Esse estudo tem como objetivo conhecer as características da relação entre a medicina Homepática e a Biomédica enqua nto partícipes de um campo institucional comum, identificando o movimento de aproximação e afastamento entre homeopatas e médicos da biomedicina e identificando os elementos de caráter ideológico, cultural e técnico-cientifico que fazem parte desse processo, segundo o ponto de vista dos profissionais não homeopatas. Por meio de levantamento da atual situação da Homeopatia no campo da saúde no Brasil, identificam-se os municípios com serviços de homeopatia na rede SUS e as faculdades de medicina que desenvolvem atividades relacionadas à homeopatia. Foram selecionados para a pesquisa os municípios com maior produção ambulatorial de consultas homeopáticas de janeiro a novembro de 2003 (Datasus) e entre as faculdades aquelas de reconhecida relevância na formação médica. Foram entrevistados 48 profissionais de saúde (apenas dois não médicos), sendo 20 docentes/pesquisadores de 11 faculdades de medicina, 16 gestores e 12 médicos que trabalham na rede publica em 6 municípios de cinco estados e do Distrito Federal. As análises foram feitas tendo como categorias de referência as concepções de campo social e cientifico de Bourdieu, as concepções de racionalidades médicas de Madel Luz e os conceitos de modelos ou arranjos tecnológicos do trabalho em saúde de Mendes-Gonçalves, de formação de identidade profissional de médico e ideologia ocupacional de Donnangelo e Schraiber. Foram descritos e analisados através dos depoimentos dos entrevistados: os aspectos considerados facilitadores da aproximação entre as duas medicinas, os que dificultam a ampliação da presença da Homeopatia no campo da saúde, as diferentes formas de apresentação das resistências e as suas concepções sobre a Homeopatia. Entre outros, os resultados apontaram que a 6 legitimação profissional, a construção do SUS e a crise da biomedicina são condições favorecedoras da presença da Homeopatia nas instituições. Mas essas condições não garantem espaços de ensino ou assistência, e as iniciativas dos homeopatas ainda dependem de simpatias locais. Os entrevistados valorizam aspectos da pratica homeopática que recuperam a ideologia ocupacional associada ao ideal de boa prática médica: abordagem integral do paciente, a recuperação da dimensão humanística da medicina e os resultados que obtém ao resolver agravos para os quais os recursos da biomedicina são inadequados ou insuficientes. Facilitam a aproximação com a Academia o interesse no desafio cientifico que representa encontrar novos modelos de pesquisa para explicar, comprovar ou medir a ação da homeopatia e a inclusão de ambientes extrahospitalares como locais de ensino. Dificultam essa aproximação as resistências ao desconhecido e as dificuldades de compreender, com a visão da racionalidade cientifica moderna, a lógica em que a homeopatia opera. Uma outra forma de resistência é considerar a Homeopatia uma medicina apenas para agravos simples e banais, caracterizando-a como uma medicina insegura. O isolamento dos homeopatas e a falta de divulgação da sua cultura foram referidos como razões que mantém o desconhecimento sobre a Homeopatia. Os entrevistados defendem que aceitar os limites de cada medicina e buscar a complementaridade pode levar ao respeito à pluralidade das medicinas, necessária para dar conta de responder à complexidade presente no campo da saúde. / The objective of this study is to access the characteristics of the relationship between homeopathic medicine and biomedicine as both participants of an interinstitucional common field, identifying the approximation and distance movements between homeopathic physicians and biomedicine physicians and identifying the elements of an ideological, cultural and technical-scientific features that are part of this process, according to the non homeopathic professionals’ point of view. The municipalities with homeopathic assistance in the public network of services (SUS) and the medical schools that develop activities related to homeopathy are identified through a survey focusing the current situation of homeopathy in the health field in Brazil. The municipalities with greater clinic production of homeopathic consultations from January to November 2003 (Datasus) and the most recognized schools, as being of major relevance to the medical education, were selected. Forty eight health professionals were interviewed (only two were not physicians), of whom 20 professors of 11 medical schools, 16 managers and 12 physicians that work in the public assistance network in 6 municipalities of five states and the Federal District. The analysis was carried out using as reference categories Bourdieu’s conceptions of social and scientific field, Madel Luz’s conception of medical rationality, Mendes-Gonçalves’ concepts of models or technological arrangements of the health work, Donnangelo and Schraiber’s conceptions of professionals’ identity formation and occupational ideology. The discourses of the interviewed professionals were described and analyzed taking 8 into consideration: the aspects considered facilitators of the approximation between the two medicines; the ones that make difficult the expansion of the homeopathy presence in the health field; presentation forms of resistance; and the professionals’ conceptions of homeopathy. Among others, the results of the study pointed out, as facilitating conditions for the presence of Homeopathy in institutions, he professional legitimation, the construction of the Universal Health System (SUS) and the biomedicine crises. However, these conditions do not guarantee teaching or assistance spaces, and the homeopathy related initiatives still depend on local sympathies. The interviewed professionals valorize aspects of the homeopathic practice that recover the occupational ideology associated to the ideal of good medical practice: integral approach of the patient, the recovering of the humanistic dimension of medicine and the results that are obtained when solving a health problem in occasions when biomedicine’s resources are inadequate or insufficient. The approximation with the academic field is facilitated by the interest in the scientific challenge that represents the encounter of new research models to explain, proof or measure homeopathy’s actions and the inclusion of extra hospital ambiences as teaching places. This approximation is made difficult by the resistance to the unknown and the difficulties of comprehension of the logic in witch homeopathy operates, difficulties related to modern science’s view on rationality. Another form of resistance is to considerate homeopathy as a medicine directed only to simple and minor health problems, characterizing it as an insecure medicine. The isolation of homeopathic professionals and the little divulgation of their culture were mentioned as reasons that sustain the lack of knowledge on Homeopathy. The interviewed professionals defend the acceptation of each medicine’s limits and the searching for complementarities that can lead to respecting the plurality of medicines, conditions that are necessary to formulate an answer to the present state of complexity in the health field.

