Researchers have noted that 70% of diseases are preventable (Ballard et al., 2007) yet few individuals use preventive services (Wang et al., 2005). The purpose of this study was to examine differences between students who seek preventive services at a university wellness center and those who do not and explore variables that impact readiness for change and health-related behavior. The Wellness Center at Southern Illinois University provides numerous direct services to students, such as alcohol and drug counseling, stress management counseling, nutrition counseling, STD testing, pregnancy counseling, biofeedback, and relationship counseling. Healthy People 2010 is a national initiative, developed by the U.S. Department of Health and Human Services, involving various efforts to promote health and prevent disease in the United States. The developers introduced Leading Health Indicators, which reflect major dimensions of health behavior and factors that affect health. These indicators, including physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, and injury and violence, are used as a guide to examine the health behaviors in college students. Seventy-nine university wellness center clients and 80 participants from the general student population completed a demographic questionnaire that included questions about participants' risky health behaviors, the Perceived Wellness Scale (Adams, Benzer & Steinhardt, 1997), the Attitudes toward Seeking Professional Psychological Help Scale- Short Form (Fischer & Farina, 1995), the Outcome Questionnaire-45.2 (Lambert et al., 1996), and the Stages of Change Scales (McConnaughy, Prochaska, & Velicer, 1983). Participants who used wellness services reported more risky health behaviors and psychological distress than the general sample. Health behaviors from this sample were compared to a national data set (YRBSS; CDC, 2005) and, although differences between specific rates of behavior were found, there was no difference in total risk score. Wellness service users were more likely to be in the contemplation stage, whereas those from the general sample were more likely to be in the action stage. Participants who were actively making a change were more likely to feel less psychological distress and have more perceived wellness than those in the contemplation stage. Participants in the maintenance stage reported having more negative wellness perceptions compared to participants in all other stages.

O estudo teve por objetivo identificar indicadores para monitoramento da saúde da pessoa idosa a partir da perspectiva do envelhecimento ativo, conforme previsto na Política Nacional de Saúde da Pessoa Idosa (PNSPI) e no Pacto pela Saúde. Foi realizada revisão da literatura, utilizando as bases de dados: LILACS, SCIELO e MEDLINE. Cento e oitenta e nove estudos foram identificados e 14 foram incluídos nesta revisão. Um total de 22 indicadores de saúde foi identificado para acompanhamento das condições de saúde da população idosa. Entre os indicadores identificados, um indicador está relacionado a aspectos demográficos; quatro ao uso dos serviços de saúde; e doze à capacidade funcional dos idosos. Todos podem ser utilizados para monitoramento da saúde da população idosa, em consonância às diretrizes da PNSPI e do Pacto pela Saúde. Observou-se a importância do uso de um conjunto de indicadores para avaliação e monitoramento adequados das condições de saúde dos idosos. Pois, os indicadores aplicados isoladamente são limitados para melhor análise dos resultados alcançados na execução da PNSPI. Os inquéritos foram a fonte de dados mais satisfatória para obtenção de informações sobre a capacidade funcional dos idosos. Embora forneçam expressiva quantidade de dados e informações sobre a saúde da população idosa, os Sistemas Nacionais de Informação do Ministério da Saúde, têm maior enfoque na morbimortalidade e não são suficientes para avaliar as especificidades das pessoas idosas sob a ótica do envelhecimento bem sucedido. / The aim of this study is to identify indicators for monitoring the health of the elderly from the perspective of active ageing, as provided in the Política Nacional de Saúde da Pessoa Idosa - PNSPI (National Health Policy for Older Persons) and the Pacto pela Saúde (Pact for Health). A review of the literature was made, using the databases: LILACS, SCIELO and MEDLINE. One hundred and eighty-nine studies were identified and 14 were included in this review. A total of 22 health indicators were identified for monitoring the health conditions of the elderly population. Among the identified indicators, an indicator is related to demographics aspects; four are related to the use of health services, and twelve are related to the functional capacity of the elderly. All of them can be used for monitoring the health of the elderly population, in line with the guidelines of PNSPI and the Pacto pela Saúde (Pact for Health). It was noted the importance of using an appropriate set of indicators for monitoring and evaluation of health conditions of the elderly. For the indicators applied alone are limited for better analysis of the results achieved in the implementation of PNSPI. The surveys were more satisfactory data source for obtaining information about the functional capacity of the elderly. While providing a significant amount of data and information about the health of the elderly population, the National Systems of Information from the Department of Health, have greater focus on morbidity-mortality are not sufficient to take into consideration the specifities of the elderly from the perspective of successful ageing.

