Made available in DSpace on 2015-05-08T14:53:29Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1355369 bytes, checksum: 9c8287916a30feac7e9a3d355e472d28 (MD5) Previous issue date: 2012-12-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This Project brings a Chance Constrained Programming substantial approaching (CCP). This kind of optimization is used to pattern uncertainties and became useful to all kind of knowledge areas. The project main idea was to show CCP s theories and beyond this to present some applications on Engineering and Public Politics areas. It is noteworthy to say that this tool is pretty important for the production systems because of its uncertainties process. So after showing the theory whose purpose is to comprehend the Chance Constrained Programming, this subject commits itself to apply such technique in Emergency Medical Care Production Services (SAMU) in João Pessoa using the proposed model from Beraldi et al. (2004). This application was really useful to define the necessary ambulances to supply João Pessoa s city as well as the local they must be. However, to understand this technique and also work with it it s necessary a previous knowledge of Statistics, Applied Mathematics and Computing. Therefore, this work emphasizes the continuous and discreet random variables, as well as the probabilistic functions and concepts. In Applied Mathematics, this work brings a Linear Optimization, Facility Location and log concave functions. Concerning to computing, it was used MATLAB R007, Google Maps and CPLEX to provide the model. The great benefit of using CCP is that it offers possible solutions to the person who chooses between them, according to the reality. / Este trabalho apresenta uma abordagem de Otimização Probabilística (OP). Esse tipo de Otimização é utilizada para modelar incertezas e se tornou útil em diversas áreas do conhecimento. O objetivo principal deste trabalho foi apresentar a teoria de OP e, além disso, expor algumas aplicações nas áreas de Engenharia e Políticas Públicas. Vale ressaltar que tal ferramenta é muito interessante para Sistemas de Produção por existir incertezas inerentes ao processo. Assim, depois de apresentada tal teoria, com o intuito de melhor compreender a melhor a ferramenta de OP, este trabalho, se propôs a aplicar tal técnica no Sistema de Produção dos Serviços de Atendimento Médico de Urgência (SAMU) da cidade João Pessoa usando o Modelo proposto por Beraldi et al.(2004). A aplicação serviu para definir a quantidade de ambulâncias necessárias para atender a demanda de João Pessoa, assim como os possíveis locais que as mesmas devem estar posicionadas. No entanto, para entender melhor sobre essa técnica e trabalhar com a mesma, é necessário um conhecimento prévio de Estatística, Matemática Aplicada e Computação. Portanto, este trabalho aborda as variáveis aleatórias discretas e contínuas, bem como conceitos de Funções de Probabilidade. Na parte da Matemática Aplicada, este trabalho aborda conceitos de Otimização Linear, Facility Location e funções log. côncavas. Quanto à computação foi utilizado MATLAB R007,Google Maps e CPLEX para realizar a aplicação do Modelo. A grande vantagem da utilização de OP é que a mesma oferece soluções viáveis cujo tomador de decisão tem a opção de escolher qual a melhor solução de acordo com sua realidade.

This work deals with the creation and implementation of standard nursing practice in a specific environment prehospital emergency care in the Medical Emergency Service Královéhradecký region. Study work is close to the case study. Author in the theoretical part defines the quality of health care from different perspectives and expectations of individual actors within the system of health services, reflects on the historical development of quality management and standards as its principal tool in the general form and applied. In detail, the author tries to define the pre-hospital emergency care (PNP) as a specific field and describe its evolution in diverse global and domestic formats. In conclusion, the author attempts to define the quality of the PNP under the criteria drawn from published materials and their own perspective of the provider. The practical part describes the author of various articles making process and implementation of standard nursing practice for paramedical crews rapid medical assistance (EPA) in the Working Group on Education and Standardization EMS Královéhradecký region. The conclusion discusses the results of a qualitative study - focus group member working group in order to analyze the strengths and weaknesses in the process and submit their own work due his own...

