Made available in DSpace on 2014-12-17T15:31:02Z (GMT). No. of bitstreams: 1 AlbertoARP.pdf: 2471246 bytes, checksum: fdc4a1ff3894363e270681912a069512 (MD5) Previous issue date: 2007-07-14 / The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health / O objetivo deste estudo foi avaliar o impacto do Programa de Sa?de da Fam?lia (PSF) sobre alguns indicadores de sa?de bucal na popula??o de Natal-RN, caracterizado como um estudo do tipo ensaio de interven??o comunit?ria em paralelo quase-randomizado. Interven??o representada pela implanta??o da Equipe de Sa?de Bucal (ESB) no PSF ocorrida em um tempo anterior ? realiza??o desse estudo. Foram sorteados 15 setores censit?rios em ?reas cobertas pelo PSF com ESB e emparelhados a outros 15 setores em ?reas n?o cobertas pelas equipes, a partir de crit?rios socioecon?micos. Durante a realiza??o do estudo alguns setores foram perdidos restando ao final 22 setores, sendo 11 cobertos e 11 n?o cobertos. As ?reas n?o cobertas foram divididas em duas condi??es, uma em que foram consideradas ?reas que apresentavam algum tipo de programa assistencial como Programa de Agentes Comunit?rios (PACS), PSF sem ESB, UBS (Unidade B?sica de Sa?de) ou sem assist?ncia, e uma outra em que foram consideradas ?reas que apresentavam apenas UBS ou aus?ncia de assist?ncia. Agentes Comunit?rios de Sa?de (ACSs) e Auxiliares de Consult?rio Dent?rio (ACDs) aplicaram um question?rio-entrevista junto ao informante mais qualificado do domic?lio e os dados obtidos por domic?lio foram transformados em dados por indiv?duos, totalizando 7.186 pessoas. Os resultados apontam para aus?ncia de diferen?a estat?stica entre os desfechos de sa?de bucal analisados na associa??o entre ?reas cobertas por ESB no PSF e ?reas n?o cobertas que apresentam algum tipo de programa assistencial, com alguns indicadores demonstrando melhores condi??es nas ?reas n?o cobertas. Quando se considera na an?lise a associa??o entre ?reas cobertas e ?reas n?o cobertas na segunda condi??o, percebe-se diferen?a estat?stica em indicadores de cobertura, com melhores condi??es para ?reas cobertas, como, por exemplo, nos indicadores N?o foi ao dentista no ?ltimo ano com p (<0,001) e OR de 1,64 e N?o teve acesso ? assist?ncia odontol?gica p (<0,001) e OR de 2,22. Por?m, os resultados demonstram aus?ncia de impacto do PSF com ESB sobre os indicadores de a??es preventivas, nas duas condi??es de n?o coberto. Isso ? percebido muito claramente quando analisamos a vari?vel dor de dente que n?o apresenta diferen?a significativa entre ?reas cobertas e n?o cobertas, vari?vel essa que ? uma das mais sens?veis na avalia??o de programas assistenciais de sa?de bucal, com p (0,430) na condi??o 1 e p (0,038) na condi??o 2, por?m, com IC (0,70-0,99). Na an?lise de indicadores de sa?de da crian?a em que ? considerada a propor??o de ?bitos em crian?as menores de um ano, a taxa de interna??o por IRA (Infec??es Respirat?rias Agudas) em menores de cinco anos e a propor??o de indiv?duos nascidos com baixo peso, verifica-se uma melhor condi??o em todos os desfechos para ?reas com PSF. Portanto, ? poss?vel concluir que a Sa?de Bucal no PSF est? exercendo pouco efeito sobre os indicadores de sa?de bucal, ainda que a estrat?gia melhore as condi??es de sa?de geral da popula??o, como, por exemplo, a sa?de da crian?a

O uso das informações e indicadores provenientes do Sistema de Informações Hospitalares do SUS (SIH/SUS), tanto para análise de situação de saúde da população como para análise do desse, SUS, é cada vez mais frequente. Tal sistema é, desde sua concepção, fortemente influenciado pelas políticas públicas na área de atenção à saúde, como as definidas pelas Normas Operacionais e os incentivos e restrições a determinadas práticas. Alterações na operação do sistema introduzem descontinuidades e vieses nas informações, provocando eventuais imprecisões ou mesmo distorções nos resultados da extração de dados do sistema. Para que se possa avaliar o resultados de políticas, a situação da assistência à saúde ou as condições de saúde de uma população, é necessário, portanto, que se tenha uma visão clara e objetiva de quais informações são disponíveis, a sua evolução e como utiliza-las, considerando devidamente as influências exógenas e endógenas do sistema. O presente estudo está estruturado de acordo com o contexto do Sistema de Informações Hospitalares. Como componente da Previdência Social, é estudada a criação do Sistema de Assistência médico-Hospitalar da Previdência Social (SAMHPS), as suas origens e seus eixos estruturantes, assim como a sua expansão para a rede filantrópica e de ensino, com a ampliação de sua cobertura. Já no contexto do Sistema Único de Saúde (SUS), é estudada a incorporação do SAMHPS ao SUS, levando à criação do SIH/SUS, com a expansão para a rede pública e a sua universalização. A influência das políticas de saúde é analisada a partir da implantação de incentivos e restrições que afetam a