The structure and systems of state health departments (SHD) may affect reporting of foodborne disease outbreak (FBDO) hospitalizations. Evaluation of SHD by investigating the contributions of structural capacity elements (SCE) will provide an accurate measure of performance and highlight areas for development of effective strategies for improvement. This study investigated the relationship between organizational and structural characteristics of SHD and systems for FBDO reporting, and included three manuscripts designed to address seven hypotheses, as well as a conclusion chapter interpreting the findings as they relate to the overall research question. Study findings identified consistently higher reports of hospitalization due to foodborne illness from third party payers compared to SHDs between 2006 and 2009 in 30 of the 31 states analyzed. Furthermore, significantly different rates of reporting among states with mixed governance classification were seen when compared to those with centralized and decentralized governance; associations between total laboratory expenditures and total food-related hospitalizations reported were also identified when analyzing healthcare claims data. This dissertation contributes to the current knowledge base for public health services and systems research, as well as food safety surveillance and reporting, and provides an innovative approach to using secondary databases to investigate food safety issues. Findings support the conclusion that collaboration between public and private agencies would support improvements in data collection and foodborne illness surveillance. / Public Health

Patients with mental illness experience dissatisfaction with their care due to lack of understanding and ignorance from the nurses. The nurses’ approach might influence these patients' experience of their care. The purpose of the literature review was to describe nurses' approach in care of patients with mental illness. The literature review is based on an inductive approach and the result is based on 14 scientific papers, of which eight used a qualitative design and sex used a quantitative design. A simpler form of content analysis was used, which resulted in four themes: the importance of knowledge, preconceived perceptions, neglect and feelings of responsibility. Nurses' attitudes to mental illness are both positive and negative. Positive approaches include feelings of responsibility for patient care. Negative approaches include neglect and negative feelings such as distrust and fear. The result of the literature review indicates a need for more education about mental illness in order to reduce stigma and knowledge gaps among registered nurses in public health services. As many results articles were related to abuse problems the area seems limited, therefore more research directed toward other mental illnesses, is recommended. / Patienter med psykisk ohälsa upplever missnöje med sin omvårdnad på grund av brist på förståelse och negligering från sjuksköterskorna. Sjuksköterskorna kan påverka dessa patienters upplevelser av omvårdnaden genom sitt förhållningssätt. Syftet med litteraturstudien var att beskriva sjuksköterskors förhållningssätt i omvårdnaden av patienter med psykisk ohälsa. Litteraturstudien grundas på en induktiv ansats och resultatet baseras på 14 vetenskapliga artiklar, varav åtta artiklar är kvalitativa och sex artiklar är kvantitativa. En enklare form av innehållsanalys användes, vilket resulterade i fyra teman: kunskapens betydelse, förutfattade uppfattningar, negligering samt känslor av ansvar. Sjuksköterskors förhållningssätt till psykisk ohälsa är både positiv och negativ. Positiva förhållningssätt inkluderar känslor av ansvar för patienternas omvårdnad. Negativa förhållningssätt inbegriper bland annat negligering samt negativa känslor som misstro och rädsla. Litteraturstudiens resultat påvisar ett behov av mer utbildning om psykisk ohälsa för att reducera stigmatisering och kunskapsluckor hos legitimerade sjuksköterskor i den allmänna hälso- och sjukvården. Området upplevdes begränsat då många funna resultatartiklar berör missbruksproblematik, därför rekommenderas mer forskning riktad mot andra psykiska sjukdomar.

