Introdução. Atualmente, inquéritos de saúde de base populacional utilizam diferentes estratégias para a obtenção de dados, como as entrevistas domiciliares e telefônicas, com a finalidade de monitorar fatores de risco e avaliar o acesso e utilização dos serviços de saúde, sendo essenciais no planejamento de políticas públicas em saúde. Objetivo. Estudar a aplicação de algumas ferramentas estatísticas utilizadas para a comparação de estimativas obtidas por diferentes inquéritos, construção de ajustes de pósestratificação e aplicação de técnicas de estimação em pequenas áreas, utilizando dados de inquéritos de saúde de base populacional realizados em áreas do Estado de São Paulo. Metodologia. Utilizando o módulo survey do pacote estatístico Stata nas versões 10.0 e 11.0 foram feitos três trabalhos. O primeiro (artigo 1) comparou estimativas segundo tipo de inquérito (domiciliar ISA-Capital 2008 e telefônico VIGITEL-SP 2008) por meio de regressão de Poisson ajustada por idade e escolaridade. O segundo (artigo 2) comparou ajustes de pós-estratificação utilizando distintos conjuntos de variáveis e três diferentes estratégias (ponderação por célula, técnica rake e uma terceira técnica combinada entre o ajuste por célula e a técnica rake). O terceiro (artigo 3) utilizou cinco técnicas (diretas e indiretas) de estimação em pequenas áreas para a obtenção de prevalências de características de saúde para uma área menor do Município de São Paulo (Distrito de Saúde do Butantã). Resultados. Não foram encontradas diferenças estatisticamente significantes entre as estimativas obtidas pelo VIGITEL e ISA-Capital para as prevalências de realização de mamografia no último ano. No entanto, para as estimativas globais de realização do exame de Papanicolaou alguma vez na vida, no último ano e de mamografia na vida, foi possível verificar diferenças, com prevalências de cobertura superiores entre as entrevistadas pelo inquérito telefônico (artigo 1). Aplicando a técnica de pós-estratificação rake, foram observadas as maiores reduções de vício, principalmente quando consideradas as variáveis sociodemográficas, associadas a cada uma das características de saúde analisadas (artigo 2). As estimativas de pequenas áreas de diferentes características de saúde obtidas por meio da calibração e via modelagem, considerando os fatores associados a cada uma delas, foram as que tiveram maior semelhança com as prevalências consideradas como sendo os verdadeiros valores populacionais (artigo 3). Conclusões. Os resultados das comparações entre os inquéritos sinalizam a tendência de superestimação de alguns indicadores de cobertura de mamografia e de Papanicolaou nos dados de pesquisa via telefone, apontando para a necessidade de novos estudos que também contribuam para o melhor entendimento dos vícios e possíveis correções com novos ajustes de pós-estratificação (artigo 1). Apesar dos ajustes de pós-estratificação não corrigirem totalmente as estimativas, as diferenças encontradas não devem ser consideradas um impedimento para a realização dos inquéritos via telefone fixo, uma vez que eles contribuem para o direcionamento de ações e novas políticas de saúde no Brasil (artigo 2). A utilização de técnicas de estimação em pequenas áreas permite o uso de determinada pesquisa, que a princípio não tenha sido desenhada para tal objetivo, identificando necessidades de determinadas regiões, contribuindo para a implantação de ações preventivas e intervenções em saúde pública em nível local (artigo 3) / Introduction. Nowadays population-based health surveys employ different strategies in order to obtain data, such as household and telephone interviews with the purpose of monitoring risk factors and evaluate the access and utilization of health services, being essential in planning public health policies. Objective. Study the implementation of some statistical tools used for comparison of estimates obtained by different surveys, creation of post-stratification adjustments and small-area estimation techniques, using data from different population-based health surveys conducted in areas of the state of São Paulo. Methodology. Using the svy commands of Stata (10.0 and 11.0), three studies were carried out. The first (paper 1) compared estimates according to the type of the survey (household survey ISACapital 2008 and telephone survey VIGITEL-SP 2008) using Poisson regression analysis adjusted by age and education. The second (paper 2) compared post-stratification adjustments utilizing different sets of variables and three different strategies (cell weighting technique, rake technique and a third \"combined\" between the rake and cell weighting). The third (paper 3) used five (direct and indirect) small-area estimation techniques for the calculation of prevalence of health characteristics for a smaller area of São Paulo (Butantã Health District). Results. There were no statistically significant differences between the estimates obtained by VIGITEL and ISACapital for the prevalence of mammography in the year