Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-09-22T19:16:04Z No. of bitstreams: 1 Alcino A C Golega.pdf: 7388772 bytes, checksum: 8eb5fba312dc9dc756493466ca4bf72a (MD5) / Made available in DSpace on 2017-09-22T19:16:06Z (GMT). No. of bitstreams: 1 Alcino A C Golega.pdf: 7388772 bytes, checksum: 8eb5fba312dc9dc756493466ca4bf72a (MD5) Previous issue date: 2017-08-25 / By 2013, UNAIDS has updated its global targets for the year 2020 for HIV-positive people; In which 90% of infected people are tested and will know that they are HIV, 90% of HIV-positive people are receiving ARV treatment, and that 90% of those people must achieve viral suppression to end the transmission of the epidemic by 2030 A The cascade of HIV continuous care is commonly represented as a bar chart that counts the number of individuals engaged in providing services to People Living with HIV / AIDS at all stages of ongoing care. The loss of individuals occurs at different points, which means that the number of people observed in each stage of the cascade is smaller than in the previous one. The objective of this study is to evaluate the steps of the continuous care of patients assisted in a public service specialized in HIV / AIDS (SAE - adult), in Santos, São Paulo, between 2009 and 2013. Methodology: This study was designed according to as standards for the construction of the Continuous Care Cascade for HIV patients, as recommended by the Brazilian Ministry of Health. It is a mixed study of Temporal and Longitudinal series, Transverse, successive and sequential cross-sections are drawn up in continuous care, represented by columns, for the years 2009 to 2013; For study purposes the study population are all HIV patients enrolled in SECRAIDS, from January 2, 2009 to December 30, 2013. Results: A total of 1,179 patients enrolled in SAE - (224), 2010 (253), 2011 (240), 2012 (216) and 2013 (246), we observed that even with a heterogeneous population, we perceive a certain homogeneity in the distribution of socio-demographic factors. In relation to sex we have a predominance of the masculine in relation to the feminine, in all the years and a variation in the reason of sex, that goes of 1.7 until 3 men for each woman. Regarding the category of exposure, each year presents the heterosexual form as preponderant with more than 50% of the cases. Regarding the age group, we noticed that the age group of 30 to 39 holds the largest number of people in every year. In the category of schooling the subgroup with more than 10 years of study concentrates the largest contingent of people. In relation to race / color, it presents above 60% of the cases of race / color White and in average 33% of browns and blacks. However, in the case of the Marital State, the subgroup Singular, more than 50% of the cases, followed by married / amassed with 30% of the cases. Although linkage to service and access to treatment increased during the period, there was a significant decrease in viral suppression. Viral suppression is directly linked to the quality of service offered to HIV patients, since it is directly linked to the link that the service establishes for this patient, as well as the possibility of performing an integral treatment and also linked to the correct use of the medication. Thus we can add that it is necessary, a good adhesion of the patient to the service, the proposed treatment, the support offered, the continuous monitoring, the withdrawal of the medication, that is, the correct use and therapeutic control, that must be studied in other works. / Em 2013 a UNAIDS, atualizou suas metas globais para o ano de 2020 para as pessoas HIV-positivas; em que 90% das pessoas infectadas são testados e saberão que são HIV, 90% das pessoas HIV-positivas estejam tratamento com ARV, e que 90% dessas pessoas devem alcançar a supressão viral, para assim acabar com a transmissão da epidemia até 2030 A cascata do cuidado contínuo do HIV é comumente representada como um gráfico de barras que contabiliza o número de indivíduos inseridos na prestação de serviços às Pessoas Vivendo com HIV/Aids em todas as etapas do cuidado contínuo. A perda de indivíduos ocorre em diferentes pontos, o que faz com que o número de pessoas observadas em cada etapa da cascata seja menor que na anterior. O objetivo deste trabalho é avaliar as etapas de cuidado contínuo dos pacientes atendidos em serviço público especializado em HIV/Aids (SAE ¿ adulto), no município de Santos, São Paulo, entre 2009 e 2013. Metodologia: Este estudo foi construído de acordo com as normas da construção da Cascata de Cuidado Contínuo para os pacientes HIV, nos moldes recomendados pelo Ministério da Saúde do Brasil. É um estudo misto, longitudinal de Série Temporal. Foram elaborados cortes transversais, sucessivos e sequenciais nos cuidados contínuos, representados por colunas, para os anos de 2009 a 2013; para fins desse estudo a população de estudo são todos os pacientes portadores do HIV matriculados no SAE - adulto, no período de 02 de janeiro de 2009 à 30 de dezembro de 2013. Resultados: Foram estudados um total de 1.179 pacientes matriculados no SAE - adulto, referente aos anos de 2009 (224), 2010 (253), 2011 (240), 2012 (216) e 2013 (246), observamos que mesmo possuindo uma população heterogênea, percebemos uma certa homogeneidade na distribuição dos fatores sócio demográficos. Em relação ao sexo temos uma predominância do masculino em relação ao feminino, em todos os anos e uma variação na razão de sexo, que vai de 1,7 até 3 homens para cada mulher. Em relação a categoria de exposição, todos os anos apresenta a forma heterossexual como preponderante com mais de 50% dos casos. Em relação a faixa etária, notamos que a faixa de 30 a 39 anos detém o maior número de pessoas em todos os anos. Na categoria de escolaridade o subgrupo com mais de 10 anos de estudo concentra o maior contingente de pessoas. Em relação a raça/cor, apresenta acima de 60% dos casos da raça/cor Branca e em média 33% de pardos e pretos. Entretanto quanto ao Estado Marital, majoritariamente o subgrupo Solteiro, acima de 50% dos casos, seguido por casados/amasiados com 30% dos casos. Embora a vinculação ao serviço e acesso ao tratamento tenham aumentado no período, houve expressiva queda na supressão viral. A Supressão Viral está diretamente ligada a qualidade do serviço oferecido aos pacientes HIV, pois está diretamente ligado ao vínculo que o serviço estabelece a este paciente, além da possibilidade de realizar um tratamento integral e também ligado ao uso correto da medicação. Assim podemos acrescentar que é necessário, uma boa adesão do paciente ao serviço, ao tratamento proposto, ao suporte oferecido, o acompanhamento contínuo, a retirada da medicação, ou seja, o uso correto e controle terapêutico, que devem ser estudados em outros trabalhos.

