Um dos problemas que afetam as cidades brasileiras é a falta de uma metodologia adequada para a implantação de equipamentos coletivos públicos (escolas, postos de saúde, entre outros), e da utilização de modo racional desses equipamentos. Esse foi o ponto de partida para esse trabalho, cujo objetivo principal foi desenvolver uma ferramenta de análise espacial para auxiliar o poder público no planejamento e na gestão dos serviços públicos de educação e saúde, no que concerne basicamente à melhor localização das unidades básicas de atendimento e à melhor distribuição dos usuários por essas unidades, buscando reduzir os custos de transporte. Após uma avaliação da atual política de distribuição e utilização dos equipamentos coletivos de educação e saúde no Brasil e no mundo, foi realizada uma análise dos conceitos relativos às ferramentas de apoio a problemas de decisão de caráter espacial, particularmente os Sistemas de Apoio à Decisão Espacial (SADE). De posse dessa base conceitual, buscou-se formular as bases de um sistema (ou uma metodologia) que apoiasse a implantação de novos equipamentos coletivos e uma utilização eficiente dos equipamentos já existentes, tendo como parâmetro principal de comparação o custo de deslocamento dos usuários. Esse sistema deveria ser adequado à realidade das cidades médias brasileiras, de maneira geral hoje inseridas num cenário de falta de planejamento e de ausência de bases de dados estruturadas (e atualizadas). Ainda, como proposta adicional, procurou-se incorporar como ferramentas de apoio ao sistema algumas técnicas emergentes que, embora relativamente pouco utilizadas no planejamento urbano até o presente momento, apresentam grande potencial para tal. São elas: os Autômatos Celulares (ou CA, Cellular Automata) e as Redes Neurais Artificiais (RNA). Os fundamentos do sistema concebido foram transpostos para uma aplicação prática desenvolvida em um Sistema de Informações Geográficas (SIG) através de um estudo de caso conduzido na cidade de São Carlos (SP), cujos resultados demonstraram que quando se pensa em otimizar os custos de deslocamento, a principal ação a ser empreendida é a redistribuição da demanda às unidades de oferta, antes de se pensar na abertura de novas unidades. Mais importante do que os resultados numéricos obtidos, foi a confirmação de que é possível se utilizar as diversas ferramentas de planejamento e gestão de modo integrado. A partir dessa metodologia, um investimento em desenvolvimento de software pode levar à construção de um efetivo Sistema de Apoio à Decisão Espacial. De maneira mais geral, pode-se afirmar que a obtenção de dados é o grande obstáculo para pesquisas dessa natureza. A montagem de uma base de dados sólida e confiável é, sem dúvida, o ponto crucial para a execução de projetos potencialmente bem sucedidos / One of the main problems faced by brazilian cities is the lack of adequate methodologies for the implementation and rational use of public service facilities (such as schools and health care centers). That was the starting point in the definition of the main objective of the present work, which is the development of a spatial analysis tool for seeking an optimal arrangement of primary health and education facilities, in order to reduce transportation costs. The use of such a tool in the public administration is important not only for planning but also for management purposes. The study starts with an investigation of approaches that have been used in real cases, in cities of different countries, to define health and education facility types and their distribution. A careful analysis of location-allocation concepts and analysis tools for the solution of spatial problems, with particular emphasis on the Spatial Decision Support Systems (SDSS), was also conducted. The system (or methodology) proposed, which was meant to support the process of location of new facilities and also an efficient use of the existing ones while reducing transportation costs, was based on that conceptual framework. The system was directed to the context of brazilian medium-sized cities, where planning concepts are not widely applied and even the databases available are sometimes very limited and frequently outdated. The system design looked for both traditional and innovative approaches and computer-based techniques, such as Cellular Automata (CA) and Artificial Neural Networks (ANN). These techniques, although not yet extensively applied in urban planning and management, seem to be promising alternatives for those activities. The integration of the different tools and techniques was tested in a practical application carried out in the city of São Carlos (SP) and developed in a Geographic Information System (GIS) environment. The results drawn from the application are clear: the main action to reduce the transportation costs in the case studied was a re-distribution of the demand. It was considerable, despite the fact that not a single facility has been added. Another important outcome of the research was the confirmation of the hypothesis that the distinct planning and management tools tested could be used in an integrated approach. Therefore, the methodology discussed here could effectively become a Spatial Decision Support System only by means of software development for building the system interfaces. As a general conclusion, the data gathering problems still seem to be the main barrier for research development in this area. Consequently, the construction of solid and reliable databases is undoubtedly a key point to start any potentially successful project

