Submitted by Jordan (jordanbiblio@gmail.com) on 2017-05-26T15:57:24Z No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-05-26T16:48:39Z (GMT) No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Made available in DSpace on 2017-05-26T16:48:39Z (GMT). No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) Previous issue date: 2014-02-07 / CAPES / A caderneta de saúde da criança é um instrumento que visa o acompanhamento integral de saúde da criança, pautado na vigilância à saúde. No Brasil, este instrumento configura-se como o principal documento para o registro das informações de saúde da criança e serve também como ferramenta de diálogo entre as famílias e os profissionais que atuam em diferentes espaços assistenciais voltados à esta população. Este estudo tem por objetivo analisar a percepção dos profissionais que atuam na atenção à criança na rede básica de saúde de Cuiabá-Mato Grosso, sobre a utilização da caderneta de saúde da criança. Trata-se de um estudo exploratório de abordagem qualitativa, que teve como sujeitos oito médicos, oito enfermeiros e quatro agentes comunitários de saúde, totalizando 20 profissionais que atuavam em unidades básicas de saúde deste município. A coleta dos dados foi realizada no período de fevereiro a março de 2013, por meio de entrevista semiestruturada, analisada pela técnica de análise temática. A análise dos dados possibilitou o agrupamento das informações em três eixos temáticos: as diversas finalidades da caderneta de saúde da criança; o preenchimento da caderneta de saúde da criança pelos profissionais e a utilização da caderneta de saúde da criança pela família. Os profissionais atribuem à caderneta a interpretação de que ela é um documento importante por conter diversas informações da saúde da criança, antes mesmo do seu nascimento. Além disso, possuem diferentes opiniões sobre a finalidade da mesma. Em relação aos dados a serem preenchidos no documento, os profissionais os percebem como importantes para o acompanhamento da saúde infantil, no entanto, para eles o registro desses ainda não recebe a devida importância em todos os atendimentos à criança. Para os profissionais, o preenchimento dos dados é de responsabilidade da equipe de saúde, médico, enfermeiro e técnicos de enfermagem. Houve discordância de opinião sobre a participação da família neste preenchimento, sendo que para uns a família não deve preencher nenhum dado, enquanto que para outros os dados de identificação, desenvolvimento e intercorrências com a criança podem ser registrados pela família. Segundo os entrevistados, vários são os fatores que influenciam o uso adequado da caderneta, tais como: perda ou esquecimento do instrumento pela mãe, burocracia do serviço, grande demanda de atividades na unidade, dentre outros. Na percepção dos participantes do estudo, apesar de a família ser orientada sobre a caderneta, esta ainda a utiliza muito pouco. Para os entrevistados, além de a família ter o direito de cobrar dos profissionais o registro dos dados na caderneta, esse comportamento da família demonstra o seu interesse pela saúde do filho e auxilia o trabalho dos profissionais. Nota-se também preocupação dos participantes do estudo quanto à utilização plena da caderneta. Assim, para que este instrumento se efetive como instrumento de vigilância e de promoção à saúde infantil, tanto os profissionais quanto as famílias deverão atribuir lhe maior valor. / The child health handbook is an instrument which aims the integral monitoring of child health, based on health surveillance. In Brazil, this instrument is configured as the main document for the information of child's health and also serves as a tool for dialogue between families and the professionals who work in different spaces for assistance to this population. This study aims to analyze the perceptions of professionals working in child care in basic health network of Cuiabá – Mato Grosso, on the use of child health handbook. This is an exploratory study of qualitative approach, which had as its subject eight doctors, eight nurses and four community health agents, totaling 20 professionals who acted in basic health units of this municipality. The data collection was carried out from February to March 2013, through a semi-structured interview, analyzed by the technique of thematic analysis. The data analysis allowed the grouping of information in three thematic axes: the several purposes of maternal and child health; the fill of the child health handbook by the professionals and the use of the child health handbook by the family. The professionals attach to the booklet the interpretation that it is an important document because it contains various information of child health, even before his birth. In addition, there are different opinions about the purpose of the same. Regarding the data to be filled in the document, the professionals refer to be important for the monitoring of children's health, however, for them the record of those still does not receive due weight in all attendances to the child. For professionals the padding of the data is of the responsibility of the health team, doctor, nurse and nursing technicians. There was disagreement of opinion on the participation of the family in this fill, and for some the family must not fill any data, while for other identification data, development and complications with the child can be registered by the family. There are many factors that influence the use of booklet by professionals such as loss or forgetfulness of the instrument by her mother, bureaucracy, high demand for service activities in the unit, among others. In the perception of the participants of the study, although the family be oriented about the booklet, the same still uses very little. For the interviewees, beyond the family having the right to ask for registration data from the professionals in the booklet, this family's behavior demonstrates its interest in the health of the child and assists the work of professionals. It is noted, also, a concern of the participants of the study regarding the full use of the notebook. Thus, for this instrument being effective such as surveillance and promotion document to child health both the professionals and the families should assign more value to it.

