Ο σκοπός της μεταπτυχιακής εργασίας, ήταν η ανάλυση, όσον αφορά την πιθανότητα σφάλματος, ενός τηλεπικοινωνιακού συστήματος το οποίο μεταδίδει ιατρική πληροφορία, ασύρματα, μεταξύ δυο κόμβων ενός δικτύου ιατρικών αισθητήρων. Το δίκτυο αυτό περιλαμβάνει έναν επιβλέποντα κόμβο ο οποίος προωθεί, τα δεδομένα που συλλέχθηκαν, σε ένα σταθμό βάσης, ο οποίος βρίσκεται σε ένα νοσοκομείο. Η μετάδοση της ιατρικής πληροφορίας επιτυγχάνεται με ένα πομποδέκτη ο οποίος είναι ενσωματωμένος σε όλους τους κόμβους του ασύρματου δικτύου. Χρησιμοποιείται ο ΧΕ1209 πομποδέκτης της εταιρίας Xemics S.A. ο οποίος χρησιμοποιεί την διαμόρφωση 2-CPFSK ενώ η φέρουσα συχνότητα είναι τα 36,86 kHz. Προτού, μεταδοθεί η ιατρική πληροφορία, γίνεται μια κατάλληλη επεξεργασία ώστε να προστατευθεί από τον πανταχού παρών θόρυβο και να φτάσει αναλλοίωτη στο δέκτη. Η επεξεργασία της ιατρικής πληροφορίας περιλαμβάνει τον κυκλικό έλεγχο πλεονασμού (Cyclic Redundancy Check - CRC) και την εφαρμογή ενός σχήματος διόρθωσης λαθών (Forward Error Correction – FEC). / The purpose of my master thesis was, the analysis, concerning the probability of error, of a telecommunication system, which transmits medical information, wireless, from one node, of a medical sensor network, to another. This network consists of a supervising node, who forwards the collected data, to a base station, which resides in a hospital. The transmission of the medical information is achieved by a transmitter embedded to all the nodes of the wireless network. We have used the ΧΕ1209 transmitter of Xemics S.A., who uses the 2-CPFSK modulation, whilst the carrier frequency is 36.86 kHz. Before the transmission of the medical information takes place, the data undergo a processing phase, in order to be protected from the ubiquitous noise, and reach the receiver intact. The processing of the medical information includes the Cyclic Redundancy Check (CRC) and the application of a form of error correction called Forward Error Correction (FEC).

Οι σύγχρονες τάσεις στο χώρο των υπηρεσιών Υγείας απαιτούν αναβάθμιση των προσφερόμενων υπηρεσιών με ταυτόχρονο εξορθολογισμό του κόστους των. Τη λύση αυτή είναι σε θέση να δώσουν συστήματα μηχανοργάνωσης των Μονάδων παροχής υπηρεσιών υγείας. Ένα ολοκληρωμένο πληροφοριακό σύστημα υγείας (ΟΠΣΥ) είναι το πληροφοριακό σύστημα εκείνο που συμβάλει στην ενοποίηση, συστηματική παρακολούθηση, διαχείριση και έλεγχο των δεδομένων (οικονομικά, επιχειρησιακά, οργανωτικά καθώς και ιατρικά δεδομένα) ενός νοσοκομείου ή, γενικά μιας μονάδας υγείας, με σκοπό την αναβάθμιση της ποιότητας των υπηρεσιών την αναδιοργάνωση των εσωτερικών διεργασιών και την εξυπηρέτηση του πολίτη. Είναι δε σημαντικός ο ρόλος του όσον αφορά τη διάχυση και αξιοποίηση της ιατρικής πληροφορίας για ερευνητικούς και στατιστικούς σκοπούς αλλά και όσον αφορά με τη χρήση νέων τεχνολογιών πληροφορικής κι επικοινωνιών από τους ιατρούς, νοσηλευτές και διοικητικό και λοιπό προσωπικό ενός νοσοκομείου. Στόχος της μεταπτυχιακής διπλωματικής αυτής εργασίας είναι η παρουσίαση των θεμάτων διαλειτουργικότητας και ανταλλαγής δεδομένων μεταξύ Πληροφοριακών Συστημάτων στο χώρο της Υγείας, ένα αντικείμενο που αποτελεί σημαντικό παράγοντα επιτυχίας και αξιοποίησης των Πληροφοριακών Υποδομών αυτών από τους επαγγελματίες Υγείας. Στις εισαγωγικές ενότητες αναλύεται η σημερινή κατάσταση στο χώρο της πληροφορικής υγείας και παρουσιάζονται τα χαρακτηριστικά των σύγχρονων ΟΠΣΥ, χρησιμοποιώντας μάλιστα ως παράδειγμα ένα εμπορικό προϊόν (το λογισμικό medico//s). Στη συνέχεια παρουσιάζονται οι κωδικοποιήσεις που χρησιμοποιούνται στα συστήματα αυτά, με ιδιαίτερη μνεία στην ελληνική μετάφραση της κωδικοποίησης ICD-10 απο το Υπουργείο Υγείας. Επίσης γίνεται ειδική αναφορά και αναλυτική παρουσίαση με παραδείγματα στο διεθνές πρωτόκολλο επικοινωνίας HL7. Στα επόμενα κεφάλαια παρουσιάζεται το πρότυπο XDS-MS, ένα πρότυπο ιατρικών εγγράφων που υπηρετεί τους σκοπούς της διαλειτουργικότητας. Αναλύονται τα περιεχόμενα του εγγράφου αλλά και η δομή της όλης υλοποίησης ώστε το έγγραφο να μπορεί να διαμοιράζεται μεταξύ των επαγγελματιών υγείας. Για τις ανάγκες της εργασίας αυτής παρουσιάζεται το πρότυπο για τις συνόψεις νοσηλείας σύμφωνα με την αρχιτεκτονική ιατρικών εγγράφων (CDA) του HL7, τόσο όπως έχει τυποποιηθεί για την υποστήριξης Αγγλόφωνων νοσοκομείων/κειμένων αλλά και όπως είναι δυνατόν να προσαρμοστεί στις ανάγκες των Ελληνικών μονάδων Υγείας και της Ελληνικής γλώσσας. Στο πλαίσιο της παρούσας εργασίας, συγκεντρώθηκαν και παρατίθενται επίσης πρότυπα ιατρικών εγγράφων απο ελληνικά νοσοκομεία που χρησιμοποιούν ΟΠΣΥ. Επίσης, προτείνονται μελλοντικές επεκτάσεις και βελτιώσεις στο ερευνητικό αντικείμενο αυτό όπως αυτές προκύπτουν από την διεθνή βιβλιογραφία. Τέλος στο Παράρτημα της εργασίας παρουσιάζονται αναλυτικά οι κώδικες των εγγράφων CDA. / With advances in technology, the health care system requires an amelioration of services offered, as well as cost control. The solution is given by Integrated Health Information Systems (IHIS), a discipline at the intersection of information science, computer science, and health care that deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, pharmacy, etc. The Cross-Enterprise Sharing of Medical Summary (XDS-MS) Integration Profile, a profile based on the HL7 Clinical Document Architecture (CDA) standard, defines the appropriate standards for document transmission and a minimum set of "record entries" that should be forwarded or made available to subsequent care provider(s) during specific transfer of care scenarios. In addition, this integration profile needs to define the utilization requirements/options for the receiving entity in order to ensure that the "care context" of the sending entity is appropriately maintained following the information transfer. So in this thesis there is an analysis of IHIS, with the paradigm of the medico//s software, as well as a presentation of coding systems in Heath Care Informatics. There are mentioned several systems, among which is found the HL7 one, analyzed by specific examples, and also the ICH-10. As for the latter there is a presentation of its greek translation as by the greek Ministry of Health. In the following chapters there is the description of the XDS-MS profile, both in its (english) version and the greek “translation”. In addition, there is a collection of medical documents by greek hospitals that use IHIS.

