Background : Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oralhealth related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions. Methods : OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen’s d) were calculated. Results : The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059). Conclusions : In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-30T12:12:17Z No. of bitstreams: 1 Bruno Vieira Cariry.pdf: 1014562 bytes, checksum: 695277f43d05386551478d66ceda3c29 (MD5) / Made available in DSpace on 2015-04-30T12:12:17Z (GMT). No. of bitstreams: 1 Bruno Vieira Cariry.pdf: 1014562 bytes, checksum: 695277f43d05386551478d66ceda3c29 (MD5) Previous issue date: 2013-12-05 / Introduction: The expansion of Family Health Estrategy in Brazil requires a construction of indicators that will evaluate the coherence of the approach effectively carried through and their guiding principles. The register in patient records is important for managers in health because it represents an indicator of quality in primary care. It can also work as an instrument of legal and ethical support for the professionals in charge of patient care, and helps in diagnosis and choosing of treatment. Objective: Evaluate the use of patient records by employees and managers of Primary Care in cities of hinterland of Paraiba state. Methodology: A semi-structured questionnaire with questions about biodemographic data and practical actions of healthcare professionals and managers towards the use of patient records was applied. Descriptive analysis was performed for all variables. Results: From analysis of the questionnaires, seven thematic categories that reflects the position of the group on the use of health records and their variables emerged: the need for a computerized system; incentive for use of records and information system; insatisfaction with manual registers; lack of knowledge of information systems; desire to classify all phases of care; uncertainty with regard to computerized system; and devaluation of records in Health. Conclusion: Managers and professionals must understand the importance of the use of patient records, in all their forms of presentation, for the process of health assistance managing as well as they should develop the stimuli in themselves and in their colleagues to make correct use of this instrument. / Introdução: A expansão da Estratégia de Saúde da Família no Brasil torna necessária a construção de indicadores que avaliem a coerência da abordagem efetivamente realizada e os seus princípios orientadores. O registro em prontuário é importante para os gestores em saúde, pois representa um indicador de qualidade da atenção básica. Também pode se constituir em instrumento para respaldo ético e legal aos profissionais responsáveis pelo cuidado ao paciente, bem como auxiliar na construção de diagnósticos e escolha de tratamentos empregados. Objetivo: Avaliar o uso de prontuários pelos profissionais e gestores da Atenção Básica em municípios do sertão paraibano. Metodologia: Foi aplicado entre os participantes um questionário semiestruturado com perguntas sobre dados biodemográficos e questões relacionadas a atitudes práticas do profissional de saúde ou gestor frente à utilização do prontuário. Foi realizada a análise descritiva de todas as variáveis. Resultados: Emergiram da análise sete temáticas de discussão que refletem o posicionamento dos grupos pesquisados sobre o uso de registros e saúde e suas variáveis: necessidade de sistema informatizado, incentivo para o uso do prontuário e sistema informatizado; insatisfação com o registro manual; pouco conhecimento sobre sistemas de informação; desejo de classificar todas as fases do atendimento, insegurança quanto ao sistema informatizado; e desvalorização dos registros em saúde. Conclusão: Gestores e profissionais devem compreender a importância de uso do prontuário, nas suas mais diferentes formas de apresentação, para o processo de gestão da assistência na saúde, bem como devem desenvolver estímulo em si mesmos e nos seus colegas para a correta utilização desse instrumento.

