A avaliação do estado de saúde percebido pelas pessoas que sofreram queimaduras tem sido realizada com instrumentos específicos como a “Burn Specific Health Scale- Revised" (BSHS-R). Alguns pesquisadores têm utilizado a BSHS-R como medida da qualidade de vida relacionada à saúde. Ela é composta por 31 itens divididos em seis subescalas (Habilidades para funções simples, Sensibilidade da pele, Tratamento, Trabalho, Afeto/imagem corporal e Relações interpessoais). O presente estudo teve como objetivos: adaptar a BSHS-R para a língua portuguesa; avaliar a validade (face, constructo) e a confiabilidade da versão adaptada em uma amostra de brasileiros que sofreram queimaduras. O processo de adaptação seguiu os seguintes passos metodológicos: tradução da BSHS-R para a língua portuguesa; avaliação por um Comitê de Juízes; “backtranslation" da versão para o inglês, comparação das duas versões em inglês; análise semântica dos itens; pré-teste da versão adaptada e aplicação da versão final em português em sujeitos que sofreram queimaduras. Participaram do estudo 82 sujeitos que haviam sido internados na Unidade de Queimados do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Constatamos predomínio de indivíduos do sexo masculino (56/82; 68,3%), casados (52/82; 63,4%), com idade entre 18 e 78 anos (média = 38,5; DP = 13,9) e baixa escolaridade (47,6%, com primeiro grau incompleto ou analfabeto). A área média de superfície corporal queimada foi de 19,3%; 24,4% dos casos apresentaram queimaduras de 3º grau típico e 63,4% queimaduras mescladas de 2º e 3º graus. O tempo de recuperação após a alta variou de 17 dias a 6 anos, sendo que 67,9% dos entrevistados apresentavam queimaduras há menos de 1 ano. Todos apresentavam seqüelas, sendo que 53 (64,6%) sujeitos tinham seqüelas tanto estéticas quanto funcionais. Na BSHS-R, as respostas variam de 1 a 5 e o intervalo possível, para a soma dos 31 itens varia de 31 a 155, sendo que quanto maior o valor, melhor a avaliação do estado de saúde. Obtivemos média de escores altos para cada um dos 31 itens da escala (3,8 + 0,8) e uma média total do instrumento de 119,4 + 24,6. Para a análise da validade de constructo, verificamos a confirmação das nossas hipóteses para a convergência entre a BSHS-R e a auto-estima e divergência entre a BSHS-R e depressão. Foram observadas correlações positivas e moderadas entre auto-estima e Afeto e imagem corporal e Relações interpessoais. Com relação às correlações inversas entre a medida de depressão e os domínios da BSHS-R, obtivemos correlações moderadas com: Sensibilidade da pele e Relações interpessoais e correlação alta com: Afeto e imagem corporal. Para a análise da confiabilidade da versão adaptada, a aplicação de testes de avaliação da consistência interna, representada pelo alfa de Cronbach, mostrou resultado estatisticamente significante, obtendo-se alfa igual a 0,94 para o instrumento como um todo e valores que variaram de 0,74 a 0,94 entre os domínios. Diante dos resultados podemos concluir que a versão adaptada para o português da BSHS-R mostrou atender os critérios de validade e confiabilidade exigidos para um instrumento de avaliação do estado de saúde, mantendo as propriedades da versão original. / The perceived health state of burn victims has been assessed using specific instruments, such as the “Burn Specific Health Scale-Revised" (BSHS-R). Some researchers to measure health-related quality of life have used it. The instrument consists of 31 items, divided into six subscales (Simple abilities, Skin sensitivity, Treatment, Work, Affect/body image and Interpersonal relations). This study aimed to: adapt the BSHS-R to Portuguese; assess face and construct validity and reliability of the adapted version in sample of Brazilian burn victims. The adaptation process followed the methodological steps: translation of the BSHS-R to Portuguese; evaluation by an expert committee; “back-translation" of the Portuguese version into English, comparison between the two English versions; semantic analysis of scale items; pretest of the adapted version and application of the final Portuguese version to