There is almost a universal agreement among scholars in information retrieval (IR) research that knowledge representation needs improvement. As core component of an IR system, improvement of the knowledge representation system has so far involved manipulation of this component based on principles such as vector space, probabilistic approach, inference network, and language modeling, yet the required improvement is still far from fruition. One promising approach that is highly touted to offer a potential solution exists in the cognitive paradigm, where knowledge representation practice should involve, or start from, modeling the human conceptual system. This study based on two related cognitive theories: the theory-based approach to concept representation and the psychological theory of semantic relations, ventured to explore the connection between the human conceptual model and the knowledge representation model (represented by samples of concepts and relations from the unified medical language system, UMLS). Guided by these cognitive theories and based on related and appropriate data-analytic tools, such as nonmetric multidimensional scaling, hierarchical clustering, and content analysis, this study aimed to conduct an exploratory investigation to answer four related questions. Divided into two groups, a total of 89 research participants took part in two sets of cognitive tasks. The first group (49 participants) sorted 60 food names into categories followed by simultaneous description of the derived categories to explain the rationale for category judgment. The second group (40 participants) performed sorting 47 semantic relations (the nonhierarchical associative types) into 5 categories known a priori. Three datasets resulted as a result of the cognitive tasks: food-sorting data, relation-sorting data, and free and unstructured text of category descriptions. Using the data analytic tools mentioned, data analysis was carried out and important results and findings were obtained that offer plausible explanations to the 4 research questions. Major results include the following: (a) through discriminant analysis category members were predicted consistently in 70% of the time; (b) the categorization bases are largely simplified rules, naïve explanations, and feature-based; (c) individuals theoretical explanation remains valid and stays stable across category members; (d) the human conceptual model can be fairly reconstructed in a low-dimensional space where 93% of the variance in the dimensional space is accounted for by the subjects performance; (e) participants consistently classify 29 of the 47 semantic relations; and, (f) individuals perform better in the functional and spatial dimensions of the semantic relations classification task and perform poorly in the conceptual dimension.

The World Wide Web has become a significant source of medical information for the public, but there is concern that much of the information is inaccurate, misleading, and unsupported by scientific evidence. This study analyzes the validity of health claims on the World Wide Web for the herbal Opuntia using an evidence-based approach, and supports the observation that individuals must critically assess health information in this relatively new medium of communication. A systematic search by means of nine search engines and online resources of Web sites relating to herbal remedies was conducted and specific sites providing information on the cactus herbal remedy from the genus Opuntia were retrieved. Validity of therapeutic health claims on the Web sites was checked by comparison with reports in the scientific literature subjected to two established quality assessment rating instruments. 184 Web sites from a variety of sources were retrieved and evaluated, and 98 distinct health claims were identified. 53 scientific reports were retrieved to validate claims. 25 involved human subjects, and 28 involved animal or laboratory models. Only 33 (34%) of the claims were addressed in the scientific literature. For 3% of the claims, evidence from the scientific reports was conflicting or contradictory. Of the scientific reports involving human subjects, none met the predefined criteria for high quality as determined by quality assessment rating instruments. Two-thirds of the claims were unsupported by scientific evidence and were based on folklore, or indirect evidence from related sources. Information on herbal remedies such as Opuntia is well represented on the World Wide Web. Health claims on Web sites were numerous and varied widely in subject matter. The determination of the validity of information about claims made for herbals on the Web would help individuals assess their value in medical treatment. However, the Web is conducive to dubious health information and individuals should exercise caution in accepting health claims unsupported by scientific evidence.