Trata-se de um estudo quantitativo com delineamento exploratório-descritivo, cujos objetivos foram conhecer a percepção dos trabalhadores de enfermagem de um hospital de ensino acerca da segurança do paciente, considerando-se as dimensões de cultura de segurança, e identificar os principais fatores que acarretam danos ao paciente na referida instituição. O estudo foi desenvolvido em um hospital público e de ensino, e a população constituída por 95 profissionais de enfermagem. A coleta de dados ocorreu entre os meses de maio a outubro de 2011, por meio de um questionário baseado na Agency Health Research Quality, empregando-se a escala de Likert e considerando-se as dez dimensões de cultura de segurança e duas variáveis de resultado: expectativas e ações dos supervisores e gerentes na promoção da segurança do paciente, aprendizado organizacional melhoria contínua, trabalho em equipe no âmbito das unidades, abertura para as comunicações, feedback e comunicação a respeito de erros, respostas não punitivas aos erros, pessoal, apoio da gestão hospitalar para a segurança do paciente, trabalho em equipe pelas unidades hospitalares, transferências internas e passagens de plantão, percepções generalizadas sobre segurança, frequência de relatórios de eventos. Os dados foram analisados em função testes estatísticos específicos. O instrumento de coleta de dados mostrou-se confiável, obtendo-se o Alpha de Cronbach igual a 0,88. Na caracterização dos sujeitos, foi verificado que 65,3% eram auxiliares de enfermagem, 26,3% enfermeiros e 8,4% técnicos de enfermagem; 73,7% do sexo feminino; 67,4% com idade entre 30 e 49 anos e com tempo de formação de 11 a 15 anos. Como principais resultados do estudo, podemos citar que, na dimensão abertura para as comunicações e comunicação a respeito dos erros, o maior índice encontrado foi de 35,8%, que afirmam que às vezes conversam livremente sobre algo que está errado e às vezes têm retorno sobre mudanças implantadas em função de eventos adversos notificados. Em relação à dimensão respostas não punitivas aos erros, 50,5% acreditam que seus erros podem ser usados contra eles; quanto ao número de eventos reportados, 76,8% nunca preencheram um relatório de eventos adversos. As dimensões que apresentaram percepção favorável foram o trabalho em equipe no âmbito das unidades e transferências internas e passagens de plantão, 64,2% consideram que os profissionais colaboram entre si quando há sobrecarga de trabalho e 44,2% afirmam que as informações sobre o cuidado do paciente não se perde com a passagem de plantão. Acreditamos que este estudo possa contribuir para as intervenções necessárias nas dimensões avaliadas e fornecer subsídios para o aprimoramento de processos assistenciais e gerenciais com foco na segurança do paciente / This is a quantitative study with descriptive exploratory design, which aimed to know the perception of nursing staff in a teaching hospital on patient safety, considering the dimensions of safety culture and identify the main factors that cause damage to the patient in that institution. The study was conducted in a public hospital and teaching and a population of 95 nurses. Data collection occurred between the months from May to October 2011, through a questionnaire based on the Agency Health Research Quality, using a Likert scale and considering the ten dimensions of safety culture and two outcome variables: expectations and actions of supervisors and managers in promoting patient safety, organizational learning - continuous improvement, teamwork within units, opening for communication, feedback and communication about error, non-punitive responses to errors, personnel, support hospital management to patient safety, teamwork by hospitals, internal transfers and tickets call, generalized perceptions about safety, frequency of events reported. The data were analyzed according to specific statistical tests. The data collection instrument was reliable, yielding a Cronbach\'s alpha equal to 0.88. The characterization of the subjects, it was found that 65.3% were nursing assistants, nurses 26.3% and 8.4% nursing technicians, 73.7% female, 67.4% aged between 30 and 49 years and training time from 11 to 15 years. As main results, we may mention that the size opening for communication and communication about the errors, the highest rate found was 35.8%, who say that sometimes talk freely about something that is wrong and sometimes has a payoff on changes implemented due to adverse events reported. In relation to the size non-punitive responses to errors, 50.5% believe that their errors can be used against them, on the number of reported events, 76.8% never filled out a report of adverse events. The dimensions that were presented favorable perception teamwork within units and internal transfers and tickets call, 64.2% believe that professionals collaborate with each other when there is extra work and 44.2% say the information about the patient care is not lost with the shift change. We believe this study contributes to the necessary interventions in the dimensions evaluated and provide subsidies for the improvement of care processes and management with a focus on patient safety