prior to the interview. However, estimates for the global results of the Pap smear at least once in life and in the past year as well as, mammography in life, we observed differences, with higher prevalence rates among respondents by telephone (paper 1). Applying the rake post-stratification technique, the largest reductions were observed in bias, especially when taking into account sociodemographic variables associated with each health characteristic analyzed (paper 2). The estimates for small areas obtained by calibration and regression, considering the factors associated with each health characteristic, were the ones most similar to the prevalence considered to be the true population values (paper 3). Conclusions. The results of the comparisons between the two surveys indicate the trend of overestimation in some indicators of prevalence of mammography and Pap smear via telephone survey, indicating a concern for further studies that also contribute to a better understanding of the bias and possible corrections with new post-stratification adjustments (paper 1). Despite the post-stratification adjustments do not completely correct the estimates, it should not be considered an impediment, since the telephone surveys contribute to the direct actions and new health policies in Brazil. (paper 2). The use of smallarea estimation techniques allows extrapolating the utilization of a research that had not been designed for such a purpose, identifying the needs of a particular region, contributing to the implementation of preventive interventions in public health at the local level. (paper 3)

Trata-se de um estudo de intervenção, com o objetivo de verificar os efeitos do uso do suporte telefônico como estratégia para incrementar a prática de atividade física de pessoas com diabetes mellitus. O estudo foi realizado em um Núcleo de Saúde da Família, de uma cidade do interior do estado de São Paulo, em 2012. A amostra foi constituída por 26 pacientes que foram alocados em dois grupos, G1 e G2. O G1 participou de um grupo de educação em diabetes com encontros semanais, durante dois meses, e recebeu acompanhamento por suporte telefônico por quatro meses. O G2 participou apenas do acompanhamento por suporte telefônico. Para a coleta de dados foi utilizado um questionário contendo variáveis sociodemográficas e clínicas, um formulário para o registro do controle metabólico e o Questionário Internacional de Atividade Física - IPAQ. Os dados foram coletados no início e no final da intervenção. Para análise, utilizou-se estatística descritiva, teste t-Student, o modelo de efeitos mistos e o teste de McNemar. Os resultados mostraram que os pacientes tinham idade entre 45 e 92 anos, 77,0% eram mulheres, 42,0% viúvo, 46,0% aposentado, 4,34 anos de estudo e renda familiar mensal de R$ 2188,91. A média do tempo de diagnóstico e tratamento do diabetes foi igual para ambos os grupos sendo de 11,62 anos para o G1 e 7,19 anos para o G2. Quanto ao nível de atividade física, verificou-se que após a intervenção nenhum paciente foi classificado como sedentário, sendo que no início 11,5% estavam nesse nível. Para o G1, 61,5% dos pacientes foram classificados como ativos após a intervenção, superando em 15,0% os resultados antes da intervenção. Para o G2, observou-se que 84,6% dos pacientes foram classificados como ativos após a intervenção, sobrepondo em 31,0% os resultados antes da intervenção. Em relação à frequência e o tempo de atividade física, os pacientes do G1 adotaram um dia a mais de caminhada na semana após a intervenção totalizando quatro dias. Houve aumento na duração da atividade física moderada durante a semana, apresentando incremento de 82 minutos na comparação antes e após intervenção. Para o G2 verificou-se incremento de dois dias a mais de caminhada durante a semana, totalizando seis dias. No que se refere às variáveis clínicas relacionadas ao controle metabólico, o G1 apresentou redução dos valores de pressão arterial sistólica, glicemia de jejum, lipoproteína de baixa densidade, colesterol total e hemoglobina glicada e incremento nos valores de lipoproteína de alta densidade e índice de massa corpórea. Para as variáveis circunferência abdominal, pressão arterial diastólica e triglicerídeo, obtiveram-se reduções estatisticamente significantes (p<=0,01). No G2 observou-se redução nos valores de circunferência abdominal, pressão arterial diastólica, glicemia de jejum, lipoproteína de baixa densidade e triglicerídeos e incremento nos valores de índice de massa corpórea, pressão arterial sistólica, lipoproteína de alta densidade, colesterol total e hemoglobina glicada. O uso do suporte telefônico como estratégia de intervenção mostrou-se uma ferramenta importante para estimular o aumento do nível de atividade física de pessoas com diabetes mellitus. / This intervention study aimed to verify the effects of the use of telephone support as a strategy to increase physical activity in people with diabetes mellitus. The study was conducted in a Family Health Unit of a city in the state of São Paulo, in 2012. The sample consisted of 26 patients who were divided into two groups, G1 and G2. The G1 attended a diabetes education group with weekly meetings for two months, and received follow-up telephone support for four months. The G2 only received follow-up telephone support. For data collection, a questionnaire containing sociodemographic and clinical variables, a form for the registration of metabolic control and the International Physical Activity Questionnaire - IPAQ were used. Data were collected at the beginning and end of the intervention. For analysis, descriptive statistics, t-Student test, mixed-effects model and McNemar test were used. The results showed that of the patients aged between 45 and 92 years, 77.0% were women, 42.0% widowed, 46.0% retired, with 4.34 years of study, and R$2,188.91 of monthly family income. The average for length of time between diagnosis and treatment of diabetes was similar for both groups, 11.62 years for G1 and 7.19 years for G2. Regarding the level of physical activity, it was found that no patient was classified as sedentary after the intervention, and 11.5% were sedentary in the beginning of the study. For G1, 61.5% of patients were classified as active after the intervention, exceeding in 15.0% the results before the intervention. For G2, it was observed that 84.6% of patients were classified as active after the intervention, overlapping in 31.0% the results before the intervention. Regarding the frequency and duration of physical activity, patients in G1 adopted one more day of walking in the week after the intervention, totaling four days. There was an increase in the duration of moderate physical activity during the week, showing an increase of 82 minutes as compared with before and after intervention. For G2 there was an increase of more two days of walking during the week, totaling six days. With regard to clinical variables related to metabolic control, the G1 showed lower values of systolic blood pressure, fasting glucose, low density lipoprotein, total cholesterol and glycated hemoglobin and higher values of high density lipoprotein and body mass index.For the variables waist circumference, diastolic blood pressure and triglycerides were obtained statistically significant reductions (p<=0.01). In the G2 there were lower values of waist circumference, diastolic blood pressure, fasting glucose, low-density lipoprotein and triglycerides and higher values of body mass index, systolic blood pressure, high density lipoprotein, total cholesterol and glycated hemoglobin. The use of telephone support as an intervention strategy proved to be an important tool to encourage increased levels of physical activity for people with diabetes mellitus.

The research described in this thesis reviewed previous uses of Interactive Voice Response (IVR), developed appropriate software, and employed IVR to obtain self-report of sensitive issues in surveys and conduct brief public health interventions. Chapter 1 introduces IVR and describes a systematic critical review of the use of IVR. IVR is a telephone interviewing technique where the human speaker is replaced by a high quality recorded interactive script to which the respondent provides answers by pressing the keys of a touch-telephone (touchphone). IVR has numerous advantages, including: economy, autonomy, confidentiality, access to certain population groups, improved data quality, standardised interviewing, multi-lingual interfaces, and detailed longitudinal assessments. Despite this, there have been few survey applications of IVR compared to alternative methods such as Computer-Assisted Telephone Interview (CATI). There has not been any evaluation of the use of IVR for asking sensitive questions in surveys or as a tool for health promotion at the community level. A literature review, described in Chapter 2, was conducted to identify other methods of asking sensitive questions. The literature review identified 19 different methods. Those methods that were most successful were those that provided the greatest degree of anonymity to the respondent. It was suggested that IVR may be a suitable method for community surveys. As described in Chapter 3, a custom software called Generalized Electronic Interviewing System (GEIS) was developed. This provided both CATI and IVR interviewing modes. As described in Chapter 4, it was found that the response rate obtained using IVR was unacceptably low, and an alternative interviewing method, the Hybrid method was developed. In the Hybrid method the interview was initiated by the interviewer but completed using IVR with GEIS. As described in Chapter 5, the IVR, CATI and Hybrid methods were used to investigate self-reported rates of alcohol and drug consumption within a telephone household survey of 2880 households. The self-report rates were compared to the National Drug Strategy Household Survey (NDSHS). Response rates did not differ significantly between the CATI and Hybrid methods, however the