The health service provides a Child Health Programme (CHP) to all children to help them attain their health and development potential. Core elements include screening, immunisations, growth and development surveillance, health promotion advice, and parenting support. The surveillance/advice/support components (known as Child Health Surveillance CHS) are delivered through a series of universally offered child health reviews mainly provided by Health Visitors (HVs) supplemented by additional support as required. Scottish policy issued in 2005 led to considerable changes to the CHP. The number of CHS reviews was substantially reduced to enable more intensive support of children who required it. A three category indicator of need was introduced at the same time to facilitate the identification of children requiring enhanced support. This thesis aims to explore the shift to more targeted provision of CHS that occurred from 2005 onwards, and to examine the impact of this on the preventive health care provided to pre-school children. The specific objectives are: · To describe the development of professional guidance on the CHP and how this has been adopted into Scottish policy. · To compare the CHP provided in Scotland to that offered in other high income countries. · To examine the impact of the changes to CHS on the coverage of universally offered child health reviews. · To explore, following the changes to CHS, which factors are associated with children being identified as in need of enhanced CHP support. · To assess the impact of the changes to CHS on the totality of preventive care provided to pre-school children by HVs and General Practitioners (GPs). The key methods used are literature review, policy analysis, and analysis of routine health data. Selected findings include the following: · All the high income countries studied provide the same basic elements as the Scottish CHP but the detail of the different programmes varies considerably. Some of the variation may reflect the different needs of different populations, but much seems to reflect different approaches to evidence interpretation and policy making in different settings. · Not all children offered ‘universal’ child health reviews actually receive them. Children from deprived areas are less likely to receive their reviews. Inequalities in review coverage have remained unchanged after the changes to CHS. · Many factors, including those reflecting infant and maternal health and family social risk, are associated with being identified by HVs as needing enhanced CHP support. The threshold at which children are identified as needing enhanced support varies between areas across Scotland. · GP provision of child health reviews has reduced after the changes to CHS as would be expected. Recorded GP provision of other preventive care consultations is uncommon and has not changed. Currently available routine data do not allow trends in the totality of HV provided care to be examined. In summary, the Child Health Programme makes an important contribution to supporting young children and their families but it is a complex service and considerable uncertainty about aspects of its content and delivery remain.

The public health significance of campylobacters lies in their role as enteropathogens of man. Zoonotic in origin, they are the most commonly reported bacterial cause of gastrointestinal infection in the developed world. Approximately 46,000 laboratory-confirmed cases are reported annually in England and Wales, and this figure underestimates community disease by a factor of eight. Infection is unpleasant and, whilst self-limiting, a tenth of cases require hospital admission for their illness. Sequelae such Irritable Bowel Syndrome, Reactive Arthritis and Guillain-Barré Syndrome compound the problem. Despite the significant public health burden posed by campylobacters, our understanding of the epidemiology of Campylobacter infection is limited. This deficiency relates to a combination of the natural history of the microorganism, the high disease incidence which exists and the epidemiological tools applied thus far to its study. In order to gain a better understanding of the epidemiology of Campylobacter infection the Campylobacter Sentinel Surveillance Scheme was conceived in 1998 and established in 1999. Through the integration of standardised epidemiological and microbiological data, it aimed to generate systematically new hypotheses for potential vehicles of infections, or transmission pathways, for campylobacteriosis. Twenty-two health authorities, representing all NHS regions at that time in England and in Wales and with a population of over 12 million people, participated in the study, which ran from May 2000 until April 2003. Standardised epidemiological data were captured on over 20,000 cases over the surveillance period and these were combined with microbiological data from detailed strain characterisation of patients‟ strains, referred at the same time. Case-case comparisons and disease determinant analysis were the epidemiological tools most commonly applied to the data. The research carried out by the candidate demonstrated that age, gender, ethnicity, occupation and socioeconomic status are major determinants for Campylobacter infection in England and Wales, and that variation in behaviour throughout the week also has a bearing on risk. It has shown that campylobacteriosis cannot be considered a single disease, as exposure differences exist in cases infected with different Campylobacter species or subspecies, and these differences can be confounded by foreign travel status. The fact that disease incidence amongst foreign travellers is country-specific suggests that the above exposure differences will be confounded further by travel destination. It has shown that outbreaks of campylobacteriosis occur more commonly than described previously, suggesting that an opportunity for furthering our understanding of infection is being missed. Finally, the dose-response relationship for Campylobacter infection has been investigated, highlighting potential implications for the design of future epidemiological studies. Policy makers should be aware that future case-control studies of Campylobacter infection will need to be larger or more complex, and hence more costly. Such costs should be weighed against the opportunity for a more accurate assessment of disease risk, leading to improved evidence-based policy development. Researchers should focus on assessing rapidly and by non-invasive means, previous exposure to campylobacters amongst healthy controls, improving further the accuracy of case-control studies, which remain the epidemiological method of choice for studying this disease. This study has demonstrated that the systematic collection of standardised epidemiological information on all cases of Campylobacter infection, reported from large, well defined populations over a prolonged period, coupled with detailed strain characterisation, can lead to public health gains.

