Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2017-06-26T11:50:59Z No. of bitstreams: 1 arquivototal.pdf: 7515806 bytes, checksum: a09d41d012f6b4bd6ac4e7f7ffd37975 (MD5) / Made available in DSpace on 2017-06-26T11:50:59Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 7515806 bytes, checksum: a09d41d012f6b4bd6ac4e7f7ffd37975 (MD5) Previous issue date: 2017-03-22 / Many indicators have been used to verify the e ciency and quality of services in primary health care. Recently, this level of attention has been evaluated in Brazil. The ambulatory cary sensitive conditions (ACSC), represent a set of health problems that should not reach tertiary care in large numbers, since an e ective primary care action would solve some of these pathologies. Hear, the present study is justi ed by the need to use hospitalizations for ACSC as a base for quality and access indicator for the Primary Care of the health system of Brazilian cities, in association with the Family Health Strategy (FHS). Therefore, we aim to estimate statistical reference values for ambulatory cary sensitive conditions, based on the adjustment of continuous probability distributions, in order to classify the health system of the Brazilian cities into levels of performance, namely: desirable, intermediate, worrying and not acceptable. The thesis that is defended is that the achievement of a statistical reference value, capable of classifying by ASCS, in performance levels for the Brazilian cities, will aid in decision-making processes in the units of FHS, optimizing the health actions in these units, as well as, providing the prevention of unnecessary expenses in the other levels of attention. This is an epidemiological, ecological and inferential study of quantitative approaches, based on the secondary database of the Hospital Information System of the Unique Health System, with the selection of absolute frequencies of diagnostic groups referring to ambulatory cary sensitive conditions to Primary Care, for 2015. Subsequently, these frequencies were transformed into rates per 10,000 inhabitants, making it possible to compare the ACSCs of all Brazilian cities, regardless of their population contingents. From the statistical point of view, the adjustment of continuous probability distributions through the goodness-of- t tests and graphic support were processed using software R, version 3.0.3. Based on the results, a greater incidence of hospital admissions was observed due to pathologies related to gastroenteric, cardiac and renal problems. In view of the three scenarios investigated (Brazil, Northeast and Para ba), the Northeast presents records of hospitalizations for asthma, a diagnosis not observed as one of the three highest incidences at national and state level. It was also evidenced that most of the Brazilian cities investigated in this study have their health systems classi ed as not acceptable. The city of S~ao Paulo, for example, is one such case accounting for 9.471 hospitalizations of patients with heart failure in 2015. Thus, its health system would be considered desirable if there were up to 1.532 records. An intermediate level of performance would range from more than 1.532 to a maximum of 2.944 cases, while the level of concern would be more than 2.944 to 4.177 hospitalizations. An unacceptable performance level is recorded from 4.177 ICSAP. In Brazil, when it comes to the Basic Attention scenario, although advances are perceived, the prospect of reducing the ACSC to minimum values, as is desirable, is still far from the reality. The use of the statistical reference value may constitute a potential tool, ready to use of the administrative managers in order to direct and subsidize proposals of health actions in the cities under their responsibility. / Uma variedade de indicadores tem sido utilizada para averiguar a e ciência e a qualidade de serviços na atenção primaria a saúde. Nos últimos anos, esse nível de atenção vem passando por avaliações no Brasil. As internações por condições sensíveis a atenção primária (ICSAP), representam um conjunto de agravos de saúde que não deveriam chegar em grande quantidade a atenção terciária, posto que uma efetiva ação da atenção primária solucionaria parte dessas patologias. Nesse contexto, a presente pesquisa se justiça pela necessidade de utilizar as ICSAP como base para um indicador de acesso e de qualidade da Atenção básica do sistema de saúde dos municípios brasileiros, em associação com a Estratégia Saúde da Família (ESF). Portanto, objetiva-se estimar valores estatísticos de referência para as internações por condições sensíveis a atenção primária, a partir do ajuste de distribuições de probabilidade contínuas, de modo a classificar o sistema de saúde dos municípios brasileiros em níveis de desempenho, a saber: desejável, intermediário, preocupante e não aceitável. Defende-se a tese de que a obtenção de um valor estatístico de referência, capaz de classificar as ICSAP, em níveis de desempenho para os municípios brasileiros, auxiliará nos processos de tomadas de decisão nas unidades de ESF, otimizando as ações de saúde nessas unidades, bem como, proporcionando a prevenção de gastos desnecessários nos outros níveis de atenção. Trata-se de um estudo epidemiológico, ecológico e inferencial, de abordagem quantitativa, realizado a partir da base de dados secundários do Sistema de Informações Hospitalares do SUS com a seleção das freqüências absolutas dos grupos de diagnósticos referentes as internações por condições sensíveis à atenção primária, referentes ao ano de 2015. A posteriori, as referidas freqüências foram transformadas em taxas por 10.000 habitantes possibilitando a comparação das ICSAP de todos os municípios brasileiros, independente dos seus contingentes populacionais. Sob o ponto de vista estatístico, o ajuste de distribuições de probabilidade contínuas por meio dos testes de aderência e suporte gráfico foram processados utilizando o software R 3.0.3. Com base nos resultados, observou-se uma incidência maior de internações hospitalares devido _a patologias relacionadas a problemas gastroentéricos, cardíacos e renais. Diante dos três cenários investigados (Brasil, Nordeste e Paraíba), a região Nordeste apresenta registros de internações por asma, diagnóstico não observado como uma das três maiores incidências a nível nacional e estadual. Evidenciou-se também, que a maioria dos municípios brasileiros investigados nesse estudo têm seus sistemas de saúde classificados como não aceitáveis. A cidade de São Paulo, por exemplo, é um desses casos, contabilizando 9.471 internações de pacientes com insuficiência cardíaca em 2015. Assim, seu sistema de saúde seria considerado de nível desejável se houvessem até 1.532 registros. Um nível intermediário de desempenho seria de mais de 1.532 até no máximo 2.944 casos, enquanto que, o nível preocupante dar-se-_a com mais de 2.944 até 4.177 internações. Um nível de desempenho não aceitável é registrado a partir de 4.177 ICSAP. No Brasil, em se tratando do quadro de Atenção Básica, embora avanços sejam percebidos, a perspectiva de redução das ICSAP a valores mínimos, como é desejável, ainda está distante da realidade. A utilização do valor estatístico de referência poder á constituir-se de uma potencial ferramenta, a disposição dos gestores administrativos no intuito de direcionar e subsidiar propostas de ações de saúde nos municípios sob sua responsabilidade.