burn victims. Study participants were 82 persons hospitalized at the Burns Unit of the Ribeirão Preto Medical School Hospital das Clínicas. Most participants were men (56/82; 68.3%), married (52/82; 63.4%), with ages ranging from 18 to 78 years (mean = 38.5; SD = 13.9) and low education levels (47.6% with incomplete basic education or illiterate). As to burn-related aspects, the mean burned body surface was 19.3%; 24.4% of cases presented typical third-degree burns and 63.4% mixed second and third-degree burns. Recovery time after discharge ranged from 17 days to 6 years; 67.9% of the interviewees had suffered the burns less than one year before the study. All participants presented sequelae and 53 (64.6%) of them suffered both esthetical and functional sequelae. What the BSHS-R is concerned, answers ranged from 1 to 5, with a possible interval for the sum of the 31 items varying between 31 and 155; the higher the score, the better the perceived health state. We obtained high mean scores for each of the 31 scale items (3.8 + 0.8) and a total mean score of 119.4 + 24.6. To analyze construct validity, we verified the confirmation of our hypothesis for convergence between BSHS-R and self-esteem and divergence between BSHS-R and depression. Positive and moderate correlations were found between self-esteem and Affect/body image and Interpersonal relations. As to inverse correlations between depression and BSHS-R domains, we found moderate correlations with: Skin sensitivity and Interpersonal Relations and high correlation with: Affect/body image. With respect to the reliability of the adapted version, the application of internal consistency tests (Cronbach’s alfa) found a statistically significant result, with an alfa of 0.94 for the instrument as a whole and scores ranging from 0.74 to 0.94 between domains. These results demonstrate that the adapted version of the BSHS-R for Portuguese attends to the validity and reliability criteria required for a health state assessment instrument and maintains the properties of the original version.

A avaliação do estado de saúde percebido pelas pessoas que sofreram queimaduras tem sido realizada com instrumentos específicos como a “Burn Specific Health Scale- Revised” (BSHS-R). Alguns pesquisadores têm utilizado a BSHS-R como medida da qualidade de vida relacionada à saúde. Ela é composta por 31 itens divididos em seis subescalas (Habilidades para funções simples, Sensibilidade da pele, Tratamento, Trabalho, Afeto/imagem corporal e Relações interpessoais). O presente estudo teve como objetivos: adaptar a BSHS-R para a língua portuguesa; avaliar a validade (face, constructo) e a confiabilidade da versão adaptada em uma amostra de brasileiros que sofreram queimaduras. O processo de adaptação seguiu os seguintes passos metodológicos: tradução da BSHS-R para a língua portuguesa; avaliação por um Comitê de Juízes; “backtranslation” da versão para o inglês, comparação das duas versões em inglês; análise semântica dos itens; pré-teste da versão adaptada e aplicação da versão final em português em sujeitos que sofreram queimaduras. Participaram do estudo 82 sujeitos que haviam sido internados na Unidade de Queimados do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Constatamos predomínio de indivíduos do sexo masculino (56/82; 68,3%), casados (52/82; 63,4%), com idade entre 18 e 78 anos (média = 38,5; DP = 13,9) e baixa escolaridade (47,6%, com primeiro grau incompleto ou analfabeto). A área média de superfície corporal queimada foi de 19,3%; 24,4% dos casos apresentaram queimaduras de 3º grau típico e 63,4% queimaduras mescladas de 2º e 3º graus. O tempo de recuperação após a alta variou de 17 dias a 6 anos, sendo que 67,9% dos entrevistados apresentavam queimaduras há menos de 1 ano. Todos apresentavam seqüelas, sendo que 53 (64,6%) sujeitos tinham seqüelas tanto estéticas quanto funcionais. Na BSHS-R, as respostas variam de 1 a 5 e o intervalo possível, para a soma dos 31 itens varia de 31 a 155, sendo que quanto maior o valor, melhor a avaliação do estado de saúde. Obtivemos média de escores altos para cada um dos 31 itens da