Made available in DSpace on 2014-12-17T15:43:52Z (GMT). No. of bitstreams: 1 PatriciaNG_DISSERT.pdf: 2029374 bytes, checksum: 7beef1937e948bf118e34bf7f689b69b (MD5) Previous issue date: 2013-03-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Sa?de Bucal na Primeira Inf?ncia, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families. / A c?rie precoce na inf?ncia, especialmente a sua forma severa, caracterizada pela natureza aguda e agressiva, pode produzir impactos negativos na qualidade de vida da crian?a, como dificuldade na mastiga??o, diminui??o do apetite, perda de peso, dificuldade em dormir, altera??o no comportamento e diminui??o do rendimento escolar, entre outros. Al?m disso, a qualidade de vida da fam?lia da crian?a portadora desse tipo de c?rie tamb?m pode ser afetada, pois os quadros de dor e desconforto causados resultam em perdas de dias de trabalho dos pais, gastos com tratamentos odontol?gicos, altera??o nos padr?es de sono e estresse. O objetivo deste estudo foi avaliar o impacto da c?rie precoce severa na inf?ncia na Qualidade de Vida Relacionada ? Sa?de Bucal (QVRSB) de crian?as pr?-escolares de creches p?blicas por meio da Escala de Impacto da Sa?de Bucal na Primeira Inf?ncia, vers?o brasileira do Early Childhood Oral Health Impact Scale (ECOHIS). Um ?nico examinador calibrado (kappa=1,0) avaliou, por meio do ?ndice ceo-s, a sa?de bucal de 116 crian?as entre 3 e 5 anos de idade, as quais foram inclu?das em um dos tr?s grupos de estudo: livre de c?rie , c?rie precoce n?o severa e c?rie precoce severa . Os pais responderam ao ECOHIS, para avaliar sua percep??o em rela??o ? QVRSB de seus filhos, al?m de um question?rio sobre condi??es socioecon?micas. A QVRSB foi mensurada por meio dos escores total e por dom?nios do ECOHIS. An?lise descritiva, teste de Mann-Whitney, teste de Kruskal-Wallis, teste do quiquadrado e regress?o m?ltipla de Poisson com vari?ncia robusta foram utilizados. Dentre as crian?as avaliadas, 38,8% eram livres de c?rie, 27,6% apresentavam c?rie precoce n?o severa e 33,6% apresentavam c?rie precoce severa. Em rela??o ao escore total do ECOHIS, a c?rie precoce severa na inf?ncia teve um maior impacto negativo na QVRSB em compara??o aos grupos livre de c?rie e c?rie precoce n?o severa (p<0,001). Em rela??o ? subescala da crian?a, houve diferen?a estatisticamente significativa entre o grupo c?rie precoce severa e os outros grupos em todos os dom?nios, com exce??o do dom?nio de auto-imagem / intera??o social. Nos dom?nios da subescala da fam?lia, houve diferen?a significativa entre os grupos c?rie precoce severa e o livre de c?rie em todos os dom?nios (p<0,001); j? entre os grupos c?rie precoce severa e c?rie precoce n?o severa , houve diferen?a estatisticamente significativa somente no dom?nio de ang?stia dos pais (p<0,001). A an?lise multivariada mostrou que a c?rie precoce na inf?ncia e a idade dos pais foram significativamente associadas ? QVRSB (p<0,05), independentemente das demais vari?veis do modelo. A presen?a de c?rie precoce severa na inf?ncia resultou em maior impacto negativo sobre a QVRSB (RPaj=6,016; IC95% = 3,12 -11,56; p<0,001), enquanto pais mais velhos relataram melhor QVRSB (RPaj = 0,603; IC95% = 0,428-0,850; p = 0,004). A presen?a de c?rie precoce severa na inf?ncia teve um impacto negativo na QVRSB de crian?as pr?-escolares e de suas fam?lias

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Made available in DSpace on 2016-08-03T16:34:33Z (GMT). No. of bitstreams: 1 MILTON GOMES DA SILVA JUNIOR.pdf: 1109156 bytes, checksum: 8031afa39a2700c734e5433199769a02 (MD5) Previous issue date: 2006-08-24 / Any form of attention is continuously present in the human conscious activity, bringing implications and interests for both the clinical and Health Psychology areas. Attention is seen as a selective, intensive and directed state of perception. Within the sports context, there is much of attention field to be explored. The goal of this work was to test the goalkeepers attention by means of two experimental tasks. Our hypothesis was that the sports practice, specifically in goalkeepers because of their training, enhances their performance in tasks apart from the peculiar concept of the sport. What is more: it provides a performance enhancement, if it is due to the perceptive component of discrimination, to the temporal placement of attention or to the attention s maintenance for extended periods; in other words, it provides a higher capacity of concentration and less fatigability. We compared 27 soccer goalkeepers, between the ages of 