Submitted by Izabela dos Santos Ferro null (izabela13@gmail.com) on 2018-03-22T13:15:43Z No. of bitstreams: 1 Dissertação Iza - Versão Final.pdf: 878210 bytes, checksum: 9828f7dbbef95687d6d98c940ed7c445 (MD5) / Approved for entry into archive by Claudia Adriana Spindola null (claudia@fct.unesp.br) on 2018-03-22T14:11:46Z (GMT) No. of bitstreams: 1 ferro_is_me_prud.pdf: 878210 bytes, checksum: 9828f7dbbef95687d6d98c940ed7c445 (MD5) / Made available in DSpace on 2018-03-22T14:11:46Z (GMT). No. of bitstreams: 1 ferro_is_me_prud.pdf: 878210 bytes, checksum: 9828f7dbbef95687d6d98c940ed7c445 (MD5) Previous issue date: 2018-02-22 / Investigações referentes à avaliação dos gastos com saúde são importantes, entretanto os métodos existentes apresentam limitações em suas aplicações, como subestimação dos valores e divergência, erros de preenchimento, limitações de ordem burocrática e falta de validação científica em relação a questionários. Objetivo: Elaborar e verificar a validade e a confiabilidade de um questionário para a avaliação do uso de serviços de saúde na atenção primária do Sistema Único de Saúde (SUS) em adultos com idade ≥ 50 anos. Métodos: Amostra composta por 64 usuários do SUS da cidade de Presidente Prudente – SP. O questionário proposto avaliou a utilização de serviços de saúde da atenção básica considerando as variáveis exames, consultas e medicamentos, nos períodos de 30 e 60 dias retroativos à data da coleta, e sua validade foi testada segundo informações contidas nos prontuários dos participantes. Para a confiabilidade foi utilizado o método “teste-reteste”, considerando um intervalo de 7 dias após a primeira avaliação. Posteriormente, os resultados foram convertidos em valores monetários e comparados segundo indicadores de saúde: idade, sexo, atividade física, composição corporal, condição econômica e escolaridade, ademais as formas de conversão foram apresentadas. Quanto à análise estatística, para observar a validade, confiabilidade, concordância numérica e consistência interna entre os dados, bem como comparação com indicadores de saúde foram utilizados os seguintes testes: Coeficiente de Correlação Intraclasse (CCI), técnica de alfa (α) de Cronbach, correlação de Spearman (rho) e teste de Wilcoxon. Para a relação entre subitens do questionário proposto e produto final foi utilizada a correlação de Pearson (r). Sendo os valores de significância estatística considerados significativos quando inferiores a 5% e o software utilizado foi o BioEstat (versão 5.0). Resultados: Quando analisada a correlação entre a quantidade total de gastos reportados através do questionário com as variáveis analisadas, consultas, exames e medicamentos, foram observados valores de correlação fraca para consultas (r=0,305) quando retroagidos 30 dias e correlação perfeita para medicamentos (r=1,00) para os dois períodos retroativos. Para a correlação entre questionário e prontuário foi observado para o período de 30 dias e 60 dias valores de CCI de fraco a moderado para consultas (CCI=0,429; CCI=0,576) exames (CCI=0,181; CCI= 0,020) e medicamentos (CCI=0,505; CCI= 0,642). Para a correlação da diferença entre valores reportados nos questionários e valores de prontuários com as variáveis descritivas, foi observada diferença estatisticamente significante para “Medicamentos 60 dias” e idade (rho=0,267) e condição econômica (rho=-0,386). Foi observada correlação fraca entre atividade física ocupacional e exames (r=0,259) somente xi para questionário, para o período retroativo de 60 dias. Para diferença entre os valores brutos de gastos reais do questionário proposto e do prontuário, houve diferença estatisticamente significativa para a variável medicamentos, quando retroagidos 30 e 60 dias (p-valor=0,016; p-valor=0,001). Para a confiabilidade intra-avaliador, retroagindo 30 dias foi observado valores de CCI excelente para consultas (CCI=0,805) e fraco (CCI=0,257) para medicamentos, e para 60 dias, foi observado CCI moderado para consultas (CCI=0,543), e fraco para exames e medicamentos (CCI=-0,104 e CCI=0,338). Para a confiabilidade interavaliadores retroagindo 30 ou 60 dias foram observados valores de CCI fraco para todas as variáveis analisadas. Conclusão: O questionário proposto