Indiana University-Purdue University Indianapolis (IUPUI) / Community Health Centers (CHCs) play a pivotal role in delivery of primary healthcare to the underserved, yet have not benefited from a modern data analytics platform that can support clinical, operational and financial decision making across the continuum of care. This research is based on a systems redesign collaborative of seven CHC organizations spread across Indiana to improve efficiency and access to care. Three research questions (RQs) formed the basis of this research, each of which seeks to address known knowledge gaps in the literature and identify areas for future research in health informatics. The first RQ seeks to understand the information needs to support operations at CHCs and implement an information architecture to support those needs. The second RQ leverages the implemented data infrastructure to evaluate how advanced analytics can guide open access scheduling – a specific use case of this research. Finally, the third RQ seeks to understand how the data can be visualized to support decision making among varying roles in CHCs. Based on the unique work and information flow needs uncovered at these CHCs, an end to-end analytics solution was designed, developed and validated within the framework of a rapid learning health system. The solution comprised of a novel heterogeneous longitudinal clinic data warehouse augmented with big data technologies and dashboard visualizations to inform CHCs regarding operational priorities and to support engagement in the systems redesign initiative. Application of predictive analytics on the health center data guided the implementation of open access scheduling and up to a 15% reduction in the missed appointment rates. Performance measures of importance to specific job profiles within the CHCs were uncovered. This was followed by a user-centered design of an online interactive dashboard to support rapid assessments of care delivery. The impact of the dashboard was assessed over time and formally validated through a usability study involving cognitive task analysis and a system usability scale questionnaire. Wider scale implementation of the data aggregation and analytics platform through regional health information networks could better support a range of health system redesign initiatives in order to address the national ‘triple aim’ of healthcare.

In this paper, I explore the relationship between academic medical centers and the local school districts in which they are situated within the context of what I experienced as a medical student working in an education non-profit. This analysis is intended to arrive at actionable reccomendations for the non-profit, RISE, with the end goal of transforming the organization into one in line with the principles of urban bioethics. The hope is that applying what I learned in the classroom, in the Urban Bioethics master’s degree program, will improve the success of RISE in its adaptation by the community and result in greater impact on education and mentorship of our students. First, in the introduction, I will describe the general healthcare landscape in the United States and how education is viewed by the healthcare system. I will also discuss in the introduction my personal experience as a medical student at Temple in Philadelphia and my exposure to the school district that led me to be involved with the education non-profit. Second, I demonstrate that education is a key social determinant of health by exploring the literature and research that supports this notion. Third, I explore the economic and political context that I believe foreshadows greater investment in education from academic health centers. Fourth, I describe the Philadelphia RISE educational organization and its current status of operations. Fifth, I consider Temple’s strategy in community engagement as a veteran role model for the fledgling non-profit. Sixth, I discuss the role of urban bioethics in shaping my ultimate recommendations to the non-profit. Seventh (and finally), I articulate the recommendations, which will most notably alter the leadership structure to incorporate community stakeholders. / Urban Bioethics

