Health organizations and governments are investing considerable resources into Internet-based health promotion. There is a large and growing body of research on health “etools” but to date most has been conducted using experimental paradigms; much less is known about those that are freely-available. Analysis was conducted of the data base generated through the operation of the freely-available health risk assessment (HRA) of the Heart and Stroke Foundation of Ontario. During the study period of February 1 to December 20, 2011, 147,274 HRAs were completed, of which 120,510 (79.8%) included consent for the use of information for research and were completed by adults aged 18 to 90 years. Comparison of Canadian users to national statistics confirmed that the HRA sample is not representative of the general population. The HRA sample is significantly and systematically biased by gender, education, employment, heath behaviours, and the prevalence of specific chronic diseases. Etool users may be a large but select segment of the population, those previously described as “Internet health information seekers.” Are all Internet health information seekers the same? To explore this issue, segmentation procedures available in common commercial packages (k-means clustering, two-step clustering, and latent class analysis) were conducted using five combinations of variables. Ten statistically significant solutions were created. The most robust solution divided the sample into four groups differentiated by age (two younger and two older groups) and healthiness, as reflected by disease and modifiable risk factor burden and readiness to make lifestyle changes. These groups suggest that while all users of online health etools may be health information seekers, they vary in the extent to which they are health oriented or health conscientious (i.e., engaging in preventive health behaviours or ready for behaviour change). It is hoped that this research will provide other organizations with similar data bases with a model for analyzing their client populations, therefore increasing our knowledge about health etool users.

Electrical power systems play a key role in production and services in both the industrial and commercial sectors and significantly affect the private lives of citizens. A major asset of any power delivery system is the transformer. Transformers represent extensive investment in any power delivery system, and because of the notable effect of a transformer outage on system reliability, careful management of this type of asset is critical. In North America, a large proportion of transformers is approaching the end of their life and should be replaced. In many cases, unexpected transformer outages can be catastrophic and cause both direct and indirect costs to be incurred by industrial, commercial, and residential sectors. Direct costs include but are not limited to loss of production, idle facilities and labour, damaged or spoiled product, and damage to equipment. For commercial customers, the effects may include damage to electrical and electronic equipment, and in some cases damage to goods. For residential customers, outages may cause food spoilage or damage to electrical equipment. In addition to direct costs, there are several types of indirect costs may also result, such as accidental injuries, looting, vandalism, legal costs, and increases in insurance rates. The main goal of this research was to assess the health and remaining lifetime of a working transformer. This information plays a very important role in the planning strategies of power delivery systems and in the avoidance of the potentially appalling effects of unexpected transformer outages. This thesis presents two different methods of assessing transformer end of life and three distinct methods of determining the health index and health condition of any working transformer. The first method of assessing transformer end of life is based on the use of Monte Carlo technique to simulate the thermal life of the solid insulation in a transformer, the failure of which is the main reason for transformer breakdown. The method developed uses the monthly average ambient temperature and the monthly solar clearness index along with their associated uncertainties in order to estimate the hourly ambient temperature. The average daily load curve and the associated uncertainties in each hourly load are then used to model the transformer load. The inherent uncertainties in the transformer loading and the ambient temperature are used to generate an artificial history of the life of the transformer, which becomes the basis for appraising its remaining lifetime. The second method of assessing transformer end of life is essentially an economic evaluation of the remaining time to the replacement of the transformer, taking into consideration its technical aspects. This method relies on the fact that a transformer fails more frequently during the wear-out period, thus incurring additional maintenance and repair costs. As well, frequent failures increase during this period also costs related to transformer interruptions. Replacing a transformer before it is physically damaged is therefore a wise decision. The bathtub failure model is used to represent the technical aspects of the transformer for the purposes of making the replacement decision. The uncertainties related to the time-to-failure, time-to-repair, time-to-switch, and scheduled maintenance time are modeled using a Monte Carlo simulation technique, which enables the calculation of the repair costs and the cost of interruptions. The repair, operation, and interruption costs are then used to generate equivalent uniform annual costs (EUACs) for the existing transformer and for a new transformer, a comparison of which enables the determination of the most economical replacement year. The case studies conducted using both methods demonstrate their reliability for determining transformer end of life for assessing the appropriate time for replacement. Diagnostic test data for 90 working transformers were used to develop three methods of estimating the health condition of a transformer, which utilities and industries can use in order to assess the health of their transformer fleet. The first method is based on building a linear relation between all parameters of diagnostic data in order to determine a transformer health index, from which the health condition of the transformer can be evaluated. The second method depends on the use of artificial neural networks (ANN) in order to find the health condition of any individual transformer. The diagnostic data for the 90 working transformers together with the health indices calculated for them by means of a specialized transformer asset management and health assessment lab, were used to train an ANN. After the training, the ANN can estimate a health index for any transformer, which can be used in order to determine the health condition of the transformer. The third method is based on finding a relation between the input data and the given health indices (calculated by the specialized transformer asset management and health assessment lab) using the least squares method. This relation then can be used to find the health index and health condition of any working transformer. The health condition determined based on these methods shows excellent correlation with the given health condition calculated by the specialized transformer asset management and health assessment lab.