apresentou validade moderada, porém não obteve resultados consistentes para a análise de confiabilidade. Mesmo existindo limitações no seu processo de elaboração, há uma relevância prática no instrumento no que diz respeito a sua facilidade de aplicação no âmbito da saúde e ainda, uma maior efetividade na análise da variável “consultas”. / Investigations related to the evaluation of health spending are important, however, existing methods present limitations in their applications, such as underestimation of values and divergence, errors of filling, bureaucratic limitations and lack of scientific validation regarding questionnaires. Aim: To elaborate and verify the validity and reliability of a questionnaire for the evaluation of the use of health services in primary care of the Unified Health System (UHS) in adults aged ≥ 50 years. Methods: Sample composed of 64 UHS users from the city of Presidente Prudente - SP. The questionnaire proposed evaluated the use of basic health care services considering the variables exams, consultations and medications, in the periods of 30 and 60 days retroactive to the date of collection, and their validity was tested according to information contained in the participants' medical records. For reliability, the "test-retest" method was used, considering an interval of 7 days after the first evaluation. Subsequently, the results were converted into monetary values and compared according to health indicators: age, sex, physical activity, body composition, economic condition and schooling, in addition the forms of conversion were presented. In order to observe the validity, reliability, numerical concordance and internal consistency between the data, as well as comparison with health indicators, the following tests were used: Intraclass Correlation Coefficient (ICC), Cronbach's alpha (α) technique, Spearman correlation (rho) and Wilcoxon's test. For the relationship between sub items of the proposed questionnaire and final product, the Pearson correlation (r) was used. Statistical significance’s values were considered significant when less than 5% and the software used was BioEstat (version 5.0). Results: When analyzing the correlation between the total amount of expenses reported through the questionnaire with the analyzed variables, consultations, exams and medications, low correlation values were observed for consultations (r=0.305) when retroactive 30 days and perfect correlation for medications (r=1.00) for the two retroactive periods. For the correlation between the questionnaire and the medical record, it was observed for the period of 30 days and 60 days the values of low to moderate ICC for consultations (ICC=0,429; ICC=0.576), exams (ICC=0,181; CCI=0,020) and medications (ICC=0.505, ICC=0.642). For the correlation of the difference between the values reported in the questionnaires and the values of the medical records with the descriptive variables, a statistically significant difference was observed for "Medications 60 days" and age (rho=0.267) and economic condition (rho=-0.386). There was a low correlation between occupational physical activity and exams (r=0.259) for questionnaire only, for the retroactive period of 60 days. For the xiii difference between the raw data of the actual spending of the proposed questionnaire and the medical record, there was a statistically significant difference for the variable drugs, when 30 and 60 days retrograde (p-value=0.016, p-value=0.001). For the intra-rater reliability, 30 days were observed values of ICC excellent for consultations (ICC=0.805) and low for medications (ICC=0.257), and for 60 days, moderate ICC was observed for consultations (ICC=0.543), and low for exams and medications (ICC=-0.104 and ICC=0.338). For the interrater reliability of 30 or 60 days, low ICC values were observed for all variables analyzed. Conclusion: The proposed questionnaire had a moderate validity, but did not obtain consistent results for the reliability analysis. Although there are limitations in its elaboration process, there is a practical relevance in the instrument regarding its ease of application in the health area and also, a greater effectiveness in the analysis of the variable "consultations".