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-11-09T10:24:20Z No. of bitstreams: 1 Augusto Sanches Viodres.pdf: 940983 bytes, checksum: 7e48e8a9ed9a1bd29fb3f172c49b9be5 (MD5) / Made available in DSpace on 2018-11-09T10:24:20Z (GMT). No. of bitstreams: 1 Augusto Sanches Viodres.pdf: 940983 bytes, checksum: 7e48e8a9ed9a1bd29fb3f172c49b9be5 (MD5) Previous issue date: 2018-09-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / From the perspective of health care training in the context of the brazilian Unified Health System and the wide range of actions in this field, the researcher takes the perspective of the experience of the subject who is ethically, politically and clinically trained through his own encounter with the health service and the work. On this encounter, health practices and practices of subjectivation are produced at once, that is, new health care approaches, new ways to produce sense, to relating to oneself and others. In order to analyze and reflect on these elements, i closely followed, as a worker-researcher, an integration action between a teaching institution and a health service: a medical school partnership with a Basic Health Unit that annually receives students as interns, accompanying some of the daily actions of the work in public and collective health. Two paths were followed: the construction of a field diary describing and analyzing this experience, in which I aimed to contextualize the ways in which Unified Health System training experiences are constructed; and the conduction of two interviews on the training itineraries of professionals involved in this practice of teaching-service integration, with the intention of illustrating and discussing the process of health care training as a field of meetings and production of subjectivity / A partir da perspectiva de formação no Sistema Único de Saúde (SUS) e a ampla gama de ações neste sentido, toma-se como norte nesta pesquisa a experiência do sujeito que se forma – eticamente, politicamente, clinicamente – por meio de seu próprio encontro com o serviço de saúde e com o trabalho em saúde. Neste encontro se produzem ao mesmo tempo práticas de saúde e práticas de subjetivação, isto é, novas maneiras de cuidar em saúde e novas maneiras de atribuir sentido, experimentar, se relacionar consigo mesmo e com os outros. Para analisar e refletir sobre esses elementos, acompanhei de perto, enquanto trabalhador-pesquisador, uma ação de integração entre instituição de ensino e serviço de saúde: parceria de uma faculdade de medicina com uma Unidade Básica de Saúde (UBS) que recebe anualmente estudantes em estágio, acompanhando algumas das ações cotidianas do trabalho na saúde pública e coletiva. Disso seguiram dois caminhos: a construção de um diário de campo que descreve e analisa essa experiência, em que objetivei contextualizar os modos pelos quais se constroem experiências de formação em serviço no SUS; a realização de duas entrevistas narrativas sobre itinerários de formação de profissionais envolvidos nessa prática de integração ensino-serviço, com a intenção de apresentar e discutir alguns elementos do processo de formação em saúde enquanto campo de encontros e produção de subjetividade

Submitted by Joana Azevedo (joanad@id.uff.br) on 2017-08-10T17:26:17Z No. of bitstreams: 1 Dissert Rodrigo Pegado.pdf: 1005553 bytes, checksum: e5130b8bb2a22a366f2e0533d79ceacc (MD5) / Approved for entry into archive by Biblioteca da Escola de Engenharia (bee@ndc.uff.br) on 2017-08-24T14:59:52Z (GMT) No. of bitstreams: 1 Dissert Rodrigo Pegado.pdf: 1005553 bytes, checksum: e5130b8bb2a22a366f2e0533d79ceacc (MD5) / Made available in DSpace on 2017-08-24T14:59:52Z (GMT). No. of bitstreams: 1 Dissert Rodrigo Pegado.pdf: 1005553 bytes, checksum: e5130b8bb2a22a366f2e0533d79ceacc (MD5) Previous issue date: 2011-12-20 / Esta pesquisa tem como objetivo identificar diretrizes de gestão para o desenvolvimento e implementação de um núcleo de ensino, pesquisa e extensão em medicina – oftalmologia. A metodologia, baseada em fundamentação teórica, incorpora contribuições dos principais autores da área e entrevistas com responsáveis por núcleos de pesquisa, ensino e extensão em oftalmologia. O resultado obtido é a validação dos contructos descritos pelos autores como importantes para o desenvolvimento e implementação de um núcleo de ensino e a absoluta unanimidade na importância dos quesitos apresentados na pesquisa de campo. / This research aims to identifying management guidelines for the development and implementation of a core teaching, research and extension in medicine - ophthalmology. The methodology, based on a theoretical basis, incorporates contributions from leading authors in the field and interviews with those responsible for core researching, teaching and extension in ophthalmology. The result is items validation described by the authors as important for the development and implementation of a nucleus of education and absolute unanimity on the importance of the questions presented in the research field.