<p>With the increasing prevalence of chronic disease throughout the world, electronic Personal Health Records (ePHRs) have been suggested as a way to improve chronic disease self-management. However, ePHRs are not yet widely used by consumers. Protection Motivation Theory (PMT) has been successfully used to explain health related behaviours among chronic disease patients. In addition, Information Systems (IS) theories such as Task Technology Fit (TTF) have been successfully used to explain information technology adoption. This study combines PMT with Perceived Task Technology Fit (PTTF) and the health self-management readiness concept of the Patient Activation Measure (PAM) to propose a research model which will aid in the understanding of ePHR adoption by chronic disease patients. The role of educational interventions on various elements of the proposed model is also examined. A survey-based study of 230 participants is used to empirically validate the proposed model via structural equation modeling techniques. Results reveal that the PMT constructs, as well as PTTF and PAM all have significant direct or indirect effects on the intention to adopt an ePHR. In addition, the educational intervention analysis indicates that the provision of advanced ePHR education positively influences various constructs in the model, while the use of fear appeals through Diabetes complication education does not have an effect.</p> / Doctor of Philosophy (PhD)

Informacijos apie asmens sveikatos būklę konfidencialumas yra svarbi įstatymų saugoma vertybė. Tačiau teisės doktrinoje, teisės aktuose ir teismų praktikoje pri¬pažįstama, kad teisė į privataus gyvenimo neliečiamumą nėra absoliuti. Kai ribojama asmens teisė į privatų gyvenimą, toks ribojimas turi būti numatytas įstatymų lygmenyje ir ad hoc analizuojama, ar toks ribojimas yra būtinas demokratinėje visuomenėje, siekiant ap¬saugoti teisėtą tikslą. Darbe yra nagrinėjami ir vertinami informacijos apie asmens sveikatos būklę atskleidimo tretiesiems asmenims atvejai, identifikuojami pažeidimai ir pateikiamos rekomendacijos, kokių teisinių priemonių įgyvendinimas padėtų tinkamai užtikrinti asmens teisę į šią privataus gyvenimo sritį. Darbe pristatoma asmens sveikatos informacijos konfidencialumo samprata, aprašoma, koks yra asmens, kaip paciento, teisės į privataus gyvenimo neliečiamumą reglamentavimas Lietuvoje, pristatoma šalių praktika, identifikuojami sveikatos informacijos konfidencialumo principo ribojimai, pateikiami atvejai, kuomet informacija apie asmens sveikatos būklę yra atskleidžiama pažeidžiant teisės aktus, taip pat vertinami atvejai, kai galimai ultra vires įstatymų leidėjas priima įstatymus, kurie prieštarauja LR Konstitucijai ir tarptautinėms sutartims. Darbe yra išsikeliamos dvi hipotezės: H1 – Lietuvoje be paciento sutikimo atskleidžiant informaciją apie paciento sveikatos būklę draudimo įstaigoms pažeidžiama asmens teisė į privatų gyvenimą; H2 – Lietuvoje... [toliau žr. visą tekstą] / Confidentiality of personal health information is an important value which is protected by The Convention for the Protection of Human Rights and Fundamental Freedoms, Constitution of the Republic of Lithuania and other laws. However, the right to confidentiality is not recognized as absolute in the doctrine of law, legislation and legal cases. When there is the restriction of confidentiality of personal health information, it is necessary to emphasize the principle of necessity to protect a legitimate target which is necessary in a democratic society. It is important to notice that every restriction must be provided at the level of a piece of legislation. In the paper there is analyzed and evaluated the cases of the disclosure of personal health information to third parties, identified violations and made recommendations what legislative measures should be implemented to ensure the patient's right to private life. In the paper there has set the following objectives: to analyze the current situation in Lithuania what there is the regulation of the patient's right to privacy; to present the practice of different countries about patient's right to privacy; to carry out a theoretical analysis by comparing the various scientific researches on the personal health privacy; to determine what is the restrictions for the principle of medical confidentiality; to identify privacy problems while disclosing personal health information; to reveal when information is disclosed in accordance... [to full text]

