L’objectif de cette thèse était d’investiguer différents choix méthodologiques, en particulier le choix du délai et la prise en compte des causes médicales de décès, dans l’élaboration des indicateurs de mortalité post-hospitalière visant à refléter la qualité des soins.Dans une première phase, les données médico-administratives hospitalières des bénéficiaires du Régime Général (RG) de l’Assurance Maladie décédés dans l'année suivant une hospitalisation en 2008 ou 2009 ont été appariées aux causes de décès (base du CépiDc). Le taux d’appariement était de 96,4%.Dans une deuxième phase les séjours pour lesquels la cause initiale de décès pouvait être qualifiée d'indépendante du diagnostic principal du séjour ont été repérés à l'aide d'un algorithme et d'un logiciel s'appuyant sur des standards internationaux. Dans une troisième phase, le modèle le plus souvent utilisé à l'international pour évaluer la mortalité intra-hospitalière (modèle « de Jarman ») a été reproduit et utilisé pour construire des indicateurs de mortalité par établissement à 30, 60, 90, 180 et 365 jours post-admission, pour l'année 2009 (12 322 831 séjours PMSI-MCO des bénéficiaires du RG).L’indicateur de mortalité intra-hospitalière s’est révélé biaisé par les pratiques de sortie des établissements (caractérisées par la durée moyenne de séjour et le taux de transfert vers d’autres établissements). Les indicateurs à 60 ou 90 jours post-admission doivent être préférés à l’indicateur à 30 jours car ils ont l’avantage d’inclure presque tous les décès intra-hospitaliers, limitant notamment les incitations à maintenir les patients en vie jusqu’à la fin de la période de suivi et/ou à cesser de leur dédier des ressources une fois ce terme atteint. L’utilisation des causes de décès en supprimant les décès indépendants change de façon négligeable les indicateurs de mortalité globale par établissement, toutefois elle pourrait être utile pour des indicateurs spécifiques, limités à certaines pathologies ou procédures.Des réserves quant à la pertinence de ces indicateurs ont été décrites (limites du modèle et des variables d'ajustement, hétérogénéité de la qualité du codage entre les établissements), mettant en évidence la nécessité de recherches complémentaires, en particulier sur leur capacité à refléter la qualité des soins et sur l’impact de leur diffusion publique. A ce jour, l’interprétation des indicateurs de mortalité par établissement nécessite la plus grande prudence. / The main objective of this PhD work was to investigate different methodological options for the elaboration of post hospital mortality indicators aiming at reflecting quality of care, in particular to identify the most relevant timeframes and to assess the contribution of the causes of death information.In a first phase, the hospital discharge data of the French General health insurance scheme beneficiaries who died during the year following an hospital stay in 2008 or 2009 were linked to the cause of death register. The matching rate was 96.4%.In a second phase, the hospital stays for which the underlying cause of death could be qualified as independent from the main diagnosis were identified with an algorithm and a software relying on international standards.In a third phase, the method most widely used to assess in-hospital mortality (Dr Foster Unit method) was reproduced and used to construct hospital mortality indicators at 30, 60, 90, 180 et 365 days post-admission, on year 2009 (12 322 831 acute-care stays)..As in other countries, in-hospital mortality revealed biased by discharge patterns in the French data: hospitals : short length-of-stay or high transfer-out rates for comparable casemix tend to have lower in-hospital mortality. The 60-day and 90-day indicators should be preferred to the 30-day indicator, because they reflect a larger part of in-hospital mortality, and are less subject to the incentives either to maintain patients alive until the end of the follow-up window or to shift resources away when this length of stay is reached. The contribution of the causes of death seems negligible in the context of hospital-wide indicators, but it could prove its utility in future health services research about specific indicators limited to selected conditions or procedures.However, reservations about the relevance of hospital-wide mortality indicators aiming at assessing quality of care are described (limits of the statistical model and adjustment variables available, heterogeneity of the coding quality between hospitals). Further research is needed, in particular on the capacity of these indicators to reflect quality of care and on the impact of their public reporting. To date, the use of hospital-wide mortality indicators needs to be extremely cautious.

