Esta dissertação de mestrado teve como objetivo avaliar a morbidade de crianças asmáticas, atendidas em um programa de saúde, na Unidade de Saúde Criança Saudável (USCS), da rede municipal de saúde de Criciúma – SC, com avaliação de variáveis clínicas e terapêuticas pré e pós-inclusão no programa. A implantação de um programa de saúde para atendimento de crianças asmáticas, na rede pública de saúde, visa ao conhecimento, adequado manejo e tratamento da asma. Esperava-se que pacientes asmáticos atendidos regularmente tivessem menor morbidade. Quanto à metodologia, foi realizado um estudo de coorte, com análise de variáveis pré e pós-acesso ao programa de saúde para crianças com asma, através da aplicação de escore de acompanhamento da gravidade da asma (EAGA). Foram incluídas oitenta e sete crianças, divididas em dois grupos de acordo com a adesão ao programa, determinada, através da analise da curva ROC para a melhora. Quanto às considerações finais sobre os resultados obtidos, pode-se afirmar que houve diferença significativa entre os grupos considerando a adesão ao programa. O grupo que não aderiu ao programa levou mais tempo para melhora e teve maior uso de corticóide sistêmico. O grupo que aderiu ao programa teve melhora clinica em menor período de tempo, com uso regular de corticóide inalado e técnica de inalação correta. Foi possível concluir, que os pacientes que aderiram ao programa obtiveram significativa diminuição de morbidade, em menor período de tempo, e foram menos expostos ao uso de corticóide sistêmico. / The objective of this master’s thesis was to evaluate the morbidity of asthmatic children treated at a health program at the “Criança Saudável” health unit, belonging to the Criciúma municipal health system, by evaluating the clinical variables and treatment before and after inclusion in the program. The analysis of the implementation of the health care program for asthmatic children in the public health system is important in order to understand the management and treatment of asthma, with a consequent reduction in morbidity of asthma patients who were assisted regularly. Patients who were assisted regularly were expected to have lower morbidity. Regarding methodology, there was a cohort study, comparing results before and after attendance to an asthma program for children through the implementation of a follow-up severity score (EAGA). Eight - seven children were included divided into two groups according to adherence to the program, determined by the ROC curve for improvement. As for final comments on the results, one can say that there was a significant difference between groups, when considering adherence to the program. There was clinical improvement sooner, with regular use of inhaled corticosteroids and a correct inhalation technique, in the adherence group. In the non-adherence group improvement took longer, and they required more courses of systemic corticosteroids. It was possible to conclude that the patients who participated in the program obtained a decrease in morbidity in less time and therefore less exposed to the use of systemic corticosteroids.

Persons with dementia experience impairments in cognitive, behavioral, and functional ability, often leading to long-term care placement. The Enhancing Care Program was developed by the Alzheimer Society of Canada to assist organizations in improving care for this population. Although this program has been implemented in many facilities, the majority have been located in urban settings and there has been limited formal evaluation. Little is known about dementia care in rural facilities, or about how programs are implemented in rural settings. The Enhancing Care Program is based on eleven guidelines that outline best practices for caring for individuals with dementia. With the assistance of a facilitator from the Alzheimer Society, a multi-disciplinary team from the facility assesses their current ability to meet each guideline. In subsequent meetings, the team establishes specific, measurable goals to improve care in targeted areas. The two purposes of this study were to conduct a process evaluation of the Enhancing Care Program and to develop theory relating to the implementation of a program in two rural long-term care facilities. Observations were made over the course of seven months as teams worked through the guidelines and set goals. Focus group interviews consisting of team members took place at the end of the observation period. In addition, individual interviews were conducted with general staff, the facility managers, and the facilitator from the Alzheimer Society. Grounded theory methodology informed the research and analysis process. The theory that emerged, The Process of Building Effective Teams, explains the transition of the participants from collections of individuals to cohesive units that functioned as teams. Five key categories were developed in the theory: trust, respectful and open communication, transformational leadership, creating change collectively, and enhanced team culture. As part of the process evaluation of the Enhancing Care Program, 24 recommendations were made for program improvements.

