Introdução: Os sintomas depressivos são prevalentes e responsáveis por intensos prejuízos psicossociais e econômicos na atualidade. Apesar de representarem uma das maiores causas de morbidade mundial, ainda encontramos o sub-diagnóstico como padrão em serviços clínicos ambulatoriais ou de atenção básica. Tal realidade dificulta os encaminhamentos precoces e tratamentos adequados para este fim. Objetivos: Identificar a presença de sintomas depressivos em pacientes ambulatoriais clínicos de um Hospital Geral e a associação destes com usos de recursos de saúde. Descrever o perfil sócio-demográfico destes pacientes e avaliar as associações entre os escores de depressão e usos de recursos de saúde ao longo de aproximadamente um ano de seguimento (artigo 1). Avaliar se os desempenhos dos instrumentos Inventário de Depressão de Beck (BDI), Escala de Depressão em Hospital Geral (EDHG) e Instrumento de Qualidade de Vida Whoqol-bref, variam conforme formato de aplicação (presencial ou por telefone) (artigo 2). Métodos: Em um delineamento de coorte prospectivo e naturalístico (artigo 1) foram convidados a participar do estudo 189 pacientes clínicos do serviço de Medicina Interna do Hospital de Clínicas de Porto Alegre. Foram aplicados o Inventário de Depressão de Beck (BDI), Escala de Depressão em Hospital Geral (EDHG) e questionário de Usos de recursos de Saúde, no tempo 1 (baseline) e 14 meses depois (seguimento). Avaliamos a prevalência de sintomas depressivos em pacientes ambulatoriais clínicos e a relação destes com utilização de recursos de saúde ao longo do seguimento. O segundo artigo refere-se a um experimento não-controlado realizado na Unidade Básica de Saúde (UBS) Santa Cecília, em Porto Alegre. Para estes participantes (380) foram aplicados os mesmos instrumentos do estudo 1, aliado ao Whoqol-bref, em formato teste-reteste (7 dias de intervalo), em 4 grupos de aplicação (presencial e por telefone). Avaliamos, assim, se instrumentos que mensuram sintomas depressivos e qualidade de vida variam seu desempenho quando aplicados por telefone, neste serviço. Resultados: Foi encontrada associação significativa entre sintomas depressivos e uso de recursos de saúde, entre eles atendimento em saúde mental, adesão ao tratamento, tratamento atual em serviço de saúde mental e uso de psicofármacos (Artigo 1). No segundo artigo, o desempenho das escalas foi invariável nos diferentes grupos de aplicação (presencial e por telefone), quando comparados, mantendo altos valores significativos de correlação (todos acima de 0,9). Conclusão: Houve prevalência elevada de sintomas depressivos em serviço ambulatorial e associações significativas em relação aos recursos de saúde utilizados. O subdiagnóstico é, ainda, padrão nestes serviços. Assim, as escalas de rastreamento e o uso do telefone podem ser meios acessíveis e viáveis para este fim. / Introduction: Depressive symptoms are prevalent and responsible for severe economic and psychosocial damages. Despite representing a major cause of morbidity worldwide, we can found the sub-diagnostic as clinical services pattern in outpatient or primary care. This reality complicates the referrals early and appropriate treatment for this purpose. Objectives: Identify the presence of depressive symptoms in outpatients from a general hospital and their association with use of health resources. Describe the socio-demographic profile of these patients and evaluate the associations between depression scores and use of health resources over the 01 year (Article 1). Assess whether the performance o Beck Depression Inventory (BDI) Instruments, Depression Scale in General Hospital (EDHG) and Quality of Life instrument WHOQOL-Bref, vary with the application format (in person or by telephone) (Article 2). Methods: In a prospective and naturalistic cohort design (article 1) were invited 189 patients from Clinical Internal Medicine Department, Hospital de Clinicas de Porto Alegre to participate in the study. We applied the Beck Depression Inventory (BDI), Scale Depression in General Hospital (EDHG) and the Uses of Health Resources Questionary at time 1 (baseline) and 14 months later (follow-up). We evaluated the prevalence of depressive symptoms in outpatients and their relationship with clinical use of health resources throughout the follow-up. The second article refers to a non-controlled experiment conducted at the Basic Health Unit (BHU) Santa Cecilia in Porto Alegre. For these participants (380) we have applied the same tools from study 1, coupled with the Whoqol-bref in format test-retest (7 days interval) in four groups of application (in person and by telephone). Thus, we evaluate if instruments that measure depressive symptoms and quality of life vary their performance when applied by telephone for this service. Results: We found a significant association between depressive symptoms and use of health resources, including mental health care, adherence to treatment, current treatment in mental health services and psychotropic use (Article 1). In the second article, the scales performance was invariant among different groups of application (in person and by telephone), maintaining high significant correlation values (all above 0.9). Conclusion: There was high prevalence of depressive symptoms in outpatients and significant associations in relation to health resources used. Sub-diagnostic is still standard in these services. Thus, the crawl scales and use of the telephone can be affordable and feasible options for this purpose. Conclusion: There was high prevalence of depressive symptoms in outpatients and significant associations in relation to health resources used. Sub-diagnostic is still standard in these services. Thus, the crawl scales and use of the telephone can be affordable and feasible options for this purpose.

