Thesis (doctoral)--University of Lund, 1981.

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1973. / eContent provider-neutral record in process. Description based on print version record.

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / The large use of oxacillin in Brazilian hospitals and the ausence of scientific data confirming its safety, justify the necessity of carrying out well âstructured studies, identifying the existence of possible triggering factors of the reactions. AIM: To study the use of oxacillin and the occurrence of adverse reactions in two different groups, identifying risk factors associated. METHODS: Children using oxacillin were monitorized from October 2000 to July 2001 in the Universitary Hospital Walter CantÃdio (HUWC), as well as ones under treatment with oxacillin of block D from Childrenâs Hospital Albert Sabin in the period of July 2001 and March 2002 (FIRST STUDY). Also, patients under treatment with oxacillin from HUWC, during the period of July until October 2003, were followed up (SECOND STUDY). The follow-up was done through daily visits in the infirmary and analysis of medical records and prescriptions, being observed the clinical history, prescribed drugs, laboratorial exams, oxacillin use, adverse reaction reports related to oxacillin (AROx) and procedures done due to these AROx. The reactions were reported and classified according to causality and gravity (both studies) and hypersensitivity type (in the SECOND STUDY). Statistical tests were used promptly. RESULTS: FIRST STUDY: In 130 children monitorized were observed both a large oxacillin exposure in the masculine sex, being used the oxacillin average dose of 216,3mg/kg/day. The accumulative incidence (AI) of AROx was equal to 20,8%, of the total of 3352 patients-day monitorized (incidence density/ ID = 0,8). Of the 43 reactions reports, the most frequent reactions were fever (50%) and cutaneous rash (35,7%). The procedure more used in the case of occurrence of AROx was the suspension of oxacillin use (51,9%). The most of reactions presented causality and gravity as Probable (55,6%) and Moderate (92,6%), respectively. In addition, the average of exposure time to oxacillin and hospitalization time were significantly different between the groups of patients that presented AROx or no. The relative risk (RR) of oxacillin exposure by more than 14 days was 5,46 to AROx occurrence. SECOND STUDY: Of the 76 patients, 36,8% ones related to allergic antecedents. Of these, 72,5% were associated to use of drugs. Oxacillin was considered as first choice drug for treatment of 75% of patients. The association oxacillin plus ceftazidima was the most used (22%) during treatments. The average dose of oxacillin prescribed was 206mg/kg/day. The average time of treatment with oxacillin was 15 days. The ineffective therapeutic (21,1%) and occurrence of adverse reaction (15,8%) caused the suspension of this antibiotic. The permanence time in the hospital of patients was 32,4% (patients-day total: 2463; ID = 0,97). The most frequent reactions were the increase of transaminases (22,1%), fever (17%) and cutaneous rash (13,6%). The majority of reactions showed causality, gravity and hypersensitivity as Probable (44,1%), Moderate (66,1%) and type B (86,4%). The presence of AROx was frequent between patients with age equal or under 14 years old (P = 0,0159)/ RR = 2,22). The incidence of adverse reactions to other medicaments was higher in the AROx patient group (P = 0,0036)/ RR = 2,66). 