Persons with dementia experience impairments in cognitive, behavioral, and functional ability, often leading to long-term care placement. The Enhancing Care Program was developed by the Alzheimer Society of Canada to assist organizations in improving care for this population. Although this program has been implemented in many facilities, the majority have been located in urban settings and there has been limited formal evaluation. Little is known about dementia care in rural facilities, or about how programs are implemented in rural settings. The Enhancing Care Program is based on eleven guidelines that outline best practices for caring for individuals with dementia. With the assistance of a facilitator from the Alzheimer Society, a multi-disciplinary team from the facility assesses their current ability to meet each guideline. In subsequent meetings, the team establishes specific, measurable goals to improve care in targeted areas. The two purposes of this study were to conduct a process evaluation of the Enhancing Care Program and to develop theory relating to the implementation of a program in two rural long-term care facilities. Observations were made over the course of seven months as teams worked through the guidelines and set goals. Focus group interviews consisting of team members took place at the end of the observation period. In addition, individual interviews were conducted with general staff, the facility managers, and the facilitator from the Alzheimer Society. Grounded theory methodology informed the research and analysis process. The theory that emerged, The Process of Building Effective Teams, explains the transition of the participants from collections of individuals to cohesive units that functioned as teams. Five key categories were developed in the theory: trust, respectful and open communication, transformational leadership, creating change collectively, and enhanced team culture. As part of the process evaluation of the Enhancing Care Program, 24 recommendations were made for program improvements.

Thesis (Ph. D.)--University of Oregon, 2002. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 108-116). Also available for download via the World Wide Web; free to University of Oregon users.

Esta dissertação de mestrado teve como objetivo avaliar a morbidade de crianças asmáticas, atendidas em um programa de saúde, na Unidade de Saúde Criança Saudável (USCS), da rede municipal de saúde de Criciúma – SC, com avaliação de variáveis clínicas e terapêuticas pré e pós-inclusão no programa. A implantação de um programa de saúde para atendimento de crianças asmáticas, na rede pública de saúde, visa ao conhecimento, adequado manejo e tratamento da asma. Esperava-se que pacientes asmáticos atendidos regularmente tivessem menor morbidade. Quanto à metodologia, foi realizado um estudo de coorte, com análise de variáveis pré e pós-acesso ao programa de saúde para crianças com asma, através da aplicação de escore de acompanhamento da gravidade da asma (EAGA). Foram incluídas oitenta e sete crianças, divididas em dois grupos de acordo com a adesão ao programa, determinada, através da analise da curva ROC para a melhora. Quanto às considerações finais sobre os resultados obtidos, pode-se afirmar que houve diferença significativa entre os grupos considerando a adesão ao programa. O grupo que não aderiu ao programa levou mais tempo para melhora e teve maior uso de corticóide sistêmico. O grupo que aderiu ao programa teve melhora clinica em menor período de tempo, com uso regular de corticóide inalado e técnica de inalação correta. Foi possível concluir, que os pacientes que aderiram ao programa obtiveram significativa diminuição de morbidade, em menor período de tempo, e foram menos expostos ao uso de corticóide sistêmico. / The objective of this master’s thesis was to evaluate the morbidity of asthmatic children treated at a health program at the “Criança Saudável” health unit, belonging to the Criciúma municipal health system, by evaluating the clinical variables and treatment before and after inclusion in the program. The analysis of the implementation of the health care program for asthmatic children in the public health system is important in order to understand the management and treatment of asthma, with a consequent reduction in morbidity of asthma patients who were assisted regularly. Patients who were assisted regularly were expected to have lower morbidity. Regarding methodology, there was a cohort study, comparing results before and after attendance to an asthma program for children through the implementation of a follow-up severity score (EAGA). Eight - seven children were included divided into two groups according to adherence to the program, determined by the ROC curve for improvement. As for final comments on the results, one can say that there was a significant difference between groups, when considering adherence to the program. There was clinical improvement sooner, with regular use of inhaled corticosteroids and a correct inhalation technique, in the adherence group. In the non-adherence group improvement took longer, and they required more courses of systemic corticosteroids. It was possible to conclude that the patients who participated in the program obtained a decrease in morbidity in less time and therefore less exposed to the use of systemic corticosteroids.