In aquaculture worldwide, diseases are a significant constraint to economic expansion. The Scottish salmonid industry has experienced many cycles of development, with episodes of little or negative profitability caused by excess of production, and times of crisis due to different disease problems. In Scotland, the early implementation of regulation largely contributed to the control of infectious disease outbreaks. The recent Chilean outbreak of infectious salmon anaemia (ISA) illustrated the threats and the impacts of disease in the aquaculture industry and the importance of implementing good regulation and husbandry practices to reduce the impact of the spread of infectious disease. Databases of site production data have an important role to play in the investigation and understanding of diseases. They store valuable data collected during the time of production, which are essential for the identification of potential health and production problems during the production cycle of farmed fish. Mortality records are one of the most important sources of information on a farm, especially if it includes the cause of death as deformities, predators and diseases. Any deviation from the expected levels of mortality may indicate production problems, infectious diseases, or inadequate welfare. The investigation of increased rates of mortality must include examining farm records, determining the influence of death rate on production and the potential risk factors of diseases in a farm. This project demonstrated the importance of mortality records for setting industry standards of “expected” mortality losses and for investigating the value of recorded mortalities as a tool for aiding in surveillance and control of infectious diseases. It also aimed to determine the utility of reported mortality in supporting and assisting management-strategy decisions at the farm and industry level. In this project, we developed a baseline benchmark curve for expected mortality losses for Atlantic salmon in seawater. This novel approach constitutes a first attempt to establish a baseline curve for normal mortality, which allows detection of potential production problems based on deviations of mortality from the baseline curve of normal mortality. The results of this study also indicated that mortality levels may vary across production cycles, which can again be identified by using the baseline. We found that site was the factor with the highest contribution to variance in mortality. This site-to-site variation in mortality may have resulted from epidemics and environmental incidents, or other local event/effects. Temperature, and/or geographical area were also characteristics that contribute to variation in mortality. The regulator, Marine Scotland Science, with the backing and support of the salmonid industry has suggested potential mortality thresholds as an indicator of presence of infectious diseases, which could be used as alerts for inspection by the official authority. In this study, high mortality rates on fish farms were investigated as an indicator of the presence of infectious disease. The analysis was performed using several analytical approaches: receiver operating characteristic (ROC) curve analysis, measures of sensitivity and specificity, and bootstrap methods. The study was performed by splitting the production cycle into small fish with mean weight below 750 g and large fish with mean weight over 750 g. In the small fish, the results did not suggest reported mortality as a strong indicator of the presence of infectious disease, which may be caused by the lack of records of infectious disease at this stage of the production cycle. In the larger fish, high mortality rates were found to be a strong potential indicator of the presence of infectious diseases, including the suggested mortality threshold. In a survey, the role of traditional diagnosis in the prevention and control of disease outbreaks was assessed. For that, key informant interviews were performed with open questions to the health or farm manager of several trout and Atlantic salmon farms and we also used the diagnostic reports of the Veterinary Diagnostic Services (VDS) from Stirling University to triangulate the data. We showed that disease diagnoses are of great importance for disease identification and control of actual diseases. Farmer’s experience was also indicated as essential in the identification of the first signs of disease, which was principally through the daily monitoring of fish. This study suggested that disease diagnosis starts at the farm level with the daily monitoring of fish and the records of different parameters by the farmer, including mortality. Those records were showed to be vital to identify problems within the production. This thesis illustrated a novel approach to investigate and interpret recorded mortality at the farm level. The results presented in this thesis indicated reported mortality as a vital on-farm tool for identification of diseases and production problems. This thesis suggested priority areas where further investigation is required.