assistência hospitalar e seu reflexo nas informações do SIH/SUS. A forma de categorização e a identificação dos prestadores são também examinadas, tendo em vista a sua importância na análise e determinação de políticas de saúde. Outro aspecto que é analisado é a forma de apropriação das informações do diagnóstico que levou à internação: a adoção da 10 Revisão da Classificação Internacional de Doenças, o caso específico das causas externas e a implantação da Tabela de Compatibilidade entre Procedimentos e Diagnósticos. Para identificar as mudanças políticas e operacionais do SUS, da regulamentação da assistência hospitalar e do SIH/SUS, foi pesquisada sua legislação Leis, Decretos, Normas Operacionais, Portarias, Instruções e Manuais. O relacionamento entre as informações e as políticas é analisado identificando a implantação destas políticas e verificando o efeito sobre os indicadores da assistência hospitalar obtidos do SIH/SUS. Como conclusão, foi visto que análises que utilizem as séries históricas devem, obrigatoriamente, levar em consideração as modificações, tanto do SUS como do SIH/SUS, para que possam chegar a conclusões mais precisas. Descontinuidades nas séries históricas efetivamente mostram modificações das políticas e da operação do sistema. A facilidade de acesso, a disponibilidade, a oportunidade e rapidez de atualização das informações do SIH/SUS são fatores positivos do sistema; é possível analisar o efeito de determinada ação pouco após a sua implantação. A análise das informações do diagnóstico denota a necessidade de treinamento dos codificadores no uso da CID-10 em morbidade e de uma ampla revisão da Tabela de Compatibilidade entre Diagnóstico Principal e o Procedimento Realizado. / The use of information and indicators derived from the Hospital Information System (SIH/SUS) of the National Health System in Brazil (SUS) is steadily increasing, either for health situation analysis as for performance analysis. Since its original conception, this system is strongly influenced by public policies in health assistance, as defined by legislation or by incentives and restriction to some medical and hospital practices. Changes in system operation also bring up discontinuities and biases in the information, eventually resulting in imprecision or even distortions in the indicators derived from the system data. In order to evaluate health policies, health assistance situation and population health status, a clear and objective approach is needed, Knowing which information is available, its evolution and how to use it, considering internal and external influences. This study aims to describe and analyze how the SUS health policies influence and are reflected in the information and indicators derived from the SIH/SUS. It is structured according its context. As Social Security component, we study the creation of the Social Security Medical and Hospital Assistance System (SAMHPS), its origins and structure and also its extension to the philanthropic and university hospitals, with its corresponding expansion of coverage. In the context of the National Health system, we have studied the transformation of the SAMPHS into SIH/SUS, its expansion to the public hospital and universal coverage. The influence of health policies is analyzed from the implementation of incentives and restrictions that affected hospital assistance and how if reflects in the SIH/SUS information. Due to their importance in the analysis and determination of health policies, the hospital categorization and identification are also examined. Furthermore, we analyzed how the diagnostic information is captured, considering the adoption of the 10th Revision of the International Classification of Diseases (ICD-10), the specific case of the external causes and the implementation of the Compatibility Table between Procedures and Diagnostics. We have studied the legislation concerning both SUS and SIH/SUS: laws, decrees, operational norms, directives, instructions and manuals, in order to identify SUS operational and political changes, hospital assistance and SIH/SUS regulation. The relationship between information and politics is analyzes identifying the implementation of these policies and verifying the effects in the hospital assistance indicators from the SIH/SUS. Concluding, we have seen that the series analysis must take in account the political and operational changes, either SUS as SIH/SUS, in order to produce more precise conclusions. Time series discontinuities effectively reflect the political and operational changes. The access, availability, opportunity and quick update of the SIH/SUS information are positive factors; they make possible to analyze the effects of some action just after its implementation. Analyzes of the diagnostic information shows the necessity of training in the use of the ICD-10 and also a full revision in the Compatibility Table between Diagnostics and Procedures.

