Made available in DSpace on 2016-04-29T13:17:51Z (GMT). No. of bitstreams: 1 Silvia Cristiane Murari.pdf: 13030417 bytes, checksum: cd899fbf081308ddeb79733213c0e4d5 (MD5) Previous issue date: 2014-02-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Autism Spectrum Disorder (ASD) is a developmental disorder of unknown etiology. The variables determining the severity of the autism like symptoms are linked to the child's life history, the child's health issues, and other environmental aspects. The lifelong effects of the autism on the child's development are related to the early detection of signs of autism and to the time of outset of clinical treatment. Primary health care professionals (i.e., pediatricians, nurses, and nursing assistants) are the first professionals to have contact with the infant. The purpose of this study was to investigate whether a child's development monitoring program in the public health care system, such as in the services provided in the Basic Health Units (BHU), constitutes an appropriate strategy for the early identification of ASD. In order to determine the feasibility of a child's development monitoring program, were assessed (a) the guidelines for professional practice in the healthcare system related to the childcare services; (b) the correlation between the professional guidelines and the protocols for measurement of children's development; (c) the types of medical records available on the child's development of 45 children between 15 days to 24 months old (i.e., symptoms reported, data on the child's social, psychomotor and language development); (d) the information on professional training and knowledge about autism of one pediatrician, one nurse and five nursing assistants; (e) video recordings of the professional's interaction with the children during the assessment conducted by a pediatrician, two nurses and seven nursing assistants, and the direct observation of child's behaviours concerning to autism like symptoms during the health care assessment. These evaluations were based on guidelines concerning to the early identification of autism available in the literature. The preliminary outcome of the study suggests that the services provided at the UBS setting may constitute an opportunity for early detection of autism. However, it is necessary to improve the child's development assessment existing protocols and professional practices. The recommended improvements should include several changes. First, the implementation of new guidelines for health care professionals concerning to the assessment of social and language development. Second, the improvement of the data collection tools used by the professionals in order to promote the easy visualization of early signs of autism through the identification of the presence or absence of typical developmental milestones and the possible presence of atypical developmental characteristics concerning to the early signs of autism. Third, the implementation of professional training on direct observation of children's behavior and children's development assessment, and implementation of information gathering protocols concerning to the parent's knowledge about the child's development, as well on provision of guidance on how parents can better participate in the identification of developmental deficits that may indicate the presence of autism / O Transtorno do Espectro Autista (TEA) é um transtorno sem etiologia definida. As variáveis que o determinam relacionam-se com a história de vida da criança, principalmente, intercorrências médicas e das interações sociais. O grau de seu comprometimento depende, em parte, do quão precocemente os primeiros sinais de seu desenvolvimento são detectados e de a criança ser encaminhada, o quanto antes, para tratamento adequado. Os primeiros profissionais a terem contado com a criança são os da atenção primária à saúde (pediatras, enfermeiros, auxiliares de enfermagem). A proposta deste trabalho foi a de investigar se um programa de vigilância do desenvolvimento infantil de um serviço público como o das Unidades Básicas de Saúde (UBS) constitui-se meio apropriado para a identificação precoce de sinais de TEA. Para isso, foram avaliados (a) o protocolo de orientação à prática profissional no atendimento de puericultura; (b) a correspondência entre as orientações do protocolo e os instrumentos de coleta sobre o desenvolvimento da criança; (c) tipos de registros (em especial, queixas, orientações profissionais, desenvolvimento social, neuropsicomotor e da linguagem da criança) contidos em 45 prontuários de crianças na faixa etária de >15 dias a 24 meses; (d) as formações profissionais e os conhecimentos sobre o TEA de um pediatra, um enfermeiro e cinco auxiliares de enfermagem, por meio de entrevistas; (e) por meio de filmagens avaliou-se os comportamentos de um pediatra, 2 enfermeiros e 7 auxiliares de enfermagem com relação à anamnese e suas interações com a criança em atendimentos de puericultura, assim como a ocorrência de comportamentos infantis, relacionados no quadro do TEA., durante atendimentos de puericultura. As referidas avaliações foram baseadas em orientações contidas na literatura sobre a identificação precoce dos sinais do TEA. Pelo conjunto dos dados e análises realizadas a resposta é positiva: os serviços de puericulturas disponíveis nas UBS podem constituir-se sim oportunidades para a identificação precoce de sinais de TEA. Contudo, avaliou-se necessário realizar aprimoramentos em todas as instâncias avaliadas. Os aprimoramentos se dariam primeiro pela inclusão, no protocolo, de novas orientações aos profissionais, especialmente com relação ao desenvolvimento social e da linguagem; segundo, pela inclusão do maior número possível de itens correspondentes às descrições do protocolo no material de coleta, bem como, a reestruturação desse material, de forma a facilitar a visualização do profissional da evolução dos comportamentos da criança e, consequentemente, a presença de possíveis atipicidades, como os sinais do TEA; terceiro, pela oferta de cursos de capacitações nos quais os profissionais sejam treinados a observar a criança, a registrar seu desenvolvimento, questionar os pais sobre o desenvolvimento dos próprios filhos, orientá-los de forma adequada para que fiquem atentos com défices de desenvolvimento que possam indicar risco de TEA

Orientador: Ricardo Luiz Dantas Machado / Banca: Vera Lúcia Pereira-Chioccola / Banca: Agnes Cristina Fett-Conte / Resumo: O Toxoplasma gondii infecta os seres humanos dentre outras vias, pelo trato gastrintestinal, um local onde se dá a expressão do perfil de glicoconjugados ABH sob controle da enzima a-2-L-Fucosiltransferase (FUTII) codificada pelo gene FUT2 (19q13.3). A presença da FUTII define o status secretor positivo, o qual é relacionado aos fenótipos eritrocitários ABO. Diante da importância epidemiológica e clínica da infecção pelo T. gondii, o objetivo desse trabalho foi testar a hipótese de que o perfil de glicoconjugados ABH expresso no trato gastrintestinal está associado à infecção por esse parasito. Foram selecionadas 367 gestantes atendidas no Ambulatório de Gestação de Alto Risco do Hospital de Base da Fundação Faculdade Regional de Medicina de São José do Rio Preto. Duas amostras de sangue, uma sem e outra com anticoagulante foram coletadas. A fenotipagem eritrocitária ABO e a detecção dos anticorpos anti-T. gondii foram realizadas pelo método hemaglutinação. A identificação do status secretor foi feita pelo método PCR-RFLP. As diferenças nas freqüências do status secretor positivo e negativo e dos fenótipos eritrocitários ABO, isoladamente ou em conjunto, não foram estatisticamente significantes na presença e na ausência desses anticorpos (p=0,26). Esses resultados sugerem que o perfil de glicoconjugados ABH expressos no trato gastrintestinal sob controle do gene FUT2 não está associado à presença de anticorpos anti-T. gondii. / Abstract: Toxoplasma gondii infects humans in several manners including by the gastrointestinal tract where the a-2-L-Fucosiltransferase (FUTII) coded by FUT2 (19q13.3) controls the expression of the ABH glycoconjugates profile. Presence of FUTII defines the positive secretor status which is associated to ABO erythrocytic phenotypes. Due to the epidemiological and clinical importance of T. gondii infection, the aim of this work was to test the hypothesis that the ABH glycoconjugate profile expressed in the gastrointestinal tract is associated to infections by this parasite. A total of 367 pregnant women from the High-Risk Pregnancy Clinical of the University Hospital de Base in São José do Rio Preto were enrolled in this study. Two blood samples were drawn with only one mixed with anticoagulant. The ABO erythrocytic phenotyping and detection of anti-T. gondii antibodies were achieved by the hemagglutination method. Identification of the secretor status was by the PCR-RFLP method. Differences in the positive and negative secretor status and ABO erythrocytic phenotypes, either in isolation or in association, were not statistically significant in respect to the presence or absence of these antibodies (p-value =0.26). These results suggest that the ABH glycoconjugate profile expressed in the gastrointestinal tract under control of the FUT2 gene is not associated to anti-T. gondii antibodies. / Mestre