Introdução: Câncer de mama é o mais comum em mulheres. Embora sua incidência ainda esteja em ascensão, as taxas de recorrência e mortalidade têm diminuído, em especial nos países desenvolvidos. Assim o câncer pode ser considerado um choque transitório que não impede que os sobreviventes retomem a normalidade em suas vidas, incluindo atividades laborais. Na América do Norte e Europa, as taxas de RT entre as pacientes com câncer de mama variam de 24-66% após 6 meses e 53-82% após 36 meses de diagnóstico. Os fatores mais associados ao RT são: idade, quimioterapia, sequelas da terapia do câncer e apoio do empregador e colegas de trabalho. Esses achados, no entanto, variam sugerindo que outros fatores e até aspectos de diferentes legislações podem interferir no RT. Na América Latina há escassez de dados sobre RT após o diagnóstico de câncer de mama. Objetivos: Avaliar as taxas de retorno ao trabalho nos meses 12 e 24 após o diagnóstico de câncer de mama e verificar a correlação de fatores à retomada ao trabalho aos 24 meses. Métodos: Estudo prospectivo observacional avaliando taxas de RT em mulheres com câncer de mama tratadas no Instituto do Câncer do estado de São Paulo, com idade > 18 e < 57 anos e que trabalhavam de forma remunerada por pelo menos 03 meses ao diagnóstico. Pacientes com doença inoperável ou metastática foram excluídas. Nos meses 06, 12 e 24 do seguimento responderam à questionários do estudo e de qualidade de vida (FACT-B), por telefone. Resultados: Entre julho/2012 e setembro/2014, 125 pacientes assinaram o TCLE. Quatro foram excluídas da análise (02 óbitos e 02 sem contato por telefone). A idade média foi de 45.1 anos (± 8,1). A maioria (94%) gostava do trabalho, 73% receberam apoio do empregador, mas apenas 29% relataram ter recebido oferta de ajuste no trabalho. Metade apresentava doença no estádio II e 93% fizeram quimioterapia como parte de seu tratamento. As taxas de RT foram 21,5%, 30,3% e 60,4% aos 06, 12 e 24 meses, após o diagnóstico de câncer de mama. Na análise multivariada os fatores que afetaram de forma positiva as taxas de RT foram: renda familiar mensal >= 02 salários mínimos (OR 17,76, IC95% 3,33-94,75, p 0,001), cirurgia conservadora da mama (OR 9,77, IC 95% 2,03-47,05, p 0,004) e oferta de ajuste no trabalho pelo empregador (OR 37,62, IC95% 2,03-47,05, p 0,004). Fatores que se associaram de forma negativa ao RT foram: terapia endócrina (OR 0,11, IC95%0,02-0,74, p 0,023) e diagnóstico de depressão após o câncer (OR 0,07, IC95% 0,01-0,63, p 0,017). Conclusões: As taxas de RT aos 12 e 24 meses após diagnóstico de câncer de mama são inferiores a maioria dos estudos conduzidos na América do Norte e Europa. Oferta de ajuste no trabalho, maior renda familiar, cirurgia conservadora da mama, terapia endócrina adjuvante e diagnóstico de depressão após o câncer de mama desempenharam importante papel no RT / Background: Breast cancer is the most common cancer in women. While its incidence has been increasing, recurrence and mortality rates have been decreasing, mainly because of better treatment options. Because of that cancer can be regarded as a transient shock that does not prevent survivors resume normality in their lives including return to their workplace. In North America and Europe return to work (RTW) rates vary among breast cancer patients from 24- 66% after 06 months and 53-82% after 36 months of diagnosis. Factors most associated with the decision to return to work are: age, chemotherapy, sequelae related to cancer therapy and support from the employer and coworkers. However, these findings vary among the different populations evaluated, suggesting that other factors and even variations in countries laws may interfere with the decision to return to work. So far there is a lack of data on RTW after breast cancer diagnosis in Latin America. Endpoints: To evaluate return to work rates on months 12 and 24 after breast cancer diagnosis, and check the correlation of some factors with the decision to return to work at 24 months. Methods: A prospective, observational study evaluating RTW rates in patients with breast cancer diagnosis, > 18 and < 57 years old and a paid work for at least 03 months at the time of dianosis. Patients with inoperable or metastatic disease were excluded. On months 6, 12 and 24 they answered a telephone interview and the quality of life questionnaire (FACT-B). Results: Between july/2012 and september/2014, 125 patients were enrolled. Two of them died and two other could not be reached by telephone, and were excluded from the analysis. Mean age was 45,1 years (± 8,1). Most of them reported that they liked their job (94%) and received support from employer (73%), but only 29,1% reported having been offered work adjustment. Half of patients had stage II disease and 93% received chemotherapy as part of their treatment. Overall, 21,5%, 30,3% and 60,4% of patients returned to work 06, 12 and 24 months after breast cancer diagnosis, respectively. In the multivariate analysis, factors associated with positive RTW outcomes included higher income (OR: 17,76, CI95% 3,33-94,75; p = 0,001), breast conserving surgery (OR: 9,77, CI95% 2,03-47,05; p = 0,004) and work adjustment (OR: 37,62, CI95% 2,03-47,05; p= 0,004). Factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR: 0,11, IC95% 0,02-0,74; p = 0,023) and depression diagnosis after breast cancer diagnosis (OR: 0,07, IC95% 0,01-0,63; p = 0,017). Conclusion: RTW rates after 12 and 24 months of breast cancer diagnosis are lower than reported in North America (with exception for low income americans) and Europe. Workplace adjustments, higher income, breast conserving surgery, endocrine therapy and depression after breast cancer played an important role in the RTW decision

