Made available in DSpace on 2016-04-27T18:47:05Z (GMT). No. of bitstreams: 1 Ana Carolina Lopez Silva.pdf: 364297 bytes, checksum: e3944ae52843e9407c50b97c4973db32 (MD5) Previous issue date: 2010-10-15 / This work aims at studying the impact of outdoors leisure activities on the life of the residents at the Elderly Nursing Home Nossa Senhora da Saúde, located in the municipality of Belo Horizonte. Based on what the residents said, there was an attempt to identify elements which could contribute to the reflection and the debate about leisure in the life of the elderly. The issue of outdoors leisure of elderly people was proposed to be thought per category of analysis as established by the literature, such as: concept of elderly, long term care institution and leisure. Two outdoors rides were performed with the residents to the Zoo and to the Museum of Arts and Trades, so that they could experience a leisure activity outside the Home. Afterwards, six interviews were conducted with the residents (three men and three women) in order to assess the impact of the outdoors leisure activities. The lack of knowledge of the elderly who were studied in relation to the issue could be observed. In the interviews, it could be verified that there was a lack of experience in terms of leisure activities through life and an attitude of passivity and renouncement of life in some of the elderly. It could also be verified that the outdoors rides brought new experiences. Therefore, it is necessary to promote more awareness about leisure in this age group, demonstrating its benefits and the various manners to experience it. This will contribute to the search for new alternatives, causing these people to escape from the routine of their homes to make their lives more pleasant / Esta pesquisa tem por objetivo estudar o impacto das atividades externas de lazer na vida dos residentes do Lar Nossa Senhora da Saúde, localizado no município de Belo Horizonte. Com base na fala dos residentes, procurou-se identificar elementos que pudessem contribuir para a reflexão e o debate sobre o lazer na vida dos idosos. Propôs-se pensar a questão do lazer externo das pessoas idosas por categoria de análise estabelecida pela literatura, como: conceito de idoso, instituição de longa permanência e lazer. Foram realizados dois passeios externos com os residentes - ao Jardim Zoológico e ao Museu de Artes e Oficio, para que eles pudessem vivenciar uma atividade de lazer externa ao Lar. Posteriormente, foram realizadas seis entrevistas com os residentes (três homens e três mulheres), para avaliar o impacto das atividades externas de lazer. Pode-se observar a falta de conhecimento, por parte dos idosos pesquisados, sobre o assunto. Nas entrevistas, pode-se constatar também uma falta de vivência de atividades de lazer ao longo da vida e uma posição de passividade e desistência da vida, por parte de alguns idosos. Percebeu-se também que os passeios externos trouxeram novas experiências. Por isso, faz-se necessário promover uma maior conscientização sobre o lazer para esta faixa etária, mostrando seus benefícios e as diversas formas de vivenciá-los. Isso contribuirá para a busca de novas alternativas, fazendo-os sair da rotina de seus lares e para tornar suas vidas mais agradáveis

Management of Public Health The assessment of patients right to choose primary health care institution in the context of competition Simona Stulpinaitytė Supervisor Prof., dr. Irayda Jakušovaitė Department of Social Medicine, Faculty of Public Health, Kaunas University of Medicine. Kaunas; 2005. 65 p. Aim of the study. To assess and compare patients possibility to use their right to choose primary health care institutions in the context of competition. Objectives. 1) To assess factors who determine the choice of private or public primary health care institution; 2) To compare patients opinion about services that are provided in public and private health care institutions; 3) To compare ethical problems in healh care in micro (doctor – pacient) level in public and private health care institutions. Methods. During the survey there were questioned 380 patients at the public and private health care institutions in Garliava. Response rate in public health care institutions was 81% and in private health care institution it was 84%. Statistical analysis was carried out using statistical package for social sciences - SPSS 11.5 for Windows. Associations between the variables were tested by Chi squared. Patients answers under provided services in public and private health care institutions were analyzed by measuring means that were compared using the Stujdent test (t). Significance level (p) less than 0,05 was considered as statistically significant (p<0,05). Results. The most... [to full text]