34% of followed patients presented at least one drug related problem involving oxacillin (DRPOx). A total of 71 DRPOx was identified. Of these DRPOx, the detection of adverse reactions was predominant (33,8%). CONCLUSION: The careful use of oxacillin is recommended in paediatrics, with duration of treatment established promptly. The empirical and prolonged exposure of this drug should be avoided. / O elevado grau de utilizaÃÃo da oxacilina nos hospitais do Brasil e a inexistÃncia de dados cientÃficos que comprovem sua seguranÃa justificam a necessidade da realizaÃÃo de estudos bem planejados que visem testar a existÃncia de fatores desencadeantes das reaÃÃes. OBJETIVOS: Estudar a utilizaÃÃo da oxacilina e a ocorrÃncia de reaÃÃes adversas em duas populaÃÃes distintas, apontando fatores de risco associados. METODOLOGIA: Foram acompanhadas crianÃas expostas à oxacilina no Hospital UniversitÃrio Walter CantÃdio (HUWC), entre outubro/2000 e julho/2001, e no bloco D do Hospital Infantil Albert Sabin, entre julho/2001 e marÃo/2002 (PRIMEIRO ESTUDO); e tambÃm, os pacientes adultos e as crianÃas expostos à oxacilina no HUWC, no perÃodo de julho a outubro de 2003 (SEGUNDO ESTUDO). O seguimento de pacientes foi feito atravÃs de visitas diÃrias Ãs enfermarias, anÃlise de prontuÃrios e prescriÃÃes, sendo observada a histÃria clinica, medicamentos prescritos, resultados de exames laboratoriais, perfil de utilizaÃÃo da oxacilina, ocorrÃncia de reaÃÃo adversa à oxacilina (RAOx) e procedimentos adotados devido à RAOx. Os casos foram notificados e classificados quanto à causalidade e gravidade (nos dois estudos) e quanto ao tipo de hipersensibilidade (no segundo estudo), sendo realizados testes estatÃsticos pertinentes. RESULTADOS: PRIMEIRO ESTUDO: A amostra foi composta por 130 crianÃas, sendo observada uma maior exposiÃÃo do sexo masculino (56,9%) e uma dose mÃdia de oxacilina utilizada, equivalente a 216,3 mg/kg/dia. A incidÃncia acumulada (IA) de RAOx foi igual a 20,8%, para um total de 3352 pacientes/dia acompanhados (densidade de incidÃncia/ DI = 0,8). De 43 reaÃÃes relatadas, as mais freqÃentes foram febre (50%) e rash cutÃneo (35,7%), A conduta mais utilizada na ocorrÃncia de RAOx foi a suspensÃo do uso da oxacilina (51,9%). A maioria das reaÃÃes tiveram causalidade ProvÃvel (55,6%) e gravidade Moderada (92,6%). As mÃdias do tempo de exposiÃÃo à oxacilina e do tempo de internamento, diferiram significantemente entre os grupos de pacientes com e sem RAOx. O risco relativo (RR) da exposiÃÃo à oxacilina por mais de 14 dias foi de 5,46 para a ocorrÃncia de RAOx. SEGUNDO ESTUDO: Dos 76 pacientes monitorizados, 36,8% referiram antecedentes alÃrgicos, dos quais 72,5% foram atribuÃdos ao uso de medicamentos. A oxacilina foi primeira escolha para o tratamento de 75% dos pacientes monitorizados e a ceftazidima, a associaÃÃo mais utilizada (22%). A dose mÃdia prescrita de oxacilina foi de 206mg/kg/dia e o tempo mÃdio de exposiÃÃo, igual a 15 dias. A ineficÃcia terapÃutica e a ocorrÃncia de reaÃÃo adversa, foram os causadores da suspensÃo do tratamento com oxacilina em 21,1% e 15,8% dos casos, respectivamente. O tempo de internaÃÃo dos pacientes foi em mÃdia 32,4 dias. Observou-se uma IA de RAOx igual a 31,6%, para um total de 2463 pacientes-dia monitorizados (DI = 0,97). As reaÃÃes mais freqÃentes foram: aumento de transaminases (22,1%), febre (17,0%) e rash cutÃneo (13,6%). A maioria das reaÃÃes foi considerada de causalidade ProvÃvel (44,1%), gravidade Moderada (66,1%) e hipersensibilidade do tipo B (86,4%). A ocorrÃncia de RAOx foi mais freqÃente entre os pacientes com idade igual ou menor que 14 anos (P = 0,0159/ RR = 2,22) e a incidÃncia de reaÃÃo adversa a outros medicamentos, foi maior no grupo de pacientes com RAOx (P = 0,0036/ RR = 2,66). Cerca de 34% dos pacientes monitorizados apresentaram pelo menos 01 problema relacionado com medicamento envolvendo a oxacilina (PRMOx), sendo identificado um total de 71 PRMOx, dos quais a ocorrÃncia de reaÃÃo adversa foi o mais freqÃente (33,8%). CONCLUSÃO: Recomenda-se a administraÃÃo cautelosa de oxacilina em crianÃas, com duraÃÃo do tratamento estabelecida, evitando-se tratamento empÃrico e uso prolongado.

