Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-10-27T13:58:03Z No. of bitstreams: 1 MariaDeJesusFreitas.pdf: 6269278 bytes, checksum: eab572eb0c1e9cb928b6119c964b54a4 (MD5) / Made available in DSpace on 2017-10-27T13:58:03Z (GMT). No. of bitstreams: 1 MariaDeJesusFreitas.pdf: 6269278 bytes, checksum: eab572eb0c1e9cb928b6119c964b54a4 (MD5) Previous issue date: 2017-10-13 / Introduction: Chronic Kidney Disease is a serious public health problem. Diabetes Mellitus and Arterial Hypertension are the main causes of the disease, easily diagnosed and treated by programs used in public health. Primary Health Care is the level of preferential attention to promote prevention and early diagnosis of cases of the disease. Objective: To evaluate the attention given to the person with Chronic Renal Disease in Basic Health Care from the perspective of patients, family members and health professionals. Methodology: Qualitative evaluation research performed in households of patients with Chronic Renal Disease, hemodialysis units and Basic Health Units of Belém-Pará. Participants were patients with chronic kidney disease, older than 19 years old, diabetic and hypertensive, living in Belém and who undertook hemodialysis in 2015, through the Unified Health System; family members indicated by the patients; physicians and nurses of Primary Health Care. In the analysis, the technique of Content Analysis in the Thematic modality was used. Results: The first article evaluated the Trajectories of Care of Chronic Renal Disease patients, seeking to identify the functions of Primary Health Care. Three Trajectories were identified: 1) Did not seek the Basic Health Unit; 2) He sought the Basic Health Unit, but did not receive the diagnosis; 3) Received a diagnosis in the Basic Health Unit and was referred to the specialty. The second article evaluated the attention given by the Basic Health Care to people with Chronic Kidney Disease, from the perspective of the interviewees, whose analysis resulted in two categories: 1) Primary Care is the place of people with Chronic Disease? (Distrust in Primary Care, Primary Care does not deal with Chronic Kidney Disease, Indifference of the multiprofessional team, Ineffectiveness in communication in the care network); 2) Basic Health Care loses contact with users on hemodialysis treatment. Conclusion: The care trajectories revealed irregular flows of care in the care network. Patients and their families did not perceive Basic Health Care as a place of care. For most professionals, Basic Health Care did not perform its function as coordinator of care, did not identify Chronic Kidney Disease and did not guarantee the maintenance of the link after starting treatment. / Introdução: A Doença Renal Crônica constitui um grave problema de saúde pública. Diabetes Mellitus e Hipertensão Arterial, são as principais causas da doença, facilmente diagnosticadas e tratadas por programas utilizados na saúde pública. Atenção Básica à Saúde é o nível de atenção preferencial para promover prevenção e diagnosticar precocemente os casos da doença. Objetivo: Avaliar a atenção prestada à pessoa portadora de Doença Renal Crônica na Atenção Básica em Saúde, na perspectiva de usuários, familiares e profissionais de saúde. Metodologia: Pesquisa de avaliação qualitativa, realizada em domicílios de portadores de Doença Renal Crônica, unidades de hemodiálise e Unidades Básicas de Saúde de Belém-Pará. Participaram portadores de Doença Renal Crônica, maiores de 19 anos, diabéticos e hipertensos, residentes em Belém e que iniciaram hemodiálise em 2015, pelo Sistema Único de Saúde; familiares indicados pelos usuários e; médicos e enfermeiras da Atenção Básica à Saúde. Na análise, utilizou-se a técnica de Análise de Conteúdo na modalidade Temática. Resultados: O primeiro artigo avaliou as Trajetórias Assistenciais de portadores de Doença Renal Crônica, buscando identificar as funções da Atenção Básica à Saúde. Foram identificadas três Trajetórias Assistenciais: 1) Não procurou a Unidade Básica de Saúde; 2) Procurou a Unidade Básica de Saúde, mas não recebeu o diagnóstico; 3) Recebeu diagnóstico na Unidade Básica de Saúde e foi encaminhado para a especialidade. O segundo artigo avaliou a atenção prestada pela Atenção Básica à Saúde para pessoas com Doença Renal Crônica, na perspectiva dos entrevistados, cuja análise resultou em duas categorias: 1) Atenção Básica é lugar de pessoas com Doença Crônica? (Desconfiança na Atenção Básica, a Atenção Básica não trata de Doença Renal Crônica, Indiferença da equipe multiprofissional, Ineficácia na comunicação na rede de atenção); 2) A Atenção Básica perde o contato com os usuários em tratamento de hemodiálise. Conclusão: As Trajetórias Assistenciais revelaram fluxos irregulares de atendimento na rede de atenção. Usuários e familiares, não perceberam a Atenção Básica à Saúde como lugar de cuidado. Para a maioria dos profissionais, a Atenção Básica à Saúde não fez sua função de garantiu a manutenção do vínculo após o início do tratamento.

