Estudo de caso do Serviço de Medicina Preventiva-SEMPRE na atenção em diabetes mellitus no interior do estado de São Paulo, com o objetivo de avaliar o impacto do SEMPRE utilizando alguns indicadores de saúde na atenção em diabetes mellitus. Para tanto, os dados foram obtidos por meio de consulta manual nos Sistemas Informatizados Serious e Qualidade de Vida e registrados em planilhas construídas no Microsoft Excel-1997 dos usuários cadastrados no período de junho a novembro de 2001. A coleta de dados ocorreu de novembro 2002 a abril de 2003 Participaram do estudo, 42 pessoas diabéticas que completaram um ano de participação no SEMPRE, sendo 36 (85,7%) do tipo 2 e 6 (14,2%) do tipo 1. Para a análise dos dados utilizamos a avaliação em saúde “estrutura-processo-resultado” (Donabedian, 1980). A estrutura ou capacidade que são as características que favorecem o oferecimento de serviços, o processo ou desempenho envolve ações dos profissionais de saúde no sistema, as ações das populações e dos pacientes, e o resultado reflete vários aspectos do estado de saúde. No SEMPRE a estrutura que compõe a organização de serviços tem o trabalho grupal realizado pela equipe multiprofissional como uma estratégia de mudança no processo de “fazer saúde”. Os resultados predominantes foram: 69,1% pessoas diabéticas do sexo feminino, 47,6% possuíam o ginásio incompleto, 54,7% são casadas e 35,7% estão na faixa etária de 70 a 79 anos de idade. Após doze meses de participação no SEMPRE, houve redução de 23,8% na média da glicemia capilar, 6,7% na pressão arterial sistólica e 7 % na pressão arterial diastólica, e a média de 1,92 Kg por pessoa no peso corporal. Em relação aos gastos com procedimentos médicos de urgência, houve redução de 74,91% no diabetes mellitus tipo 1 e 40,4% no tipo 2, quanto ao gasto com procedimentos médicos em geral, houve redução de 11,1% no tipo 2 e 3,8% no tipo 1, comparando um ano antes e um ano depois da participação no SEMPRE. A análise estatística demonstrou que há diferença significativa entre a média antes e depois da participação no SEMPRE nas seguintes variáveis: gasto com procedimentos médicos para os diabéticos tipo 1, glicemia capilar pós-prandial e pressão arterial diastólica para os diabéticos tipo 2. Esses dados apontam para a importância de serviços inovadores em medicina preventiva, principalmente, no que tange ao melhor controle metabólico e redução de custos, bem como servir de base para avaliar o impacto de futuras intervenções. / The case study in a Service of Preventive Medicine–SEMPRE with carriers of diabetes mellitus in the interior of the State of São Paulo, which had as objective to evaluate the impact of Service of Preventive Medicine–SEMPRE using of the health indicators with carriers of diabetes mellitus. For that, the data were gotten by means of manual consultation in the Computerized Systems Serious and Quality of Life and registered in spreadsheets constructed in the Microsoft Excel-1997 of the users registered in the period from June to November, 2001. The collection of data occurred from November to April, 2003. 42 carriers of diabetes mellitus who had completed one year of participation in SEMPRE, took part in this study, considering that 36 (85,7%) were type 2 and 6 (14,2%) were type 1. For the analysis using of the “structure-process-outcome” (Donabedian,1980). The structure or capacity that consists of characteristics that favor the offer of services, the process or performance involves the health professionals actions in the system, the populations and the patients actions, and the result reflects various aspects of the health state. The structure composes the organization of services that has the group work carried through by the multiprofessional team as a strategy of change in the process of “making health”. The predominant results were: 69.1% of the carriers of diabetes were women, 47.6% had the incomplete secondary school, 54.7% were married and 35.7% in the age group from 70 to 79 years old. There was reduction of 23,8% in the average of the glicemia, 6.7% in the systolic arterial pressure and 7 % in the diastolic arterial pressure, in the corporal weight after the twelve months of participation in SEMPRE. In relation to the expenses with urgent medical procedures, there was reduction of 74,91% in diabetes mellitus type 1 and 40,4% in type 2; concerning the expense with medical procedures in general, there was reduction of 11,1% in type 2 and 3,8% in type 1, comparing one year before and one year after the participation in SEMPRE. The statistics analyses demonstrated that comparing one year before and one year after the participation in SEMPRE there was difference between in the average of the variables: the expense with medical procedures in general for the diabetes type 1, the glicemia and the diastolic arterial pressure for the diabetes type 2. These data point to the importance of innovative services in preventive medicine with carriers of diabetes mellitus, mainly, to what refers to the best metabolic control and reduction of costs, like to serve for basis to evaluate the impact of the intervention futures.