The aim of this project was to investigate what information is critical to convey to nurses when performing digital triage. In addition, the project aimed to investigate how such information could be visualized. This was done through a combined user research and machine learning approach, which enabled for a more nuanced and thorough investigation compared to only making use of one of the two fields. There is sparse research investigating how digital triaging can be improved and made more efficient. Therefore, this study has contributed with new and relevant insights. Three machine learning algorithms were implemented to predict the right level of care for a patient. Out of these three, the random forest classifier proved to have the best performance with an accuracy of 69.46%, also having the shortest execution time. Evaluating the random forest classifier, the most important features were stated to be the duration and progress of the symptoms, allergies to medicine, chronic diseases and the patient's own estimation of his/her health. These factors could all be confirmed by the user research approach, indicating that the results from the approaches were aligned. The results from the user research approach also showed that the patients' own description of their symptoms was of great importance. These findings served as a basis for a number of visualization decisions, aiming to make the triage process as accurate and efficient as possible.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-19T16:23:48Z No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) / Made available in DSpace on 2017-04-19T16:23:48Z (GMT). No. of bitstreams: 1 Vitor Secretti Bertoncello_.pdf: 8707879 bytes, checksum: 8c444504769b11f83390c5d057d72e7c (MD5) Previous issue date: 2017-02-21 / Nenhuma / O crescimento constante da expectativa de vida no Brasil trouxe à tona um desafio para a rede de atendimento de saúde. A maior longevidade da população resulta diretamente no aumento do registro de doenças crônicas, elevando a procura por atendimento médico. A superação desse desafio passa pela mudança no modelo de atendimento de saúde, cujo objetivo é inserir o paciente como membro ativo no cuidado ao próprio bem-estar. Esse novo modelo gerou demanda por novas soluções de tecnologia de informação e comunicação capazes de atender satisfatoriamente ao paciente, como soluções em computação móvel e ubíqua. Assim, o presente trabalho propõe o modelo chamado AllHealthcare, consistindo em uma solução de registro de saúde pessoal (PHR), em que o próprio paciente é capaz de construir um Perfil de Acompanhamento Dinâmico (PAD) para seus cuidados de saúde, de acordo com suas necessidades, e alterá-lo conforme novas demandas ou focos venham a ser considerados. Tal dinamismo na construção de um perfil personalizado é alcançado devido ao modelo proposto se basear em arquétipos do padrão OpenEHR, o que também atribui a característica de interoperabilidade semântica à presente proposta. Em revisão de pesquisas com foco em PHR, grande parte das soluções encontradas são concebidas e focadas para tratamento de determinada doença, ou seus modelos não atendem a um conjunto de requisitos operacionais importantes e atuais, como a mobilidade do cuidado de saúde e a interoperabilidade semântica das informações de saúde. Do modelo proposto, foi implementado um protótipo funcional, o qual passou por três etapas de avaliação. Nas três etapas de avaliação os resultados foram positivos e e os participantes apontaram um conjunto de possíveis melhorias, mesmo assim, aplicando-se o modelo de aceitação de tecnologia (TAM) a 22 usuários do protótipo, obteve uma aceitação média de 86,6%. / The constant growth of life expectancy in Brazil brought to the focus a challenge for the healthcare systems. The increased longevity of the population directly results in increased registration of chronic diseases, increasing the demand for healthcare. Overcoming this challenge is to change the health care model, whose goal is to insert the patient as an active member in the care of own welness. This new model has generated demand for new information and communication technologies solutions able to satisfactorily meet the patient, as solutions in mobile and ubiquitous computing. Thus, this paper proposes the model called AllHealthcare, consisting of a personal health record (PHR) solution that the patient is able to build a Dynamic Accompanying Profile (PAD) for their health care, according to their needs, and change it as new demands or focus may be considered. This dynamism in building a custom profile is achieved due to the proposed model is based on openEHR standard archetypes, which also provides the feature of semantic interoperability to this proposal. In a review research focusing on PHR, most of the solutions founded are designed and focused for treatment of a particular disease or their models do not fulfill a number of important and current operational requirements, such as healthcare mobility and semantic interoperability of health information. From the proposed model, a functional prototype was implemented, underwent through three stages of evaluation. In the three evaluation stages, the results were positive and the participants pointed out a set of possible improvements, even though applying the technology acceptance model (TAM) to 22 prototype users, obtained an average acceptance of 86.6%.