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-10-24T13:21:58Z No. of bitstreams: 1 andreydasilvabrugger.pdf: 2828426 bytes, checksum: 40c60333fec12f724bfded7bb90bf6df (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-11-23T12:21:10Z (GMT) No. of bitstreams: 1 andreydasilvabrugger.pdf: 2828426 bytes, checksum: 40c60333fec12f724bfded7bb90bf6df (MD5) / Made available in DSpace on 2018-11-23T12:21:10Z (GMT). No. of bitstreams: 1 andreydasilvabrugger.pdf: 2828426 bytes, checksum: 40c60333fec12f724bfded7bb90bf6df (MD5) Previous issue date: 2018-08-22 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho é fruto de pesquisa de dissertação de mestrado que teve como pano de fundo o fortalecimento da participação e do controle social na gestão do sistema único de saúde. O desenvolvimento da pesquisa está calcado no estudo de caso do Projeto Polo Institucional de Fortalecimento da Gestão Participativa do Sistema Único de Saúde (SUS), o PoloSUS. O PoloSUS é fruto de uma pareceria entre a Secretaria de Gestão Estratégica e Participativa do Ministério da Saúde (SGEP-MS) e a Universidade Federal de Juiz de Fora (UFJF), através da Escola de Governo e Cidadania (EGC), com base na Política Nacional de Gestão Estratégica e Participativa do SUS (ParticipaSUS), tendo como principal objetivo a promoção do fortalecimento das políticas de gestão participativa no âmbito do SUS através da geração de conhecimentos e capacitação dos gestores públicos e lideranças sociais, congregando elementos de extensão, pesquisa e inovação tecnológica social. A parceria abrangeu 280 municípios subdivididos em 17 municípios-polo. A dissertação possui o objetivo de avaliar a eficácia de parcerias entre o Ministério da Saúde e entidades como as Universidades e ONG´s para a execução de políticas públicas, perquerindo quais os incentivos e obstáculos na realização dessas parcerias. A hipótese inicial é que o Governo busca essas parcerias para ter maior capilaridade no território e/ou por não ter toda a expertise requerida em seus quadros para a execução da política. Busca-se, ainda, avaliar se a entidade parceira, no presente estudo de caso, a UFJF, também possuía condições de executar os objetivos delineados no termo de convênio. Dessa maneira, almeja-se saber o que foi o PoloSUS, como funcionou – com suas conquistas e fracassos – e os eventuais efeitos gerados pelo projeto, através de entrevistas e utilização do estudo de caso fundado nas fases/ciclos de análise de políticas públicas. / The present workis the result of a dissertation research that had as background the strengthening of participation and social control in the management of the SUS. The research development is based on the case study of the Pole Institutional Project to Strengthen Participative Management of the Unified Health System (SUS), PoloSUS. PoloSUS is the result of a partnership between the Department of Strategic and Participatory Management of the Ministry of Health (SGEP-MS) and the Federal University of Juiz de Fora (UFJF), through the School of Government and Citizenship (EGC), based on the National Policy on Strategic and Participatory Management of SUS (ParticipaSUS), with the main objective of promoting the strengthening of participatorymanagement policies within SUS, through the generation of knowledge and training of public managers and social leaders, gathering elements of extension, research and social technological innovation. The partnership covered 280 municipalities subdivided into 17 polo municipalities. The purpose of this dissertation is to evaluate the effectiveness of partnerships between the Ministry of Health and entities such as universities and NGOs for the implementation of public policies, and to identify the incentivesand obstacles in the implementation of these partnerships. The initial hypothesis is that the Government seeks these partnerships to have greater capillarity in the territory and / or to not have all the expertise required in its staff to carry out the policy. It is also sought to evaluate if the partner entity, in the present case study, the UFJF, also had the conditions to execute the objectives delineated in the term of agreement. In this way, it is desired to know what was the PoloSUS, how it worked -with its achievements and failures -and the possible effects generated by the project, through interviews and use of the case study based on the phases / cycles of public policy analysis.