15 and 27, divided by their time of practice. In this study, we used a computer commercial program, configured to the creation of attention tests (Stim, Neurosoft. Inc.), which controls all of aspects of the task. We correlated the reaction time and the percentage of rights with the length of the goalkeeping raining in months (along with the age). We divided the group of goalkeepers into two subgroups by means of the training time median. Despite the high correlation between training time and age, in our sample there was no significant correlation between age and performance in both of the tasks. The correlation between performance and training time was highly significant on task I. we did not verify the correlation between performance and training time on tasks II, despite the significant correlation between the performance on the two tasks. Correlation analyses between training time and performance were carried out on the tasks, separated by blocks. On task I, the correlation between training time and performance in each block was always significant; both in the parametric and non-parametric test. On task II, however, there was no significant correlation between training time and performance in any of the blocks. In the categorical analysis, which is an analysis of the two groups that were divided into two subgroups by means of the training time median, the difference in performance between the subgroups was significant only on task I, in the total sum of rights (T-test of independent samples; F=4.36, p=0.037) and in the rights within the two blocks (block 3 p=0.048; block 4 p=0.026). With training time, the enhancement of what differs them and the increase in fatigability condition tend to refine and reduce. The sports practice can indeed enhance the perceptive capacity and the attention s maintenance, which is the basis of the human discipline for the achievement of any task. Consequently, an affective and somatic increase, besides a cognitive intellectual increase, brings a real applicability in people s quality of life / Alguma forma de atenção está continuamente presente na atividade consciente humana, trazendo implicações e interesses tanto de cunho clínico quanto para a Psicologia da Saúde. A atenção é entendida como um estado seletivo, intensivo e dirigido da percepção. Dentro do contexto esportivo a muito da atenção para ser explorada. O objetivo neste trabalho foi testar a atenção de goleiros de futebol de campo através de duas tarefas experimentais. Nossas hipóteses foram que prática esportiva, especificamente em goleiros, e em função do seu treinamento, melhora seu desempenho em tarefas dissociativas do contexto peculiar ao esporte. E ainda; havendo melhora no desempenho, se é devida a componente perceptivo de discriminação, ao alocamento temporal de atenção, ou à sustentação da mesma por períodos prolongados, isto é, uma maior capacidade de concentração ou menos fadigabilidade. Comparamos 27 goleiros de futebol de campo, com idades entre 15 e 27 anos; separados por tempo de treino. Utilizamos neste estudo um programa comercial de computador, configurado para a criação de testes de atenção (Stim, Neurosoft. Inc); que controla todos os aspectos da tarefa. Correlacionamos tempo de reação e porcentagem de acertos com duração do treinamento dos goleiros em meses (e com a idade). Dividimos o grupo de goleiros em dois subgrupos, pela mediana de tempo de treinamento. Apesar da alta correlação entre tempo de treinamento e idade, inevitavelmente em nossa amostra, não houve correlação significativa entre idade e desempenho em ambas as tarefas. A correlação entre desempenho e tempo de treinamento foi altamente significativa na tarefa I. Não verificamos a correlação entre desempenho e tempo de treinamento na tarefa II, apesar da correlação significativa entre desempenhos nas duas tarefas. Foram feitas análises de correlações entre tempo de treinamento e desempenho nas tarefas separadas por blocos. Na tarefa I, a correlação entre tempo de treino e desempenho em cada bloco foi sempre significativa; tanto em teste paramétrico quanto em teste não paramétrico. Já na tarefa II não houve correlação significativa em tempo de treinamento e desempenho em qualquer dos blocos. Na análise categórica, ou seja, dos grupos divididos em dois subgrupos pela mediana de tempo de treinamento; a diferença de desempenho entre os subgrupos foi significativa apenas na tarefa I, no total de acertos (T- test de amostras independentes; F=4.36, p=0.037) e em acertos nos últimos dois blocos (bloco 3 p=0.048; bloco 4 p=0.026). Com o tempo de treinamento, a melhora no que diferenciar e o aumento na condição da fadigabilidade, tende a refinar e a diminuir. A prática esportiva pode de fato melhorar a capacidade perceptiva e a sustentação da atenção, que é à base da disciplina humana para realização de qualquer tarefa. Conseqüentemente, uma melhora afetiva e somática, além disso, uma melhora cognitiva e intelectual traz consigo uma aplicabilidade real na qualidade de vida das pessoas

