Orientador: Anibal Faundes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T02:15:48Z (GMT). No. of bitstreams: 1 Viana_FranciscoJoseMachado_D.pdf: 6336629 bytes, checksum: 3497f0e3050f2c437022be217d4d77a0 (MD5) Previous issue date: 2009 / Resumo: Objetivo: Avaliar a efetividade de intervenções que objetivavam aprimorar o atendimento em um serviço de atenção a mulheres em situação de violência sexual e estudar a história de algumas dessas mulheres e os fatores associados ao tipo de violência sofrido. Sujeitos e Método: O estudo baseou-se no acompanhamento durante cinco anos das mulheres atendidas após agressão sexual na Maternidade Odete Valadares de Belo Horizonte, MG. Trata-se de estudo observacional, que em um primeiro estágio constou de uma retrospectiva realizada de 2003 a abril de 2006 e foi prospectivo do mês de maio de 2006 em diante, embasado em dados coletados nas fichas de notificação de violência dos prontuários e por meio de entrevistas realizadas durante o atendimento. Apresenta uma avaliação da efetividade de mudanças realizadas para prolongar o seguimento e para estimular a precocidade da consulta após a violência. Em relação às mulheres atendidas, procurou-se estudar suas características e os fatores associados às características da agressão sexual sofrida por mulheres considerando a via do coito, com as categorias somente vaginal, anal não exclusivo e oral não exclusivo, e número de vias de coito, categorizado em única e múltipla. Os fatores de risco foram características sociodemográficas e circunstâncias da agressão. Resultados: 681 mulheres foram atendidas no período. O retorno após a emergência aumentou de 25,3% para 47,3% após a primeira intervenção, mas não houve aumento na proporção das que continuaram o seguimento por mais de 90 ou 180 dias. A segunda intervenção não teve efetividade para estimular a consulta das mulheres dentro dos três primeiros dias decorridos em relação aos fatores associados ao tipo de agressão. Na análise ajustada, a ocorrência na via pública foi fator de proteção para coito exclusivamente vaginal e de risco para coito anal. Mulheres com mais escolaridade tiveram mais probabilidade de coito apenas vaginal e foi fator de proteção para coito anal. Ser agredida por desconhecido foi fator de risco para sexo oral Conclusão: A avaliação das intervenções para aprimorar o atendimento à mulher em situação de violência sexual na MOV mostra que não é uma tarefa fácil e que se trata de um processo muito dinâmico que precisa de constante avaliação. Algumas características da mulher e das circunstâncias da agressão permitem identificar maior risco de determinado tipo de agressão. O elemento principal é o atendimento solidário e compreensivo destas mulheres por uma equipe bem preparada, mas é preciso uma avaliação permanente das ações realizadas para conseguir o objetivo de prevenir as consequências deletérias da violência sobre a saúde e a vida destas mulheres / Abstract: Objective: To evaluate interventions performed with the purpose of improving the care of women who suffer sexual violence and to identify risk factors for the different types of sexual violence Subjects and Method: This is a prospective, observational study based on the data collected by mean of interviews carried out during the care and registered in the files of the Odete Valadares Maternity hospital of Belo Horizonte, MG. Evaluates de effectiveness of two interventions intending to stimulate and prolong the follow-up after the emergency care and to shorten the period between the aggression and the first visit to the emergency service. For the identification of risk factors for type of violence, the outcomes evaluated were route of penetration with categories, only vaginal, non-exclusive anal and non-exclusive oral, and number of routes of penetration categorized in single or multiple. The risk factors were socio-demographic characteristics and circumstances of the aggression. An unadjusted and adjusted analysis, estimating Odds Ratio was performed. Results: 650 women received care during the period. The return for follow up increased from 25,3% to 47,3% after the first intervention, but the second intervention had no effect over to the percentage of women requesting care during the first 72 hours after the aggression. In relation to of risk factors for type of violence, the adjusted analysis showed that aggression in the streets was protective for exclusively vaginal sex and a risk factor for anal penetration. Women with higher education had greater probability of only vaginal coitus and it was a protective factor for anal sex. Being attacked by an unknown person was a risk factor for oral sex. Conclusion: The evaluation of interventions with the purpose of improving the care of women who suffer sexual violence shows that is not an easy task, but of a very dynamic process requiring constant evaluation and adaptation. Some characteristics of women and the circumstances of the violence allow identifying a higher risk of the various route of penetration during sexual violence. The key element of the care is solidarity and understanding toward the women from a well trained professional team, but a permanent and careful evaluation of the actions taken to achieve the purpose of preventing the negative effects of sexual violence over the health and life of these women is an essential requirement / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