Um dos problemas que afetam as cidades brasileiras é a falta de uma metodologia adequada para a implantação de equipamentos coletivos públicos (escolas, postos de saúde, entre outros), e da utilização de modo racional desses equipamentos. Esse foi o ponto de partida para esse trabalho, cujo objetivo principal foi desenvolver uma ferramenta de análise espacial para auxiliar o poder público no planejamento e na gestão dos serviços públicos de educação e saúde, no que concerne basicamente à melhor localização das unidades básicas de atendimento e à melhor distribuição dos usuários por essas unidades, buscando reduzir os custos de transporte. Após uma avaliação da atual política de distribuição e utilização dos equipamentos coletivos de educação e saúde no Brasil e no mundo, foi realizada uma análise dos conceitos relativos às ferramentas de apoio a problemas de decisão de caráter espacial, particularmente os Sistemas de Apoio à Decisão Espacial (SADE). De posse dessa base conceitual, buscou-se formular as bases de um sistema (ou uma metodologia) que apoiasse a implantação de novos equipamentos coletivos e uma utilização eficiente dos equipamentos já existentes, tendo como parâmetro principal de comparação o custo de deslocamento dos usuários. Esse sistema deveria ser adequado à realidade das cidades médias brasileiras, de maneira geral hoje inseridas num cenário de falta de planejamento e de ausência de bases de dados estruturadas (e atualizadas). Ainda, como proposta adicional, procurou-se incorporar como ferramentas de apoio ao sistema algumas técnicas emergentes que, embora relativamente pouco utilizadas no planejamento urbano até o presente momento, apresentam grande potencial para tal. São elas: os Autômatos Celulares (ou CA, Cellular Automata) e as Redes Neurais Artificiais (RNA). Os fundamentos do sistema concebido foram transpostos para uma aplicação prática desenvolvida em um Sistema de Informações Geográficas (SIG) através de um estudo de caso conduzido na cidade de São Carlos (SP), cujos resultados demonstraram que quando se pensa em otimizar os custos de deslocamento, a principal ação a ser empreendida é a redistribuição da demanda às unidades de oferta, antes de se pensar na abertura de novas unidades. Mais importante do que os resultados numéricos obtidos, foi a confirmação de que é possível se utilizar as diversas ferramentas de planejamento e gestão de modo integrado. A partir dessa metodologia, um investimento em desenvolvimento de software pode levar à construção de um efetivo Sistema de Apoio à Decisão Espacial. De maneira mais geral, pode-se afirmar que a obtenção de dados é o grande obstáculo para pesquisas dessa natureza. A montagem de uma base de dados sólida e confiável é, sem dúvida, o ponto crucial para a execução de projetos potencialmente bem sucedidos / One of the main problems faced by brazilian cities is the lack of adequate methodologies for the implementation and rational use of public service facilities (such as schools and health care centers). That was the starting point in the definition of the main objective of the present work, which is the development of a spatial analysis tool for seeking an optimal arrangement of primary health and education facilities, in order to reduce transportation costs. The use of such a tool in the public administration is important not only for planning but also for management purposes. The study starts with an investigation of approaches that have been used in real cases, in cities of different countries, to define health and education facility types and their distribution. A careful analysis of location-allocation concepts and analysis tools for the solution of spatial problems, with particular emphasis on the Spatial Decision Support Systems (SDSS), was also conducted. The system (or methodology) proposed, which was meant to support the process of location of new facilities and also an efficient use of the existing ones while reducing transportation costs, was based on that conceptual framework. The system was directed to the context of brazilian medium-sized cities, where planning concepts are not widely applied and even the databases available are sometimes very limited and frequently outdated. The system design looked for both traditional and innovative approaches and computer-based techniques, such as Cellular Automata (CA) and Artificial Neural Networks (ANN). These techniques, although not yet extensively applied in urban planning and management, seem to be promising alternatives for those activities. The integration of the different tools and techniques was tested in a practical application carried out in the city of São Carlos (SP) and developed in a Geographic Information System (GIS) environment. The results drawn from the application are clear: the main action to reduce the transportation costs in the case studied was a re-distribution of the demand. It was considerable, despite the fact that not a single facility has been added. Another important outcome of the research was the confirmation of the hypothesis that the distinct planning and management tools tested could be used in an integrated approach. Therefore, the methodology discussed here could effectively become a Spatial Decision Support System only by means of software development for building the system interfaces. As a general conclusion, the data gathering problems still seem to be the main barrier for research development in this area. Consequently, the construction of solid and reliable databases is undoubtedly a key point to start any potentially successful project