Orientador: Mariana Dorsa Figueiredo / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T07:20:27Z (GMT). No. of bitstreams: 1 Fernandes_JulianaAzevedo_M.pdf: 1592369 bytes, checksum: 3c7f9266b99433e622de75d231dca2f9 (MD5) Previous issue date: 2014 / Resumo: Este estudo buscou compreender as práticas de Apoio Institucional e Cogestão desenvolvidas no Sistema Único de Saúde de Campinas/SP pelos Apoiadores Institucionais dos Distritos Sanitários do município, caracterizando o contexto institucional e identificando o perfil dos mesmos e um conjunto de aspectos relacionados à sua prática de trabalho cotidiana. O Apoio Institucional é a aplicação metodológica do Método Paideia, que aposta no modelo de cogestão para interferir nos processos de gestão, compreendendo que os sujeitos envolvidos no trabalho, embora com diferentes graus de saber e de poder, são capazes de articular seus projetos e interesses aos compromissos requeridos pelas instituições. Foram aplicados questionários com perguntas abertas e fechadas a todos os Apoiadores do município que consentiram em participar da pesquisa e, num segundo momento, foram realizados grupos focais com aqueles que preencheram os critérios de inclusão. Os dados quantitativos foram compilados com o Programa Microsoft Excel e utilizamos da construção de uma narrativa para compor o discurso dos Apoiadores nos grupos focais, posteriormente validada em um grupo de devolutiva que pretendeu ainda produzir novas reflexões junto ao grupo. A análise de dados foi realizada a partir da abordagem hermenêutica formulada por Gadamer e do referencial interpretativo da narrativa proposto por Ricouer. Observou-se que, no contexto de grave crise instalada na cidade, os Apoiadores Institucionais têm encontrado dificuldade para atuar de acordo com o que eles próprios entendem que deveria ser o trabalho de Apoio e também daquilo que foi proposto pelo Método Paideia. Consideramos relevante dar continuidade ao estudo, explorando a temática sob a ótica dos serviços que são apoiados, dos gestores do nível central e dos usuários do SUS Campinas / Abstract: This study aimed to understand the Institutional Support and co-management practices on Unified Health System (SUS) in the city of Campinas-SP developed by Institutional Supporters of the municipality¿s sanitary districts, characterizing the institutional context and identifying the profile of them and a set of aspects related to their daily work practices. The Institutional Support is the methodological application of the Paideia Method, which bets on co-management model to intervene in management processes, comprehending that the subjects involved in the work are able to articulate their projects and interests with the commitments required by the institutions, although with different degrees of knowledge and power. We applied questionnaires with open and closed questions to all Institutional Supporters of the city that consented to participate in this research, and in a second moment, focus groups were conducted with those who met the inclusion criteria. Quantitative data were compiled with Microsoft Excel Program and we used the construction of a narrative to compose the Institutional Supporters¿ speech on focus groups, subsequently validated in a feedback group that also pretended to produce new reflections within the group. The data analysis was conducted from a hermeneutic approach formulated by Gadamer and from the interpretive referential of the narrative proposed by Ricoeur. It was observed that, on the context of a serious crisis installed in the city, the Institutional Supporters have found difficult to act according to what they themselves understand that should be the Institutional Supporters¿ work and also according to what is proposed by the Paideia Method. We considered relevant the continuity of the study exploring the thematic from the perspective of the services that are supported, the managers at the central level, and the users of Unified Health System (SUS) of Campinas, Brazil / Mestrado / Política, Gestão e Planejamento / Mestra em Saúde Coletiva, Política e Gestão em Saúde

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This dissertation presents as object of study my trajectory in experience-training as a Mental Health worker (MS) inserted in the institutional context of the Unified Health System (SUS) of two municipalities of Sergipe: Aracaju and Itabaiana. The research, therefore, is located in the relations between the areas of Education-Health and Education-Work, specifically oriented by the institutional intersections between the National Policy on Permanent Education in Health (PEPS) and the National Humanization Policy (PNH) By the Ministry of Health (MS) through a commitment to the inseparability between training and work. In this sense, the objective of this research was to analyze in what ways my work experiences, in the SUS context, can be