Electrical power systems play a key role in production and services in both the industrial and commercial sectors and significantly affect the private lives of citizens. A major asset of any power delivery system is the transformer. Transformers represent extensive investment in any power delivery system, and because of the notable effect of a transformer outage on system reliability, careful management of this type of asset is critical. In North America, a large proportion of transformers is approaching the end of their life and should be replaced. In many cases, unexpected transformer outages can be catastrophic and cause both direct and indirect costs to be incurred by industrial, commercial, and residential sectors. Direct costs include but are not limited to loss of production, idle facilities and labour, damaged or spoiled product, and damage to equipment. For commercial customers, the effects may include damage to electrical and electronic equipment, and in some cases damage to goods. For residential customers, outages may cause food spoilage or damage to electrical equipment. In addition to direct costs, there are several types of indirect costs may also result, such as accidental injuries, looting, vandalism, legal costs, and increases in insurance rates. The main goal of this research was to assess the health and remaining lifetime of a working transformer. This information plays a very important role in the planning strategies of power delivery systems and in the avoidance of the potentially appalling effects of unexpected transformer outages. This thesis presents two different methods of assessing transformer end of life and three distinct methods of determining the health index and health condition of any working transformer. The first method of assessing transformer end of life is based on the use of Monte Carlo technique to simulate the thermal life of the solid insulation in a transformer, the failure of which is the main reason for transformer breakdown. The method developed uses the monthly average ambient temperature and the monthly solar clearness index along with their associated uncertainties in order to estimate the hourly ambient temperature. The average daily load curve and the associated uncertainties in each hourly load are then used to model the transformer load. The inherent uncertainties in the transformer loading and the ambient temperature are used to generate an artificial history of the life of the transformer, which becomes the basis for appraising its remaining lifetime. The second method of assessing transformer end of life is essentially an economic evaluation of the remaining time to the replacement of the transformer, taking into consideration its technical aspects. This method relies on the fact that a transformer fails more frequently during the wear-out period, thus incurring additional maintenance and repair costs. As well, frequent failures increase during this period also costs related to transformer interruptions. Replacing a transformer before it is physically damaged is therefore a wise decision. The bathtub failure model is used to represent the technical aspects of the transformer for the purposes of making the replacement decision. The uncertainties related to the time-to-failure, time-to-repair, time-to-switch, and scheduled maintenance time are modeled using a Monte Carlo simulation technique, which enables the calculation of the repair costs and the cost of interruptions. The repair, operation, and interruption costs are then used to generate equivalent uniform annual costs (EUACs) for the existing transformer and for a new transformer, a comparison of which enables the determination of the most economical replacement year. The case studies conducted using both methods demonstrate their reliability for determining transformer end of life for assessing the appropriate time for replacement. Diagnostic test data for 90 working transformers were used to develop three methods of estimating the health condition of a transformer, which utilities and industries can use in order to assess the health of their transformer fleet. The first method is based on building a linear relation between