No description available.

Head stabilisation during gait related tasks is thought to be fundamental to whole body stability, but this has received little attention in the older population. There is a need to examine any age related changes in neuromechanical mechanisms underpinning head stabilisation that may challenge the control of head stability, and consequently whole body stability. The present Thesis examined the mechanisms contributing to head stabilisation, and whole body stability during two gait tasks, steady state gait and gait initiation in young and older females, with the overall aim of contributing to negating fall risk. Four studies were designed to examine a) head position and walking speed on gait stability during steady state gait; b) neuromechanical mechanisms underpinning head stabilisation during gait initiation; c) head position on whole body stability during gait initiation; and d) head stabilisation during gait initiation at different speeds. Results showed that a) gait stability, was unaffected by head position and different walking speeds during steady state gait, b) decreased head stability in older individuals during gait initiation can be attributed to a deterioration of the neuromechanical mechanisms relating to head stability, c) free head movement during gait initiation does not affect head stabilisation or whole body stability but it does affect gait parameters, while d) initiating gait at faster than comfortable speeds compromises head stabilisation and reduces whole body stability in older individuals. Collectively, these results demonstrate that older individuals adopt an increased head flexion position when walking, while impaired head stability can be attributed to deterioration of the function of their neuromechanical mechanisms compared to their younger counterparts during gait tasks at comfortable speeds. These findings provide an understanding of the effect head stabilisation can have on older adults’ gait and on their fall risk during gait and gait initiation.

Eye movements are used day-to-day to acquire visual information. Vision is also used for postural control. There are growing indications eye movements can affect postural control. However, this has not been investigated in older adults, which is surprising given the high incidence of falls in older populations. The present thesis aims to address this. The first experimental chapter explores the effects of eye movements on balance during standing in young and older adults. The findings show decreased stability during smooth pursuits, whereas saccades maintained stability to that when fixating a static target. The older adults matched the younger groups performance throughout. The second experimental chapter explores the effects of smooth pursuits and saccades on balance during locomotion in young and older adults. Smooth pursuits were shown to decrease stability, whilst saccades maintained stability compared to fixating a static target. The effects of the eye movements were similar in the older adults. However, the elders exhibited lower baseline stability. The third experimental chapter explores the effects of tracking a real-world stimulus (another person known as `pedestrian') on balance control during locomotion. The pedestrian could be standing still or walking. Fixating the stationary and the walking pedestrian decreased stability similarly when compared to free gaze when the pedestrian was not present. To determine whether these results were transferable to natural gaze rather than instructed gaze, the fourth experimental chapter explores free gaze patterns in a similar real-world environment. Both the young and older adults typically fixated the pedestrian when he was standing still and walking, but began to ignore him once he had walked away from their direction heading. Therefore, experiment 3 behaviour was transferable to natural gaze patterns. The older adults also adopted a more cautious approach by fixating regions on the ground initially, and for longer, before looking to their direction heading.