A Dengue, que se tornou um grave problema de Saúde Pública, é uma endemia viral com quatro sorotipos conhecidos. Atualmente todos circulam no Brasil. Os vetores do vírus são os mosquitos Aedes aegypti, adaptados ao ambiente urbano. A ocorrência das epidemias de dengue são associadas à presença do Ae. aegypti, ao clima favorável, ao conhecimento e atitude da população, a eficácia e cobertura dos programas governamentais de controle e vigilância do vetor, à má disposição de resíduos sólidos, a estrutura de saneamento, ao grau de urbanização, a densidade do vetor, a mobilidade da população e circulação dos sorotipos do vírus. Os objetivos desta pesquisa foram verificar se o modelo de Vigilância Ambiental em Saúde e Educação Ambiental reduz a frequência de infestação do Ae. aegypti e, consequentemente, o risco de incidência e analisar a distribuição espacial dos criadouros do mosquito do gênero Aedes aegypti na cidade de Araguari, MG. O desenho de estudo adotado foi o ecológico e a teoria dos Complexos Patogênicos. Utilizou-se dados epidemiológicos, entomológicos, climatológicos, espaciais, divididos por setores censitários, e os programas livres Google Earth para geocodificação e Terra View para espacialização dos criadouros, geração de buffers com raio de abrangência de 280 metros, para análise estatística utilizando o estimador de Kernel e geração dos mapas de Densidade dos Criadouros. Para verificar a efetividade do conjunto de ações, realizou-se uma comparação de médias dos índices de infestação prediais, dos Distritos de Piracaíba e Amanhece, considerando o período antes, durante e depois do conjunto de ações realizadas no Distrito de Amanhece. Utilizou-se o programa estatístico Action versão 4.5, o teste de Kruskal-Wallis, segundo método Kruskal- Wallis rank sum test e o Graph Pad Prism 5.0. Em todo este período de estudo, a temperatura e a umidade relativa se apresentaram em condições ótimas ao Ae. aegypti. A comparação entre o antes, o durante e o depois, não teve resultado estatisticamente significativo, no entanto de qualquer forma pôde ser observado que as ações reduziram a infestação predial a níveis inferiores à 1% no Distrito de Amanhece. A distribuição geográfica dos criadouros aponta que praticamente todos os setores censitários da cidade de Araguari estiveram em situação de risco, em diferentes graus, no período analisado. Concluiu-se com esta pesquisa que o modelo de ações desenvolvido no Distrito de Amanhece pode ser desenvolvido em localidades tais como a cidade de Araguari. A infestação predial foi registrada durante todo o período pesquisado e a presença de criadouros corroborou para a infestação do Aedes aegypti, no decorrer dos anos. O aumento da infestação do Ae. aegypti inicia entre os meses de outubro e novembro, com os maiores índices sendo registrados entre os meses de janeiro a março, reduzindo-se efetivamente, em abril e junho. Os tipos de criadouros predominantes na cidade de Araguari foram os depósitos móveis, ao nível do solo para armazenamento doméstico, lixo, sucata e materiais de construção. A participação pró ativa da comunidade e sua sensibilização são imprescindíveis para controle do mosquito e redução do risco de Dengue em Araguari. / Dengue is an endemic viral which became a serious public health problem. It has four serotypes, all circulating in Brazil. The vectors of the virus are mosquitoes Aedes aegypti, adapted to the urban environment. The occurrence of dengue epidemics is associated with the Ae. aegypti presence, favorable climate, information about prevention and preventive attitudes by the citizens, the effectiveness and coverage of control programs and vector surveillance, disposal solid waste, sanitation, urbanization, density of the vector, population mobility and dengue virus circulation. The main aim of the study was to verify whether the model of Environmental Health Surveillance and Environmental Education reduces Ae. aegypti infestation and therefore the risk of incidence and analyze the spatial distribution of mosquito breeding in Araguari, MG. This is an ecological study and the theory which was applied was pathogenic complex. It was used epidemiological, entomological, climatological and space data, Google Earth for geocoding and Terra View for spatialization. The averages of infestation levels from Districts of Piracaíba and Amanhece were compared to verify the effectiveness of the actions considering the period before, during and after the set of actions performed in the District of Amanhece. Statistical programs, Action and Graph Pad Prism, were used. Throughout this study period, the temperature and relative humidity were relevant to the Ae. aegypti. The comparison between before, during and after the set of actions showed that there was not a statistically significant result, but anyway it could be observed that the actions reduced the infestation to levels lower than 1% in Amanhece. The geographical distribution of breeding shows that Araguari was at risk, in the analyzed period. The conclusion of this research was that the model actions developed in the District of Amanhece can be applied in locations such as the city of Araguari. The infestation was recorded during all the survey period and the presence of breeding confirmed the infestation of Ae. aegypti, over the years. The infestation of Ae. aegypti starts to increase between October and November, with the highest rates being recorded from January to March, and being effectively reduced in April and June. In Araguari prevails deposits mobile ground level storage to household waste, scrap, and construction materials. proactive participation and awareness of the community are essential for controling the mosquito breeding and so reducing the risk of Dengue.