all parameters of diagnostic data in order to determine a transformer health index, from which the health condition of the transformer can be evaluated. The second method depends on the use of artificial neural networks (ANN) in order to find the health condition of any individual transformer. The diagnostic data for the 90 working transformers together with the health indices calculated for them by means of a specialized transformer asset management and health assessment lab, were used to train an ANN. After the training, the ANN can estimate a health index for any transformer, which can be used in order to determine the health condition of the transformer. The third method is based on finding a relation between the input data and the given health indices (calculated by the specialized transformer asset management and health assessment lab) using the least squares method. This relation then can be used to find the health index and health condition of any working transformer. The health condition determined based on these methods shows excellent correlation with the given health condition calculated by the specialized transformer asset management and health assessment lab.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A avaliaÃÃo do impacto de intervenÃÃes educativas surge para identificar a efetividade de programas, softwares, curso e treinamentos que envolvam profissionais e sujeitos com necessidades de capacitaÃÃo. O curso Ãlcera por PressÃo Online, utilizado nesta tese, trata-se de uma tecnologia de informaÃÃo e comunicaÃÃo desenvolvida para capacitar profissionais de enfermagem sobre a prevenÃÃo e tratamento de Ãlcera por pressÃo (UP) em pacientes nas diversas esferas de cuidado. A UP, alÃm de ser um problema de saÃde pÃblica mundial, provoca a realizaÃÃo de estudos que buscam formas de minimizar esse problema, alÃm de ser um indicador de qualidade da assistÃncia de enfermagem adotado em instituiÃÃes de saÃde. Foi objetivo desta tese avaliar o impacto de uma intervenÃÃo educativa a partir de uma tecnologia de informaÃÃo e comunicaÃÃo sobre prevenÃÃo e tratamento de UP em uma unidade de terapia intensiva de um hospital universitÃrio de Fortaleza/CE. Trata-se de um estudo quase experimental, com abordagem antes e depois, realizado no perÃodo de setembro de 2011 a junho de 2012. Participaram da pesquisa 94 pacientes (47 antes e 47 depois) e nove enfermeiras do setor. O estudo foi dividido em trÃs fases: prÃ-intervenÃÃo, intervenÃÃo e pÃs-intervenÃÃo. Foram utilizados para coleta de dados formulÃrios com variÃveis clÃnicas e sociais dos pacientes; dados referentes à assistÃncia de enfermagem na prevenÃÃo e tratamento de UP; a escala de avaliaÃÃo de risco de Braden; questionÃrio com variÃveis sociais das enfermeiras; e o questionÃrio de avaliaÃÃo de conhecimento sobre UP de Pieper e Mott (1995). Os dados foram organizados no Programa Excel e analisado no Programa estatÃstico SAS, com a utilizaÃÃo dos Testes t de Student, Exato de Fisher, Qui-quadrado corrigido de Yates, T de Wilcoxon e U de Wilcoxon-Mann-Whitney para anÃlise estatÃstica. A pesquisa obteve a aprovaÃÃo do Comità de Ãtica em Pesquisa da instituiÃÃo com protocolo n 098.09.11. Os resultados apontaram similaridade entre os grupos prà e pÃs-intervenÃÃo em relaÃÃo Ãs caracterÃsticas sociais e fatores clÃnicos avaliados (p&#706;0,05), exceto no item readmissÃo que sà esteve presente na primeira fase. A avaliaÃÃo de risco, a descriÃÃo da pele e a descriÃÃo de medidas preventivas apresentaram melhor porcentagem no grupo pÃs-intervenÃÃo, mas sem diferenÃa estatisticamente significante (p=0,839; p=0,865; p=0,723, respectivamente). A maioria dos pacientes do grupo prÃ-intervenÃÃo (53,19%) apresentou UP; essa superioridade tambÃm ocorreu em relaÃÃo à presenÃa de UP na admissÃo na UTI, com diferenÃa significante em relaÃÃo ao grupo pÃs-intervenÃÃo (p=0,046). A prevalÃncia de UP na UTI diminuiu de 36,23% para 27,36%; e a incidÃncia de 31,91% para 19,14% depois da intervenÃÃo educativa. A maioria dos pacientes do grupo prÃ-intervenÃÃo apresentou risco elevado de desenvolver UP (57,44%) e o grupo pÃs-intervenÃÃo, risco moderado (51,06%). Entre as nove enfermeiras, a maioria jà tinha