Bakgrund: Antalet patienter som behöver vård i hemmet ökar stadigt. För att vården ska ske personcentrat och patientsäkert, så behövs en god teamsamverkan mellan läkare och distriktssköterskor. Det är angeläget att undersöka hur denna teamsamverkan mellan distriktssköterskor och läkare fungerar för att kunna identifiera områden där förbättringar krävs. Syfte: Syftet var att beskriva distriktssköterskors erfarenheter av teamsamverkan med läkare i hemsjukvården. Metod: En kvalitativ intervjustudie genomfördes med induktiv ansats. Ändamålsenligt urval tillämpades och resulterade i 15 semistrukturerade intervjuer. Informanterna bestod av distriktssköterskor, grundutbildade sjuksköterskor och en specialistsjuksköterska inom vård av äldre från nio olika kommuner i södra Sverige. Samtliga informanter var kvinnor. Kvalitativ innehållsanalys användes för bearbetning av datamaterialet. Resultat: Tre kategorier framkommer i resultatet: Distriktssköterskors erfarenheter av läkares tillgänglighet i hemsjukvården, Respekt mellan distriktssköterskor och läkare i hemsjukvården samt Distriktssköterskors erfarenheter av hemsjukvårdens och vårdcentralens organisering. Kategorierna mynnade ut i ett gemensamt tema som lyder: Distriktssköterskor och läkare i hemsjukvården behöver varandra. Slutsats: Teamsamverkan mellan distriktssköterskor och läkare är nödvändigt i hemsjukvården. Samverkan brister mellan distriktssköterskor och läkare likväl mellan hemsjukvård och vårdcentral. Teamsamverkan mellan professioner och samverkan mellan hälsoorganisationer måste förbättras för att främja patienters hälsa. / Background: The number of patients being dependent on home care is constantly increasing. In order to provide patient-centered and safe health care, good team collaboration between general practitioners and district nurses must be established. It is important to investigate how this team collaboration is facilitated as this could provide better understanding of the topic which could pinpoint areas of improvement. Purpose: The purpose was to describe district nurses' experiences of team collaboration with general practitioners in home care. Method: A qualitative interview study was carried through with an inductive approach. Purposive sampling was applied and resulted in 15 semi-structured interviews. The informants consisted of district nurses, registered nurses and one specialist nurse of elderly care from nine different municipalities in south of Sweden. All informants were women. Qualitative content analysis was applied to process the gathered data. Results: The result is presented in three different categories: District nurses' experiences of general practitioners' accessibility in home care, Respect between district nurses and general practitioners in home care, District nurses' experiences of the organization of home care and health care centers. These categories resulted in a general theme described as: District nurses and general practitioners in home care need each other. Conclusions: Team collaboration between district nurses and general practitioners is vital within the home care sector. Collaboration between home care providers and health centers is also necessary for enabling this team collaboration. The result of this study shows that the team collaboration is lacking between district nurses and general practitioners as well as between home care providers and health centers. The team collaboration between both professions and health organizations must be improved in order to promote the health of all patients.

Federally qualified health centers (FQHCs) are instrumental in providing top tier healthcare and other resources to underserved populations. Whether they administer services in house or refer patients to other providers, FQHCs aim to provide comprehensive primary and preventative care services to people of all ages. They offer a range of services, from doctor and dental appointments to mental health and substance abuse counseling, regardless of a patient’s insurance status. To receive funding, FQHCs must follow the regulations and quality standards set forth by groups like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Resources and Services Administration (HRSA). A variety of barriers prevent young adults (18-24), particularly from underserved communities, from accessing resources available at community health centers (CHCs). Encouraging more people to utilize the preventative care resources provided by community health centers will increase quality of life for underserved populations, reduce the future burden on the healthcare system, and allow CHCs to access more funding. Strategies to reach this currently hard-to-reach population were developed through interviews with health educators, analysis of existing patient data, benchmarking FQHCs across the United States, and surveying the target population. Barriers to utilizing preventative care resources were collected and current patient outreach strategies were assessed. New strategies were proposed and evaluated by current patient educators at FQHCs. This research will outline a cohesive set of effective patient outreach strategies for FQHCs to increase their young adult patient base, particularly regarding preventative care.