Introdução. Inquéritos domiciliares têm sido utilizados em estudos epidemiológicos desde o início do século passado. Com o passar do tempo, os métodos de realização de entrevistas foram se aperfeiçoando, possibilitando maior rapidez e exatidão nas informações obtidas. As entrevistas realizadas via telefone tornam o processo mais fácil, ágil e de menor custo. Objetivo. Comparar os moradores do município de São Paulo que possuíam telefone fixo em sua residência, com os que disseram não possuir o referido aparelho, quanto a variáveis demográficas, de condições de vida, estilo de vida, estado de saúde e também quanto ao uso e acesso aos serviços de saúde. Metodologia. Utilizando o módulo survey do pacote estatístico Stata em sua versão 9.2, foi feita uma caracterização do perfil desses dois grupos de entrevistados (com e sem telefone fixo). Foram calculados também, os vícios que a não cobertura por parte da população sem telefone ocasiona às estimativas e foi verificado como um ajuste de pós-estratificação diminui este vicio. Resultados. Dos 3333 entrevistados na cidade de São Paulo, 77,7% possuíam telefone fixo residencial; foi detectada associação estatisticamente significante entre a presença de telefone fixo e as variáveis: naturalidade, raça/cor, religião, situação conjugal, escolaridade do chefe de família, renda, tabagismo, alcoolismo, presença de morbidade referida, hipertensão, auto-avaliação em saúde, realização de mamografia, exame de próstata, consultas odontológicas, consumo de medicamentos e utilização do SUS para a realização dos exames de saúde. Ao se retirar da análise, a população sem telefone fixo, as estimativas de exame de pré-natal e próstata, tabagismo, alcoolismo, auto-avaliação de saúde, consultas odontológicas e a utilização do SUS para os exames de pré-natal e Papanicolaou foram as que tiveram maior vício. Após o ajuste de pósestratificação, houve uma melhora em todas as estimativas que estavam associadas à posse do telefone fixo, porém o vício não foi reduzido por completo. Conclusão. A exclusão dos moradores sem aparelho telefônico é uma das principais limitações e fonte de vício em pesquisas via telefone, mesmo em lugares onde a cobertura seja considerada razoável. Este obstáculo não deve ser considerado um impedimento, no entanto, algumas precauções e ajustes terão que ser utilizados para se reduzir os vícios, contribuindo para a estimação e interpretação correta dos resultados, já que estes levantamentos via telefone servem não apenas para se conhecer o estado de saúde da população, mas também contribuem para a orientação no planejamento de ações e novas políticas de saúde pública. / Introduction. Household surveys have been widely used in epidemiologic studies since the beginning of the 20th century. The methods used in interviews have improved and become a more precise way to obtain information. Telephone interviews make the whole process easier, quicker and less expensive. Objective. To compare households with and without telephone living in São Paulo city analyzed by demographic life conditions, life style, health state and access to health services. Methods. Using Stata 9.2 (survey package), the residents were separated in two groups (with and without telephone). The biases created by the non-coverage of nontelephone respondents from the data bank were estimated and a poststratification adjustment was applied with the purpose of reducing this bias. Results. About 77.7% of respondents reported owning a telephone in the city of São Paulo which was statistically associated to region of birth, race, religion, marital status, schooling of household head, income, smoking status, alcoholism, morbidity, hypertension, self-health status, breast and prostate exam, dental care, medicine use, and also the utilization of Brazilian National Health System (SUS) in health exams. Excluding the respondents without telephone from the analysis, prevalence estimates of prenatal and prostate exam, smoking status, alcoholism, self-health status, dental care and the utilization of Brazilian National Health System in prenatal care and Papanicolaou exam were extremely affected by non-coverage bias. Nevertheless after post-stratification adjustment, the bias has been diminished to all variables associated to telephone ownership, but not completely. Conclusion. The exclusion of persons without telephone is one of the main limitations, as well as, is a great source of bias in telephone surveys, even in areas where the coverage is relatively high. However, it should not be considered a barrier, since some precautions are taken in order to reduce bias, improve the estimates and provide correct interpretation of results, the telephone survey is not only important to (get to) know the population health status, but it also contribute to supporting new public health action.