In the United States, African American women remain underrepresented in senior leadership positions in many workforce sectors, including the federal sector. Despite this challenge, a few African American women have successfully attained senior leadership responsibilities in a public health service agency. Using intersectionality and social cognitive career theory as the theoretical frameworks, the purpose of this study was to explore the lived experiences of African American women leaders in their career advancement to senior leadership positions in a health service agency of the Department of Health and Human Services in the United States. The research questions explored the experiences and perceptions of these women leaders and ways the intersection of race and gender contributed to their leadership experiences. A qualitative research design using a transcendental phenomenological approach was the chosen method. Data were collected through semistructured interviews with eight African American women leaders at the General Schedule Grade 15 and Senior Executive Service levels. Data were analyzed using the van Kaam method modified by Moustakas. Results indicated that while African American women leaders faced challenges and barriers, strategies exist to enhance career advancement. The results from this study may support social change by elevating understanding of the experiences and perspectives whereby strategies for increasing the career advancement of aspiring African American women leaders can be identified. When organizational leaders become more culturally competent, they can implement approaches that promote diversity within the senior leadership positions, which can have an overall effect on meeting the needs of a diverse population.

Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure. A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

<p>Syftet med studien var att jämföra den upplevda arbetssituationen hos tandhygienister inom folktandvården med tandhygienister inom den privata tandvården. Tandhygienister i södra Sverige som var registrerade hos SRAT (n=313) tillfrågades att delta i studien. Enkäten skickades ut elektroniskt, vilket gav en svarsfrekvens på 48% (n=151). Inom folktandvården svarade 59% (n=101) och inom den privata tandvården svarade 35% (n=50). Enkätfrågorna omfattade arbete, arbetsklimat, arbetssituation, profession, hälsa, inflytande och stöd i yrkesrollen samt bakgrundsfrågor om ålder, kön, anställningsform och arbetstid. Resultaten visade statistiskt signifikanta skillnader (p<0,05) mellan tandhygienister inom folktandvården och tandhygienister inom den privata tandvården gällande i vilken utsträckning de styrde över sina tidsbokningar, upplevde trötthet, orolighet, besvär från rygg, nacke eller axlar samt besvär från andra delar av kroppen. En statistisk signifikant skillnad (p<0,01) mellan tandhygienister inom folktandvården och tandhygienister inom den privata tandvården syntes även i vilken utsträckning respondenterna styrde över sin arbetstakt. Slutsatsen av studiens begränsade material är att tandhygienisterna inom den privata tandvården tycktes ha en mer positiv syn på deras arbetssituation än tandhygienisterna inom folktandvården.</p> / <p>The aim of this study was to compare the perceived work situation among dental hygienists in the public dental health service with dental hygienists in private practice. Dental hygienists in southern Sweden who were registered at SRAT (n= 313) were asked to participate in the study. The questionnaire was sent out electronically, which gave a response rate of 48% (n= 151). The response rate in the public dental health sevice was 59% (n= 101) and in private practice 35% (n=50). The survey questions covered work, work atmosphere, work situation, profession, health, influence and collegial support together with background questions about age, gender, employment status and working hours. The result showed a statistically significant difference (p<0.05) between the dental hygienists in the public dental health service and dental hygienists in private practice as regards to what extent the dental hygienists decided over their own scheduled time, experienced tiredness, worry, disorders from the back, neck or shoulders and disorders from other parts of the body. A statistically significant difference (p<0.01) between the dental hygienists in the public dental health service and the dental hygienists in private practice was also shown as regards to what extent the dental hygienists could control their own work pace. The conclusion from the limited material of this study is that the dental hygienists in private practice seemed to have a more positive view of their work situation compared to the dental hygienists in the public dental health service.</p>

<p>The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.</p><p>We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.</p><p>A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.</p><p>In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.</p>

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.

Syftet med studien var att jämföra den upplevda arbetssituationen hos tandhygienister inom folktandvården med tandhygienister inom den privata tandvården. Tandhygienister i södra Sverige som var registrerade hos SRAT (n=313) tillfrågades att delta i studien. Enkäten skickades ut elektroniskt, vilket gav en svarsfrekvens på 48% (n=151). Inom folktandvården svarade 59% (n=101) och inom den privata tandvården svarade 35% (n=50). Enkätfrågorna omfattade arbete, arbetsklimat, arbetssituation, profession, hälsa, inflytande och stöd i yrkesrollen samt bakgrundsfrågor om ålder, kön, anställningsform och arbetstid. Resultaten visade statistiskt signifikanta skillnader (p&lt;0,05) mellan tandhygienister inom folktandvården och tandhygienister inom den privata tandvården gällande i vilken utsträckning de styrde över sina tidsbokningar, upplevde trötthet, orolighet, besvär från rygg, nacke eller axlar samt besvär från andra delar av kroppen. En statistisk signifikant skillnad (p&lt;0,01) mellan tandhygienister inom folktandvården och tandhygienister inom den privata tandvården syntes även i vilken utsträckning respondenterna styrde över sin arbetstakt. Slutsatsen av studiens begränsade material är att tandhygienisterna inom den privata tandvården tycktes ha en mer positiv syn på deras arbetssituation än tandhygienisterna inom folktandvården. / The aim of this study was to compare the perceived work situation among dental hygienists in the public dental health service with dental hygienists in private practice. Dental hygienists in southern Sweden who were registered at SRAT (n= 313) were asked to participate in the study. The questionnaire was sent out electronically, which gave a response rate of 48% (n= 151). The response rate in the public dental health sevice was 59% (n= 101) and in private practice 35% (n=50). The survey questions covered work, work atmosphere, work situation, profession, health, influence and collegial support together with background questions about age, gender, employment status and working hours. The result showed a statistically significant difference (p&lt;0.05) between the dental hygienists in the public dental health service and dental hygienists in private practice as regards to what extent the dental hygienists decided over their own scheduled time, experienced tiredness, worry, disorders from the back, neck or shoulders and disorders from other parts of the body. A statistically significant difference (p&lt;0.01) between the dental hygienists in the public dental health service and the dental hygienists in private practice was also shown as regards to what extent the dental hygienists could control their own work pace. The conclusion from the limited material of this study is that the dental hygienists in private practice seemed to have a more positive view of their work situation compared to the dental hygienists in the public dental health service.

The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time. We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care. A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large. In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.