A violência sexual provoca sofrimento e produz consequências de ordem física e psicológica que se fazem escutar no espaço clínico. É preconizado pelo Ministério da Saúde que a assistência se faça por meio de abordagem interdisciplinar capacitada, porém, nota-se que existe uma carência na literatura a respeito de atendimentos psicológicos realizados e seus resultados, principalmente na abordagem psicanalítica. É dado clínico que a violência sexual se repete em muitos casos, que mulheres adultas que relatam ter vivido essa experiência na infância mantenham segredo, e que a manutenção desse segredo resulta em consequências, muitas vezes sobrecarregando os serviços públicos de saúde. Temos percebido que o segredo vem sendo justificado em função do vínculo afetivo existente entre agredido e agressor, entretanto a clínica nos mostra que apesar da presença dessas características, nem sempre esse silenciamento se dá em função disso e que frequentemente o segredo vem ocupar uma função de possível manutenção de uma posição subjetiva que talvez não possa ser revelada. Assim, essa justificativa engessada poderia impossibilitar que essas mulheres fossem tratadas. Acreditando na relevância da compreensão clínica da função do segredo no tratamento psíquico de cada mulher, tanto do ponto de vista conceitual quanto da manutenção de uma posição subjetiva, apresentamos uma investigação teórica a respeito da violência sexual e do conceito de segredo nas obras de Freud e de Lacan, bem como uma revisão da literatura científica especializada. Abordamos também conceitos psicanalíticos como silêncio, não-dito, complexo de édipo e constituição de sujeito, trauma, repetição e fantasia, para discutir questões relacionadas às articulações da violência sexual e o segredo com a psicanálise, enfatizando a escolha pelo segredo como algo que tem a função de resguardar a fantasia. Refletimos também a importância de serviços à violência sexual para o sistema de saúde brasileiro no que se refere a possível contribuição para a diminuição da sobrecarga nas instituições públicas, bem como caminhos para que psicólogos que trabalhem ou pretendam trabalhar em instituições de saúde e/ou consultórios particulares com pacientes que apresentam histórico de violência sexual, possam pensar em possibilidades de prevenção, direção de tratamento do sofrimento psíquico e interlocução com os demais saberes da área da saúde, corroborando para novos projetos de serviços interdisciplinares e novas pesquisas / The Sexual violence causes suffering and produces physical and psychological consequences that can be listened in the clinical space. The Brazilian health department recommends that social assistance should be provided by specialized interdisciplinary approach; however, there is a lack of literature about psychological services and results performed, especially in the psychoanalytic approach. The clinical observation testifies that sexual violence can be a repetition in many cases, that the adult women who have suffered abuse during their childhood keep the that as a secret, and that the maintenance of such secrecy results in consequences, that often overload the public health services. We realized along the studies that the secret has been justified by the emotional connection between the abused and the abuser, however the clinic experience shows us that despite the presence of these characteristics, this silencing is not always related to the emotional relationship described above but is often related to the possibility of maintaining a subjective position which may not be revealed. Therefore, this \"assumed\" reason could make it impossible for these women to be treated. Based on the belief that clinically the secrecy has its function on the way we can conduct the treatment of each women from the theoretical point of view as well as the maintenance of a subjective position we present a theoretical research about sexual violence and the concept of secrecy in the Freud and Lacan literature, as well as review of the specialized scientific researches. We analyzed psychoanalytic concepts such as silence, the unsaid, the Oedipus complex and the psychic constitution, trauma, repetition and fantasy. We discussed the issues related to the links of sexual violence and secrecy with the psychoanalysis, emphasizing the \"choice\" for the secrecy as something that has the function of protecting the fantasy. We also considered the importance of multidisciplinary services supporting treatments of sexual violence victims in the Brazilian health system in order to reduce the overload on public institutions, as well as, the possibility of finding ways for psychologists to work with patients who have sexual violence history. At last, we discussed the possibilities of prevention, the treatment of psychological suffering and the dialogue among the health fields such as medical and social services, corroborating for new projects of interdisciplinary services and new researches

Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.