Orientador: Kamal Abdel Radi Ismail / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-04T07:17:14Z (GMT). No. of bitstreams: 1 Goulart_MarceloMagalhaes_M.pdf: 9682705 bytes, checksum: cef6e14e1c5be1d97e9dd8d289828945 (MD5) Previous issue date: 2005 / Resumo: A partir dos meados dos anos 90, com o surgimento da telefonia celular analógica e posteriormente digital, o número de usuários da telefonia celular aumenta vertiginosamente e em 2004 já supera no Brasil o número de telefones fixos, 54 milhões de celulares e 49 milhões de telefones fixos (Dados Teleco de Junho/2004). Este trabalho descreve de uma forma geral a proposta do desenvolvimento de um protótipo elétrico/eletrônico e mecânico de um sistema de monitoração e controle de inclinação (Tilt) e coordenação (Azimute) das antenas das estações rádio base da telefonia celular, facilitando-se desta forma enormemente a otimização da infra-estrutura já existente das operadoras de telefones portáteis. O estudo se baseia na utilização de microcontroladores para a realização de controle e monitoração dos sensores de inclinação e azimute instalados na simulação de uma estrutura de torre de uma estação rádio base (ERB) / Abstract: Starting from the middles of the nineties, with the appearance of the analogical mobile telephone and later digital, the number of users of the cellular mobile telephone increases vastly and in 2004 it already overcomes in Brazil the number of fixed telephones, 54 million of cellular mobile telephone and 49 million telephones fixed (Data from Teleco jun/2004).This work describe the proposal of the development of a prototype electric/electronic and mechanic of a monitoring and control system of inclination (Tilt) and coordination (Azimuth) of the antennas of the stations radio-base of the mobile telephone, being facilitated this way vastly the optimization of the infrastructure already existent of the operators of telephones mobile. The study if it bases on the microcontrollers use for accomplishment of control and monitoring of the sensor of inclination and azimuth installed in the simulation of a structure of tower of a station radio base (ERB) / Mestrado / Instrumentação e Controle Industrial / Mestre Profissional em Engenharia Mecanica

The market for IP telephony has increased over the years, more organizations integrate this technology with their existing networks. The advantages with IP telephony are the possibility to integrate different networks and transfer voice, data and video. However, the technology does not differ from other new technologies when it comes to handling security problems. The risks may increase when voice and data are transferred in the same network. Therefore it is important to elucidate the security aspects for IP networks. This thesis evaluates the technology by performing a comparison between traditional telephony and IP telephony in order to analyze the maintenance and security aspects of these two technologies. The comparison is based on the security services, authentication, integrity, confidentiality, non-repudiation and availability since these are the fundamental security aspects of IP telephony according to the authors. The result of the comparison indicates that IP telephony fulfils the most important security services, i.e. authentication, integrity and confidentiality. The PSTN (Public Switched Telephone Network) is seen as a secure network, because it is closed, e.g. only the operator has access.