This study investigates different factors related to master's degree graduates 1965-1976 in Physical Education at North Texas State University in order to gain information about the master's degree program's relevance to the subsequent career. The findings of the study support the following conclusions: 1. Approximately two-thirds of the graduates thought the program had satisfactorily prepared them for their current positions. 2. Seventy per cent of the graduates suggested there should be a core of courses required in the master's degree program in physical education. The courses most often included in the responses regarding core courses were Research Perspective in Physical Education, Thesis, Mechanical Analysis of Motor Skills, Professional Preparation in Physical Education, Administrative Problems in Physical Education, and Testing in Physical Education. 3. The greatest strengths of the master's degree program in physical education at North Texas State University as reported by the graduates were faculty, research work for students, teaching resources and courses available. 4. The greatest weakness of the master's degree program in physical education at North Texas State University as indicated by the graduates was availability of facilities. 5. The majority of the graduates suggested the following: candidates should be free to select a variety of courses, should have the opportunity to select a specialized track, candidates should be involved in the procedures for preparation of degree plan, should increase physical education facilities and equipment, and should supplement the library in the department in order to facilitate research of relevant periodicals and journals.

Title: Determination of the occurrence of poor posture and muscle imbalance of female students agend 15-19 and possibilities of influencing that by elements of health physical education. Objectives: The aim of this study is determination of change in posture and muscle imbalance due to regural health exercise for the period of 3 months Methods: Klein, Thomas and Mayer test method was used to determine posture of each proband. Functional tests of muscles with tendency to shorten were performed according to Bursová (2005), Hošková and Matoušová (2000), Pernicová et al. (1993). Functional tests of muscles with a tendency to become flabby were tested according to Hošková and Matoušová (2000). The method of theoretical analysis and synthesis was used for the chapter "Piece of knowledge" (Štumbauer, 1990). The chapter "Knowledge of data" was processed by Microsoft Office Excel. One-piece non-parametric Wilcoxon test was used to verify the results. Results: In the chapter "Results" we find detailed information about probands, which we have gained from the questionnaire and from a personal interview. Each proband is discussed and evaluated by means of testing posture and muscle imbalance. Keywords: posture, muscle imbalance, muscle balance, testing, tight muscles, flabby muscles, health physical education,...

Black women in the United States have a high prevalence of hypertension and suffer the most complications of cardiovascular disease. Black women, though aware of the dangers associated with hypertension, have limited opportunity to access health care and or change their lifestyles. The purpose of this quantitative cross-sectional study was to test if there was a significant difference in hypertension awareness, health care access/use, and lifestyle modifications in Black women prior to and post implementation of The Patient Protection and Affordable Care Act, as compared to women of other races. The behavior modification theory guided this study. Secondary data from the National Health Interview Survey for the years 2009 to 2013 for women ages 20 - 65 were analyzed using logistic regression analysis. According to the study results, there was no association (p values > 0.05) among variables age, education, income, length of employment, and hypertension awareness, health care access/use, and life style modification among Black women in the United States, as compared to women of other races. The findings from this study may allow researchers and policy makers to develop more culturally significant health services for Black women. These findings could create positive social change by targeting programs that promote hypertension awareness leading to effective lifestyle changes in Black women.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser.

