The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, 2014. / Brief background to the study The national guidelines for maternity care in South Africa recommend that a standardised maternity case record be used by all facilities at all levels of care in order to improve the quality of care for pregnant women. According to the National Department of Health, this will facilitate continuity and quality of care for women during pregnancy, labour and post-partum. Aim of the study The aim of the study was to assess whether the implementation of the new maternity case record has improved the quality of care for pregnant women. Methodology An exploratory, descriptive study using both quantitative and qualitative design was used to conduct the study. Data was collected through a retrospective record review using a checklist for the quantitative strand, and from midwives using unstructured interviews for the qualitative strand. The quantitative data set was analysed using the Statistical Package for the Social Sciences version 21.0 and the qualitative strand was analysed using the Tesch’s method of data analysis. Results The results of the record review revealed that although the recording was done fairly well, there were a number of activities and interventions that were recorded poorly or not recorded at all in some primary health care clinic. The midwives verbalised that many mistakes and mismanagement of ante-natal care clients emanated from the structure and the design of the new maternity case record. Recommendations Recommendations include the following: communication of policies and protocols to the midwives should be done timeously, provision of in-service education and/or updates on new developments, strengthening of supportive supervision, the Nursing colleges be kept up-to-date with new developments in nursing practice and that a broader study involving other districts and provinces be conducted.

Η πολλαπλή σκλήρυνση (σκλήρυνση κατά πλάκας) είναι ένα αυτοάνοσο νόσημα που χαρακτηρίζεται απομυελινωτικές βλάβες που οδηγούν σε καταστροφή νευραξόνων επηρεάζοντας τις λειτουργίες του ανθρώπινου οργανισμού. Οι ασθενείς παρουσιάζουν νευρολογικά ελλείμματα σε διαφορετικές τοποθεσίες και σε διαφορετικούς χρόνους. Η πολλαπλή σκλήρυνση εμφανίζεται σε κάθε ηλικία, ακόμα και στα παιδιά, αλλά είναι σαφώς συχνότερη σε νέους ανθρώπους 20-40 ετών και ειδικά στις γυναίκες. Μετά από ένα αρχικό επεισόδιο απομυελίνωσης, η σκλήρυνση κατά πλάκας μπορεί να ακολουθήσει ένα από τα τρία διαφορετικά μοτίβα: υποτροπιάζουσα, πρωτογενής προοδευτική, ή δευτερογενής προϊούσα, μετά από μια υποτροπιάζουσα φάση. Η ιατρική παρακολούθηση και παρέμβαση με θεραπείες απαιτεί ένα σύνολο από επαναλαμβανόμενες εργαστηριακές εξετάσεις. Η πορεία της νόσου χαρακτηρίζεται αδιαμφισβήτητα από συσσώρευση αναπηρίας που οδηγεί τον ασθενή σε χρήση βοηθημάτων κίνησης έως και ανάγκη φροντιστή. Ένας σύγχρονος ιατρικός φάκελος είναι ιδιαίτερα χρήσιμος μιας και οι νεότερες και αποτελεσματικότερες θεραπείες απαιτούν λεπτομερές ιστορικό του ασθενούς. Στην παρούσα εργασία θα αναπτυχθεί μια βάση δεδομένων σε γλώσσα mysql, διεπαφή με γλώσσα php. / Multiple Sclerosis is a chronic, inflammatory, demyelinating disease of the central nervous system (CNS) and is one of the most common causes of neurological disability in young adults. It is characterized by multi-focal recurrent attacks of neurological symptoms and signs with variable recovery. Eventually, the majority of patients develop a progressive clinical course . The exact cause of multiple sclerosis is unknown, although an autoimmune process has been implicated. The clinical course of MS is highly variable, ranging from sub-clinical disease to rapidly progressive MS. The major rationale for the MSBase project is the creation of a base platform to facilitate the clinical practice. The MSBase is dedicated to providing doctors who want to help ms patient with the best possible independent logistic solution to the challenges of the disease at no cost.