O estudo teve por objetivo identificar indicadores para monitoramento da saúde da pessoa idosa a partir da perspectiva do envelhecimento ativo, conforme previsto na Política Nacional de Saúde da Pessoa Idosa (PNSPI) e no Pacto pela Saúde. Foi realizada revisão da literatura, utilizando as bases de dados: LILACS, SCIELO e MEDLINE. Cento e oitenta e nove estudos foram identificados e 14 foram incluídos nesta revisão. Um total de 22 indicadores de saúde foi identificado para acompanhamento das condições de saúde da população idosa. Entre os indicadores identificados, um indicador está relacionado a aspectos demográficos; quatro ao uso dos serviços de saúde; e doze à capacidade funcional dos idosos. Todos podem ser utilizados para monitoramento da saúde da população idosa, em consonância às diretrizes da PNSPI e do Pacto pela Saúde. Observou-se a importância do uso de um conjunto de indicadores para avaliação e monitoramento adequados das condições de saúde dos idosos. Pois, os indicadores aplicados isoladamente são limitados para melhor análise dos resultados alcançados na execução da PNSPI. Os inquéritos foram a fonte de dados mais satisfatória para obtenção de informações sobre a capacidade funcional dos idosos. Embora forneçam expressiva quantidade de dados e informações sobre a saúde da população idosa, os Sistemas Nacionais de Informação do Ministério da Saúde, têm maior enfoque na morbimortalidade e não são suficientes para avaliar as especificidades das pessoas idosas sob a ótica do envelhecimento bem sucedido. / The aim of this study is to identify indicators for monitoring the health of the elderly from the perspective of active ageing, as provided in the Política Nacional de Saúde da Pessoa Idosa - PNSPI (National Health Policy for Older Persons) and the Pacto pela Saúde (Pact for Health). A review of the literature was made, using the databases: LILACS, SCIELO and MEDLINE. One hundred and eighty-nine studies were identified and 14 were included in this review. A total of 22 health indicators were identified for monitoring the health conditions of the elderly population. Among the identified indicators, an indicator is related to demographics aspects; four are related to the use of health services, and twelve are related to the functional capacity of the elderly. All of them can be used for monitoring the health of the elderly population, in line with the guidelines of PNSPI and the Pacto pela Saúde (Pact for Health). It was noted the importance of using an appropriate set of indicators for monitoring and evaluation of health conditions of the elderly. For the indicators applied alone are limited for better analysis of the results achieved in the implementation of PNSPI. The surveys were more satisfactory data source for obtaining information about the functional capacity of the elderly. While providing a significant amount of data and information about the health of the elderly population, the National Systems of Information from the Department of Health, have greater focus on morbidity-mortality are not sufficient to take into consideration the specifities of the elderly from the perspective of successful ageing.

Este trabalho faz uma abordagem pouco explorada dos indicadores de saÃde, em especial da âMortalidade Infantil": uma reflexÃo sobre a sua âidentidadeâ como indicador de saÃde. Respaldado em um estudo que mescla a leitura epistemolÃgica com a antropolÃgica, procuramos analisar sobre que processos a diminuiÃÃo da taxa de mortalidade infantil no CearÃ, perÃodo de 1993 a 1997, se estabelece como indicador de saÃde. Para tal empreendimento lanÃamos mÃo de uma breve recuperaÃÃo histÃrica dos fundamentos conceituais desse indicador e, atravÃs de uma pesquisa de campo com base na metodologia qualitativa, a partir de situaÃÃes vivenciadas nos municÃpios de Itapajà e Ipueiras, procuramos explicitar os processos que levaram à diminuiÃÃo da Taxa de Mortalidade Infantil (TMI) no CearÃ. Os resultados encontrados revelam que a mortalidade infantil, como indicador de saÃde, nÃo se trata de parÃmetro estÃtico e fixo; seu valor e poder de revelar mudanÃas nas condiÃÃes de saÃde e de vida das populaÃÃes vÃm se modificando com a histÃria, o tempo e o lugar, a depender de transformaÃÃes sociais, polÃticas e tecnolÃgicas. No CearÃ, no perÃodo em estudo, ela nÃo representou mudanÃas significativas na saÃde da populaÃÃo ou mesmo na saÃde da crianÃa, mas, basicamente, avanÃos tecnolÃgicos, cuidados primÃrios e seletivos de saÃde, especificamente de assistÃncia à crianÃa de atà 1 ano de idade. Verificamos ainda que em ambos os municÃpios, tanto no de maior quanto no de menor diminuiÃÃo da TMI, foram aplicados o mesmo modelo e igual metodologia para a sua reduÃÃo, ocorrendo a maior diferenÃa entre os municÃpios apenas na forma organizada e prioritÃria de sua implantaÃÃo. Os relatos colhidos evidenciam que o modelo terapÃutico implantado, embora de