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No. of bitstreams: 2 Queiroz, Ana Carolina de Castro Mendonça-2013-Dissertação.pdf: 1461928 bytes, checksum: 1e938ff9a4c4df1f3a83d36e1fc6e349 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-04-27 / Patients with advanced cancer are impaired in their various dimensions and therefore have a higher risk for developing pressure ulcers (PU). Little is known about the magnitude of this problem in patients receiving palliative care which hampers progress in comprehensive care for the patient and family. In order to broaden the understanding of the topic, this study was developed with the purpose to analyze the pressure ulcers and the risk for development of pressure ulcers in cancer patients receiving palliative home care. This is a longitudinal, descriptive and quantitative approach, closed cohort, conducted at the Grupo de Apoio Paliativo ao Paciente Oncológico of the Associação de Combate ao Câncer de Goiás, from December 2011 to July 2012. Data collection was performed on 7 evaluations. The first evaluation was undertaken at the patient’s home through interview and clinical assessment of patients. The remaining evaluations were done via telephone 7, 14, 21 and 28 days after the first evaluation. Forty-five and 90 days after the date of inclusion in the study, patients were assessed for survival. Data on sociodemographic, clinical, PU (when present), risk of PU by the Braden Scale and if patient was alive or not was collected. Descriptive analysis was performed as well as the Fisher exact test and associations were considered significant when p<0.05. The study included 64 patients with cancer in palliative care (68.8% male, 45.3% white, 54.7% under 70 years old, 62.5% with KPS <50%, 57.8% with urinary incontinence). Forty-six patients completed the evaluations to D28, and at 45 and 90 days, a total of 25 and 33 participants had died, respectively. Twelve (18.8%) patients had PU. Of these, 75.0% were men, they had one to three PUs, totaling 19 lesions, of which 89.4% started at home and 47.4% were stage 3 lesions. The only statistically significant difference between the groups was that the presence of PU was more frequent among those who already had a history of previous wound. There was an increased risk of PU throughout the study period and found that the risk for PU was higher in those who died within 45 days after the first evaluation. There was no significant association between PU and survival using the Kaplan-Meier method (p=0.072). PU consisted of a significant event occurring in the population studied and the risk increased with the approach of death. This indicates that systematic care for prevention of PU to reduce risk and achieve early diagnosis of PU should be performed by palliative care health team, minimizing the suffering of terminal patients. / Pacientes com câncer avançado apresentam-se debilitados em seus diversos domínios e, consequentemente, apresentam maior risco para o desenvolvimento de Úlcera Por Pressão (UPP). Pouco se sabe sobre a magnitude desse problema em pacientes recebendo cuidados paliativos o que dificulta o avanço no cuidado integral ao paciente e família. Com a finalidade de ampliar a compreensão sobre o tema, o presente estudo foi desenvolvido com o objetivo de analisar as úlceras por pressão e o risco para desenvolvimento de úlceras por pressão em pessoas com câncer em cuidados paliativos domiciliares. Trata-se de um estudo longitudinal, descritivo, com abordagem quantitativa, tipo coorte fechada. conduzido no Grupo de Apoio Paliativo ao Paciente Oncológico da Associação de Combate ao Câncer de Goiás, no período de dezembro de 2011 a julho de 2012. A coleta de dados foi realizada em 7 momentos. No primeiro momento, a coleta foi realizada no domicílio por meio de entrevista e avaliação clínica dos pacientes. As demais coletas foram realizadas via telefone nos dias 7, 14, 21 e 28 após a primeira avaliação. Quarenta e cinco e 90 dias após a data de inclusão no estudo, buscou-se identificar se o paciente estava vivo. Foram coletados dados sociodemográficos, clínicos, sobre a UPP (quando presente), risco de UPP pela Escala de Braden e se estava vivo ou não. Foi realizada análise descritiva, o teste exato de Fischer e consideraram-se significativas as associações com p<0,05. Participaram do estudo 64 pacientes com câncer em cuidados paliativos (68,8% homens, 45,3% brancos, 54,7% com idade menor que 70 anos, 62,5% com KPS <50%, 57,8% com incontinência urinária). Quarenta e seis pacientes completaram as avaliações propostas até D28 e ao final de 45 e 90 dias, um total de 25 e 33 participantes tinham ido a óbito, respectivamente. Doze (18,8%) pacientes apresentaram UPP, dos quais 75,0% eram homens. Os participantes apresentaram de uma a três UPPs, totalizando 19 lesões, sendo que 89,4% surgiram no domicílio e 47,4% de estágio 3. A única diferença estatisticamente significante entre os grupos foi de que a presença de UPP foi mais frequente entre aqueles que já tinham história de lesão anterior. Houve aumento do risco de UPP ao longo do período de estudo e observou-se que o risco para UPP foi maior naqueles que morreram até 45 dias após a primeira avaliação. Não houve associação significativa entre UPP e sobrevida pela curva de Kaplan-Meier (p=0,072). UPP consistiu em evento de ocorrência expressiva na população estudada e o risco é cada vez maior com a aproximação da morte. Isso indica que cuidados sistematizados para prevenção de UPP a fim de reduzir riscos e realizar diagnóstico precoce de UPP, minimizando sofrimento na terminalidade, devem ser incluídos na atuação das equipes de cuidados paliativos domiciliares.