存取控管是電子病歷 (Electronic Medical Records, EMR)安全防護的核心課題。為了因應醫病關係的變動及確保病患隱私，EMR的存取控管必須滿足動態和細緻化這兩大需求。但這樣的需求並不容易實現，因為負責存取控管的程式碼具有橫跨 (cross-cutting)的特性，必須嵌入到應用系統的各個模組，很容易與應用邏輯發生夾雜不清的現象。礙於現有的程式機制和開發工具對於這樣的安全需求無法提供有效的支援，因此本研究將以剖面導向程式設計 (Aspect Oriented Programming，AOP)技術為基礎，設計一個宣告式EMR安全控管方法，。 在我們的方法中，安全控管邏輯將從EMR系統的核心抽離，並且匯集到單一的剖面 (Aspect)模組，使原有的系統更加模組化 (modularity)。此外，利用我們開發的存取控管程式碼產生器，安全管理者可以藉由宣告組態檔的方式產生EMR的存取控管程式碼。如此一來，安全管理者不僅可以容易地掌握全局、減少分散管理可能造成的疏失，更可以大幅減少維護EMR存取安全所需的時間及成本。 / This paper presents an aspect-oriented approach to providing adaptable access control framework for Electronic Medical Records (EMR) on Web-based platform. In our scheme, access control logic is decoupled from the core of application and collected into separate aspect modules which are automatically synthesized from access control rules in XML format and properly designed aspect templates. The generated aspect modules will then be compiled and integrated into the underlying application using standard aspect tools. At runtime, these aspect codes will be executed to enforce the required access control without any runtime interpretation overhead. Future changes of access control rules can also be effectively realized through these mechanisms without actual coding. This will not only improve the system’s modularity but also make the task of enforcing comprehensive access control more adaptable.

Since the 1990 the use of Electronic Patient Records (EPR) in health services has become increasingly prevalent world wide. EPR has become an important aspect of the continuous improvement of patient care. Transferring all patient records from paper based to electronic is now a priority for many health services. The research reported in this thesis is sponsored by Hamad Medical Corporation (HMC) to provide opportunity to explore the potential role for EPR in the Medical Records Department. The study has been designed to gain better understanding of the users perspectives with regard to the use of patient records. In order to analyse and understand the complex dynamic involved in the management and use of patient records, it was recognised that systems thinking offered an appropriate framework for this research. Soft System Methodology (SSM) was therefore applied to the analysis of the data and used to inform the development of a conceptual model. Using SSM in combination with the structured questionnaire survey and telephone semi-structured interview, triangulation of methods was achieved. Use of these generated rich data revealing for example the general dissatisfaction expressed with the existing manual patient records system, the lack of confidentiality, poor legibility, shortage of space and the frequent misfiling of records. The need to address these problems has informed the strategic plan for the development and implementation of EPR for HMC. The research has successfully addressed the stated aims and research questions and guided the formulation of proposals for improvements.

