This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

本文探討近數十年來非政府組織「為何」（why）在國際社會積極參與國際組織的各項議題，其興起的因素與相關的基礎理論。然而，由於世界衛生組織是一個以主權國家為會員組成的政府間組織，台灣至今還未能成為它的會員國；非政府組織「如何」（how）參與此一國際組織，本文從三個面向來進行分析，第一，非政府組織參與WHO的角色定位；第二，非政府組織對於國際政策諸如醫療、人道救援等的參與策略；第三，討論非政府組織在國際參與過程中與政府的關係；此外，並探討台灣非政府組織國際參與的機會與可能的挑戰。 就理論意義而言，學者將非政府組織與全球化的發展趨勢聯繫起來，關注於非政府組織如何在國際參與各項全球議題（Held & Mcgrew, 2002；Peck, 1998；Scholte, 2000）。就現有的非政府組織研究來看，學界少有將全球議題和國家、非政府組織相連結者（Weiss, 1999；Brown. et.al., 2000；CIVICUS, 1998；MS, 2000），此一研究缺口主要與它在國際政策層面的重要性未獲得密切注意有關。目前有若干學術著作把國家與非國家行動者合併在一起探討，Weiss & Gordenker (1996)在「非政府組織、聯合國及全球治理」（NGOs, The UN, & Global Governance）一書中，從UN與NGO的連結試圖解釋全球治理的問題；Fisher（1998）的「非政府組織與第三世界的政治發展」（NGOs and the Political Development of the Third World）一書探討的NGO與第三世界國家政治發展的關係。本文主要為了突顯NGO的參與對國家主導全球議題等鉅觀社會變遷的影響之外，並以中介角色來理解它與政府和政府間組織如聯合國、世界衛生組織的關連。 在資料蒐集與分析方面，台灣非政府組織在國際上從事醫療及人道救援有其長遠的歷史，然關於這方面的學術研究、討論，卻是近幾年才開始興起。本文採用質性研究的文獻檢閱、深度訪談和參與觀察等研究方法。對此一議題的思考、研究，透過搜集、閱讀以世界衛生組織為研究主題或相關的國內外期刊文章，釐清目前世界衛生組織研究領域的內容，以進一步確定計畫研究範圍、研究主軸與訪談對象。針對非政府組織部分的訪談對象，作者選擇了：台灣國際醫學聯盟等共18個民間團體以及2個政府機構做為研究訪談對象。 研究發現茲分為理論層面和實務層面兩方面對照說明： （一）關於非政府組織在國際參與的角色定位，指涉非政府組織在國際社會所扮演的是一種中介角色；還是第二軌道外交功能、或對政府間國際關係的輔助作用。究實而論，台灣非政府組織參與世界衛生組織之行動，其理論意涵意味著上述三種的角色功能，但本文研究發現政府偏好以動員方式鼓勵非政府組織去參與，而此種「動員式外交」活動究竟能夠收到多大的效果，不無爭議，容易造成台灣NGO在國際發展角色的曖昧不明，引發非政府組織角色定位的疑問。 （二）非政府組織在國際組織系統中並不具有政府的合法性，亦不具有治理上的權威，故而它對於國際事務的影響力，所憑藉的僅為一種策略途徑的運用。從台灣參與的個案，本文發現非政府組織除了運用協商談判的途徑，或與政府協商、或國際組織協商之外，國內非政府組織所運用的途徑，主要為倡議導向的途徑、策略聯盟的途徑以及訴諸直接服務的途徑。 （三）台灣非政府組織積極參與政府間國際組織，理論上可以與外交議題進行連結，因此政府與非政府組織在某些政策層面維持良好的互動。本研究發現台灣非政府組織與政府的互動情形，存在下列的問題：1、第二軌道外交價值觀認知之不同，政府急於加入WHO這種國際政府間組織，但大多NGO卻認為政府不應將外交當作唯一考量，希望能夠加強非政府組織實際參與的實質內涵；2、非政府組織與政府參與國際的方式缺乏共識，非政府組織不認同政府對外之參與模式，反而認為政府應該做好整合資源的工作，協助國內NGO從事國際活動，盡量讓NGO可以發揮各自領域之所長，而不只是經費補助而已；3、台灣NGO與政府的關係可區分為：收編、合作、互補和對抗等類型，其中若干非政府組織與政府傾向於一種合作型的「官民策略」(Government-NGO Participant Strategy)，就加入世界衛生組織的目標而言，兩者維持相互依賴的關係。 / The paper attempts to explore related issue that Non-Governmental Organizations (NGOs) in Taiwan participating in the activities of ‘World Health Organization’ (WHO). In terms of literature review and theory approach, this paper examines why NGOs involved in global issue, and explores NGOs appearance cause and related basic theory. However, WHO is an inter-governmental organization composed of a number of member state, so far Taiwan couldn’t still be allowed to be a member of WHO. Based on qualitative research it also examines NGOs how to participate in such an intergovernmental organization, there are three main analyzing aspects. First, this paper intends to discuss the role and position of a civil organization concerning how to participate in WHO meeting and activities. Second, some of the NGOs discussed here directly provide strategies to attend international policy in WHO areas such as health, and human aid. Third, the diverse relations between NGOs and government institution may be formed with participating different processes of international action. Furthermore, we discuss the opportunities and limitations on participating actions of NGOs in Taiwan.