baixo custo e "eficaz", nÃo à dotado de sustentabilidade, haja vista trazer consigo grandes distorÃÃes educativas, pedagÃgicas e atà de financiamento, tornando-o cada vez mais difÃcil de ser aplicado e sustentado, aparentemente em um misto de origem ideolÃgica, polÃtica e organizacional. As conclusÃes desse estudo apontam para a urgÃncia de uma revisÃo do modelo de intervenÃÃo e da metodologia utilizada para a diminuiÃÃo da TMI, no CearÃ, com o intuito de abolir suas distorÃÃes e muni-la de sustentabilidade. / This paper presents an approach underexplored health indicators , especially the " Infant Mortality " : a reflection on your " identity " as a health indicator . Backed in a study that merges the epistemological reading with anthropological , about which we analyzed processes to decrease the infant mortality rate in Cearà , the period from 1993 to 1997 , is established as a health indicator . for this project we used a brief recovery hysterical conceptual foundations of this indicator and , through a field research based on qualitative methodology , from situations experienced in the municipalities of Itapajà and Ipueiras , we explain the processes that led to the decline of Infant Mortality Rate ( IMR ) in Cearà . These results show that the infant mortality as a health indicator , not parameter is static and fixed , their value and power to reveal changes in health and life of the people have been changing with the story , the time and place , depending on the social, political and technological . Cearà in the period study , it did not represent significant changes in population health or the health of the child, but basically , technological advances , and selective primary care health , specifically for child care for up to 1 year old. verified although in both municipalities , both in higher and in lower decrease in IMR , we applied the same model and the same methodology to reduce it , the biggest difference occurring between the municipalities only in an organized manner and priority of its implementation . reports show that harvested therapeutic model deployed , although inexpensive and " effective " , is not endowed with sustainability , considering bring large distortions educational , pedagogical and even financing , making it increasingly difficult to be implemented and sustained , apparently in a mixed origin ideological , political and organizational . findings of this study point to the urgent need for a review of the intervention model and methodology used for the reduction of IMR in Cearà , with the aim of abolishing its distortions and muni her sustainability .

Orientador: Silvia Maria Santiago / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T18:28:30Z (GMT). No. of bitstreams: 1 Nagahama_ElizabethErikoIshida_D.pdf: 3286413 bytes, checksum: c24d1f29f2e1b001b96e1e6c888df8db (MD5) Previous issue date: 2006 / Resumo: Esta pesquisa objetivou avaliar a qualidade da atenção ao parto nos dois hospitais de referência para atendimento ao parto SUS no município de Maringá-Paraná, com enfoque na humanização do cuidado. Realizou-se estudo avaliativo transversal, misto e formativo, por meio de pesquisa em prontuário hospitalar e entrevista estruturada com 569 puérperas atendidas nos dois hospitais, no período de março/2005 a fevereiro/2006. Foram utilizados sete indicadores de processo da qualidade na assistência ao parto humanizado. Os indicadores relacionados ao trabalho de parto foram: fornecimento às mulheres de todas as informações e explicações que desejassem, presença do acompanhante, uso de métodos não-invasivos e não-farmacológicos de alívio da dor e oferecimento de líquidos por via oral. A presença do acompanhante na sala de parto, o fornecimento às mulheres de todas as informações e explicações que desejassem, e o contato pele a pele entre mãe e filho em sala de parto qualificaram o atendimento na sala de parto. Por meio do estabelecimento de escores para cada um dos indicadores e da somatória obtida em cada um deles, a assistência hospitalar foi qualificada em quatro níveis: insatisfatória, regular, boa e excelente. Considerou-se a taxa de cesárea o indicador de resultado, como reflexo da utilização da tecnologia médica no parto. A análise exploratória foi realizada nos softwares Excel, Statistica e Sphinx. As associações entre duas variáveis foram testadas pelo teste Qui-quadrado e, para comparação de médias, utilizou-se o teste T de Student, com nível de significância de 5%. As mulheres eram, caracteristicamente, jovens, com companheiro fixo, segundo grau completo, sem atividade econômica remunerada e a maioria teve o parto a termo. Quanto à qualidade da assistência, 52,7% das mulheres tiveram atendimento considerado regular, 28,9% boa, 17,4% insatisfatória e 1,0% excelente. Na média geral de escores, o hospital 1 apresentou média superior (7,2) ao segundo (6,7). Contudo, ambos obtiveram desempenho classificado