Les médecins de famille, les pédiatres, les chiropraticiens et les physiothérapeutes sont parmi les professionnels de la santé les plus susceptibles de rencontrer des patients atteints d’une scoliose idiopathique adolescente. Les recherches démontrent que certaines lacunes existent à l’égard des connaissances acquises, par ces professionnels, dans le domaine musculosquelettique, incluant la scoliose. De plus, il ne semble pas exister d’informations sur le niveau de connaissances et la démarche clinique de ces professionnels en matière de scoliose, bien que les bonnes pratiques actuelles dictent une détection hâtive de cette condition pour en optimiser la gestion thérapeutique. Les objectifs de notre étude visaient donc à évaluer les connaissances ainsi que les aptitudes en matière de démarche clinique des professionnels les plus susceptibles à traiter des patients atteints d’une scoliose idiopathique adolescente. À l’aide d’un questionnaire semi-structuré, 51 professionnels de la santé ont été interviewés. Parmi ces professionnels recrutés par l'entremise de leur ordre professionnel respectif, on retrouvait 21 médecins de famille, 10 pédiatres, 10 chiropraticiens et 10 physiothérapeutes. Les entrevues évaluaient les connaissances en matière de signes cliniques, de facteurs de risque, de démarche clinique et de processus référentiel vers les soins spécialisés. De plus, les préférences des professionnels à l’égard des guides de bonne pratique ont été abordées. Parmi les professionnels interviewés, 59 % étaient des femmes, 43 % étaient âgés de moins de 40 ans et la moyenne d’années de pratique était de 20,3 ans. Les résultats démontrent qu’il existe des lacunes à l’égard des connaissances des signes cliniques et des facteurs de risque : moins du tiers des professionnels interviewés pouvaient mentionner au moins 2 signes cliniques et 31 % d’entre eux ne pouvaient se souvenir des facteurs de risque associés à la scoliose idiopathique adolescente; les médecins de famille étaient les moins connaissants dans ces domaines. De plus, en présence d’une mise en contexte nécessitant une référence urgente en soins spécialisés, 70 à 90 % des professionnels auraient référé le patient en dépit du fait que seulement 38 à 60 % d’entre eux considéraient cette situation comme urgente. Près de 40 % des professionnels mentionnaient qu’ils seraient inconfortables à gérer un patient atteint d’une scoliose. Néanmoins, la majorité d’entre eux reconnaissaient qu’il existe un problème en ce qui a trait à l’accessibilité aux soins spécialisés en orthopédiatrie. Presque la totalité c’est-à-dire, 98 % étaient favorables à la production de guides de bonne pratique et les accueilleraient positivement dans leur pratique quotidienne. Les conclusions de cette étude ont montré qu’il existe des vides en matière de connaissances de signes cliniques et de facteurs de risque de progression de la scoliose idiopathique adolescente; ces lacunes ont particulièrement été remarquées chez les médecins de famille. La majorité des professionnels reconnaissent l’importance de référer les conditions urgentes en soins spécialisés. Néanmoins, tous semblent souligner des difficultés dans ce processus référentiel. Une meilleure collaboration interprofessionnelle semble prometteuse en ce qui concerne la gestion de patients atteints d’une scoliose idiopathique adolescente. / Family physicians, peadiatricians, chiropractors and physical therapists are among health professionals most likely to encounter and treat patients with adolescent idiopathic scoliosis. Research shows that there are gaps in musculoskeletal knowledge among professionals but no studies assess knowledge of scoliosis among professionals most likely to treat patients with scoliosis. Best current practice dictates that early detection of adolescent idiopathic scoliosis leads to better decision-making regarding optimal course of management. The objectives of our study were to evaluate basic knowledge and the management skills of professionals most likely to encounter adolescent idiopathic scoliosis. We developed a semi-structured questionnaire and interviewed 51 health professionals. Among these professionals, who were recruited through their professional regulatory board registries, were 21 family physicians, 10 peadiatricians, 10 chiropractors and 10 physical therapists. The interview assessed knowledge of clinical signs and risk factors, management options, including referral to specialized care. We also discussed preferences and acceptability of clinical guidelines in regard to scoliosis. Among interviewed professionals, 59 % were female, 43 % were under 40 and mean years of practice was 20.3. Our results demonstrated gaps in