Following the Second World War, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) teamed up to construct an international Codex Alimentarius (or “food code”) in 1962. Inspired by the work of its European predecessor, the Codex Europaeus, these two UN agencies assembled teams of health professionals, government civil servants, medical and scientific experts to draft food standards. Once ratified, the standards were distributed to governments for voluntary adoption and implementation. By the mid-1990s, the World Trade Organization (WTO) identified the Codex as a key reference point for scientific food standards. The role of science within this highly political and economic organization poses interesting questions about the process of knowledge production and the scientific expertise underpinning the food standards. Standards were constructed and contested according to the Codex twin goals of: (1) protecting public health, and (2) facilitating trade. One recent criticism of Codex is that these two aims are opposed, or that one is given primacy over the other, which results in protectionism. Bearing these themes in mind, in this dissertation I examine the relationship between the scientific and the ‘social’ elements embodied by the Codex food standards since its inception after the Second World War. I argue that these attempts to reach scientific standards represent an example of coproduction– one in which the natural and social orders are produced alongside each other. What follows from this central claim is an attempt to characterize the pre-WTO years of the Codex through a case study approach. The narrative begins with a description of the predecessor regional group the Codex europaeus, and then proceeds to key areas affecting human health: 1) food additives, 2) food hygiene, and 3) pesticides residues.

Concept of health education in kindergarten This thesis deals with the concept of a healthy lifestyle for preschool children and of health education in nursery schools. The first part of this work is the definition of "health" and individual determinants of health such as lifestyle, environment and health. The thesis deals with the various components of health education in kindergarten, the movement of children in kindergarten, nutrition, inner comfort and overall environment of the nursery school in the context of the Framework Curriculum for preschool education. The subject of research of this thesis is two-stage evaluation process and questionnaire, which is presented to teachers of kindergartens.

