Since the South African Department of Health has tabled legislation to make fluoridation of public water supplies mandatory, the issue of whether fluoride is beneficial or harmful has, once again, become controversial in South Africa. We reviewed the literature, the experiences of fluoridation in overseas countries and the latest WHO recommendations, and have found that fluoride is desirable at certain levels, and undesirable above these. The following recommendations are made for optimum fluoride levels in South Africa's potable water: The decision to fluoridate a public water supply must be a community decision taken after public consultation. However, it can only be reached when the public is properly informed about the issue. Optimum levels of fluoride for human health range from 0.4 to 0.7 mg F/l, depending on the maximum mean annual temperature. The maximum level of 0.7 mg F/l should not be exceeded. Accordingly, it is recommended that in areas where natural fluoride concentrations in the drinking water exceed 0.7 mg F/l steps be taken to defluoridate the water. As an interim measure, a scale of temperature-adjusted optimum fluoride levels should be adopted in South Africa, rather than a single level covering the wide-ranging ambient temperatures (and corresponding consumption rates of drinking water) in the country. A sliding scale would mean that the community within a water supply region can determine its own fluoride consumption within the optimum range. Fluoridation should be considered only a short-term measure, until economic conditions are such that all South Africans have access to proper dental health care. The duration of fluoridation of a community water supply, and the level of fluoridation (within the optimum range of fluoride levels) should both be considered community decision. However, defluoridation should be a permanent necessity in those areas where the drinking water exceeds levels of 0.7 mg F/l.

Since the South African Department of Health has tabled legislation to make fluoridation of public water supplies mandatory, the issue of whether fluoride is beneficial or harmful has, once again, become controversial in South Africa. We reviewed the literature, the experiences of fluoridation in overseas countries and the latest WHO recommendations, and have found that fluoride is desirable at certain levels, and undesirable above these. The following recommendations are made for optimum fluoride levels in South Africa's potable water: The decision to fluoridate a public water supply must be a community decision taken after public consultation. However, it can only be reached when the public is properly informed about the issue. Optimum levels of fluoride for human health range from 0.4 to 0.7 mg F/l, depending on the maximum mean annual temperature. The maximum level of 0.7 mg F/l should not be exceeded. Accordingly, it is recommended that in areas where natural fluoride concentrations in the drinking water exceed 0.7 mg F/l steps be taken to defluoridate the water. As an interim measure, a scale of temperature-adjusted optimum fluoride levels should be adopted in South Africa, rather than a single level covering the wide-ranging ambient temperatures (and corresponding consumption rates of drinking water) in the country. A sliding scale would mean that the community within a water supply region can determine its own fluoride consumption within the optimum range. Fluoridation should be considered only a short-term measure, until economic conditions are such that all South Africans have access to proper dental health care. The duration of fluoridation of a community water supply, and the level of fluoridation (within the optimum range of fluoride levels) should both be considered community decision. However, defluoridation should be a permanent necessity in those areas where the drinking water exceeds levels of 0.7 mg F/l.

Techn. Universiẗat, Diss., 2004--Berlin.