A Dengue, que se tornou um grave problema de Saúde Pública, é uma endemia viral com quatro sorotipos conhecidos. Atualmente todos circulam no Brasil. Os vetores do vírus são os mosquitos Aedes aegypti, adaptados ao ambiente urbano. A ocorrência das epidemias de dengue são associadas à presença do Ae. aegypti, ao clima favorável, ao conhecimento e atitude da população, a eficácia e cobertura dos programas governamentais de controle e vigilância do vetor, à má disposição de resíduos sólidos, a estrutura de saneamento, ao grau de urbanização, a densidade do vetor, a mobilidade da população e circulação dos sorotipos do vírus. Os objetivos desta pesquisa foram verificar se o modelo de Vigilância Ambiental em Saúde e Educação Ambiental reduz a frequência de infestação do Ae. aegypti e, consequentemente, o risco de incidência e analisar a distribuição espacial dos criadouros do mosquito do gênero Aedes aegypti na cidade de Araguari, MG. O desenho de estudo adotado foi o ecológico e a teoria dos Complexos Patogênicos. Utilizou-se dados epidemiológicos, entomológicos, climatológicos, espaciais, divididos por setores censitários, e os programas livres Google Earth para geocodificação e Terra View para espacialização dos criadouros, geração de buffers com raio de abrangência de 280 metros, para análise estatística utilizando o estimador de Kernel e geração dos mapas de Densidade dos Criadouros. Para verificar a efetividade do conjunto de ações, realizou-se uma comparação de médias dos índices de infestação prediais, dos Distritos de Piracaíba e Amanhece, considerando o período antes, durante e depois do conjunto de ações realizadas no Distrito de Amanhece. Utilizou-se o programa estatístico Action versão 4.5, o teste de Kruskal-Wallis, segundo método Kruskal- Wallis rank sum test e o Graph Pad Prism 5.0. Em todo este período de estudo, a temperatura e a umidade relativa se apresentaram em condições ótimas ao Ae. aegypti. A comparação entre o antes, o durante e o depois, não teve resultado estatisticamente significativo, no entanto de qualquer forma pôde ser observado que as ações reduziram a infestação predial a níveis inferiores à 1% no Distrito de Amanhece. A distribuição geográfica dos criadouros aponta que praticamente todos os setores censitários da cidade de Araguari estiveram em situação de risco, em diferentes graus, no período analisado. Concluiu-se com esta pesquisa que o modelo de ações desenvolvido no Distrito de Amanhece pode ser desenvolvido em localidades tais como a cidade de Araguari. A infestação predial foi registrada durante todo o período pesquisado e a presença de criadouros corroborou para a infestação do Aedes aegypti, no decorrer dos anos. O aumento da infestação do Ae. aegypti inicia entre os meses de outubro e novembro, com os maiores índices sendo registrados entre os meses de janeiro a março, reduzindo-se efetivamente, em abril e junho. Os tipos de criadouros predominantes na cidade de Araguari foram os depósitos móveis, ao nível do solo para armazenamento doméstico, lixo, sucata e materiais de construção. A participação pró ativa da comunidade e sua sensibilização são imprescindíveis para controle do mosquito e redução do risco de Dengue em Araguari. / Dengue is an endemic viral which became a serious public health problem. It has four serotypes, all circulating in Brazil. The vectors of the virus are mosquitoes Aedes aegypti, adapted to the urban environment. The occurrence of dengue epidemics is associated with the Ae. aegypti presence, favorable climate, information about prevention and preventive attitudes by the citizens, the effectiveness and coverage of control programs and vector surveillance, disposal solid waste, sanitation, urbanization, density of the vector, population mobility and dengue virus circulation. The main aim of the study was to verify whether the model of Environmental Health Surveillance and Environmental Education reduces Ae. aegypti infestation and therefore the risk of incidence and analyze the spatial distribution of mosquito breeding in Araguari, MG. This is an ecological study and the theory which was applied was pathogenic complex. It was used epidemiological, entomological, climatological and space data, Google Earth for geocoding and Terra View for spatialization. The averages of infestation levels from Districts of Piracaíba and Amanhece were compared to verify the effectiveness of the actions considering the period before, during and after the set of actions performed in the District of Amanhece. Statistical programs, Action and Graph Pad Prism, were used. Throughout this study period, the temperature and relative humidity were relevant to the Ae. aegypti. The comparison between before, during and after the set of actions showed that there was not a statistically significant result, but anyway it could be observed that the actions reduced