Attractiveness matters in business markets, because firms do not dedicate resources equally to all partners. Instead they invest more resources in partners with higher relational attractiveness. Firms need to become attractive in order to gain access to more resources or to be able to work with more skilled or reputable partners. This dissertation studies the construct of relational attractiveness of the customer (RAC), defined as the attractiveness of a business relationship with a particular customer in the eyes of the supplier. The research also investigates corporate online references (COR), because gaining powerful referrals is one of the driving forces behind creating attractiveness in business markets. The study is a three-stage research project drawing on an empirical investigation comprising two focus groups, 79 interviews, a survey of 107 suppliers and online referral data from 1002 companies. These studies investigate the conditions and configurations leading to high or low relational attractiveness, and the motivational conditions and structure of a specific corporate online referral network. Bearing in mind that attractiveness exists in the eyes of the beholder, Study I resolves the previously unclarified problem of how attractiveness can be achieved in different ways. Social Exchange Theory helps to identify conditions of RAC: Trust, Dependency, Financial, Non-Financial Rewards and Costs. In Study II conditions of Trust and Dependency are further developed into Relational Fit and the Comparison Level of Alternatives that address the mutuality and network perspectives of relationship development. The time perspective is introduced to the configurational analysis of RAC through the Maturity condition. As it is revealed in Study I and II, Nonfinancial Rewards are important in creating attractiveness and one of their essential forms is referrals that are addressed in more detail in Study III. This PhD research takes a configurational approach to attractiveness and explores different causal recipes in order to reach the same outcome. In order to investigate the relational complexity of attractiveness, fuzzy set Qualitative Comparative Analysis (fsQCA) is applied throughout the three studies combined with some other methods, such as content analysis and Social Network Analysis (SNA). QCA is a data analytic strategy that combines within-case analysis and formalised cross-case studies in order to identify multiple configurations leading to the same outcome. Hence, QCA deals more efficiently with the equifinality of complex business problems compared with traditional data analysis methods. Equifinality means that there are various ways in the causal system of achieving the desired outcome. QCA is sufficient in handling methodological challenges such as multi-causality (an outcome of interest rarely has a single cause), interrelatedness (causes are usually not independent of one another) and asymmetry (a specific cause may have different effects on the outcome depending on the context). By challenging existing knowledge, the results show that there is no one best way to achieve relational attractiveness. It is achievable even if Trust and Financial Rewards are not present. Very high RAC was typically achieved in less mature relationships. During the initiation of referral relationships in the case of COR, the expected increase in the initiators` attractiveness in the eyes of potential future partners also plays a vital role. The generalizability of the findings has some limitations, especially regarding the qualitative study where the results are appropriate to falsify some theories (for example, the primary importance of Financial Rewards) but their impact is more related to theoretical development than to statistical generalizability.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL). Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The questionnaire assessed physical activity levels and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However, there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health&nbsp; benefits to the general population. / South Africa

Eating disorders can lead to a negative impact on students' academic growth, nutrition and can cause death (Claude-Pierre, 1997; Manley, Rickson, & Standeven, 2000; Romeo, 1996). Early intervention by referring students to professional counseling might help counter these negative consequences. The teacher is in the position to assist students by providing health information, identifying those with problems, and intervening for a variety of dysfunctions that may include the eating disorders called anorexia nervosa and bulimia nervosa (Myers-Clark & Christopher, 2000). However teachers are in a difficult position to know when to address student concerns and judge what action to take (Ransley,1999). Teachers' engagement seems crucial (Smolak, Harris, Levine, & Shisslak, 2001) since eating disorders are being identified in younger children.The purpose of this study was to examine (a) the relationships of the theoretical constructs, attitude, subjective norm, and perceived behavioral control of the theory of planned behavior as predictors of behavioral intention (Ajzen & Fishbein, 1980) of middle school teachers to identify and refer suspected anorexia nervosa (AN) and/or bulimia nervosa (BN) students for professional help; and (b) the actual behavior of middle school teachers who reported having ever referred a student suspected of having AN and BN and those teachers who reported not having made such a referral. One hundred fourteen middle school teachers in Broward County, Florida volunteered to participate in the ex post facto research. Data were collected from a questionnaire. Multiple regression analysis revealed that the constructs of subjective norm (perception of what others think about one's performance of behavior combined with motivation to comply) and perceived behavioral control (perception regarding the extent of the difficulty of performing the behavior) were predictive of teachers' intent (likelihood of engaging in a behavior) to refer. However, the analysis revealed that attitude (overall positive or negative feeling with respect to performing the behavior) was not predictive of teachers' intent. Discriminant function analysis revealed that both intent and perceived behavioral control were predictive of group membership, either having referred a student suspected of having an eating disorder for counseling or not having made such a referral. Attitude and subjective norm were not predictive of group membership.