No description available.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-07T15:58:14Z No. of bitstreams: 2 antonio_moacir_jesus_lima.pdf: 1041718 bytes, checksum: 2bdc2714f3684716a51ed9d113e2646f (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-07T16:00:38Z (GMT) No. of bitstreams: 2 antonio_moacir_jesus_lima.pdf: 1041718 bytes, checksum: 2bdc2714f3684716a51ed9d113e2646f (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-07T16:02:42Z (GMT) No. of bitstreams: 2 antonio_moacir_jesus_lima.pdf: 1041718 bytes, checksum: 2bdc2714f3684716a51ed9d113e2646f (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Made available in DSpace on 2015-01-07T16:02:46Z (GMT). No. of bitstreams: 2 antonio_moacir_jesus_lima.pdf: 1041718 bytes, checksum: 2bdc2714f3684716a51ed9d113e2646f (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Previous issue date: 2013 / O estudo buscou compreender as contribui??es do Pr?-Sa?de I para a forma??o profissional em Enfermagem na Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), sob a ?tica de discentes, docentes e egressos. Com abordagem qualitativa e recurso metodol?gico da Hist?ria Oral para avalia??o das narrativas, complementado por uma an?lise documental para confirma??o dos fatos. Entrevistou-se dezessete (17) participantes, sendo: sete (07) discentes, cinco (05) docentes e cinco (05) egressos. Utilizou-se a pergunta norteadora: Comente como o Pr?-Sa?de I contribuiu ou contribui para a forma??o profissional em enfermagem. Essa sofreu v?rios desdobramentos ao longo das entrevistas de acordo com o conhecimento do colaborador, trouxe maior clareza ? vis?o de cada entrevistado. Realizou-se a an?lise dos dados com base na hist?ria oral ap?s a transcria??o das narrativas. Organizou-se as informa??es coletadas nas categorias tem?ticas: Atributos da escrita e confec??o do projeto; Dificuldades para a defini??o e conceitua??o do pr?-sa?de I; Pouca divulga??o da Estrat?gia de Reorienta??o principalmente entre os alunos; Como se deu o primeiro contato do discente com o pr?-sa?de I; Como ? a intera??o do programa com as disciplinas curriculares da gradua??o em enfermagem; Como se manifestam as formas de contribui??o do pr?-sa?de I para suporte da forma??o profissional; A diferen?a do perfil do aluno inserido com o aluno n?o inserido na estrat?gia; A Estrutura??o f?sica proporcionada ao curso de gradua??o; Apoio para estrutura??o f?sica de UBS; Est?mulo para confec??o do primeiro Projeto Pol?tico Pedag?gico do curso de gradua??o em enfermagem; Dificuldade dos discentes para caracterizarem as Diretrizes Curriculares Nacionais (DCN) e a Reorienta??o Nacional da Forma??o Profissional em Sa?de; Formas de contribui??es para a forma??o dos docentes e Contribui??es para forma??o dos profissionais dos servi?os de sa?de em Aten??o B?sica ? Sa?de. Na compreens?o das estruturas conceituais, este estudo desvela concep??es e significados atribu?dos ? forma??o profissional considerando a trajet?ria pessoal de cada colaborador. E oferece subs?dios para uma discuss?o ampla sobre a forma??o profissional em enfermagem a partir do Pr?-Sa?de I, visando estimular os cursos de gradua??o a realizarem uma releitura do projeto pedag?gico no sentido de efetivarem as adequa??es necess?rias para que a forma??o seja no sentido de produzir profissionais com perfil indicado pelas DCN. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2013. / ABSTRACT The study sought to understand the contributions of Pro-Health I for vocational training in Nursing at the Federal University of the Jequitinhonha and Mucuri (UFVJM), from the perspective of students, faculty and alumni. Using a qualitative approach and methodological resource for evaluating Oral History of the narratives, supplemented by a document analysis to confirm the facts. We interviewed seventeen (17) participants, as follows: seven (07) students, five (05) teachers-five (05) graduates. We used the guiding question: Discuss how the Pro-Health I contributed or contributes to the professional training in nursing. This undergone several developments throughout the interviews according to the knowledge of the employee, brought greater clarity to the vision of each interviewee. We conducted data analysis based on oral history after trans-creation of narratives. Was organized information gathered in thematic categories: Attributes of writing and preparation of the project; difficulties for the definition and conceptualization of health pro-I; Little dissemination Strategy Reorienting especially among students, How was the first contact with the student the pro-health I. How is the interaction of the program with the disciplines of undergraduate nursing curriculum; Like manifest forms of contribution of health pro-I to support training; Unlike the student profile inserted with the student not inserted in the strategy; Structuring The physical proportionate to the degree course; Support for physical structuring of UBS; Stimulus for making the first Political Pedagogical Project of the degree course in nursing students' difficulty to characterize the National Curriculum Guidelines (DCN) and the National Reorientation Vocational Training in Health; Forms of contributions to the training of teachers and contributions to the training of professionals of the health services in Primary Health On the understanding of conceptual frameworks, this study reveals concepts and meanings attributed to training considering the personal trajectory of each employee. And provides grants for a broad discussion on vocational training in nursing from the Pro-Health I, to stimulate undergraduate courses to undertake a reassessment of the education program in order to actualize the necessary adjustments so that the training is in the sense of producing professionals with profile indicated by DCN.