Made available in DSpace on 2014-06-12T18:29:31Z (GMT). No. of bitstreams: 2 arquivo3460_1.pdf: 9606201 bytes, checksum: 522885c74fabba7080761a9a8396bd03 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / Descoberto em 1975 o Parvovírus B19 (B19V) é o único membro da família Parvoviridae que apresenta comportamento patogênico em humanos. A persistência do vírus em vários tecidos, após infecção aguda, assim como sua presença em doenças do tecido conectivo e/ou autoimunes, reforça sua associação com várias patologias entre elas a Artrite Reumatóide (AR). Este trabalho teve como objetivos: verificar a associação entre infecção pelo B19V e o desenvolvimento da AR, traçar o perfil dos pacientes com AR quanto à atividade da doença utilizando o HAQ (The Health Assessment Questionnaire) e CDAI (Clinical Disease Activity Index) e correlacionar os dados encontrados com o resultado da sorologia para B19V. Trata-se de um estudo do tipo caso-controle com 92 portadores de AR e 92 com Osteoartrite (OA) constituindo o grupo controle, ambos originados do Ambulatório de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco. O estudo foi realizado de março a novembro de 2007. A sorologia para quantificação de IgG anti B19V foi realizada pelo ensaio imunoenzimático (ELISA) (RIDASCREEN®). Aplicou-se um questionário durante a entrevista para coleta de dados referente à doença. Foram excluídos da análise 18 pacientes por apresentarem resultado do ELISA indeterminado. Na análise observou-se predomínio do sexo feminino em mais de 90% no grupo de AR bem como em OA. A média de idade dos grupos foi de 50,5 ± 11,5 anos para AR e 57,4 ± 9,9 anos para OA respectivamente. Foi encontrada uma maior prevalência de IgG anti-B19V e um risco relativo de 2,69 (x2=26,40; p < 0,001) no grupo de AR quando comparados com o controle. Analisando os dados do HAQ, pudemos estimar que dos 74 pacientes, 30/74 (40,5%) apresentavam pouca ou nenhuma limitação funcional, 17/74 (23%) moderada limitação e 27/74 (36,5%) acentuada ou total incapacidade funcional. Segundo o CDAI observamos que dos 74 pacientes estudados, 14/74 (18,9%) sugeriam remissão do quadro de doença, 18/74 24,3%) baixa atividade de doença, 16/74 (21,6%) moderada atividade de doença e 26/74 (35,1%) doença em atividade. Não houve concordância entre os parâmetros de atividade da AR e a positividade para B19V. Os resultados encontrados sugerem a participação do B19V como um dos gatilhos que determinam o aparecimento da AR

Magister Curationis - MCur (Dept. of Nursing) / This phenomenological study explored the lived experiences of undergraduate community health nursing students at the University of the Western Cape who conducted a family health assessment learning task in communities during their clinical fieldwork placement.The population included the 2008 semester two, third year undergraduate baccalaureus nursing students. These students completed their community health nursing modules at the end of the first semester. A total of nine (9) out of the eighty- nine (89) semester two students participated in this qualitative research study. The purposive and convenient sample consisted of those students who agreed to voluntarily participate in the research study. In-depth interviews were conducted with seven (7) female and two (2) male students to collect data. Field notes were taken and utilized to capture non-verbal communication of the participants. The focus f the researcher was to explore the lived experiences of students and not that of the family whom they interviewed. All interviews were audio recorded nd validated by participants after transcription, before any of the data was used for the data analysis process. The data collected was categorized into themes as guided by the systematic data analyses process according to Tesch’s (1990) method, as cited in Creswell (2003). Saturation was tested after nine interviews and the researcher found that no new data emerged. The importance of the research study was to reflect on the exploration of the self-reported lived experiences of the third year community ealth nursing students while conducting the family health assessment learning task. / South Africa

American youth are facing a mental health crisis. Rates of depression and suicide continue to rise among all children ages 12-17. While there is considerable research on the mental health of underserved children, much less is known about the mental health status of youth from affluent communities. The purpose of this study was to evaluate the effectiveness of community health assessment (CHA)-driven mental health interventions on the youth of affluent communities. Using a pre and post evaluation model, this study compared the frequencies of self-reported depression and suicide ideation for students in Grades 8, 10, and 12, and geographic location of the youth of affluent communities before and after implementing CHA-driven interventions. The diffusion of innovation theory guided this study and a quantitative quasiexperimental research design was used. The Utah Student Health and Risk Prevention survey provided 2,973 responses from students attending public high school during the 2011, 2013, 2015, and 2017 school years. Acting as the control, survey responses for depression and suicide ideation from 2011, prior to CHA-driven interventions, were compared to postCHA intervention efforts in 2013, 2015, and 2017. Statistical analyses indicated that the change in self-reported frequencies of depression and suicide ideation were not statistically significant for grade level or geographic location before and after CHA-driven mental health interventions. The results of this study might help local public health agencies working in affluent communities understand how the mental health status, especially among the youth demographic, might shape the future of public health and the role of public health practitioners in promoting social change.