escala (3,8 + 0,8) e uma média total do instrumento de 119,4 + 24,6. Para a análise da validade de constructo, verificamos a confirmação das nossas hipóteses para a convergência entre a BSHS-R e a auto-estima e divergência entre a BSHS-R e depressão. Foram observadas correlações positivas e moderadas entre auto-estima e Afeto e imagem corporal e Relações interpessoais. Com relação às correlações inversas entre a medida de depressão e os domínios da BSHS-R, obtivemos correlações moderadas com: Sensibilidade da pele e Relações interpessoais e correlação alta com: Afeto e imagem corporal. Para a análise da confiabilidade da versão adaptada, a aplicação de testes de avaliação da consistência interna, representada pelo alfa de Cronbach, mostrou resultado estatisticamente significante, obtendo-se alfa igual a 0,94 para o instrumento como um todo e valores que variaram de 0,74 a 0,94 entre os domínios. Diante dos resultados podemos concluir que a versão adaptada para o português da BSHS-R mostrou atender os critérios de validade e confiabilidade exigidos para um instrumento de avaliação do estado de saúde, mantendo as propriedades da versão original. / The perceived health state of burn victims has been assessed using specific instruments, such as the “Burn Specific Health Scale-Revised” (BSHS-R). Some researchers to measure health-related quality of life have used it. The instrument consists of 31 items, divided into six subscales (Simple abilities, Skin sensitivity, Treatment, Work, Affect/body image and Interpersonal relations). This study aimed to: adapt the BSHS-R to Portuguese; assess face and construct validity and reliability of the adapted version in sample of Brazilian burn victims. The adaptation process followed the methodological steps: translation of the BSHS-R to Portuguese; evaluation by an expert committee; “back-translation” of the Portuguese version into English, comparison between the two English versions; semantic analysis of scale items; pretest of the adapted version and application of the final Portuguese version to burn victims. Study participants were 82 persons hospitalized at the Burns Unit of the Ribeirão Preto Medical School Hospital das Clínicas. Most participants were men (56/82; 68.3%), married (52/82; 63.4%), with ages ranging from 18 to 78 years (mean = 38.5; SD = 13.9) and low education levels (47.6% with incomplete basic education or illiterate). As to burn-related aspects, the mean burned body surface was 19.3%; 24.4% of cases presented typical third-degree burns and 63.4% mixed second and third-degree burns. Recovery time after discharge ranged from 17 days to 6 years; 67.9% of the interviewees had suffered the burns less than one year before the study. All participants presented sequelae and 53 (64.6%) of them suffered both esthetical and functional sequelae. What the BSHS-R is concerned, answers ranged from 1 to 5, with a possible interval for the sum of the 31 items varying between 31 and 155; the higher the score, the better the perceived health state. We obtained high mean scores for each of the 31 scale items (3.8 + 0.8) and a total mean score of 119.4 + 24.6. To analyze construct validity, we verified the confirmation of our hypothesis for convergence between BSHS-R and self-esteem and divergence between BSHS-R and depression. Positive and moderate correlations were found between self-esteem and Affect/body image and Interpersonal relations. As to inverse correlations between depression and BSHS-R domains, we found moderate correlations with: Skin sensitivity and Interpersonal Relations and high correlation with: Affect/body image. With respect to the reliability of the adapted version, the application of internal consistency tests (Cronbach’s alfa) found a statistically significant result, with an alfa of 0.94 for the instrument as a whole and scores ranging from 0.74 to 0.94 between domains. These results demonstrate that the adapted version of the BSHS-R for Portuguese attends to the validity and reliability criteria required for a health state assessment instrument and maintains the properties of the original version.