De forma acentuada nos últimos anos, há ênfase de que os cuidados de saúde oferecidos à população devam ser ofertados por ações e serviços qualificados de Atenção Primária à Saúde (APS). O Brasil tem feito esforços no sentido de orientar seu Sistema Único de Saúde, de caráter universal e descentralizado, por meio de um modelo de APS, que é a Estratégia Saúde da Família (ESF). Nesse contexto, em 2002, o município de Belo Horizonte, com uma população de 2.412.937 habitantes promoveu uma mudança macro estrutural no seu sistema de saúde, expandindo o acesso à saúde a 70% da população por meio da Estratégia de Saúde da Família. Essa reorientação pressupõe o acesso universal e contínuo a serviços de saúde de qualidade e resolutivos, a efetivação da integralidade em seus vários aspectos, bem como, a coordenação dos usuários na rede de serviços, devendo proporcionar maior racionalidade na utilização dos demais pontos da rede de atenção à saúde, como nas internações hospitalares. No contexto internacional, uma série de investigações sobre indicadores da atividade hospitalar tem sido utilizados como medida da efetividade da APS. Entre eles, o ambulatory care sensitive conditions (Internações por Condições Sensíveis à Atenção Primária – ICSAP), utilizado como medida indireta do funcionamento da atenção primária à saúde, tanto para avaliar impacto global da adequação da atenção primária nos sistemas de saúde , seu acesso ou qualidade, como para analisar a utilização inadequada da atenção hospitalar. Analisou-se espaço-temporalmente as taxas de ICSAP, modelando sua associação para variáveis relacionadas às características organizacionais das equipes de saúde da família e aos indicadores demográficos e sócio-econômicos da população do município, modeladas através de modelos mistos. Do total de 435.253 internações (249/10.000/ano) que ocorreram no município entre 2003 e 2006, as ICSAP somaram 115.340 (26,4% - 66/10.000/ano). O declínio global nas internações por ICSAP foi de 17,9% ao longo do período, enquanto das não ICSAP apenas 8,3% ( p<0,001). Em 2003, as mulheres dos setores censitários de médio IVS tiveram 110 internações /10.000 habitantes a mais em comparação com mulheres dos setores de baixo IVS. Nos setores de elevado IVS, partiam de 204/10.000 internações a mais que nas de baixo risco (P<0,001). No entanto, houve nítida diminuição dessas desigualdades com o decorrer de tempo, após a implantação das equipes de saúde da família: as ICSAP em mulheres dos setores de baixo IVS, a queda das taxas padronizadas anuais das ICSAP de 2003 a 2006 foi de 5,9/10.000 hab., para aquelas de setores de médio IVS de 34,8/10.000 hab. e nos setores de elevado IVS. 55,9/10.000 hab (P<0,001). Cinco grupos de diagnósticos representam 59,3% do total das ICSAP no período. Em termos percentuais, o maior declínio correspondeu às internações por doenças inflamatórias dos órgãos pélvicos femininos (71%), doenças imunizáveis (58%) e hipertensão (49%), enquanto que as internações por broncopneumonia bacteriana e acidente vascular cerebral não apresentaram redução no período. A associação de aspectos ligados à qualidade dos serviços, como a manutenção do mesmo médico nas equipes, foi capaz de reduzir em 0,53 ICSAP por 10.000 hab./ano para as mulheres (IC (95%) -1,03; -0,04) e de 0,22 ICSAP por 10.000 hab./ano para os homens (IC (95%) -0,62; 0,16), por cada mês a mais de permanência do mesmo médico nas equipes. Os resultados sugerem que a Estratégia Saúde da Família pode contribuir de maneira importante não apenas na diminuição das taxas de internação por