Nagrinėjama skirtingais medicinos informatikos standartais ar jų skirtingomis versijomis sąveikaujančių asmens sveikatos priežiūros įstaigos informacinių sistemių integracija. Pagal Kauno Dainavos poliklinikos informacinių sistemų integracijos uždavinius pasirinktas artimiausias teorinis integracijos modelis. Jo pagrindu parengti tarpinio (integracinio) IS sluoksnio/modulio funkciniai reikalavimai, užtikrinantys vienareikšmius paciento sąryšius su jo sveikatos duomenimis, esančiais skirtingose sistemose. Panaudojant medicinos informatikos standarto HL7 bibliotekas 2-ai ir 3-iai versijoms, sukurtas ir sėkmingai išbandytas tarpinio (integracinio) IS sluoksnio/modulio prototipas, leidžiantis automatiškai formuoti procedūrų užsakymo identifikatorius ir, jų pagrindu, nuorodas į duomenų archyvą. Integralumas tarp 2-os ir 3-os versijos sutampančių komponentų užtikrinamas trigeriais: įterpiant, keičiant bei trinant įrašus iš vietos versijos komponento, jis bus atitinkamai modifikuotas ir kitoje versijoje. Toks duomenų sluoksnio realizavimas leidžia sumažinti verslo logikos sluoksnio sudėtingumą, kai naudojama trijų lygių architektūra, bei pačių duomenų transformacijų skaičių. / The research is devoted to an integration of health information systems, when the interoperability should be utilised using different health informatics standards or their versions. To meet the integration goals, the theoretical model, closest to a particular situation of the Dainava outpatient clinic in Kaunas, had been chosen. Based on the model, the functional requirements for the middleware (integration) layer had been defined in order to ensure unambiguous links between patient data, stored in different systems. The middleware software prototype had been developed using messaging libraries for the HL7 versions v2 and v3. The middleware was successfully tested for automatic generation of orders for procedures and links to the procedure result data in the archive. The integration of the HL7 v2 and v3 coincidental components is achieved using trigger events for synchronous data manipulations. Such rules, implemented at the data layer, leads to less complex logics at business process layer and to lower number of data transformations. After automatic orders generation from referrals model implementation, we had to produce Worklist management system prototype to ensure full control of coming patient examinations. In this scenario DICOM based data models and terms had been chosen to use.

Το Τ.Ε.Π ( Τμήμα Επειγόντων Περιστατικών ) ενός νοσοκομειακού συγκροτήματος είναι Αυτόνομο Τμήμα στελεχωμένο από ιατρικό , νοσηλευτικό και παραϊατρικό προσωπικό και που καλείται να αντιμετωπίσει επείγοντα περιστατικά σε καθημερινή 24ωρη βάση. Αποτελεί το μοναδικό ίσως φορέα παροχής επείγουσας φροντίδας σε ολόκληρους πληθυσμούς νομών, δεδομένης της παντελούς έλλειψης ή ανεπάρκειας στη χώρα μας, υπηρεσιών πρωτοβάθμιας φροντίδας υγείας. Οι ανάγκες για παροχή υπηρεσιών υγείας αυξάνονται με ρυθμούς δυσανάλογους σε σχέση με τους διαθέσιμους πόρους για υγειονομική φροντίδα, γεγονός που δυσχεραίνει την εξασφάλιση της αποδοτικής λειτουργίας των Τ.Ε.Π και κατά συνέπεια δεν διασφαλίζεται η παροχή υψηλού επιπέδου υπηρεσιών. Για να επιτευχθεί η αποδοτική λειτουργία των Τ.Ε.Π θα πρέπει να εξευρεθούν τρόποι και λύσεις που θα αξιοποιούν και τις τεχνολογίες πληροφορικής και επικοινωνίας (Τ.Π.Ε) για την επιτάχυνση των λειτουργικών διεργασιών του Τ.Ε.Π και για την αποτελεσματική αντιμετώπιση των περιστατικών, διατηρώντας υψηλά το επίπεδο ικανοποίησης από τις παρεχόμενες υπηρεσίες όλων των ασθενών. / -

Contexto: A morbimortalidade por causas externas constitui um dos mais graves problemas de saúde pública global. Dentre as estratégias preventivas primárias, a educação para a segurança é uma das áreas em que é mais nítida a influência das concepções das pessoas sobre as atitudes e determinantes de vulnerabilidades e resiliências. Especialistas da disciplina do controle de injúrias físicas, no âmbito da língua inglesa, hegemônica, advogam pela proscrição do termo acidente, pelo menos do léxico acadêmico, mas também evitando o seu emprego na promoção da saúde, por conta de um potencial efeito negativo de suas alegadas acepções pré-científicas de imprevenibilidade nas ações educativas. Essa questão, ainda polêmica entre os pesquisadores de língua inglesa, nunca foi estudada na língua portuguesa. Seu estudo tem grande relevância para a inserção da pesquisa brasileira nas iniciativas em andamento, no âmbito mundial, para a normalização terminológica nesse campo de conhecimento. Observa-se uma tendência crescente na utilização do termo injúria, nos textos acadêmicos originais em português, com definição equivalente à dos textos em inglês, fenômeno que merece um olhar mais atento. Objetivos: Promover a inserção da discussão terminológica no campo das ciências médicas, por meio do olhar crítico sobre o impacto da passagem de falantes do português por cursos de graduação selecionados sobre suas concepções dos vocábulos acidente e injúria, principalmente quanto à associação com noções de causalidade, intencionalidade, previsibilidade e prevenibilidade. Métodos: Estudo observacional, transversal, com coleta de informações quantitativas por meio de enquete autoadministrada realizada integralmente pela internet. A amostra alvo compreendeu estudantes de primeiro e último ano de medicina, direito, comunicação e educação de todas as escolas da cidade de Porto Alegre, Brasil. Desenvolvemos um aplicativo original, capaz de recrutar respondentes, enviar convites pessoais por e-mail, armazenar as respostas e exportar os dados. O software e os dados foram hospedados em um site específico do projeto, com acesso permanente pela internet. As variáveis preditoras foram os seguintes atributos dos sujeitos: idade, sexo, estágio do curso, curso, inclinação política, espiritualidade, arrojo, hábito de ler instruções sobre produto de limpeza, fonte de orientação sobre segurança, uso do cinto de segurança, uso de assento infantil de segurança, uso de capacete de ciclista, modo de armazenar arma de fogo, experiência com perda de ente querido por causas externas, experiência de hospitalização por causas externas e conhecimento de causas de morte de crianças e de adolescentes. As variáveis de desfecho foram as seguintes concepções dos sujeitos acerca dos termos acidente, injúria e lesão: tipo de dano; associações de ideias com as três palavras; noções de fatalidade, intencionalidade, previsibilidade e prevenibilidade associadas à palavra acidente; associação de traumatismo cranioencefálico com injúria, acidente ou lesão; grau de prevenibilidade atribuído a cada uma das três palavras e culpabilidade da vítima num caso definido de acidente com criança. Para investigar a associação entre atributos e concepções submetemos os dados à análise de correspondência simples e ao teste qui-quadrado com análise de resíduos. Resultados: A taxa de resposta à enquete foi de 34,5%. Metade dos sujeitos responderam até o segundo dia, 66,3% durante a primeira semana. 4,2% dos sujeitos se recusaram a revelar sua religião e 19,2% se recusaram a revelar sua inclinação política, enquanto apenas 2,8% se recusaram a responder questões sobre concepções e atitudes. Não houve diferença significativa entre os que responderam cedo ou tarde, quanto a atributos e concepções selecionados. Estudantes de medicina se distinguiram dos demais pelas associações com a arreligiosidade, com o conhecimento de que a mortalidade de crianças e jovens se dá principalmente por causas externas e com o hábito de buscar orientação sobre segurança em fontes especializadas. Os sujeitos revelaram percepção preponderante de que os chamados acidentes são preveníveis e tal percepção não mudou se a palavra usada na pergunta foi injúria ou lesão. A palavra acidente evocou noções de prevenibilidade em 85,1% dos sujeitos, previsibilidade em 50,3%, fatalidade em 15,1%, e intencionalidade em 2,3%. Religiosidade apresentou correspondência com noções de não previsibilidade e fatalidade atribuídas à palavra acidente. Calouros associaram a palavra acidente a noções de não previsibilidade, enquanto formandos foram significativamente distintos em considerar que acidentes podem ser previstos. Os sujeitos associaram injúria com dano moral, de modo quase unânime e, em menor grau, com noções de calúnia e difamação; uma porção limitada associou injúria com dano físico e ferimento. Associaram mais a palavra lesão com dano físico, mas também revelaram concepções igualitárias