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Doctor of Philosophy(PhD) / The aim of the work reported in this thesis was to develop a scoring algorithm that converts ratings from a validated disease-specific quality of life questionnaire called the Utility-Based Questionnaire-Cancer (UBQ-C) into a utility index that is designed for evaluating clinical trials to inform clinical decisions about cancer treatments. The UBQ-C includes a scale for global health status (1 item); and subscales for physical function (3 items), social/usual activities (4 items), self-care (1 item), and distresses due to physical and psychological symptoms (21 items). Data from three studies was used. A valuation survey consisted of patients with advanced cancer (n=204) who completed the UBQ-C and assigned time-trade-off utilities about their own health state. Clinical trials were of chemotherapy for advanced (n=325) and early (n=126) breast cancer. A scoring algorithm was derived to convert the subscales into a subset index, and combine it with the global scale into an overall quality of life index, which was converted to a utility index with a power transformation. Optimal weights were assigned to the subscales that reflected their correlations with a global scale in each study. The derived utilities were validated by comparison with other patient characteristics. Each trial was evaluated in terms of differences in utility between treatment groups. In the valuation survey, the weights (range 0 to 1) for the subset index were: physical function 0.28, social/usual activities 0.06, self-care 0.01, and distresses 0.64. Weights for the overall quality of life index were health status 0.65 and subset index 0.35. The mean of the utility index scores was similar to the mean of the time trade-off utilities (0.92 vs. 0.91, p=0.6). The weights were adjusted in each clinical trial. The utility index was substantially correlated with other measures of quality of life, discriminated between breast cancer that was advanced rather than early (means 0.88 vs 0.94, p<0.0001), and was responsive to toxic effects of chemotherapy in early breast cancer (mean change 0.07, p<0.0001). There were trends to better mean scores on the utility index for patients allocated to standard-dose versus high-dose chemotherapy in the early cancer trial (p=0.1), and oral versus intravenous chemotherapy in the advanced cancer trial (p=0.2). In conclusion, data from a simple, self-rated, disease-specific questionnaire can be converted into a utility index based on cancer patients’ preferences. The index can be optimised in different clinical contexts to reflect the relative importance of different aspects of quality of life to the patients in a trial. The index can be used to generate utility scores and quality-adjusted life-years in clinical trials. It enables the evaluation of the net effect of treatments on health-related quality of life (accounting for trade-offs between disparate aspects); the evaluation of the net benefit of treatments (accounting for trade-offs between quality of life and survival); and an alternate perspective for comparing the incremental cost-effectiveness of treatments (accounting for trade-offs between net benefit and costs). The practical significance of this work is to facilitate the integration of data about health-related quality of life with traditional trial endpoints such as survival and tumour response. This will better inform clinical decision-making, and provide an alternate viewpoint for economic decision-making. Broadly, it will help patients, clinicians and health funders make better decisions about cancer treatments, by considering potential trade-offs between effects on survival and health-related quality of life.