condições sensíveis à atenção primária em grandes metrópoles, como na promoção de maior eqüidade na atenção à saúde da população. / The role of qualified actions and services of primary health care has received a pronounced emphasis in recent years. In this regard, Brazil has organized its universal and decentralized National Health System using its model of primary care - the Family Health Strategy (FHS). In this context, in 2002, the city of Belo Horizonte, whith 2,412,937 inhabitants, promoted a change in its macro structural health system, expanding the population access to health though an increase of 70% in Family Health Strategy coverage. This shift presupposes universal and continuous access to resolutive and qualified health services, the achievement of integrality in various aspects, as well as the coordination of users of the network of health services, aiming to result in a greater efficiency in the use of other points of health care, such as in hospital care, in the network. In the international context, a series of investigations of indicators of hospital activity have been used as a measure of the effectiveness of primary care. Among them, the construct of Ambulatory Care Sensitive Conditions (ACSC) has been applied as an indirect measure of the functioning of primary health care, both to assess the overall impact of primary care in health systems, including questions of access and quality, and to evaluate the inappropriate use of hospital care. In this study, we investigated trends and factors associated with avoidable hospitalizations due to ACSC following the implementation of the Family Health Strategy in Belo Horizonte - Brazil. To do so, we considered spacetime rates of these hospitalizations, modelling their association with organizational characteristics of the strategy and socio-economic and demographic indicators of the population. Of the total of 435,253 hospitalizations (249/10.000/year) that occurred in the municipality between 2003 and 2006, those sensitive to ambulatory care totaled 115,340 (26.4%, 154,07/10.000 in 2006). The overall decline in admissions for these sensitive conditions was 17.9% over the period, while that of non-sensitive ones was only 8.3% (p<0.001). The reduction in standardized rates of annual ACSC from 2003 to 2006 was higher in census tracts of greater socioeconomic vulnerability. This decline was more pronounced in women, with reductions of 5.9, 34.8 and 55.9 hospitalizations /10.000 inhabitants in areas of low, medium and high vulnerability during the period (p <0.001). Five groups of diagnoses led to 59.3% of total ACSC hospitalizations during the period. In percentage terms for diagnostic groups, the biggest declines were for inflammatory diseases of female pelvic organs (71%), diseases preventable by immunization (58%) and hypertension (49%); while hospitalizations for bacterial pneumonia and stroke showed no reduction in the period. In terms of aspects related to quality of services, maintaining the same physician in the Family Health Team associated with lower rates of hospitalization - 0.53 less hospitalizations per 10,000 inhabitants/year for women (- 0,53 CI (95%) -1.03, -0.04) and 0.22 less per 10,000 inhabitants/year for men (- 0,22 CI (95%) -0.62, 0.16) for each additional month that the same doctor remained with the team. The results suggest that the Family Health Strategy can play an important role in reducing the rates of hospitalizations for ambulatory care sensitive conditions in large cities, as well as in promoting greater equity in health care.