understood as formative processes that allowed a certain openness in my sensitive. In order to do so, the empirical locus of research is limited to service, between 2008 and 2013, at CAPS ad Primavera (Aracaju-SE) and CAPS I Renato Bispo (Itabaiana-SE). My theoretical and methodological orientation was based on the extension of the concept of openness to the sensitive (BURITI, 2011; RANCIÈRE, 2009), in the critical references of health training based on medical normalization (ABRAHÃO and MERHY, 2014), the cartographic method proposed by Deleuze and Guattari (1995) and the implications of the analysis of implication elaborated by Lourau (1975). Two scenes from my work experience in the SUS / SE were selected from four memory collections constructed during the indicated period - affection box, cartographic diary, experience reports and memory records related to the opening to the sensitive. For the analysis of the scenes I used the following concepts of tools, which served me as categories of experience: territory, estrangement, (dis)learning, experimentation, invention, production. Finally, the narratives produced in this dissertation speak of a formation permeated by the sensitive and fruit of everyday encounters. / Esta dissertação apresenta como objeto de estudo a minha trajetória de experiência-formação enquanto trabalhadora da Saúde Mental (SM) inserida no contexto institucional do Sistema Único de Saúde (SUS) de dois municípios sergipanos: Aracaju e Itabaiana. A pesquisa, portanto, está situada nas relações entre as áreas Educação-Saúde e Educação-Trabalho, especificamente orientada pelas interseções institucionais entre a Política Nacional de Educação Permanente em Saúde (PEPS) e a Política Nacional de Humanização (PNH), gestadas em 2004 pelo Ministério da Saúde (MS) mediante compromisso com a indissociabilidade entre formação e trabalho. Nesse sentido, o objetivo desta pesquisa foi analisar de que formas as minhas experiências de trabalho, no contexto do SUS, podem ser compreendidas como processos formativos que possibilitaram uma certa abertura para o sensível. Para tanto, o lócus (ou recorte) empírico da investigação está circunscrito à minha passagem, entre 2008 e 2013, pelos CAPS ad Primavera (Aracaju-SE) e CAPS I Renato Bispo (Itabaiana-SE). Minha orientação teórico-metodológica foi construída com base na ampliação do conceito de abertura para o sensível (BURITI, 2011; RANCIÈRE, 2009), nas referências que criticam uma formação em saúde pautada na normalização médica (ABRAHÃO e MERHY, 2014), no método cartográfico proposto por Deleuze e Guattari (1995) e nas ponderações da análise de implicação elaborada por Lourau (1975). Foram selecionadas duas cenas de minha experiência de trabalho no SUS/SE a partir quatro acervos de memória construídos ao longo do período indicado – caixa de afecções, diário cartográfico, relatos de experiência e registros de memória relacionados à abertura para o sensível. Para a análise das cenas utilizei os seguintes conceitos-ferramentas, que me serviram de categorias da experiência: território, estranhamento, (des)aprendizagem, experimentação, invenção, produzir-se. Por fim, as narratividades produzidas nessa dissertação falam de uma formação permeada pelo sensível e fruto dos encontros cotidianos.

Le Canada est l’un des plus grands pays exportateurs de porc du monde et le Québec à lui seul compte pour 6% de ce commerce mondial. Pour conserver sa compétitivité et l’excellence de ses produits, une connaissance approfondie des agents infectieux circulant au sein des troupeaux est primordiale. Plusieurs pathogènes sont peu étudiés et pourtant retrouvés chez les porcs à travers la planète. Cette étude avait pour but l’évaluation de la prévalence des astrovirus porcins, calicivirus, kobuvirus porcin, rotavirus, torque teno sus virus ainsi que le virus de l’hépatite E lors du suivi de porcelets dans un réseau de production porcine, de la maternité jusqu’en fin d’engraissement. Nous voulions brosser un portrait de l’excrétion de ces virus à travers les différentes étapes de production des animaux. L’échantillonnage de porcelets sains et en diarrhée en pré-sevrage a permis de déterminer lesquelles de ces infections virales constituaient des facteurs de risque pour la diarrhée à ce stade de production. Le virome intestinal, la partie virale du microbiome, a également été caractérisé permettant de connaître la diversité des virus entériques porcins aux différentes étapes de production, ainsi qu’entre les porcelets sains et en diarrhée. De plus, la dissémination du virus de l’hépatite E dans l’environnement ainsi que les sources probables de contamination ont été décrites à l’aide d’échantillons provenant des environnements intérieurs et extérieurs de fermes d’engraissement, de la cour d’un abattoir et de transporteurs d’animaux. Les résultats obtenus ont permis de décrire les dynamiques temporelles d’excrétion de ces virus