de dano físico, moral e material. Estudantes de cursos e estágios diferentes variaram significativamente em suas concepções de acidente e injúria. Estudantes de medicina se colocaram em franca oposição aos de todos os demais cursos no tangente à associação de injúria com danos físicos. Estudantes de direito associaram acidente com noções de negligência, dano moral e difamação. Estudantes de educação associaram acidente com noções de não prevenibilidade e fatalidade. Conclusões: A enquete online para investigar concepções de estudantes universitários acerca de injúrias físicas é factível e produz taxas de resposta similares às da literatura. Um período de acompanhamento superior a três semanas não é recomendável; limitar os esforços de recrutamento de respondentes a esse tempo restrito permite uma concentração mais racional de recursos. A enquete online é efetiva na abordagem de questões sensíveis, como atitudes em segurança, inclinação religiosa e política. A análise geométrica de dados é eficaz em evidenciar correspondências entre um grande número de modalidades de variáveis categóricas e denota de modo apropriado as suas associações estatisticamente significativas. A análise de resíduos ajustados mais ratifica do que enfraquece a análise geométrica. O currículo médico promove a terminologização da palavra injúria. Um modelo conceptual da injúria como entidade nosológica tem que respeitar o fato da terminologização da palavra injúria no âmbito médico, assim como conceder que a significação leiga da palavra acidente é um evento antecedente não intencional e prevenível, potencialmente gerador de injúria. No âmbito da linguagem médica, há uma definição de espaços semânticos específicos para os termos lesão (com acepção de dano anatomopatológico sem causação externa) e injúria (com acepção de dano físico, com ou sem lesão). Noções populares vinculadas à palavra acidente têm mais sutilezas do que sustentam os que propugnam pelo seu banimento do léxico acadêmico. / Background: Morbidity and mortality due to external causes constitute one of the most serious public health problems worldwide. Among primary preventive strategies, safety education is one of the areas in which people's conceptions are more likely to influence both attitudes and determinants of vulnerability and resilience. Injury control experts, within the hegemonic English language, advocate for proscribing the term accident at least from the academic vocabulary, but also for avoiding its use in health promotion, due to a potential deleterious effect of its alleged pre-scientific notion of nonpreventability upon educative actions. Such issue, which is an ongoing controversy among English speaking researchers, has never been studied within the Portuguese realm. Its study bears great relevance towards introducing Brazilian research into the current worldwide initiatives pursuing terminology normalization within this field of knowledge. There is a growing trend of original academic texts written in Portuguese to use the term injury with an equivalent meaning to that used in English; this phenomenon deserves a harder look. Objectives: To promote the introduction of terminology discussion in the field of medical sciences, by means of a critical gaze upon how the passage of Portuguese speakers through selected undergraduate university courses may have an impact on their conceptions of the words accident and injury, mainly as to associations with notions of causality, intent, foreseeability and preventability. Methods: A cross-sectional observational study, which collected quantitative information by means of a self-administered web-based questionnaire. The target sample comprised first-year and last-year students of medical, law, communication and education schools in Porto Alegre, Brazil. We devised an original software application, which was capable of organizing the recruited information concerning prospective respondents, sending out customized e-mail invitations, gathering and housing response data in an online database, and exporting data to statistical softwares. All softwares and data were hosted in a project specific site with continuous Internet access. Predictor variables were the following subjects' attributes: age, sex, course stage, political and religious persuasion, risk-taking proclivity, habit of reading cleaning products' package insert instructions, source of safety orientation, safety belt wearing habits, use of child safety seat, cycling helmet wearing habits, gun storing, personal (or close relation) injury history, and knowledge about child and adolescent causes of death. Outcome variables were the following conceptions of the terms accident, injury and lesion: type of damage; associations of some ideas with the three words; notions of fatality, intent, foreseeability and preventability associated with the word accident; association of head trauma with accident, injury and lesion; degree of preventability attributed to each of the three words; and victim culpability in a case of child accident. We investigated associations between attributes and conceptions by means of simple correspondence analysis and chi-square test with residual analysis. Results: The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. 4.2% subjects refused to disclose religious persuasion, and 19.2% refused to disclose political persuasion, whereas only 2.8%, on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions. Medical students were distinguished from the rest due to their associations with nonreligiosity, knowledge that most child and youth deaths have external causes, and searching safety orientation in specialized sources. Subjects showed preponderant perception that so-called accidents are preventable, and such perception did not change whether the question used the word injury or lesion. The word accident evoked the notion of preventability to 85.1% of the subjects, foreseeability to 50.3%, fatality to 15.1%, and intentionality to 2.3%. Religiosity showed correspondence with notions of nonprevisibility and fatality being attributed to the word accident. First-year students associated the word accident with notions of nonprevisibility, while last-year students were significantly distinct as they considered that accidents can be foreseen. Subjects unanimously associated injury with moral damage, and to a lesser degree with notions of calumny and defamation; a limited portion associated injury with physical damage and wound. They mainly associated the word lesion with physical damage, but also revealed equivalent conceptions of physical, moral, and material damage. Students from different courses and stages significantly varied in their conceptions of accident and injury. Medical students were in stark opposition to those from the other courses as to their association of injury with physical damage. Law students associated accident with notions of negligence, moral damage, and defamation. Education students associated accident with notions of nonpreventability and fatality. Conclusions: Web surveying university students' conceptions about injuries is feasible and yields response rates similar to those found in the literature. A follow-up period longer than three weeks is not warranted; restricting recruiting efforts to such period of time allows a more rational allocation of resources. A web survey is effective in tackling sensitive issues, such as safety attitudes, religious and political persuasion. Geometric data analysis is efficacious in evincing correspondences among a great number of categorical variable modalities, and appropriately denotes their statistically significant associations. The adjusted standardized residual analysis ratifies more than weakens the geometric analysis. Medical curriculum promotes the terminologization of the word injury. A conceptual framework of injury as a nosologic entity must acknowledge the fact of terminologization of the word injury in the medical realm, as well as concede the lay signification of the word accident as an anteceding, unintentional, and preventable event, which potentially causes injury. Within the realm of medical language, there is a definition of specific semantic spaces for the terms lesion (with the acception of anatomopathological damage without external causation) and injury (with the acception of physical damage, with or without lesion). Lay notions of the word accident carry more subtleties than those who advocate for banning it from the academic lexicon maintain.