This thesis deals with the research quality of life of students studying the Faculty of Philosophy University of South Bohemia in the České Budějovice. In the form of an email questionnaire survey were contacted 915 students during the academic year 2012/2013. The questionnaire was produced by Doc. MUDr. Tatianou Kimákovou, CSc., from The Department of Medicine, UPJŠP in Košice, as a pilot study for The Czech Republic. The investigation is focused on health, nutrition, smoking, consumption of alcohol, substance abuse and physical activities. The results are subject of the discussion and compared with JU research and investigation of SZÚ for Czech population.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The production and cultivation of native tree seedlings have difficulties that can be attended to through the knowledge of the environmental factors and microorganisms affecting seed germination, as well as the interaction between forest species and the Trichoderma, which is a genus of fungi used in plant pathogens biological control and promotion of plant growth. This study aimed to investigate the germination of Gochnatia polymorpha (Less.)Cabrera, identifying the fungi associated with diaspores and evaluate the effect of Trichoderma spp. in promoting germination and plant growth. In the study of seed germination, the seeds have been subjected to temperatures of 15°, 20°, 25° and 30° C with a photoperiod of 16 hours and continuous darkness. In another experiment the effect of sodium hypochlorite (NaClO) has been evaluated on seed germination and contamination of the seeds with and without Papus at concentrations of 0, 1, 2, 3 and 4%. Identification of fungi present in the diaspores has been performed by the methods of filter paper and plating on BDA culture medium. In the study of the interaction between G. polymorpha and Trichoderma spp. TSM1 and TSM2 isolates of Trichoderma viride, 2B2 and 2B22 of Trichoderma harzianum and two commercial products, Agrotrich® and Trichodermil®, have been analyzed in the contamination of and germination of the seeds, using the cellophane in vitro technique .The antagonism of these isolates to four fungi of the genera Bipolaris, Alternaria, Cladosporium and Phoma, previously isolated from diaspores, has been evaluated by the technique of direct confrontation. The ex vitro interaction experiments have been conducted in a greenhouse with autoclaved and not autoclaved substrates. It has been concluded that the seeds germinated both in the presence and absence of light and temperatures of 15° and 20° C have been the most appropriate. The tested concentrations of NaClO did not interfere with seed germination, but in diaspores with papus the lowest contamination rates have been in the concentrations of 0% and 4%; yet in the diaspores without papus, the lowest rates have been in the concentrations of 3, 4 and 0%. In the diaspores the fungi genera Bipolaris, Alternaria, Cladosporium, Phoma, Aspergillus and Epicoccum have been identified. By the technique of in vitro cellophane, all tested isolates of Trichoderma spp. have been effective in controlling the contamination of the seeds, but it has been not possible to assess the effect of Trichoderma spp. in seed germination. In direct confrontation technique, the 2B22 isolate and the product Agrotrich ® have been the most effective. In both autoclaved and not autoclaved substrates, the tested isolates did not interfere in seedling emergence, but the isolates of 2B2 and 2B22 of T. harzianum promoted the vegetative growth of G. polymorpha. / A produção e cultivo de mudas florestais nativas possuem dificuldades que podem ser atendidas através do conhecimento dos fatores ambientais e dos microrganismos que afetam a germinação das sementes, assim como, da interação entre espécies florestais e Trichoderma, que é um gênero de fungos utilizado no controle biológico de fitopatógenos e na promoção do crescimento vegetal. Este trabalho objetivou estudar a germinação das sementes de Gochnatia polymorpha (Less.) Cabrera, identificar os fungos associados aos