Made available in DSpace on 2016-04-29T14:17:35Z (GMT). No. of bitstreams: 1 Lucirley Mazera.pdf: 737252 bytes, checksum: eda4ba22395bf86bca4d5ab4433b5246 (MD5) Previous issue date: 2008-10-14 / Chronic renal disease and hemodialysis treatment imposes a big strain and series of limitations to the patient, with regard of the biological, sociological, and psychological perspectives. In this context, practical intervention of the social work is of great need and relevance. The research objective was the understanding of the social modifications in the lifestyle of chronic renal disease patients submitted to hemodialysis treatment from the patient's most significative experiences and introspective reflections about the illness and it's treatment. From our experience and the results obtained from the present investigation, some remarkable aspects are: the public health policies contribution aimed to patients with chronic renal disease, such as rights assurance, based on ANVISA's RDC-154 (2004); the knowledge correlated to the social stigma and to the discriminatory process imposed by the illness-related segregation; the importance of the actuation of the Social Services with the chronic renal patients submitted to hemodialysis, through the Professional Mediation. The methodology used was video recorded Focus Groups. The objective was to understand how the chronic renal patients submitted to hemodialysis experience the treatment and the most significative difficulties during the sickening process. Some empirical categories emerged from the process, such as Disease, Family, Kidney Transplant, Health Teams, Multidisciplinary Team. Willing to discuss the profession essence, we evolved a reflexion based on the emerged categories / A doença renal crônica e o tratamento de hemodiálise impõem ao paciente renal crônico, um grande desgaste e uma série de limitações que envolvem o biológico, o social e o psicológico. Neste contexto, a intervenção prática do assistente social se faz presente e necessária. Neste sentido esta pesquisa objetivou compreender as modificações sociais no modo de vida dos pacientes renais crônicos em hemodiálise, a partir da vivência e das inflexões mais significativas que o paciente atribui à doença e seu tratamento. Através da experiência que reunimos nesta área e dos estudos obtidos através da presente investigação, alguns aspectos merecem destaque: a contribuição das políticas públicas de saúde destinadas aos pacientes renais crônicos como garantia de direitos, a partir da RDC-154 de 2004 da ANVISA; os necessários conhecimentos correlatos ao estigma social e ao processo discriminatório da segregação imposta pela doença; a importância da ação do Serviço Social com os pacientes renais crônicos em hemodiálise, através da mediação profissional. A metodologia utilizada foi norteada pela técnica de grupo focal em vídeo, com o objetivo de compreender como os pacientes renais vivenciam a experiência do tratamento e as dificuldades mais significativas no processo do adoecimento. Como resultado deste processo algumas categorias empíricas emergiram, tais como, doença, família, transplante renal, equipes de saúde, equipe multiprofissional. Em torno delas desenvolvemos uma reflexão, procurando remeter ao debate a essência da profissão

[pt] A presente dissertação avalia um software médico através de parâmetros e critérios ergonômicos. Primeiramente descrevem- se os conceitos relativos a Tecnologia da Informação e conceitua-se o software como um dos subsistemas de qualquer sistema de Tecnologia da Informação. A partir de então, verificou-se as etapas de desenvolvimento de software, relacionados ao contexto de usabilidade. Levantaram-se também os principais problemas de interação encontrados no software. A segunda parte da pesquisa, um estudo de caso, inclui a realização de heurística, entrevistas, grupo de foco e técnica de eliciação do conhecimento (card sorting), para que os usuários pudessem expressar sua opinião com relação ao software, às dificuldades encontradas e à utilização de menus. / [en] This thesis evaluates a medical software according to ergonomic criteria and parameters. Firstly, the concepts related to Information technology were described and the software was defined as one of the subsystems together whith the presentation of Information Technology. After that, the stages of software design were determined: context of usability. The main problems related to software interfaces were also described. The second part of this research, a case study, included heuristic approach, interview, focus groups and a knowledge elicitation (card sorting). So that users would have the opportunity to express their opinions in relation to the difficulties faced with its use.