The importance of health care institutions’ management is accepted about 20 years ago. First in Lithuania the post of hospital administrator was established in Hospital of Kaunas University of Medicine in 1996. It is the first investigation of the expediency’s appreciation of hospital administrator’s post in Lithuania. Aim of the study: to evaluate the appreciation of the hospital administrator’s post. Objectives: 1) To analyse papers influencing on hospital administrator’s job. 2) To investigate and compare the opinion of hospital administrators and departments’ chiefs about the necessity of manager in hospital. Methods: The study consists of the responses of 34 chiefs and 54 administrators of departments of Kaunas Medical University Hospital. We asked questions of chiefs and administrators to determine the necessity of administrator’s role in health care organization, what functions hospital administrators should do. The administrators’ response rate was 65% (35 of 54), the chiefs’ rate was 79% (27 of 35). There were used T and Chi-square tests, hospital administrators were compare to chiefs of departments. In all instances statistical significance is set at 0.05 level. Results: There is done the analysis of health care institutions’ management and roles of hospital administrator. By investigation in Hospital of Kaunas University of Medicine all chiefs of departments (100%) and almost all hospital administrators (97%) predicate that the post of hospital administrator is... [to full text]

Magistro baigiamasis darbas sudarytas iš trijų pagrindinių dalių. Pirmoje dalyje analizuojami teoriniai vidaus medicininio audito sveikatos priežiūros įstaigose aspektai bei modeliai, nagrinėjamas vidaus medicininio audito teisinis reglamentavimas Lietuvoje. Antroje dalyje analizuojama VšĮ Respublikinės Panevėžio ligoninės vidaus medicininio audito veikla 2010 – 2013 m., jos organizavimas ir vykdymas. Trečiojoje darbo dalyje įvertinama vidaus medicininio audito veikla Respublikinėje Panevėžio ligoninėje vidaus medicinos auditorių ir konsultantų požiūriu. Magistro baigiamojo darbo pabaigoje, remiantis vidaus medicininio audito 2010 – 2013 m. veiklos analize ir kokybinio tyrimo rezultatais, pateikiamos išvados ir rekomendacijos Respublikinės Panevėžio ligoninės vidaus medicininio audito veiklos gerinimui. / The Master’s Thesis consists of three basic parts. In the first part theoretical aspects and models of internal medical audit in health care institutions are analysed. The first part also deals with legal regulation of internal medical audit in Lithuania. In the second part organization and implementation of internal medical audit activity in the Public Institution Panevėžys Republican Hospital during the period of 2010 – 2013 is analysed. In the third part of the Thesis internal medical audit activity in the Public Institution Panevėžys Republican Hospital is evaluated at the approach of internal medical auditors and consultants. Following the analysis of the internal medical audit activity of 2010 – 2013 and the results of the qualitative research, in the final part of the Master’s Thesis conclusions and recommendations for the improvement of internal medical audit activity in the Public Institution Panevėžys Republican Hospital are presented.

As complicações de pacientes com insuficiência renal crônica submetidos ao tratamento hemodialítico representam desafios para os profissionais de saúde. A variabilidade de fatores de risco que predispõem a essas complicações têm sido, freqüentemente, investigada na literatura científica. Nesse sentido, objetivou-se descrever as complicações locais e sistêmicas dos pacientes com insuficiência renal crônica a partir da implantação do cateter temporário de duplo lúmen para hemodiálise até sua retirada definitiva. Trata-se de um estudo de segmento que avaliou prospectivamente os pacientes da implantação do cateter até sua retirada definitiva. Para o estabelecimento do grupo estudado foi considerado um período de seis meses consecutivos de julho a dezembro de 2003. Assim, após a aprovação do Comitê de Ética em pesquisa procedeu-se a coleta dos dados. Para análise dos resultados realizou-se a codificação das variáveis no banco de dados do programa Microsoft Excel mediante dupla digitação, e, utilizou-se o programa Software Statistical Package for Social Sciences, versão 10.0 na análise estatística. Dos 64 pacientes avaliados 38 (59,4%) eram do sexo masculino, 20 (31,2%) tinham como causa provável da insuficiência renal a nefroesclerose hipertensiva, e, 35 (54,7%) implantaram o cateter devido à necessidade do tratamento hemodialítico imediato. Totalizou-se no período 145 cateteres implantados, 29 (45,3%) dos pacientes tiveram implantes únicos, 98 (67,6%) dos acessos foram a veia jugular interna direita, 40 (27,6%) das trocas dos cateteres foram devido a febre. O tempo médio de permanência dos cateteres foi de 30 dias. A complicação local mais freqüente em 41 (64%) dos pacientes foi o funcionamento inadequado do cateter com 26 dias de média para a ocorrência, e, a complicação sistêmica mais freqüente em 24 (37,5%) foi a febre com 34 dias de média para sua ocorrência, 27 (42,2%) dos pacientes apresentaram infecção do sítio de inserção, e, 30 (47%) infecção da corrente sanguínea. O Staphylococcus aureus foi o microrganismo mais isolado em 10 (33,4%) das hemoculturas. Observou-se que 45 (70,4%) dos pacientes retiraram definitivamente o cateter devido à punção da fístula arteriovenosa. O estudo apontou aspectos preocupantes, dentre eles, o tempo de permanência do cateter, que expõe sobremaneira o paciente a diferentes complicações, em especial, a infecção. A confecção da fístula arteriovenosa representa uma importante alternativa que contrapõe o uso do cateter temporário. / Complications in chronic renal insufficiency patients under dialysis treatment represent important challenges to health professionals. The variety of risk factors predisposing towards these complications have frequently been discussed in scientific literature. Thus, this study aimed to describe the local and systemic complications of chronic renal insufficiency patients who were using a temporary double-lumen catheter for hemodialysis treatment, until its final withdrawal. A segment research prospectively studied patients from the moment the catheter was inserted until its final withdrawal. A period of six consecutive months, from July to December 2003, was considered to determine the group of patients ti be studied. Thus, after ethical approval, data were collected through interviews, clinical exams and patient record evaluation. For the result analysis, the variables were coded in a database through double data entry in Microsoft Excel and Software Statistical Package Social Sciences, version 10.0 was used for statistical analysis. 38 (59.4%) of the 64 patients were men, 20 (31.2%) showed hypertensive nephrosclerosis as the probable cause of insufficiency renal and 35 (54.7%) inserted the catheter due to the need for immediate hemodialysis treatment. 145 catheters were inserted during the period, 29 (45.3%) of which were single implants and the right internal jugular vein was the access in 98 cases (67.6%). Average catheter permanence time was 30 days. Catheters were substituted in 40 cases (27.6%) due to fever. The most frequent local complication was inadequate functioning in 41 (64%) cases, with an average occurrence of 26 days, while the most frequent systemic complication was fever in 24 cases (37.5%), with an average occurrence of 34 days. Infection of the insertion site occurred in 27 (42.2%) cases and infection of the blood flow associated with the catheter in 30 (49%) cases. Sthaphylococos aureus was the most frequently isolated microorganism in 10 (33.4%) blood cultures. 45 (70.4%) final catheter withdrawals were due to arterio-venous fistula puncture. This analysis revealed various preoccupying aspects, including the catheter permanence time, which highly exposes the patient to different complications, particularly infection.

This text considers a possibilities of using business valuation methods in an evaluation of the private and public health care institutions in the Czech Republic. It tries to explain the specifics associated with the functioning of health care institutions and their influence on the choice of the valuation standards, valuation methodology and the selection of the final method of valuation. The first part describes health care institutions and their operation in the health care market. Other parts deal with the possibilities of the evaluation separately for private and public health care institutions. Differences are summarized in the conclusion.

