeto acessível é aquele que atende Normas Técnicas de acessibilidade garantindo a utilização dos ambientes por pessoas com deficiência e/ou mobilidade reduzida, o projeto universal é baseado em princípios do Desenho Universal (DU) e visa criar espaços que não segregam e que atendam o maior número possível de diversidades. Esta pesquisa teve por objetivo demonstrar a diferença entre estes conceitos aliando conceitos do DU aos parâmetros de acessibilidade apresentados na norma técnica NBR 9050:2004, que trata da acessibilidade a edificações, mobiliário, espaços e equipamentos urbanos sendo a principal referência utilizada no Brasil para orientação técnica de soluções arquitetônicas acessíveis. A metodologia incluiu uma análise de conteúdo de publicações referentes à acessibilidade no ambiente construído e uma pesquisa de exemplos iconográficos e diretrizes conceituais dos princípios do DU aplicados a projetos de arquitetura. O resultado da pesquisa foi à criação de um documento de auxílio ao arquiteto durante a elaboração de projetos. Este documento relaciona de maneira síncrona alguns parâmetros de acessibilidade que constam na NBR 9050:2004 com os conceitos do DU, facilitando o entendimento destes conceitos para a sua aplicação no projeto de arquitetura. Desta forma esta pesquisa pretende contribuir para a elaboração de projetos que expressem com clareza os conceitos de uma arquitetura universal / Abstract: The need to produce accessible architecture is increasingly asked for and therefore it is important for designers to fully understand the difference between the concept of "accessible" architecture and the concept of "universal" architecture. While accessible design attends Technical Standards by ensuring the accessibility of environments for people with disabilities and/or with reduced mobility, universal design is based on the principles of Universal Design (UD) and aims to provide spaces that do not segregate and that serve the biggest number of diversities. This study demonstrated the difference between these concepts adding the concepts of UD to the accessibility parameters presented in the Brazilian technical standard NBR 9050:2004, that deals with accessibility of buildings, furniture, spaces and urban equipment and is the main reference in Brazil for technical orientation towards accessible architecture solutions. The methodology included an analysis of the content of publications relating to questions of accessibility in the built environment and a search of examples and conceptual guidelines to incorporate UD principles into architectural designs. The result of this study was the creation of a document to help designers during their design process and project development. This document connects some accessibility parameters synchronously contained in the standard NBR 9050:2004 with the concepts of UD, facilitating the understanding of these concepts for their application in architectural design. Thus this research contributes to the development of design solutions that express more clearly the concepts of a universal architecture / Mestrado / Arquitetura, Tecnologia e Cidade / Mestra em Arquitetura, Tecnologia e Cidade

No description available.

This research thesis presents a study of mobile-enhanced accessibility evaluation. In the first phase we have identified the evaluation methods that enable evaluation of mobile-enhanced accessibility. In the second phase we have performed evaluation of a specific mobile-enhanced accessibility prototype named “Augment” based on some selected evaluation methods that enables evaluation of mobile-enhanced accessibility. Finding methodologies for accessibility evaluation is just as important as early assessment. Therefore, in the last step on the basis of the evaluation results and literature review findings, we have presented an efficient and usable evaluation method that would enable valid and reliable evaluation of mobile-enhanced accessibility. The name of the presented evaluation method is “AccessEva” that is a diary method supported by a software application, which will run on a smart phone with the mobile-based accessibility software. This enables the testers to survey user attitudes, and experiences about the mobile-enhanced accessibility. At the end of this diary method period we suggest that a group discussion will be introduced and conducted together with the participants under the supervision of evaluators. / Cell No: +4670044884

Transport accessibility to healthcare facilities is a major issue in the United Kingdom, as recently demonstrated by the shift away from providing healthcare in acute hospitals to care closer to home . Common measures of accessibility focus on the creation of distance or travel time contours around a destination and devote less attention to individual differences such as user perceptions, their transport usage, and area-wide factors including income deprivation, safety and security. Failure to account for such factors may result in imperfect decision making in terms of healthcare relocation and reconfiguration. This thesis therefore aims to develop a user-based accessibility model by focusing on both individual socio-economic (e.g. age, gender, access to transport modes) and area-wide characteristics (e.g. income deprivation, public transport provision, safety and security). In order to identify important factors that affect accessibility and to develop the user-based accessibility model, two revealed preference questionnaire surveys were undertaken at Loughborough and Hinckley. The purpose of the first questionnaire was to understand underlying factors affecting accessibility to a healthcare facility. The results revealed that both individual and area-wide factors affect transport accessibility to a healthcare facility. The purpose of the second questionnaire was conducted to capture data relating to users perception of accessibility and their socio-economic factors so as to develop a user-perception based accessibility model. Network-based travel time and travel distance as well as public transport provision data from a respondent home to a healthcare facility were generated using a GIS technique. Individual-level questionnaire data were then integrated with the other secondary datasets (e.g. Census, Index of Multiple Deprivation, Accidents) using postcodes of survey respondents. Both single-level and multilevel mixed-effects linear regression models were employed to develop a relationship between user-perceptions relating to accessibility and the factors influencing accessibility. Multilevel models that can control data from the two levels (i.e. individuals nested within local areas) provided better goodness-of-fit statistics compared with those of single-level regression models. The results indicate that travel distance by car, number of available direct bus services, age, and destination choices affect user-perceptions of accessibility to a healthcare facility. For instance, if travel distance by car increases by one mile then the perception of accessibility to a healthcare facility decreases by four units (on a scale of 0-100). Surprisingly, many area-wide factors such as security and safety, income deprivation were found to be statistically insignificant. In order to see which healthcare facility is more accessible, calibrated multilevel models along with number of people within the catchment area were then employed to predict the overall accessibility score related to a healthcare facility. This is important for policy makers in healthcare facility relocation and reconfiguration with respect to user perception of transport accessibility. Also it would be valuable to organisations that need to make decisions based on their users perceptions who are the real decision makers as to whether to use a facility or not.

The degree of connectivity and proximity that results from the configuration of land uses and associated transport networks is an important concept in much of the transportation research agenda. A substantial body of work has developed around the idea that compact, mixed-use development with multimodal transport options will shape travel behavior, increasing the use of transit, walking, and cycling for routine travel. Yet empirical evidence is somewhat mixed. One of the reasons for this uncertainty is the difficulty of defining and measuring sprawl in a meaningful way for use in quantitative analyses, rather than using regionally idiosyncratic or mono-dimensional definitions of sprawl. A recently released national dataset measuring multiple dimensions of urban form offers an opportunity to explore the relationship between transportation and sprawl. This study uses a series of spatial regressions to model effects on the share of a county's workers who commute by driving alone. The results for income are found to be robust across various model specifications, confirming the well-established, positive relationship between income and d riving to work. The results for the Street Accessibility Factor suggest characteristics of the street network are related to the choice to commute by driving alone, with more compact street networks and greater connectivity associated with reduced driving alone. The Land Use Mixing Factor has little power in explaining travel behavior, despite its intuitive appeal as the land use component of the commute mode decision. / Series: SRE - Discussion Papers

Background: Integrated working between health and social care services within England has been encouraged by Government policy in the last decade, and has been argued to provide a seamless, joined up experience for service users (Department of Health 2011). One way of integrating care is through the use of a single point of access to health and social care services. A single point of access to services has been trialled in mental health and learning disability services to improve access, and following on from policy (e.g. Department of Health 2007) and support from literature (Rogers, Entwistle & Pencheon 1998; Lovell & Richards 2000; Raine, Carter, Sensky & Black 2005) a single point of access to health and social care for older adults has been implemented in parts of the UK. This thesis examines the implementation of one such single point of access. Objectives: The aim of the study was to examine the single point of access and whether it had any impact upon integrated working within a county in England, UK. Methods: An ethnographic approach was taken, using a combination of methods including interviews, focus groups and observations. This was complemented by a grounded theory approach to analysis. Findings: The single point of access had an adverse effect upon integration. The poor management of change and lack of communication led to issues within the single point of access such as failure of IT systems and duplication. Staff became frustrated and disengaged from the process, and consequently reported feeling disempowered, retreating back to their professional 'tribes'. Conclusion: Firm conclusions about the efficacy of a single point of access with regard to its effect upon integrated working could not be reached. However, the findings suggest that clear communication, continued change management and recognition of professional culture are decisive factors when attempting to integrate health and social care. Further research into the impact of a single point of access upon integration as well as outcomes for service users is recommended.

Magister Educationis - MEd / Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined. / South Africa