entériques porcins en fonction des stades de production des porcs, démontrant une différence dans l’excrétion de ces virus en fonction de l’âge. Les calicivirus, ainsi que les astrovirus porcins groupes 3 et 5 étaient des facteurs de risque de diarrhée en maternité. Pour la première fois au Canada, la détection et la caractérisation des souches du kobuvirus porcin ont été réalisées, permettant de mieux comprendre leur diversité et leur persistance à travers les stades de production. La diversité du virome entérique porcin a été analysée avec la plateforme de séquençage MiSeq et cette diversité était différente entre les porcelets sains et en diarrhée, ainsi qu’entre les stades de production. Cependant, les traitements enzymatiques utilisés pour le prétraitement des échantillons fécaux ne permettaient pas le séquençage de certains virus à ARN simple-brin. Des souches similaires du virus de l’hépatite E étaient présentes dans l’environnement des fermes, ainsi qu’aux endroits communs à forte circulation des intervenants du réseau. Les activités dans la cour de l’abattoir pourraient donc être impliquées dans la dissémination de ce virus. Cette étude a permis de mieux connaitre la prévalence et la distribution des virus entériques infectant les porcs. De plus, certains des virus entériques étudiés ont été reconnus comme facteurs de risque de la diarrhée en co-infections et devront être étudiés en détail pour comprendre leurs mécanismes en relation avec la diarrhée néonatale. Des interventions plus spécifiques lors d’éclosion de diarrhées porcines, dont l’étiologie est inconnue, pourront donc être réalisées, ainsi que l’élaboration de mesures de biosécurité plus adaptées en fonction du stade de production des porcs. / Canada is a major pork exporter around the world and the province of Quebec alone accounts for 6% of this trade. To maintain the province’s competitiveness and the excellence of its products, a comprehensive understanding of the infectious agents circulating in herds is essential. Several pathogens have been intensively studied, while others have yet to be investigated even though they have been reported in pigs all around the world. This study evaluated the prevalence of porcine astroviruses, calicivirus, porcine kobuvirus, rotavirus, torque teno sus virus and hepatitis E virus, monitored in a pig production network, from the nursing farms to the end of the fattening farms to portray the excretion patterns of these viruses through the different life stages of pigs. The sampling of healthy piglets alongside piglets with diarrhea in the nursing farms allowed to determine which viruses, or co-infections of viruses were factors of diarrhea at this life stage. The intestinal virome, the viral part of the microbiome, was characterized and viral diversity of porcine enteric viruses at different life stages, as well as between healthy and diarrheic piglets were evaluated. Moreover, the dissemination of the hepatitis E virus in the farm environment, as well as the possible sources of contamination were described, from the indoor and outdoor environment of fattening farms, the slaughterhouse yard and animal transporters. The results obtained in this study described the temporal excretion dynamics of these porcine enteric viruses according to the life stages of the pigs, demonstrating the difference in the excretion of the studied viruses according to the life stage. The calicivirus, as well as the porcine astrovirus groups 3 and 5 were found to be risk factors for diarrhea in the nursing farms. For the first time in Canada, the detection and characterization of porcine kobuvirus strains were evaluated and provided a better understanding of their diversity and the persistence of these strains in the network. The porcine enteric virome diversity was analyzed on a MiSeq sequencing platform and this diversity was different between healthy and diarrheic piglets, as well as between the different life stages. However, the different enzymatic treatments used as pretreatments for fecal samples altered the ability to detect certain single-stranded RNA viruses. Similar strains of the hepatitis E virus were present in the indoor and outdoor environment of the fattening farms, as well as in common places of high circulation from the various stakeholders in the pig production network. The activities in the slaughterhouse yard could therefore be involved in the spread of this virus. This study shed light on enteric viruses infecting pigs. In addition, some of the infections from enteric viruses studied were risk factors for diarrhea in co-infections and will need to be studied in more details to understand their mechanisms, in relation to neonatal diarrhea. More specific interventions during outbreaks of porcine diarrhea of unknown etiology could be carried out, as well as the development of more adapted biosecurity measures according to the life stage of the pigs.