response rate for IVR was significantly less than the other methods. The Hybrid and IVR methods obtained significantly higher self-report consumption rates for alcohol and marijuana, and significantly higher hazardous drinking scores using Alcohol Use Disorders Identification Test (AUDIT). In Chapter 6 a pilot of an IVR cervical screening brief advice interface is described. A total of 5000 households were contacted by the IVR system. The system randomly selected an eligible woman aged 18-69 per household and determined her cervical screening status. A total of 661 women listened to the IVR message. The IVR call was shown to be acceptable and inexpensive compared to a mail pamphlet intervention. In Chapter 7 a randomized controlled trial of an IVR cervical screening brief advice involving 17,008 households is described. Cervical screening rate data were obtained from the Health Insurance Commission (HIC) for a period spanning six months before and following the intervention. The cervical screening rate was increased in the intervention postcodes by 0.43% compared to the control postcodes, and the increase was greater for older women at 1.34%. This was a desirable outcome since this group is considered to be an at-risk group. The overall conclusion was that IVR technology could be feasibly used to contact women to deliver brief interventions aimed at increasing cervical screening rates, but the cost per screen was likely to be high. It is suggested that an IVR system could be linked to cervical screening registers to more directly and economically contact women, and provide an efficacious complementary approach to the existing letter reminder system. / PhD Doctorate

People with disabilities are both functionally and socially disadvantaged and the lack of access to mobile communication technology adds to their disadvantage. Changes and benefits we have seen in our society with the advent of mobile phones and associated electronic communication for people without disabilities have not migrated to people with disabilities. The comprehensive communication capability of a mobile phone can enable users anywhere to independently access a very wide range of communication, information and control systems and services. This research has addressed the key accessibility issues faced by people with disabilities who need or want to use the mobile phone for voice and data communication. The research revealed that: � there exist accessible features on mobile phones that can better assist people with disabilities in using the phone; � through education and training, people with disabilities can develop or be provided with effective and efficient ways to access and use the phone; � current, off-the-shelf telecommunications equipment such as car kits, speakerphone, voice recognition technology, wireless connectivity capability on mobile phones can enable people with disabilities, even severe physical disabilities, to access the telecommunications network and services; and � with a suitable interfacing system in place, Augmentative and Alternative Communication (AAC) device users can operate the phone for voice and data communication, which previously had not been possible. Trials established that people with a range of physical disabilities can use and should have equal access to telecommunications equipment and services. This research has shown that, with the right policies, processes and support through equipment matching, education, training and delivery, current off-the-shelf solutions can help people with disabilities to effectively communicate with other members of our society and to access the same range of information systems and services enjoyed by able-bodied members of the community. An interfacing system has been developed to provide users of AAC technology with the ability to use a mobile phone for voice calls and text messaging (SMS). It is confidently predicted that other features and services on the phone such as speakerphone, digital camera and FM radio, email and internet-based applications, and local or remote appliances and devices, can be controlled via the AAC device. Outcomes and findings have confirmed the main hypothesis of the thesis that, despite very limited mobility, speed, accuracy and vocal communication ability, users will be able to successfully operate the mobile phone itself, and use it for various modes of bidirectional communication with systems to which they choose to connect. The overall outcomes of the research have established that the benefits and usefulness of the mobile phone are so significant that they should become a necessity for people with a disability. It has been successfully demonstrated that, with the proper mechanisms and educational programs in place, the provision of accessible mobile phones for people with disabilities can significantly improve their quality of life through increased range of accessible activities, and will improve their independence, engagement with their peers, safety, security and self-esteem.