knowledge with respect to clinical signs and risk factors. Less than a third of professionals were able to mention at least 2 clinical signs and 31 % were unaware of any risk factors associated with scoliosis progression. Family physicians appeared least knowledgeable in these areas. When presented with a situation where urgent referral was indicated, 70 – 90 % said that they would refer the patient although only 38 – 60 % rated this case as urgent. Close to 40 % of professionals indicated that they would not be comfortable doing the follow-up of a patient with a scoliosis. Nevertheless, the majority felt that accessibility to specialized care was a problem. Almost all (98 %) mentioned that the development of clinical guidelines would positively affect their daily practice. In conclusion, our study shows that knowledge gaps exist among professionals regarding clinical signs and risk factors of curve progression in adolescent idiopathic scoliosis. Most professionals recognize the importance of referring urgent cases to specialized care although there may be problems with access to peadiatric orthopedic specialists. Interprofessional collaboration may be a promising approach to improve management of patients with adolescent idiopathic scoliosis.

Titre : La médecine familiale vue par des jeunes omnipraticiens : rejet de la vocation et de la continuité des soins. Alors qu’une proportion préoccupante de québécois et canadiens n’a pas accès à un médecin de famille et que les efforts se multiplient pour résoudre cette situation problématique, les jeunes omnipraticiens optent de plus en plus pour des profils de pratique spécialisés, délaissant la continuité de soins. Nous avons interviewé 18 jeunes médecins de famille présentant un profil de pratique surspécialisé et analysé leur propos avec une méthodologie qualitative. Ce mémoire propose, à l’aide d’une approche de théorisation ancrée, une théorie empiriquement fondée permettant de mieux comprendre ce phénomène, ses origines et ses conséquences. Nos observations nous amènent à proposer la théorie suivante : les jeunes omnipraticiens urgentistes sont des professionnels autonomes dynamiques et changeants : ils sont non-fixés personnellement et non-fixés professionnellement. Leur système de valeur (qualité de vie et liberté, compétence, performance, valorisation et satisfaction) constitue l’argument principal de leurs choix professionnels et de leur conception de leurs rôles et responsabilités : ils sont donc mus primairement par des intérêts individualistes. À ce stade-ci de leur vie et de leur carrière, la responsabilité sociale et le sens du devoir envers la population ne figurent pas parmi leurs valeurs fondamentales. Cette théorie novatrice qui propose que leurs choix professionnels se basent d’abord et avant tout sur leurs valeurs permet de mieux comprendre pourquoi les efforts actuels de valorisation de la médecine familiale ne génèrent pas les résultats escomptés. Nous proposons une nouvelle compréhension du sens, de l’origine et des implications des choix professionnels des jeunes généralistes tant aux plans pédagogique, professionnel que de santé populationnelle. / Title: Young GPs' View of Family Medicine: Rejecting Vocation and Continuity of Care. Despite multiple attempts by medical authorities and faculties of medicine across Canada to remedy the acute shortage of family physicians in Canada, such a shortage is currently aggravated by the career choices of young family physicians that choose more and more to practice in subspecialized disciplines. We interviewed 18 young family physicians and analysed their views using a grounded theory approach to better understand this phenomenon, its origins and its consequences. Young generalists are autonomous professionals constantly engaged in a dynamic redefinition of their personal and professional ties. Their conception of the role they play and the responsibilities that are incumbent upon them, as well and the choices they make are based on certain core values. Those values include liberty, competence, performance/efficiency, valorisation and satisfaction. Their interests and goals are therefore primarily individualist ones. At this moment in their lives and careers, social responsibility and the sense of duty towards the population are simply not among their core priorities. This innovative theory sheds light on young generalists' values and the perception they have of their roles and responsibilities. Our analysis offers therefore a new understanding of their career choices. It helps grasp why current attempts to value family medicine are not successful and proposes new pedagogical and organisational ideas for addressing this issue.