realizado curso sobre UP (55,56%) e curso na modalidade EAD (55,56%). O nÃmero de acertos de questÃes sobre prevenÃÃo foi superior no grupo pÃs-intervenÃÃo com 81,93%, sendo tambÃm esse grupo o que apresentou maior porcentagem de acertos nas questÃes relacionadas ao estadiamento da UP (93,20%). A diferenÃa no nÃmero de acertos e de pontos entre os grupos apresentou diferenÃa significante (p&#706;0,05). Concluiu-se que a intervenÃÃo educativa gerou impacto na diminuiÃÃo da prevalÃncia e incidÃncia de lesÃes na UTI e na aquisiÃÃo de conhecimento das enfermeiras, principalmente, relacionado ao estadiamento das lesÃes. / Educational interventions impact assessment appears to identify the effectiveness of programs, software, courses and trainings that involve professionals and individuals who present capacity needs. The Pressure Ulcer Online Course used in this thesis is an information and communication technology (ICT) developed to qualify nursing professionals to prevent and treat Pressure Ulcer (PU) in patients in all care situations. The PU, besides being a worldwide health problem, assembles studies that search ways of minimizing this problem, and it is a quality nursing assistance indicator adopted by health institutions. The objective of this thesis was to evaluate the impact of an educational intervention using an information and communication technology on prevention and treatment of pressure ulcer at an Intensive Care Unit of a Teaching Hospital in Fortaleza/CE. This is a quasi-experimental study with a before and after approach carried out from September 2011 to June 2012. 94 patients (47 patients before and 47 patients after) and 09 nurses from the ICU have participated in the research. The study has been divided into three phases: pre-intervention, intervention, and post-intervention. In order to collect data, we used questionnaires for patientsâ social and clinic variables; data regarding nursing assistance for PU prevention and treatment; Braden scale for assessing pressure ulcer risk; questionnaire for nursesâ social variables; and the Pieperâs and Mottâs (1995) questionnaires to evaluate the nursesâ knowledge of PU. Data was organized using Microsoft Excel and analyzed using the Statistic Software SAS. Statistical analyses were carried out using the Studentâs t-test, Fisherâs Exact test, and Yatesâ corrected Chi-square test, Wilcoxon T test, and Wicoxon-Mann-Whitney U test. The ethical committee of the institution has approved this research under protocol number 098.09.11. Results have pointed out similarity between the pre and post-intervention groups regarding social characteristics and clinical factors (p&#706;0.05) that have been analyzed, excepting the readmission item, which was present only in the first phase. Risk assessment, skin description and prevention measures description have shown better percentage in the post-intervention group, but there was no statistically significant difference (p=0.839; p=0.865; p=0.723, respectively). Most patients from the pre-intervention group (53.19%) have presented PU; this superiority has also happen regarding PU presence at the patientâs admission to hospital with significant difference related to the post-intervention group. PU prevalence at the IUC has decreased from 36.23% to 27.36% and incidence has reduced from 31.91% to 19.14 after the educational intervention. Most patients from the pre-intervention group have presented high risk for developing PU (57.44%) and the post-intervention group has present moderate risk (51.06%). Most of the nine nurses have already taken a course on PU (55.56%) and an online course (55.56%). Number of correct answers about prevention was higher in the post-intervention group, which showed a percentage of 81.93% correct answers. This group was also the one presenting the greatest percentage in questions about PU staging (93.20%). Difference on the number of correct answers and points between the groups have presented significant difference (p<0.05). We concluded that the educational intervention has impacted on the decrease of lesions prevalence and incidence at the IUC and on the nurses knowledge acquisition, mainly, regarding lesions staging.