Esta dissertação de mestrado teve como objetivo avaliar a morbidade de crianças asmáticas, atendidas em um programa de saúde, na Unidade de Saúde Criança Saudável (USCS), da rede municipal de saúde de Criciúma – SC, com avaliação de variáveis clínicas e terapêuticas pré e pós-inclusão no programa. A implantação de um programa de saúde para atendimento de crianças asmáticas, na rede pública de saúde, visa ao conhecimento, adequado manejo e tratamento da asma. Esperava-se que pacientes asmáticos atendidos regularmente tivessem menor morbidade. Quanto à metodologia, foi realizado um estudo de coorte, com análise de variáveis pré e pós-acesso ao programa de saúde para crianças com asma, através da aplicação de escore de acompanhamento da gravidade da asma (EAGA). Foram incluídas oitenta e sete crianças, divididas em dois grupos de acordo com a adesão ao programa, determinada, através da analise da curva ROC para a melhora. Quanto às considerações finais sobre os resultados obtidos, pode-se afirmar que houve diferença significativa entre os grupos considerando a adesão ao programa. O grupo que não aderiu ao programa levou mais tempo para melhora e teve maior uso de corticóide sistêmico. O grupo que aderiu ao programa teve melhora clinica em menor período de tempo, com uso regular de corticóide inalado e técnica de inalação correta. Foi possível concluir, que os pacientes que aderiram ao programa obtiveram significativa diminuição de morbidade, em menor período de tempo, e foram menos expostos ao uso de corticóide sistêmico. / The objective of this master’s thesis was to evaluate the morbidity of asthmatic children treated at a health program at the “Criança Saudável” health unit, belonging to the Criciúma municipal health system, by evaluating the clinical variables and treatment before and after inclusion in the program. The analysis of the implementation of the health care program for asthmatic children in the public health system is important in order to understand the management and treatment of asthma, with a consequent reduction in morbidity of asthma patients who were assisted regularly. Patients who were assisted regularly were expected to have lower morbidity. Regarding methodology, there was a cohort study, comparing results before and after attendance to an asthma program for children through the implementation of a follow-up severity score (EAGA). Eight - seven children were included divided into two groups according to adherence to the program, determined by the ROC curve for improvement. As for final comments on the results, one can say that there was a significant difference between groups, when considering adherence to the program. There was clinical improvement sooner, with regular use of inhaled corticosteroids and a correct inhalation technique, in the adherence group. In the non-adherence group improvement took longer, and they required more courses of systemic corticosteroids. It was possible to conclude that the patients who participated in the program obtained a decrease in morbidity in less time and therefore less exposed to the use of systemic corticosteroids.

A partir dos dados coletados pelo Programa de Defesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Município de Bauru no período de 11 de maio de 1986 a 10 de novembro de 1987, avaliou-se a capacidade de elementos clínicos e sociais, de fácil obtenção no momento do parto, predizer a mortalidade e internação de crianças entre O e 6 meses. O critério diagnóstico com maior sensibilidade para discriminar um grupo de crianças que devem receber uma atenção especial nos períodos de O a 6 dias e de 7 dias a 6 meses foram: - O a 6 dias: peso do recém nascido abaixo de 2500 gr, mãe menor de 18 anos e malformação congênita. - 7 dias a 6 meses: peso ao nascer abaixo de 2750 gr, renda familiar per capita abaixo de 0.75 salário mínimo, e malformação congênita. Outros critérios diagnósticos são apresentados e comparados com estes, entre os quais o do Programa de Defesa da Vida dos Lactentes, calculando-se as respectivas sensibilidades, especificidades e percentual de crianças classificadas como de risco. O mesmo critério diagnóstico proposto para prevenir a mortalidade entre 7 dias e 6 meses foi utilizado para calcular a sensibilidade quando o desfecho e a internação. / According to the data of the \"Infant Life Defense Program\" of the Public Health Office of the \"Municipallity of Bauru during the period of may 11, 1986 to november 10, 1987, we tried to evaluate the capacity of clinical and social characteristics which are obtained at the moment of birth for predicting mortality and hospitalization of children until 6 monthes of life. The diagnostic criterion with more sensitivity to choose a percentage of children to require special care between the first 7 days and betwen 7 days to 6 months of life: - O to 6 days: birth weight less than 2500 g., adolescent pregnancy and congenital malformations. - 7 d. to 6 m.: birth weight less than 2750 g., family revenue less than $27 per capita in a month and congenital malformations. Other diagnostic criteria have been shown and compared by the sensitivity and specificity to the proposals above in which the \"Infant Life Defense Program\" was included. The same diagnostic criteria was used to evaluate the sensitivity for hospitalization.