Riscos ambientais (RA) podem ser causados por agentes biológicos, químicos, físicos e ergonômicos que, quando presentes nos ambientes de trabalho são capazes de causar danos à saúde do trabalhador em função de sua natureza, intensidade ou tempo de exposição. Especialmente em serviços de saúde, os RA relativos à exposição dos trabalhadores aos diferentes tipos de agentes presentes nesses ambientes, são de grande significado para a saúde ocupacional. O reconhecimento dos RA e a adoção de medidas para a prevenção e minimização desses riscos, devem ser sempre realizados, de forma a envolver tanto as instituições como os próprios trabalhadores, visando maior segurança ocupacional. Esta investigação objetivou avaliar a realidade de exposição a RA em uma Unidade Mista de Saúde (UMS) do interior do estado de São Paulo, a partir da percepção dos seus trabalhadores. Trata-se de uma pesquisa de campo, de caráter descritivo e exploratório, realizada por meio de abordagem quali-quantitativa. A coleta de dados foi feita por meio de entrevista, utilizando um roteiro constituído por perguntas semi-estruturadas e check-list, realizada com dois grupos distintos de sujeitos: um grupo constituído pelos trabalhadores das diferentes áreas de atuação do local selecionado e, outro grupo, constituído apenas pelos gestores da UMS. A pesquisa teve aprovação do CEP da EERP/USP. Os dados coletados foram organizados em um banco de dados do Excel e categorizados em tabelas e gráficos, procedendo-se à análise estatística descritiva. Os resultados foram obtidos a partir de uma amostra composta por 48 sujeitos (82,8% de todos os trabalhadores do local selecionado para este estudo), pertencentes a todas as 17 categorias profissionais existentes no serviço. A idade média dos sujeitos no momento das entrevistas era de 38 anos e a faixa etária predominante, de 21 a 30 anos para 35,4% dos entrevistados. A maior parte dos sujeitos (52,1%) pertencia ao gênero feminino. Quanto à carga horária de trabalho, 16 entrevistados (33,4%) relataram que a soma da carga horária de todos os empregos por ocasião da entrevista correspondia a mais de 41 horas semanais, sendo que 8 (50%) desses referiram uma carga horária semanal acima de 70 horas e, 1 deles referiu desempenhar uma carga horária de até 100 horas semanais. Quando questionados por meio de questões abertas sobre RA presentes em qualquer tipo de ambiente de trabalho e RA presentes no local da investigação, 95,8% dos sujeitos relataram já terem ouvido falar sobre o assunto e igual percentual indicaram pelo menos um RA no seu local de trabalho. Porém, quando utilizado um check-list para identificação e quantificação dos RA presentes na UMS, 100 % dos sujeitos relataram a presença de pelo menos um RA de cada natureza no serviço, destacando-se o relato da presença dos seguintes agentes, de acordo com os maiores percentuais obtidos em cada natureza de risco citado: bactérias (91,7%), vírus (91,7%), poeiras (79,2%), calor (72,9%), postura inadequada (66,7%), monotonia/repetitividade (66,7%), iluminação inadequada (33,3%) e ligações elétricas deficientes (33,3%). No que se refere a acidentes no ambiente de trabalho, 18,8% dos sujeitos relataram ter sofrido pelo menos um acidente de trabalho na UMS, envolvendo materiais perfurocortantes, quedas, ferimentos, exposição cutâneo-mucosa a materiais biológicos, agressão física por pacientes e acidentes em ambulâncias. Quanto aos gestores, foi referida por esses sujeitos a existência de RA no serviço; porém, segundo os respondentes, ainda não havia uma rotina para categorização e quantificação dos RA na Unidade, que também ainda não possuía Mapa de Risco (MR) e Programa de Prevenção a Riscos Ambientais (PPRA), ambos exigidos pela legislação brasileira a todas as instituições de saúde, independente do grau de risco. Conclui-se com este estudo, pelo relato dos sujeitos, que a UMS possui riscos ambientais que podem afetar a saúde dos trabalhadores. Assim, deve ser realizado um planejamento imediato de reconhecimento e avaliação desses RA, bem como de adoção de medidas para sua prevenção e minimização, com base no estabelecimento de MR e de um PPRA, sendo esta uma das principais proposições a ser feita ao serviço. Além disso, é necessário incluir um programa de educação continuada aos trabalhadores, visando contribuir para a promoção da saúde ambiental e ocupacional no local de estudo. / Environmental risks (ER) can be caused by biological, chemical, physical and ergonomic agents that, when present in the workplace, can cause damage to workers\' health due to their nature, intensity or length of exposure. Especially in healthcare services, ER related to the exposure of workers to different types of agents present in these environments, are significant for occupational health. The recognition of ER and the adoption of measures to prevent and minimize these risks, should always be performed, in order to involve both institutions and workers themselves, aiming at greater occupational safety. This descriptive, exploratory, qualitative and quantitative field research aimed to evaluate the reality of exposure to ER in a Mixed Health Unit (MHU) in the interior of the state of São Paulo, from the perception of its workers. This is a, performed by means of qualitative and quantitative