the infestation to levels lower than 1% in Amanhece. The geographical distribution of breeding shows that Araguari was at risk, in the analyzed period. The conclusion of this research was that the model actions developed in the District of Amanhece can be applied in locations such as the city of Araguari. The infestation was recorded during all the survey period and the presence of breeding confirmed the infestation of Ae. aegypti, over the years. The infestation of Ae. aegypti starts to increase between October and November, with the highest rates being recorded from January to March, and being effectively reduced in April and June. In Araguari prevails deposits mobile ground level storage to household waste, scrap, and construction materials. proactive participation and awareness of the community are essential for controling the mosquito breeding and so reducing the risk of Dengue.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-14T16:16:53Z No. of bitstreams: 1 Amanda de Lucas Xavier Martins.pdf: 962273 bytes, checksum: 5b921f6ea1462bdfdbe2799ee7991f92 (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-14T16:18:15Z (GMT) No. of bitstreams: 1 Amanda de Lucas Xavier Martins.pdf: 962273 bytes, checksum: 5b921f6ea1462bdfdbe2799ee7991f92 (MD5) / Made available in DSpace on 2014-10-14T16:18:15Z (GMT). No. of bitstreams: 1 Amanda de Lucas Xavier Martins.pdf: 962273 bytes, checksum: 5b921f6ea1462bdfdbe2799ee7991f92 (MD5) / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / O estudo buscou compreender na literatura científica e documentos oficiais da saúde a centralidade do trabalho do Agente Comunitário de Saúde (ACS), mediados pelo ideário da Promoção de Saúde, na Estratégia de Saúde da Família e Atenção Básica de Saúde (ESF/ABS). O ACS assume caráter central na prática sanitária pela Vigilância em Saúde articulada ao ideário da Promoção da Saúde, considerando papel mediador entre serviços dessa área e a população no território. O levantamento da literatura e os documentos oficiais apontam para a importância desse ideário na definição das atribuições dos ACS, demonstrando, entretanto, conflitos e contradições nas concepções de saúde envolvidas na prática sanitária e a reorientação do modelo de atenção à saúde. O ideário da Promoção de Saúde tem despontado como atualização no discurso das Políticas de Saúde para controle sanitário e para mediação de conflitos no âmbito local, em que o papel do ACS é dilemático e central na ESF/ABS. A prática sanitária, conforme perspectiva institucional, tem direcionado a ação educativa e o incentivo à ‘participação comunitária’ para viés behaviorista e biomédico, associados à pactuações por metas, em que, atualmente, destaca-se as Doenças e Agravos Não Transmissíveis (DANTs). Por outro lado, o legado anterior dos movimentos populares em saúde aponta para viabilidade histórica da ‘participação comunitária’ na luta pela saúde enquanto direito social, sentido mais próximo da Saúde Coletiva e dos princípios constitucionais do Sistema Único de Saúde (SUS). Essa perspectiva se mantém como horizonte a ser alcançado sob inflexões no financiamento, gestão e formulação das políticas de saúde no âmbito da aparelhagem estatal. / The study sought to understand the scientific literature and official documents of the centrality of the health work of Community Health Agents (ACS), mediated by the ideology of Health Promotion in Primary Care and Family Health Health Strategy (FHS / ABS). The ACS plays a central character in the health practice Health Surveillance articulated the ideology of Health Promotion, considering mediator between services in this area and the role population in the territory. The survey of the literature and official documents indicate the importance of this notion in defining the duties of the ACS, showing, however, conflicts and contradictions in health concepts involved in health practice and reorientation of the health care model. The ideology of health promotion has emerged as updated the discourse of Health Policy for sanitary control and mediation of conflicts at the local level, where the role of the ACS is dilemmatic and central in the ESF / ABS. The health praxis, as institutional perspective, has directed educational activities and the encouragement of 'community participation' for behavioral and biomedical bias associated with the pacts by targets, which currently stands out the Noncommunicable Diseases and (DANTs). Moreover, the previous legacy of popular movements in health points to historical viability of 'community participation' in the fight for health care as a social right, closest meaning of Public Health and the constitutional principles of the Unified Health System (SUS). This perspective remains as goal to be reached under inflections in financing, management and formulation of health policies within the state apparatus.