Det huvudsakliga syftet med denna C-uppsats är att undersöka hur teleoperatörer anpassar sin verksamhet för att bemöta den förändrade användningen av mobiltelefonen. Studien har undersökt hur operatörerna hanterar kunder som vill använda mobila tjänster istället för fasta. Mobiltelefonen används idag av teleoperatörens kunder för mer än bara samtal och textmeddelanden. För att besvara frågeformulering har intervjuer med fem teleoperatörer som tillsammans äger mer än 97 % av den svenska telemarknaden. Intervjuerna visar att teleoperatörer är mycket medvetna om de förändringar som har ägt rum och att de försöker vinna tid för att anpassa sin verksamhet, produkter och tjänster för den nya användningen av mobiltelefonen. Framtida abonnemang kommer att bli dyrare för att kompensera förlusten av intäkter från SMS och röstsamtal. Operatörernas kunder kommer ha möjlighet att ta med sig sina olika abonnemang som bl.a. tv-kanaler och bredband till sommarstugan och på så sätt undvika att betala för flera olika typer av abonnemang. / The main purpose of this C-level essay is to examine how telephone operators adapt their activities to address the changing use of the mobile phone. Also to examine how the phone operators deal with customers who want to use mobile services instead of fixed line services. Today, the mobile phone is used by customers for more than just calls and text messages. In order to answer our questionnaires we have chosen to interview five telephone operators who share more than 97% of the Swedish telecommunications market. The interviews with the five operators show us that they are aware of the changes that are taking place and that they are trying to gain time in order to adapt their products and services for the new uses of the mobile phone. Future subscriptions will be more expensive to compensate for the loss of revenue from text messaging and voice calls. The customer will be able to bring their TV channels and broadband with them to such places as the summer cottage and thus avoid having several different types of subscriptions.

Background. Telephone advice increases the accessibility to health care and the streamlined work at primary health care centres. The goal of telephone advice nursing is to give the caller a correct advice, adapted to the caller’s situation, in order to reach correct care level. However, registered nurse’s telephone advice includes risks for misjudgement. Aim. The aim was to describe the view of registered nurse’s telephone advice at primary health care centres and call canters. The issues were if registered nurse perceived difficulties in their telephone advice and in that case, which the difficulties are. Method. A literature study was used, with systematic search in Cinahl and Pubmed, and also a manual search. In total 13 articles were included in this study. Content analysis was used. Results. Registered nurse’s had difficulties in telephone advice in following areas: computerized decision aids, non-visual communication, third-part communication, limited resources, the registered nurse's vulnerability, genus and ethnicity, and also ethical questions. Conclusion. Registered nurses perceive difficulties in telephone advice. Registered nurses should take part in the development of computerized decision support and receive continuous training in communication skills. Registered nurse’s telephone advice should be facilitated by the existence of an open climate at the workplace, to discuss and to reflect on difficulties in telephone advice.  Keywords. Perception, telenursing, telephone consultation, literature review. / Bakgrund. Telefonrådgivning ökar tillgängligheten till sjukvården och effektiviserar vårdcentralernas arbete. Målet med telefonrådgivning är att ge rådsökande rätt råd, anpassade efter dennes unika situation för att rådsökande ska nå rätt vårdnivå. Men sjuksköterskans telefonrådgivning innefattar risker för felbedömningar. Syfte. Syftet var att beskriva sjuksköterskan syn på sin telefonrådgivning vid vårdcentraler och sjukvårdsrådgivningar. Frågeställningar var om sjuksköterskan uppfattar svårigheter i sin telefonrådgivning och i så fall vilka svårigheterna var. Metod. En litteraturstudie med systematisk sökning i Cinahl och Pubmed samt manuell sökning. Sökningen resulterade i totalt 13 vetenskapliga artiklar, vilka analyserade enligt innehållsanalys. Resultat. Sjuksköterskans hade svårigheter i telefonrådgivning inom följande områden: datoriserat beslutstöd, icke-visuell kommunikation, uppgifter i andrahand, begränsade resurser, sjuksköterskans utsatthet, genus och etnicitet samt etiska frågor. Slutsats: Sjuksköterskans uppfattar svårigheter i telefonrådgivning. Sjuksköterskorna bör vara med att utveckla det datoriserade beslutstödet och få fortlöpande utbildning i kommunikationsfärdigheter. Sjuksköterskans telefonrådgivning bör underlättas av att det råder ett öppet klimat på arbetsplatsen för att diskutera och reflektera de svårigheter som finns med telefonrådgivning. Nyckelord. Svårigheter, sjuksköterskor, telefonrådgivning, litteraturstudie.