Здоровье населения является одной из основных характеристик социально-экономического развития страны и трудовым потенциалом общества. Показатели здоровья населения напрямую зависят от состояния системы здравоохранения на территории, функционирования системы в значительной степени определяется системой финансового обеспечения. Отечественная система здравоохранения и обязательного медицинского страхования претерпела за последнее десятилетие ощутимые изменения. Модернизации подверглась нормативно-правовая база, существенно поменялась идеология подхода к системе оказания медицинской помощи, все большее значение уделяется интересам гражданина, пациента, изменился механизм финансирования лечебной сети. Обязательное медицинское страхование становится основным источником обеспечения прав граждан, прописанных в конституции, на получение бесплатной медицинской помощи. Региональный опыт развития и управления здравоохранением и обязательным медицинским страхованием может быть эффективно экстраполирован на федеральный уровень, может объективно повысить качество и доступность оказываемой населению медицинской помощи. Этот тезис выглядит вполне жизнеспособным при оценке реализации социальной политики в сфере здравоохранения в Свердловской области - регионе, который благодаря своему экономическому и геополитическому положению в течение многих лет остается территорией, определяющей вектор развития отрасли здравоохранения в Российской Федерации. / Population Health is one of the main characteristics of the socio-economic development of the country and the labour potential of the society. Health indicators of the population directly dependent on the state of the health system in the territory, the functioning of the system is largely determined by the system of financial provision. National health care system and compulsory medical insurance has undergone over the past decade, a tangible change. Modernization undergone regulatory framework, has significantly changed the ideology of the approach to the system of medical care, an increasing importance is given to the interests of the citizen, the patient, has changed the mechanism of funding health care. Compulsory health insurance is becoming the main source for the rights of citizens prescribed in the Constitution, to receive free medical care. Regional experience in the development and management of health and mandatory health insurance can be effectively extrapolated to the Federal level, could objectively improve the quality and accessibility of the provided medical care. This thesis looks quite viable in the evaluation of social policy implementation in the sphere of health in the Sverdlovsk region is the region that due to its economic and geopolitical position for many years is still a territory, defining the vector of development of the health sector in the Russian Federation.

Bakgrund: Våld i nära relation är ett samhällsproblem som drabbar både kvinnor och män. Våldet sker i olika samhällsklasser och geografiska områden. Det pågår ofta under en lång tid och utövas främst i hemmet, vilket gör det svårt att upptäcka. Ett stort mörkertal förekommer på grund av skuld- och skamkänslor hos offren. Det finns olika typer av våld och det finns särskilt utsatta grupper som riskerar att utsättas för våld i nära relation. Normaliseringsprocessen är en överlevnadsstrategi för de utsatta. De våldsutsatta upplever svårigheter att avslöja sin utsatthet för vårdpersonalen. Akutmottagningen är ofta en första instans där våldsutsatta söker hjälp. Syfte: Syftet var att sammanställa kunskap om vårdpersonalens upplevda förutsättningar att ställa frågor om våld i nära relation till vuxna personer som söker vård på en akutmottagning. Metod: En kvalitativ strukturerad litteraturöversikt med en induktiv ansats genomfördes. Elva vetenskapliga artiklar inkluderades och en tematisk analys användes. Resultat: Sex deskriptiva teman framkom: behov av kunskap och utbildning, vårdpersonalens förhållningssätt påverkar patientmötet, behov av en anpassad arbetsmiljö, behov av tydliga strukturer och riktlinjer, stöd och hjälp av kollegor samt att patientens och närståendes agerande påverkar. Därefter framkom tre analytiska teman: förståelse för patienten, begränsad av yttre faktorer och det mellanmänskliga samarbetet. Slutsats: Vårdpersonalen upplevde att kunskap och utbildning var förutsättningar för att kunna ställa frågor om våld i nära relation. De efterfrågade också organisatoriska förutsättningar, såsom anpassad arbetsmiljö, riktlinjer och rutiner. Ett gott samarbete med kollegor och en förståelse för patienten bidrar till att frågor kan ställas om våld i nära relation. / Background: Intimate partner violence is a societal problem that affects both women and men. The violence takes place in different social classes and geographical areas. It often goes on for a long time and is mainly practiced in the home, making it difficult to detect. A great deal of unknown cases occur due to feelings of guilt and shame in the victims. There are different types of violence and there are particularly vulnerable groups that are at risk of being exposed to intimate partner violence. The normalization process is a survival strategy for the vulnerable. The victims of violence experience difficulties in revealing their exposure to healthcare staff. The emergency department is often the first instance where victims of violence seek help. Purpose: The aim was to compile knowledge about the healthcare staff's perceived prerequisites for asking questions about intimate partner violence to adults seeking care in an emergency department. Method: A qualitative structured literature review with an inductive approach was carried out. Eleven scientific articles were included, and a thematic analysis was used. Results: Six descriptive themes emerged: need for knowledge and training, the approach of the healthcare staff affects the patient encounter, need for an adapted work environment, need for clear structures and guidelines, support and help from colleagues and that the actions of the patient and their relatives have an influence. Subsequently, three analytical themes emerged: understanding of the patient, being limited by external factors, and the interpersonal collaboration. Conclusion: The healthcare staff felt that knowledge and education were prerequisites for being able to ask questions about intimate partner violence. They also requested organizational prerequisites, such as an adapted work environment, guidelines and routines. Good cooperation with colleagues and an understanding of the patient contribute to the ability to ask questions about intimate partner violence.