No description available.

Wetlands are significant contributors to global biodiversity, supporting disproportionately high numbers of species relative to their area. Riparian areas associated with wetlands provide many services that are both ecologically and economically important, such as groundwater recharge, sediment capture and shoreline stabilization, flood mitigation, nutrient processing, increased water quality, carbon sequestration, and essential habitat for wildlife. Agricultural activity has resulted in the drainage or modification of between 40-70% of wetland basins within the Prairie Pothole Region of the northern Great Plains. The impacts of human activity on the remaining wetlands are difficult to estimate and there is no one optimal indicator or assessment method that is applicable to all regions or situations. Locally developed riparian health assessments, designed to evaluate wetland function under different grazing regimes, are cost-effective with the potential for broader use in wetland environmental assessment, monitoring, and management or restoration activities. In this study I investigated the hypothesis that riparian health assessments can distinguish between wetlands in five categories of land use that represent different levels of anthropogenic modification: ungrazed cultivated cropland, ungrazed native grassland, grazed native grassland, ungrazed tame perennial forage, and grazed tame perennial forage. Noting that current riparian health assessment protocols lack a community composition component other than the presence and distribution of invasive and disturbance species, I also sampled plant species frequency at each of my study sites. I found that wetlands in cultivated croplands had significantly lower riparian health scores than wetlands in both tame and native grasslands. Among tame and native sites, grazing status was more important than upland cover type in determining wetland health, with grazed wetlands receiving significantly lower scores than their ungrazed counterparts. Despite their functional similarity to wetlands within native grasslands, species composition of wetlands within ungrazed tame perennial forage more closely resembled that of wetlands in cultivated uplands. Although grazing negatively affected riparian ground cover and soil stability, it significantly reduced both the overall cover and distribution of invasive plant species along wetland reaches. These results suggest that upland revegetation and restoration of function to degraded wetlands is not necessarily followed by re-establishment of original riparian species composition. If biodiversity is a desired outcome of wetland restoration efforts, additional measures must be taken to enable the establishment and persistence of preferred plant species.

A novel system identification (SI)-based structural health assessment (SHA) procedure has been developed integrating several theoretical and implementation aspects. The procedure assesses health of structures using limited noise-contaminated dynamic responses and without using input excitation information. Since most practical structures are three dimensional (3D), the procedure has been developed for general 3D structures, represented by finite elements (FEs). The procedure identifies defects by tracking the changes in the stiffness of the elements in the FE representation. Once a defective element is identified, defect spot can be identified accurately within the defective element. The procedure is denoted as 3D Generalized Iterative Least-Squares Extended Kalman Filter with Unknown Input (3D GILS-EKF-UI) and implemented in two stages. In Stage 1, based on the available responses, substructure(s) are selected and the 3D GILS-UI procedure is used to generate the unknown input excitation, stiffness parameters of the elements in the substructure, and two Rayleigh damping coefficients. Using information from Stage 1, stiffness parameters for the whole structure are identified using EKF with Weighted Global Iteration (EKF-WGI) in Stage 2. The procedure accurately identified defect-free and defective states of various 3D structures using only analytically generated limited responses. To increase the robustness, 3D GILS-EKF-UI has been extended to develop an integrated structural health assessment strategy, denoted as Iterative Least-Squares Extended Kalman Filter with Unknown Input and Advanced Digital Integration Technique (ILS-EKF-UI-ADIT). The procedure has been implemented in three stages. In Stage 1, an advanced digital integration technique (ADIT) is implemented for post-processing of noise-contaminated acceleration time-histories, addressing all major challenges of digital integration. It also overcomes non-convergence issue in Stage 2 that arises due to phase-shift and amplitude errors. In Stage 2, substructure(s) are identified using the least-squares procedure. In Stage 3, stiffness parameters for the whole structure are identified using the EKF-WGI procedure. ILS-EKF-UI-ADIT has been verified in presence of relatively large noise in the acceleration time-histories, measured at small part(s) of defect-free and defective structures, without using excitation information. The SHA procedure is robust and has the potential to be applied for the health assessment, maintenance, retrofitting, and life extension of existing structural systems.