approach. Data collection was carried out through interviews, using a script consisting of semi-structured questions and a check-list, performed with two different groups of subjects: one group consisting of workers from different performance areas of the selected venue, and another group consisting only by the managers of the MHU. The research was approved by the Ethics Research Board of the University of Sao Paulo at Ribeirão Preto College of Nursing. Collected data were organized into an Excel database and categorized in tables and charts, after which descriptive statistics was performed. Results were obtained from a sample of 48 subjects (82.8% of the total number of workers of the venue selected for this study), who worked in all 17 professional categories of the service. The average age of the subjects at the time of the interviews was 38 years and the predominant age was from 21 to 30 years for 35.4% of respondents. Most subjects (52.1%) were female. Regarding the workload, 16 respondents (33.4%) reported that the sum of the workload of all jobs at the time of the interview was over 41 hours per week, 8 (50%) of them reported a weekly workload over 70 hours and one reported a workload of up to 100 hours a week. When respondents were asked, using open questions, about ER present in any work environment and ER present at the research site, 95.8% of the subjects reported having heard about it and the same percentage indicated at least one ER at their work venue. When using a checklist for identification and quantification of ER present at the MHU, 100% of the subjects reported the presence of at least one ER of each type at the service, highlighting the presence of the following agents, according to the highest percentages obtained for each kind of risk mentioned: bacteria (91.7%), viruses (91.7%), dust (79.2%), heat (72.9%), poor posture (66.7%), monotony/repetitiveness (66.7%), inadequate lighting (33.3%) and bad electrical connections (33.32%). As to the accidents in the workplace, 18.8% of the subjects reported having experienced at least one accident at work at the MHU, involving sharp materials, falls, cuts, mucocutaneous exposure to biological materials, physical aggression by patients and accidents in ambulances. Managers reported the existence of ER in the service, but, according to them, there was not a routine for categorization and quantification of ER in the unit yet, which also did not had a Risk Map (RM) and Environmental Risks Prevention Program (ERPP), both required by the Brazilian law to all health institutions, regardless of the degree of risk. It is concluded, by the report of the subjects, that the MHU has environmental risks that can affect workers\' health. Thus, the immediate planning should be done for recognition and evaluation of these ER, as well as for the adoption of measures for its prevention and minimization, based on the establishment of a RM and ERPP, which is one of the main proposals that will be made to the service. In addition, there is need to include a continuing education program to workers, aiming to contribute to the promotion of environmental and occupational health at the study site

Esse estudo teve como objetivo analisar o atendimento das demandas de saúde mental na rede de atenção à saúde no município de Cordeirópolis, interior de São Paulo. Tal análise compreendeu a descrição da estrutura desta rede e a percepção dos profissionais sobre a identificação e cuidado das demandas de saúde mental. Para tanto, realizou-se uma pesquisa qualitativa, transversal do tipo descritivo-exploratória. Foram utilizados dados primários e secundários. Os dados foram coletados entre junho de 2013 e maio de 2014 através de análise documental e entrevistas semiestruturadas. Os dados secundários foram obtidos a partir de registros do Departamento de Informática do Sistema Único de Saúde (DATASUS), dos documentos que embasam o funcionamento dos serviços estudados (planilhas com dados dos acolhimentos no ano de 2012, o projeto de implantação do Centro de Atenção Psicossocial - CAPS e o Plano de Funcionamento do serviço) além do Plano Municipal de Saúde \"2010- 2013\". Já os dados primários foram obtidos através de entrevistas com 20 profissionais de saúde de nível médio e superior que atuavam nos serviços estudados a saber, CAPS, Ambulatório de Saúde Mental, Pronto-Socorro e Estratégias de Saúde da Família. O referencial teórico adotado para análise foram os pressupostos de Bárbara Starfield em relação à organização dos sistemas de saúde sob a lógica da Atenção Primária a Saúde. Assim os dados foram analisados utilizando a análise documental e análise de conteúdo. Os resultados apontaram que a rede de atenção psicossocial do município estava estruturada com importantes pontos de atenção (CAPS, o Ambulatório de Saúde Mental, as Estratégias de Saúde da Família e Pronto-Socorro) e equipes com número e diversificação considerável