Since the 1960s the focus of animal welfare has been mainly on the negative aspects of welfare and on minimizing and alleviating these negatives. Lately, the focus has been not only on the negative features of welfare that should be kept above a minimum standard, but also on the positive ones that should be enforced. Positive welfare goes a step beyond the common welfare approach and focuses additionally on the positive aspects that animals should have in their lives. This review analyses the behavioral indicators that have been proposed as positive welfare indicators of the domestic pig and have been studied theoretically or experimentally. Various behavioral indicators have been proposed but play is the positive indicator that has been studied the most, followed by exploratory and social affiliative behaviors. Vocalizations and ear and tail postures have also been proposed as promising positive welfare indicators but more research is needed to clearly understand the expression of these behaviors and the affective states that they indicate. According to the literature results, the Welfare Quality protocol for pigs is the only protocol that evaluates the positive welfare of the pig on the farm level. Play, exploratory and social affiliative behaviors are being measured. In addition, positive emotions are being measured via Qualitative Behavioral Assessment (QBA). / Efter 1960-talet, fokuserar djurvälfärden huvudsakligen på de negativa aspekterna av välfärd och på att minimera och lindra de negativa aspekterna. Under de senaste åren, har fokus legat inte bara på att minimera de negativa aspekterna och hålla dem över en minimistandard utan också på att förstärka de positiva. Positiv välfärd går ett steg framåt i det gemensamma välfärdssynsättet och fokuserar dessutom på de positiva aspekterna som djur bör ha i sina liv. Denna översyn analyserar de positiva beteendeindikatorer på djurvälfärd, de som har föreslagits som positiva välfärdsindikatorer för den domesticerade grisen och har studerats teoretiskt eller experimentellt. Bland alla indikatorer har lekbeteende studerats mest, följt av undersökingsbeteende och sociala affiliativa beteenden. Vokalisationer och öron- och svansställningar har också föreslagits som lovande positiva välfärdsindikatorer men fler studier bör göras för att tydligt förstå uttrycket av dessa beteenden och grisens känslor som de indikerar. Enligt litteraturen, är Welfare Quality protokoll för grisar det enda protokollet som utvärderar grisens positiva välfärd på gårdsnivå. Lekbeteende, undersökningsbeteende och sociala affiliativa beteenden mäts. Dessutom, positiva känslor mäts via QBA.

The implementation of game elements has quintessentially uplifted the overall experience of applications in various domains and thereby expanding the customer base. This process is called gamification which has now been introduced in many domains. The purpose of the study is to understand gamification and how its impact would be if it is deployed in a financial savings application. The gamified elements are implemented based on a gamification framework called the Octalysis framework1. This Octalysis framework is a human-centric gamification framework which serves as a template to implement the required gamified elements. Based on a pre-study of financial applications and the Octalysis framework, two distinct prototypes (Version A and Version B) of the same mobile app concept were developed where the difference is the presence of gamified elements in one prototype. The evaluation is based on analyzing the impact the gamified elements have caused on the usability and the emotional engagement of the financial savings application. The participants are provided to interact with both prototypes and interviews are conducted to evaluate the emotional engagement and the usability of both the prototypes of the financial savings application. The study shows an increase in emotional engagement corresponding to the gamified elements whereas the usability more or less remained the same, indicating a deeper investigation of the gamified elements with regards to usability is required.

Introdução: Amplo debate tem associado a incorporação de novas tecnologias para a saúde com os custos crescentes dos sistemas de saúde. Face à dúvidas \"se as novas tecnologias são parte do problema, parte da solução ou as duas coisas\" relativamente à saúde da população e do sistema de saúde, este estudo de caso analisa a incorporação de três inovações no Instituto do Coração, InCor-HC/FMUSP, visando elaborar quais fatores influenciaram a decisão de adoção e exemplificar as metodologias de avaliação de novo medicamento, de procedimento diagnóstico e intervenção cirúrgica. A avaliação das tecnologias para a saúde, ATS, pode auxiliar a constituir algumas propostas de respostas. Metodologia: estudo qualitativo empírico em caso retrospectivo de incorporação de três inovações para assistência de alta complexidade em cardiologia. As metodologias utilizadas consistiram em entrevistas aos tomadores de decisão, revisões sistemáticas da literatura relevante, descritiva ou meta-analítica, e análise de impacto econômico hospitalar. Resultados: O padrão do InCor para a incorporação das inovações funciona como um sistema social criativo, sob uma estratégia prática pluralista, ou seja, utilizam as pesquisas, aprovadas pela Comissão de Ética e Pesquisa do InCor e do HC, que se sucederam e que sucedem em incrementos, verificando e ajustando as informações segundo os resultados obtidos para desenhar novas pesquisas. Os atores construíram conhecimentos e negociaram protocolos de pesquisa, promoveram a capacitação de super-especialistas técnicos, transferindo práticas internacionais e gerando conhecimentos adaptados à realidade do Brasil. A avaliação do medicamento tacrolimus demonstra que se poderia resgatar uma média de 75% das rejeições refratárias às terapias convencionais, proporcionando um custo hospitalar de R$ R$ 102,99 por dia de sobrevida nos 8 adultos e R$ 137,53 nas 13 crianças observadas, comparativamente à R$ 229,00 e R$ 260,00, com ciclosporina, respectivamente. Assim, se evitaria 37% da mortalidade associada à episódios de rejeição nos pacientes com transplante cardíaco e, mesmo no único óbito, o custo hospitalar por dia de sobrevida foi de metade que o custo dos períodos observados nos 32 pacientes sob ciclosporina que foram a óbito. O diagnóstico por