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The present study investigated high risk behaviors in a population of college students through the use of a large, national quantitative data set and individual qualitative interviews. Since millions of students are enrolled in higher education, which often comes at a great financial cost and sacrifice to them and their families (Henretta, Wolf, Van Voorhis & Soldo, 2012), this is a particularly important population to study. Additionally, despite being a time of optimal health, adolescence is also a time of increased mortality, particularly as it relates to social morbidities (Resnick et al., 1997). While risk taking amongst college students manifests itself in many ways, the primary focus of this research will be on alcohol use, drug use and sexual behavior. Recent research in the field, including the composite measure of psychosocial maturity (Steinberg, Cauffman, Woolard, Graham & Banich, 2009a), the social neuroscience perspective (Steinberg, 2008) and current trends in alcohol use, drug use and sexual behaviors amongst college students were examined. The American College Health Association National College Health Assessment II (ACHA-NCHA II) provided statistically significant evidence that students who drink more (frequency and quantity) have lower overall GPAs, experience more negative consequences as a result of their drinking and experience more impediments to academic success. Students who live on campus, are members of Greek fraternities and sororities and/or are varsity athletes engage in higher levels of binge drinking than their peers. Additionally, students who drink more (frequency and quantity) engage in other risky behaviors (unprotected sex, NMPD use, etc.) at higher rates than their peers. Qualitative interviews with high achieving students who engaged in various levels of risk taking resulted in the explication of six distinct themes: defining and conceptualizing risk taking, decision making, painting a picture of individual risk taking, academic achievement, peer perceptions and influence, and achieving both (what allows a high risk student to also be high achieving). In addition to the above analyses, the present study also examines implications for practitioners and directions for future research. / Educational Psychology

The intestinal tract of salmonids provides a dynamic interface that not only mediates nutrient uptake but also functions as the first line of defence against ingested pathogens. Exposure of the immune system to beneficial microorganisms and different dietary immunostimulants via the intestine has been shown to prime the immune system and help in the development of immune competence. Furthermore, the morphology and function of teleostean intestines are known to respond to feed components and to ingested and resident bacterial communities. Histological appraisal is still generally considered to be the gold standard for sensitive assessment of the effects of such dietary modulation. The aim of the present study was to improve understanding of salmonid intestinal function, structure and dynamics and to use the knowledge gained to develop a model for analysis, which would allow intestinal health to be assessed with respect to different intestinal communities and feed components. Virtual histology, the process of assessing digital images of histological slides, is gaining momentum as an approach to supplement traditional histological evaluation methodologies and at the same time, image analysis of digitised histological sections provides a practical means for quantifiable assessment of structural and functional changes in tissues, being both objective and reproducible. This project focused on the development of a rapid, practical analytical methodology based on advanced image analysis, that was able to measure and characterise a range of features of the intestinal histology of Atlantic salmon in a quantitative manner. In the first research chapter, the development of a novel histological assessment system based upon advanced image analysis was described, this being developed with the help of a soybean feed model known to induce enteropathy in Atlantic salmon. This tool targeted the evaluation of the extent of morphological changes occurring in the distal intestine of Atlantic salmon following dietary modulation. The final analytical methodology arrived at, could be conducted with minimal user-interaction, allowing rapid and objective assessment of 12 continuous variables per histological frame analysed. The processing time required for each histological frame was roughly 20-25 min, which greatly improved the efficiency of conducting such a quantitative assessment with respect to the time taken for a subjective semi-quantitative alternative approach. Significant agreement between the fully automated and the manual morphometric image segmentation was achieved, however, the strength of this quantitative approach was enhanced by the employment of interactive procedures, which enabled the operator / observer to rectify preceding automated segmentation steps, and account for the specimen’s variations. Results indicated that image analysis provided a viable alternative to a pathologist’s manual scoring, being more practical and time-efficient. In the second research chapter, feeding Atlantic salmon a high inclusion level of unrefined SBM (25 %) produced an inflammatory response in the distal intestine as previously described by other authors. The model feed trial successfully generated differentiable states, although these were not, for the most part, systemically differentiable through the majority of standard immunological procedures used, being only detectable morphologically. Quantitation of morphometric parameters associated with histological sections using the newly developed image analysis tool successfully allowed identification of major morphological changes. Image analysis was thus shown to provide a powerful tool for describing the histomorphological structure of Atlantic salmon distal intestine. In turn, the semi-automated image analysis methods were able to distinguish normal intestinal mucosa from those affected by enteritis. While individual parameters were less discriminatory, use of multivariate techniques allowed better discrimination of states and is likely to prove the most productive approach in further studies. Work described in the third research chapter sought to validate the semi-automated image analysis system to establish that it was measuring the parameters it was purported to be measuring, and to provide reassurance that it could reliably measure pre-determined features. This study, using the same sections for semi-quantitative and quantitative analyses, demonstrated that the quantitative indices performed well when compared to analogous semi-quantitative descriptive parameters of assessment for enteritis prognosis. The excellent reproducibility and accuracy performance levels indicated that the image analysis system was a useful and reliable morphometric method for the quantification of SB-induced enteritis in salmon. Other characteristics such as rapidity, simplicity and adaptability favour this method for image analysis, and are particularly useful where less experienced interpreters are performing the analysis. The work described in the fourth research chapter characterised changes in the morphology of the intestinal epithelial cells occurring as a result of dietary modulation and aspects of inflammatory infiltration, using a selected panel of enzyme and IHC markers. To accomplish this, image analysis techniques were used to evaluate and systematically optimise a quantitative immunolabelling assessment protocol. Digital computer-assisted quantification of labelling for cell proliferation and regeneration; programmed cell death or apoptosis; EGCs and t-cell like infiltrates; mobilisation of stress-related protein regenerative processes and facilitation of nutrient uptake and ion transport provided encouraging results. Through the description of the intestinal cellular responses at a molecular level, such IHC expression profiling further characterised the inflammatory reaction generated by the enteropathic diet. In addition, a number of potential diagnostic parameters were described for fish intestinal health e.g. the relative levels of antigenicity and the spatial distribution of antigens in tissues. Work described in the final research chapter focused on detailed characterisation of intestinal MCs / EGCs in order to try to elucidate their functional role in the intestinal immune responses. Through an understanding of their distribution, composition and ultrastructure, the intention was to better characterise these cells and their functional properties. The general morphology, histochemical characteristics and tissue distribution of these cells were explored in detail using histochemical, IHC and immunogold staining / labelling, visualised using light, confocal and TEM microscopy. Despite these extensive investigations, their physiological function and the content of their granules still remain somewhat obscure, although a role as immunodulatory cells reacting to various exogeneous signals through a finely regulated process and comparable to that causing the degranulation of mammalian MCs is suggested. The histochemical staining properties demonstrated for salmonid MCs / EGCs seem to resemble those of mammalian mucosal mast cells, with both acidophilic and basophilic components in their granules, and a granule content containing neuromodulator / neurotransmitter-peptides such as serotonin, met-enkephalin and substance-p. Consequently, distinguishable bio-chromogenic markers have been identified that are of utility in generating a discriminatory profile for image analysis of such cells.