[pt] Este trabalho envolveu a discussão dos modos pelos quais estão organizadas as práticas pedagógicas desenvolvidas no ensino médico de graduação da Faculdade de Medicina da UFRJ, tendo como contexto as políticas de ensino superior e de saúde da década de 70 ao momento atual. Duas foram as questões que serviram de ponto de partida para a pesquisa: quais foram os efeitos da mudança físico- espacial sobre as concepções de formação médica dos antigos professores da Praia Vermelha; e quais eram e quais são as lógicas ordenadoras prevalentes nos diferentes períodos. Do ponto de vista metodológico, trabalhei com relatos orais na linha da história de vida de 21 professores oriundos da Praia Vermelha, procurando identificar em suas narrativas os significados da mudança a respeito do projeto pedagógico da Escola de Medicina da UFRJ, as posições assumidas por eles diante dos efeitos produzidos pela mudança, através da análise de suas trajetórias. Documentos referentes à educação médica, às políticas de saúde e às políticas de ensino superior constituíram-se em referências indispensáveis para o mapeamento das configurações do ensino médico de graduação em nosso país, em especial a partir da Reforma Universitária de 1968. Para o desenvolvimento da pesquisa, Pierre Bourdieu revelou- se como um dos interlocutores centrais. A potencialidade dos conceitos de habitus, capital e campo permitiu pensar o princípio da ação histórica na relação entre dois estados do social: a história objetivada nas coisas, sob a forma de instituições, e a história encarnada nos corpos sob a forma de disposições duráveis, o habitus (Bourdieu, 1994), no nosso caso, a constituição do habitus docente. Lutas e conflitos em torno de tomadas de posições acerca das concepções da Faculdade de Medicina da UFRJ foram sendo mapeadas e ajudaram a revelar as correlações de força que atravessaram essa instituição desde os anos 60. O trabalho está estruturado em torno dos seguintes eixos: as mudanças da Praia Vermelha para o Fundão e as conseqüências provocadas por esse deslocamento físico- espacial na reconfiguração dos campos de poder no interior da Faculdade de Medicina e em última instância na Universidade; as formas de ingresso na carreira docente no período estudado e os efeitos da reforma universitária sobre essas carreiras, sobre as representações dos saberes e conhecimentos que compõem com o habitus a formação do professor de medicina; a formação profissional promovida pelo curso de Medicina, inscrevendo-a no contexto histórico das práticas pedagógicas descritas na literatura do campo da educação médica, bem como dos efeitos das políticas de saúde, da configuração do mercado de trabalho nessa área. Em que pese o esforço que a Faculdade de Medicina vem realizando, como (i) integrar o currículo a partir de iniciativas interdepartamentais; (ii) aumentar as atividades práticas; (iii) inserir o aluno na rede básica de saúde; (iv) tornar obrigatório o internato médico nas áreas consideradas básicas; (v) discutir a relação médico- paciente via criação de uma disciplina, os resultados sinalizam para a existência de contradições entre a intenção e a efetividade dessas medidas. Assim, tem prevalecido ainda um enfoque predominantemente hospitalar e uma abordagem que privilegia o atendimento especializado de doenças que exigem o uso intensivo de tecnologia, fugindo das recomendações de centrar mais a prática nos aspectos preventivos das doenças. O apelo das especialidades, com maior prestígio e remuneração, a necessidade de dedicação à pesquisa pelos professores como pré-requisito para titulação, e o avanço do conhecimento médico são os fatores apontados para o declínio da propedêutica médica de cunho indiciário, e o sucesso observado na introdução de práticas pedagógicas conside / [en] This paper encompasses the discussion about the forms of organization of pedagogical practices developed in the undergraduate program at the School of Medicine at UFRJ (Federal University of Rio de Janeiro). The study ambiance involves university teaching and health policies that have prevailed in Brazil from the 1970 s until today. The research stemmed from two questions: the effect of physical-spatial change on concepts that underlie the medical formation among former faculty members (at Praia Vermelha building in the neighborhood of Urca); secondly, the guiding logics that prevailed in the two different periods. From a methodological viewpoint, I worked with oral reports that followed the life story of 21 faculty members who had come from Praia Vermelha, attempting to identify the meaning of change related to the pedagogical project at the School of Medicine at UFRJ in their narratives and the attitudes they adopted to cope with the effects produced by such changes in the analysis of their