Den här avhandlingen undersöker utvecklingen av en elektronisk förvaltning ur ett legitimitetsperspektiv. Det övergripande syftet är att analysera den reella och potentiella förändring som e-förvaltning innebär för den offentliga förvaltningens legitimitetsgrunder, både i form av hur e-förvaltning har formulerats som idé, och hur det konkret har gått till när e-förvaltning har implementerats i praktiken. Avhandlingen består av fem artiklar som undersöker olika aspekter av syftet, från idéerna bakom e-förvaltning på internationell nivå, till implementeringsprocessen på lokal nivå. Den övergripande analysen använder sig av så kallad pragmatisk institutionalism, samt perspektiv på hur legitimitet skapas och upprättshålls i förvaltningen. En fallstudie av en svensk kommun utgör det huvudsakliga empiriska materialet. Detta material kompletteras med en mindre studie av ytterligare en svensk kommun, samt dokumentstudier av den Europeiska Unionens policy för e-förvaltning. Avhandlingen lyfter fram fyra huvudsakliga slutsatser: (1) e-förvaltningsreformer bidrar till skapandet av en ny praxis, där den praktiska utvecklingen och tillämpningen av IT blir ett allt viktigare inslag i den studerade kommunens organisering och serviceutövning, (2) detta bidrar till en omorganisering av aktörsroller- och förhållanden. Ledande tjänstemän i kommunen övertar den strategiska styrningen av utvecklingsprocessen från lokala politiker, medan kommunens närbyråkrater kringgås genom att medborgaren förväntas ta ett större eget ansvar för interaktionen med förvaltningen, (3) legitimitetsgrunder såsom brukarinflytande och kundanpassning placeras därmed i förgrunden medan den politiska styrningen och bedömningen hamnar i bakgrunden, (4) dessa förändringar tyder på allt starkare inslag av en gör-detsjälv-logik, där legitimitet i genomförandeprocesser främst grundar sig i individens möjlighet till självbetjäning och självförvaltning via elektroniska kanaler. / This thesis explores the development of an electronic government from a legitimacy perspective. The overarching aim is to analyse the actual and potential processes of change and impacts of e-government on bases of legitimacy within public administration – both with regards to how the ideas behind e-government have been formulated as well as how e-government in practise has been realised. The thesis consists of five articles that examine different aspects of the overarching aim; from the ideas behind e-government on an international level, to the practical implementation process in local government. The overarching analysis uses an institutional perspective and perspectives on the creation and maintenance of legitimacy in public administration. An in-depth case study of a Swedish municipality provides the main empirical material for the analysis. In turn, the material is supplemented with a smaller case study of another Swedish municipality, as well as document studies of the e-government policy of the European Union. The analysis arrives at four overarching conclusions: (1) egovernment reforms contribute to new practises, in which the development and application of IT is becoming increasingly central for the local organisation and the provision of public services, (2) this contributes to a reorganisation of actor roles and relationships. Leading public officials shoulder the strategic steering usually confined to local politicians, whilst street-level bureaucrats are circumvented by citizens since citizens are expected to shoulder greater individual responsibility in their interaction with administrations, (3) in turn, certain bases for legitimacy are placed in the foreground, in particular user influence and customer adaptation, whilst political steering and evaluation are downplayed, (4) these developments point at the emergence of a do-it-yourself-logic, in which legitimacy is mainly based on creating sufficient preconditions for individual selfservices and self-government through the electronic channels of administrations.

Orientador: Gastão Wagner de Sousa Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T17:31:05Z (GMT). No. of bitstreams: 1 Nascimento_RobertaSoares_D.pdf: 1746323 bytes, checksum: c99f33ea2452bdbaaa3f70d60f291f19 (MD5) Previous issue date: 2010 / Resumo: A Hipertensão Arterial (HA) e o Acidente Vascular Cerebral (AVC) como analisadores da atenção básica no SUS em Campinas. No Brasil o AVC é uma das primeiras causas de morte e importante fonte de incapacidade permanente entre adultos. Utilizaremos este agravo como analisador da atenção básica e sua relação com o diagnóstico e tratamento da HA. Descrevemos o perfil das vítimas de AVC e seu atendimento hospitalar no período de abril de 2006 a março de 2007. Descrevemos a ocorrência do agravo como indicador indireto de acesso de pacientes crônicos ao SUS, uma vez que o principal precursor do AVC é a HA que é um problema com prioridade de abordagem na rede básica. Analisamos narrativas produzidas a partir de grupos focais entre usuários e trabalhadores das Unidades Básicas de Saúde (UBS) sobre a amplitude de sua intervenção clínica. Consultamos as fichas familiares dos referidos pacientes na UBS e entrevistamos gerentes locais sobre a organização dos serviços. Agrupamos 06 UBS em três diferentes graus de implantação dos arranjos organizacionais e diretrizes do projeto Paidéia de saúde da Família, como o vínculo e adscrição de clientela por equipe de referência, a institucionalização do trabalho em equipe, atividades assistenciais coletivas e estratégias de intervenção no território. Analisamos as UBS com SUS dependência alta mas ao mesmo tempo com um grau de organização e cobertura assistencial maior ou igual a 50% Observamos a organização do processo de trabalho, agendas individuais, grupos, outras ações de promoção em saúde e atendimento domiciliar / Abstract: Arterial Hypertension and Cerebrovascular Accident as analyzers of primary care in the health care system in Campinas. In Brazil, the stroke is one of the leading causes of death and a major source of permanent disability among adults. We will use this harm as the primary analyzer of the basic attention and its relationship with diagnosis and treatment of hypertension. We describe the victims' profile of stroke and their hospital care from April 2006 to March 2007. We describe the occurrence of the disease as an indirect indicator of chronic patients' access to SUS since the main precursor of stroke is hypertension, which is a problem with priority in the basic approach. We analyzed narratives produced from focus groups among users and employees of the Basic Health Units (UBS) on the extent of their clinical intervention; consulted the records of those patients' family in the UBS and interviewed local managers on the organization of services. 06 UBS were grouped into three different degrees of implementation of organizational arrangements - Paideia Health Family Project's guidelines - as the bond and assignment of customers for reference team, the institutionalization of work, the teamwork, the collective welfare activities and the strategies of intervention on territory. We analyzed UBS with similar characteristics and with high dependence for the population by the Unified Health System (SUS) but, at the same time, with a degree of organization installed and welfare coverage greater than or equal to 50%. We observed the organization of the work process, individual agendas, educational groups on health and other actions to promote health and home care / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