Dans cette thèse, nous avons examiné différentes possibilités d'intégration des décisions d'ordonnancement avec des informations provenant de systèmes avancés des contrôles des procédés dans la fabrication de semi-conducteurs. Nous avons développé des idées d'intégration et défini des nouveaux problèmes d'ordonnancement originales : Problème d'ordonnancement avec des contraintes de temps (PTC) et problème d'ordonnancement avec l'état de santé des équipement (PEHF). PTC et PEHF ont des fonctions objectives multicritères.PTC est un problème d'ordonnancement des familles de jobs sur des machines parallèles non identiques en tenant compte des temps de setup et des contraintes de temps. Les machines non identiques signifient que toutes les machines ne peuvent pas traités (qualifiés) tous les types de familles d'emplois. Les contraintes de temps nommés aussi Thresholds sont inspirées des besoins de l'APC. Elle est liée à l'alimentation régulière des boucles de contrôle de l'APC. L'objectif est de minimiser la somme des dates de fin et les pertes de qualification des machines lorsqu'une famille de jobs n'est pas ordonnancée sur la machine donnée avant un seuil de temps donné.D'autre part, PEHF est une extension de PTC. Il consiste d'intégrer les indices de santé des équipements (EHF). EHF est un indicateur associé à l'équipement qui donne l'état de la. L'objectif est d'ordonnancer des tâches de familles de jobs différents sur les machines tout en minimisant la somme des temps d'achèvement, les pertes de qualification de la machine et d'optimiser un rendement attendu. Ce rendement est défini comme une fonction d'EDH et de la criticité de jobs considérés. / In this thesis, we discussed various possibilities of integrating scheduling decisions with information and constraints from Advanced Process Control (APC) systems in semiconductor Manufacturing. In this context, important questions were opened regarding the benefits of integrating scheduling and APC. An overview on processes, scheduling and Advanced Process Control in semiconductor manufacturing was done, where a description of semiconductor manufacturing processes is given. Two of the proposed problems that result from integrating bith systems were studied and analyzed, they are :Problem of Scheduling with Time Constraints (PTC) and Problem of Scheduling with Equipement health Factor (PEHF). PTC and PEHF have multicriteria objective functions.PTC aims at scheduling job in families on non-identical parallel machines with setup times and time constraints.Non-identical machines mean that not all miachines can (are qualified to) process all types of job families. Time constraints are inspired from APC needs, for which APC control loops must be regularly fed with information from metrology operations (inspection) within a time interval (threshold). The objective is to schedule job families on machines while minimizing the sum of completion times and the losses in machine qualifications.Moreover, PEHF was defined which is an extension of PTC where scheduling takes into account the equipement Health Factors (EHF). EHF is an indicator on the state of a machine. Scheduling is now done by considering a yield resulting from an assignment of a job to a machine and this yield is defined as a function of machine state and job state.

La construction de modèles de pronostic nécessite la compréhension du processus de dégradation des composants critiques surveillés afin d’estimer correctement leurs durées de fonctionnement avant défaillance. Un processus de d´dégradation peut être modélisé en utilisant des modèles de Connaissance issus des lois de la physique. Cependant, cette approche n´nécessite des compétences Pluridisciplinaires et des moyens expérimentaux importants pour la validation des modèles générés, ce qui n’est pas toujours facile à mettre en place en pratique. Une des alternatives consiste à apprendre le modèle de dégradation à partir de données issues de capteurs installés sur le système. On parle alors d’approche guidée par des données. Dans cette thèse, nous proposons une approche de pronostic guidée par des données. Elle vise à estimer à tout instant l’état de santé du composant physique et prédire sa durée de fonctionnement avant défaillance. Cette approche repose sur deux phases, une phase hors ligne et une phase en ligne. Dans la phase hors ligne, on cherche à sélectionner, parmi l’ensemble des signaux fournis par les capteurs, ceux qui contiennent le plus d’information sur la dégradation. Cela est réalisé en utilisant un algorithme de sélection non supervisé développé dans la thèse. Ensuite, les signaux sélectionnés sont utilisés pour construire différents indicateurs de santé représentant les différents historiques de données (un historique par composant). Dans la phase en ligne, l’approche développée permet d’estimer l’état de santé du composant test en faisant appel au filtre Bayésien discret. Elle permet également de calculer la durée de fonctionnement avant défaillance du composant en utilisant le classifieur k-plus proches voisins (k-NN) et le processus de Gauss pour la régression. La durée de fonctionnement avant défaillance est alors obtenue en comparant l’indicateur de santé courant aux indicateurs de santé appris hors ligne. L’approche développée à été vérifiée sur des données expérimentales issues de la plateforme PRO-NOSTIA sur les roulements ainsi que sur des données fournies par le Prognostic Center of Excellence de la NASA sur les batteries et les turboréacteurs. / Constructing prognostics models rely upon understanding the degradation process of the monitoredcritical components to correctly estimate the remaining useful life (RUL). Traditionally, a degradationprocess is represented in the form of physical or experts models. Such models require extensiveexperimentation and verification that are not always feasible in practice. Another approach that buildsup knowledge about the system degradation over time from component sensor data is known as datadriven. Data driven models require that sufficient historical data have been collected.In this work, a two phases data driven method for RUL prediction is presented. In the offline phase, theproposed method builds on finding variables that contain information about the degradation behaviorusing unsupervised variable selection method. Different health indicators (HI) are constructed fromthe selected variables, which represent the degradation as a function of time, and saved in the offlinedatabase as reference models. In the online phase, the method estimates the degradation state usingdiscrete Bayesian filter. The method finally finds the most similar offline health indicator, to the onlineone, using k-nearest neighbors (k-NN) classifier and Gaussian process regression (GPR) to use it asa RUL estimator. The method is verified using PRONOSTIA bearing as well as battery and turbofanengine degradation data acquired from NASA data repository. The results show the effectiveness ofthe method in predicting the RUL.