Syfte: Att belysa vad som tas upp i vårdprogram angående vårdmöte och stöd till cancerpatienter. Bakgrund: På grund av det ökade antalet människor som får diagnosen cancer, är sjuksköterskor i behov av mer kunskap om vårdmöte och stöd till cancerpatienter. Metod: Att analysera data genom en kvalitativ litteraturstudie som behandlar omvårdnads - och psykosociala aspekter i vårdprogram. Resultat: Delaktighet genom information, stöd genom kommunikation, att uppmärksamma psykisk ohälsa samt att bemöta existentiella frågor har visat sig vara viktiga delar och utgör resultatets fyra temaområden. Slutsats: Vårdprogram har visat sig innehålla en ojämn fördelning av information angående vårdande möten och stöd till cancerpatienter. Sammantaget ger dock det material som presenteras i studiens resultat, en relativt mångfacetterad bild av hur vårdmöte och stöd kan ges under olika faser i cancerpatienters sjukdomsförlopp. Klinisk implikation: Denna studie kan vara en bra källa till information för sjuksköterskor om vård och stöd i der dagliga mötet med cancerpatienter. Genom att erbjuda användbara råd och strategier kan denna studie skapa en ökad känsla av självförtroende inför svåra situationer som sjuksköterskan kan möta. / Aim: To enlighten what is included in health care programs regarding the caring encounter and support for cancer patients.Background: Due to the increasing number of people that are diagnosed with cancer, nurses are in need of more knowledge regarding caring encounters and support to cancer patients.Method: To analyze data using a qualitative study of literature concerning nursing care - and psychosocial aspects in health care programs.Result: Participation through information, support through communication, noticing mental illness and dealing with existential questions have shown to be important parts and are the result’s four thematic areas.Conclusions: Health care programs have shown to contain an uneven distribution of information concerning caring encounters and support to cancer patient. However the information altogether, which is presented in the result of the study, shows a relatively multifaceted picture of how caring encounters and support can be given in the various phases in cancer patients’ disease progression.Clinical implication: This study can be a good source of information for nurses regarding the care and support in their daily encounters with cancer patients. By offering useful advice and strategies, this study can create an increased sense of self-confidence in difficult situations that nurse’s might face.

A partir dos dados coletados pelo Programa de Defesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Município de Bauru no período de 11 de maio de 1986 a 10 de novembro de 1987, avaliou-se a capacidade de elementos clínicos e sociais, de fácil obtenção no momento do parto, predizer a mortalidade e internação de crianças entre O e 6 meses. O critério diagnóstico com maior sensibilidade para discriminar um grupo de crianças que devem receber uma atenção especial nos períodos de O a 6 dias e de 7 dias a 6 meses foram: - O a 6 dias: peso do recém nascido abaixo de 2500 gr, mãe menor de 18 anos e malformação congênita. - 7 dias a 6 meses: peso ao nascer abaixo de 2750 gr, renda familiar per capita abaixo de 0.75 salário mínimo, e malformação congênita. Outros critérios diagnósticos são apresentados e comparados com estes, entre os quais o do Programa de Defesa da Vida dos Lactentes, calculando-se as respectivas sensibilidades, especificidades e percentual de crianças classificadas como de risco. O mesmo critério diagnóstico proposto para prevenir a mortalidade entre 7 dias e 6 meses foi utilizado para calcular a sensibilidade quando o desfecho e a internação. / According to the data of the \"Infant Life Defense Program\" of the Public Health Office of the \"Municipallity of Bauru during the period of may 11, 1986 to november 10, 1987, we tried to evaluate the capacity of clinical and social characteristics which are obtained at the moment of birth for predicting mortality and hospitalization of children until 6 monthes of life. The diagnostic criterion with more sensitivity to choose a percentage of children to require special care between the first 7 days and betwen 7 days to 6 months of life: - O to 6 days: birth weight less than 2500 g., adolescent pregnancy and congenital malformations. - 7 d. to 6 m.: birth weight less than 2750 g., family revenue less than $27 per capita in a month and congenital malformations. Other diagnostic criteria have been shown and compared by the sensitivity and specificity to the proposals above in which the \"Infant Life Defense Program\" was included. The same diagnostic criteria was used to evaluate the sensitivity for hospitalization.

This study was an analysis of social work practice in a medical setting: analyzing the work of a medical social worker in an outpatient clinic located in a metropolitan area. The primary purpose of this descriptive study was to evaluate the performance of a medical social worker in a Kaiser-Permanente outpatient clinic and to determine if there were possible associations between social work intervention and patient utilization of existing services offered by the Kaiser Health Care system, also referred to herein as Kaiser. Specifically, the study attempted to determine if there were quantitative changes in patient contacts, and utilization of certain services such as clinic visits, telephone contacts, prescriptions, emergency room visits, hospitalizations, and physicians seen before and after social worker intervention. If there were changes, what were the direction and quantity? Did changes vary according to type of service? Did patient utilization of medical care vary according to the number of social work contacts?