Durant ces dernières années, de nombreux travaux de recherches ont été menés dans le domaine des réseaux multi-sauts sans fil à contraintes (MWNs: Multihop Wireless Networks). Grâce à l'évolution de la technologie des systèmes mico-electro-méchaniques (MEMS) et, depuis peu, les nanotechnologies, les MWNs sont une solution de choix pour une variété de problèmes. Le principal avantage de ces réseaux est leur faible coût de production qui permet de développer des applications ayant un unique cycle de vie. Cependant, si le coût de fabrication des nœuds constituant ce type de réseaux est assez faible, ces nœuds sont aussi limités en capacité en termes de: rayon de transmission radio, bande passante, puissance de calcul, mémoire, énergie, etc. Ainsi, les applications qui visent l'utilisation des MWNs doivent être conçues avec une grande précaution, et plus spécialement la conception de la fonction de routage, vu que les communications radio constituent la tâche la plus consommatrice d'énergie.Le but de cette thèse est d'analyser les différents défis et contraintes qui régissent la conception d'applications utilisant les MWNs. Ces contraintes se répartissent tout le long de la pile protocolaire. On trouve au niveau application des contraintes comme: la qualité de service, la tolérance aux pannes, le modèle de livraison de données au niveau application, etc. Au niveau réseau, on peut citer les problèmes de la dynamicité de la topologie réseau, la présence de trous, la mobilité, etc. Nos contributions dans cette thèse sont centrées sur l'optimisation de la fonction de routage en considérant les besoins de l'application et les contraintes du réseau. Premièrement, nous avons proposé un protocole de routage multi-chemin "en ligne" pour les applications orientées QoS utilisant des réseaux de capteurs multimédia. Ce protocole repose sur la construction de multiples chemins durant la transmission des paquets vers leur destination, c'est-à-dire sans découverte et construction des routes préalables. En permettant des transmissions parallèles, ce protocole améliore la transmission de bout-en-bout en maximisant la bande passante du chemin agrégé et en minimisant les délais. Ainsi, il permet de répondre aux exigences des applications orientées QoS.Deuxièmement, nous avons traité le problème du routage dans les réseaux mobiles tolérants aux délais. Nous avons commencé par étudier la connectivité intermittente entre les différents et nous avons extrait un modèle pour les contacts dans le but pouvoir prédire les future contacts entre les nœuds. En se basant sur ce modèle, nous avons proposé un protocole de routage, qui met à profit la position géographique des nœuds, leurs trajectoires, et la prédiction des futurs contacts dans le but d'améliorer les décisions de routage. Le protocole proposé permet la réduction des délais de bout-en-bout tout en utilisant d'une manière efficace les ressources limitées des nœuds que ce soit en termes de mémoire (pour le stockage des messages dans les files d'attentes) ou la puissance de calcul (pour l'exécution de l'algorithme de prédiction).Finalement, nous avons proposé un mécanisme de contrôle de la topologie avec un algorithme de routage des paquets pour les applications orientés évènement et qui utilisent des réseaux de capteurs sans fil statiques. Le contrôle de la topologie est réalisé à travers l'utilisation d'un algorithme distribué pour l'ordonnancement du cycle de service (sleep/awake). Les paramètres de l'algorithme proposé peuvent être réglés et ajustés en fonction de la taille du voisinage actif désiré (le nombre moyen de voisin actifs pour chaque nœud). Le mécanisme proposé assure un compromis entre le délai pour la notification d'un événement et la consommation d'énergie globale dans le réseau. / Great research efforts have been carried out in the field of challenged multihop wireless networks (MWNs). Thanks to the evolution of the Micro-Electro-Mechanical Systems (MEMS) technology and nanotechnologies, multihop wireless networks have been the solution of choice for a plethora of problems. The main advantage of these networks is their low manufacturing cost that permits one-time application lifecycle. However, if nodes are low-costly to produce, they are also less capable in terms of radio range, bandwidth, processing power, memory, energy, etc. Thus, applications need to be carefully designed and especially the routing task because radio communication is the most energy-consuming functionality and energy is the main issue for challenged multihop wireless networks.The aim of this thesis is to analyse the different challenges that govern the design of challenged multihop wireless networks such as applications challenges in terms of quality of service (QoS), fault-tolerance, data delivery model, etc., but also networking challenges in terms of dynamic network topology, topology voids, etc. Our contributions in this thesis focus on the optimization of routing under different application requirements and network constraints. First, we propose an online multipath routing protocol for QoS-based applications using wireless multimedia sensor networks. The proposed protocol relies on the construction of multiple paths while transmitting data packets to their destination, i.e. without prior topology discovery and path establishment. This protocol achieves parallel transmissions and enhances the end-to-end transmission by maximizing path bandwidth and minimizing the delays, and thus meets the requirements of QoS-based applications. Second, we tackle the problem of routing in mobile delay-tolerant networks by studying the intermittent connectivity of nodes and deriving a contact model in order to forecast future nodes' contacts. Based upon this contact model, we propose a routing protocol that makes use of nodes' locations, nodes' trajectories, and inter-node contact prediction in order to perform forwarding decisions. The proposed routing protocol achieves low end-to-end delays while using efficiently constrained nodes' resources in terms of memory (packet queue occupancy) and processing power (forecasting algorithm). Finally, we present a topology control mechanism along a packet forwarding algorithm for event-driven applications using stationary wireless sensor networks. Topology control is achieved by using a distributed duty-cycle scheduling algorithm. Algorithm parameters can be tuned according to the desired node's awake neighbourhood size. The proposed topology control mechanism ensures trade-off between event-reporting delay and energy consumption.