Purpose: To conduct a secondary analysis of survey data collected at a large, urban university assessing for change in students' alcohol use perceptions and behaviors between 2002 and 2004. After the baseline data collection in 2002, the campus launched an intensive media intervention to normalize low-risk drinking. Simultaneously, the campus shifted from being a primarily commuter to primarily residential. Methods: This cross-sectional analysis used data collected from students in randomly selected undergraduate classes in February 2002 (n= 662) and 2004 (n=1334). The survey instrument used was the National College Health Assessment. Variables were categorized as demographic, alcohol perception, and alcohol related behavior. Because the media intervention targeted undergraduate students, decisions were made to limit analysis to traditional undergraduate students and to eliminate extreme self-reported drinking outliers by only including 18-24 year old undergraduates and those who reported drinking 25 or fewer drinks per sitting. Frequency tables were used to assess patterns. Independent samples t-tests and Pearson correlation coefficients were also calculated. Results: Consistent with the literature review, this study confirmed the existence of alcohol use misperceptions. The percent of the sample reporting accurate low-risk use perceptions increased. Despite correcting misperceptions, this study failed to document a decrease in high risk alcohol use and harm. Independent samples t-tests calculations revealed a statistically significant change in perception (t=6.49; pConclusions: This study adds to the body of literature that documents misperceptions are positively correlated with heavy drinking. The review of the literature also suggests that residential campuses have higher consumption rates than commuter campuses. In light of the 25% increase in residence hall space that occurred at this campus, one might have predicted that alcohol consumption should have increased. It is possible that no change was beneficial change. The planning and implementation phases of social norms campaigns on college and university campuses must take into account changes to the campus environment and changes in the student population demographics.

O estudo objetivou avaliar as características organizacionais e de desempenho dos serviços de saúde no acesso dos doentes para o tratamento da tuberculose no município de Campina Grande PB. Método: pesquisa avaliativa, de abordagem quantitativa que utilizou o desenho de estudo seccional ou transversal, tendo como quadro teórico as dimensões da Atenção Primária em Saúde, proposta por Starfield (2002). Para coleta de dados foi utilizado um instrumento Primary Care Assessment Tool (PCAT), elaborado por Starfield (2000). Adaptado e validado para o Brasil por Almeida e Macinko (2006). Adaptado para a atenção à tuberculose por Villa e Ruffino-Netto (2006). Participaram do estudo 106 doentes que receberam tratamento da TB no período de julho/2006 a agosto/2007. A análise de dados foi realizada em quatro etapas: caracterização dos sujeitos do estudo, análise de freqüência, construção de indicadores e análise de variância, análise de confiabilidade do questionário. Resultados: dos 106 doentes, 83,96% realizaram tratamento auto-administrado e 16,03%, tratamento supervisionado (TS); 42,45% são do sexo feminino e 57,54% do sexo masculino, com 20,75% sem escolaridade e 57,54% com baixa escolaridade. Quanto à variável durante o tratamento faltou medicamento para a TB, os valores médios para os indicadores do PSF/PACS foi de 4,71 e desvio-padrão, dp = 0,58 e para AMBRF média de 4,95 e dp de 0,25 configurando que as médias de respostas se encontram muito próximas ao escore 5 que corresponde à categoria nunca. Não foram observados diferenças entre os indicadores das diferentes unidades PSF/PACS e AMBRF. Para a variável conseguiram consulta no prazo de 24 horas as médias obtidas pelos indicadores das unidades PSF/PACS (4,34) e AMBRF (3,86) não foram consideradas significativamente diferentes. Com relação a perder o turno de trabalho ou compromisso para consultar os dados mostram que as médias obtidas pelos indicadores das unidades PSF/PACS (3,12) e AMBRF (2,59) não foram considerados estatisticamente significantes. Para a variável aguardar mais que 60 minutos para o atendimento, os indicadores das unidades