?rea de concentra??o: Sa?de Coletiva. / Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T13:33:28Z No. of bitstreams: 2 patricia_maria_lopes_rocha_correa.pdf: 526931 bytes, checksum: 805797d7f659090dda3ebba83e68646c (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T13:34:00Z (GMT) No. of bitstreams: 2 patricia_maria_lopes_rocha_correa.pdf: 526931 bytes, checksum: 805797d7f659090dda3ebba83e68646c (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T13:35:02Z (GMT) No. of bitstreams: 2 patricia_maria_lopes_rocha_correa.pdf: 526931 bytes, checksum: 805797d7f659090dda3ebba83e68646c (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Made available in DSpace on 2015-01-08T13:35:02Z (GMT). No. of bitstreams: 2 patricia_maria_lopes_rocha_correa.pdf: 526931 bytes, checksum: 805797d7f659090dda3ebba83e68646c (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Previous issue date: 2013 / Este estudo teve como objetivo conhecer a percep??o acad?mica do aluno de gradua??o em odontologia sobre a sa?de coletiva, a sua forma??o profissional em sa?de coletiva e a sua perspectiva em trabalhar no Sistema ?nico de Sa?de (SUS). A metodologia utilizada foi a pesquisa qualitativa e explorat?ria. Os dados foram coletados nos meses de fevereiro a abril de 2013, por meio de entrevistas individuais semiestruturadas, gravadas, transcritas, submetidas ? analise de conte?do do tipo tem?tica e discutidas ? luz de alguns estudiosos do assunto. Contou com a colabora??o de treze acad?micos de gradua??o em odontologia de uma institui??o p?blica de ensino dos Vales do Jequitinhonha e Mucuri. Em rela??o ? percep??o sobre sa?de coletiva, foi poss?vel identificar tr?s categorias: a sa?de coletiva como atendimento ? comunidade; a sa?de coletiva como preven??o e a sa?de coletiva como ?rea interdisciplinar. Quanto ? forma??o profissional, os acad?micos ressaltaram a dist?ncia entre a teoria apresentada no curso e a pr?tica no servi?o p?blico; bem como a estrutura curricular vigente, direcionando a forma??o para o consult?rio particular. Para alguns desses acad?micos, trabalhar no SUS est? associado a: oportunidade para adquirir experi?ncia e necessidade financeira; compromisso com a sa?de coletiva e articular o servi?o p?blico com o servi?o privado. E, para outros, o SUS n?o se apresenta como campo profissional. A pesquisa revela a necessidade de oferecer uma forma??o em sa?de coletiva estruturada a partir do cuidado coletivo com a sa?de, para que o aluno possa conhecer e refletir o que ? na atualidade a sa?de coletiva e o SUS, bem como o caminho que se faz atrav?s de integra??o efetiva entre ensino-servi?o, articulando pol?ticas de educa??o e pol?ticas de sa?de, adequando os novos egressos ?s necessidades sociais da popula??o. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2013. / ABSTRACT The aim of the present study was to analyze the academic perception of dentistry students of public health care, the student?s professional education in the area of public health, and their perspective of working in the public health care system. A qualitative, exploratory and descriptive study was undertaken. Data was collected between the months of February and April 2013 through semi-structured individual interviews, which were recorded, transcribed, submitted to thematic analysis and discussed in the light of existing scientific literature on the object. A total of 13 dental students from the Public Education Instituition of Valeys Jequitinhonha e Mucur? participated in the study. In relation to public health three categories were identified: community health care; prevention based in public health care, and interdisciplinary public health care. With regard to professional education the students emphasized the gap between the theoretical formation in the course and the realities of the public health care system, and the course curriculum of the that directs the graduate towards private practice. For these students working in the public health system is associated with: the opportunity to acquire experience, financial necessity, a commitment to public health, and linking the public and private health care systems. For others the public health care system was not mentioned as a professional area. The study revealed the importance of offering professional education that considers the difficulties of working in the public health care system, integration between education and work, and of creating education and health policies that prepare newly graduated health professionals to address the social needs of the population.