Submitted by Jordan (jordanbiblio@gmail.com) on 2017-05-26T15:57:24Z No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-05-26T16:48:39Z (GMT) No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Made available in DSpace on 2017-05-26T16:48:39Z (GMT). No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) Previous issue date: 2014-02-07 / CAPES / A caderneta de saúde da criança é um instrumento que visa o acompanhamento integral de saúde da criança, pautado na vigilância à saúde. No Brasil, este instrumento configura-se como o principal documento para o registro das informações de saúde da criança e serve também como ferramenta de diálogo entre as famílias e os profissionais que atuam em diferentes espaços assistenciais voltados à esta população. Este estudo tem por objetivo analisar a percepção dos profissionais que atuam na atenção à criança na rede básica de saúde de Cuiabá-Mato Grosso, sobre a utilização da caderneta de saúde da criança. Trata-se de um estudo exploratório de abordagem qualitativa, que teve como sujeitos oito médicos, oito enfermeiros e quatro agentes comunitários de saúde, totalizando 20 profissionais que atuavam em unidades básicas de saúde deste município. A coleta dos dados foi realizada no período de fevereiro a março de 2013, por meio de entrevista semiestruturada, analisada pela técnica de análise temática. A análise dos dados possibilitou o agrupamento das informações em três eixos temáticos: as diversas finalidades da caderneta de saúde da criança; o preenchimento da caderneta de saúde da criança pelos profissionais e a utilização da caderneta de saúde da criança pela família. Os profissionais atribuem à caderneta a interpretação de que ela é um documento importante por conter diversas informações da saúde da criança, antes mesmo do seu nascimento. Além disso, possuem diferentes opiniões sobre a finalidade da mesma. Em relação aos dados a serem preenchidos no documento, os profissionais os percebem como importantes para o acompanhamento da saúde infantil, no entanto, para eles o registro desses ainda não recebe a devida importância em todos os atendimentos à criança. Para os profissionais, o preenchimento dos dados é de responsabilidade da equipe de saúde, médico, enfermeiro e técnicos de enfermagem. Houve discordância de opinião sobre a participação da família neste preenchimento, sendo que para uns a família não deve preencher nenhum dado, enquanto que para outros os dados de identificação, desenvolvimento e intercorrências com a criança podem ser registrados pela família. Segundo os entrevistados, vários são os fatores que influenciam o uso adequado da caderneta, tais como: perda ou esquecimento do instrumento pela mãe, burocracia do serviço, grande demanda de atividades na unidade, dentre outros. Na percepção dos participantes do estudo, apesar de a família ser orientada sobre a caderneta, esta ainda a utiliza muito pouco. Para os entrevistados, além de a família ter o direito de cobrar dos profissionais o registro dos dados na caderneta, esse comportamento da família demonstra o seu interesse pela saúde do filho e auxilia o trabalho dos profissionais. Nota-se também preocupação dos participantes do estudo quanto à utilização plena da caderneta. Assim, para que este instrumento se efetive como instrumento de vigilância e de promoção à saúde infantil, tanto os profissionais quanto as famílias deverão atribuir lhe maior valor. / The child health handbook is an instrument which aims the integral monitoring of child health, based on health surveillance. In Brazil, this instrument is configured as the main document for the information of child's health and also serves as a tool for dialogue between families and the professionals who work in different spaces for assistance to this population. This study aims to analyze the perceptions of professionals working in child care in basic health network of Cuiabá – Mato Grosso, on the use of child health handbook. This is an exploratory study of qualitative approach, which had as its subject eight doctors, eight nurses and four community health agents, totaling 20 professionals who acted in basic health units of this municipality. The data collection was carried out from February to March 2013, through a semi-structured interview, analyzed by the technique of thematic analysis. The data analysis allowed the grouping of information in three thematic axes: the several purposes of maternal and child health; the fill of the child health handbook by the professionals and the use of the child health handbook by the family. The professionals attach to the booklet the interpretation that it is an important document because it contains various information of child health, even before his birth. In addition, there are different opinions about the purpose of the same. Regarding the data to be filled in the document, the professionals refer to be important for the monitoring of children's health, however, for them the record of those still does not receive due weight in all attendances to the child. For professionals the padding of the data is of the responsibility of the health team, doctor, nurse and nursing technicians. There was disagreement of opinion on the participation of the family in this fill, and for some the family must not fill any data, while for other identification data, development and complications with the child can be registered by the family. There are many factors that influence the use of booklet by professionals such as loss or forgetfulness of the instrument by her mother, bureaucracy, high demand for service activities in the unit, among others. In the perception of the participants of the study, although the family be oriented about the booklet, the same still uses very little. For the interviewees, beyond the family having the right to ask for registration data from the professionals in the booklet, this family's behavior demonstrates its interest in the health of the child and assists the work of professionals. It is noted, also, a concern of the participants of the study regarding the full use of the notebook. Thus, for this instrument being effective such as surveillance and promotion document to child health both the professionals and the families should assign more value to it.