Contexto: A morbimortalidade por causas externas constitui um dos mais graves problemas de saúde pública global. Dentre as estratégias preventivas primárias, a educação para a segurança é uma das áreas em que é mais nítida a influência das concepções das pessoas sobre as atitudes e determinantes de vulnerabilidades e resiliências. Especialistas da disciplina do controle de injúrias físicas, no âmbito da língua inglesa, hegemônica, advogam pela proscrição do termo acidente, pelo menos do léxico acadêmico, mas também evitando o seu emprego na promoção da saúde, por conta de um potencial efeito negativo de suas alegadas acepções pré-científicas de imprevenibilidade nas ações educativas. Essa questão, ainda polêmica entre os pesquisadores de língua inglesa, nunca foi estudada na língua portuguesa. Seu estudo tem grande relevância para a inserção da pesquisa brasileira nas iniciativas em andamento, no âmbito mundial, para a normalização terminológica nesse campo de conhecimento. Observa-se uma tendência crescente na utilização do termo injúria, nos textos acadêmicos originais em português, com definição equivalente à dos textos em inglês, fenômeno que merece um olhar mais atento. Objetivos: Promover a inserção da discussão terminológica no campo das ciências médicas, por meio do olhar crítico sobre o impacto da passagem de falantes do português por cursos de graduação selecionados sobre suas concepções dos vocábulos acidente e injúria, principalmente quanto à associação com noções de causalidade, intencionalidade, previsibilidade e prevenibilidade. Métodos: Estudo observacional, transversal, com coleta de informações quantitativas por meio de enquete autoadministrada realizada integralmente pela internet. A amostra alvo compreendeu estudantes de primeiro e último ano de medicina, direito, comunicação e educação de todas as escolas da cidade de Porto Alegre, Brasil. Desenvolvemos um aplicativo original, capaz de recrutar respondentes, enviar convites pessoais por e-mail, armazenar as respostas e exportar os dados. O software e os dados foram hospedados em um site específico do projeto, com acesso permanente pela internet. As variáveis preditoras foram os seguintes atributos dos sujeitos: idade, sexo, estágio do curso, curso, inclinação política, espiritualidade, arrojo, hábito de ler instruções sobre produto de limpeza, fonte de orientação sobre segurança, uso do cinto de segurança, uso de assento infantil de segurança, uso de capacete de ciclista, modo de armazenar arma de fogo, experiência com perda de ente querido por causas externas, experiência de hospitalização por causas externas e conhecimento de causas de morte de crianças e de adolescentes. As variáveis de desfecho foram as seguintes concepções dos sujeitos acerca dos termos acidente, injúria e lesão: tipo de dano; associações de ideias com as três palavras; noções de fatalidade, intencionalidade, previsibilidade e prevenibilidade associadas à palavra acidente; associação de traumatismo cranioencefálico com injúria, acidente ou lesão; grau de prevenibilidade atribuído a cada uma das três palavras e culpabilidade da vítima num caso definido de acidente com criança. Para investigar a associação entre atributos e concepções submetemos os dados à análise de correspondência simples e ao teste qui-quadrado com análise de resíduos. Resultados: A taxa de resposta à enquete foi de 34,5%. Metade dos sujeitos responderam até o segundo dia, 66,3% durante a primeira semana. 4,2% dos sujeitos se recusaram a revelar sua religião e 19,2% se recusaram a revelar sua inclinação política, enquanto apenas 2,8% se recusaram a responder questões sobre concepções e atitudes. Não houve diferença significativa entre os que responderam cedo ou tarde, quanto a atributos e concepções selecionados. Estudantes de medicina se distinguiram dos demais pelas associações com a arreligiosidade, com o conhecimento de que a mortalidade de crianças e jovens se dá principalmente por causas externas e com o hábito de buscar orientação sobre segurança em fontes especializadas. Os sujeitos revelaram percepção preponderante de que os chamados acidentes são preveníveis e tal percepção não mudou se a palavra usada na pergunta foi injúria ou lesão. A palavra acidente evocou noções de prevenibilidade em 85,1% dos sujeitos, previsibilidade em 50,3%, fatalidade em 15,1%, e intencionalidade em 2,3%. Religiosidade apresentou correspondência com noções de não previsibilidade e fatalidade atribuídas à palavra acidente. Calouros associaram a palavra acidente a noções de não previsibilidade, enquanto formandos foram significativamente distintos em considerar que acidentes podem ser previstos. Os sujeitos associaram injúria com dano moral, de modo quase unânime e, em menor grau, com noções de calúnia e difamação; uma porção limitada associou injúria com dano físico e ferimento. Associaram mais a palavra lesão com dano físico, mas também revelaram concepções igualitárias de dano físico, moral e material. Estudantes de cursos e estágios diferentes variaram significativamente em suas concepções de acidente e injúria. Estudantes de medicina se colocaram em franca oposição aos de todos os demais cursos no tangente à associação de injúria com danos físicos. Estudantes de direito associaram acidente com noções de negligência, dano moral e difamação. Estudantes de educação associaram acidente com noções de não prevenibilidade e fatalidade. Conclusões: A enquete online para investigar concepções de estudantes universitários acerca de injúrias físicas é factível e produz taxas de resposta similares às da literatura. Um período de acompanhamento superior a três semanas não é recomendável; limitar os esforços de recrutamento de respondentes a esse tempo restrito permite uma concentração mais racional de recursos. A enquete online é efetiva na abordagem de questões sensíveis, como atitudes em segurança, inclinação religiosa e política. A análise geométrica de dados é eficaz em evidenciar correspondências entre um grande número de modalidades de variáveis categóricas e denota de modo apropriado as suas associações estatisticamente significativas. A análise de resíduos ajustados mais ratifica do que enfraquece a análise geométrica. O currículo médico promove a terminologização da palavra injúria. Um modelo conceptual da injúria como entidade nosológica tem que respeitar o fato da terminologização da palavra injúria no âmbito médico, assim como conceder que a significação leiga da palavra acidente é um evento antecedente não intencional e prevenível, potencialmente gerador de injúria. No âmbito da linguagem médica, há uma definição de espaços semânticos específicos para os termos lesão (com acepção de dano anatomopatológico sem causação externa) e