studies and life story. Documents involving medical training, health policies and university teaching issues became essential references for a map of the undergraduate medical education in our country, especially after the University Reform in 1968. Pierre Bourdieu was a central interlocutor for the development of the research. The potential of concepts such as habitus, capital and field allowed us to envisage the principle of historical action within the relationship of two social states: the objective history of things, in the form of institutions, and the history incarnated in bodies in the form of durable dispositions, the habitus (Bourdieu, 1994), in our case the constitution of a teaching habitus. Struggles and conflicts for position take over concerning the concepts at the School of Medicine at UFRJ were gradually mapped and helped reveal the correlation of forces that prevailed in the institution since the 1960 s. The work is structured around three guide lines: the transfer from Praia Vermelha to the premises on Fundão Island and the consequences of that physical-spatial change to the power shift in the recess of the School of Medicine and, ultimately, the University as a whole; the procedures that applied to faculty members during the admission process in the studied period, to mention the effects of the university reform on their professional careers, on the representation of knowledge and scholarship which, together with habitus, make up the education of the Medicine Professor; firstly the professional education offered by the Medical School, which inserts it in the historical context of pedagogical practices described in medical education literature; and secondly the effect health policies had on the labor market structure in that field. The School of Medicine has been making efforts to (i) integrate its curriculum based on interdepartmental initiatives; (ii) increase the number of practical activities; (iii) place the students within the basic net of health services; (iv) enforce compulsory medical internship in essential areas; (v) discuss doctor-patient relationships in a specific discipline. Nevertheless, in spite of those efforts, the results indicate contradictions between their intended effects and their efficacy. So, a largely hospital-oriented focus has prevailed, fostering an approach that privileges specialized treatment of diseases with the intense application of technological resources. This approach opposes recommendations which prescribe medical practices centered on disease prevention. The appeal of medical specialists is that they have more prestige and better rates of pay; therefore the professors need to dedicate time to research as a pre-requisite to conquer titles for their career improvement, and the advance of medical knowledge are the contributing factors that account for the decline of symptom-oriented medical procedures and the success of pedagogical practices that are considered innovative, such as problem-based learning and evidence-based medicine. These factors also contribute to the o

Les progrès continus de la recherche scientifique dans le domaine de la santé ont entraîné une augmentation de l'espérance et de la qualité de vie. Ainsi, le développement de nouveaux médicaments et des dispositifs médicaux a permis d'améliorer les conditions sanitaires et la prise en charge des patients au prix d'une inflation des dépenses de santé. Ces évolutions ont eu pour conséquences d'inciter les états à mettre en place des procédures d'évaluation de l'efficacité et de la gestion des risques liés à ces nouvelles approches thérapeutiques. Plus récemment, les restrictions budgétaires liées à la crise économique dans de nombreux pays de l'OCDE ont contraint les états à diminuer la part de leur budget consacré à la santé. Cette situation les a conduits à mettre en place des politiques de santé basées sur l'optimisation des ressources.En ce sens, l'évaluation médico-économique et la pharmaco-épidémiologie constituent pour les acteurs de santé et pour les décideurs politiques un outil d'analyse décisionnelle particulièrement légitime. Ils sont aujourd'hui de plus en plus intégrés dans les réflexions sur les stratégies de soins et dans la mise en place des programmes de santé. L'objectif de notre travail de recherche a été à travers deux projets, d'étudier l'intérêt de l'évaluation médico-économique et de la pharmaco-épidémiologie en chirurgie pédiatrique. Ainsi, dans une première partie plus théorique, une synthèse des différentes études de pharmaco-économie, de pharmaco-épidémiologie a été conduite et un état des lieux des études d'évaluation médico-économiques dans la chirurgie de l'enfant a été réalisé. Dans une seconde partie plus pratique, les deux projets concernant la chirurgie pédiatrique sont présentés :- Le projet 1 (pharmaco-économie) présente l'évaluation et l'analyse coût-efficacité dutraitement du reflux vésico-urétéral de grade modéré chez l'enfant.