Made available in DSpace on 2015-05-14T12:09:08Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 57344 bytes, checksum: b884e23935e5ceee51d185143cf09aed (MD5) Previous issue date: 2009-07-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The underground waters usually present excellent chemical quality, physics and bacteriological, being appropriate for the human consumption, in the most of time, with just simplified treatment ( Chlorination), it play an important role in the public and private provisioning all over the world. However, the use of those waters without any previous treatment in an urban mesh unprovided sanitary exhaustion , it characterizes conjugated factors , that can be used in the construction of maps, in the sense of detecting risk areas the health population, for the consumption of the bad quality water. In that feeling, the present work had as main objective to analyze the relationship among the quality of the underground water , the conditions of basic sanitation and the health population of the city Pedras de Fogo _PB. It is justified such justified such research for the fact that under ground water consumption for human consumption is high of city. That is verified by the great numbers of the underground wells existent. In those wells fire the attention the fact of not having the quality control water, nor in the perforation phase and nor during its useful life, exposing the population to scratch out of contracting diseases , mainly the diarrheas. The applied methodology of work used of techniques of Geoprocessing. In this work a SIG was developed, that counts with the cartographic base containing the blocks and the Pedras de Fogo - PB limits represented by polygons. The space analysis of the relationships between health and atmosphere was developed being used the program ARC GIS 9.1 . For the space positioning of the wells, they were accomplished and positioning 232 wells in area under study using the GPS Etrex Garming. It was made sampling of water quality using a 26 wells strategically located, being related to confirmed data of phathologies in the water conduction sanitation data, forming maps of environmental risk. Starting from the field rising, of the space analyze, laboratory and obtained interpretations performed, it follows that existent relationship among the use of underground water, the polluted wells , its offences in heath, the urban space without sanitary exhaustion an the form as the water is treated in homes represents the most important factors in the configuration of the Pedras de fogo PB urban space, as risk area the human health. Grand direction, the present work to point the condition of risk at acquire disease for custom at water at bad quality in tree area of space urban of Pedras de Fogo, district city Mangueira, center of city at parcel Planalto, respectitve. The construction of those risk maps shows useful in the aid of planning of surveillance in heath at local level. / As águas subterrâneas apresentam geralmente excelentes qualidades química, física e bacteriológica, sendo apropriadas para o consumo humano, na maioria das vezes, com apenas tratamento simplificado (cloração) e desempenham um papel fundamental no abastecimento público e privado em todo o mundo. No entanto, a utilização dessas águas sem qualquer tratamento prévio em uma malha urbana desprovida de esgotamento sanitário, caracteriza fator conjugado, que pode ser utilizado na construção de mapas, no sentido de detectar áreas de riscos à saúde da população pelo consumo de água de má qualidade. Nesse sentido o presente trabalho teve como objetivo principal analisar espacialmente as relações entre a qualidade da água subterrânea, as condições de saneamento básico e a saúde da população da cidade de Pedras de Fogo PB. Justifica-se tal pesquisa pelo fato de que o uso de água subterrânea para consumo humano é elevado na cidade. Isso é verificado pelo grande número de poços freáticos existentes. Nesses poços chama a atenção o fato de não se ter controle de qualidade da água, nem na fase de perfuração e nem durante sua vida útil, expondo a população a riscos de contrair doenças, principalmente as diarréicas. Na metodologia de trabalho utilizou-se de técnicas de geoprocessamento, tendo sido desenvolvido um SIG, que conta com a base cartográfica contendo os quarteirões e os limites de Pedras de Fogo PB, representados por polígonos. A análise espacial das relações entre saúde e ambiente foi desenvolvida utilizando-se o programa ArcGIS 9.1. Para o posicionamento espacial dos poços, foram localizados e plotados 232 poços na área sob estudo, utilizando o GPS Etrex Garmim. Foi feita uma amostragem de qualidade da água utilizando-se 26 poços estrategicamente localizados, sendo associadas a dados confirmados de patologias de veiculação hídrica e a dados de saneamento, formando mapas de risco ambiental. A partir dos levantamentos de campo, das análises laboratoriais e interpretações realizadas, podese concluir que as relações existentes entre o uso de água subterrânea, os poços contaminados, os agravos em saúde, a área urbana sem esgotamento sanitário e a forma como a água é tratada nos domicílios caracteriza o espaço urbano de Pedras de Fogo com áreas de risco à saúde humana. Neste sentido, o presente trabalho aponta a situação de risco em contrair doença pelo uso de água de má qualidade em três áreas do espaço urbano de Pedras de Fogo: bairro da Mangueira, centro da cidade e loteamento Planalto, respectivamente. A construção desses mapas de risco mostra-se útil no auxílio do planejamento de ações de vigilância em saúde a nível local.