M.Tech. / In the volatile telecommunication industry, innovation is the key to success. Mobile Telephone Network South Africa (MTN SA) needs to launch new products and services consistently to stay on the competitive edge. Consequently, effective project management becomes the key to gaining the competitive advantage by turning new product or service concepts into reality. According to Nokes and Kelly (2007:153–156), there is a high correlation between project success and effective project scope management. The effectiveness of project scope management can drastically affect the success of projects, as changes to the project scope may severely affect the project value creation, timeline, quality and cost. Accordingly, high project scope management maturity would contribute tremendously to the effectiveness of project management. The purpose of this present research is to define a roadmap to guide MTN’s Business Optimisation (BO) department to project scope management excellence. To meet this aim, the researcher utilises the concept of a Project Management Maturity Model (PMMM), as a guideline for the creation of a project scope management maturity model. The created project scope management maturity model is then utilised to provide an effective means to measure MTN SA’s project scope management maturity and identify the gaps prohibiting MTN SA from project scope excellence (Kerzner, 2004:193). Based on the literature review on the elements of project scope excellence, this paper suggests that there is a general misunderstanding regarding the definition of maturity. Many believe that process rigorousness indicates maturity, and have forgotten the criticality of the organisational culture that fosters an environment for project scope excellence and the effective use of the project scope process. iii This research offers a comparative study on the most popular and effective maturity models in the market, to identify the models that truly contribute to project scope management success and excellence. Finally, the research tailors the models to a project scope management focused maturity model, to assess MTN SA’s project scope management maturity from all aspects, and proposes a roadmap toward project scope management excellence.

M.Comm. / This dissertation is an investigation into the changing role, task and utility of the secretary as a resource for the manager in Technikon SA(TSA). In today's office, a secretary can no longer offer just technical skills and personal attributes alone. The secretary must be involved as an energetic and vital member of the group. The secretary must appreciate the possibilities of making an increased contribution to the success of the manager by managing the time available to the secretary more effectively. The secretary has to understand the factors which operate in inter-personal work relations. The secretary must be a skilled communicator and organiser. The secretary needs a talent for detailed administration. The secretary often has a controlling and planning function. Secretaries have a significant role to play in maintaining good relations with all within the organisation, and in creating a favourable image to those outside. A secretary should be able to lubricate the wheels of the manager's work and exercise intelligent anticipation by thinking for and with the manager. The first part of this study exists of a literature overview of the secretary in die business world. Special attention is given to the role of the secretary and the need for a secretary; the changing office environment; the changing role of the secretary; the impact of technology and the changing role of the secretary and the secretary's role in the upcoming virtual office. The changing career path of the secretary is also addressed. The literature overview ends with an overview of the utilisation of the secretary and the establishment of an optimal work relationship between secretary and manager and the