In order to survive in today’s business world it is necessary to win contracts. If companies fail to do this then their existence is threatened. Therefore, the manner in which companies conduct their contract winning activities become of paramount importance. Much focus in software engineering research and academic literature centres around the post-contract winning activities, such as project planning, costing and scheduling. The emphasis on the contract winning process, though not neglected, is quite small in comparison. There exists a need for more research in this interesting area and this thesis aims to partly address this need. Consequently, the main focus of this research is the contract winning process. The approach used to investigate this area consisted of a theoretical study followed by an empirical study, where eight small development companies were interviewed. The findings show that a uniform formal process does not exist for winning and negotiating contracts. As a result of these findings, from both the theoretical and empirical studies, a contract winning process model for small development companies was formulated. The proposed model consists of five sequential stages with recommended activities for each stage. The model is intended for small software engineering development companies but because the model is generic it could also be used by non-software companies.

Abstract The proportion of single-parent families has increased in the last few decades world-wide, mostly due to high divorce rates. Also in Finland growing numbers of children spend part of their childhood in single-parent families. The aim of this study was to investigate in a longitudinal perspective, the possible long-term effects of the childhood family structure on psychological, physical and criminal outcomes of an offspring during adulthood. A large, prospectively collected general population birth cohort (n= 11 017), the Northern Finland 1966 Birth Cohort, was used as a study population. This database provided the information on childhood family structure of cohort members with additional information of sociodemographic factors of the family and of the child. Information concerning physical and psychiatric illnesses were gathered from the Finnish Hospital Discharge Register (FHDR). Death certificates and the information from national crime registers were also obtained. Females with a single-parent family background were more commonly hospital-treated (61.3 % vs. 56.7 %) for any physical condition than females with a two-parent family background. For males such difference in overall physical illness was not found. Both females and males from single-parent families had more commonly been hospital-treated for some diagnoses in the ICD-category of "injury and poisoning" than had other cohort members. Furthermore, females from single-parent families had also more commonly been treated due to pregnancy-related conditions such as induced abortions. During the follow-up time (16 to 28 years of age) 117 (90 males, 27 females) cohort members had died. Males with single-parent family background exhibited an increased mortality risk, especially due to suicides (OR=2.5, 95% CI 1.1-5.8, adjusted for psychiatric hospital diagnosis, parental social class). Criminality was more common among both males and females from single-parent families compared with other cohort members. The results showed that the risk of violent offending and recidivism was increased up to 8-fold if the cohort male member had been born and raised in a single-mother family over most of his childhood. Parental divorce also doubled the risk for both violent and recidivistic offending. Non-violent offences among males were associated only with parental death and divorce. Furthermore, drunk driving was more common among both males and females with single-parent background. Males who were born into single-mother families were at the highest risk of drunk driving offences in adulthood (OR=2.4, 95% CI 1.4-4.2, adjusted for maternal age, psychiatric hospital diagnosis, parental social class). In this study it was shown that young adults with single-parent families in childhood experienced a more stressful pathway from late adolescence to adulthood. However, most of the offspring of single-parent families did well during the follow-up time. Strategies to promote the well-being of children and adolescents in single-parent families are of prime importance for preventive health care.

Magister Public Health - MPH / Background: Even though there have been marked increases in the number of patients accessing HIV care and treatment in sub-Saharan Africa, challenges in patient retention remain. Most health systems in sub-Saharan Africa routinely report on loss to follow up of patients, but only a limited number of factors associated with loss to follow up are measured. In Kenya there is limited research on loss to follow up in HIV care and treatment programs. This study reports on rates of loss to follow up and factors associated with loss to follow up at the New NyanzaProvincial General Hospital (NNPGH) in Kisumu, Kenya. Methods: A retrospective cohort study of 4,740 adult patients that was registered for HIV and AIDS care and treatment between 2003 and 2008 was conducted. Data was analysed using SAS 9.2 and STATA 10. Cox proportional hazard ratio was calculated to describe the association between risk factors and loss to follow up. Results of the total 4740 patients, 64.6% were female, males [median age of 36 (IQR 30-44) years vs. 32 (IQR 26-39) years for females] were older than females, more males (68.3%) were married, more females (6.2%) had no education and 68% of all patients enrolled had been lost to follow up over 6 years. Risk for lost to follow up was greater amongst males (Adjusted Hazard Ratio (AHR) =1.12; 95% Confidence Interval (CI) = 1.02-1.22); younger patients(15-30 vs. >40 years: AHR=1.37, 95%CI = 1.23 – 1.53; and 31-40 vs. >40 years: AHR=1.15, 95%CI=1.03-1.28); those who were unemployed (AHR=1.14, 95%CI=1.05-1.25); and having advanced HIV disease (WHO stage 4 vs. WHO stage 1: AHR=1.53, 95%CI=1.29-1.81). Patients on ART (AHR=0.64, 95%CI=0.52-0.78) at enrollment were less likely to be lost to follow-up compared to those in HIV care. Conclusion: More attention is needed in developing retention strategies for patients with much focus on patients on care. Targeted intervention is required to improve retention amongst males, unemployed patients, patients with advanced HIV disease and younger patients. Additionally, targeted follow up in the community for patients on care is required.