Doctor of Philosophy(PhD) / The aim of the work reported in this thesis was to develop a scoring algorithm that converts ratings from a validated disease-specific quality of life questionnaire called the Utility-Based Questionnaire-Cancer (UBQ-C) into a utility index that is designed for evaluating clinical trials to inform clinical decisions about cancer treatments. The UBQ-C includes a scale for global health status (1 item); and subscales for physical function (3 items), social/usual activities (4 items), self-care (1 item), and distresses due to physical and psychological symptoms (21 items). Data from three studies was used. A valuation survey consisted of patients with advanced cancer (n=204) who completed the UBQ-C and assigned time-trade-off utilities about their own health state. Clinical trials were of chemotherapy for advanced (n=325) and early (n=126) breast cancer. A scoring algorithm was derived to convert the subscales into a subset index, and combine it with the global scale into an overall quality of life index, which was converted to a utility index with a power transformation. Optimal weights were assigned to the subscales that reflected their correlations with a global scale in each study. The derived utilities were validated by comparison with other patient characteristics. Each trial was evaluated in terms of differences in utility between treatment groups. In the valuation survey, the weights (range 0 to 1) for the subset index were: physical function 0.28, social/usual activities 0.06, self-care 0.01, and distresses 0.64. Weights for the overall quality of life index were health status 0.65 and subset index 0.35. The mean of the utility index scores was similar to the mean of the time trade-off utilities (0.92 vs. 0.91, p=0.6). The weights were adjusted in each clinical trial. The utility index was substantially correlated with other measures of quality of life, discriminated between breast cancer that was advanced rather than early (means 0.88 vs 0.94, p<0.0001), and was responsive to toxic effects of chemotherapy in early breast cancer (mean change 0.07, p<0.0001). There were trends to better mean scores on the utility index for patients allocated to standard-dose versus high-dose chemotherapy in the early cancer trial (p=0.1), and oral versus intravenous chemotherapy in the advanced cancer trial (p=0.2). In conclusion, data from a simple, self-rated, disease-specific questionnaire can be converted into a utility index based on cancer patients’ preferences. The index can be optimised in different clinical contexts to reflect the relative importance of different aspects of quality of life to the patients in a trial. The index can be used to generate utility scores and quality-adjusted life-years in clinical trials. It enables the evaluation of the net effect of treatments on health-related quality of life (accounting for trade-offs between disparate aspects); the evaluation of the net benefit of treatments (accounting for trade-offs between quality of life and survival); and an alternate perspective for comparing the incremental cost-effectiveness of treatments (accounting for trade-offs between net benefit and costs). The practical significance of this work is to facilitate the integration of data about health-related quality of life with traditional trial endpoints such as survival and tumour response. This will better inform clinical decision-making, and provide an alternate viewpoint for economic decision-making. Broadly, it will help patients, clinicians and health funders make better decisions about cancer treatments, by considering potential trade-offs between effects on survival and health-related quality of life.

Recent advancements in Artificial Intelligence has prompted a shearexplosion of new research initiatives and applications, improving notonly existing technologies, but also opening up opportunities for newand exiting applications. This thesis explores the MIMIC-III intensive care unit database and conducts experiment on an interpretable feature space based on sever-ty scores, defining a patient health state, commonly used to predict mortality in an ICU setting. Patient health state trajectories are clustered and correlated with administered medication and performed procedures to get a better understanding of the potential usefulness in evaluating treatments on their effect on said health state, where commonalities and deviations in treatment can be understood. Furthermore, medication and procedure classification is carried out to explore their predictability using the severity subscore feature space.

The diploma thesis titled "A health state assessment in the Czech Republic and in states of the European Union" is a theoretically conceived work that offers comprehensive information on assessment activities focused on the sickness insurance in the Czech Republic and other five selected countries of the European Union. A choice of the selected states has been affected both geographical and historical linkages to the Czech Republic as well as differences in the social security systems. The most attention has been devoted to the assessment activities under the sickness insurance of the Czech Republic. For other countries there has been particularly given a course of the health state assessment due to the illness, pregnancy and maternity or care for a household member. The aim of the thesis is to analyze the process of the health state assessment in the Czech Republic and a subsequent comparison of those results with a situation in the selected countries of the European Union, namely the Slovak Republic, Poland, Austria, Great Britain and France. To identify differences and to focus on strengths and weaknesses of the systems or to suggest a more efficient solution within the Czech Republic. The results of the thesis show that in all researched countries a medical certificate of the incapacity for work is the legal condition for an acquisition of claims to sickness benefits and the procedure for an obtaining of the certificate is similar in all six countries. It is the examination and health state assessment by a physician authorized by a body administering the social security in the given country. Despite differences of the social security systems in individual countries, a connecting element for the claim to the benefit is the participation on the social insurance. This thesis may also serve the general public as a summary of findings on the issue of the health state assessment under the sickness insurance in the Czech Republic and selected countries of the European Union and for a better orientation in the given systems.