La protection de l’intimité et de la vie privée des personnes est une préoccupation majeure de notre société car elle favorise la santé et le bien-être des individus. La confidentialité est un des éléments du droit au respect de la vie privée. Élément indispensable à la relation de confiance, le respect de la confidentialité soulève quelques problèmes quant à son maintien dans la relation impliquant les enfants. L’objectif de la présente étude est tout d’abord, d’explorer les différentes dynamiques entourant le secret thérapeutique ou la confidentialité de même que son application, à la lumière des pratiques internationales. Ensuite, elle vise à comprendre les perceptions et le sens de la confidentialité du dossier médical des enfants chez les professionnels de la santé et de l’éducation. Enfin, ce travail vise à comprendre les motivations et la connaissance des impacts du bris de confidentialité par ces professionnels. Il s'agit d'une étude qualitative de nature exploratoire. Les données proviennent d'entrevues semi-dirigées réalisées auprès de dix-neuf personnes oeuvrant de près ou de loin auprès des enfants. Une grille d'entrevue a été utilisée pour la collecte des données. Les résultats permettent d'observer que : tout d’abord, sur le plan international, il y a une absence d’uniformité dans l’application du concept de confidentialité. Son degré de protection dépend du contexte juridique d'un système donné Ensuite, l’étude démontre une relation entre la sensibilité du répondant et son milieu professionnel usuel. En effet, les professionnels de la santé, membres de corporation professionnelle, ont une vision beaucoup plus déontologique de la confidentialité et ils sont très sensibles à la question de la confidentialité, car celle-ci constitue une valeur centrale. Par contre, les professionnels de l’éducation, en l’absence d’identité professionnelle commune, s’inspirent d’une approche institutionnelle qu’éthique et ils apparaissent nettement moins sensibles à la confidentialité. Bref, le respect de la confidentialité est lié à une question de responsabilité sociale des professionnels. Enfin, le bris de la confidentialité est motivé par divers facteurs légitimes (pour raisons légale ou judiciaire, contexte de collaboration) et illégitimes (la négligence, l’erreur, l’inconduite). / Protecting intimacy and the privacy of individuals is a major concern of our society because it promotes health and well-being of individuals. Confidentiality is an element of the right to respect for privacy. Indispensable to the relationship of trust, the respect of confidentiality raises several problems as for its maintenance in the relationship involving children. The objective of this study is firstly, to explore the different dynamics surrounding therapeutic secrecy or confidentiality and its application in the light of international practices. Second, it seeks to understand perceptions and sense of confidentiality of medical records of children among health professionals and education. Finally, this work aims to understand the motivations and knowledge of the impacts of breach of confidentiality by such professionals. This is an exploratory qualitative study. Data result from semi-structured interviews conducted with nineteen people working near or far from the children. A grid of interview was used for data collection. The results allow observing that: firstly, internationally, there is a lack of uniformity in applying the concept of confidentiality. Its degree of protection depends on the legal context of a given system. Secondly, the study shows a relationship between the sensitivity of the respondent and his usual professional environment. Indeed, health professionals, members of Professional Corporation, have ethics’ view or perception of confidentiality and they are very sensitive to the issue of confidentiality, because it constitutes a core value. On the other hand, the education professionals, in the absence of common professional identity, were inspired by institutional approach than ethical and they appear much less sensitive to confidentiality. In short, privacy is related to an issue of social responsibility of professionals. Finally, the breaking of confidentiality is motivated by legitimate factors (such as legal or judicial reasons, collaboration’s context) and illegitimate (negligence, error, misconduct).

The purpose of this study was to: (1) identify the sources of job-related stress which create excessive pressures for the directors and faculty of medical record administration and medical record technology programs; (2) identify the strategies that the directors and faculty of medical record administration and medical record technology programs find most helpful in coping with stress; (3) determine the relationship among demographic variables and job-related stressors as perceived by the directors and faculty of medical record administration and medical record technology programs; and (4) determine the difference among the means of five stress factors as perceived by the directors of medical record administration, faculty of medical record administration, directors of medical record technology and faculty of medical record technology programs. Questionnaires were mailed to 403 respondents. The response rate was 81.3%. Within the limitations of this study, the results revealed that "Having insufficient time to keep abreast of current developments in my field"was the highest stressor. The top stress coping strategy was "Social interaction." The relationship between demographic variables and five stress factors of reward and recognition, time constraint, departmental influence, professional identity and student interaction revealed a positive correlation between degree and professional identity factor, and a negative correlation between degree and student interaction factor. The results also indicated a positive correlation between type of program and the factors-time constraint, professional identity and student interaction; a positive correlation between academic rank and the factors--time constraint and student interaction; a positive correlation between teaching responsibilities and time constraint factor; and a positive correlation between marital status and professional identity factor. The directors and faculty of medical record administration perception of time constraint and professional identity factors differed from that of the directors and faculty of medical record technology programs.