Indicadores de qualidade hospitalar correspondem a medidas que contém informações relevantes sobre determinados atributos e dimensões que caracterizam a qualidade de diferentes instituições de saúde. Tais medidas são capazes de sinalizar eventuais deficiências ou práticas de sucesso associadas à qualidade dos serviços de saúde. O presente estudo teve por finalidade desenvolver uma ferramenta computacional de análise, voltada para o gerenciamento hospitalar, com o objetivo de se obter um instrumento que possa ser utilizado para monitorar e avaliar a qualidade dos serviços oferecidos por instituições hospitalares através da análise e gerenciamento de indicadores de qualidade hospitalar. Os indicadores alvo para avaliar a qualidade dos serviços representaram um subconjunto de indicadores de qualidade denominados Inpatient Quality Indicators (IQIs) da Agency for Healthcare Research and Quality (AHRQ). A partir da revisão bibliográfica de textos científicos na área e com base nas dimensões de processo e resultado do Modelo Donabediano, foram selecionados vinte e dois indicadores da AHRQ, que avaliam a mortalidade por determinadas afecções e procedimentos cirúrgicos, bem como a quantidade e a qualidade dos procedimentos realizados nas instituições de saúde. A ferramenta foi construída em dois módulos: um módulo responsável pela geração dos indicadores a partir de dados coletados de um banco de dados relacional; e outro destinado ao estudo e análise das séries temporais dos indicadores, permitindo o acompanhamento da evolução dos mesmos de forma histórica. Os dados utilizados para a geração dos indicadores são oriundos da base de dados do Observatório Regional de Atenção Hospitalar (ORAH), que consiste numa entidade responsável pelo processamento de dados de internação de quarenta hospitais públicos e privados, distribuídos ao longo de vinte e seis municípios da região de Ribeirão Preto, São Paulo, Brasil, que compõem a Departamento Regional de Saúde XIII (DRS-XIII). A ferramenta computacional foi concluída e validade com êxito e suas funcionalidades foram disponibilizadas para gestores de saúde e acadêmicos através do portal web de conteúdo vinculado ao ORAH. Em adição, os resultados obtidos através do uso da ferramenta foram utilizados para analisar a situação da assistência hospitalar na região de Ribeirão Preto através da comparação histórica dos indicadores entre as três microrregiões de saúde que compõem a DRS-XIII: Aquífero Guarani, Vale das Cachoeiras e Horizonte Verde. A análise destes resultados também foi essencial para verificar a capacidade da ferramenta em prover informações relevantes para a gestão hospitalar. A partir da análise dos resultados obtidos, concluímos que a ferramenta permite a definição de um panorama geral da assistência hospitalar na região de Ribeirão Preto. De acordo com os achados deste estudo, também verificamos que os indicadores de qualidade hospitalar da AHRQ cumpriram seu papel como medidas sentinela e foram capazes de identificar certos aspectos associados à realidade. Entretanto, a análise dos resultados também remeteu à necessidade de introduzir novas variáveis que permitam conhecer o real estado dos pacientes e as condições estruturais das diferentes instituições de saúde, visto que os indicadores selecionados, por si só, não fornecem aos gestores de saúde uma avaliação final da qualidade das instituições hospitalares. / Inpatient quality indicators are measures that provide relevant inforrnation on the level of quality of care delivered by hospitals and healthcare services. These measures are capable of signaling eventual problems or successful practices associated with the quality of care provided by health services. This project was aimed to create an instrument to assess the quality of care delivered by hospitals by developing a web application whose functionalities focused on monitoring a subset of inpatient quality indicators (IQIs), extracted from the Agency for Healthcare Research and Quality (AHRQ). Based on literature review and on the components of process and outcomes defined by the Donabedian model, there were selected twenty-two AHRQ\'s inpatient quality indicators that are commonly used to evaluate the mortality associated with certain conditions and procedures, as well as the quantity and quality of certain medical procedures. The software is composed by two components: one is responsible for calculating the indicators using admission data extracted from an operational database; the other one is meant