injúria (com acepção de dano físico, com ou sem lesão). Noções populares vinculadas à palavra acidente têm mais sutilezas do que sustentam os que propugnam pelo seu banimento do léxico acadêmico. / Background: Morbidity and mortality due to external causes constitute one of the most serious public health problems worldwide. Among primary preventive strategies, safety education is one of the areas in which people's conceptions are more likely to influence both attitudes and determinants of vulnerability and resilience. Injury control experts, within the hegemonic English language, advocate for proscribing the term accident at least from the academic vocabulary, but also for avoiding its use in health promotion, due to a potential deleterious effect of its alleged pre-scientific notion of nonpreventability upon educative actions. Such issue, which is an ongoing controversy among English speaking researchers, has never been studied within the Portuguese realm. Its study bears great relevance towards introducing Brazilian research into the current worldwide initiatives pursuing terminology normalization within this field of knowledge. There is a growing trend of original academic texts written in Portuguese to use the term injury with an equivalent meaning to that used in English; this phenomenon deserves a harder look. Objectives: To promote the introduction of terminology discussion in the field of medical sciences, by means of a critical gaze upon how the passage of Portuguese speakers through selected undergraduate university courses may have an impact on their conceptions of the words accident and injury, mainly as to associations with notions of causality, intent, foreseeability and preventability. Methods: A cross-sectional observational study, which collected quantitative information by means of a self-administered web-based questionnaire. The target sample comprised first-year and last-year students of medical, law, communication and education schools in Porto Alegre, Brazil. We devised an original software application, which was capable of organizing the recruited information concerning prospective respondents, sending out customized e-mail invitations, gathering and housing response data in an online database, and exporting data to statistical softwares. All softwares and data were hosted in a project specific site with continuous Internet access. Predictor variables were the following subjects' attributes: age, sex, course stage, political and religious persuasion, risk-taking proclivity, habit of reading cleaning products' package insert instructions, source of safety orientation, safety belt wearing habits, use of child safety seat, cycling helmet wearing habits, gun storing, personal (or close relation) injury history, and knowledge about child and adolescent causes of death. Outcome variables were the following conceptions of the terms accident, injury and lesion: type of damage; associations of some ideas with the three words; notions of fatality, intent, foreseeability and preventability associated with the word accident; association of head trauma with accident, injury and lesion; degree of preventability attributed to each of the three words; and victim culpability in a case of child accident. We investigated associations between attributes and conceptions by means of simple correspondence analysis and chi-square test with residual analysis. Results: The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. 4.2% subjects refused to disclose religious persuasion, and 19.2% refused to disclose political persuasion, whereas only 2.8%, on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions. Medical students were distinguished from the rest due to their associations with nonreligiosity, knowledge that most child and youth deaths have external causes, and searching safety orientation in specialized sources. Subjects showed preponderant perception that so-called accidents are preventable, and such perception did not change whether the question used the word injury or lesion. The word accident evoked the notion of preventability to 85.1% of the subjects, foreseeability to 50.3%, fatality to 15.1%, and intentionality to 2.3%. Religiosity showed correspondence with notions of nonprevisibility and fatality being attributed to the word accident. First-year students associated the word accident with notions of nonprevisibility, while last-year students were significantly distinct as they considered that accidents can be foreseen. Subjects unanimously associated injury with moral damage, and to a lesser degree with notions of calumny and defamation; a limited portion associated injury with physical damage and wound. They mainly associated the word lesion with physical damage, but also revealed equivalent conceptions of physical, moral, and material damage. Students from different courses and stages significantly varied in their conceptions of accident and injury. Medical students were in stark opposition to those from the other courses as to their association of injury with physical damage. Law students associated accident with notions of negligence, moral damage, and defamation. Education students associated accident with notions of nonpreventability and fatality. Conclusions: Web surveying university students' conceptions about injuries is feasible and yields response rates similar to those found in the literature. A follow-up period longer than three weeks is not warranted; restricting recruiting efforts to such period of time allows a more rational allocation of resources. A web survey is effective in tackling sensitive issues, such as safety attitudes, religious and political persuasion. Geometric data analysis is efficacious in evincing correspondences among a great number of categorical variable modalities, and appropriately denotes their statistically significant associations. The adjusted standardized residual analysis ratifies more than weakens the geometric analysis. Medical curriculum promotes the terminologization of the word injury. A conceptual framework of injury as a nosologic entity must acknowledge the fact of terminologization of the word injury in the medical realm, as well as concede the lay signification of the word accident as an anteceding, unintentional, and preventable event, which potentially causes injury. Within the realm of medical language, there is a definition of specific semantic spaces for the terms lesion (with the acception of anatomopathological damage without external causation) and injury (with the acception of physical damage, with or without lesion). Lay notions of the word accident carry more subtleties than those who advocate for banning it from the academic lexicon maintain.