- Le projet 2 (pharmaco-épidémiologie) est une étude multicentrique prospective surl'épidémiologie de l'invagination intestinale aiguë de moins de 1 an (EPIstudy) / The continuing progress of scientific research in the field of health have led to increasingexpectancy and quality of life. Thus, the development of new medicines and medical deviceshave improved the health conditions and treatment of patients at the cost of inflation inhealth spending. These developments have effects for encouraging states to implementprocedures of effectiveness assessment and management of risks associated with these newtherapeutic approaches.More recently, budget cuts due to the economic crisis in many OECD countries havecompelled states to reduce the proportion of their budgets on health. This led them todevelop health policies based on resource optimization.In this sense, the health econoic evaluation and pharmacoepidemiology are for healthcarestakeholders and policy makers a tool for decisional analysis. They are now increasingly integrated into reflection on care strategies and the implementation of health programs. The objective of our research has been through two projects, to study the interest of the health economic evaluations and pharmacoepidemiology in pediatric surgery. Thus, in a first, theoretical part, it is a synthesis of various studies of pharmaco-economics, pharmacoepidemiology was conducted and an inventory of economic evaluation studies in pediatric surgery was performed. In the second part more convenient, both projects are presented in pediatric surgery :- Project 1 (pharmacoeconomic) presents evaluation and cost-effectiveness analysis oftreatment of moderate grade of vesicoureteral reflux in children.- Project 2 (Parmacoepidemiology) is a prospective multicenter study of theepidemiology of acute intussusception among infants (EPIstudy)

Oggi, l'Italia è un paese multietnico. Dietro i movimenti migratori non vi sono però solo dati statistici, ma persone con culture e storie personali diverse, con cui gli operatori a contatto con gli immigrati devono confrontarsi. Ciò ha condotto alla nascita della mediazione linguistico-culturale, un settore sorto nella fase più acuta del fenomeno dell'immigrazione, gli anni Novanta, per rispondere alle esigenze specifiche di assistenza medica e legale degli immigrati. L'intento del presente lavoro di ricerca è quello di studiare l'interazione verbale e non verbale tra medico o infermiere e paziente straniero nel contesto della mediazione linguistica-culturale in una struttura socio-sanitaria. All'interno dell'interazione verbale si analizzeranno le teorie della cortesia linguistica applicate a un contesto socio-sanitario multietnico. Si andrà a verificare se esiste una lingua di mediazione, se la lingua inglese funge da lingua franca nell'interazione verbale medico o infermiere e paziente straniero e se esistano strategie empatiche comunicative verbali e non verbali comunemente utilizzate in corsia dal personale ospedaliero. Si studierà inoltre come l'analisi della conversazione, in particolare l'analisi delle strategie empatiche comunicative verbali e non verbali, possa essere utilizzata a fini didattici e pedagogici nella formazione linguistica e interculturale di studenti di medicina nel nuovo contesto sociosanitario multiculturale. / Italian society has undergone massive transformation, arising today as a true multiethnic society. Migration movements are not simply a phenomenon of statistical data but involve people from different cultures and personal backgrounds. Immigration is behind the onset of community interpreting in Italy at the beginning of the '90s. Community interpreters catered for all medical and legal needs of immigrants. Today, it is common practice in Italy that doctors and nurses interact with immigrant patients. The aim of the thesis is to study verbal and non-verbal strategies of communication between doctors or nurses and immigrant patients in this new multiethnic medical environment. The study will examine strategies of politeness theory, whether English is a lingua franca in the doctor or nurse and immigrant patient interaction and whether there are empathic verbal and non-verbal strategies of communication commonly used in the hospital ward by doctors and nurses. The study will also examine how conversational analysis, in particular the analysis of empathic verbal and non-verbal strategies of communication can be used for didactic and pedagogical purposes so as to prepare medical students linguistically and culturally to interact with their future patients in this new multiethnic medical environment.