for the study and analysis of time series of the indicators, which allows the monitoring of its values over the years. The indicators were ca1culated using administrative data from the Observatory for Hospital Care\'s database (ORAH, from the acronyrn in Portuguese \"Observatório Regional de Atenção Hospitalar\"). The Observatory for Hospital Care is responsible for processing admission data collected from forty hospitals located throughout Ribeirao Preto region, in the Brazilian state of Sao Paulo. The management of hospitals located in the Ribeirao Preto region is conducted by the Regional Department of Health XIII (DRS-XIII, from the acronyrn in Portuguese \"Departamento Regional de Saúde XIII). The web application\'s services were made available to health service administrators and academic personnel through the ORAH\'s website. The results provided by this computational tool were also used to analyze the situation of care delivered by the hospitals in Ribeirao Preto region, which is subdivided into three microregions: Aquifero Guarani, Horizonte Verde e Vale das Cachoeiras. The historic values of the indicators were compared between these three microregions. The analysis of these results was also important to verify whether the web application is actually able to provi de enough inforrnation to acknowledge the reality of the hospitals in Ribeirao Preto region. According to the results, we verified that the AHRQ\'s inpatient quality indicators have fulfilled their role in signalizing certain aspects related to the quality of care of the hospitals, but they do not provi de enough inforrnation to establish a defini tive quality assessment of hospital services. Therefore, we verified the need of introducing new attributes in order to understand and acknowledge the clinical condition of the hospitalized patients, as well as the structure and resources available in the hospitals.

This thesis focuses on health among children in the medieval town Old Lödöse (1100-1500 AD) in western Sweden. Through the study of health indicators (enamel hypoplasia, growth retardation and porotic hyperostosis) on adults (45 crania), children (31 complete individuals) and the commingled remains of children from severeal contexts. The results showed 66,7% (N= 30 of 45) of the adults and 67,7% (N= 21 of 31) of the children had presence of stress indicators. Although 61,5% (N=8 of 13) of the children and 37,5% (N=15 of 40) of the adults had presence of cribra orbitalia it manifested mildly on several of the individuals. Enamel hypoplasia was present on 53,8% (N= 7 of 13) of the children and 36,8% (N= 15 av 38) of the adults. The enamel disturbances occurred by the ages of two to five. Growth retardation was minimal and was within the standard deviation for each method. The population suffered from ill health due to varying degrees as a result of the urban environment, parasites and infections. Several of the individuals have experienced periods of stress during childhood. The population sample was compared to material from Skara (1100-1500 AD) and New Lödöse (1473-1624 AD). The comparison showed that there was similar health parameters in all three cities during the Middle Ages. / Syftet med denna studie var att undersöka hälsa respektive ohälsa hos barn i medeltida Gamla Lödöse (1100-1500 e.Kr.) genom att studera frekvensen av stressmarkörer. Materialet bestod av 45 kranier från vuxna individer (både män och kvinnor), 31 individer under 20 år samt  209 enskilda element från omrörda kontexter (barn). MNI för barnen i studien blev totalt 56. De stressmarkörer som studerades var emaljhypoplasier, porotic hyperostosis (cribra orbitalia, cribra cranii, cribra humeralis och cribra femoralis) och tillväxtstörningar. Hos vuxna individer studerades endast cribra orbitalia, cribra cranii och emaljhypoplaiser. Resultatet visade att 66,7% (N= 30 av 45) av de vuxna individerna uppvisade spår av stressmarkörer medan 67,7% (N=21 av 31) av barnen (endast de kompletta individerna) uppvisade spår av stressmarkörer. Cribra orbitalia uppvisades hos 61,5% (N= 8 av 13) av barnen medan hos de vuxna individerna var frekvensen endast 37,5% (N= 15 av 40). Nästintill alla individer hade mild grad av cribra orbitalia, likaså för cribra cranii. Emaljhypoplasier fanns hos 53,8% (N= 7 av 13) av barnen medan hos de vuxna var frekvensen 36,8% (N= 14 av 38). Emaljhypoplasierna uppstod i åldern två till tre hos barnen och åldern tre till fem år för de vuxna individerna. Tillväxtstörningarna hos barnen var minimala och inom standardavvikelserna för respektive metod. Slutsatsen var att den undersökta population led av ohälsa i varierande grad från ung ålder och att flera har upplevt episoder av stress orsakade av bland annat miljömässiga faktorer som ökade risken för infektionssjukdomar och parasiter. I jämförelser med material från Skara (1100-1500 e.Kr.) och Nya Lödöse (1473-1624 e.Kr.) framkom det att frekvensen av stressmarkörer är högre, men att antalet undersökta individer är mindre i Gamla Lödöse. Förutom det tros städerna ha varit lika gällande hälsoparametrar hos barn.

