PhD, Faculty of Health Sciences, University of the Witwatersrand / Background: Chronic diseases have increased worldwide. Despite the significant advances in medical science, the management of chronic diseases continues to be poor. To meet this challenge, we need to try to implement existing chronic illness models of prevention, early detection, and risk factor management. This is achievable in part by linking primary health care clinicians, such as primary health care nurses (PHCNs) and hospital-based medical specialists. This study evaluated a ‘real life’ chronic disease outreach program (CDOP), which assisted PHCNs with the early detection and management of chronic illnesses known to cause chronic kidney disease (CKD) and cardiovascular disease (CVD). PHCNs are critical in the management of chronic illnesses but they require ongoing support of and links with specialists. This will ensure that current guidelines reach the people receiving primary health care (PHC) and detection of those needing referrals. Aims: The study aimed to determine if CDOP was an effective method for the early detection and management of diabetic and hypertensive patients at high risk for complications like stroke, ischaemic heart disease and CKD. It also aimed to evaluate the PHCNs’ knowledge and motivation, and to elucidate the challenges facing the current health system in the management of patients with chronic conditions. Methods: Patients at risk for complications were enrolled for increased monitoring and clinical support and management, at 20 clinics in Soweto, South Africa (SA). CDOP used a paper-based support and patient care system, modelled on the Wagner Chronic Illness Care Model (CICM). The components for evaluation included: (i) Focus on monitoring functional and clinical outcomes (ii) Health system interventions, such as increased ‘decision support’ and the development of a ‘prepared motivated health care team’ and (iii) Enhancing PHCNs’ knowledge and motivation. The evaluation followed the various elements of the Wagner CICM, as well as drawing on the WHO Innovative Care for Chronic Conditions (ICCC) Framework. A cohort analysis of functional and clinical outcomes in enrolled patients was conducted. PHCN knowledge and motivation was assessed through self administered questionnaires. Health worker knowledge was evaluated through the use of case scenarios and multiple choice questions. On the theme of health worker motivation, Franco’s model, with Penn-Kekana’s adaptation, was used to develop the questions and analyse diary recordings. Diary recordings of PHCNs and meetings with regional and provincial health managers’ discussions were collected by CDOP staff during follow-up focus groups and feedback meetings. Diaries were analysed thematically. The CDOP evaluation is thus a triangulated analysis of clinical and functional outcomes, diary recordings, and the self-administered questionnaire. Results: The CDOP ran from 2003-2006, during which time 618 patients (61% females, 39% males) deemed at risk of CKD or CVD were enrolled; 55% had uncontrolled hypertension (HTN), 45% DM with HT and/or proteinuria. Patients were followed for 2 years. In total, 108 patients completed 2 years of follow up, most of whom were referred for specialist support (n=69, 11%), more intensive medication regimes or because were not available in the PHC system. Most did not require referral (515, 82%), 35 (6%) were referred but never arrived at the hospital and 6 (1%) died. Twelve percent had advanced CKD, 2% required dialysis, 6.9% required medications not available to primary care clinics, and 1% died. As a tool to detect those needing referral, the program was successful. The sensitivity and specificity for detecting those needing referral was 95% and 100%, respectively.. However, although PHCNs were able to detect high risk patients, not all those referred arrived at the hospital. Hypertension, blood glucose, cholesterol and proteinuria control significantly improved in those followed (p<0.01) over 2 years, but no improvement was noted with weight control. Importantly, proteinuria and kidney function, in patients with static stable renal function, measured by estimated GFR equations and urine dipstick or albumin creatinine ratio (ACR), did not worsen significantly. Of the remaining 510 patient enrolled but not followed up, 213 (35%) were reabsorbed into the routine clinics, and a further, 123 (20%) of patients enrolled were lost to follow up completely. The diary recording thematic analysis revealed the problem of poor patient follow up, attributed to the poor existing health system in the clinics, competing demands on PHCNs, staff shortages, high staff turnover, and the low motivation and morale of clinicians. The analysis of the health worker questionnaire showed improved motivation and statistically better knowledge in those PHCNs involved with CDOP compared to those who were not exposed to the program (p<0.0034). Conclusions: CDOP was successful in supporting PHCNs, detecting patients with advanced disease and ensuring their early referral. Such programs are able to correctly detect people with disease, but this is dependent on the health and program systems being intact. It also improved patient risk factor control in the sub-set of referred patients and impacted on PHCNs’ existing knowledge and motivation for caring for patients. Its weaknesses were related to the poor existing health systems and infrastructure, and the poor integration of chronic illness care in the region. The PHC clinics had poor follow up compared with that in the hospital setting. The study also revealed an overworked, poorly supported, and frustrated primary health care team. This was despite the fact that the PHCNs were willing and motivated to deliver a good service.