La Valeur statistique de la vie humaine (VSVH) est un outil d’analyse économique, qui est définie comme la valeur qu’une personne est prête à payer (CAP) pour réduire le risque de mortalité ou de morbidité. L’intérêt d’un tel outil est d’estimer monétairement le bénéfice social d’un projet d’investissement destiné à réduire le risque, mais aussi d’établir un arbitrage entre plusieurs alternatives. Répondre à l’aléa moral dans un contexte de rareté des ressources est parfaitement adéquat avec la VSVH. Avec l’estimation des personnes de leurs capacités de paiement en fonction de leurs perceptions du risque et de leur niveau de revenu, les personnes sont positionnées comme les seules juges de la valeur de leurs vies. Parce que, les personnes déterminent librement les CAPs en fonction de leurs préférences personnelles et que ces préférences sont intégrées dans la détermination d’un choix social, la VSVH ne contredit pas le cadre normatif d’établissement d’une décision. Néanmoins, le welfarisme comme une source des méthodes d’estimation de la VSVH est en relation directe avec l’utilitarisme. Au final, la valeur estimée par la VSVH est de nature subjective. Dans le domaine de la santé, la VSVH doit dépasser le cadre subjectif d’une estimation pour répondre à l’éthique normative qui décrit la pratique médicale, notamment la prise en considération de l’autonomie personnelle, la notion personnelle de la bonne vie et la notion universelle de la personne. L’objectif de notre travail est de rechercher les arguments d’établissement d’une valeur de référence de la VSVH qui endosse un cadre normatif. Cela nécessite une analyse approfondie au sein de la théorie économique du bien-être. / The value of statistical life (VSL) is an economic analytical tool, which is defined as the value that a person is ready to pay (WTP) in order to reduce the risk mortality or morbidity. The advantage of such a tool is to monetarily estimate the social benefit of an investment project which is made to reduce the risk, but also to establish an arbitrage between several alternatives. Respond to the moral hazard in a context pertaining to the scarcity of resources, which is perfectly in keeping with VSL. With people’s estimation on their willingness to pay, depending on how they perceive risks and their income level, people are positioned as the sole judges as for the value of their lives. Because people freely determine the WTP depending on their personal preferences and these preferences are included in order to determine a social choice. The value of statistical life doesn’t contradict the normative framework of establishing a decision. Nonetheless, welfarism which is a source of estimating methods of VSL is directly related to utilitarianism. Eventually, the estimated value by VSL is subjective nature. In the health sector, the VSL needs to surpass the subjective framework of an estimation in order to answer the normative ethic which describes the medical practice, especially by taking personal self-sufficiency into account but also the personal notion of a good life and the universal notion of the person. Researching establishing arguments of reference value pertaining to VSL which takes on a normative framework and this is objective when it comes to our work. This theoretically requires an in-depth analysis within the economic theory of well-being.

