<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

Objetivos. Avaliar as condições do acesso aos serviços de saúde da população residente no Estado de São Paulo, e da eficiência na utilização dos recursos para a produção ambulatorial e hospitalar do SUS, segundo os Departamentos Regionais de Saúde - DRS. Métodos. O estudo baseou-se em dois parâmetros. O primeiro foi a utilização de dados já existentes, ou seja, as informações disponíveis sobre o tema em bancos de dados públicos: tanto registros administrativos como pesquisas domiciliares. O segundo parâmetro foi o emprego de métodos quantitativos que permitissem a inferência sobre as condições do acesso e eficiência para os Departamentos Regionais de Saúde do Estado de São Paulo. Para a análise do acesso aos serviços de saúde utilizaram-se modelos de regressão logística com efeitos mistos e a análise de eficiência foi realizada a partir da aplicação da técnica de Análise Envoltória de Dados DEA. Resultados. No Estado de São Paulo, a heterogeneidade das condições econômicas, sociais e demográficas existentes nas diferentes regiões do Estado não se reflete na condição de procura e utilização dos serviços de saúde, mas no grau de dependência de suas populações ao Sistema Único de Saúde. O PSF é um fator que aumenta a probabilidade de utilização dos serviços de saúde, particularmente do SUS, pela população e, a condição de posse do plano de saúde não é garantia para o atendimento. Entre os departamentos eficientes encontram-se tanto aqueles que agregam municípios produtores de serviços de saúde de média e alta complexidade, quanto os DRSs caracterizados pela produção ambulatorial em atenção básica, em especial programas específicos na área da atenção básica. Conclusões. Os resultados obtidos mostram um Estado de São Paulo menos desigual quanto ao acesso aos serviços de saúde, quando se consideram os resultados de estudos sobre utilização de serviços de saúde realizados a partir das bases de dados da PNAD para os anos 1998 e 2003. A ação do SUS mostra-se de acordo como a diretriz de equidade prevista na Lei Orgânica da Saúde. A eficiência na produção de saúde é observada em diferentes contextos relacionados aos SUS, dado que ocorre tanto nos departamentos em que o setor privado é um simples coadjuvante quanto naqueles em que o setor privado é responsável por importante segmento do setor saúde. / Objectives. To evaluate the conditions of access to the health services of population living in São Paulo State, and evaluate the efficiency in the use of resources to the production of Sistema Único de Saúde SUS, according to the Health Regional Departments HRD. Method. The study was based on two parameters. The first one was the use of pre existing data, that is, accessible information about this issue in public data warehouse: administrative registers and also housing surveys. The second parameter was the use of quantitative methods which would permit the inference about conditions of access and efficiency to the Health Regional Departments of São Paulo State. To the analysis of access to the health services was used logistic regression models with mixed effects and the efficiency analysis was done applying the Data Envelopment Analysis DEA. Results. In São Paulo State, the heterogeneity of economical, social and demographic conditions that exist in the different regions does not reflect in the condition of search and use of health services but does reflect in the dependency level of São Paulo population of SUS. The PSF is a factor that increases the probability of population use of health services, specially SUS, and having a health plan is not a guarantee of attendance. Among the efficient departments are that ones which gather cities that are producers of medium and high complexity health services and the HRD that produce basic attention, in special, specific programs in the basic attention field. Conclusion. Results show a less uneven São Paulo State in respect to access to the health services when considering results of studies about the use of health services done with 1998 and 2003 PNAD data warehouse. SUS action is accordingly with the equality guideline expected in the Organic Health Law. The efficiency in the health production is observed in a variety of context related to SUS, what occurs not only in the departments where the private sector is a simple auxiliary but also in the ones where the private sector is the responsible for an important segment of health sector.

No description available.