Objectives: The aim of the study was to ascertain the efficacy of an intervention -where laboratory test costs were provided to clinicians as a pocket-sized brochure - to reduce the laboratory test costs over a 4 month period. Design: This was a non randomised intervention study where the intervention. group was compared to a similar and concurrent control group regarding the difference in laboratory test costs over a specified period in a specific year. The costs incurred were also computed for the same 2 groups over an identical time period and seasonal period in the preceding year, referred to as the control period. Setting and Subjects: The study was conducted in the Internal Medicine Wards at the Steve Biko Academic Hospital. The intervention period was during the winter months of May to August 2008 and the pre-intervention period was in the same months of the preceding year. Outcome measures: In the two (2007 and 2008) 4 month periods, for each patient admitted, the number of days in hospital and the laboratory tests ordered were computed. For the Intervention and control groups, pre and post intervention cost and days in hospital were estimated. The differences in logcosts per day were compared over time using ANOVA with group (1-2), time (1-2) and group*time as factors. Results: The mean cost per patient admitted in the intervention group decreased from R 2864.09 to R 2097.47 as a result of the intervention – a 27 % reduction in cost. The mean cost per day in the intervention group as a whole also decreased from R 442.90 to R 284.14 due to the intervention – a 36% reduction in cost. By contrast, in the control group, all costs increased in the control group from the pre-intervention to intervention periods – mean cost per admission in this group increased from R 1859.87 to R 2429.25 – an increase of 23%. The mean cost per day admitted in this group also increased from R 363.54 to R 371.92 – an increase of 2.2%. Conclusion: A heightened awareness of the cost of a laboratory test be it prospectively or retrospectively is a cost-effective and sustainable method of making doctors order tests rationally and appropriately. / Dissertation (MSc)--University of Pretoria, 2011. / Internal Medicine / unrestricted

No description available.

SUMMARY Aim of the study – to assess the attitudes of patients and their partners to the quality of service in the secondary and tertiary obstetrical in-patient clinics. Objectives: 1) to evaluate the attitudes of patients to the quality of obstetrical care services; 2) to compare the quality of services among secondary and tertiary obstetrical clinics; 3) to determine the factors influencing the satisfaction with obstetrical care services; 4) to evaluate the attitudes of patients’ partners to the quality of obstetrical care services. Methods: The anonymous survey of parturient women (patients) and their partners (participants in childbirth) was performed in different obstetrical clinics since 1st January to 30th December 2004. The survey was conducted in the secondary care obstetrical in-patient Silutė (level A) and Panevezys (level B) clinics and also in the tertiary care Kaunas obstetrical in-patient clinic (Hospital of Kaunas University of Medicine). The number of participants was following: in Silute; 304 parturient women and 145 their partners, in Panevezys 416 and 253 and in Kaunas 256 and 111 respectively. Response rate varied between 73% and 96%. The difference between categorical variable was assessed using chi-square (χ²) test. Correlation analysis was performed using Spearman coefficient of rank correlation. Results: Majority of respondents were satisfied with childbirth (91% ) and postnatal care (95%). The satisfaction with quality of services was not related... [to full text]

Esta tese tem por objeto descrever e analisar o processo de desenvolvimento da Política Nacional de Saúde Bucal (PNSB) no terceiro nível de atenção. Para entender esse desenvolvimento, foram realizados três macroprocessos de pesquisa. O primeiro grupo de pesquisas procurou mapear a distribuição espacial dos hospitais com disponibilidade de leitos/SUS nos país e saber, dentre estes, quantos contam com serviços de atenção à saúde bucal cadastrados no Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES). O segundo grupo de pesquisas se ocupou em levantar junto ao DATASUS, através das ferramentas de consulta TABNET e TABWIN, dados nacionais relativos ao movimento das Autorizações de Internação Hospitalar (AIH) voltadas para procedimento de código 041402041-3 cuja descrição é Tratamento Odontológico para Pacientes com Necessidades Especiais em todas as unidades hospitalares que apresentaram este tipo de produção no país no biênio 2011/12. Foram consideradas 15 categorias de análise. O terceiro grupo de pesquisas buscou levantar junto ao site do Ministério da Saúde dados das Comissões Intergestores Regionais (CIR) existentes no Brasil até dezembro de 2012 assim como os Planos Diretores de Regionalização (PDR) e os Planos Estaduais de Saúde (PES) dos 26 estados e do Distrito Federal. Os resultados da pesquisa foram cotejados com aqueles verificados no TABWIN acerca do local de internação e de residência dos usuários SUS que se submeteram ao procedimento pesquisado. A fim de permitir uma análise comparativa deste processo numa perspectiva internacional, também foram levantados dados acerca da assistência hospitalar pública em saúde bucal levada a termo nos três países da América do Norte e em 31 países da Europa. Os resultados das pesquisas revelaram o caráter focalizador da atual ação da PNSB, em contraste com a atenção à saúde bucal hospitalar realizada na grande maioria dos países estudados. Entre outros resultados, as pesquisas permitiram concluir que: somente 32% dos hospitais que apresentaram AIH para os fins pesquisados possuía serviço de atenção à saúde bucal cadastrado SCNES; 1% das AIH apresentadas está relacionado ao atendimento de pacientes internados por motivos médicos; e 44% dos estados brasileiros preveem em seus instrumentos de gestão a atenção à saúde bucal em nível hospitalar. Assim, são apresentadas algumas sugestões tanto para o aperfeiçoamento da normatização da PNSB no que diz respeito à gestão da Rede de Cuidados à Pessoa com Deficiência, como para a expansão e extensão dos cuidados assistenciais em saúde bucal a todos os pacientes internados ou em tratamento ambulatorial nos hospitais do SUS. / This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Healths data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Healths website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals.