Made available in DSpace on 2011-05-04T12:36:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Introdução: Os trabalhadores rurais, além do crescente risco de intoxicação por agrotóxicos, estão sujeitos a outros riscos decorrentes da utilização de maquinário e equipamentos manuais, assim como da proximidade com áreas naturais, expondo esses indivíduos ao contato com animais peçonhentos. Estão expostos ainda às condições climáticas e a sobrecarga física decorrente de fatores organizacionais como repetitividade, levantamento freqüente de peso e posições inadequadas. Objetivos: Analisam-se neste estudo os principais problemas de saúde que levam agricultores do município de Nova Friburgo-RJ a procurar atendimento médico de emergência e estabelecer possíveis inter-relações desses agravos com o processo de produção rural. Caracterizam-se, também, entre os atendimentos por causas externas, aqueles que podem configurar a ocorrência de acidentes de trabalho. Método: O estudo se baseia na análise das informações contidas nos Boletins de Atendimento Médico (BAM) provenientes do Hospital Municipal Raul Sertã em Nova Friburgo–RJ, no qual constam os dados pessoais do trabalhador, assim como a causa do atendimento e o diagnóstico. Foram selecionados os BAMs referentes aos atendimentos a trabalhadores rurais nos anos de 2003 a 2005, resultando em banco com 9.930 BAMs, do qual foi retirada uma amostra aleatória estratificada no tempo por mês e ano de 1083 BAMs. Resultados: No que se refere às causas de atendimento analisadas nos BAMs, as causas externas representaram 25,2% dos casos. Cerca de 2,0% dos casos foram referentes a acidentes ofídicos e 17,0% a lesões, a maior parte ocorreu nos membros inferiores, os trabalhadores do sexo masculino apresentaram a maioria desses agravos (p<0,001) e os indivíduos situados nas faixas etárias entre 18 e 59 anos concentraram cerca de 70,0% dos casos (p<0,05). Ressalte-se, portanto, que a maioria dos casos ocorreu com indivíduos do sexo masculino em idade produtiva. No que tange aos diagnósticos a quantidade de causas externas sobe para cerca de 30,0%. Ocorreram ainda cerca de 23,0% diagnósticos de lesão. No entanto, somente dois casos foram descritos como acidente de trabalho nos diagnósticos. Foram ainda 4 casos diagnosticados como intoxicação por agrotóxicos. Destaca-se ainda a dor de coluna com 6,0% das causas de atendimento, os transtornos psíquicos com aproximadamente 2,0% e a dispnéia com cerca de 3,0%. Conclusão: Os danos à saúde dos trabalhadores rurais devem ser compreendidos como expressão da organização e da divisão do trabalho, uma vez que grande parte desses episódios pode estar associada a riscos ocupacionais. / Introduction: The rural workers, in addition to the growing risk of pesticide poisoning, are subject to other risks arising from the use of machinery and equipment manuals, as well as proximity to natural areas, exposing these individuals to contact with venomous animals. They are also exposed to climatic conditions and physical overload due to organizational factors such as repeatability, frequent lifting of weight and inappropriate positions. Objectives: This study analyzed by the main health problems that lead farmers in the municipality of Nova Friburgo-RJ seeking emergency medical care and establish possible relations of these problems with the process of rural production. They are characterized, too, among the attendants by external causes, those who can configure the occurrence of accidents at work. Method: The study is based on analysis of information contained in Bulletins of Medical Care (BAC) from the Municipal Hospital Raul Sertã in Nova Friburgo-RJ, which are the personal data of the worker, as well as the question of care and diagnosis. We selected the BACs relating to the care workers in the years 2003 to 2005, resulting in a bank with 9930 BACs, which was withdrawn from a random sample of time stratified by month and year of 1083 BACs. Results: Regarding the causes of care analyzed in BACs, external causes accounted for 25,2% of cases. Approximately 2,0% of the cases were related to Snakebite and 17,0% to injuries, most occurred in the lower limbs, working men had most of these injuries (p<0,001) and individuals located in the tracks age between 18 and 59 years concentrated around 70,0% of cases (p<0,05). It was emphasized, so that the majority of cases occurred in male subjects in productive age. With regard to the diagnosis of external causes the amount rises to about 30,0%. There were still about 23,0% diagnoses of injuries. However, only two cases have been described as an accident at work in diagnostics. 4 cases were also diagnosed as pesticide poisoning. It is also the Low back pain with 6,0% of the causes, psychic disorders with approximately 2,0% and dyspnea with about 3,0%. Conclusion: The damage to the health of rural workers must be understood as an expression of the organization and division of labor, since many of these episodes can be associated with occupational risk.