Este estudo descritivo / exploratório com análise documental, retrospectivo, utilizando o método de Estudo de Caso tem como objetivo avaliar o módulo de Gerenciamento de Unidade (PAGU) com foco no Prontuário Eletrônico do Paciente (PEP). No Complexo Hospitalar, campo de estudo, foi implantado o Sistema de Gestão Hospitalar em 2005. Iniciou-se com o levantamento da história da implantação do Sistema de Gestão Hospitalar seguindo seis fases: como primeira fase considerou-se o planejamento iniciado em 2002, seguindo para a fase de análise funcional com a determinação de rotinas, protocolos e processos operacionais; na fase de determinação de requisito avaliaram-se as necessidades da instituição em relação ao sistema, a fase do desenho e desenvolvimento foi realizada pela empresa contratada. A quinta fase constituiu-se a implementação. Como última fase considerou-se a avaliação do hardware e software realizada pelos responsáveis do Setor de Informática. Verificaram-se várias necessidades as quais foram atendidas, em parte, pela empresa contratada e outras, pelos responsáveis do setor de Informática do complexo hospitalar. O modelo proposto para avaliar o módulo PAGU baseou-se nas normas e padrões preconizados pela (ISO) International Organization for Standardization - (IEC) (International Electrotechnical Commission) 9126-4 Qualidade em uso. Para avaliar a realização das Prescrições Médica e de Enfermagem, selecionaram-se 45 e 35 usuários, respectivamente. Foram realizadas duas avaliações, sendo que entre a primeira e segunda foram implementadas melhorias que proporcionaram bons efeitos. Baseado nas normas ISO/IEC 9126-4 Qualidade em uso obtiveram-se os seguintes resultados: Métrica da Efetividade - a eficácia da tarefa realizada pelo segmento médico foi de 100% em ambas as avaliações, e 93% e 100% para o segmento Enfermeiro. Métrica de Produtividade - o tempo médio da realização da prescrição foi de 4,39 min na primeira e 6,21 min. na segunda avaliação para o usuário médico. O usuário enfermeiro obteve o resultado de 4,05 min. na primeira e 3,02 min. na segunda avaliação. O resultado da Métrica de Segurança do paciente relacionado à quantidade de itens prescritos com algum erro, pelo usuário médico, foi na primeira avaliação 1,94 e na segunda, 0,37 itens. O usuário enfermeiro resultou em 1,26 na primeira e 0,33 itens na segunda avaliação. Com respeito às falhas relacionadas à segurança, o usuário médico apresentou 1,84 itens na primeira e 0,32 itens na segunda avaliação, já o enfermeiro verificou-se 0,65 itens na primeira e 0,09 itens na segunda avaliação. Relacionado à economia obteve-se o valor de 0,13 na primeira e 0,09 itens na segunda avaliação para o usuário médico. O usuário enfermeiro obteve 0,99 itens na primeira avaliação e 0,24 na segunda. Na Métrica de Satisfação / Desempenho constatou-se o valor de 5,82 na primeira e 5,75 na segunda avaliação para o usuário médico e 5,58 na primeira e 6,41 na segunda avaliação para o usuário enfermeiro. Concluiu-se que a avaliação da realização da Prescrição, no módulo PAGU, atingiu respostas positivas na maioria das características. Os resultados obtidos neste estudo serão utilizados para ações de melhorias e treinamentos. Essa pesquisa proporciona a disseminação do conhecimento, em saúde e enfermagem / This descriptive, exploratory study with retrospective document analysis aims, using case study methodology, to evaluate the Management Unit module (PAGU) focused on the Electronic Health Record (EHR). The Hospital Management System was implemented in the Hospital Complex, field of study, in 2005. It began with a survey of the history of implementation of the Hospital Management System following six phases: the planning, which started in 2002, was considered the first phase. This was followed by the functional analysis stage with the determination of routines, protocols, and operational processes. In the requirement determination phase, the needs of the institution in relation to the system were evaluated. The design and development phase was carried out by the contractor. The fifth phase consisted of implementation. As a final step we considered the evaluation of the hardware and software comprising the I.T. systems. There were several needs which were met not only by the contractor but also by the staff responsible for the hospital\'s IT department. The model proposed to evaluate the PAGU module was based on norms and standards set by the (ISO) International Organization for Standardization - (IEC) (International Electro-technical Commission) 9126-4 Quality in use. In order to evaluate the performance of Physicians\' and Nurses\' Prescriptions, we selected 45 and 35 users, respectively. Two evaluations were carried out, and between them, improvements were implemented yielding positive effects. Based on ISO / IEC 9126-4 Quality in use, the following results were found: Effectiveness Metrics - the effectiveness of tasks performed by the physicians was 100 % in both evaluations, and for the nurses 93 % and 100 %. Productivity Metrics - the average time for completion of medical prescription was 4.39 min in the first evaluation and 6.21 min in the second for the physicians. The nurses obtained results of 4.05 min in the first and 3.02 min in the second evaluation. The result of the Patient Safety Metrics in relation to the amount of items prescribed with an error, concerning the physicians, was 1.94 items in the first evaluation and 0.37 items in the second. As for the nurses, this result was 1.26 items in the first evaluation and 0.33 in the second. With respect to security-related crashes, the physicians presented 1.84 items in the first evaluation and 0.32 items in the second, while the nurses\' result was 0.65 items in the first evaluation and 0.09 items in the second. In relation to economy, the values obtained for the physicians were 0.13 items in the first evaluation and 0.09 items in the second evaluation, while for the nurses these values were 0.99 items in the first evaluation and 0.24 in the second. In the satisfaction / performance metric a value of 5.82 was found in the first and 5.75 in the second evaluation for the physicians and 5.58 in the first evaluation and 6.41 in the second evaluation for the nurses. It was concluded that the evaluation of the performance of prescription module PAGU achieved positive responses relating to the majority of characteristics. The results of this study will be used for training purposes and quality improvement. This research provides the dissemination of knowledge in health care and nursing

Para avaliar as características clínico-laboratoriais dos pacientes co-infectados com HIV e VHC, foram revisados os prontuários de pacientes atendidos no Núcleo de Extensão para Atendimento de Pacientes com HIV/AIDS (Casa da AIDS) da Divisão de Clínica de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de acordo com o esquema antirretroviral que receberam pelo menos com seis meses de antecedência da primeira biopsia hepática realizada. Foram pesquisados os 3.512 prontuários de pacientes em acompanhamento na Casa da AIDS à procura de casos de conversão sorológica para o VHC. Desses pacientes, 435 não tinham feito nenhuma avaliação, sendo possível discriminar a presença de sorologia só em 3.077 pacientes, dos quais 468 (15,20%) apresentaram positividade para o VHC. Fizeram parte da amostra 111 pacientes, dos quais 74 foram tratados com medicamentos inibidores de protease (grupo CIP) e 37 tratados sem medicamentos inibidores de protease (grupo SIP) dentro do seu esquema antirretroviral altamente ativo (HAART). Dados epidemiológicos, clínicos e laboratoriais foram pesquisados com referência a seu comportamento separados de acordo com o tipo de terapia antirretroviral recebida (com ou sem inibidor da protease). Foi observada uma população jovem (média de 41 anos em ambos os grupos) de predominância masculina (74,3% no grupo CIP e 51,4% no grupo SIP) de raça branca (CIP 80,6% e SIP 94,4%) de grau educacional não profissional (CIP 92,9% e SIP 100%). Tinham antecedentes de risco para ambas as infecções em 93,2% dos pacientes CIP e 