Background. A demanda por cuidados médicos especializados vem aumentando em todo o mundo. Analisamos uma iniciativa de telemedicina para reduzir o tempo entre encaminhamento e consulta especializada e o número de pacientes na fila de espera. Métodos. Um estudo retrospectivo com controles contemporâneos foi realizado entre junho de 2014 a julho de 2016. As especialidades selecionadas foram incluídas em uma intervenção de telemedicina e comparadas com as especialidades controle reguladas de forma padrão. Os pacientes de intervenção foram combinados com um conjunto aleatório de controles (proporção 1: 1) por semestre e ano de inclusão na lista de espera e pelo índice de demanda e oferta de consultas especializadas (número de pacientes na fila de espera em junho de 2014 dividido pela média de consultas médicas especializadas disponibilizadas durante os 25 meses que compõem o período de análise). A intervenção de telemedicina incluiu o desenvolvimento de protocolos de referência e classificação de risco de pacientes na fila de espera. O tempo de espera para a consulta presencial e a magnitude da diminuição do número de pacientes na fila no final da observação foram os desfechos primários. Resultados. Nefrologia, pneumologia, urologia, neurologia, neurocirurgia e reumatologia foram selecionados para a intervenção, para um total de 50.185 pacientes (idade média: 51,5 anos) versus 50,124 pacientes controles (idade média: 52,2 anos). O tempo médio para o agendamento de consultas foi de 583,5 dias no grupo de intervenção versus 599,8 dias nos controles (p <0,001). O volume da lista de espera diminuiu 61,4% no grupo de intervenção e 53,2% no grupo controle 13 (<0,001). Para pacientes de alto risco (grupo de intervenção apenas), o tempo médio entre encaminhamento e consultas foi de 235,43 dias. Conclusões. A intervenção de telemedicina foi eficaz para diminuir o tempo de espera, especialmente para indivíduos de alto risco, e número de pacientes em espera para consultas médicas especializadas, o que sinaliza um efeito positivo sobre a eficiência do sistema de saúde, com redução de tempo e custos de deslocamentos, além de potencializar a prevenção quaternária ao prevenir consultas desnecessárias com médicos especilaistas, por meio do melhor manejo dos médicos de atenção primária. / Background. The demand for specialist care is increasing worldwide. We tested a telemedicine initiative to reduce the time between referral and specialist appointment and the number of waitlisted patients. Methods. A retrospective trial with contemporaneous controls was conducted between June 2014-July 2016. Selected specialties were included in a telemedicine intervention and compared to control specialties covered by the usual gatekeeping program. Intervention patients were matched to a random set of controls (1:1 ratio) by semester and year of inclusion in the waiting list and by the specialty demand to supply ratio (number of waitlisted patients in June 2014 divided by the mean number of appointment slots during the 25 months comprising the period of analysis). The telemedicine intervention encompassed development of referral protocols and risk classification of waitlisted patients. Waiting time to face-to-face consultation and magnitude of decrease in the number of waitlisted patients at the end of the observation were defined as primary outcomes. Results. Nephrology, pulmonology, urology, neurology, neurosurgery, and rheumatology were selected for the intervention, for a total 50,185 patients (mean age: 51.5 years) vs. 50,124 patients controls (mean age: 52.2 years). Mean referralto- appointment time was 583.5 days in the intervention group vs. 599.8 days in controls (p<0.001). Waitlist volume decreased 61.4% in the intervention group and 53.2% in the control group (<0.001). For high-risk patients (intervention group only), mean time between referral and appointments was 235.43 days. 15 Conclusions. The telemedicine intervention was effective to decrease wait time, especially for high-risk individuals, and number of waitlisted patients, which signal a positive effect of e-consultations on the knowledge of primary care physicians, reducing time and travel costs and enhancing a quaternary prevention and avoiding unnecessary consultations. / Telemedicina

The goal of San Bernardino County Medical Information Resource is to develop, coordinate, and implement a centralized information and referral database that contains information about health and human services provided by public and private entities throughtout the county of San Bernardino and is accessible to the public via the Internet.