Contexto: A morbimortalidade por causas externas constitui um dos mais graves problemas de saúde pública global. Dentre as estratégias preventivas primárias, a educação para a segurança é uma das áreas em que é mais nítida a influência das concepções das pessoas sobre as atitudes e determinantes de vulnerabilidades e resiliências. Especialistas da disciplina do controle de injúrias físicas, no âmbito da língua inglesa, hegemônica, advogam pela proscrição do termo acidente, pelo menos do léxico acadêmico, mas também evitando o seu emprego na promoção da saúde, por conta de um potencial efeito negativo de suas alegadas acepções pré-científicas de imprevenibilidade nas ações educativas. Essa questão, ainda polêmica entre os pesquisadores de língua inglesa, nunca foi estudada na língua portuguesa. Seu estudo tem grande relevância para a inserção da pesquisa brasileira nas iniciativas em andamento, no âmbito mundial, para a normalização terminológica nesse campo de conhecimento. Observa-se uma tendência crescente na utilização do termo injúria, nos textos acadêmicos originais em português, com definição equivalente à dos textos em inglês, fenômeno que merece um olhar mais atento. Objetivos: Promover a inserção da discussão terminológica no campo das ciências médicas, por meio do olhar crítico sobre o impacto da passagem de falantes do português por cursos de graduação selecionados sobre suas concepções dos vocábulos acidente e injúria, principalmente quanto à associação com noções de causalidade, intencionalidade, previsibilidade e prevenibilidade. Métodos: Estudo observacional, transversal, com coleta de informações quantitativas por meio de enquete autoadministrada realizada integralmente pela internet. A amostra alvo compreendeu estudantes de primeiro e último ano de medicina, direito, comunicação e educação de todas as escolas da cidade de Porto Alegre, Brasil. Desenvolvemos um aplicativo original, capaz de recrutar respondentes, enviar convites pessoais por e-mail, armazenar as respostas e exportar os dados. O software e os dados foram hospedados em um site específico do projeto, com acesso permanente pela internet. As variáveis preditoras foram os seguintes atributos dos sujeitos: idade, sexo, estágio do curso, curso, inclinação política, espiritualidade, arrojo, hábito de ler instruções sobre produto de limpeza, fonte de orientação sobre segurança, uso do cinto de segurança, uso de assento infantil de segurança, uso de capacete de ciclista, modo de armazenar arma de fogo, experiência com perda de ente querido por causas externas, experiência de hospitalização por causas externas e conhecimento de causas de morte de crianças e de adolescentes. As variáveis de desfecho foram as seguintes concepções dos sujeitos acerca dos termos acidente, injúria e lesão: tipo de dano; associações de ideias com as três palavras; noções de fatalidade, intencionalidade, previsibilidade e prevenibilidade associadas à palavra acidente; associação de traumatismo cranioencefálico com injúria, acidente ou lesão; grau de prevenibilidade atribuído a cada uma das três palavras e culpabilidade da vítima num caso definido de acidente com criança. Para investigar a associação entre atributos e concepções submetemos os dados à análise de correspondência simples e ao teste qui-quadrado com análise de resíduos. Resultados: A taxa de resposta à enquete foi de 34,5%. Metade dos sujeitos responderam até o segundo dia, 66,3% durante a primeira semana. 4,2% dos sujeitos se recusaram a revelar sua religião e 19,2% se recusaram a revelar sua inclinação política, enquanto apenas 2,8% se recusaram a responder questões sobre concepções e atitudes. Não houve diferença significativa entre os que responderam cedo ou tarde, quanto a atributos e concepções selecionados. Estudantes de medicina se distinguiram dos demais pelas associações com a arreligiosidade, com o conhecimento de que a mortalidade de crianças e jovens se dá principalmente por causas externas e com o hábito de buscar orientação sobre segurança em fontes especializadas. Os sujeitos revelaram percepção preponderante de que os chamados acidentes são preveníveis e tal percepção não mudou se a palavra usada na pergunta foi injúria ou lesão. A palavra acidente evocou noções de prevenibilidade em 85,1% dos sujeitos, previsibilidade em 50,3%, fatalidade em 15,1%, e intencionalidade em 2,3%. Religiosidade apresentou correspondência com noções de não previsibilidade e fatalidade atribuídas à palavra acidente. Calouros associaram a palavra acidente a noções de não previsibilidade, enquanto formandos foram significativamente distintos em considerar que acidentes podem ser previstos. Os sujeitos associaram injúria com dano moral, de modo quase unânime e, em menor grau, com noções de calúnia e difamação; uma porção limitada associou injúria com dano físico e ferimento. Associaram mais a palavra lesão com dano físico, mas também revelaram concepções igualitárias de dano físico, moral e material. Estudantes de cursos e estágios diferentes variaram significativamente em suas concepções de acidente e injúria. Estudantes de medicina se colocaram em franca oposição aos de todos os demais cursos no tangente à associação de injúria com danos físicos. Estudantes de direito associaram acidente com noções de negligência, dano moral e difamação. Estudantes de educação associaram acidente com noções de não prevenibilidade e fatalidade. Conclusões: A enquete online para investigar concepções de estudantes universitários acerca de injúrias físicas é factível e produz taxas de resposta similares às da literatura. Um período de acompanhamento superior a três semanas não é recomendável; limitar os esforços de recrutamento de respondentes a esse tempo restrito permite uma concentração mais racional de recursos. A enquete online é efetiva na abordagem de questões sensíveis, como atitudes em segurança, inclinação religiosa e política. A análise geométrica de dados é eficaz em evidenciar correspondências entre um grande número de modalidades de variáveis categóricas e denota de modo apropriado as suas associações estatisticamente significativas. A análise de resíduos ajustados mais ratifica do que enfraquece a análise geométrica. O currículo médico promove a terminologização da palavra injúria. Um modelo conceptual da injúria como entidade nosológica tem que respeitar o fato da terminologização da palavra injúria no âmbito médico, assim como conceder que a significação leiga da palavra acidente é um evento antecedente não intencional e prevenível, potencialmente gerador de injúria. No âmbito da linguagem médica, há uma definição de espaços semânticos específicos para os termos lesão (com acepção de dano anatomopatológico sem causação externa) e injúria (com acepção de dano físico, com ou sem lesão). Noções populares vinculadas à palavra acidente têm mais sutilezas do que sustentam os que propugnam pelo seu banimento do léxico acadêmico. / Background: Morbidity and mortality due to external causes constitute one of the most serious public health problems worldwide. Among primary preventive strategies, safety education is one of the areas in which people's conceptions are more likely to influence both attitudes and determinants of vulnerability and resilience. Injury control experts, within the hegemonic English language, advocate for proscribing the term accident at least from the academic vocabulary, but also for avoiding its use in health promotion, due to a potential deleterious effect of its alleged pre-scientific notion of nonpreventability upon educative actions. Such issue, which is an