Face au vieillissement démographique, l’adéquation de l’offre et de la demande de la prise en charge de la dépendance est au cœur des politiques de santé publique. L’objectif de ce travail est d’estimer la consommation d’hébergement des personnes âgées dépendantes pour un horizon de 5 à 10 ans en intégrant l’origine géographique des résidents. En effet, ces derniers ne cherchent pas nécessairement une réponse d’hébergement à proximité de leur lieu de résidence. On peut ainsi bâtir un « scénario moyen » pour mesurer la consommation d’hébergement actuelle, construire des bassins gérontologiques et envisager des projections d’hébergement les plus précises possibles, selon le postulat « toute chose égale par ailleurs ». Cette recherche menée en Poitou-Charentes en 2010 permet une analyse prospective qui annonce un déficit du nombre de places d’hébergement dès 2017 et qui devrait s’amplifier au cours des années suivantes. Ces résultats trouvent toute leur légitimité pour aider la planification gérontologique et adapter l’offre à la demande à différentes échelles. De plus, ils rendent possible l’appréhension du volume d’emplois non « délocalisables ». / In view of demographic ageing, the adequacy between supply and demand of older population needs is placed in the heart of the public health policy. The aim of this work is to estimate the housing consumption of dependent older people for the time horizon from 5 to 10 years by integrating the geographical origins of residents. In fact, these latter don't necessarily look for an accommodation close to their place of residence. Thus a 'medium scenario' can be proposed to measure the current consumption,build gerontological basins and plan the most accurate possible senior housing projections according to 'all else being equal' principle. This research conducted in Poitou-Charentes in 2010 allows to do a prospective analysis which reveals a deficit in the number of rousing places from 2017 and this deficit is expected to increase over the following years. These results have all legitimacy to help gerontological planning and adapt supply to demand at different scales. Moreover, they make possible the estimation of the volume of 'non relocatable' jobs.

No Brasil o numero de pacientes deficientes orais ainda é crescente, o edentulismo é caracterizado como uma condição evitável em que um ser humano tem perda completa dos dentes, que, segundo a organização mundial da saúde, surge em a consequência de um sistema de saúde deficiente que afeta a saúde geral da população, bem como a sua qualidade de vida. Com objetivo de tratar esta deficiência surgem os implantes dentários, uma das modalidades mais praticadas na atualidade em ciências médicas, com uma taxa de sobrevida de 95% a longo prazo em estudos publicados. O objetivo deste trabalho foi avaliar por meio de interferometria ótica 3D as superfícies de união de implantes Hexágono externo e seu pilar protético universal de quatro marcas vendidas no mercado nacional, quanto seus parâmetros de lisura Sa (rugosidade média) e mensurar metricamente o nível de adaptação entre o pilar protético e implantes utilizando microscopia eletrônica de varredura. Foram escolhidas quatro marcas de implantes do tipo hexágono externo e quatro pilares protéticos do tipo universal para próteses cimentadas de quatro diferentes fabricantes disponíveis no mercado brasileiro, para cada amostra implante ou pilar protético foram feita 06 medições para estabelecer uma média de rugosidade das superfícies sob os parâmetros de rugosidade Sa, Ssk e Sku, na sequência unidas e realizadas 06 medições em MEV para avaliar a qualidade do gap. Após a avaliação, os dados foram submetidos a ANOVA, teste t (0,05) e regressão linear dos dados. Onde descarta-se a hipótese igualdade entre as marcas com 95% de confiança para os parâmetros Sa e Gap, porém o teste “t”dois fatores revelam igualdade entre as marcas 01 e 02 para o valor de Sa e Gap nos implantes e igualdade entre as marcas 01 e 03 dos valores Sa dos pilares protéticos. / In Brazil the number of oral deficient patients is still increasing, edentulismo is characterized as an avoidable condition in which a human being has complete loss of teeth, which, according to the world health organization, arises in the consequence of a poor health system Which affects the general health of the population, as well as their quality of life. In order to treat this deficiency, dental implants arise, one of the most practiced modalities in the medical sciences today, with a 95% long-term survival rate in published studies. The objective of this work was to evaluate the external bonding surfaces of the external Hexagon implants and its universal prosthetic pillar of four brands sold in the Brazilian market through its 3D optical interferometry, as well as its smoothness parameters (mean roughness) and to measure the adaptation level Between the prosthetic abutment and implants using scanning electron microscopy. Four brands of external hexagon type implants and four universal type prosthetic abutments were selected for cemented prostheses from four different manufacturers available in the Brazilian market. For each implant sample or prosthetic abutment, measurements were made to establish a roughness mean of the surfaces under Roughness parameters Sa, Ssk and Sku, in the sequence joined and performed 06 MEV measurements to evaluate the quality of the gap. After the evaluation, the data were submitted to ANOVA, t test (0.05) and linear regression of the data. Where the hypothesis equality between the brands with 95% confidence for the Sa and Gap parameters is discarded, but the "t" test two factors reveals equality between the 01 and 02 marks for the value of Sa and Gap in the implants and equality between Marks 01 and 03 of the values Sa of the prosthetic abutments.

Face au vieillissement démographique, l’adéquation de l’offre et de la demande de la prise en charge de la dépendance est au cœur des politiques de santé publique. L’objectif de ce travail est d’estimer la consommation d’hébergement des personnes âgées dépendantes pour un horizon de 5 à 10 ans en intégrant l’origine géographique des résidents. En effet, ces derniers ne cherchent pas nécessairement une réponse d’hébergement à proximité de leur lieu de résidence. On peut ainsi bâtir un « scénario moyen » pour mesurer la consommation d’hébergement actuelle, construire des bassins gérontologiques et envisager des projections d’hébergement les plus précises possibles, selon le postulat « toute chose égale par ailleurs ». Cette recherche menée en Poitou-Charentes en 2010 permet une analyse prospective qui annonce un déficit du nombre de places d’hébergement dès 2017 et qui devrait s’amplifier au cours des années suivantes. Ces résultats trouvent toute leur légitimité pour aider la planification gérontologique et adapter l’offre à la demande à différentes échelles. De plus, ils rendent possible l’appréhension du volume d’emplois non « délocalisables ». / In view of demographic ageing, the adequacy between supply and demand of older population needs is placed in the heart of the public health policy. The aim of this work is to estimate the housing consumption of dependent older people for the time horizon from 5 to 10 years by integrating the geographical origins of residents. In fact, these latter don't necessarily look for an accommodation close to their place of residence. Thus a 'medium scenario' can be proposed to measure the current consumption,build gerontological basins and plan the most accurate possible senior housing projections according to 'all else being equal' principle. This research conducted in Poitou-Charentes in 2010 allows to do a prospective analysis which reveals a deficit in the number of rousing places from 2017 and this deficit is expected to increase over the following years. These results have all legitimacy to help gerontological planning and adapt supply to demand at different scales. Moreover, they make possible the estimation of the volume of 'non relocatable' jobs.