<p>När en person söker en första kontakt med hälso- och sjukvården sker det oftast via ett telefonsamtal till vårdcentralen. Vid telefonsamtalet, som tas emot av en sjuksköterska, bedöms och åtgärdas vårdsökarens ärende. Sjukskrivningar är ett av många ärenden som hanteras. De senaste åren har hanteringen av sjukskrivningar i Svensk hälso- och sjukvård förändrats vilket har orsakat en minskning av antalet sjukskrivningar. Sjuksköterskor har i varierande grad deltagit i denna utveckling och denna studie vill synliggöra sjuksköterskans deltagande i vården av sjukskrivna på vårdcentralen.</p><p>Syftet var att beskriva sjuksköterskors erfarenheter av telefonrådgivning på vårdcentralen och speciellt hantering av sjukskrivningar. Studien är kvalitativ med induktiv ansats. Datainsamling har skett genom fokusgruppssamtal med 14 stycken sjuksköterskor som arbetar med telefonrådgivning på tre vårdcentraler. Insamlat material analyserades med kvalitativ innehållsanalys.</p><p>Gruppsamtalen visade att sjuksköterskors erfarenheter av telefonrådgivning är att arbetet är kvalificerat och stimulerande. Hanteringen av sjukskrivningar innefattar att göra bedömning, ge patienten information och bevaka patientens rättigheter. Hindrande och möjliggörande omständigheter påverkar sjuksköterskornas arbete och deras hantering. De hindrande omständigheterna kan ibland leda till att sjuksköterskan vill frånsäga sig ansvar. Studien har identifierat ett behov av att tydliggöra omvårdnadsansvaret för verksamma sjuksköterskor i telefonrådgivning på vårdcentral så att sjuksköterskans bedömningar i telefonrådgivningssituationen i högre grad baseras på omvårdnadens mål.</p> / <p>When a person seeks contact with community health services in Sweden it’s usually via a phone call to the primary health care centre. By the phone call, received by a nurse, the health seeker’s case is assessed and addressed. Sick leave is one of many cases being managed. In recent years, management of sick leave in Swedish primary health care has changed and decreased the number of sick leaves. However, nurses have in varying degrees, participated in this change. This study will visualize the nurse's participation in the care of patients on sick leave at the primary health care centre.</p><p>The aim was to describe nurses' experiences of telephone advisory services at the primary health care centre and especially the management of sick leaves. The study is qualitative with an inductive approach. Data collection was done through focus group discussions with 14 nurses working with telephone advisory services at three primary health care centres. Collected material was analyzed by qualitative content analysis.</p><p>The group discussions demonstrated nurses' experiences of telephone advisory services as qualified and stimulating. The specific management of sick leave was described as a combination of making assessment, providing patient information and monitoring the patient's rights. Obstructing and enabling circumstances affect nurses telephone advisory services and their management of sick leaves. The obstucitive cirumstances sometimes causes nurses wanting to abdicate responsibility. The study has identified a need to clarify the caring responsibility for nurses in telephone advice services so that nurse's assessments increasingly are based on caring goales.</p>

<p>Purpose/aim: The purpose is to get increased knowledge about how the communication had developed from the first contact online to the first meeting in real life and even after when it had turned into a real relationship. I also wanted to know why the eight women I interviewed experienced that the Internet is a good venue to meet and develop a real relationship at and if there existed any differences between those four women who were a bit older and those four women who were young.</p><p>Material/method: When the purpose with this survey stood clear I decided to use interviews as the method to find out more about my subject. I decided to do eight interviews and I contacted eight women who all found their partners online that were willing to help me and answer my interview questions. I did six of the total eight interviews through MSN Messenger and the other two through the telephone.</p><p>Main results: I found out that three of the older women had used e-mail and telephone and sometimes SMS communication to find out more about their soon to be partner and after that decided to meet the other person in real life. One of the older women and all four of the younger ones had used a Community and Instant Messenger to communicate with their soon to be partner, they also used the telephone and SMS to communicate with each other but Instant Messenger was the medium that dominated in their wish to communicate. Those instant messenger communications were also a difference that I came to see between how the younger and older women communicated and the fact that three of the older women told me that they had used the Internet to search for a partner while one of the older women and all of the younger ones told me they didn’t search for anyone at all it just happened that they found someone and came to like that person.Keywords: Internet dating, instant messaging, Community, computer mediated communication, telephone communication, face to face communication.</p>

Elections are one of the most fundamental activities of a democratic society. As is the case in any other aspect of life, developments in technology have resulted changes in the voting procedure from using the traditional paper-based voting to voting by use of electronic means, or e-voting. E-voting involves using different forms of electronic means like / voting machines, voting via the Internet, telephone, SMS and digital interactive television. This thesis concerns voting by telephone, or televoting, it starts by giving a brief overview and evaluation of various models and technologies that are implemented within such systems. The aspects of televoting that have been investigated are technologies that provide a voice interface to the voter and conduct the voting process, namely the Election Markup Language (EML), Automated Speech Recognition (ASR) and Text-to-Speech (TTS).