como regular e resultado da assistência insatisfatório, determinado pelas altas taxas de cesárea. Sob o ponto de vista do acesso à qualidade da atenção, registraram-se iniqüidades, determinadas por fatores individuais, contextuais e, em particular, relacionadas à oferta desigual de práticas comprovadamente benéficas que qualificam o atendimento. A precariedade das informações recebidas no trabalho de parto e no parto, a negligência de informações, as dificuldades relatadas pelas parturientes para garantir a presença do acompanhante no trabalho de parto e durante o parto, o uso restrito dos métodos não farmacológicos de alívio da dor no trabalho de parto, as práticas relativas ao contato da mãe com seu bebê na sala de parto e as taxas abusivas de cesáreas apontaram a necessidade de reorganização da prática obstétrica nas duas maternidades. O estudo indicou que os fatores institucionais, as rotinas hospitalares, o modelo assistencial centrado no profissional médico e, sobretudo, a prática e postura individual dos profissionais de saúde definiram a qualidade do atendimento, à medida que dificultaram a implantação do modelo humanizado e negaram às mulheres o exercício pleno de seus direitos sexuais e reprodutivos. A pesquisa norteou caminhos que podem contribuir para a melhoria da qualidade da atenção ao parto SUS no município de Maringá. Dentre estes, destacam-se a sensibilização e capacitação da equipe de saúde, mudanças nas rotinas, nas práticas institucionais e, especialmente, a efetiva incorporação do modelo humanizado da atenção como diretriz e filosofia institucional / Abstract: The objective of this research was to evaluate the quality of the delivery care offered by two hospitals that are reference for The Public Health System in the city of Maringá, State of Paraná, Brazil. The evaluation emphasized the humanized care, and it has been made a transversal and formative study with the hospital registers and a standardized interview to 569 puerperal women who where attended in both hospitals. The study period was from March 2005 to February 2006. Seven indicators of the care quality process were used. The indicators related to labor were: to give all the information wanted and explanation to women¿s doubts; a companion in the delivery room and the use of non invasive and non pharmacological methods to alleviating pain and offering, indeed, liquids to oral ingestion. These procedures qualified the attendance into the delivery room. Through the establishment of scores to each indicator and the sum resulted from each one of them, the hospital was qualified in four quality levels of assistance: unsatisfactory, regular, good and excellent. It was considered as an evaluation result indicator the cesarean rate. It can be considered a reflex on the utilization of medical technology during delivery. The exploratory analysis was made using Excel, Statistica and Sphinx software. The associations between two variables were tested by the Chi-Square test and in order to compare means, it was used the Student T test using a 5% of significance level. Most women were young, with only one mate, complete high schooled, unemployed and the majority had the delivery termed. The evaluation of the quality of assistance showed 52,7% that received a regular attendance, 28,9% good, 17,4% unsatisfactory and 1,0% excellent. The average of scores showed hospital one with a better score (7,2) than hospital 2 (6,7). Contrary on expectation, both presented a regular performance and as a result, an unsatisfactory attendance, defined by the high occurrence of cesarean sections. Considering the quality of care, it has been referred iniquities, determined by the occurrence of factors related to the unbalanced offer to practices recognized as beneficial that qualify the attendance. The lack of information during labor and delivery, the difficulties to assure the presence of the mate or another companion during the labor and delivery, the strict use of non pharmacological methods to alleviate pain in labor and delivery, the difficulties to mother-baby interaction into the delivery room and the misused demands of caesarian sections pointed out the need of reorganization of the obstetric practice in both maternities. The study indicated that the institutional factors, the hospital routines, and the organization care model, centered on the physician and indeed, the isolated practice and behavior of the health professional staff members, defined the quality of attention. Most part of the difficulties occurred on acceptance of the humanized model and to denial women¿s sexual and reproductive rights. This research aimed to contribute improving the quality of attention at the public health system delivery process in the city of Maringá and also, sensitizing and qualifying the health staff members, providing routine and institutional changes and meanly incorporating the humanized model of attention as the institutional philosophy, new behaviors and conducts / Doutorado / Saude Coletiva / Saude Coletiva