A violência sexual provoca sofrimento e produz consequências de ordem física e psicológica que se fazem escutar no espaço clínico. É preconizado pelo Ministério da Saúde que a assistência se faça por meio de abordagem interdisciplinar capacitada, porém, nota-se que existe uma carência na literatura a respeito de atendimentos psicológicos realizados e seus resultados, principalmente na abordagem psicanalítica. É dado clínico que a violência sexual se repete em muitos casos, que mulheres adultas que relatam ter vivido essa experiência na infância mantenham segredo, e que a manutenção desse segredo resulta em consequências, muitas vezes sobrecarregando os serviços públicos de saúde. Temos percebido que o segredo vem sendo justificado em função do vínculo afetivo existente entre agredido e agressor, entretanto a clínica nos mostra que apesar da presença dessas características, nem sempre esse silenciamento se dá em função disso e que frequentemente o segredo vem ocupar uma função de possível manutenção de uma posição subjetiva que talvez não possa ser revelada. Assim, essa justificativa engessada poderia impossibilitar que essas mulheres fossem tratadas. Acreditando na relevância da compreensão clínica da função do segredo no tratamento psíquico de cada mulher, tanto do ponto de vista conceitual quanto da manutenção de uma posição subjetiva, apresentamos uma investigação teórica a respeito da violência sexual e do conceito de segredo nas obras de Freud e de Lacan, bem como uma revisão da literatura científica especializada. Abordamos também conceitos psicanalíticos como silêncio, não-dito, complexo de édipo e constituição de sujeito, trauma, repetição e fantasia, para discutir questões relacionadas às articulações da violência sexual e o segredo com a psicanálise, enfatizando a escolha pelo segredo como algo que tem a função de resguardar a fantasia. Refletimos também a importância de serviços à violência sexual para o sistema de saúde brasileiro no que se refere a possível contribuição para a diminuição da sobrecarga nas instituições públicas, bem como caminhos para que psicólogos que trabalhem ou pretendam trabalhar em instituições de saúde e/ou consultórios particulares com pacientes que apresentam histórico de violência sexual, possam pensar em possibilidades de prevenção, direção de tratamento do sofrimento psíquico e interlocução com os demais saberes da área da saúde, corroborando para novos projetos de serviços interdisciplinares e novas pesquisas / The Sexual violence causes suffering and produces physical and psychological consequences that can be listened in the clinical space. The Brazilian health department recommends that social assistance should be provided by specialized interdisciplinary approach; however, there is a lack of literature about psychological services and results performed, especially in the psychoanalytic approach. The clinical observation testifies that sexual violence can be a repetition in many cases, that the adult women who have suffered abuse during their childhood keep the that as a secret, and that the maintenance of such secrecy results in consequences, that often overload the public health services. We realized along the studies that the secret has been justified by the emotional connection between the abused and the abuser, however the clinic experience shows us that despite the presence of these characteristics, this silencing is not always related to the emotional relationship described above but is often related to the possibility of maintaining a subjective position which may not be revealed. Therefore, this \"assumed\" reason could make it impossible for these women to be treated. Based on the belief that clinically the secrecy has its function on the way we can conduct the treatment of each women from the theoretical point of view as well as the maintenance of a subjective position we present a theoretical research about sexual violence and the concept of secrecy in the Freud and Lacan literature, as well as review of the specialized scientific researches. We analyzed psychoanalytic concepts such as silence, the unsaid, the Oedipus complex and the psychic constitution, trauma, repetition and fantasy. We discussed the issues related to the links of sexual violence and secrecy with the psychoanalysis, emphasizing the \"choice\" for the secrecy as something that has the function of protecting the fantasy. We also considered the importance of multidisciplinary services supporting treatments of sexual violence victims in the Brazilian health system in order to reduce the overload on public institutions, as well as, the possibility of finding ways for psychologists to work with patients who have sexual violence history. At last, we discussed the possibilities of prevention, the treatment of psychological suffering and the dialogue among the health fields such as medical and social services, corroborating for new projects of interdisciplinary services and new researches

Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities. A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. iii This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index – which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is “low tech” in that it runs on a “stand alone” personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

Using a structural approach, this study addresses the issues surrounding direct service delivery of the Family Preservation program in Riverside County.

Orientador: Jamile Sanches Codogno / Resumo: A Síndrome Metabólica (SM) tem sido apontada como importante fator no aumento do risco de doenças cardiovasculares, problema de saúde pública mundial. A doença tem apresentado elevados custos com a utilização de serviços de saúde direcionados aos seus componentes. O estudo objetivou avaliar a presença de SM em adultos, atendidos pelo SUS, assim como a influência da prática de atividade física habitual (AFH) nos custos com serviços de saúde de pacientes com SM. O estudo é de característica transversal, a amostra foi selecionada por meio da sexta coleta de estudo de coorte, realizada na atenção primária de duas Unidade Básicas de Saúde (UBS) da cidade de Presidente Prudente. Participaram deste estudo aqueles que faziam parte da coorte e demonstraram interesse em participar e estiveram presentes em todas as avaliações anteriores. Era necessário ter idade igual ou acima de 50 anos e ter registro ativo na UBS. A SM foi verificada por meio das variáveis bioquímicas, glicose, lipoproteína de alta densidade (HDL) e triglicerídeos (TG) analisadas por meio de exames laboratoriais realizados por laboratórios credenciados. A pressão arterial sistólica e diastólica a circunferência de cintura fora, verificadas por avaliadores. O nível da atividade física habitual (AFH) foi avaliado por questionário e, através de registros em prontuários médicos, foram verificados os custos com serviços de saúde dos pacientes participantes da pesquisa. Esta dissertação foi estruturada em dois capítulos, di... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The study aimed to evaluate the presence of MS in adults, assisted by SUS, as well as the influence of the practice of habitual physical activity (AFH) in the costs of health services for patients with MS. The study is cross-sectional, the sample was selected through the sixth collection of a cohort study, carried out in the primary care of two Basic Health Units (UBS) in the city of Presidente Prudente. Participated in this study those who were part of the cohort who showed interest in participating and were present in all previous evaluations. It was necessary to be 50 years old or over and have active registration at UBS. MS was verified by means of the biochemical variables glucose, high-density lipoprotein (HDL) and triglycerides (TG) were analyzed through laboratory tests performed by accredited laboratories, the systolic and diastolic blood pressure and waist circumference was verified by evaluators. The level of habitual physical activity (AFH) was assessed using a questionnaire, and through medical records, the costs of health services of the patients participating in the research were verified. This dissertation was structured in two chapters, divided as follows: Chapter 1- introduction, objectives and general methodology of the dissertation; Chapter 2- article with the objective of evaluating the prevalence of MS in patients of the Unified Health System (SUS) in Presidente Prudente and analyzing the contribution of its components on the costs of health services in ... (Complete abstract click electronic access below) / Mestre