Submitted by DIEGO JACOME VALOIS TAFUR (diegotafur@ibest.com.br) on 2017-11-10T19:28:13Z No. of bitstreams: 1 Dissertação - Diego Valois - Estudo de caso da PPP dos complexos hospitalares - final para depósito 2.pdf: 844378 bytes, checksum: 8b7c810084db8d6f1d6e4cb2e03b7548 (MD5) / Approved for entry into archive by Thais Oliveira (thais.oliveira@fgv.br) on 2017-11-10T20:13:01Z (GMT) No. of bitstreams: 1 Dissertação - Diego Valois - Estudo de caso da PPP dos complexos hospitalares - final para depósito 2.pdf: 844378 bytes, checksum: 8b7c810084db8d6f1d6e4cb2e03b7548 (MD5) / Made available in DSpace on 2017-11-13T12:30:17Z (GMT). No. of bitstreams: 1 Dissertação - Diego Valois - Estudo de caso da PPP dos complexos hospitalares - final para depósito 2.pdf: 844378 bytes, checksum: 8b7c810084db8d6f1d6e4cb2e03b7548 (MD5) Previous issue date: 2017-03-17 / O presente trabalho tem como objetivo a análise do estudo de caso do projeto de Parceria Público-Privada (‘PPP’), regida pela Lei nº 11.079/2004, referente à ‘Concessão Administrativa para a construção, operação de serviços ‘bata cinza’ e manutenção de Complexos Hospitalares de São Paulo’. Para tanto, foi analisado todo o processo administrativo para o desenvolvimento e concretização do projeto, incluindo a fase de Manifestação de Interesse Privada - MIP; as providências adotadas pelo Governo do Estado de São Paulo para a estruturação da PPP; o procedimento licitatório; e a assinatura do contrato, que representa o modelo final da PPP. Da análise deste processo administrativo, foi possível perceber certas particularidades atinentes a cada fase do processo de contratação pública, especialmente sobre alguns riscos apresentados pelos particulares, tal como o risco da governança entre os serviços ‘bata-branca’, de responsabilidade da equipe médica, e os serviços ‘bata-cinza’, de responsabilidade da concessionária. Assim, a presença do mencionado risco no modelo pesquisado é prova que fatores políticos e sociais estão presentes na modelagem de projetos, cabendo aos seus responsáveis compatibilizar os interesses por meio de estrutura contratual adequada. Pretende-se, portanto, analisar quais os mecanismos utilizados para superar o referido risco, de modo que o estudo sistematizado possa servir de dado para projetos com semelhante característica. Por fim, serão apresentadas informações e análise crítica sobre aspectos destacados ao longo do processo administrado objeto da pesquisa. / This work aims the case study about private-public partnership, ruled by Lei nº 11.079/2004, about public concession for construction, ‘gray coat’ and São Paulo hospital complex maintenance. Therefore all public procedure was analyzed for the development and execution, including the Private Expression of Interest, the São Paulo Government providences for the private-public partnership conclusion, the bidding procedure and final agreement for the contract. From the analysis it was possible to detect particularities for each stage of the public contract, especially about risks pointed by the private partner, like managing risks among ‘white coat’ services, medical team responsibilities, and ‘gray coat’ services, private partner responsibilities. This mentioned risk presence proves that political and social factors are elements of the project model, being up to the developers to make compatible the interests through the right contractual structure. At last, info and critical analysis about the highlights during the public procedure will be presented.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries. / Revisión por pares

The study aimed to investigate the implementation of customer care at the Casualty Department of Edenvale Regional Hospital in Gauteng Province. The research was conducted using a qualitative case study approach, which sought to gain deeper understanding of the impact of customer care in the hospital’s Casualty Department from the employees’ point of view. Data was collected from 16 purposively selected respondents using semi-structured interviews and document analyses were interpreted by the researcher to give voice and meaning to the assessment topic. Data was analysed using the Content Analysis framework and six themes emerged from the data analysis: (1) High expectation levels from the community; (2) Quality of patient care; (3) Lack of resources; (4) Malfunctioning equipment; (5) Compromised safety and security; (5) Strategies to improve customer care; and (6) The effect of policies and guidelines on the quality of services rendered. The study revealed that the surrounding community that is served by the Edenvale Hospital’s Casualty Department had high expectations which the hospital was unable to meet because of the many limitations, especially resource constraints. The issues and difficulties associated with overcrowding in the emergency section were raised by respondents, who reported several challenges experienced in the hospital. These included patients sleeping on floor mattresses and even on stretchers, inadequate beds, shortage of staff, malfunctioning equipment and lack of sufficient infrastructure. These challenges resulted in long waiting periods for patients to be given open beds in the wards, bad attitudes from both patients and employees alike, poor communication among staff and patients and their families, and an unsafe environment for the staff and customers (patients). There is hence a need for the Gauteng Health Department together with the hospital management to review resources allocated to the Edenvale Regional Hospital and to increase awareness among the community about the operations of the level 2 hospitals such as this. / Public Administration / M. P. A.