Objetivos. Avaliar as condições do acesso aos serviços de saúde da população residente no Estado de São Paulo, e da eficiência na utilização dos recursos para a produção ambulatorial e hospitalar do SUS, segundo os Departamentos Regionais de Saúde - DRS. Métodos. O estudo baseou-se em dois parâmetros. O primeiro foi a utilização de dados já existentes, ou seja, as informações disponíveis sobre o tema em bancos de dados públicos: tanto registros administrativos como pesquisas domiciliares. O segundo parâmetro foi o emprego de métodos quantitativos que permitissem a inferência sobre as condições do acesso e eficiência para os Departamentos Regionais de Saúde do Estado de São Paulo. Para a análise do acesso aos serviços de saúde utilizaram-se modelos de regressão logística com efeitos mistos e a análise de eficiência foi realizada a partir da aplicação da técnica de Análise Envoltória de Dados DEA. Resultados. No Estado de São Paulo, a heterogeneidade das condições econômicas, sociais e demográficas existentes nas diferentes regiões do Estado não se reflete na condição de procura e utilização dos serviços de saúde, mas no grau de dependência de suas populações ao Sistema Único de Saúde. O PSF é um fator que aumenta a probabilidade de utilização dos serviços de saúde, particularmente do SUS, pela população e, a condição de posse do plano de saúde não é garantia para o atendimento. Entre os departamentos eficientes encontram-se tanto aqueles que agregam municípios produtores de serviços de saúde de média e alta complexidade, quanto os DRSs caracterizados pela produção ambulatorial em atenção básica, em especial programas específicos na área da atenção básica. Conclusões. Os resultados obtidos mostram um Estado de São Paulo menos desigual quanto ao acesso aos serviços de saúde, quando se consideram os resultados de estudos sobre utilização de serviços de saúde realizados a partir das bases de dados da PNAD para os anos 1998 e 2003. A ação do SUS mostra-se de acordo como a diretriz de equidade prevista na Lei Orgânica da Saúde. A eficiência na produção de saúde é observada em diferentes contextos relacionados aos SUS, dado que ocorre tanto nos departamentos em que o setor privado é um simples coadjuvante quanto naqueles em que o setor privado é responsável por importante segmento do setor saúde. / Objectives. To evaluate the conditions of access to the health services of population living in São Paulo State, and evaluate the efficiency in the use of resources to the production of Sistema Único de Saúde SUS, according to the Health Regional Departments HRD. Method. The study was based on two parameters. The first one was the use of pre existing data, that is, accessible information about this issue in public data warehouse: administrative registers and also housing surveys. The second parameter was the use of quantitative methods which would permit the inference about conditions of access and efficiency to the Health Regional Departments of São Paulo State. To the analysis of access to the health services was used logistic regression models with mixed effects and the efficiency analysis was done applying the Data Envelopment Analysis DEA. Results. In São Paulo State, the heterogeneity of economical, social and demographic conditions that exist in the different regions does not reflect in the condition of search and use of health services but does reflect in the dependency level of São Paulo population of SUS. The PSF is a factor that increases the probability of population use of health services, specially SUS, and having a health plan is not a guarantee of attendance. Among the efficient departments are that ones which gather cities that are producers of medium and high complexity health services and the HRD that produce basic attention, in special, specific programs in the basic attention field. Conclusion. Results show a less uneven São Paulo State in respect to access to the health services when considering results of studies about the use of health services done with 1998 and 2003 PNAD data warehouse. SUS action is accordingly with the equality guideline expected in the Organic Health Law. The efficiency in the health production is observed in a variety of context related to SUS, what occurs not only in the departments where the private sector is a simple auxiliary but also in the ones where the private sector is the responsible for an important segment of health sector.

This research sought to identify the determinants of nonuse and high use of physician services and assess whether or not patterns of nonuse and high use changed over time. The population of interest was a group of elderly unmarried women who participated in the Longitudinal Retirement History Survey from 1969 to 1979. Andersen and Newman's (2) health care services utilization model served as the conceptual framework for this research. Of specific interest was the relationship between age strata and health care behavior. Age proved to be a stratifying variable within the health care delivery system. Over the ten year survey period, the health care behavior of preretirement and postretirement nonusers and high users differed significantly. A decline in nonuse was also associated with the transition years. This finding could be attributed to the "near poor" becoming eligible for Medicare. In any event, these data show that utilization of physician services is likely to increase among some unmarried women in their middle 60's.

No description available.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-28T18:07:34Z No. of bitstreams: 1 Monica Holanda de Oliveira.pdf: 889461 bytes, checksum: fe3e81f0965ab39bec9922f3afb1c17a (MD5) / Made available in DSpace on 2015-04-28T18:07:34Z (GMT). No. of bitstreams: 1 Monica Holanda de Oliveira.pdf: 889461 bytes, checksum: fe3e81f0965ab39bec9922f3afb1c17a (MD5) Previous issue date: 2013-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This is an analysis of the pattern of utilization of health services, important theme in the literature in the areas of policy, planning and management. Through this type of study we obtain indirect information about the access of health services, highlighting elements for the maintenance or repair of health policies. Aimed to characterize the use of physical therapy services for adults and seniors in the city of Praia Grande, SP. We conducted cross-sectional study, based population through household survey. The sampling technique was to conglomerates, which were adopted as primary and secondary units of sampling, respectively, the census sector and the household. The draw for the 40 sectors was done by SPSS software, with the probability of the draw is proportional to the number of residents of the same, a household was selected and it was made from the distribution of enrollment and other households. All residents of selected households were asked to answer the survey. Questionnaires were administered through netbooks operating system designed specifically for this purpose. The system was composed of 10 modules designed to capture and data persistence. 659 households were visited in which 1011 residents responded to the questionnaire. The prevalence of physical therapy in the past 12 months was 3%. 66,7% have a salary range 1-3 minimum wages, 86.7% own their own homes. 37% were seen by the public sector and 63% by private health system. It was found that access to physiotherapy service is still restricted mainly to the poorest segment of the population. The female uses more to physiotherapy services and this county had greater use of the use of physical therapy by the private health system. / Trata-se de uma análise do perfil de utilização de serviços de saúde, tema importante na literatura, nas áreas de políticas, planejamento e gestão. Através desse tipo de estudo podemos obter informações indiretas sobre o acesso dos serviços de saúde, apontando elementos para a manutenção ou correção das políticas de saúde. Teve como objetivo caracterizar a utilização de serviços de fisioterapia por adultos e idosos no município de Praia Grande, SP. Foi realizado estudo de corte transversal, com base populacional, através de inquérito domiciliar. A técnica de amostragem foi a de conglomerados, sendo adotados como unidades primárias e secundárias de amostragem, respectivamente, o setor censitário e o domicílio. O sorteio dos 40 setores foi feito através do software SPSS, sendo que a probabilidade do sorteio é proporcional ao número de moradores do mesmo, um domicílio foi sorteado e a partir dele foi feito a distribuição e arrolamento dos demais domicílios. Todos os moradores dos domicílios sorteados foram convidados a responder o inquérito. Os questionários foram aplicados através de netbooks em sistema operacional elaborado especificamente para este fim. O sistema foi composto por 10 módulos desenvolvidos para a captura e persistência de dados. Foram visitados 659 domicílios nos quais 1011 moradores responderam ao questionário. A prevalência do uso de fisioterapia nos últimos 12 meses foi de 3%. 66,7% têm faixa salarial de 1 a 3 salários mínimos, 86,7% possuem casa própria. 37% foram atendidos pelo setor público e 63% pelo sistema privado de saúde. Verificou-se que o acesso ao serviço de fisioterapia ainda é restrito principalmente à parcela mais pobre da população. O sexo feminino recorre mais aos serviços de fisioterapia e neste município teve maior utilização do uso de fisioterapia pelo sistema privado de saúde.

Composition of web services is one of the flexible and easiest approaches for creating composite services that fulfill complex tasks. Together with providing convenience in creation of new software applications, service composition has various challenges. One of them is the satisfaction of user-defined Quality of Service (QoS) requirements while selecting services for a composition. Load balancing issue is another challenge as uncontrolled workload may lead to violation of service providers&rsquo / QoS declarations. This thesis work proposes a QoS aware method for optimum service composition while taking into account load balancing. M/M/C queuing model is utilized for the individual services to determine sojourn time distribution for possible compositions. Percentile of the execution time, price and availability are considered as QoS parameters. Proposed algorithm selects the optimum composition according to QoS constraints and utility provided by the services. The performance of the method is evaluated by custom simulation software and is compared to two other methods, random selection and average execution timebased optimal service selection.

Objectif : L’objectif général de cette étude est de comprendre en quoi l’utilisation des services de santé et de disponibilité des ressources en santé au Québec sont équitables. Méthodes : De type transversal et corrélationnel, cette étude intéresse les 95 territoires CSSS du Québec, et couvre les années 2006-2007 et 2008-2009. L’indice de défavorisation matérielle et sociale de Pampalon est mis en lien avec deux séries de variables, soit celles d’utilisation des services par CSSS (services hospitaliers; services médicaux; services CLSC) et celles de disponibilité des ressources (capacité financière; capacité matérielle, capacité humaine; viabilité). Pour ce faire, des analyses de variance ont été effectuées. Le modèle intégrateur de la performance des services de santé EGIPSS et celui de l’utilisation des services de santé de Donabedian servent de cadre d’analyse. Résultats : L’utilisation des services de santé est équitable en ce qui concerne la défavorisation matérielle, mais pas en ce qui a trait à la défavorisation sociale. L’utilisation des services médicaux dispensés par les omnipraticiens est plus élevée chez les populations les plus favorisées socialement comparativement aux populations les plus défavorisées. Toutefois, l’utilisation des médecins spécialistes est plus équitable que celle des omnipraticiens, cela, chez les populations défavorisées autant matériellement que socialement. Les hospitalisations évitables sont plus élevées chez les populations les défavorisées socialement comparativement aux populations les plus favorisées. En termes de disponibilité des ressources, les populations défavorisées disposent de plus de ressources que les plus favorisées, sauf en ce qui concerne la répartition du personnel. Conclusion : En général, il existe très peu d’iniquités dans l’utilisation des services de santé au Québec. Par ailleurs, la disponibilité des ressources en santé est relativement équitable au Québec, exception faite de la disponibilité du personnel. / Objectives: The general objective of this study is to understand in what the use of health services and the availability of health resources in Quebec are fair. Methods: This cross-sectional and corelational study interests the 95 territories CSSS of Quebec, and covers the years 2006-2007 and 2008-2009. The material and social deprivation index of Pampalon is put in connection with two series of variables, such those of the use of the services by CSSS (hospital services; medical services; CLSC services) and those of availability of the resources (financial capacity; material capacity, human capacity; viability). To do it, analyses of variance were made. The integrative model of the health service performance (EGIPSS) and that of the use of the health services of Donabedian serve as frame of analysis. Results: The use of health services is fair as regards the material deprivation, but not in what concerned the social deprivation. The use of medical services dispensed by the general practitioners is more raised at the population the most favored socially compared with the most disadvantaged population. However, the use of the specialists is fairer than that of the general practitioners, it, for the populations disadvantaged so materially as socially. The avoidable hospitalizations are more raised at the population the most disadvantaged socially compared with the most favored. In terms of the availability of resources, the disadvantaged populations have more resources than the most favored populations. Conclusion: Generally, there are very few inequities in the use of health services in Quebec. Besides, the availability of the resources regarding health is relatively fair in Quebec, exception made by the distribution of the staff.