diásporos e avaliar o efeito de Trichoderma spp. na promoção da germinação e do crescimento vegetal. No estudo da germinação das sementes, os diásporos foram submetidos às temperaturas de 15°, 20°, 25° e 30°C com fotoperíodo de 16 horas e escuro contínuo. Em outro experimento foi avaliado o efeito do hipoclorito de sódio (NaClO) na germinação das sementes e na contaminação dos diásporos com e sem papus, nas concentrações 0, 1, 2, 3 e 4%. A identificação dos fungos presentes nos diásporos foi realizada pelos métodos do papel de filtro e do plaqueamento em meio de cultura BDA. No estudo da interação entre G. polymorpha e Trichoderma spp. foram avaliados os isolados TSM1 e TSM2 de Trichoderma viride, 2B2 e 2B22 de Trichoderma harzianum e dois produtos comerciais, Agrotrich® e Trichodermil®, na contaminação dos diásporos e na germinação das sementes, através da técnica in vitro do papel celofane. O antagonismo de tais isolados a quatro fungos dos gêneros Bipolaris, Alternaria, Cladosporium e Phoma, previamente isolados dos diásporos, foi avaliado pela técnica de confrontação direta. Os experimentos de interação ex vitro foram realizados em casa de vegetação com substrato autoclavado e não autoclavado. Conclui-se que as sementes germinam tanto na presença quanto na ausência de luz, sendo que as temperaturas de 15° e 20°C são as mais adequadas. As concentrações de NaClO testadas não interferem na germinação das sementes, mas em diásporos com papus as menores médias de contaminação são nas concentrações 0% e 4%; já em diásporos sem papus, as menores médias são nas concentrações 3, 4 e 0%. Os gêneros fúngicos identificados nos diásporos são Bipolaris, Alternaria, Cladosporium, Phoma, Aspergillus e Epicoccum. Com a técnica in vitro do papel celofane, todos os isolados de Trichoderma spp. testados são eficientes no controle da contaminação dos diásporos, mas não é possível avaliar o efeito de Trichoderma spp. na germinação das sementes. Na técnica confrontação direta, o isolado 2B22 e o produto Agrotrich® são os mais eficientes. Tanto em substrato autoclavado quanto em não autoclavado, os isolados testados não interferem na emergência das plântulas, mas os isolados 2B2 e 2B22 de T. harzianum promovem o crescimento vegetativo de G. polymorpha.

Submitted by Caroline Falcao (caroline.rfalcao@ufpe.br) on 2017-06-05T16:43:39Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Cleiton Rodrigues DISSERTACAO.pdf: 2782017 bytes, checksum: 935d414b68c65e8f31ec74f933b497be (MD5) / Made available in DSpace on 2017-06-05T16:43:39Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Cleiton Rodrigues DISSERTACAO.pdf: 2782017 bytes, checksum: 935d414b68c65e8f31ec74f933b497be (MD5) Previous issue date: 2013-12-13 / Os estudos de avaliação dos serviços de saúde pública crescem a cada dia, investigando as prioridades para intervenção e planejando os recursos que contribuam para a qualidade do serviço oferecido. As ações de melhoria da saúde pública buscam acompanhar as mudanças no perfil demográfico e epidemiológico da população brasileira, formulando programas e políticas governamentais que atendam as necessidades de seus pacientes. Sendo assim, os estudos de avaliação dos serviços públicos de saúde devem articular uma série de relações, associando componentes do serviço e de infraestrutura, atividades produzidas e resultados de curto e longo prazo. Partindo desse pressuposto, este trabalho teve como objetivo propor uma metodologia que integre o Modelo de KANO com as perspectivas do Balanced Scorecard (BSC) para avaliação de um Programa de Saúde oferecido por um Hospital público da cidade de Recife. O Modelo de KANO serviu para categorizar os atributos mais relevantes dentro da unidade hospitalar e as perspectivas do BSC complementaram a avaliação, desdobrando as ações para o alcance da satisfação de seus stakeholders. A partir da distribuição dos atributos entre as perspectivas, foi possível constatar que a priorização das características: “Envolvimento dos Gestores da Alta Administração”, “Localização”, “Equipamentos conservados e modernos” e “Prontidão dos funcionários da Farmácia” exercem um maior impacto na satisfação dos clientes. A associação entre as ferramentas se revela útil para a orientação do Planejamento Estratégico e uma melhor compreensão dos gestores quanto aos aspectos que mais impactam na satisfação dos pacientes assistidos pelo Programa. / The studies of public health services grow every day, investigating the priorities of the intervention and planning the resources which contribute for the quality