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Introduktion: Alla röntgenundersökningar med joniserande strålning ska vara berättigade och optimerade. Detta kräver röntgenremisser av god kvalité. Syfte: Syftet med litteraturöversikten var att beskriva faktorer som har påverkan i röntgenremissens berättigandeprocess. Metod: En allmän litteraturöversikt baserad på kvantitativa studier som kvalitetsgranskats. Resultat: Resultatet presenteras i fem kategorier: berättigade och oberättigade röntgenundersökningar, avsaknad av klinisk information, användning av riktlinjer, införande av intervention och röntgenremissens utformning. Slutsats: Röntgenremissers kvalité har betydelse i berättigandeprocessen. Antalet oberättigade röntgenundersökningar minskar genom ökad kunskap vilket gör utbildning för remitterande läkare till en nyckelfaktor. Detta leder till säkrare sjukvård där patienter inte utsätts för onödig joniserande strålning. / Introduction: All x-ray examinations with ionizing radiation must be justified and optimized. This requires radiology referral of good quality. Aim: The aim of the study was to describe factors that affect the process of justification in radiology referrals. Method: A general literature review based on quantitative studies that have been verified based on its credibility. Result: The results are presented in five categories: justified and unjustified x-ray examinations, lack of clinical information, use of guidelines, introduction of intervention and the design of the radiology referral. Conclusion: The quality of the radiology referral has significance in the process of justification. Number of unjustified x-ray examinations are reduced through increased knowledge, which makes education for referring physicians a keyfactor. This leads to safer healthcare where patients are not exposed to unnecessary ionizing radiation.

The author addresses the following objectives: (1) Examines whether a state can withdraw a case upon which an indictment has been made by the International Criminal Court (ICC) (2) Determine and elucidate on the circumstances under which a referral can be withdrawn from ICC jurisdiction. (3) Clarifies whether a referral can be withdrawn if the referring state develops mechanisms for domestic trial of relevant ICC crimes / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2008. / A Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Dr.Atangcho Akonumbo, Faculté des Sciences Sociales et de gestion, Université Catholique d’Afrique Centrale, Yaoundé Cameroun / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

Den svenska hälso- och sjukvårdsbranschen för djur har under 2000-talet expanderat markant. För att driva en konkurrenskraftig verksamhet i en bransch som ständigt utvecklas är det viktigt att organisationen arbetar med förbättringsarbeten för att hålla jämna steg. Syftet med studien är att kartlägga en organisations interna och externa remisshandläggningsprocess med avsikt att synliggöra förbättringsmöjligheter.   I fallstudien har empiriinsamling genomförts med hjälp av litteraturstudie, observationer och intervjuer. Litteraturstudien genomfördes med avsikt att skapa ett teoretiskt ramverk. Observationer och interjuver utfördes med nio av fallklinikens remisshanterande personal i syfte att kartlägga remissprocessen och identifiera eventuella problemområden. Empirin visar att remisshandläggningsprocessen består av fyra delprocesser där det går att identifiera problemområden och förbättringsmöjligheter. Remissprocessen har en grundstruktur men det finns inget standardiserat arbetssätt och därför förekommer individualiserade tillvägagångssätt vid remisshantering. Samtliga respondenter är eniga om att den externa remisshandläggnings­processen fungerar bättre idag jämfört med tidigare. För de interna remisserna finns det ingen vedertagen administrativ process och empirin är inte tillräcklig för att kunna genomföra en processkartläggning.   En förbättringsmöjlighet är att implementera ett standardiserat tillvägagångssätt för remiss­hantering eftersom suboptimering då utesluts vilket effektiviserar den kompletta remisshand­läggningsprocessen. Dessutom skulle standardisering kunna bidra till en förståelse för hela flödet vilket är avgörande för ett lyckat förbättringsarbete. / The Swedish industry in animal health and medical care has expanded significantly during the 2000s. To run a competitive business in an industry that is constantly developing, it is of importance that the organization works with development to keep pace. The purpose of the study is to map the organization’s internal and external referral process with the intention of visualizing improvement opportunities.   In the case study, empirical data was collected with the help of a literature study, observations, and interviews. The literature study was conducted with the intention of creating a theoretical framework. Observations and interviews were performed with nine of the clinic’s referral managing staff to map the referral process and identify any problem areas. Empirical data shows that the referral process consists of four subprocesses where it is possible to identify problem areas and opportunities for improvement. The referral process has a basic structure, but there is no standardized working method and therefore there are individualized approaches when handling referrals. All respondents agree that the external referral process works better today than in the past. For the internal referrals, there is no established administrative process, and the collected empirical data is therefore not sufficient to be able to conduct a process mapping.   An opportunity for improvement is to implement a standardized approach to referral management because suboptimization is then excluded, which streamlines the complete referral process. Furthermore, standardization could contribute to an understanding of the entire flow, which is essential for a successful improvement project. / <p>Examen i vårdadministration, YH-utbildning: 20 Yh-poäng</p>