Made available in DSpace on 2016-06-02T19:48:20Z (GMT). No. of bitstreams: 1 4305.pdf: 2120950 bytes, checksum: 959d202140129b116f54d9eadf3aab57 (MD5) Previous issue date: 2012-02-29 / The objective of this study was to understand the psychological and cultural meanings of health professionals of Primary Health Care (PHC) on the issue of women in situations of domestic violence served by them including their uncertainties and difficulties. We tried to interpret the views of these professionals, or their ideas, perceptions and concepts with which they work. The research consisted of Basic Health Units (BHU) of a municipality in the state of Sao Paulo. This is a qualitative study with semi-structured interviews, which contents were analyzed for their utterances expressed during these interviews. We tried to close the final number of participants for sampling by empirical and theoretical saturation. In other words, utterances (corresponding to the empirical data "raw") were analyzed, interview by interview, and were organized into categories formulated in accordance with the theoretical view of the researchers, the interruption of data collection occurred when the empirical data did not support anymore the formulation of new analytical categories and also no longer contributed to the deepening of the categories set out above, in the judgment of the researchers. The results are the 14 subjects that after transcribed, correspond to a corpus of 42,336 words. Respondents comprise a relatively heterogeneous group, with regard to trained professionals (nurses, nursing assistant, nurse, doctors, dentists and pharmacists). For each of the pre-made categories, which were translated into the proposed topics to the participants, were formulated analytical categories: themes or types of statements related to the problems surrounding the issue of women in violent situations (understanding of the phenomenon), emerged in these three Categories: About the violence, risk factors, gender issues. In pre-category themes or types of statements related to the first reception and care for women victims of violence were raised three categories: APS and violence against women, Dynamics of the reception and first aid, Notification. In the themes or types of statements related to other procedures to be undertaken in the APS and women in situations of violence fell into two categories: secondary and tertiary preventive measures and Prevention. Finally, the pre-category: themes or types of statements about the possible difficulties in personal and institutional care provided in APS appeared four: Social and psychosocial, educational difficulties, intrasectoral difficulties, and intersectoral difficulties. The work of discussion of these results was performed by means of a gender perspective. It can be concluded from the difficulty of PHC professionals in meeting the women in violent situations, and these difficulties begin to address the woman who is in this situation to the development / implementation of the plan of care. There is a need for intersectoral work of the network to approach these women and full inclusion in school curricula of the problem for society to constantly look for gender equality and so you can prepare your professionals to meet these women. The limits of the research were identified. / O objetivo deste trabalho foi compreender significações psicológicas e culturais de profissionais de saúde da Atenção Primária à Saúde (APS) sobre a questão das mulheres em situação de violência doméstica por eles atendidas, incluindo suas eventuais dúvidas e dificuldades. Procuramos interpretar os pontos de vista desses profissionais, ou seja, suas ideias, percepções e conceitos com que trabalham. O campo de pesquisa foi constituído por Unidades Básicas de Saúde (UBS) de um município do interior do Estado de São Paulo. Trata-se de um estudo qualitativo com entrevistas semidirigidas, cujos conteúdos foram analisados quanto às enunciações expressas durante esses depoimentos. Procurou-se fechar o número final de participantes pela técnica de amostragem por saturação empírica e teórica. Noutros termos, as enunciações (correspondentes aos dados empíricos brutos ) foram analisadas, entrevista por entrevista, e foram organizadas em categorias formuladas de acordo com a visão teórica dos pesquisadores; a interrupção da coleta de dados deu-se quando os dados empíricos não mais subsidiaram a formulação de novas categorias analíticas e também não mais contribuíram para o aprofundamento das categorias anteriormente formuladas, segundo o julgamento dos pesquisadores. Os resultados dizem respeito a