of the offered service. The actions of improvement of public health search to go with the changes in the demographic and epidemic profile of the Brazilian population, creating government programs and policies that provides the necessities of their patients and also provides a life quality improvement. That said, the evaluation studies of the public health services must speak clearly a series of relations, associating services and infrastructure components, activities produced and long time and short time results. Assuming that, this work had as objective propose a methodology that integrates the KANO’s Model with the Balanced Scorecard (BSC) perspectives, to evaluate a Health Program offered by a public Hospital in the city of Recife. The KANO’s Model acted to categorize the most relevant attributes inside the Hospital unity and the BSC perspectives complemented the evaluation, doing its utmost the actions to reach the satisfaction of the Stakeholders, where the focus was the patient. From the distribution of the attributes among the perspectives, it was possible to notice that the priority of the characteristics: “High Administration Manager’s Involvement”, “Localization”, “Modern and Conserved Equipment” and “Pharmacy Employees On Duty”, have a major impact on the client’s satisfaction. The association between those elements reveals useful for the Strategic Planning orientation and a better government comprehension about the most impacting aspects of the patients satisfaction assisted by the Program.

Health policy makers are struggling to manage health care and spending. To identify strategies for improving health quality and reducing health spending, policy makers need to first understand health risks and outcomes. Despite lacking some desirable clinical detail, existing health care databases, such as national health surveys and claims and enrollment data for insured populations, are often rich in information relating patient characteristics to heath risks and outcomes. They typically encompass more inclusive populations than can feasibly be achieved with new data collection and are valuable resources for informing health policy. This dissertation illustrates how the Medicare Current Beneficiary Survey (MCBS) and MassHealth data can be used to develop models that provide useful estimates of risks and health quality measures. It provides insights into: 1) the benefits of a proxy for the Framingham cardiovascular disease (CVD) risk score, that relies only on variables available in the MCBS, to target health interventions to policy-relevant subgroups, such as elderly Medicare beneficiaries, based on their risk of developing CVD, 2) the importance of setting appropriate risk-adjusted quality of care standards for accountable care organizations (ACOs) based on the characteristics of their enrolled members, and 3) the outsized effect of high- frequency hospital users on re-admission measures and possibly other quality measures. This work develops tools that can be used to identify and support care of vulnerable patients to both improve their health outcomes and reduce spending – an important step on the road to health equity.

Objective: Self-stigma in overweight and obese individuals has strong associations with impairment in mental and global health. This study sought to explore self-compassion as a psychological resource in the self-stigma process. Methods: In a 2012 representative German population survey of N = 1,158 overweight and obese individuals, self-compassion was examined as a mediator between self-stigma and mental and physical health outcomes, including BMI (kg/m 2 ), using structural equation modeling and controlling for sociodemographic factors. Results: Psychological variables were assessed using validated self-report questionnaires. Self-compassion partially mediated the relationships between self-stigma and depression, somatic symptoms, and health status / quality of life, lowering the predictive effect of self-stigma on the outcomes by approximately one-third. In contrast, self-compassion, because it was unrelated to BMI, did not mediate the association between self-stigma and BMI. Conclusion: Self-compassion has the potential to act as a buffer against the mental and global health detriments of self-stigma in overweight and obesity and could thus represent a target for interventions to reduce self-stigma and prevent these health impairments. In order to influence the association between self-stigma and BMI, self-compassion should conceptually be linked to weight management.