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2017-09-19T20:56:23Z No. of bitstreams: 1 Danielle Cristina Campos de Souza.pdf: 1576989 bytes, checksum: da92792bd527aad6147656d031525bac (MD5) / Made available in DSpace on 2017-09-19T20:56:23Z (GMT). No. of bitstreams: 1 Danielle Cristina Campos de Souza.pdf: 1576989 bytes, checksum: da92792bd527aad6147656d031525bac (MD5) Previous issue date: 2017-02-06 / With the objective of analyzing the results of the implantation of electronic systems and tools, used to perform the regulation of high complexity access, that is, consultation schedules and specialized outpatient exams, this research starts from an exploratory descriptive analysis, promoting a greater knowledge on the history of the Regulation of Access to Assistance (Also called regulation of access or care regulation) and the implementation of a computerized system that acts in this practice. With the 1988 Constitution, the Unified Health System was defined as the right of all, and the State should guarantee equal access. At the outset, it found difficulties in broadening access to citizens and decentralize health actions, dividing the responsibility between States and Municipalities. The approach used was qualitative and quantitative, because it intends to describe and interpret the phenomena, besides analyzing the information collected. The regulation of access to care had its mark with publication of NOA / SUS 2001(Health Care Operational Standard), and has intensified over the years, even with the challenges encountered in achieving the quality required by SUS users and meet the needs that vary according to your individual profile. Since its inception in 2008 through ordinance no. 1,559, presented advances related to the improvement of the quality of care flows making this dimension of regulation can be considered the user's access door to public health services. That is why the main objective of the research consists of analyzing the indicators of satisfaction and absenteeism, because, these are the ones that reveal how the image of the institution is and their use in relation to supply and demand. In August 2010, the Central of Regulation of the Health Services Offering - CROSS, and was implanted in the Hospital of this work with its various functions, allowing a more practical and organized flow to promote access to SUS users, so in this work will be evaluated the impact of the schedules made through the CROSS system allowing outpatient access and evaluating the indicators that effectively present the impact of its implementation. The obtained results indicate positive changes and improvements in the quality of care, since it adopts more adequate protocols in the practice of health care regulation. / Com o objetivo de analisar os resultados da implantação de sistemas e ferramentas eletrônicas, utilizados para executar a regulação do acesso de alta complexidade, ou seja, agendamentos de consultas e exames ambulatoriais especializados, esta pesquisa parte de uma análise exploratória descritiva, promovendo um maior conhecimento sobre a história da Regulação do Acesso à Assistência (também denominada regulação do acesso ou regulação assistencial) e a implantação de um sistema informatizado que atua nessa prática. Com a Constituição de 1988, o Sistema Único de Saúde foi definido como sendo direito de todos, devendo o Estado, garantir o acesso igualitário. Em seu início, encontrou dificuldades em ampliar os acessos aos cidadãos e descentralizar as ações de saúde, dividindo a responsabilidade entre Estados e Municípios. A abordagem utilizada foi qualitativa e quantitativa, pois tem a intenção de descrever e interpretar os fenômenos, além de analisar as informações coletadas. A regulação do acesso à assistência teve seu marco com a publicação da NOA/SUS 2001 (Norma Operacional de Assistência à Saúde), e tem se intensificado no decorrer dos anos, mesmo com os desafios encontrados em atingir a qualidade exigida pelos usuários do SUS e atender as necessidades que variam de acordo com seu perfil individual. Desde sua instituição, em 2008 através da portaria nº 1.559, apresentou avanços relacionados à melhoria da qualidade dos fluxos assistenciais, fazendo com que essa dimensão da regulação possa ser considerada a porta de acesso do usuário aos serviços públicos de saúde. Por isso, o objetivo principal da pesquisa consiste em analisar os indicadores de satisfação e absenteísmo, pois, estes são os que revelam como está a imagem da instituição e seu aproveitamento com relação à oferta e demanda. Em agosto de 2010, surgiu a Central de Regulação de Oferta de Serviços de Saúde – CROSS, e foi implantada no Hospital alvo deste trabalho com suas diversas funções, permitindo um fluxo mais prático e organizado de promover o acesso aos usuários do SUS, por isso, neste trabalho será avaliado o impacto dos agendamentos realizados por meio do sistema CROSS, permitindo o acesso ambulatorial e avaliando os indicadores que apresentem efetivamente o impacto de sua implantação. Os resultados obtidos apontam mudanças positivas e melhorias na qualidade assistencial, pois passa a seguir protocolos mais adequados na prática da regulação assistencial.