entrevistas com 14 sujeitos que, depois de transcritas, corresponderam a um corpus de 42.336 palavras. Os entrevistados compõem um grupo relativamente heterogêneo quanto às formações profissionais (enfermeiros, auxiliar de enfermagem, técnico de enfermagem, médicos, odontólogos e farmacêutico). Para cada uma das pré-categorias formuladas, que foram traduzidas em questões propostas aos participantes, foram formuladas categorias analíticas. A primeira correspondeu a temas ou tipos de enunciados relacionados à problemática que envolve a questão da mulher em situação de violência (compreensão do fenômeno); nestas surgiram três categorias: Sobre a violência, Fatores de riscos, Questões de gênero. A segunda correspondeu a enunciados relacionados à recepção e aos primeiros cuidados às mulheres em situação de violência foram levantadas três categorias: APS e a violência contra mulher, Dinâmica da recepção e primeiros cuidados e Notificação. Da terceira pré-categoria, relativa a temas ou tipos de enunciados relacionados aos outros procedimentos a serem empreendidos na APS quanto às mulheres em situação de violência, emergiram duas categorias: Medidas preventivas secundárias e terciárias e Prevenção. Por fim, na pré-categoria relativa aos temas ou tipos de enunciados sobre as eventuais dificuldades pessoais e institucionais nos atendimentos realizados na APS, foram elaboradas quatro: Questões sociais e psicossociais, Dificuldades educacionais, Dificuldades intrasetoriais, Dificuldades intersetoriais. O trabalho de discussão destes resultados foi realizado por meio da perspectiva teórica de gênero. Podese concluir a dificuldade dos profissionais da APS no atendimento das mulheres em situação de violência, sendo que essas dificuldades iniciam-se na abordagem inicial da mulher que se encontra nessa situação até a elaboração/execução do plano de cuidado. Observa-se a necessidade do trabalho da rede intersetorial para a abordagem integral dessas mulheres e a inserção da problemática nos currículos escolares para que a sociedade caminhe em busca da igualdade de gênero e para que possa preparar seus profissionais para o atendimento dessas mulheres. Os limites da pesquisa foram apontados.

A epidemia do HIV/Aids é hoje, no Brasil, um fenômeno de grande magnitude e extensão. A doença avança sobre uma parte da população fisicamente fragilizada e de abordagem mais complexa: as pessoas idosas. Este estudo tem como objetivo conhecer a visão de profissionais de saúde da rede frente à possibilidade de infecção por HIV/Aids no paciente idoso. Trata-se de um estudo observacional transversal, realizado na cidade de Uberlândia, Minas Gerais, no período de novembro de 2013 a dezembro de 2015, tendo como participantes Médicos, Cirurgiões Dentistas e Enfermeiros lotados na Rede Municipal de Atenção Primária, com uma amostra de 220. Usando análise fatorial, alguns fatores não relacionados à formação dos profissionais de saúde e outros diretamente relacionados; apenas estes últimos apresentaram diferenças entre as profissões. A investigação da visão do profissional em relação à possibilidade de infecção de HIV/Aids em idosos deve ser trabalhada de forma específica para cada tipo de profissional. É fundamental a necessidade de atualização de cada profissional da área da saúde no sentido de poder realizar um diagnóstico precoce que vise proteger a integridade do paciente idoso acometido pelo HIV/Aids. / The HIV/Aids epidemic is today, in Brazil, a phenomenon of great magnitude and extent. The disease progresses over a physically weakened, and with more complex approach, portion of the population: the elderly. This study has the objective to know the vision of health professionals facing the possibility of HIV/Aids in the elderly. It is a cross-sectional observational study conducted in the city of Uberlandia, Minas Gerais, Brazil, from November 2013 to December 2015, with the participants Doctors, Dental Surgeons and nurses stationed in the Municipal Network of Primary Care, with a sample of 220. Using factor analysis, factors unrelated to the training of health professionals and others directly related; only the latter showed differences between the professions. The investigation of the professional view on the possibility of infection of HIV/Aids in the elderly should be crafted specifically for each type of professional, meeting the specific difficulties of training each degree course. It is crucial the need to update each professional in the health care field in order to be able to make an early diagnosis aimed at protecting the elderly patient's integrity affected by HIV/Aids. / Dissertação (Mestrado)