Purpose/aim: The purpose is to get increased knowledge about how the communication had developed from the first contact online to the first meeting in real life and even after when it had turned into a real relationship. I also wanted to know why the eight women I interviewed experienced that the Internet is a good venue to meet and develop a real relationship at and if there existed any differences between those four women who were a bit older and those four women who were young. Material/method: When the purpose with this survey stood clear I decided to use interviews as the method to find out more about my subject. I decided to do eight interviews and I contacted eight women who all found their partners online that were willing to help me and answer my interview questions. I did six of the total eight interviews through MSN Messenger and the other two through the telephone. Main results: I found out that three of the older women had used e-mail and telephone and sometimes SMS communication to find out more about their soon to be partner and after that decided to meet the other person in real life. One of the older women and all four of the younger ones had used a Community and Instant Messenger to communicate with their soon to be partner, they also used the telephone and SMS to communicate with each other but Instant Messenger was the medium that dominated in their wish to communicate. Those instant messenger communications were also a difference that I came to see between how the younger and older women communicated and the fact that three of the older women told me that they had used the Internet to search for a partner while one of the older women and all of the younger ones told me they didn’t search for anyone at all it just happened that they found someone and came to like that person.Keywords: Internet dating, instant messaging, Community, computer mediated communication, telephone communication, face to face communication.

Progress in energy harvesting technology and the increasing need for the energy efficient and environmentally friendly applications have called for reconsideration of communication systems. This reconsideration results in new problem formulations regarding the recent developments on energy harvesting systems. Recently, optimal strategies for various types of energy harvesting networks have been developed based on different harvesting models. This thesis reports the results of our research to develop the optimal scheduling structures on an energy harvesting broadcast and fading channels, and to devise online implementable algorithms for a point-to-point communication system. Particularly, structural properties of an optimal offline schedule in, (1) an energy harvesting broadcast channel with one transmitter two receivers, (2) a single user communication system under fading conditions, are investigated. Moreover, an online algorithm is proposed for a single-user energy harvesting communication system considering the physical constraints and necessities regarding implementation. The proposed scheme is implemented through GNU Radio framework on a USRP device.

Spectrum has been a scarce commodity in RF communication. Acoustic data communication is an alternative to RF communication where data is transmitted through sound waves. In this thesis, several different aspects of acoustic data communication are investigated. A physical test setup is built where the data communication spectrum extends up to 40 kHz. Impulse response of the acoustic channel is considered in a laboratory environment. Acoustic spectrum beyond the hearing limit between 25 kHz to 35 kHz is found as a suitable band for the developed setup. Distance and multipath components are important factors, determining the communication accuracy. The physical layer for the communication system is built by taking RF Pager system as a reference. This system is also modified to improve the performance. Dierent modulation techniques are used in order to evaluate their performances for acoustic channels. BFSK, BPSK, QPSK, GMSK, OFDM, DSSS and FHSS techniques are implemented for comparison. Total and effective bit rate are considered for the overall performance evaluation of differentt modulation techniques. Several experiments are done in laboratory environment where there are several multipath components. As the distance between the transmitter and receiver is increased, path loss and multipath increases. It is shown that certain modulation techniques are more robust to multipath and are better candidates for acoustic communication. While acoustic environment is inefficient in terms of power, it is still a good candidate for communication in short distances.