Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Trata-se de uma pesquisa de natureza qualitativa, que teve como objetivo analisar os processos e fatores intervenientes para a tomada de decisÃo em sistemas municipais de saÃde. Os sujeitos da pesquisa foram secretÃrios municipais de saÃde do Estado do CearÃ, selecionados com base em atributos definidos para a conduÃÃo da pesquisa. O instrumento de coleta de informaÃÃes foi um roteiro de entrevista, semiestruturado, contendo os principais elementos divididos em blocos: Poder TÃcnico, Poder Administrativo e Poder PolÃtico, com suporte no referencial teÃrico do sanitarista latino-americano Mario Testa. A aplicaÃÃo foi realizada individualmente, utilizando-se de gravaÃÃo como recurso de Ãudio, apÃs autorizaÃÃo e assinatura do Termo de Consentimento Livre Esclarecido. A anÃlise se deu pela tÃcnica da AnÃlise de ConteÃdo, na perspectiva de Bardin (1977). ApÃs estudo dos dados, pÃde-se observar que no processo decisÃrio hà o entrelaÃamento dos trÃs poderes, alÃm das muitas complexidades e subjetividades envolvidas nos processos da gestÃo de saÃde. Com origem nas informaÃÃes coletadas nas entrevistas, depreende-se que as dificuldades apontadas no processo decisÃrio resultam bem mais das relaÃÃes entre os atores envolvidos na atividade da gestÃo do que em aspectos objetivos, quais sejam, o porte do municÃpio e/ou a carÃncia de recursos, na maioria das vezes, utilizada como argumento para justificar a ineficÃcia da polÃtica pÃblica de saÃde. De todo estudo realizado, constata-se que o cotidiano do gestor municipal de saÃde està congestionado no conflito entre as ordenanÃas administrativas dispostas na legislaÃÃo do sistema de saÃde e a atuaÃÃo dos agentes polÃticos, descompassados em relaÃÃo ao planejamento administrativo e à capacidade econÃmica dos sistemas de saÃde municipais. O grau de influÃncia do poder polÃtico na tomada de decisÃo dificulta o nÃvel de qualidade das equipes e a execuÃÃo de aÃÃes planejadas. Enquanto o poder polÃtico atua na influÃncia, o Poder JudiciÃrio impÃe a substituiÃÃo dos critÃrios de atendimento por meio de decisÃes que invertem a ordem de preferÃncia, ensejando, na maioria das vezes, a desigualdade entre os usuÃrios.

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International Telemetering Conference Proceedings / October 20-23, 2003 / Riviera Hotel and Convention Center, Las Vegas, Nevada / Modern aircraft and space vehicles routinely sense and record vast quantities of information relevant to assessing the vehicles’ health. However, limitations imposed by the bandwidth of telemetry and network connections prevent real-time transmission of the complete data set to central stations for analysis. An online health-management system suitable for bandwidth-limited network environments that enables interrogation of the full data set by ground-based operators is described. The system uses distributed objects organized in a data processing hierarchy linked by a buffered data-management subsystem. Reduced health information is routinely transmitted, but dynamic reports may be requested on demand from any object.

International Telemetering Conference Proceedings / October 27-30, 1997 / Riviera Hotel and Convention Center, Las Vegas, Nevada / Stanford’s Space Systems Development Laboratory is developing methods for automated spacecraft health operations. Such operations greatly reduce the need for ground-space communication links and full-time operators. However, new questions emerge about how to supply operators with the spacecraft information that is no longer available. One solution is to introduce a low-bandwidth health beacon and to develop new approaches in on-board summarization of health data for telemetering. This paper reviews the development of beacon operations and data summary, describes the implementation of beacon-based health management on board SAPPHIRE, and explains the mission operations response to health emergencies. Additional information is provided on the role of SSDL’s academic partners in developing a worldwide network of beacon receiving stations.

<p>Lack of knowledge about stroke in general and specific knowledge of the risk factors, signs, and symptoms of stroke results in the late presentation of patients at hospital. The aim of this study was to determine the knowledge of stroke among hypertensive patients in the Tanga region of Tanzania. To investigate this, a cross-sectional survey using a quantitative research design was used.</p>

Master of Public Health - MPH / Decentralisation of multi-drug resistant tuberculosis (MDR-TB) services has resulted in improved access to care, with community-based treatment of MDR-TB shown to be more effective than centralised hospital-based care. Furthermore, increasing bed shortages resulted in the National Department of Health establishing MDR-TB policy guidelines in 2011. However, the extent to which this policy has been implemented by the decentralised MDR- TB sites and the factors influencing implementation of the policy from a management perspective were not well described. The aim of this study was therefore to explore and compare the actual and ascribed roles and responsibilities of key management-level role players at the decentralised MDR-TB sites, and to explore the factors influencing implementation of the MDR-TB decentralisation policy (2011).

The purpose of this study was to understand the cultural context in which Amish families manage the care of a child with a chronic illness and how it frames the interface with the larger health care delivery system outside their communities. The aims of this study were to describe Amish families' understanding of their children's chronic illnesses, and to describe Amish families' health management and health seeking behaviors for their children within the Amish community and with health services outside their community. Ethnographic research methods were used to paint a cultural portrait of individuals and families, using data sources such as formal and informal interviews with participants, participant observations in the Amish community and family homes, Amish newspapers, and direct observations in health care clinic settings. Informants in this study included Amish families, Amish community members, and health care providers to illustrate commonalities and differences in perspectives on the chronic illness management for children. The study made use of ethnographic analysis, guided by thematic and cultural narrative techniques, to describe Amish family management for children with chronic illnesses in a way that pulls forward how their cultural background is involved in their behaviors and experiences. The results of this study highlight several points: a) the Amish community influences how families understand and appraise concern for their children's illnesses, and families prioritize children's function as a measure of health/illness and see children as ultimately in the hands of God; b) minimal entanglement with the health care community allows for children to be as normalized as possible into the everyday life of the Amish community; c) families prefer to use home remedies to lower costs, potentially prevent the need for health services, and alleviate their child's symptoms in their own homes and community; d) when seeking health services, families prefer treatments they can manage in their homes, health care providers who are knowledgeable about the use of Amish home remedies for their children, and the ability to make health decisions in consideration of the impact to the greater Amish community. To provide culturally competent care for Amish children, this study describes provider competencies needed to understand and accommodate the child's family cultural orientation, values, beliefs, and health care practices into cooperative care planning. One of the most significant attributes for providers to understand when working with Amish families is their collectivist perspective. As collectivists, these families may place the ultimate Amish community goals of believing in God, separation from society, and traditional lifestyle choices over their own when caring for children with chronic illnesses. This is a difficult competency for health care providers who function within a larger medical legal system that requires the placement of individuals above other considerations. It is at the intersection of these two cultures that this study is situated.