本文旨在研究臺北市樟新社區與一壽重殘照顧中心之互動，關於一個都市社區與精神障礙照顧機構之互動情形。分析主要分為兩部分，第一部份回溯一壽重殘照顧中心進入樟新社區之過程與情形，第二部分則分析樟新社區與一壽重殘照顧中心現階段之互動情形與未來建議。此外，本文也特別引用了「鄰避情結」（即「不要在我家後院」，”Not-In-My-Backyard syndrome”，簡稱NIMBY）作為論述基礎，試圖去檢視社區居民對於照顧中心的觀感，找出居民排斥或接納照顧中心之情形與原因等，並以衝突歷程的概念去剖析互動現狀。本研究目的則是希望透過個案研究，探討一個社區如何與精神障礙照顧服務機構互動，以從中找出能使社區居民與照顧服務機構二者共生、互助、融合之社區工作精隨。 本研究採質性研究之個案研究法，運用多重資料來源，並藉由觀察互動及深度訪談法來蒐集資料。其中深度訪談選取參與或了解本研究議題者作為訪談對象，包括規劃或承辦照顧中心進入社區的政府人員、來自照顧中心承辦單位及在照顧中心服務的管理者或工作者、對議題了解或熟悉社區事務的社區居民，藉此先行了解一壽重殘照顧中心進入社區之過程，包括照顧中心設立的過程與決策考量、照顧中心設立時與社區之衝突對立情形，以及政府單位、民間團體、社區居民三方對於衝突對立的認知、處理方式或行動。再者，也深度探究社區與機構過去至今的互動樣貌，包括社區與照顧中心的互動現況、社區居民對照顧中心設立觀感與鄰避情結、社區居民排斥或接納照顧中心之情形與原因，進而找出促進照顧中心融合社區或其他可能作法。 最後，根據本研究，提出相關政策建議如下： 一、檢討我國公有土地政策，以避免社福資源被稀釋； 二、讓障礙者參與決策過程，以落實真正的社區照顧； 三、在各地廣設心理衛生中心，讓障礙者能在原本的社區居住； 四、透過立法保障與教育倡導，以維護障礙者之居住權； 五、組織經營照顧中心志工團，並促進機構與社區的互惠及共生關係； 六、社區或機構相關工作者可採低姿態、柔性、創意方式，長期經營社區關係。 　　 關鍵字：社區、精神障礙、照顧機構、鄰避情結 / This research aims to study the interaction between the Zhangxin Community in Taipei City, an ordinary community in a big city, and the Taipei Yi-Shou Care Center, an institution for the psychiatric disabled. In the first part of the study, the researcher reviews the process of how the Taipei Yi-Shou Care Center moved into the Zhangxin community, whereas the second part analyzes the interaction between them and further provides suggestions for future cooperation. Besides, the researcher specifically adopts the concept of “Not-in-my-backyard syndrome” (NIMBY) as the theoretical background to survey the perceptions of the community residents toward the care center. Moreover, this study identifies the reasoning behind the acceptance or refuse of the move-in of the care center. Finally, this paper analyzes current status of interactions through the lens of conflict process. In summary, the aim of the research is to identify how community residents interact with an institution for the psychiatric disabled; furthermore, this study concludes the essence of community work in helping community residents and health care institution to cohabit, achieve mutual help, and integrate with each other. This research adopts case study method and collects data from multiple sources, such as onsite observation of the interaction and in-depth interview. For the in-depth interview, this study recruited key persons who have participated in and are aware of the issue. Therefore, the interviewees range from the government officials who have planned or taken charge of the move-in, the managers or workers of the care center or higher level of administration, to the Zhangxin community residents who are aware of the issue or general community affair. Accordingly, this paper first strives to investigate the move-in process, from the decision-making processes of the establishment of the Taipei Yi-Shou Care Center and the conflicts between the supporters and critiques during construction, to the perceptions, solutions, and actions toward the problem from the government, non-government organizations, and the residents. Second, the study thoroughly reviews the history of the interaction pattern between the residents and the institution, including the status quo of the interaction, the perception and the NIMBY of the residents toward the care center, and the situation and reasons of acceptance or refuse of the care center. In the end, this paper proposes possible means to help the care center better integrate with the community. This research proposes six suggestions for policy below: 1. Review the policy of public lands to avoid diluting the resources of social welfare. 2. Invite the disabled to participate in policy making to realize essential community care. 3. Set up community mental health centers to render the opportunities for the disabled to live in the original community. 4. Safeguard the right of residence of the disabled through legislation and education. 5. Organize volunteer groups of the care center, and improve the mutual benefit and cohabitation relationship between the institution and the community. 6. Community and institution workers manage long-term relationship with the community through modest attitude and in flexible, creative ways. Key words: community, psychiatric disability, care institution, Not-In-My-Backyard syndrome(NIMBY).

Made available in DSpace on 2016-04-25T20:21:30Z (GMT). No. of bitstreams: 1 Nuno de Noronha da Costa Bispo.pdf: 633926 bytes, checksum: fba4e0c29be6015341a6ccad6478b3ed (MD5) Previous issue date: 2015-08-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Despite the large number of healthy elderly people, old age is also followed by an overall decline in health conditions, especially among institutionalized elderly people. The general objective of this anthropological research is to verify the impact of diseases on the everyday life of institutionalized elderly people and their present and future consequences. The investigation took place at Asilo São Vicente de Paulo de Londrina, a nursing home with 37 residents. Data were collected through observations and interviews and analyzed through the description of the observations and the hermeneutic-dialectical method. Results showed loss of autonomy and personal control. Based on the participants comments, the study detected a perception of the sickening body, mobility loss, lack of freedom, physical dependence to carry out routine activities, occupation reduction and isolation, difficulty to sleep and hopelessness in regards to the future. In its final considerations, the study highlights the importance of the anthropological investigation in a Long-term Care institution for the elderly / Apesar de haver um grande número de pessoas idosas saudáveis, a velhice também é acompanhada pelo declínio geral das condições de saúde, especialmente entre idosos institucionalizados. Verificar o impacto das doenças na vida cotidiana em pessoas idosas institucionalizadas e seus desdobramentos no presente e no futuro foi o objetivo geral desta pesquisa antropológica. O campo de investigação desenvolveu-se no Asilo São Vicente de Paulo de Londrina, com 37 residentes. Na metodologia utilizou-se para a coleta de dados a observação e a entrevista, que foram analisados através da descrição da observação e pelo método hermenêutico-dialético. Nos resultados observou-se a perda da autonomia e do controle pessoal. Nas falas dos participantes, constatou-se a percepção do corpo que adoece, o acometimento da mobilidade, a perda da liberdade, a dependência física nas atividades do cotidiano, a diminuição da ocupação, o isolamento, a dificuldade para dormir e a esperança no futuro. Nas considerações finais, foi destacada a importância da investigação antropológica em uma Instituição de Longa Permanência para Idosos