Bakgrund: Fosterrörelserna ses som ett friskhetstecken. Fostrets rörelser ändrar karaktär under graviditeten, men det är en myt att de ofta blir svagare i slutet av graviditeten. Minskade fosterrörelser är ett viktigt kliniskt tecken som kan föregå intrauterin fosterdöd (IUFD). Kvinnan tar telefonkontakt när hon är orolig då hon upplever ett ändrat rörelsemönster. Socialstyrelsens nya riktlinjer finns till för korrekt handläggning, undersökning utan fördröjning kan förebygga livshotande tillstånd hos fostret. Syftet var att beskriva barnmorskors erfarenheter av telefonrådgivning till gravida som kontaktar förlossningsavdelningen gällande minskade fosterrörelser.Design: Studien har utgått ifrån en kvalitativ design med deskriptiv ansats. Datainsamlingen utfördes med semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys.Deltagare och omgivning: Tio barnmorskor som arbetade vid en förlossningsavdelning i norra Sverige.Resultat: I studien framkom två huvudkategorier, försöka bemöta oron samt komma till ett beslut och sju kategorier. Barnmorskorna är medvetna om vilka riskfaktorer som föreligger för minskade fosterrörelser och IUFD samt kring andra faktorer som kan ha betydelse för fosterrörelserna. Barnmorskorna ger “handgripliga” råd till kvinnan innan hon återkommer och i vissa fall erbjuds undersökning direkt. Telefonrådgivning förekommer dagligen och barnmorskorna belyser vikten av att vara lyhörd och ta kvinnans oro på allvar. Det ses som svårt att bedöma fostrets välmående över telefonen. Kommunikationen och erfarenhetsutbyte mellan kollegor anses värdefullt, men det upplevs även som en svårighet att ta del av nya riktlinjer på kliniken. Slutsats: Telefonrådgivningen är en komplex uppgift där en korrekt handläggning som grundar sig på evidens är avgörande för fostrets överlevnad. Riktlinjer och PM måste utformas för att barnmorskorna ska kunna handlägga minskade fosterrörelser på likartat sätt. Kliniska implikationer: Gravida kvinnor bör få information om fosterrörelser på mödravården för att öka medvetenheten. Ett nationellt utformat PM för rådgivning vid minskade fosterrörelser bör upprättas för kvinnors lika vård på lika villkor. Ökad medvetenhet hos vårdgivare om att undvika avvaktande råd då dessa saknar evidens. Nyckelord: Barnmorska, minskade fosterrörelser, IUFD, telefonrådgivning, rådgivning

M.Comm. / A modern electronic telephone exchange is very flexible in terms of size. Such exchanges can vary in size from a few lines to more than 50 000 lines. They can be expanded at any time to cater for more subscribers. This means that the telecommunications service provider is able to build the exchange just large enough to supply service to the subscribers in the area, and then expand the exchange on a regular basis as needed to cater for any growth in demand for exchange connections. The main advantage of this flexible approach is that money is not tied up in very expensive exchange equipment which is not being used.

The spatially distributed adaptive array is defined and analyzed. It is applied to both time division multiple access (TDMA) and code division multiple access (CDMA) cellular networks to improve the outage probability at either the base station or mobiles. In a TDMA network, the distributed array consists of three sub-arrays at alternate corners of a hexagonal cell. It is shown analytically that the SINR of combined beamforming of the distributed sub-arrays is greater than or equal to the SIR or independent beamforming of the sub-arrays. Closed form solutions are derived for estimating the BER performance of Rayleigh fading mobile signals received at a distributed adaptive array with combined beamforming of the sub-arrays. The simulated TDMA uplink outage probability of multiple same-cell co-channel users in a fading environment is compared between conventional, spatially distributed arrays with independent beamforming of the sub-arrays and combined beamforming of the sub-arrays. The effect of the antenna element spacing, number of elements and angular spread is also investigated. Spatially distributed arrays are formed in a CDMA network on the downlink with arrays in multi-way soft handoff with the mobiles. The outage probability performance of combined beamforming of the arrays in handoff is compared to independent beamforming of the arrays as well as to conventional sectorized antennas. The range between mobiles and distributed sub-arrays in the case of a spatially distribu-ted array can be larger than between conventional center cell arrays and mobiles. Therefore, the effect of interference on the range increase relative to an omni antenna of adaptive and phased arrays in a multipath environment for both narrowband and wideband spread spectrum systems is investigated. An analytical model for predicting the asymptotic range limitation of phased arrays when the angular spread exceeds the array beamwidth is derived. / Thesis (PhD (Electronic Engineering))--University of Pretoria, 2006. / Electrical, Electronic and Computer Engineering / unrestricted

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