PSF/PACS (3,34) e AMBRF (2,97), não foram considerados estatisticamente significantes. Quanto às variáveis doentes de TB necessitam utilizar transporte motorizado para consultar, pagar pelo transporte e fazer tratamento perto da sua casa, os indicadores utilizar transporte motorizado PSF/PACS (4,68) e AMBRF (1,31), pagar pelo transporte para consultar PSF/PACS (4,68) e AMBRF (1,73), fazer tratamento perto de casa PSF/PACS (4,43) e AMBRF (1,13) foram considerados estatisticamente significantes. Para a variável visita domiciliar, os indicadores visita domiciliar PSF/PACS (2,53) e AMBRF (1,19) foram considerados estatisticamente significantes. Os coeficientes do Alpha de Cronbach não padronizados e padronizados foram, respectivamente, 0,7275 e 0,7075, com base nos 8 (oito) itens do questionário. Conclusão: Apesar do município ter 85 equipes de PSF, o TS foi incorporado ou assumido apenas por uma pequena fração dos profissionais das equipes do PSF como uma estratégia de tratamento. Embora o tratamento da TB seja disponibilizado pelo serviço público de saúde, ainda representa um custo econômico para o doente de TB em função da necessidade de deslocamento até o serviço de saúde, bem como a perda do turno de trabalho para ser consultado / The aim of the present study was to assess the performance and organizational characteristics of health services providers in terms of patients access to tuberculosis treatment in Campina Grande, PB. Method: It is a, transversal, or cross sectional evaluation-like study using a quantitative approach based on Starfields (2002) theory on the dimensions of Health Primary Care. An instrument designed by Starfield (Primary Care Assessment Tool), which was later adapted and validated for use in Brazil by Almeida and Macinko (2006) was used for data collection. The same tool was then adapted by Villa and Ruffino Netto (2006) to be used for TB attention. One hundred and six patients who received TB treatment from July 2006 to August 2007 participated in the study. Data analysis was performed in four steps: characterization of the participants of the study; frequency analysis; construction of indicators and variance analysis; and questionnaire confidence analysis. Results: Out of one hundred and six patients, 83.9% received self-administered treatment and 16% received supervised treatment; 42.45% of the patients were female and 57.54% were male; 20.75% had no education and 57.54% had low educational levels. In relation to the variable no TB medication available during treatment the mean values for PSF/PACS indicators were 4.71 and the deviation pattern was dp = 0.58 and for AMBRF indicators the mean values were 4.95 and the deviation pattern was 0.25 , meaning that the answers averages were close to score 5.0, which corresponded to the category never. No differences between the different PSF/PACS and AMBRF units indicators were found. As for the variable got an appointment in twenty four hours, the averages obtained from the PSF/PACS (4.34) and AMBRF (3.86) indicators were not considered significantly different. In relation to missing a work shift due to the medical appointment data show that the averages obtained from the PSF/PACS (3.12) and AMBRF (2.59) were not statistically significant. Regarding the variables Tb patients have to use motor vehicle, pay for transportation, and receive treatment near their homes, the indicators use motor vehicle (PSF/PACS=4.68 and AMBRF = 1.31), pay for transportation (PSF/PACS = 4.68 and AMBRF =1.73), and receive treatment near their homes (PSF/PACS = 4.43 and AMBRF= 1.13) were considered statistically significant. In relation to the variable home visit, indicators both from the PSF/PACS units (2.53) and AMBRF (1.19) were considered statistically significant. Standardized and non-standardized Chronbachs Alpha coefficients based on the eight items in the questionnaire were 0.7275 and 0.7075, respectively. Conclusion: Although the city has eighty five PSF health teams, only a mall number of health professionals have actually incorporated ST as a treatment strategy. Besides, even though TB treatment is available in the public health services providers it still represents an economic cost to the TB patient because they have to use motor vehicle transportation and miss a work shift in order to go to the health units

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.