training and development of the secretary. The last part of the study exists of the results of a questionnaire compiled and distributed to all the secretaries in TSA and interviews with some managers in TSA. The secretary's in TSA perform basic secretarial functions. The nature of the secretary's work is determined by the specific department where the secretary is working. TSA secretary's uses the most up to date technology in the execution of their work. Secretaries have limited authority and responsibility regarding their work but they can almost always influence there manager's decisions regarding office related issues. There is no real career path for the secretary in TSA, which is a big frustration for the secretaries. Because there is a not a definite career path and no distinction between for example a junior secretary, secretary, senior secretary etc, some secretaries tend to be over and others under utilised. The nature of the secretary's work can determine that a secretary is more involved with aspects such as project management, budgeting and scheduling. These secretaries do not get the recognition they deserve and is still on the same level as all the other secretaries in TSA. The secretaries in TSA is equipped with the write training, development and experience to fulfil work with more authority and responsibility. The role of the secretary in TSA will definitely change in future. Both managers and secretaries see the role of the secretary to be changed to that of a personal assistant with the necessary authority and responsibility to handle lower level management work. The secretary will have more decision power in the execution of the Technikon's policy and procedures an better utilised.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-08-16T17:00:00Z No. of bitstreams: 1 EdianeSantosCairesDissertacao2015.pdf: 1101397 bytes, checksum: 6cad8132318feef960f0ba4b00fc7062 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-08-16T17:00:05Z (GMT) No. of bitstreams: 1 EdianeSantosCairesDissertacao2015.pdf: 1101397 bytes, checksum: 6cad8132318feef960f0ba4b00fc7062 (MD5) / Made available in DSpace on 2017-08-16T17:00:05Z (GMT). No. of bitstreams: 1 EdianeSantosCairesDissertacao2015.pdf: 1101397 bytes, checksum: 6cad8132318feef960f0ba4b00fc7062 (MD5) Previous issue date: 2015-01-01 / Introduction: The increased morbidity and mortality of males and decreased life expectancy of man, and the lack of prevention habits underlie current discussions of Men's Health in order to seek reflections that bring men to the assistance health through pragmatic change in men's attitude. Objective: To assess the knowledge and adherence to the Family Health Strategy and prostate cancer in men Bahian farmers. Methodology: We conducted two semistructured interviews, where the first had specific issues classified into eight categories: the participation of men in family health strategy (ESF), knowledge about prostate cancer, demand for health services, education level the socio - economic, age, marital status and quality of life. The second interview was conducted by a validated multidimensional instrument for assessing the quality of life, and the SF 36. Results: The sample 354 men, and 328 (92.7%) farmers, with an average age of 57.94 ?? 11, 74 years (40-87), 282 married (79.9%) and 288 (81.6%) with an income equal to the minimum wage. The school was found up to four years of study to 322 men (91.2%). Of the total interviewed 287 subjects (81.1%) know the unity of the Family Health Strategy, however, the demand on health services is mainly for Disease Control 188 men (53.3%) and prevention for 139 men 39.5%. The questioning of the AC Prostate, 340 men (95.80%) have heard about this subject, and 258 people (72.90%) have knowledge of the examinations related to this disease, 149 individuals (42.10%) already performed the rectal exam and 191 respondents (54.20%) PSA testing, on demand of men to health services only 15 subjects (4.2%) of the total interviewed seek health services. Regarding quality of life, there was a significant difference in the field vitality when compared Group 1 characterized by individuals who are part of the ESF with the Group 2 made up of individuals who are not part of the ESF, we find an average of 62, 50 ?? 18.80 vs. 59.93 ?? 21.09 respectively (p = 0.05). Conclusion: It was found that most men had knowledge of pathology and examinations necessary for independent prevention education level. However, when it was discussed the conduct of these tests it was found that half of the men even though endowed with knowledge, did not perform the tests. The education of men to the attention of Prostate CA showed no direct relationship, in relation to preventive tests, it was found that the number of individuals who have not made the digital rectal exam is higher of that feature up to four years of education. The completion of the examination is not subject to family income as men despite having knowledge about the theme does not perform the usual preventive exams. Regarding the quality of life it became clear that the accession of the man prioritized the actions taken by the health team providing a better quality of life to participating users. / Introdu????o: O aumento da morbimortalidade do sexo masculino e a diminui????o da expectativa de vida do homem, bem como a escassez de h??bitos de preven????o fundamentam as discuss??es atuais acerca da Sa??de do Homem com o intuito de buscar reflex??es que tragam os homens para a assist??ncia em sa??de por meio de mudan??as pragm??ticas na postura masculina. Objetivo: Verificar o conhecimento e ades??o ?? Estrat??gia de Sa??de da Fam??lia em homens lavradores baianos. Metodologia: Foram realizadas duas entrevistas semiestruturadas, onde a primeira apresentava quest??es especificas classificadas em oito categorias: a participa????o do homem na estrat??gia de sa??de da fam??lia (ESF), o conhecimento sobre c??ncer de pr??stata, procura pelos servi??os de sa??de, o n??vel de escolaridade, a condi????o s??cio ??? econ??mica, a idade, o estado civil e a qualidade de vida por meio de uma segunda entrevista com o instrumento multidimensional validado para an??lise, o SF 36. Resultados: Participaram da amostra 354 homens, sendo 328 (92,7%) lavradores, com idade m??dia de 57,94 ?? 11,74 anos (40-87), 282 casados (79,9%) e 288 (81,6%) com renda igual a um sal??rio m??nimo. A escolaridade encontrada foi de at?? quatro anos de estudo para 322 homens (91,2%). Do total dos entrevistados 287 indiv??duos (81,1%) conhecem a unidade de Estrat??gia de Sa??de da Fam??lia, por??m, a procura nos servi??os de sa??de ?? principalmente para controle de doen??as para 188 homens (53,3%) e preven????o para 139 homens 39,5%. Ao questionar sobre o CA de Pr??stata, 340 homens (95,80%) j?? ouviram falar sobre este tema, sendo que 258 pessoas (72,90%) tem conhecimento sobre os exames relacionados a esta patologia, 149 indiv??duos (42,10%) j?? realizaram o exame de toque retal e 191 dos entrevistados (54,20%) o exame de PSA, sobre a procura dos homens aos servi??os de sa??de somente 15 indiv??duos (4,2%) do total entrevistado procuram os servi??os de sa??de. Em rela????o a qualidade de vida, verificou-se diferen??a significativa no dom??nio vitalidade, quando compara-se o Grupo 1 caracterizado por indiv??duos que fazem parte da ESF com o Grupo 2 formado por indiv??duos que n??o fazem parte da ESF, encontrando um valor m??dio de 62,50 ?? 18,80 vs 59,93 ?? 21,09 respectivamente (p= 0,05). Conclus??o: Verificou-se que a maioria dos homens apresentaram conhecimento acerca da patologia e dos exames necess??rios para a preven????o independentemente do n??vel de escolaridade. Entretanto, quando foi discutido a realiza????o destes exames observou-se que metade dos homens ainda que dotado de conhecimento, n??o realizou os exames. A escolaridade dos homens ao conhecimento do CA de Pr??stata n??o apresentou rela????o direta, em rela????o aos exames de detec????o precoce, verificou-se que o n??mero dos indiv??duos que n??o fizeram o toque retal encontra-se maior entre com que apresentam at?? quatro anos de instru????o. A realiza????o do exame n??o est?? condicionada a renda familiar j?? que os homens apesar de apresentar conhecimento acerca da tem??tica n??o realiza os exames habituais de preven????o. Em rela????o ?? qualidade de vida evidenciou-se que ?? ades??o do homem priorizou as a????es desenvolvidas pela equipe de sa??de proporcionando uma melhor qualidade de vida aos usu??rios participantes.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-08-17T23:04:11Z No. of bitstreams: 1 ArdigleusaAlvesCoelho_TESE.pdf: 5269699 bytes, checksum: 4d60ce010870248fb2e8dd6e387ac7b5 (MD5) / Approved for entry into archive by clediane guedes (clediane@bczm.ufrn.br) on 2016-08-17T23:06:49Z (GMT) No. of bitstreams: 1 ArdigleusaAlvesCoelho_TESE.pdf: 5269699 bytes, checksum: 4d60ce010870248fb2e8dd6e387ac7b5 (MD5) / Made available in DSpace on 2016-08-17T23:06:49Z (GMT). No. of bitstreams: 1 ArdigleusaAlvesCoelho_TESE.pdf: 5269699 bytes, checksum: 4d60ce010870248fb2e8dd6e387ac7b5 (MD5) Previous issue date: 2015-03-04 / O Brasil ? um dos pa?ses que concentram 80% da carga de tuberculose no mundo. No contexto da aten??o prim?ria brasileira, fatores interferem para que as equipes de sa?de da fam?lia possam incorporar as atividades de controle da doen?a no processo de trabalho. O controle da doen?a depende da forma como os servi?os de sa?de est?o organizados para garantir o acesso ao diagn?stico precoce e ao tratamento. Esse estudo tem como objetivo geral analisar o controle da tuberculose no contexto da aten??o prim?ria ? sa?de no Brasil. Os objetivos espec?ficos s?o comparar o tratamento diretamente observado com o regime autoadministrado em pessoas com tuberculose; Verificar se o Programa Nacional de Controle da Tuberculose ? avali?vel e elaborar um modelo te?rico e l?gico para avalia??o deste programa; avaliar a rela??o entre porte populacional dos munic?pios e as caracter?sticas de estrutura e processo de cuidado a pacientes de tuberculose na aten??o prim?ria no Brasil. Realizou-se uma revis?o sistem?tica, seguida de um estudo de avaliabilidade e de um estudo transversal. Os achados da revis?o sistem?tica revelam que n?o houve diferen?a significativa entre os grupos de tratamento (observado e n?o observado) para cura (OR 1,06. IC95% 0,75 - 1,50) e para conclus?o do tratamento (OR 1,64, IC 95% 0,79 - 3,42). Menor abandono no grupo com tratamento supervisionado e n?o houve diferen?a estatisticamente significativa entre os grupos (OR 0,73, CI 95% 0,58-0,92). O risco de morte foi maior no regime de tratamento autoadministrado (OR 1,49 IC 95% 1,03 - 2,45). A hetorogeinadade entre os estudos analisados n?o permite afirmar que nao h? diferen?a estatisticamente significativa para cura e tratamento conclu?do. A pr?-avalia??o do Programa de Controle de Tuberculose possibilitou a descri??o do Programa, elabora??o e pactua??o do modelo l?gico e a matriz de relev?ncia dos indicadores. Caracterizou-se os seus elementos estruturantes, defini??o de indicadores de estrutura e processo, al?m das perguntas avaliativas. Uma avalia??o somativa com enfoque na an?lise dos efeitos da interven??o de controle da tuberculose ? recomendada. A avalia??o das caracter?sticas de estrutura e processo de cuidado ? pessoa com tuberculose revelou melhor desempenho para as equipes de aten??o b?sica de munic?pios classificados como metr?pole no acesso, coordena??o do cuidado e qualidade t?cnica da aten??o. Em rela??o ao acesso: 98,5% acolhimento a demanda espont?nea; 95,8% programa??o de consultas. Na coordena??o do cuidado, 93,2% exist?ncia de protocolo para tuberculose. Quanto a qualidade t?cnica da aten??o ? tuberculose verifica-se que 93,4% acompanhamento de tratamento diretamente observado, 95,8% com busca ativa de faltosos ao tratamento, 64,0% oferta de a??es