angiotomocoronariografia em pacientes com angina atípica e risco moderado permitiria orientar o manejo de até dois terços destes casos evitandose coronariografias invasivas. Isto permitiria aumentar a resolutividade do Departamento de Hemodinâmica de 25% para mais 20% dos casos assim estudados, com economias para o InCor, aumento do acesso e resolutividade, podendo evitar até 2.000 mortes, e com o acréscimo estimado de <10% do valor destas 14% mais angioplastias e 6% mais revascularizações cirúrgicas para o SUS. A ablação cirúrgica tem o potencial de curar >10% das fibrilações atriais refratárias a medicamentos em pacientes com indicação de cirurgia aberta para correção de problemas cardíacos estruturais, evitando morbidade e mortalidade em até 1.000 pacientes por ano, se houver suposição que esta seja utilizada apenas com as cirurgias valvares no âmbito do SUS. Conclusões e discussão: As novas tecnologias estudadas proporcionam benefícios à saúde, mas ainda possuem variados graus de incerteza sobre aspectos de segurança e sobre seu potencial de impacto econômico para os programas assistenciais para o InCor e para o SUS. O InCor e os demais hospitais universitários possuem alta capacidade técnica instalada, onde a estruturação de pesquisas facilita e permite a incorporação de inovações de alta complexidade, sem contudo haver planejamento econômico para os programas de assistência à saúde. O isolamento destes atores, em relação às instâncias gestoras do SUS, permite construções sob visões parciais e imediatistas, permite desenvolvimento de interesses externos e diversos, e, por outro lado, pressiona de maneira desordenada a organização e o sistema de saúde. A integração da capacidade profissional, instalada nos hospitais universitários, dentro do circuito de planejamento de médio e longo prazo para o SUS, avaliando as tecnologias inovadoras comparativamente às estabelecidas para a saúde, com base na epidemiologia local observada, pode permitir uma atualização planejada e contínua dos serviços de saúde, construída sobre bases sólidas de conhecimento científico adaptado à nossa realidade e com o responsável equilíbrio orçamentário. / Introduction: There is an ongoing international debate associating the increasing health care costs with adoption of new health technologies. To aid to ascertain whether new health technologies are part of the problem, part of the solution or both in relation to the health of the population and of the health care system, this case study analyses retrospectively three recent decisions to adopt innovations at the Heart Institute, InCor-HC/FMUSP. In order to provide examples of the application of methods for health technologies assessment, the InCor Board of Directors indicated one innovative drug, a new diagnostic procedure and a recent surgery. Methods: Qualitative, retrospective field evaluation of the three decisions for the highest complexity of care in cardiology. Decision-makers survey, systematic reviews (descriptive or meta-analytic) and hospital economic impact analysis were the methodologies applied to this case. Results: A pattern of new technologies incorporation through incremental research, a strategic and pluralist practice emerged within a creative social system. Approved by the InCor and HC Research Ethics Boards and based on previous research results, successive investigations verified and adjusted the informations and generated additional research. Thus, the decision-makers do build knowledge, negotiate research protocols, promote very technical specialists formation and transfer international practice, inter- and up-grading it to the Brazilian reality. Evaluation of these three innovative technologies results are: - The drug tacrolimus may rescue and resolve an average of 75% of the episodes of rejection refractory to conventional medications. The average hospital cost observed (since conversion from CSA, censored at March the 30th, 2006) was of US$45 or R$102.99 per day of survival in 8 adults and of US$61 or R$137.53 for the 13 children (<18 years of age), compared with R$ 229.00 and R$ 260.00, respectively, in those who remained under cyclosporine treatment. Thus, it could prevent 37% rejection related mortality and bring some economy (even in the single child death observed, the hospital cost per day until death was the half of the cost observed for the 32 cyclosporine treated). - The tomoangiocoronariography diagnosis for patients presenting atypical angina and moderate to low risk of stenosis may orient and modify up to 66% clinical decisions preventing requirement of an invasive procedure. This would increase 20% to the Haemodynamic Department 25% resolutivity, may prevent up to 2000 deaths with an estimated additional 10% of the costs of 14% more angioplasties and 6% increase in surgical coronary bypasses for the health care system. - Surgical ablation has the potential to cure more than 10% of medications refractory atrial fibrillation in patients undergoing open heart surgery for structural corrections. Supposing it is restricted only to the group of patients undergoing valve surgery in the health care system, it could prevent morbidity and mortality for up to 1000 patients. Conclusions and discussion: The new technologies evaluated bring benefits to the health of the patients. Safety concerns and economic impact for the InCor and for the health care system assistance programs require further investigation. InCor and the other university hospitals have enhanced technical capacity installed. The structured research facilitates and allows incorporation of highly complex innovations without planning future programs for care. The isolation of these decision makers from the health care system decision planners allows partial views and immediacies. Such a distance facilitates development of external and diverse interests. These facts, consequently, pressures on the organization and the health care system. The integration of the university hospitals installed professional capacities, within an average and long term health care system plans, making evaluations of the innovative health technologies in comparison with the established ones based on local epidemiology, may permit a planned and continuous actualization of the health services on solid scientific basis adapted to the Brazilian reality and with a responsible financial balance.

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