Submitted by Fabricia Fialho Reginato (fabriciar) on 2015-07-28T22:33:26Z No. of bitstreams: 1 CristianoBrum.pdf: 8266440 bytes, checksum: 2fc6720638df8dd9a5999cef25a374e1 (MD5) / Made available in DSpace on 2015-07-28T22:33:26Z (GMT). No. of bitstreams: 1 CristianoBrum.pdf: 8266440 bytes, checksum: 2fc6720638df8dd9a5999cef25a374e1 (MD5) Previous issue date: 2013-03-05 / Nenhuma / O contexto centralizador do Estado Novo trouxe ao Rio Grande do Sul José Bonifácio Paranhos da Costa, um técnico federal do DNS para assumir os serviços de saúde do Estado. Este médico sanitarista gaúcho, radicado no Rio de Janeiro chega em um contexto de verticalização das políticas e é um personagem fundamental para o entendimento desse contexto. No Rio Grande do Sul, Bonifácio Costa realizou, seguindo diretrizes federais a Reforma Sanitária de 1938 e criou o Departamento Estadual de Saúde. Nosso objetivo foi reconstruir a trajetória pessoal e profissional do gaúcho José Bonifácio Paranhos da Costa, bem como seu pensamento médico, e suas relações em diversos âmbitos, a fim de perceber se essas variáveis influenciaram sua atuação e a reforma da saúde por ele promovida em 1938 no Departamento Estadual de Saúde do Rio Grande do Sul; e entender como se relacionam estes elementos. Numa perspectiva microanalítica procuramos, utilizando procedimento de cruzamento nominal de fontes, traçar a rede de relações de nosso personagem, percebendo a existência de mediadores e facilitadores durante sua trajetória profissional. Devido à falta de estudos que foquem a saúde pública neste período, procuramos também realizar um “inventário” das principais ações do Departamento Estadual de Saúde. No que diz respeito à autonomia, percebemos que ao mesmo tempo em que realizou todas as exigências do Departamento Nacional de Saúde, também criou uma atmosfera administrativa diferenciada; a qual tentou Bonifácio Costa, inclusive importar para outros estados e aplicá-la a âmbito federal, numa iniciativa descentralizadora, que rompia com a ideia de política vertical. / The centralizing context of the Estado Novo (Getúlio Vargas’s dictatorship, between 1937-1945) brought José Bonifácio Paranhos da Costa to Rio Grande do Sul. He was a federal technician from the National Department of Health, and was to take over the health services of the state. This public health physician, himself born in the state of Rio Grande do Sul and living in Rio de Janeiro, arrived in a context of verticalization of policies and knowing about him is essential to understand this reality. In Rio Grande do Sul, Bonifácio Costa performed the Sanitary Reform of 1938, according to federal guidelines, and established the State Department of Health. Our goal was to reconstruct the personal and professional history of José Bonifácio Paranhos da Costa, and also his medical thinking and his relationships in various spheres, in order to find out whether these variables influenced his work and the health reform he promoted in 1938 in the Rio Grande do Sul State Department of Health; and also to underestand how these elements are related. From a microanalytic perspective, using a procedure of “nominal record linkage”, we sought to trace the network of relationships of our character, perceiving the existence of brokers and facilitators during his professional career. Due to the lack of studies focusing on public health during this period, we also tried to “inventory” the main actions of the State Department of Health. As regards autonomy, we perceived that, at the same time as he fulfilled all requirements of the National Department of Health, Bonifácio Costa also established a different administrative atmosphere that he even tried to import to other states and apply at the federal level, in a decentralizing initiative that broke with the idea of a vertical policy.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3- reengineer the current reporting process to improve turnaround time. Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available.

Indiana University-Purdue University Indianapolis (IUPUI) / Consistent under-reporting of autism cases by Indiana physicians to the Indiana Birth Defects and Problems Registry (IBDPR) has made quality autism-related data very difficult to obtain (Indiana Birth Defects and Problems Registry [IBDPR], 2011). As a result, the Indiana State Department of Health (ISDH) currently also utilizes data from billing information that it receives from hospital discharges. However, such cases must be investigated further because autism is often merely suspected as a possibility in the discharge data. A chart auditor must therefore review the child’s chart to determine if the condition is confirmed. Meanwhile, the Indiana Department of Education (IDOE) has a different diagnostic procedure from physicians for determining whether a student has an Autism Spectrum Disorder (ASD), which qualifies him or her for special education. A physician diagnosis of autism does not guarantee that a child will receive special education from public schools. With all of these current complications surrounding autism, announced changes in the definition of autism by the American Psychiatric Association (APA) will likely have effects on both the special education field and the public health field. There is a possibility that children who had previously received special education could cease to maintain their eligibility and may find it difficult to obtain benefits. The IDOE may find it necessary to reevaluate their criteria for determining special education eligibility. Additionally, public health officials may see the definition changes affect the number of autism cases they perceive their populations to have, thus impacting community and policy decisions. This study was performed as an attempt to investigate and compare the sources used by the IBDPR to obtain autism data, and determine whether or not the resulting data creates an accurate depiction of the autistic population of Indiana. It was also performed to speculate whether a stricter definition of autism will result in a higher quality of data for the IBDPR and a more consistent view on the disorder between the ISDH and the IDOE. Perhaps from such consistency and simpler definitions, future recorded data will more closely resemble that of reality, enabling the ISDH to utilize the IBDPR to its full extent. Using current definitions for an exploratory analysis of data from the past five years, a discrepancy clearly exists between the IBDPR and the reality of the population of Indiana.