educativas, 91,3% busca ativa de sintom?ticos respirat?rios. Cabe destacar que metr?poles apresentaram maior tempo m?dio de espera para escuta/acolhimento (24,41 minutos); para consulta previamente agendada (23,52 dias); para consulta em pneumologia (87,12 dias). Percebem-se fragilidades na estrutura e processo da aten??o ? tuberculose, principalmente no controle especializado da doen?a e na qualidade t?cnica entre os munic?pios. Recomenda-se refor?o, particularmente na qualidade t?cnica para aumentar a cobertura de acompanhamento do tratamento, busca de sintom?ticos respirat?rios e das a??es educativas. / O Brasil ? um dos pa?ses que concentram 80% da carga de tuberculose no mundo. No contexto da aten??o prim?ria brasileira, fatores interferem para que as equipes de sa?de da fam?lia possam incorporar as atividades de controle da doen?a no processo de trabalho. O controle da doen?a depende da forma como os servi?os de sa?de est?o organizados para garantir o acesso ao diagn?stico precoce e ao tratamento. Esse estudo tem como objetivo geral analisar o controle da tuberculose no contexto da aten??o prim?ria ? sa?de no Brasil. Os objetivos espec?ficos s?o comparar o tratamento diretamente observado com o regime autoadministrado em pessoas com tuberculose; Verificar se o Programa Nacional de Controle da Tuberculose ? avali?vel e elaborar um modelo te?rico e l?gico para avalia??o deste programa; avaliar a rela??o entre porte populacional dos munic?pios e as caracter?sticas de estrutura e processo de cuidado a pacientes de tuberculose na aten??o prim?ria no Brasil. Realizou-se uma revis?o sistem?tica, seguida de um estudo de avaliabilidade e de um estudo transversal. Os achados da revis?o sistem?tica revelam que n?o houve diferen?a significativa entre os grupos de tratamento (observado e n?o observado) para cura (OR 1,06. IC95% 0,75 - 1,50) e para conclus?o do tratamento (OR 1,64, IC 95% 0,79 - 3,42). Menor abandono no grupo com tratamento supervisionado e n?o houve diferen?a estatisticamente significativa entre os grupos (OR 0,73, CI 95% 0,58-0,92). O risco de morte foi maior no regime de tratamento autoadministrado (OR 1,49 IC 95% 1,03 - 2,45). A hetorogeinadade entre os estudos analisados n?o permite afirmar que nao h? diferen?a estatisticamente significativa para cura e tratamento conclu?do. A pr?-avalia??o do Programa de Controle de Tuberculose possibilitou a descri??o do Programa, elabora??o e pactua??o do modelo l?gico e a matriz de relev?ncia dos indicadores. Caracterizou-se os seus elementos estruturantes, defini??o de indicadores de estrutura e processo, al?m das perguntas avaliativas. Uma avalia??o somativa com enfoque na an?lise dos efeitos da interven??o de controle da tuberculose ? recomendada. A avalia??o das caracter?sticas de estrutura e processo de cuidado ? pessoa com tuberculose revelou melhor desempenho para as equipes de aten??o b?sica de munic?pios classificados como metr?pole no acesso, coordena??o do cuidado e qualidade t?cnica da aten??o. Em rela??o ao acesso: 98,5% acolhimento a demanda espont?nea; 95,8% programa??o de consultas. Na coordena??o do cuidado, 93,2% exist?ncia de protocolo para tuberculose. Quanto a qualidade t?cnica da aten??o ? tuberculose verifica-se que 93,4% acompanhamento de tratamento diretamente observado, 95,8% com busca ativa de faltosos ao tratamento, 64,0% oferta de a??es educativas, 91,3% busca ativa de sintom?ticos respirat?rios. Cabe destacar que metr?poles apresentaram maior tempo m?dio de espera para escuta/acolhimento (24,41 minutos); para consulta previamente agendada (23,52 dias); para consulta em pneumologia (87,12 dias). Percebem-se fragilidades na estrutura e processo da aten??o ? tuberculose, principalmente no controle especializado da doen?a e na qualidade t?cnica entre os munic?pios. Recomenda-se refor?o, particularmente na qualidade t?cnica para aumentar a cobertura de acompanhamento do tratamento, busca de sintom?ticos respirat?rios e das a??es educativas.