The review of the literature reveals the historical nature of Vocational Education programs and how they relate to the importance of Virginia Tech's two-year post-secondary Agricultural Technology Program. The literature review also provides a historical review of information regarding Virginia Tech's Agricultural Technology program, brief histories of other post-secondary land-grant two-year agricultural programs, vocational education philosophers, and two-year program evaluations. The purpose of this study was to perform an evaluation of past performance of the two-year Agricultural Technology Program at Virginia Tech as perceived by the two-year program graduates. The study focused on two points, a) the graduate's opinions with regards toward the improvement of the program on behalf of the students, and b) the strength and weaknesses of the program in order to determine what the program has accomplished and where it should be headed. Five research questions guided this study: 1. How pleased were the graduates with the education they received through the Agricultural Technology Program? 2. What is the salary range of the graduate's first job after graduation and what is their present salary range? 3. What were the strengths and weaknesses of the program as perceived from the graduates? 4. What are the Agricultural Technology graduates current occupations? 5.What recommendations do the graduates have for the improvement of the Agricultural Technology Program? A survey instrument was used as the research method for the collection of the data. A pilot study was performed to test the survey instrument. Three rounds of survey instruments were sent to increase the possible response rate. A non-respondents study was performed to determine if there was a difference between the respondents and non-respondents of the survey instrument. Frequencies, mean, median, mode, and standard deviation were used in the analysis of the data. The population consists of all of those that graduated from the two-year Agricultural Technology Program at Virginia Polytechnic Institute and State University from the date of the programs first graduation class (1989) to the fall semester of 1998. Because there was such a small number of subjects within the population, to prevent sampling error, and to be able to prevent any deviation of assumptions between the sample and the population the whole population was mailed an evaluation instrument. All three of the mailings yielded a total 215 received survey instruments for a 62% response rate from an N of 343. This left a total of 128 or 37% non-respondents. A reliability test was run in SPSS using the Cronbach Alpha method, also know as Alpha coefficient, the Standard Item Alpha = .7661. The major conclusions of the study were that the Agricultural Technology Program graduates were pleased with the overall education that was received at Virginia Tech, the mean salary for the graduates first job was between $18,000 and $23,999, the mean of the graduates current job is between $24,000 and $29,999, the major strengths to the program were the mandatory internship requirement, the hands-on courses, and the advisors for the program, the weaknesses of the program are issues with the transferability of credit hours to the four-year program, additional computer and technology courses and information are needed, and a lack of available elective course offerings. Just over 78% of the program graduates are employed within the field of agriculture and 16% have gone back to farm ownership or to work on the family farm. Some of the major recommendations that were made by the program graduates were to offer additional courses and options, add more emphasis to computers and technology, additional job placement services, and to allow students to take more four-year courses. Based on the findings recommendations were made about further studies for the addition of courses, faculty, program options, more emphasis of technology in courses, curriculum development, job placement, and credit hour transferability. Specific recommendations were made for an external review to be performed of the Agricultural Technology Program, a formal review of curriculum, additional courses in computers and technology, and further research to be performed with regards to policy change in transferability of credit hours to the four-year program, addition of courses offered as electives, and for students to take courses provided by the four-year program. / Ph. D.

The global commitment by governments throughout the world to scaling up access to Antiretroviral Therapy (ART) in response to the crisis imposed by the HIV epidemic has resulted in a large number of people living with Human Immune-deficiency Virus (HIV) worldwide. According to statistics provided by the World Health Organization (WHO), there were approximately 35 million people living with HIV (PLWHIV) in 2012.1This large number of PLWHIV observed in recent years reflects the life-prolonging benefit effects of ART. / Dissertation (MSc)--University of Pretoria, 2014. / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted