Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-19T17:32:57Z No. of bitstreams: 1 priscilaalmeidabarbosa.pdf: 4564248 bytes, checksum: c56ec8ffae2bff3e6da770300f357c0e (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-29T12:31:03Z (GMT) No. of bitstreams: 1 priscilaalmeidabarbosa.pdf: 4564248 bytes, checksum: c56ec8ffae2bff3e6da770300f357c0e (MD5) / Made available in DSpace on 2017-06-29T12:31:03Z (GMT). No. of bitstreams: 1 priscilaalmeidabarbosa.pdf: 4564248 bytes, checksum: c56ec8ffae2bff3e6da770300f357c0e (MD5) Previous issue date: 2014-02-21 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O câncer de mama é o mais frequente entre as mulheres no Brasil, com grande importância epidemiológica e relevante impacto social, tornando-se foco da atenção na saúde dado as conseqüências que o diagnóstico e o tratamento acarretam na qualidade de vida destas mulheres. Avaliar a qualidade de vida relacionada à saúde (QVRS) de mulheres tratadas cirurgicamente de CA de mama no Hospital Maria José Baeta ReisAsconcer, na cidade de Juiz de Fora, pólo de referencia em tratamento oncológico. Foram avaliadas 121 mulheres com câncer de mama atendidas em unidade de tratamento oncológico de referência do sistema público, sendo coletados dados de prontuários e realizada entrevista e exame físico no ato da consulta. A entrevista compreendeu na aplicação dos instrumentos de qualidade de vida, European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLC 30 BR-23) e o questionário de sintomas e funções do MMSS, Disability Arm Shoulder and Hand (DASH), que caracterizou a funcionalidade no presente estudo. Os escores médios do EORTC QLC 30 BR-23 e total do DASH foram considerados como variáveis dependentes, e como variáveis independentes as características sócio-demográficas, clínicas, tratamento e tumor. As variáveis foram expressas em média e desvio padrão; e a análise estatística constou dos testes Kruskal Wallis, Mann-Whitney e teste t de Student, com nível de significância de 5%, sendo, então, construído modelo de regressão linear múltipla. Para construção do banco de dados e análise foi usado o SPSS 19. Da população do estudo, 94,6% das mulheres tem idade superior a 50 anos; 52% vivem sem companheiro; 66% possuem grau de escolaridade baixo e 71,9% relataram sua ocupação atual como do lar ou aposentadas; cerca de 63,5% estavam acima do peso; 76% das mulheres apresentaram estadiamento clínico avançado III-IV; 65,3% foram submetidas à cirurgia conservadora e em 31,5% foi realizada pesquisa de linfonodo sentinela; 81,7% receberam quimioterapia, 85% foram submetidas à radioterapia e 87,5 % estavam em uso de hormonioterapia. O linfedema foi diagnosticado em 7,4% da população. Os valores médios do EORTC QLC 30 BR23 demonstraram uma tendência para boa QVRS, sendo a escala funcional a mais comprometida com as piores médias de escores observadas. A população teve bom desempenho funcional de MMSS, representado pelo baixo escore total do DASH. Houve significância estatística entre a escala de sintomas do instrumento e as mulheres obesas (p = 0,029 e p = 0,015, respectivamente); que realizaram radioterapia ajduvante (p = 0,052), que tiveram maior número de linfonodos dissecados (p = 0,024). E entre o IMC ≥ 30 e a funcionalidade (p = 0, 001). As percepções subjetivas influenciaram todos os domínios do EORTC QLC 30 BR23 (p < 0,01), bem como a funcionalidade (p < 0,01). Após controle pela variável mão funcional demonstraram serem variáveis explicativas da QVRS o IMC, reconstrução mamária, sensação de peso no braço, redução da ADM do ombro e sensação de blusa apertada; e seqüencialmente o IMC, trabalho ativo, restrição ADM ombro e sensação de blusa apertada para a funcionalidade. Nesta amostra, apesar das percepções subjetivas terem sido preditoras de maior influencia negativa na QVRS, a presença de linfedema e queixas auto relatadas não parecem influenciar a funcionalidade dos MMSS, que teve bom desempenho funcional. / Breast cancer is the most common among women in Brazil, with great epidemiological importance and significant social impact, becoming the focus of attention given the health consequences that entail the diagnosis and treatment on quality of life of these women. Assessing quality of life related to health (HRQOL) in women treated surgically for breast CA in Maria José Baeta Reis-Asconcer Hospital in the city of Juiz de Fora, pole reference in cancer treatment. We evaluated 121 women attended at a cancer treatment referral unit in the public health system, collecting data from medical records and doing interviews and physical exams as part of the consultation. The interview included the application of quality of life measurements, the European Organization for Research and Treatment of Cancer, Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-C30 BR-23), and the morbidity of upper limb physical function and symptoms questionnaire, Disabilities of the Arm, Shoulder, and Hand (DASH), which characterized functionality in the present study. The EORTC QLQ-C30 BR-23 mean scores and DASH outcomes were considered as dependent variables, and the independent variables were socio-demographic, clinical, treatment, and tumor characteristics. The variables were expressed in terms of mean and standard deviation; and the statistical analysis consisted of Kruskal Wallis, Mann-Whitney, and Student's t tests, with a significance level of 5%, followed by the construction of a multiple linear regression model. SPSS 19 was used for database construction and analysis. Of the study population, 94.6% of the women were over 50 years of age, 52% lived without a partner, 66% had a low level of education, and 71.9% reported their current occupation as homemaker or retired; about 63.5% were overweight; 76% of the women had advanced clinical stages, III-IV, 65.3% had undergone conservative surgery, and on 31.5%, sentinel lymph node research had been conducted; 81.7% had received chemotherapy, 85% had undergone radiotherapy, and 87.5% were using hormone therapy. Lymphedema was diagnosed in 7.4% of the population. The mean values of the EORTC QLQ-C30 BR-23 showed a trend for good HRQOL, the functional scale being the most impaired, having the worst mean scores observed. The population had good upper limb functional performance, represented by low total DASH scores. There was statistical significance between the instrument's scale of symptoms and the women who were obese (p = 0.029 and p = 0.015, respectively), those who underwent adjuvant radiotherapy (p = 0.052), and those who had a higher number of lymph node dissections (p = 0.024). And between BMI ≥ 30 and functionality (p = 0.001). Subjective perceptions influenced all areas of the EORTC QLQ-C30 BR-23 (p < 0.01), as well as functionality (p < 0.01). After controlling for the variable, functional hand, what proved to explain HRQOL were the variables BMI, breast reconstruction, a heavy feeling in the arm, reduced range of motion in the shoulder, and a tight shirtsleeve sensation; and in turn, BMI, active work, limited shoulder range of motion, and a tight shirt-sleeve feeling, for functionality. In this sample, although the subjective perceptions were predictors of greater negative influence on HRQOL, the presence of lymphedema and self-reported complaints does not seem to influence the functionality of the upper limbs, which had good functional performance.

Orientadores: Eliana Martorano Amaral, Maria José Martins Duarte Osis / Texto em português e inglês / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T07:32:37Z (GMT). No. of bitstreams: 1 Luz_AdrianaGomes_D.pdf: 2135363 bytes, checksum: 77f86d7ebfa7deb2bd88661c7df7380d (MD5) Previous issue date: 2013 / Resumo: Introdução: A morte materna é a 5ª meta do Desenvolvimento do Milênio e persiste como um problema complexo de saúde. Para alcançar esta meta, é preciso conhecer exatamente quais as condições e processos de cuidado que levam as mulheres a situações clínicas críticas e morte durante o ciclo gravídico-puerperal. Neste cenário, um grupo de pesquisadores implantou um projeto com objetivo de criar a rede nacional de cooperação científica para realizar vigilância, estimar frequência dos casos de near-miss maternos, realizar uma investigação multicêntrica sobre a qualidade dos cuidados das mulheres com complicações severas na gestação e conduzir uma avaliação multidimensional de um grupo selecionado destas mulheres (Rede Nacional de Vigilância de Morbidade Materna Grave - RNVMMG), composta de 27 serviços de referência em diferentes regiões do Brasil. Objetivo: avaliar a perspectiva dos profissionais sobre o impacto na qualidade dos cuidados oferecidos às mulheres com a participação do serviço na Rede Nacional de Vigilância de Morbidade Materna Grave (RNVMMG). Sujeitos e Métodos: Estudo multicêntrico com todos os participantes da RNVMMG nas 27 unidades obstétricas das cinco diferentes regiões geográficas do Brasil. Para o estudo, realizaram-se entrevistas com os coordenadores, pesquisadores e gestores de cada instituição, 6 e 12 meses após o término da coleta de dados da Rede. Os dados foram coletados a partir das entrevistas telefônicas gravadas, utilizando sistema digital NVIVO 9.0 ®, após consentimento informado verbal. Foi realizada análise qualitativa de conteúdo das respostas abertas das entrevistas e análise descritiva dos dados quantitativos. O conteúdo das respostas abertas foi submetido à análise temática, definindo-se as categorias e subcategorias emergentes dos discursos dos profissionais, segundo sua inserção institucional e na Rede. Resultados: Foram realizadas 122 entrevistas nas duas fases, incluindo pesquisadores e gestores dos serviços participantes, abrangendo 75,3% das entrevistas previstas, com maior participação dos gestores na 2ª fase. A maioria dos entrevistados considerou que a participação na RNVMMG mudou sua percepção e atitude diante da identificação dos casos de risco à morbidade/ mortalidade materna, ajudou a difundir os conhecimentos adquiridos no próprio serviço e tomar a conduta médica mais eficiente na condução desses casos. A divulgação científica dos resultados finais foi um fator determinante, em muitos serviços, para a discussão de mudanças de protocolo. Porém, não ficou evidente um impacto institucional duradouro. A necessidade de manter uma rede de vigilância morbidade materna grave foi salientada. Conclusão: Houve uma mudança significativa na capacidade dos profissionais que participaram da RNVMMG para identificar os casos, que se aprimorou ao longo do tempo. Os serviços participantes em sua maioria tiveram melhoria na qualidade dos cuidados oferecidos / Abstract: Background: Maternal death remains as a complex health problem and its reduction is the 5th Millennium Development Goal. To achieve this goal, countries need to know exactly what conditions lead to the death of women during pregnancy and childbirth. In this scenario, a group of researchers implemented a project to create a national network of scientific cooperation to surveillance, in order to know the frequency of near miss, to conduct a multicenter investigation on quality care of women with severe complications in pregnancy and to conduct a multidimensional assessment of a select group of these women (Brazilian Network for Surveillance of Severe Maternal Morbidity - BNSMM), with the participation of 27 centers in different regions of the country, Objective: To evaluate the perspective of professionals about the impact of the surveillance during the network study on the quality of care .Subjects and Methods: A multicenter study with 27 obstetric referral facilities in 5 different geographic regions of Brazil. For the study, researchers conducted a telephone interview with research coordinator, principal investigator and manager from each institution, six and 12 months after the end of the data collection from the surveillance study. Data was collected through interviews recorded using a digital system NVIVO® 9.0, after verbally authorized informed consent. Data analysis was performed by qualitative content analysis of open answers from the interviews and descriptive data analysis. The contents of the open answers were subjected to thematic analysis, defining the categories and subcategories of emerging discourses of professionals according to their insertion and institutional network. Results: We performed a total of 122 interviews in two phases including researchers and managers of the participating hospitals, covering 75.3% of the sample, with greater involvement of managers in the 2nd phase. Most of researchers felt that participation in BNSMM changed their perception and attitude towards the identification of cases with risk of severe maternal morbidity / mortality and helped to disseminate the knowledge acquired in the service itself and they considered that the medical management was more efficient in conducting these cases. Participants believe that the scientific publication of the final results was a determining factor to change practice. However, there was no evidently a lasting institutional impact. Participants emphasized need to maintain a network of severe maternal morbidity surveillance. Conclusion: There was a significant change in the ability of the professionals who participated in the RNVMMG to identify cases, which improved over time. Services participants mostly had improvement in quality of care offered / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

Orientador: Mary Angela Parpinelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:08:15Z (GMT). No. of bitstreams: 1 Giordano_JulianaCamargo_M.pdf: 5014845 bytes, checksum: 8f26e41d63dca41f45a8a0fc08108351 (MD5) Previous issue date: 2013 / Resumo: Introdução: A mortalidade materna (MM) é um forte indicador de disparidades nos direitos das mulheres. O estudo dos casos de Near Miss (NM) é estratégico para identificar falhas no atendimento obstétrico. Em números absolutos, tanto MM quanto a ocorrência de eclâmpsia são eventos raros. Objetivo: avaliar os principais preditores de desfecho maternal grave (DMG: NM materno e MM) para eclâmpsia. Métodos: análise secundária de um estudo transversal, multicêntrico, incluindo 27 unidades obstétricas de referência de todas as cinco regiões do Brasil, entre 2009/2010. Foram identificados 426 casos de eclâmpsia e classificados de acordo com os resultados: DMG e não-DMG. As regiões brasileiras foram divididas em regiões de menor e maior renda e calculados os indicadores de cuidados obstétricos pela OMS. SPSS® e Stata® softwares foram utilizados para avaliar as características maternas, história clínica e obstétrica e o acesso aos serviços de saúde como preditores para a DMG, e correspondentes resultados perinatais, através do cálculo das razões prevalência (RP), respectivos intervalos de confiança de 95% (IC) e ainda aplicada à análise de regressão múltipla de Poisson (ajustada para o efeito cluster). Resultados: a prevalência e o índice de mortalidade por eclâmpsia em regiões de menor e maior renda foram de 0,8% / 0,2% e 8,1% / 22%, respectivamente. Dificuldades no acesso aos serviços de saúde: internação em UTI (RP ajustada 3,61, IC 95% 1,77-7,35) e monitorização inadequada (RP ajustada 2,31, IC 95% 1,48-3,59) foram associadas com DMG, também a morte perinatal foi maior neste grupo (RP ajustada 2,30; IC de 95% 1,45-3,65). Conclusão: a morbidade / mortalidade associada com eclâmpsia foi elevada no Brasil, especialmente nas regiões de baixa renda. A qualificação do atendimento à saúde materna e melhorias nos atendimentos das emergências são essenciais para aliviar a carga de eclâmpsia / Abstract: Background: Maternal mortality (MM) is a core indicator of disparities in women rights. Studying Near Miss cases is strategic to identify breakdowns in obstetrical care. In absolute numbers, both MM and the occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). Methods: secondary analysis of a multicentre cross-sectional study, including 27 referral obstetric units from all five regions of Brazil, from 2009/2010. 426 cases of eclampsia were identified and classified according to outcomes: SMO and non-SMO. We divided Brazilian regions in lower and higher income regions and calculated the obstetric care indicators by WHO. SPSS® and Stata® softwares were used to assess the maternal characteristics, clinical and obstetrical history, access to health services as predictors for SMO, and correspondent perinatal outcomes, by calculating the prevalence ratios (PR), respective 95% confidence interval (CI) and also applying Poisson multiple regression analysis (adjusted for cluster effect). Results: prevalence and mortality index for eclampsia in lower and higher income regions were0.8%/ 0.2% and 8,1%/ 22%, respectively. Difficulties on access health care: ICU admission (adjPR 3.61; 95%CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95%CI 1.48-3.59) were associated with SMO, also perinatal death was higher in this group (adjPR 2.30; 95%CI 1.45-3.65). Conclusions: morbidity/mortality associated with eclampsia were high in Brazil, especially in lower income regions. Qualifying maternal health and improvements in emergency care are essential to relieve the burden of eclampsia / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Orientador: Rosana Aparecida Baeninger / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas / Made available in DSpace on 2018-08-20T16:47:05Z (GMT). No. of bitstreams: 1 Marques_AngelaMaria_D.pdf: 3764996 bytes, checksum: 13cf12325bbe619ce1c5fbd0ef97563c (MD5) Previous issue date: 2012 / Resumo: Os estudos sobre mobilidade e circulação de pessoas estão, em sua maioria, vinculados à motivação econômica, a educação. A utilização dos serviços da rede pública de saúde entre países fronteiriços vem sendo estudada recentemente e o Brasil com sua vasta fronteira, principalmente com a Bolívia e o Paraguai vem sendo alvo de uma mobilidade relacionada à busca pelos serviços do Sistema Único de Saúde (SUS). Mato Grosso do Sul, é uma das Unidades Federativas que faz divisa com os dois países e onde se observa a existência de uma mobilidade diária, consequente das relações comerciais e de vizinhança entre as cidades fronteiriças, e onde se sobressai um tipo de mobilidade relacionada à busca por esses serviços de saúde, atrelada a uma mudança de residência. Como objetivo principal esta tese se propõe a delinear a mobilidade e circulação naquela região, com a finalidade de utilização dos serviços da rede pública de saúde e sua provável vinculação a fixação de residência em Corumbá, cidade fronteiriça. Pretende-se mostrar, que essa mobilidade fronteiriça é motivada pela busca de qualidade de vida no que se refere a melhoria e acesso aos serviços de saúde. Com base nesse contexto, foram realizadas pesquisas bibliográficas sobre estudos de mobilidade fronteiriça, utilização dos serviços do SUS em regiões de fronteiras, assim como sobre o contexto histórico de formação dessas fronteiras, e sobre o Projeto SIS Fronteiras. O compilamento de dados do Censo Demográfico do IBGE de 1991 e 2010 e do INE-Instituto Nacional de Estadística da Bolívia teve como finalidade o delineamento do perfil demográfico de Corumbá-MS e Puerto Quijarro e Puerto Suarez, respectivamente. Complementarmente, foi realizada uma pesquisa qualitativa, sendo entrevistadas as enfermeiras das Unidades Básicas de Saúde de Corumbá, para averiguar como se relacionava a busca pelos serviços do SUS pelos bolivianos, principalmente os fronteiriços, e sua relação com a fixação de residência em Corumbá-MS. Na realidade analisada concluiu-se que a mobilidade fronteiriça é a resultante da interação e integração onde o local interage com o espaço de vida e determina o tempo de residência dos bolivianos fronteiriços, à medida que se constata que a utilização dos serviços da rede de saúde pública em Corumbá é um motivo consequente da necessidade de melhoria da qualidade de vida, e respectiva mudança de residência / Abstract: Constant migration has been an integral part of humanity's interaction with the environment for hundreds of thousands of years. The search for better resources, economic opportunities and higher education has been a key factor to encourage migration. The usage of public health services across neighboring countries is increasingly being studied. Due to its vast borderlands, especially with Bolivia and Paraguay, Brazil has received thousands of immigrants who were underserved by or excluded from the medical care system in their homelands and looked for the services offered by the Brazilian health care system, the Unified Health System (SUS). In this context, a daily activity is observed in Mato Grosso do Sul, which is one of the Federal States that borders the two countries referenced above. This activity is a consequence of trade relations between the neighboring cities as well as the health care opportunities that have stood out, and can potentially represent a change of residency as a result of the health care provided by SUS in the state. As its main objective, this study aims to outline an analysis of the population's mobility related to the use of public health services, and its probable link to residency establishment in Corumbá, the border city in the region. Therefore, this study will correlate the border activity with the search for quality of life in terms of better and more accessible health care. Based in this context, the literature researched aimed to build reasoning on the study of border mobility, the use of SUS services in bordering regions, the historical context of these boundaries, as well as the application of a qualitative research, survey data from the demographic census of 1991 and 2010 from IBGE to outline the demographic profile of Corumbá-MS and data from the INE, National Institute of Statistics of Bolivia to present a demographic profile of Puerto Suarez and Puerto Quijarro. Thereby, this study will review the relations between the search for SUS services by Bolivians, especially the borders and the possibility of residency establishment in Corumbá-MS. It was concluded that the mobility across borders is the result of integration and interaction where the location interacts with the living space and determines the residency time of a person. In addition, given the known precariousness of health services in cities bordering with Bolivia, as well as the need for improved quality of life and use of services of public health network in Corumbá by Bolivians, this reality can be modeled as a change in one's permanent residency / Doutorado / Demografia / Doutor em Demografia

Abstract This study focuses on the development of a bone collecting device for intra-oral bone harvesting and on the introduction of a new bone graft donor site, zygomatic bone. A bone collector was constructed and tested in vitro. This bone collector is suitable and efficient in dental implant related bone grafting surgery. It was also found to be more efficient and with a larger capacity in bone harvesting when compared to the two commercially available bone collectors. A zygomatic bone harvesting technique is introduced in this study. The safety and morbidity of the method was assessed in a cadaver and a prospective clinical study. In the cadaver study, 40 procedures were performed. The complications during the cadaver harvesting included 15 perforations into the maxillary sinus and 7 perforations into the infratemporal fossa. The only intra-operative complication in 32 clinical operations was perforation of the maxillary sinus in 33% of the zygomatic sites. None of these patients experienced any post-operative problems related to the perforation. Patients needed pain medication for a mean time of four days and they did not demonstrate any paresthesias or altered sensations in the donor area. The yield of the bone graft from zygomatic bone was quantified in cadaver and clinical studies. In the cadaver study, the average yield of the graft was 0.59 ml. In the clinical study the average graft volume was 0.90 ml. The required reconstructions were accomplished in all clinical cases. In the prospective clinical study, the bone grafts from the zygomatic bone were used simultaneously with one-stage dental implants placement. Bone grafting was employed at 72 of the 82 implant sites. Two of the bone grafted implants failed, yielding a survival rate of 97.2% for bone grafted implants and 97.6% for the whole study group. Grafted sites healed remarkably well, and no obvious signs of graft resorption were noted during the 26.9 months follow-up period. The bone collector developed in this study is an effective instrument in intra-oral bone harvesting. The zygomatic bone can be regarded as a safe bone harvesting donor site and the yield of bone graft from this area is sufficient for moderate defects in resorbed alveolar ridges.

Jakobsbergsgeriatriken och Stockholms Läns Sjukvårdsområde betonar vikten av värdeskapande insatser och arbetssätt. Med patientperspektiv skapas resultat av betydelse för patienten. Delaktighet anges som en viktig del. Återkommande patientenkäter  visar att det finns ett gap mellan målbild och arbetssätt på kliniken. Syftet med förbättringsarbetet var att öka patienternas delaktighet under hela vårdtillfället. Syftet med studien var att identifiera vilka erfarenheter som kunde knytas till förändrade arbetssätt. Med kvalitativ metod genom interaktiv forskningsansats för förbättringsarbetet arbetade medarbetarna fram förslag på arbetssätt och metoder som bättre kunde gynna patientdelaktighet, vilka testades genom upprepade PDSA-hjul. För att besvara frågeställningarna till studien av förbättringsarbetet användes mixed method. Semistrukturerad fokusgruppsintervju, enskilda djupintervjuer, två patientenkäter låg till grund för utvärdering av upplevelser av de förändrade arbetssätten.   Förbättringsarbetet resulterade i ett flertal förändrade arbetssätt från inskrivning till utskrivning, där patientens egna förväntningar, önskemål och behov blivit tydligare.  Exempel på förändringar;  Fokus på delaktighet från inskrivningssamtalet, avstämning halvvägs in i vårdtillfället för att fånga nya frågor och ytterligare identifierande behov/ förväntningar. Studiens resultat påvisar vikten av tydlig kommunikation/information inom teamet och med patienten som partner i beslutsfattande. Insikter om teamprocesser och aktiviteter som behöver anpassas ytterligare under vårdprocessen för att skapa bättre förutsättningar för ökad patientdelaktighet. / Jakobsberg Geriatric Clinic emphasizes the importance of value creation and working methods from a patient perspective that gives results of relevance to the patient, where participation is given as an essential part. Patient surveys have shown that there is a gap between the target and working processes, which does not promote participation sufficiently.   The purpose of the improvement work was to increase patient participation throughout the hospital stay. The purpose of the study was to identify experiences that could be linked to the changing working methods, through a patient’s as well as an employee’s perspective.  The Improvement work was performed with a quality design and an interactive research approach where care-staff drafted proposals on useful methods that would better favor patient participation. These methods were then tested by repeated PDSA-wheels.  To answer the questions to the study, mixed method was used. Semi-structured focused group interviews were conducted and participation observations occurred. Individual interviews were held and patient’s surveys were filled out to evaluate the experience of the changing working method.  The improvement work resulted in a number of changes, from admission to discharge, where the patient’s own expectations, wishes and needs, became more central. Examples of changes; an increased focus on patient participation, from the enrollment, as well a reconciliation offered midway through the care episode with the purpose to catch arising issues and to identify additional needs.  The findings in the study demonstrate the importance of clear communication / information within the team and with the patient as a partner in decision-making. Insights on team processes and activities that need to be further adapted during the care process to create better conditions for increased.

Magister Artium (Development Studies) - MA(DVS) / Acquired Immune Deficiency Syndrome (AIDS) which is caused by the Human Immunodeficiency Virus (HIV) is not only an epidemiological problem but also one of the developmental challenges in developing countries. The epidemic is severely affecting the productive part of the population (15 to 49 age range), that is believed to be ‘the motor of development’. Ethiopia is one of the Sub-Saharan African countries whose economy is affected by the epidemic. The country is assigned along with India, China, Nigeria and Russia as the ‘next wave of HIV/AIDS’ with large populations at risk from HIV infection, that will overtake the current epidemic prevalence rate in central and southern Africa (NIC, 2002). The epidemic is also among the challenges facing the agricultural sector of the country which provides half of the country’s GDP. Although agriculture is the backbone of the economy, little effort has been made to estimate the impact of the epidemic and many existing studies focus on urban areas instead of rural areas. Therefore, the research reported on in this thesis assesses the extent and channels of the impact of HIV/AIDS on agricultural production. The research measured the extent of the impact of the epidemic on factors of production such as labor, capital stock and land use, which are the determinants of agricultural production. The research was conducted in Ada’a district in Eastern Showa province, Ethiopia, which is one of the top agricultural production areas of the country and also one of the most vulnerable areas for HIV/AIDS. Stratified random sampling and judgmental sampling techniques were employed to identify sample cases. In addition, both primary and secondary data sources were used to gather the required data/information. The primary sources of data collection methods include PRA, individual interviews, focus groups, photographs and observations. Secondary sources include reports from governmental and nongovernmental organizations, health centers, agricultural bureaus, books, newspapers, the internet, etc. The collected data was analyzed by using spread sheets-2003. The interpretation of the results was supported by graphs, tables and photos. Two stages of ordinary least square (OLS) estimation were done. The first stage was to estimate the impact of HIV/AIDS on production factors whereas the second stage estimation was done to estimate the impact of HIV/AIDS on output (income) of farmers via the impacts on factors of production. The findings of the analysis indicated that HIV/AIDS has been affecting factors of production significantly, i.e. by reducing labor-hours, depleting the capital stock of farmers and by its impact on the use of land (reducing the amount of land cultivated). The findings also indicated that HIV/AIDS has been decreasing the agricultural income of farmers.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic non-communicable diseases, including cardio-vascular diseases and stroke, cancer, type 2 diabetes and chronic pulmonary disorders, are rapidly emerging as leading causes of morbidity and premature mortalities globally. The majority of the populations worldwide have experienced major transformations in disease profiles and health status characterized by a shift from infectious diseases and nutritional deficiencies to a predominance of chronic diseases of lifestyle. This epidemiological transition is regarded as an outcome of the environmental and socioeconomic changes following urbanization.Common behavioral health risk factors, such as smoking, risky alcohol consumption,sedentarism, overweigh/obesity and hypertension, have consistently been attributed to the development of chronic non-communicable diseases among populations.This thesis seeks to describe the epidemiology of the major common risk factors for noncommunicable diseases among people living in Mombasa, Kenya. The study responds to the WHO’S recommendations on comprehensive and continuous risk factor surveillance as an essential component of the public health information system and a vital health promoting strategy in the control and prevention of non-communicable diseases.A cross-sectional study design using the WHO STEPwise protocol was employed.Convenient stratification of the Mombasa population was done according to gender, age and setting categories. Using the Yamane formula n = N/1+ N(e²), a sample of 500 participants aged 15 to 70 years was arrived at. The researcher then conveniently selected public high schools, tertiary institutions, workplaces and a marketplace as the study settings.The WHO STEPS instrument (Core and Expanded Version 1.4) was used for data collection. Step 1 involved gathering information on socio-demographic characteristics and health-related behaviors of the participants using close-ended structured questions. Step involved the taking of simple anthropometrical measurements pertaining to height, weight, waist circumference, blood pressure and pulse rate.Data were captured, cleaned and analyzed using the Statistical Analysis System (SAS) and SPSS version 16.0. Chi-square and Spearman correlation tests were used to determine associations between socio-demographic variables and behavioral health risk factors.The results indicated that 61% of the study participants possessed at least one of the investigated risk factors. 17% of the participants had a multiple risk factor profile, with 54% more females having a higher mean risk factor score compared to 46% of their male counterparts.Physical inactivity, hypertension and overweight/obesity were the most common registered risk factors, accounting respectively for 42%, 24% and 11%. Physical inactivity and hypertension formed the commonest cluster of multiple risk factor patterns; they co-occurred in 68% of the participants with a multiple risk factor profile.Increasing age, female gender and a low level of educational attainment were factors seen to be significantly associated with the development of risk factors for non-communicable diseases among the participants. It was observed that the burden of risk factors was unequally distributed among Mombasa residents; intervention programs based on our findings should therefore be used to ensure effectiveness. Future studies using nationally representative samples are further suggested to provide a more comprehensive analysis of a national risk factor profile.

Magister Curationis - MCur / The objectives of this study were to determine midwives’ knowledge in performing foetal heart rate monitoring, to assess midwives’ abilities in the interpretation of foetal heart rate patterns according to their years of clinical experience as a registered midwife.

The decline in mortality was the most important cause of the great increase in population in Sweden in the 19th century. Especially important was the part played by the decline in infant mortality and mortality among small children. The purpose of this study has been to investigate on the basis of a local example, Linköping during the period 1860-94, the changes in morbidity and mortality in different population groups, and to analyse what factors played a significant role in bringing about the changes. The study is not only epidemiological. It also deals with new technology, new ideas and different actors. The focus is on three arenas: the societal level, the environmental level and the individual level. By the societal level is meant the central arena and the decisions that were taken there. The environmental level contains the study of local public health and a reconstruction of how water and drainage progressed and what properties it came to year by year. The individual level involves the study of a number of variables which the individuals themselves can have influenced in different degrees. / Den här studien behandlar utvecklingen i Linköping 1860-94, en period som kännetecknades av en medveten strävan från samhällets sida att påverka hälsoförhållandena till det bättre. Från år 1860 förbättrades dödsorsaksstatistiken och strax därefter, 1863, genomfördes kommunreformen som gjorde genomgripande samhällsinsatser möjliga. Undersökningsperioden slutar 1894. Det viktigaste källmaterialet, de datoriserade kyrkböckema, upphhör då, men många av de studerade skillnadema mellan olika befolkningsgrupper har också reducerats betydligt. En senare tidsperiod kräver andra verktyg än de som används här. Avhandlingens syfte är att utifrån ett lokalt exempel studera hur förändringen i dödlighet (och i någon mån sjuklighet) gick till i olika befolkningsgrupper och analysera vilka faktorer som varit betydelsefulla för den. Avhandlingen är inte enbart epidemiologisk utan handlar i lika hög grad om ny kunskap, ny teknologi, nya ideer och deras spridning samt de olika aktörema på såväl lokal som central nivå i det expanderande Sjukvårdssverige. Att studera en lokal miljö ger många möjligheter att observera sådant som är omöjligt via aggregerade data på nationell nivå. Mängder av variabler kan kontrolleras, men i vilken grad speglar resultaten från Linköping förhållanden i andra städer i Sverige och Västeuropa? Till detta återkommer vi senare.