89,2% dos SIP. E com um consumo considerado habitual no grupo CIP em 40% dos casos e nenhum em 42,3% dos casos no grupo SIP. Presença de alguma doença definidora de AIDS durante o curso da doença foi identificado unicamente no 18,9% dos casos CIP e no 13,5% dos casos SIP. Consumo de drogas hepatotóxicas foi observado (8,1% no grupo CIP e 13,5% no SIP). Houve elevação média das enzimas hepáticas em ambos os grupos (TGO 52,1 no grupo CIP e 53,2 no SIP) em ausência de sintomas relacionáveis com doença hepática (16,2% em ambos os grupos). A média de CD4 em ambos os grupos foi maior de 350 cel/ml (CIP 362,2 e SIP 378,1). O grau de fibrose foi predominantemente baixo em ambas as populações (0-2 em 63,6% dos pacientes CIP e 80% dos casos SIP) com atividade necro-inflamatória somada de entre 5-7 no 51,3% dos pacientes CIP e 42,9% do grupo SIP. Sugere-se realização de biopsia seqüencial para melhor avaliar a evolução da doença hepática de acordo com o esquema HAART recebido / In order to evaluate the clinical and laboratorial characteristics of the co-infected HIV-HCV patients, medical charts were reviewed from the AIDS outpatient clinic, of the department of Infectious Diseases, São Paulo University School of Medicine, according to the antiretroviral treatment taken at least six months prior to the first liver biopsy performed. A total of 3.512 medical charts were reviewed from patients followed by the AIDS outpatient clinic, in search of patients of serological conversion for HCV. Of these patients 435 were never tested for HCV. From the 3.077 patients who had performed HCV serology, 468 of them (15,20%) were positive for the virus. The sample consisted of 111 patients. Were treated with protease inhibitor drugs (w/ PID group) 74, and 37 without protease inhibitor drugs (w/o PID group), according to their Highly Active Anti-Retroviral Therapy (HAART). Epidemiological, clinical and laboratorial data were analyzed according to the antiretroviral therapy received (with or without protease inhibitors). It was observed a young population (mean age of 41 years old in both groups), predominantly male (74,3% w/ PID, and 51,4% w/o PID), white (80,6% w/ PID, and 94,4% w/o PID), non-professional educational degree (92,9% w/ PID, and 100% w/o PID). The 93,2% w/ PID were, and 89,2% w/o PID of the patients had risk factors for both HIV and HCV. A usual alcoholic intake was observed in 40% of the w/ PID group, and no alcohol use was observed in 42,3% of the w/o PID group. The presence of AIDS defining diseases during the time of disease were observed only on 18,9% of the w/ PID group, and on 13,5% of the w/o PID group. Hepatotoxic drugs intake was observed in 8,1% of the w/ PID group, and in 13,5% of the w/o PID group. An average elevation of liver enzymes was observed in both groups (TGO 52,1 w/ PID, and 53,2 w/o PID), in absence of liver disease-related symptoms (16,2% in both groups). The CD4 mean in both groups was above 350 cel/ml (362,2 w/ PID and 378,1 w/o PID). Fibrosis degree was predominantly low on both populations (0-2 in 63,6% of patients w/ PID and 80% of patients w/o PID), with cumulative necro-inflamatory activity between 5-7 in 51,3% of patients w/ PID and 42,9% of patients w/o PID. We suggest that a new liver biopsy should be performed in order to better evaluate the development of the hepatic disease according to the HAART received

Diversos estudos afirmam que a exposição à poluição atmosférica pode resultar em aumento de casos de doenças cardiovasculares e respiratórias. Esses desfechos estão relacionados, principalmente, a altas taxas de internações e óbitos em países desenvolvidos. O presente trabalho objetivou estimar os efeitos da variação diária na concentração dos poluentes atmosféricos nos atendimentos de emergência por hipertensão arterial ou doenças respiratórias estratificados por sexo e por faixa etária. Trata-se de estudo ecológico de séries temporais realizado a partir dos registros de prontuários de atendimentos de emergência por hipertensão arterial ou doenças respiratórias de adultos e idosos