Orientadores: Antonio Carlos Pereira, Luciane Miranda Guerra / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T18:15:23Z (GMT). No. of bitstreams: 1 SotoRojas_GabrielaChristiel_M.pdf: 1152282 bytes, checksum: 82faf924e89a35748696e48cec06bfeb (MD5) Previous issue date: 2014 / Resumo: Apesar dos avanços e esforços feitos na implementação de políticas publicas de saúde bucal, ainda persiste a dificuldade no acesso e uso dos serviços odontológicos, como é refletido nos resultados das ultimas pesquisas de interesse nacional como a Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008 e SB Brasil 2010, onde grande porcentagem da população refere nunca ter ido ao dentista. São múltiplos os fatores que facilitam ou dificultam o acesso e uso destes serviços, um deles é o modelo de organização da demanda odontológica adotada pelas Equipes de Saúde Bucal (ESB), a qual deve desenvolver ações que lidem com as necessidades agudas e crónicas dos pacientes. Assim estas ações são registradas por meio dos indicadores no Sistema de Informação Ambulatorial (SIA) e no Sistema de Informação da Atenção Básica (SIAB), para ser avaliadas e monitoradas visando um melhor acesso aos serviços. Nesse contexto, o objetivo do estudo foi analisar a influencia da organização da demanda nos indicadores de saúde bucal, por meio da comparação destes indicadores entre 5 Unidades de Saúde da Família (USF) que trabalham com modelo de demanda espontânea e 5 USF que trabalham com demanda programada em saúde bucal. Todas as USF pertencentes ao município de Piracicaba, foram escolhidas aleatoriamente. Foram coletados os dados secundários da produção odontológica ambulatorial proveniente do SIA e do SIAB, do período de fevereiro até setembro 2013. Os dados coletados de cada USF foram organizados em indicadores, levando em conta a população de cada USF, estes indicadores foram: 1) acessibilidade; 2) razão de urgência odontológica; 3) resolutividade; 4) razão de exodontias por restaurações 5) razão de procedimentos básicos (dentística, periodontia, exodontia) 6) razão de procedimentos preventivos. Aplicou-se o teste t de Student ao nível de significância de 5% . Houve diferenças entre as unidades que trabalham com demanda livre e demanda organizada nos indicadores de razão de urgências, exodontia/restauração e razão de exodontias, sendo estes valores maiores no modelo da demanda espontânea. Conclui-se que o modelo de organização da demanda odontológica adotado pelas ESB nas USF interfere na procura de urgências odontológicas e razão de exodontias / Abstract: Despite advances and efforts in the implementation of public policies for oral health, there remains the difficulty in access to and use of dental services, as reflected in the results of the latest research of national interest such as the National Research by Sample (PNAD) 2008 and SB Brazil 2010 where a large percentage of the population reported having never been to the dentist. There are multiple factors that facilitate or hinder access to and use of these services, one of them is the organizational model adopted by the demand of dental oral health teams (ESB), which should develop actions that address acute and chronic needs of patients. So these actions are recorded by means of the indicators in the Outpatient Information System (SIA) and the Primary Care Information System (SIAB), to be evaluated and monitored to better access to services. In this context, the aim of the study was to analyze the influence of two models of clinical care in oral health indicators, by comparing these indicators between 5 Family Health Units (USF) working with the spontaneous demand model and 5 USF working with demand model scheduled in oral health. All USF are located in Piracicaba and were randomly chosen. Secondary data of daily production spreadsheets were collected from the information system (SIA and SIAB). Data belong to the period from February to September 2013. These data collected from each USF were organized into indicators: 1) reason of accessibility; 2) ratio of dental emergency; 3) solving; 4) reason for extractions restorations 5) ratio of basic procedures (esthetic dentistry, periodontics, tooth extraction) 6) ratio of preventive procedures. Was applied the Student's t test at a significance level of 5 %. There were differences between the USF working with spontaneous demand model and demand model scheduled, due to indicators of emergency, extraction/restoration and tooth extraction ratio, with higher values in the spontaneous demand model. Concluding that the model of clinical dental care adopted by ESB interferes in seeking emergency dental and extractions reason / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