Made available in DSpace on 2016-04-26T14:55:36Z (GMT). No. of bitstreams: 1 Nuno de Noronha da Costa Bispo.pdf: 633926 bytes, checksum: fba4e0c29be6015341a6ccad6478b3ed (MD5) Previous issue date: 2015-08-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Despite the large number of healthy elderly people, old age is also followed by an overall decline in health conditions, especially among institutionalized elderly people. The general objective of this anthropological research is to verify the impact of diseases on the everyday life of institutionalized elderly people and their present and future consequences. The investigation took place at Asilo São Vicente de Paulo de Londrina, a nursing home with 37 residents. Data were collected through observations and interviews and analyzed through the description of the observations and the hermeneutic-dialectical method. Results showed loss of autonomy and personal control. Based on the participants comments, the study detected a perception of the sickening body, mobility loss, lack of freedom, physical dependence to carry out routine activities, occupation reduction and isolation, difficulty to sleep and hopelessness in regards to the future. In its final considerations, the study highlights the importance of the anthropological investigation in a Long-term Care institution for the elderly / Apesar de haver um grande número de pessoas idosas saudáveis, a velhice também é acompanhada pelo declínio geral das condições de saúde, especialmente entre idosos institucionalizados. Verificar o impacto das doenças na vida cotidiana em pessoas idosas institucionalizadas e seus desdobramentos no presente e no futuro foi o objetivo geral desta pesquisa antropológica. O campo de investigação desenvolveu-se no Asilo São Vicente de Paulo de Londrina, com 37 residentes. Na metodologia utilizou-se para a coleta de dados a observação e a entrevista, que foram analisados através da descrição da observação e pelo método hermenêutico-dialético. Nos resultados observou-se a perda da autonomia e do controle pessoal. Nas falas dos participantes, constatou-se a percepção do corpo que adoece, o acometimento da mobilidade, a perda da liberdade, a dependência física nas atividades do cotidiano, a diminuição da ocupação, o isolamento, a dificuldade para dormir e a esperança no futuro. Nas considerações finais, foi destacada a importância da investigação antropológica em uma Instituição de Longa Permanência para Idosos

Magistro baigiamajame darbe išanalizuota ir įvertinta sveikatos priežiūros institucijoje teikiamų socialinių paslaugų kokybė, iškelta kokybės matavimo ir vertinimo problema bei pateikti siūlymai, kaip šias problemas spręsti. Pirmojoje darbo dalyje teoriniu aspektu tiriama viešųjų paslaugų vadyba, pateikiama socialinių paslaugų samprata, aptariamas jos teisinis reglamentavimas. Antrojoje dalyje nagrinėjama paslaugų kokybės vadyba, paslaugų kokybės sampratos problematika, kokybės matavimo ir vertinimo pagrindinės tendencijos bei problemos. Trečiojoje darbo dalyje pateikiama empirinių tyrimų rezultatų analizė, kuri atskleidžia sveikatos priežiūros įstaigoje teikiamų socialinių paslaugų kokybę ir šių paslaugų matavimo problematiką. / The Final Master Work analyzes and assesses the quality of social services offered in health care institution, reveals the problem of quality evaluation and assessment, and provides recommendations for solving the problems. The first part of the Final Work analyzes the management of public relations, introduces the concept of social services and discusses the legal regulation of the concept. The second part provides the research on the quality management of services, the issues in the concept of quality of services and the basic tendencies and problems in quality evaluation and assessment. The third part gives the analysis of the results of empirical surveys that reveals the quality of social services offered in health care institutions and the problem of services evaluation.