atendidos no Hospital de Emergências Albert Sabin, do município de São Caetano do Sul, entre janeiro de 2010 a dezembro de 2011. Para a análise dos dados foram utilizados o modelo linear generalizado de regressão de Poisson e o modelo de defasagem de distribuição polinomial de terceiro grau, explorando estruturas de defasagens até seis dias após a exposição aos poluentes. As estimativas foram controladas para variáveis meteorológicas, sazonalidade e tendência de curta duração (dias da semana). Os indivíduos mais idosos se mostraram mais sensíveis aos efeitos dos poluentes do ar. Na estratificação por sexo, os homens foram mais susceptíveis quando expostos ao PM10 para os atendimentos por pneumonias e as mulheres para os atendimentos por doenças chiadoras. Para cada aumento de 22,4ug/m3 de PM10, houve um aumento de 16,2% (25,5% - 7,6%) nos atendimentos de hipertensão arterial nos idosos no dia da exposição ao poluente. Para infecções de vias aéreas superiores, o aumento mais robusto foi notado entre os homens no dia da exposição ao PM10, com 8,6% (3,6% - 14%) e entre os idosos, também de forma aguda, com 7,6% (0,7% - 15%). As mulheres expostas ao PM10 tiveram um aumento de 15,7% (5,4% - 26,3%) nos atendimentos por doenças chiadoras. Entre os idosos, esse aumento foi de 25,4% (12,1% - 40,2%) para este mesmo desfecho. Para pneumonias, o efeito mais robusto foi observado entre os idosos no dia da exposição ao PM10, com um aumento de 15,8% (0,9% - 32,8%) nos atendimentos. A cidade de São Caetano do Sul possui um perfil de poluição semelhante às grandes metrópoles, caracterizada por emissão de veículos e indústrias. Os resultados apresentados neste trabalho alertam para a necessidade da elaboração de políticas públicas na região para um melhor monitoramento e controle da poluição atmosférica, com o intuito de prevenir futuros agravos à saúde da população / Several studies claim that exposure to air pollution can result in increased cases of cardiovascular and respiratory diseases. These outcomes are mainly related to high rates of hospital admissions and deaths in developed countries. This study aimed to estimate the effects of daily variation in the concentration of air pollutants in emergency treatment for high blood pressure or respiratory diseases, stratified by sex and age group. It is an ecological time series study, conducted from emergency visits for high blood pressure or respiratory disease of adults and elderly assisted at the Emergency Hospital Albert Sabin in São Caetano do Sul between January 2010 December 2011. For data analysis was used generalized linear model Poisson regression model and polynomial distribution lag third degree, exploring lags structures up to six days after exposure to pollutants. The estimates were controlled to weather variables, seasonal and short-term trend (weekdays). Older individuals were more sensitive to the effects of air pollutants. In stratification by sex, men were more susceptible when exposed to PM10 to care for pneumonia and women to care for diseases wheezing. For each increase of 22.4 ug / m3 of PM10, there was an increase of 16.2% (25.5% - 7.6%) in hypertension in the elderly care on the day of exposure to the pollutant. For upper respiratory tract infections, the strongest increase was noted among men on the day of exposure to PM10, with 8.6% (3.6% - 14%) and among the elderly, too acutely, with 7, 6% (0.7% - 15%). Women exposed to PM10 increased by 15.7% (5.4% - 26.3%) in treated for wheezing. Among the elderly, the increase was 25.4% (12.1% - 40.2%) for the same outcome. Pneumonias for the most robust effect was observed among the elderly on the day of exposure to PM10, with an increase of 15.8% (0.9% - 32.8%) in attendance. The city of São Caetano do Sul has a pollution profile similar to large cities, characterized by emission vehicles and industries. The results presented in this study point to the need of public policy development in the region for better monitoring and control of air pollution, in order to prevent future health problems of the population