L’abeille fait partie des organismes non-cibles pour lesquels le risque présenté par les pesticides est évalué avant leur mise sur le marché. Actuellement, la procédure d’évaluation du risque chez l’abeille est remise en cause, notamment à cause du décalage qui existe avec l’état des connaissances scientifiques. Ce travail se focalise sur le cas précis de l’exposition des abeilles aux pesticides lors de pulvérisations. Le but étant d’identifier les points d’amélioration et de proposer des alternatives pertinentes à la procédure actuelle régissant l’homologation des produits phytopharmaceutiques.Tout d’abord, nous avons pu montrer qu’une grande variabilité de la DL50 pouvait exister en fonction des pesticides. Ceci nous a amené à proposer l’utilisation d’une nouvelle valeur toxicologique critique plus protectrice (BMD5). Dans un deuxième temps, c’est l’exposition des abeilles aux pesticides pulvérisés qui nous a intéressés. La surface d’exposition d’une abeille a été déterminée, permettant ainsi le calcul d’une dose d’exposition par individu sur la base des doses par hectare. Puis, le cas particulier d’une exposition aux pesticides via les ailes a été étudié révélant sa potentielle importance dans les scénarios d’exposition. Enfin, nous avons montré que l’abeille métabolise rapidement les pesticides contrairement à ce que le séquençage de son génome peut laisser penser.Ce travail apporte de nouveaux éclairages concernant l’évaluation du risque présenté par les pesticides chez l’abeille et souligne l’importance d’une évaluation pertinente à la fois de la toxicité des pesticides et de l’exposition pour l’établissement de rapports de risque pertinents. / The honey bee is both an animal of production and a polylectic pollinator. It is partly because of this double status that the honey bee is one of the non-target organisms for which the effects of pesticides are evaluated before they are placed on market. Today, the procedure of risk assessment in the honey bee is reconsidered, in particular because of the gap that exists with the scientific knowledgeThis work is focused on the special case of exposure of the honey bee subjected to pesticide sprays. The intended aim is to identify points that can be improved and to propose relevant alternatives to the current registration procedure of plant protection products. First, we showed that a great variability of the DL50 exists according to pesticides. This led us to propose the use of a more protective critical toxicicty value as reference (BMD5). Second, we were interested in the exposure to pesticides when the honeybee is subjected to pesticide sprays. The exposure surface area of a bee was determined allowing the calculation of an individual dose of exposure on the basis of field rates (g/ha). Then, we focused on the specific case of an exposure to pesticides through the wings and reveal its potential importance in the exposure assessment. Finally, we showed that the honey bee has a fast pesicide metabolism contrary to what the sequencing of its genome can let think. This work provides new insights concerning the pesticide risk assessment in honey bees and highlights the importance to perform a relevant assessment of the pesticide toxicity and exposure for the calculation of pertinent the hazard quotients.

The main theme of dissertation theses is systems of ventilation and air-condition used in buildings. Work consists of analyse of this systems and parameters of indoor clime whose are affected by them. It summarizes demands on the process of calculation the energy efficiency of the building services by actual legislative. On one chosen type of building is done the energy simulation of implemented systems of ventilation and air-condition by energy efficiency and their specific need of energy.

Leitthema ARBEIT(S).WISSEN.SCHAF(F)T ; Grundlage für Management & Kompetenzentwicklung Mit zunehmendem Alter kommt es zu einer Verringerung der Beweglichkeit. Mit Hilfe digitaler Menschmodelle können daraus resultierende Auswirkungen auf die Arbeitsgestaltung analysiert und bei der Planung von Arbeitssystemen berücksichtigt werden. Als Voraussetzung dafür müssen in Menschmodellen valide Daten integriert werden. Hierzu werden im Beitrag Datenquellen zur Beweglichkeit in Bezug zur altersbedingten Veränderung vorgestellt und deren Nutzung zur Ableitung von Referenzdaten für eine Integration in digitale Menschmodelle diskutiert. Als Quellen können Fachbücher, Primärstudien, Reviews und Meta-Analysen verwendet werden. Diese sind anhand von Kriterien zur Qualität und der Aufstellung von Referenzwerten zu bewerten. Im Ergebnis wird festgestellt, dass es wesentliche Unterschiede in der Studien- und Berichtsqualität gibt. Insbesondere fehlende Angaben zur Erhebung und der Studienpopulation erschweren die Studienbewertung und Einordnung hinsichtlich Referenzwerte. Referenzdaten unterscheiden sich auch hinsichtlich der Bereitstellung von alters- und geschlechtsspezifischen Angaben. Um eine adäquate Integration in digitale Menschmodelle vornehmen zu können, muss eine kritische Auseinandersetzung mit der Qualität der Erhebung und Repräsentativität der Daten erfolgen.

This thesis deals with low level DC voltage measurement by three methods. First part of this thesis describes each method. It is about potentiometric method, reference step method and direct method. This thesis also describes Josephson voltage standard which was used for calibration nanovoltmeter and Zener reference. The theoretical part of this thesis also deals with the evaluation of key comparison data. The main goal of this thesis is the comparison of methods used to measure low level DC voltage. The practical part of the thesis deals with the implementation of measurement with all methods in cooperation with Czech metrology institute. The measured values are processed including uncertainty evaluations. The final part of this thesis focuses on comparison of measurement methods. The key comparison reference value and the degree of equivalence of the measurement of each method are determined. Next part of comparison consisted of graphic comparison of methods. The end of the thesis contains evaluation of the achieved results.