ongoing controversy among English speaking researchers, has never been studied within the Portuguese realm. Its study bears great relevance towards introducing Brazilian research into the current worldwide initiatives pursuing terminology normalization within this field of knowledge. There is a growing trend of original academic texts written in Portuguese to use the term injury with an equivalent meaning to that used in English; this phenomenon deserves a harder look. Objectives: To promote the introduction of terminology discussion in the field of medical sciences, by means of a critical gaze upon how the passage of Portuguese speakers through selected undergraduate university courses may have an impact on their conceptions of the words accident and injury, mainly as to associations with notions of causality, intent, foreseeability and preventability. Methods: A cross-sectional observational study, which collected quantitative information by means of a self-administered web-based questionnaire. The target sample comprised first-year and last-year students of medical, law, communication and education schools in Porto Alegre, Brazil. We devised an original software application, which was capable of organizing the recruited information concerning prospective respondents, sending out customized e-mail invitations, gathering and housing response data in an online database, and exporting data to statistical softwares. All softwares and data were hosted in a project specific site with continuous Internet access. Predictor variables were the following subjects' attributes: age, sex, course stage, political and religious persuasion, risk-taking proclivity, habit of reading cleaning products' package insert instructions, source of safety orientation, safety belt wearing habits, use of child safety seat, cycling helmet wearing habits, gun storing, personal (or close relation) injury history, and knowledge about child and adolescent causes of death. Outcome variables were the following conceptions of the terms accident, injury and lesion: type of damage; associations of some ideas with the three words; notions of fatality, intent, foreseeability and preventability associated with the word accident; association of head trauma with accident, injury and lesion; degree of preventability attributed to each of the three words; and victim culpability in a case of child accident. We investigated associations between attributes and conceptions by means of simple correspondence analysis and chi-square test with residual analysis. Results: The response rate was 34.5%. Half of the subjects responded by the second day, 66.3% during the first week. 4.2% subjects refused to disclose religious persuasion, and 19.2% refused to disclose political persuasion, whereas only 2.8%, on average, refused to answer questions on conceptions and attitudes. There was no significant difference between early and late respondents in respect to selected attributes and conceptions. Medical students were distinguished from the rest due to their associations with nonreligiosity, knowledge that most child and youth deaths have external causes, and searching safety orientation in specialized sources. Subjects showed preponderant perception that so-called accidents are preventable, and such perception did not change whether the question used the word injury or lesion. The word accident evoked the notion of preventability to 85.1% of the subjects, foreseeability to 50.3%, fatality to 15.1%, and intentionality to 2.3%. Religiosity showed correspondence with notions of nonprevisibility and fatality being attributed to the word accident. First-year students associated the word accident with notions of nonprevisibility, while last-year students were significantly distinct as they considered that accidents can be foreseen. Subjects unanimously associated injury with moral damage, and to a lesser degree with notions of calumny and defamation; a limited portion associated injury with physical damage and wound. They mainly associated the word lesion with physical damage, but also revealed equivalent conceptions of physical, moral, and material damage. Students from different courses and stages significantly varied in their conceptions of accident and injury. Medical students were in stark opposition to those from the other courses as to their association of injury with physical damage. Law students associated accident with notions of negligence, moral damage, and defamation. Education students associated accident with notions of nonpreventability and fatality. Conclusions: Web surveying university students' conceptions about injuries is feasible and yields response rates similar to those found in the literature. A follow-up period longer than three weeks is not warranted; restricting recruiting efforts to such period of time allows a more rational allocation of resources. A web survey is effective in tackling sensitive issues, such as safety attitudes, religious and political persuasion. Geometric data analysis is efficacious in evincing correspondences among a great number of categorical variable modalities, and appropriately denotes their statistically significant associations. The adjusted standardized residual analysis ratifies more than weakens the geometric analysis. Medical curriculum promotes the terminologization of the word injury. A conceptual framework of injury as a nosologic entity must acknowledge the fact of terminologization of the word injury in the medical realm, as well as concede the lay signification of the word accident as an anteceding, unintentional, and preventable event, which potentially causes injury. Within the realm of medical language, there is a definition of specific semantic spaces for the terms lesion (with the acception of anatomopathological damage without external causation) and injury (with the acception of physical damage, with or without lesion). Lay notions of the word accident carry more subtleties than those who advocate for banning it from the academic lexicon maintain.

Patient’s mobility throughout his lifetime leaves a trial of information scattered in laboratories, clinical institutes, primary care units, and other hospitals. Hence, the medical history of a patient is valuable when subjected to special healthcare units or undergoes home-care/personal-care in elderly stage cases. Despite the rhetoric about patient-centred care, few attempts were made to measure and improve in this arena. In this thesis, we will describe and implement a high-level view of a Patient Centric information management, deploying at a preliminary stage, the use of Agent Technologies and Grid Computing. Thus, developing and proposing an infrastructure that allows us to monitor and survey the patient, from the doctor’s point of view, and investigate a Persona, from the patients’ side, that functions and collaborates among different medical information structures. The Persona will attempt to interconnect all the major agents (human and software), and realize a distributed grid info-structure that directly affect the patient, therefore, revealing an adequate and cost-effective solution for most critical information needs. The results comprehended in the literature survey, consolidating Healthcare Information Management with emerged intelligent Multi-Agent System Technologies (MAS) and Grid Computing; intends to provide a solid basis for further advancements and assessments in this field, by bridging and proposing a framework between the home-care sector and the flexible agent architecture throughout the healthcare domain.