de profissionais. Em relação à percepção dos participantes sobre a saúde mental, identificou-se uma justaposição de visões que ora corroboram o paradigma biomédico, ora o conceito ampliado de saúde. Esta diversidade de concepções ilustra o fato que saúde e saúde mental se entrecruzam e confundem-se dentro da história da humanidade, tendo sido tratadas como distintas apenas com o nascimento da psiquiatria, quando essa especialidade toma para si o objeto \"psíquico\", salientando a divisão mente-corpo. Essa diferença de concepções, pode também explicar as ações ora focadas na remissão de sintomas, tratamento medicamentoso e encaminhamento para internação, ora com vistas para aspectos psicossociais, como por exemplo, escuta, acompanhamento psicólogico, criação de vínculo, oficinas de geração de renda, passeios, dentre outras. Dessa forma, o presente estudo permitiu demarcar uma série de potencialidades da rede de saúde do município em questão no atendimento a demanda de saúde mental, no entanto foram também destacadas algumas recomendações importantes para sua melhoria / This study aimed to analyze the treatment for mental health demands in the health care network in Cordeirópolis, São Paulo. This analysis included the description of the network\'s structure and the perception of the professionals about the identification and care of the mental health\'s demands. For this, we used a cross-sectional, qualitative and descriptive- exploratory survey. We used primary and secondary data. Data were collected between June 2013 and May 2014 through semi-structured interviews and documentary analysis. The theoretical framework adopted for analysis were the assumptions of Barbara Starfield in relation to the organization of health systems under the logic of Primary Health Care. Secondary data were obtained from the Unified Health System database (Departamento de Informática do Sistema Único de Saúde - DATASUS), data of the respective services and the Municipal Health Plan \"2010-2013\". For document analysis, we selected the documents that support the service operation: spreadsheets with data screening of 2012, the implementation project of the Community Health Center (Centro de Atenção Psicossocial - CAPS) and this Service Operation Plan. For the primary data, we selected 20 health professionals at middle and senior levels who worked in the these services: CAPS, Outpatient Mental Health Clinic, First Aid Station and Family Health Program. Thus the data were analyzed using document analysis and content analysis. The results showed that the psychosocial care\'s network of the council was structured with important services (CAPS, the Outpacient Mental Health Clinic, Family Health Program and First Aid Station) and teams with considerable diversity and number of professionals. Regarding the participants\' perceptions about mental health, we identified a juxtaposition of views that either corroborates the biomedical paradigm and the wider concept of health at other times. The diversity of views presented by participants illustrates the fact that health and mental health are intertwined and confused in the history of mankind and have been treated as distinct, only with the birth of psychiatry, when this specialty takes on the \'psychic\' object, emphasizing the mind-body division. This difference of views, can also explain the actions focused on remission of symptoms, drug treatment and referral for hospitalization, sometimes overlooking psychosocial aspects, such as listening, psychological counseling, bond\'s creation, CAPS\'s patients in workshops for income, tours, among others. Thus, the present study allows demarcate a series of network capabilities of the studied municipal health service in the demand for mental health, however were also highlighted some important recommendations for improvement

Objetivou-se identificar os fatores de risco para o Acidente Vascular Cerebral em indivíduos adultos ou idosos assistidos por núcleos de saúde do município de Bauru-SP. Trata-se de um estudo observacional de investigação transversal dos fatores de risco para o acidente vascular cerebral, realizado com 536 indivíduos que nunca tiveram esse acometimento neurológico e que possuíam idade igual ou superior a 40 anos. Foi realizada entrevista individual para investigação dos fatores de risco e classificação socioeconômica. Na análise dos dados foi aplicado o teste qui-quadrado e realizada a regressão logística múltipla (p<0,05). Houve predominância do sexo feminino (64,6%) e da faixa etária até 59 anos (56,9%). 47,0% se declararam brancos, 69,8% tinham de 1 a 8 anos de estudo, 78,2% pertenciam à classe socioeconômica baixa superior e 50,4% passaram por atendimento médico no último mês. 99,1% possuíam algum fator de risco. O excesso de peso e a inatividade física mostraram-se fatores predominantes (59,9%), seguido por hipertensão arterial (56,2%), histórico familiar (40,7%), dislipidemia (27,8%), diabetes mellitus (24,6%), uso de tabaco (18,7%), episódio anterior de Acidente Isquêmico Transitório (7,8%) e consumo excessivo de álcool (2,3%). A distribuição dos fatores de risco apresentou influência do sexo, grupo etário, grau de instrução, núcleo de saúde e período decorrente desde a última consulta médica, entretanto essa influência não ocorreu de forma homogênea. Para excesso de peso, indivíduos entre 40 e 59 anos tiveram 2.77 vezes mais chances do que indivíduos com mais de 60 anos e pertencer ao núcleo A aumentou 2.50 vezes as chances do que frequentar o núcleo D. Para inatividade física, indivíduos entre 40 e 59 anos apresentaram 1.51 vezes mais chances quando comparados àqueles com mais de 60 anos. Hipertensão arterial apresentou 2.49 vezes mais chances de ocorrer naqueles com mais de 60 anos e nos que foram ao médico há menos de um ano (2.85 vezes mais chances). Em relação ao histórico familiar pertencer ao sexo feminino aumentou em 1.63 vezes as chances. Quanto à dislipidemia, o sexo feminino mostrou 1.93 vezes mais chances, assim como os indivíduos com idade acima de 60 anos (1.68 vezes mais chances) e aqueles que foram ao médico há menos de um ano (2.43 vezes mais chances). A diabete mellitus teve 2.09 vezes mais chances de ocorrer em sujeitos com mais de 60 anos, assim como naqueles que foram ao médico há menos de um ano (2.50 vezes mais chances). Para uso de tabaco, homens tiveram 1.96 vezes mais chances, além disso, pertencer ao núcleo A aumentou 2.27 vezes as chances quando comparados ao núcleo C e aqueles que foram ao médico há mais um ano apresentaram cerca de 2.07 vezes mais chances de serem usuários de tabaco. O episódio anterior de acidente isquêmico transitório teve 2.29 vezes mais chances de ocorrer em indivíduos com mais de 60 anos. Para consumo excessivo de álcool, os homens apresentaram 25.0 vezes mais chances. Concluiu-se que 99,1% dos sujeitos apresentaram algum fator de risco, sendo o excesso de peso, inatividade física e hipertensão arterial os prevalentes. / This study aimed to identify risk factors for stroke in adults or elderly assisted by health centers in the city of Bauru-SP. This is an observational study of transversal investigation of risk factors for stroke, conducted with 536 individuals who have never had this neurological involvement and had aged 40 years. Individual interview was conducted to investigate the risk factors and socioeconomic classification. In the data analysis we applied the chi-square test and performed multiple logistic regression (p<0.05). Patients were predominantly female (64.6%) and the age group up to 59 years (56.9%). 47.0% reported they are white, 69.8% had 1 to 8 years of schooling, 78.2% belonged to the upper low socioeconomic class and 50.4% have undergone medical care in the last month. 99.1% had some risk factor. Excess weight and physical inactivity proved predominant factors (59.9%), followed by hypertension (56.2%), family history (40.7%), dyslipidemia (27.8%), diabetes mellitus (24.6%), tobacco use (18.7%), previous episode Transient Ischemic Attack (7.8%) and excessive alcohol consumption (2.3%). The distribution of risk factors presented influence of gender, age group, education level, health centers and period from since the last medical visit, however this influence does not occur homogeneously. To \"overweight\" individuals between 40 and 59 years were 2.77 times more likely than those over 60 years old and belong to the health center A increased 2.50 times the chances to attend the health center D. For \"physical inactivity\", individuals between 40 and 59 years had 1.51 times more likely than those with more than 60 years. \"Hypertension\" presented 2.49 times more likely to occur in those over 60 years and have been to the doctor for less than one year (2.85 times more likely). Regarding the \"family history\" being female increased by 1.63 times the odds. As for \"dyslipidemia\", the female showed 1.93 times more likely, as well as persons aged over 60 years (1.68 times more likely) and those who have been to the doctor for less than one year (2.43 times more likely). The \"diabetes mellitus\" had 2.09 times more likely to occur in individuals over 60 years as well as those who went to the doctor for less than one year (2.50 times more likely). For \"tobacco use\", men were 1.96 times more likely, moreover, belongs to the health center A increased 2.27 times the odds when compared to the health center C and those who went to the doctor for another year showed about 2.07 times more likely to be tobacco users. The \"previous episode of Transient Ischemic Attack\" had 2.29 times more likely to occur in individuals over 60 years. To \"excessive alcohol consumption\", men were 25.0 times more likely. It was concluded that 99.1% of the subjects had any risk factor, being overweight, physical inactivity and hypertension prevalent.

Objetivou-se identificar os fatores de risco para o Acidente Vascular Cerebral em indivíduos adultos ou idosos assistidos por núcleos de saúde do município de Bauru-SP. Trata-se de um estudo observacional de investigação transversal dos fatores de risco para o acidente vascular cerebral, realizado com 536 indivíduos que nunca tiveram esse acometimento neurológico e que possuíam idade igual ou superior a 40 anos. Foi realizada entrevista individual para investigação dos fatores de risco e classificação socioeconômica. Na análise dos dados foi aplicado o teste qui-quadrado e realizada a regressão logística múltipla (p<0,05). Houve predominância do sexo feminino (64,6%) e da faixa etária até 59 anos (56,9%). 47,0% se declararam brancos, 69,8% tinham de 1 a 8 anos de estudo, 78,2% pertenciam à classe socioeconômica baixa superior e 50,4% passaram por atendimento médico no último mês. 99,1% possuíam algum fator de risco. O excesso de peso e a inatividade física mostraram-se fatores predominantes (59,9%), seguido por hipertensão arterial (56,2%), histórico familiar (40,7%), dislipidemia (27,8%), diabetes mellitus (24,6%), uso de tabaco (18,7%), episódio anterior de Acidente Isquêmico Transitório (7,8%) e consumo excessivo de álcool (2,3%). A distribuição dos fatores de risco apresentou influência do sexo, grupo etário, grau de instrução, núcleo de saúde e período decorrente desde a última consulta médica, entretanto essa influência não ocorreu de forma homogênea. Para excesso de peso, indivíduos entre 40 e 59 anos tiveram 2.77 vezes mais chances do que indivíduos com mais de 60 anos e pertencer ao núcleo A aumentou 2.50 vezes as chances do que frequentar o núcleo D. Para inatividade física, indivíduos entre 40 e 59 anos apresentaram 1.51 vezes mais chances quando comparados àqueles com mais de 60 anos. Hipertensão arterial apresentou 2.49 vezes mais chances de ocorrer naqueles com mais de 60 anos e nos que foram ao médico há menos de um ano (2.85 vezes mais chances). Em relação ao histórico familiar pertencer ao sexo feminino aumentou em 1.63 vezes as chances. Quanto à dislipidemia, o sexo feminino mostrou 1.93 vezes mais chances, assim como os indivíduos com idade acima de 60 anos (1.68 vezes mais chances) e aqueles que foram ao médico há menos de um ano (2.43 vezes mais chances). A diabete mellitus teve 2.09 vezes mais chances de ocorrer em sujeitos com mais de 60 anos, assim como naqueles que foram ao médico há menos de um ano (2.50 vezes mais chances). Para uso de tabaco, homens tiveram 1.96 vezes mais chances, além disso, pertencer ao núcleo A aumentou 2.27 vezes as chances quando comparados ao núcleo C e aqueles que foram ao médico há mais um ano apresentaram cerca de 2.07 vezes mais chances de serem usuários de tabaco. O episódio anterior de acidente isquêmico transitório teve 2.29 vezes mais chances de ocorrer em indivíduos com mais de 60 anos. Para consumo excessivo de álcool, os homens apresentaram 25.0 vezes mais chances. Concluiu-se que 99,1% dos sujeitos apresentaram algum fator de risco, sendo o excesso de peso, inatividade física e hipertensão arterial os prevalentes. / This study aimed to identify risk factors for stroke in adults or elderly assisted by health centers in the city of Bauru-SP. This is an observational study of transversal investigation of risk factors for stroke, conducted with 536 individuals who have never had this neurological involvement and had aged 40 years. Individual interview was conducted to investigate the risk factors and socioeconomic classification. In the data analysis we applied the chi-square test and performed multiple logistic regression (p<0.05). Patients were predominantly female (64.6%) and the age group up to 59 years (56.9%). 47.0% reported they are white, 69.8% had 1 to 8 years of schooling, 78.2% belonged to the upper low socioeconomic class and 50.4% have undergone medical care in the last month. 99.1% had some risk factor. Excess weight and physical inactivity proved predominant factors (59.9%), followed by hypertension (56.2%), family history (40.7%), dyslipidemia (27.8%), diabetes mellitus (24.6%), tobacco use (18.7%), previous episode Transient Ischemic Attack (7.8%) and excessive alcohol consumption (2.3%). The distribution of risk factors presented influence of gender, age group, education level, health centers and period from since the last medical visit, however this influence does not occur homogeneously. To \"overweight\" individuals between 40 and 59 years were 2.77 times more likely than those over 60 years old and belong to the health center A increased 2.50 times the chances to attend the health center D. For \"physical inactivity\", individuals between 40 and 59 years had 1.51 times more likely than those with more than 60 years. \"Hypertension\" presented 2.49 times more likely to occur in those over 60 years and have been to the doctor for less than one year (2.85 times more likely). Regarding the \"family history\" being female increased by 1.63 times the odds. As for \"dyslipidemia\", the female showed 1.93 times more likely, as well as persons aged over 60 years (1.68 times more likely) and those who have been to the doctor for less than one year (2.43 times more likely). The \"diabetes mellitus\" had 2.09 times more likely to occur in individuals over 60 years as well as those who went to the doctor for less than one year (2.50 times more likely). For \"tobacco use\", men were 1.96 times more likely, moreover, belongs to the health center A increased 2.27 times the odds when compared to the health center C and those who went to the doctor for another year showed about 2.07 times more likely to be tobacco users. The \"previous episode of Transient Ischemic Attack\" had 2.29 times more likely to occur in individuals over 60 years. To \"excessive alcohol consumption\", men were 25.0 times more likely. It was concluded that 99.1% of the subjects had any risk factor, being overweight, physical inactivity and hypertension prevalent.

Bakgrund: Vårdcentralernas telefonrådgivning har under de senaste 50 åren växt fram som ett svar på utvecklingen i samhället och hälso- och sjukvården. Specialistsjuksköterskornas telefonrådgivning ställer höga krav på kompetens och bred kunskap. Syfte: Att undersöka vad som påverkar specialistsjuksköterskans upplevelse av telefonrådgivning på vårdcentral. Metod: Sjuksköterskor och specialistsjuksköterskor som var verksamma på vårdcentral ombads att anonymt svara på frågor gällande upplevelser av telefonrådgivning, via en sluten grupp för sjuksköterskor på Facebook. Det inkom 95 fullständigt ifyllda svar. Samtliga informanter var kvinnor i åldrar mellan 23 och 62 år med erfarenhet av telefonrådgivning från mindre än ett år till 24 år. Resultat: Informanterna beskrev telefonrådgivningen som meningsfull och utvecklande. De mötte oftast vänliga och tacksamma patienter, men fick ibland även hantera ilska och frustration från uppringarna. Det framkom att många ärenden skulle kunna hanteras av annan yrkeskategori. Många upplevde svårigheter med kommunikationen, som när specialistsjuksköterskan inte kunde se eller förstå patienten på grund av språksvårigheter. Tekniska lösningar för att överbrygga bristen på visuell kontakt föreslogs. Samtalstiden var oftast begränsad vilket kunde upplevas stressande då specialistsjuksköterskan på kort tid och utan att se patienten, skulle fatta rätt beslut om lämplig åtgärd. Mer utbildning och handledning i telefonrådgivning efterfrågades samt fler tillfällen till konsultation med kollegor. Det framkom även förslag till förbättringar av den fysiska arbetsmiljön. Slutsats: Kommunikationen med patienter och kollegor är av stor betydelse för specialistsjuksköterskans upplevelse av telefonrådgivningen. Organisationen har möjlighet att förbättra förutsättningarna för arbetsmiljön samt erbjuda utbildning och handledning. / Background: Telephone counseling at Community health centers has emerged during the past 50 years, as a consequence of the development in society as well as within the healthcare. Nurse specialists' telephone counseling require a high level of competence in many areas of expertise. Aim: To investigate what influence the nurse specialists' experiences of telephone counseling. Method: Nurses and nurse specialists who were active at a Community health center were asked to anonymously answer a few questions through a closed Facebook-group. We received 95 complete answered questionnaires. All informants were women in ages between 23 and 62 with experiences of telephone counseling from less than a year to 24 years. Results: The informants described the telephone counseling as both meaningful and developing. Most of the time they met patients who were friendly and grateful, but sometimes they also faced anger and frustration from the ones calling. Many contacts could have been handled by someone else with less experience and formal competence. Quite a few experienced challenges in the communication, as for example when the specialist nurse could not see the person calling or when the person had difficulties with the language. Technical solutions were suggested to overcome the absence of visual contact. The time for each call was limited, which could be as a stress-factor, since the specialist nurse, in short time and without visual contact with the patient, had to make a decision on appropriate action. Further education and mentoring in telephone counseling were asked for, as well as more options to consult with colleagues. Improvements regarding the occupational health were also suggested. Conclusion: Communication with patients and colleagues is of great importance for the nurse specialist's experiences of telephone counseling. The organization has the opportunity to improve the conditions for occupational health as well as provide education and mentoring.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.