Dans ce mémoire, différentes architectures pour le contrôle et la surveillance des systèmes techniques complexes de grande dimension (STCGD) sont discutées. Les problématiques de maintenance conditionnelle et d'évaluation de l'état de santé sont définies. Les types de diagnostic et de pronostic sont présentés afin d'aboutir à une évaluation de l'état de santé des STCGD. Les études relatives au diagnostic décentralisé sont discutées puis les apports des NTIC et des technologies distribuées au diagnostic sont présentés. Par la suite, le diagnostic distribué et les travaux relatifs à ce mode de déploiement sont introduits. Les limites des approches centralisées et décentralisées du diagnostic sont présentées et confrontées à l'apport des approches distribuées. Les informations et/ou les connaissances supports aux diagnostic et au pronostic ainsi que leur modélisation afin de les exploiter sont décrites et formalisées. Une caractérisation des statuts que peut prendre un composant est proposée. Il est décrit les pré-requis nécessaires pour la couche de surveillance des STCGD et les principes du diagnostic et du pronostic sont ensuite présentés sous la forme de différents algorithmes. Enfin, une méthode d'évaluation de l'état de santé des STCGD est proposée. Plusieurs déploiements peuvent être envisagés pour l'évaluation de la santé des STCGD. Une plateforme de simulation a été développée pour évaluer les performances des déploiements centralisés et distribués. La plateforme a eu pour but de se comporter comme la couche de surveillance d'un STCGD. Un cas d'étude paramétrable est proposé pour chacun des deux déploiements et leurs performances sont comparées. / In this dissertation, various architectures for the control and the monitoring of Large Scale Complex Technical Systems (LSCTS) are discussed. The problematic of condition-based maintenance and health status assessment is defined. A diagnostic and prognostic typology is presented leading to the assessment of the health status of LSCTSs. Decentralized diagnosis studies are discussed then the contributions of the ICT and of the distributed technologies for the diagnosis are presented. Thereafter, the distributed diagnosis and works relative to this kind of deployments are introduced. The limits of the centralized and decentralized diagnosis approaches are presented. Then the centralized approaches are compared to the distributed ones. Information and/or knowledge that support the diagnosis and the prognosis as well as their modeling in order to exploit them are described and formalized. A characterization is proposed for the different status of a component can be in. Requirements are described for the monitoring layer of the LSCTSs are described in order to implement the proposed diagnosis and prognosis principles that are then specified by the means of algorithms. Eventually, a health assessment method of the LSCTSs is also proposed. Several deployments can be considered to implement the health assessment of the LSCTSs. A simulation platform, which was developed to evaluate the performances of the centralized and the distributed deployments, is presented. Among the purposes of the platform, one is to behave as the monitoring layer of a LSCTS. A use case is proposed for two deployments and their performances are compared.