This study occupies itself with legal aspects of invalidity from youth. It represents an issue that is very significant from the social point of view although not regulated as single problem by law. However the whole theme infiltrates to another specific fields: social insurance, assessment medicine, psychology, juristic section, medicinal issue, ethics, upbringing and special pedagogy in a broad meaning. Current Czech law regulation of theme concerning benefits for persons with long-term unfavorable health state is based on concept of full and partial invalidity pension as benefits within pension insurance scheme and pension increase for incapacity (helplessness). Generally full and partial invalidity pension benefits originate from reduction of gainful activity and reaching of relevant time period of pension insurance. According to a survey it is evident that number of awarded full and partial invalidity pensions has increased in {\clqq}Jihočeský`` region. Respecting diagnostic flags structure the greatest occurrence of full invalidity pensions from youth has been recorded in group of intermediate cephalonia. Solving of social insurance of the elderly is planned under the pension reform at the present. The main goal of invalidity pension is permission to live as close as possible to normal state thus to face up to a handicap and to secure appropriate family, social and work life. In fine we could deduce that there should be confirmation of obligatory conversion of full invalidity pension to old-age pension when reaching retirement age within Czech pension reform. In my study I have focused on some factors decisive for occurrence of full or partial invalidity. It represents socially significant problems in broad range of relations that establish or could establish. Long-term loss or reduction of ability to work have negative impact not only on individuals but also affect social status of their families and thus negatively influence the whole society. Exclusion from work process traumatizes young people. Pension benefits provided to the disabled from youth are not deduced from tolled premiums. That is the reason I think this should be solved out of the pension insurance system as well as pension increase for incapacity (helplessness). Costs on these benefits would be compensated by state budget within pension insurance system in the near future with perspective of transmission of these benefits to other social scheme. In this connection it is necessary to emphasize that mankind should be made sure that there is basic perception and crucial aim of social welfare in focusing on level and quality of life of individuals and their families not affected by unfavorable social or economic influences as well as their health state and well-being that will not be compounded by diseases and injuries. This fact will substantially affect the strategy of modern social policy.

The theme of this thesis is to compare free housing with a milking robot, milking of serious housing in the pipeline. The evaluation is focused on milk yield and its quality, reproductive performance and health. It is also monitored by the free choice of milking cows during the day. Consideration is also observed in stable microclimate. Everything is assessed under operational conditions. Object of study is a refurbished barn, where both systems are in operation. Were measured and compared observed values of milk production, reproduction and health status between groups. The observed values were evaluated in the program Statistica 9th of a computerized milking robot system was speciaed the period of time when Nada dairy milk provides the most of milk through a robot.. In the area of dairy cattle milking robot reaches a higher milk yield and increasing the percentage of lactose recovery. Milking stalls of the pipeline has better results in the percentage of protein recovery. The choice of time period of milking cows, the most milk by dairy cows wasprovided between 10:00-18:00 pm. In the area of reproduction achieved better results with loose housing milking robot. The issue of health status showed a statistically better health outcomes for the free housing with a milking robot.

The thesis deals with the contemporary topic of cognitive deficit present by schizophrenic people. It introduces the subjective point of view of the patients in more detail, which means the experience of deficits in the cognitive area. The text itself consists, as usual, of the theoretical and the research section. The theoretical section deals with the specifics of cognitive functions and their deficits present by schizophrenic patients. It focuses more closely on the subjective point of view of an individual, the impairment-related experience which follows from the impaired cognitive functions. The thesis pursues also the impact of cognitive impairment on an individual's life. A part of the theoretical section is also dedicated to the tools designated to measure cognitive functions. The major subpart is dedicated to self-evaluating tool entitled Frankfurt Complaint Questionnaire (FCQ), concerning primarily its origin, description and psychometric properties. The research section is based on the usage of the Czech translation of the FCQ in practice. Based on an observation of a sample of 53 individuals diagnosed with F20.0 and 53 healthy people, the psychometric qualities of the FCQ (discriminant validity, Cronbach's alpha, test-retest reliability) were examined. In case of patients diagnosed with...