A aprovação da Estratégia Global e do Plano de Ação sobre Saúde Pública, Inovação e Propriedade Intelectual (GSPOA), no âmbito da Organização Mundial da Saúde (OMS), está baseada na percepção da necessidade de melhoria nas condições de acesso dos países em desenvolvimento a medicamentos e outros produtos que atendam às suas necessidades específicas de saúde pública. Para tanto, a GSPOA está dividida em 8 elementos principais, 25 subitens, distribuídos por 108 pontos de ação, que visam aumentar a eficácia na promoção da inovação dentro dos países, através do desenvolvimento institucional, investimento e coordenação de áreas relevantes para a inovação em saúde. Nesse contexto, o escopo da presente investigação doutoral consiste em perscrutar os desafios para a plena implementação da referida política internacional no Brasil. Trata-se de estudo de caso - enquanto método de investigação qualitativa - que tem sua aplicação quando o pesquisador busca uma compreensão extensiva e com mais objetividade e validade conceitual, do que propriamente estatística. Perquiriu-se, destarte, políticas públicas nacionais, observando racionalmente se promoveram alguma alteração efetiva no âmbito interno, relacionadas com a pesquisa e desenvolvimento e ao acesso a medicamentos seguros, eficazes, de qualidade, e, principalmente, a preços acessíveis. Partindo de uma perspectiva crítica, e marcos teóricos consagrados, buscou-se situar a GSPOA num contexto de saúde transnacional em uma era de globalização, e os desafios para implementar mais completamente um direito à saúde, que transcenda medicamentos e exigências individuais, e que promova a reconsideração da relação sistêmica entre pesquisa farmacêutica, interesse comercial e assistência à saúde pública. Observamos que, para o período de 2008-2015, houve um processo de recrudescimento das políticas de inovação na seara da saúde, bem como êxito na promoção de iniciativas relativas à identificação de lacunas, e na formulação de estratégias que priorizam explicitamente a pesquisa e desenvolvimento em doenças negligenciadas de maior incidência no país. No entanto, verificou-se que tais ferramentas ainda são insuficientes para a efetiva superação do hiato tecnológico, e do déficit público referente às importações de insumos para o setor saúde. Um dos principais desafios relacionados com a inovação em saúde seria justamente colocar o sistema universal de saúde em posição de centralidade no âmbito das políticas do Estado. Em suma, tem-se que tais desafios têm origem orçamentário-financeira, normativa e institucional. Orçamentário-financeira porque o subfinanciamento do SUS é histórico, impactando nas demandas de pesquisa e desenvolvimento na seara sanitária. Quanto ao aspecto normativo, contata-se que opções equivocadas, especialmente quando da promulgação da Lei de Propriedade Industrial (nº 9.279/1996), comprometem a instrumentalização de políticas progressistas para que a propriedade intelectual responda melhor às reais necessidades de saúde pública. Em relação ao marco institucional, constatou-se que o diálogo entre os órgãos da Administração Pública, envolvidos na seara do acesso a medicamentos, em suas mais diversas interfaces, tem sua ação prejudicada diante da sobreposição dos interesses econômicos frente à segurança sanitária. A superação de tais entraves, para a plena implementação da GSPOA no Brasil, é deveras imprescindível, numa ação positiva no contexto do direito social à saúde e ao acesso universal a medicamentos / The approval of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA) within the framework of the World Health Organization (WHO) is based on the perception of the need to improve the access conditions of developing countries to medicines and other products that meet your specific public health needs. To this end, GSPOA is divided into 8 main elements, 25 sub-items, distributed by 108 action points, aimed at increasing efficiency in promoting innovation within countries, through institutional development, investment and coordination of areas relevant to innovation in health. In this context, the scope of this doctoral research consists of examining the challenges for the full implementation of this international policy in Brazil. It is a case study - as a method of qualitative research - that has its application when the researcher seeks an extensive understanding and with more objectivity and conceptual validity, than properly statistical. National public policies have been sought, rationally observing whether they have promoted any effective changes at the internal level related to research and development and access to safe, effective, quality and, above all, affordable medicines. From a critical perspective, and with established theoretical frameworks, the aim was to situate the GSPOA in a transnational health context in an era of globalization, and the challenges to more fully implement a right to health, which transcends medicines and individual demands, and promotes the reconsideration of the systemic relationship between pharmaceutical research, commercial interest and public health assistance. We note that, for the period 2008-2015, there was a process of strengthening innovation policies in health, as well as successful initiatives to identify gaps, and the formulation of strategies that explicitly prioritize research and development in neglected diseases of greater incidence in the country. However, it was verified that such tools are still insufficient for the effective overcoming of the technological gap, and of the public deficit regarding imports of inputs for the health sector. One of the main challenges related to health innovation would be precisely to place the universal health system in a position of centrality within the scope of State policies. In summary, these challenges have a budgetary-financial, normative and institutional origin. Budgetary-financial because SUS underfunding is historical, impacting the demands of research and development in the sanitary seara. Regarding the normative aspect, it is suggested that misguided options, especially when promulgating the Industrial Property Law (No. 9.279 / 1996), compromise the use of progressive policies so that intellectual property responds better to the real needs of public health. In relation to the institutional framework, it was found that the dialogue between the Public Administration organs, involved in the area of access to medicines, in its most diverse interfaces, is affected by the overlapping of economic interests in relation to health security. The overcoming of such obstacles, for the full implementation of the GSPOA in Brazil, is indeed essential, in a positive action in the context of the social right to health and universal access to medicines

Trauma de crânio leve (TCE leve) é definido como um déficit neurológico transitório que ocorre após um trauma incluindo história de náuseas, vômitos, cefaléia ou tontura acompanhada de alteração ou perda da consciência com duração inferior a 15 minutos, amnésia pós traumática e Escala de Coma de Glasgow entre 13 e 15. Apesar da alta taxa de sobrevida, pode cursar com alguma morbidade, principalmente nos três primeiros meses posteriores ao trauma e cerca de 18 % dos pacientes desenvolvem pelo menos uma síndrome psiquiátrica no primeiro ano após o acidente. O diagnóstico ainda é um desafio no sentido de minimizar-se gastos desnecessários com exames subsidiários entretanto, intervenções precoces podem evitar seqüelas. Nosso objetivo foi verificar o impacto do TCE leve na qualidade de vida de suas vítimas e diagnosticar as várias alterações neuropsicológicas que podem advir deste trauma. Esses alterações podem ser verificadas através de instrumentos de pesquisa. Inicialmente, foram avaliadas cinqüenta vítimas com TCE leve, atendidas no Hospital João XXIII, em Belo Horizonte - MG, as quais foram submetidas a dosagem de proteína S100B e tomografia de crânio (TCC) na admissão. Nessa fase, verificou-se que a proteína S100B tem valor preditivo negativo de 100%. Dezoito meses após o trauma, esses pacientes foram procurados em suas residências, quando foi lhes solicitado para que respondessem a quatro instrumentos de pesquisa [dois para diagnóstico de qualidade de vida (World Health Organization WHOQOL-100), e o Short Form-36 (SF-36), um para análise da presença de ansiedade e depressão (Escala Hospitalar de Ansiedade e Depressão (EHAD) e o Questionário de Sinais e Sintomas (QSS), baseado no Post Concussion Questionnaire] com o objetivo de pesquisar a presença de sinais e sintomas da síndrome pós-concussão. Também foram pesquisados aspectos sociodemográficos, como idade, escolaridade, estado civil, renda pessoal e origem desta renda. Os mesmos questionários foram preenchidos por um grupo de controle composto, necessariamente, por coabitantes dos pacientes, sem história de trauma craniano de qualquer gravidade e com idade a mais próxima possível da do paciente. Na avaliação pelo WHOQOL-100, pacientes apresentaram qualidade de vida inferior nos domínios nível de independência, ambiente e no total de domínios (p< 0,05). Na avaliação do SF-36, pacientes revelaram qualidade de vida inferior nos domínios capacidade funcional, vitalidade, saúde mental (p<0,001), dor, estado geral de saúde e aspectos mentais (p<0,05). Pacientes apresentaram mais ansiedade e estavam uma classe acima de seus controles pela EHAD. Pacientes referem ainda número maior de sinais e sintomas da síndrome pós-concussão do que seus respectivos controles. Não verificamos correlação entre a qualidade de vida, classificação na EHAD ou número de sinais e sintomas da SPC com as dosagens de proteína S100B ou com a presença de lesão na TCC realizadas na admissão / Mild head trauma (MHT) is defined as a transitory neurological deficit that happens after the trauma and includes a history of nausea, vomiting, headache or dizziness and loss or alteration of consciousness (less than 15 minutes), post-trauma amnesia, and Glasgow Coma Scale (GCS) at admission between 13 and 15. Despite the high survival rates, some morbidity has been observed in the three month period after this trauma. Approximately 18% of head trauma patients develop at least one psychiatric syndrome in the first year after the accident. The diagnostics difficulty and the risks of complications after the MHT continue to be a relevant problem at the emergency departments around the world. Limitations of active participation in daily life are alterations that influence life quality. Several of these alterations may be diagnosed through Interview Instruments. Our study was divided in two phases. In the first phase, 50 MHT patients admitted at Hospital João XXIII, Belo Horizonte-MG, Brazil, had protein S100B dosing and head CT taken at admission. Concentration values of S100B lower than 0.01 g/l were considered negative once this was the lowest value found in patients who did not show brain injuty signs in the CT scan. In that study it was found that protein S100B has 100% negative predictive value. In this second phase of the study, 18 months after the trauma, these patients were contacted at their homes and asked to answer four self- assessment questionnaires: two for quality of life diagnostic - World Health Organizations WHOQOL-100 and the Short Form-36 (SF36); one for the analysis of anxiety and depression - Hospital anxiety and depression scale-HADS; and one instrument developed by the author based on the Rivermead Post Concussion Questionnaire to evaluate the presence of post-concussion syndrome signs and symptoms. Several socio-demographic aspects were also analyzed, including income, source of income, means of transportation used, etc. The same questionnaires were filled by a control group formed necessarily by patients co-inhabitants, with no history of head trauma of any severity, and with closest age as possible to the patients. In the WHOQOL assessment patients showed a lower quality of life in the independence, environment, as well as in the total domains (p< 0,05). In the SF 36 assessment patients showed a lower quality of life in the functional capacity, vitality, and mental health domains (p<0,001); and also in pain, general health situation, and mental aspects (p<0,05). Patients showed more anxiety and, in the HADS Scale, showed at least a level higher, on average, than their controls. Patients also showed a higher number of post-concussion signs and symptoms than their respective controls. We did not find correlation between the later quality of life and protein S100B dosing at admission. We were not able to find correlation between the protein concentrations with the presence of brain lesions in the CCT scans taken at patients admission in the emergency department

Made available in DSpace on 2014-07-29T15:25:17Z (GMT). No. of bitstreams: 1 Tese Neuma Chaveiro.pdf: 5331512 bytes, checksum: be70c1881af4f07e3e7dd0bb8aa23138 (MD5) Previous issue date: 2011-11-29 / Introduction: The evaluation of the quality of life of the deaf community is limited by the difficulties of communication in the oral and written language, thence the necessity of developing reliable instruments in sign language with methodological strictness that includes particular characteristics of the deaf people. Among the cultural lines of the deaf community, sign language is the most emphasized one: besides being a linguistical system, it is an element of constitution of the deaf person identity. In Brazil, it is legally assured the deaf the right to communicate in his natural language, that is, Brazilian Sign Language (LIBRAS), with no imposition of the usage of the majority language of the country. This doctoring thesis is part of the WHOQOL-LIBRAS project, a result of a partnership between Federal University of Goiás, World Health Organization and Brazil´s WHOQOL group in Federal University of Rio Grande Do Sul. In order to perform the WHOQOL-LIBRAS project, it was divided into two sub-projects with distinct but interdependent stages: Project 1 - Construction of the WHOQOL-BREF and WHOQOL-DIS versions in LIBRAS; Project 2 - Application/validation of the WHOQOL-BREF and WHOQOL-DIS instruments in the LIBRAS version. This thesis comprises Project 1. General Objective: Build the LIBRAS version of the WHOQOL-BREF and WHOQOL-DIS instruments to evaluate the brazilian deaf community quality of life. Methods: A transversal and exploratory study, designing based in the Methodological Research. The methodology proposed by the World Health Organization was used and adapted to the deaf community, and in accordance with the criteria established with Brazil WHOQOL group, the accomplishment of the project was divided into 13 phases: 1. creation of the QUALITY OF LIFE sign; 2. development of the answer scales in LIBRAS; 3. translation by a bilingual group; 4. recouncilling version; 5. first retrotranslation; 6. production of the version in LIBRAS to be provided to the focal groups; 7. realization of the Focal Groups; 8. review by a monolingual group; 9. revision by the bilingual group; 10. semantic/syntactic analysis and second retrotranslation; 11. re-evaluation of the retrotranslation by the bilingual group; 12. recording the final version into the software in studio; 13. software development of the WHOQOL-BREF and WHOQOL-DIS instruments into the LIBRAS version. Results: Peculiar characteristics of the deaf people culture pointed to the necessity of adaptations in the application methodology of focal groups when it is compound by deaf people. The writing conventions of the signed languages are yet not consolidated, thus, some difficulties were faced in graphically register the translation phases of Portuguese into LIBRAS. Linguistics structures that caused major problems in translation were those that included portuguese idiomatic expressions, for many of them are no equivalent concepts between Portuguese and LIBRAS. In the end, it was possible to build up a WHOQOL-BREF and WHOQOL-DIS software in LIBRAS. Conclusion: The WHOQOL-BREF and the WHOQOL-DIS in LIBRAS will allow the deaf to express about the quality of life in an autonomous way, and this will make possible to investigate more accurately the issues of deaf people quality of live. Besides, the WHOQOL-BREF and the WHOQOL-DIS in LIBRAS will be part of the World Health Organization instruments for evaluating quality of life. / Introdução: A avaliação da qualidade de vida da população surda é limitada pelas dificuldades de comunicação na língua oral e escrita, daí a necessidade de desenvolver instrumentos confiáveis em língua de sinais com rigor metodológico que inclua as características particulares do povo surdo. Dentre os traços culturais da população surda, o que mais se destaca é a língua de sinais: além de ser um sistema linguístico, é um elemento de constituição da identidade da pessoa surda. No Brasil, é garantido legalmente o direito ao surdo de se comunicar na sua língua natural, ou seja, na Língua Brasileira de Sinais (LIBRAS), sem imposição ao uso da língua majoritária do país. Essa tese de doutorado faz parte do projeto WHOQOL-LIBRAS, resultado da parceria entre a Universidade Federal de Goiás, a Organização Mundial de Saúde e o Grupo WHOQOL do Brasil na Universidade Federal do Rio Grande do Sul. Para sua execução o projeto WHOQOL-LIBRAS foi dividido em dois projetos, com etapas distintas, mas interdependentes: Projeto 1 Construção da versão em LIBRAS do WHOQOL-BREF e WHOQOL-DIS; Projeto 2 Aplicação/validação da versão em LIBRAS dos instrumentos WHOQOL-BREF e WHOQOL-DIS. A presente tese constitui o Projeto 1. Objetivo geral: Construir a versão em LIBRAS dos instrumentos WHOQOL-BREF e WHOQOL-DIS para avaliação da qualidade de vida da população surda brasileira. Métodos: Estudo transversal e exploratório, delineado com base na Pesquisa Metodológica. Utilizou-se a metodologia proposta pela Organização Mundial de Saúde (OMS), adaptada para população surda, e em acordo com os critérios estabelecidos com o Grupo WHOQOL do Brasil a execução do projeto foi dividida em 13 etapas: 1. criação do sinal QUALIDADE DE VIDA; 2. desenvolvimento das escalas de respostas em LIBRAS; 3. tradução por um grupo bilíngue; 4. versão reconciliadora; 5. primeira retrotradução; 6. produção da versão em LIBRAS a ser disponibilizada aos grupos focais; 7. realização dos grupos focais; 8. revisão por um grupo monolíngue; 9. revisão pelo grupo bilíngue; 10. análise sintática/ semântica e segunda retrotradução; 11. reavaliação da retrotradução pelo grupo bilíngue; 12. filmagem em estúdio da versão final para o software; 13. Desenvolvimento do software dos instrumentos WHOQOL-BREF e WHOQOL-DIS na versão em LIBRAS. Resultados: Características peculiares da cultura do povo surdo apontaram a necessidade de adaptações na metodologia de aplicação de grupos focais quando compostos por pessoas surdas. As convenções de escrita das línguas sinalizadas não estão consolidadas, por isso encontrou-se dificuldades em registrar graficamente as etapas de tradução do Português para LIBRAS. As estruturas linguísticas que causaram maiores problemas de tradução foram as que incluíram expressões idiomáticas do Português, muitas das quais não têm conceitos equivalentes entre o Português e a LIBRAS. Ao final foi possível construir um software do WHOQOL-BREF e WHOQOL-DIS em LIBRAS. Conclusão: O WHOQOL-BREF e o WHOQOL-DIS em LIBRAS possibilitarão que os surdos, de maneira autônoma, se expressem no que respeita a qualidade de vida, o que permitirá investigar com mais precisão questões de qualidade de vida das pessoas surdas. Além disso, o WHOQOL-BREF e o WHOQOL-DIS em LIBRAS farão parte dos instrumentos de avaliação de qualidade de vida da Organização Mundial de Saúde.

Introdução O Transtorno de Déficit de Atenção/hiperatividade (TDAH) tem sido muito estudado, mas informações econômicas referentes ao seu tratamento com o metilfenidato de liberação imediata (MFD-LI) ainda necessitam ser exploradas. Grande parte da população mundial, principalmente aqueles que vivem em países em desenvolvimento, utiliza essa formulação como principal escolha para o tratamento do TDAH. Esses países, por sua condição financeira, necessitam informações de análises econômicas para administrar de forma eficiente os recursos públicos destinados aos setores da saúde. Objetivos Avaliar a eficácia do MFD-LI através de estudos com tempo superior a 12 semanas, e realizar uma análise econômica para o tratamento do TDAH com MFD-LI para crianças e adolescentes brasileiros. Método O estudo foi planejado em cinco etapas: 1) estimativa de custo do não tratamento do TDAH para o Brasil, e estimativa de economia com tratamento com MFD-LI; 2) revisão sistemática da literatura nas principais bases de dados internacionais onde se buscaram estudos abertos com tratamento do TDAH com MFD-LI por tempo igual ou superior a 12 semanas; também foram feitas metanálises e uma metaregressão 3) estudo naturalístico para obterem-se dados de uma amostra brasileira referentes a probabilidades de uso e sucesso com tratamento com MFD-LI por 12 semanas, e estimar os utilities desses indivíduos; 4) painel Delphi com especialistas em TDAH no Brasil; 5) estudo de custo-efetividade para o tratamento do TDAH com MFD-LI no Brasil, utilizando um Modelo de Markov. A perspectiva adotada será a do sistema público de saúde brasileiro como pagador. Resultados Os resultados principais encontrados para cada uma das etapas foram: 1) a estimativa de custos anuais com o TDAH não tratado no Brasil foi de R$ 1.594 bilhões/ano, e da quantia que poderia ser economizada se tratado, R$ 1 bilhão/ano. 2) na revisão sistemática da literatura, de 4.498 resumos, sete foram incluídos para compor a metanálise. O tempo de tratamento variou entre 13 e 104 semanas. O efeito agregado para desatenção e hiperatividade medida pelos pais, respectivamente, foi 0.96 (95%CI 0.60 - 1.32) e 1.12 (95%CI 0.85 - 1.39), e pelos professores 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). A metaregressão não mostrou associação entre as variáveis idade, qualidade do artigo e tempo de tratamento com heterogeneidade. 3) no estudo naturalístico, de 171 pacientes avaliados, 73 forneceram informações para o baseline, e 56 para a 12a semana de tratamento com MFD-LI. Os utilities para um paciente com TDAH não tratado (baseline) foram 0.69 (crianças) e 0.66 (adolescentes), e estimaram-se ganhos entre 0.09 a 0.10 utilities/mês, se tratados adequadamente. 4) no painel Delphi, de 26 especialistas, 14 responderam o questionário online, e foi estimado que a probabilidade dos pacientes não tratados se manterem sintomáticos na 12a semana seria de 91%, e 9% a probabilidade de melhora espontânea; 5) no estudo de custo-efetividade, para o caso base, estimou-se que o Incremental Cost Effectiveness Ratio (ICER) seja I$9,103/QALY (Quality Adjusted Life Years) para crianças e I$11,883/QALY para adolescentes em um horizonte temporal de 06 anos. Para os cenários mais desfavoráveis, os ICERS mais elevados foram I$95,164/QALY para 50% de sucesso com o tratamento, e I$15,000/QALY para 70% de adesão em um horizonte temporal de 06 anos. Conclusões O MFD-LI é um tratamento eficaz para crianças e adolescentes, por um período superior a 12 semanas. Entretanto, o Brasil pode estar aumentando os custos referentes à saúde por não estar fornecendo um tratamento eficaz e economicamente acessível para o TDAH. O tratamento mostrou ser uma opção custo-efetiva para crianças e adolescentes brasileiros, mesmo em cenários desfavoráveis para o tratamento. / Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a well-known psychiatric disorder, but some economical aspects of the treatment with Methylphenidate Immediate-release (MPH -IR) still need to be explored. A large number of people around the world, most living in Low-Middle Income Countries (LMIC), use this formulation as the first choice for ADHD treatment. These countries, due to their financial condition, need information from health economic analyzes to efficiently manage the public resources allocated to the health sector. Objective To study the efficacy of MPH-IR reviewing studies conducted for more than 12 weeks long, and to perform an economic analysis for the treatment of ADHD with MPH-IR for Brazilian children. Method The study was planned in a five stages process: 1) to estimate the cost of untreated ADHD for Brazil, and to estimate the savings if MPH-IR were adequately provided; 2) systematic review of the literature to identify papers published where young patients with ADHD were treated with MPH-IR for more than 12 weeks, and to perform a meta-analysis and a meta-regression; 3) to conduct a naturalistic study with a Brazilian sample to collect the probabilities of use and success with the MPH-IR treatment for 12 weeks, and to estimate the utilities; 4) to perform a Delphi panel with ADHD Brazilian experts; 5) to conduct a cost-effectiveness analysis for the treatment of ADHD with MPH-IR in Brazil, using a Markov model. The perspective is the one of the Brazilian public health system as the payer. Results The main findings for each step were: 1) the estimated annual expenditures with untreated ADHD in Brazil were R$1.594billon/year, and the estimated amount that could be saved was R$1billion/year; 2) in the systematic review, from 4,498 abstracts, 7 studies were selected. The length of treatment ranged from 13 to 104 weeks. The aggregate effects for inattention and hyperactivity, according to parents evaluations were respectively 0.96 (95%CI 0.60 - 1.32) and 1.12 (95%CI 0.85 - 1.39), and for teachers 0.98 (95%CI 0.09 - 1.86) e 1.25 (95% CI 0.7 - 1.81). There was no evidence of association between heterogeneity and the variables, age, paper quality and length of treatment; 3) in the naturalistic study, from 171 patients assessed, 73 provided information in the baseline, and 56 in the 12th week of MPH-IR treatment. Utilities for an untreated ADHD patient (baseline) were 0.69 (children) and 0.66 (adolescents), and it was estimated a gain ranging from 0.09 to 0.10 utilities/month if subjects were properly treated; 4) in the Delphi Panel, 26 experts were addressed and 14 filled in the online questionnaire. It was estimated the probability of untreated patients to remain symptomatic on the 12th week to be 91%, and the probability of spontaneous improvement, 9%; 5) in the cost-effectiveness analysis, for the base case, it was estimated an Incremental Cost Effectiveness Ratio (ICER) of I$9,103/QALY (Quality Adjusted Life Years) for children and I$11,883/QALY for adolescents, in a time horizon of 6 years. The worst case scenarios were also tested, and the highest ICER were I$95,164/QALY when patient reached 50 % of success with the treatment, and I$15,000/QALY if only 70% of use was observed in a time horizon of 6 years. Conclusions MPH-IR is an efficacious treatment for ADHD children and adolescents for periods longer than 12 weeks. However, Brazil may be probably wasting money due to not provide an efficient and affordable treatment for ADHD such as the MPH-IR. The treatment proved to be cost-effective for children and adolescents living in Brazil, even when the worst case scenarios were tested.

<p>This study attests to the fact that disability is an issue in conflict-affected populations, in particular refugees. Refugees with disabilities living in Mayukwayukwa refugee camp also have poor HRQOL similar to other studies. Education was the only variable significantly correlated to the psychological and social domains of the HRQOL. The study highlighted that environmental and personal variables played a role in the determination of health related quality of life among refugees with disabilities.</p>