The objective of this thesis is to improve the understanding of how several individual characteristics, namely education (years of schooling), health indicators (height, weight, smoking, alcohol consumption, and exercise), criminal behavior, and crime victimization, influence labor market outcomes in the short and long run. The first part of the thesis consists of three studies in which I adopt a within-twin-pair difference approach to analyze how education, health indicators, and earnings are associated with each other over the life cycle. The second part of the thesis includes two studies in which I use field experiments in order to test the employability of exoffenders and crime victims. The first essay, Learning for life?, describes an analysis of the education premium in earnings and health-related behaviors throughout adulthood among twins. The results show that the education premium in earnings, net of genetic inheritance, is rather small over the life cycle but increases with the level of education. The results also show that the education premium in health-related behaviors is mainly concentrated on smoking habits. The influences of education on earnings and health-related behaviors seem to work independently of each other, and there are no signs that health-related behaviors influence the education premium in earnings or vice versa. The second essay, Blowing up money?, details an analysis of the association between smoking and earnings in two different historical social contexts in Sweden: the 1970s and the 2000s. I also consider possible differences in this association in the short and long run as well as between the sexes. The results show that the earnings penalty for smoking is much stronger in the 2000s as compared to the 1970s (for both sexes) and that it is larger in the long run as compared to the short run (for men). The third essay, Two by two, inch by inch, describes an analysis of the height premium among Swedish twins. The results show that the height premium is relatively constant over the life cycle and that it is larger below median height for men and above median height for young women. The estimates are similar for monozygotic and dizygotic twins, indicating that environmentally and genetically induced height differences are similarly associated with earnings over the life cycle. The fourth essay, The employability of ex-offenders, published in IZA Journal of Labor Policy (2017), 6:6, details an analysis of whether male and female exoffenders are discriminated against when applying for jobs in the Swedish labor market. The results show that employers do discriminate against exoffenders but that the degree of discrimination varies across occupations. Discrimination against ex-offenders is pronounced in female-dominated and high-skilled occupations. The magnitude of discrimination against exoffenders does not vary by applicants’ sex. The fifth essay, Victimized twice?, describes an analysis of whether male and female crime victims are discriminated against when applying for jobs in the Swedish labor market. This study is the first to consider potential hiring discrimination against crime victims. The results show that employers do discriminate against crime victims. The discrimination varies with the sex of the crime victim and occupational characteristics and is concentrated among high-skilled jobs for female crime victims and among femaledominated jobs for male crime victims.

In this dissertation System Dynamics is used as a modelling approach to model health care systems to gain a better understanding of the system’s behaviour. This improved understanding can be used to better manage the system and in turn will translate to improved health outcomes. The characteristics of complex systems were reviewed to define a health system as a complex system. Four appropriate modelling approaches was studied that could be used to model complex systems. These modelling approaches included: Monte Carlo Simulation, Discrete Event Simulation, System Dynamics and Agent Based Modelling. System Dynamics was identified as being the most appropriate modelling methodology to be used for the framework. Before the framework was developed health system performance measurement was reviewed to further the understanding of health system measurement. The framework was developed according to the insights gained from the previous reviews. Specifically the elements identification was customised to the health care environment based on available health indicators. The framework was applied in a case study where a section of the South Africa health care system was modelled to focus interventions for human immunodeficiency virus (HIV). The outcomes of the case studies delivered an increased understanding of the system behaviour and also showed appropriates of the framework. / Dissertation (MEng)--University of Pretoria, 2012. / Industrial and Systems Engineering / unrestricted

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