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Soil health-based agricultural management practices are widely promoted to improve soil structure, infiltration and reduce erosion. This study was conducted at two locations in North-Central Mississippi to evaluate the influence of different cover crop species and poultry litter on soil health that can impact crop production, climate change, and resilience. The results indicated that the cover crops showed a little effect on some soil health indicators compared to control treatment. However, in one location, rye, and a mixture of cover crops decreased bulk density and increased available water content and organic matter. The poultry litter had a positive effect on most soil physical and chemical health indicators. The cover crop species at Pontotoc decreased bulk density, increased field capacity, CEC, and total carbon. However, there was no significant effect of cover crops on most soil chemical health indicators, and soil responses may take more than five years for the changes to appear.

As the public and government officials become aware of the impact of public health on communities, it is important that relevant public health statistics be available for decision making. Existing web resources have limited visualization options, cannot visually compare a county to all others in the US, and cannot compare the counties in an arbitrary region to all others in the US. The College of Public Health Indicator Visualization Tool (CPHIVT) is a web application providing visualization and ranking for a county in the US in comparison to all counties for a specific health indicator. An iterative development methodology was used to complete major features and refine the features over time. Features divided into small tasks that could be completed within two-week cycles. After the first version of the web application was completed and presented to the client, client feedback on the application was used to refine specifications and was incorporated into planning for future iterations. Iterative development was adopted with a focus on improving and expanding existing features and making the application publicly available online. A suite of automated user interface tests is being developed to verify the application’s functions. Making a complete version of the application publicly available involves significant research and software configuration to deploy the web application in a secure and performant manner. The web application has two major components corresponding to its two major user groups. The first component allows authenticated users from the Department of Public Health to upload and manage sets of data for various health indicators. Tools are included to automatically process uploaded data points. This allows the information presented on the web site to be expanded and kept up to date over time with minimal effort. The second component is accessible to anyone and allows a user to choose to a state or county with text search or hierarchical navigation. The application then provides graphical charts showing that location’s standing for various health indicators compared to all other counties nationally. This is accomplished by applying percentile rankings to the counties and plotting the percentiles against the values for a selected indicator. A user can save a generated chart to a variety of export formats including PNG image or PDF document. The application is expected to serve as a tool for many community members. Staff and students at the College of Public Health will use this tool for presentations and research. County health departments will be able to use the tool when planning community programs. County government leaders can use this tool to determine areas of need in the community. Decision makers will have the ability to visualize their county or region as compared to the nation, not just to neighboring counties or within a state.