Esta tese tem por objeto descrever e analisar o processo de desenvolvimento da Política Nacional de Saúde Bucal (PNSB) no terceiro nível de atenção. Para entender esse desenvolvimento, foram realizados três macroprocessos de pesquisa. O primeiro grupo de pesquisas procurou mapear a distribuição espacial dos hospitais com disponibilidade de leitos/SUS nos país e saber, dentre estes, quantos contam com serviços de atenção à saúde bucal cadastrados no Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES). O segundo grupo de pesquisas se ocupou em levantar junto ao DATASUS, através das ferramentas de consulta TABNET e TABWIN, dados nacionais relativos ao movimento das Autorizações de Internação Hospitalar (AIH) voltadas para procedimento de código 041402041-3 cuja descrição é Tratamento Odontológico para Pacientes com Necessidades Especiais em todas as unidades hospitalares que apresentaram este tipo de produção no país no biênio 2011/12. Foram consideradas 15 categorias de análise. O terceiro grupo de pesquisas buscou levantar junto ao site do Ministério da Saúde dados das Comissões Intergestores Regionais (CIR) existentes no Brasil até dezembro de 2012 assim como os Planos Diretores de Regionalização (PDR) e os Planos Estaduais de Saúde (PES) dos 26 estados e do Distrito Federal. Os resultados da pesquisa foram cotejados com aqueles verificados no TABWIN acerca do local de internação e de residência dos usuários SUS que se submeteram ao procedimento pesquisado. A fim de permitir uma análise comparativa deste processo numa perspectiva internacional, também foram levantados dados acerca da assistência hospitalar pública em saúde bucal levada a termo nos três países da América do Norte e em 31 países da Europa. Os resultados das pesquisas revelaram o caráter focalizador da atual ação da PNSB, em contraste com a atenção à saúde bucal hospitalar realizada na grande maioria dos países estudados. Entre outros resultados, as pesquisas permitiram concluir que: somente 32% dos hospitais que apresentaram AIH para os fins pesquisados possuía serviço de atenção à saúde bucal cadastrado SCNES; 1% das AIH apresentadas está relacionado ao atendimento de pacientes internados por motivos médicos; e 44% dos estados brasileiros preveem em seus instrumentos de gestão a atenção à saúde bucal em nível hospitalar. Assim, são apresentadas algumas sugestões tanto para o aperfeiçoamento da normatização da PNSB no que diz respeito à gestão da Rede de Cuidados à Pessoa com Deficiência, como para a expansão e extensão dos cuidados assistenciais em saúde bucal a todos os pacientes internados ou em tratamento ambulatorial nos hospitais do SUS. / This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Healths data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Healths website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals.

INTRODUÇÃO: As intervenções de promoção da saúde mental avançam e atividades não medicamentosas ganham espaço. Neste sentido, estudos apontam a atenção plena (mindfulness) como estratégia integrativa para o enfrentamento do estresse e de transtornos mentais comuns, bem como para obtenção do autocuidado. Mindfulness é referido no contexto laico contemporâneo como um estado mental presente em todos os indivíduos em maior ou menor intensidade que pode ser cultivado diariamente através de práticas meditativas. OBJETIVO: Descrever o nível da autopercepção de comportamentos relacionados à Mindfulness em profissionais da saúde de um Hospital Terciário e analisar a associação dos níveis de mindfulness autopercebidos com determinados indicadores das condições de vida e saúde. MÉTODO: Foi realizado um estudo transversal com 97 profissionais da saúde que compõem o complexo do Hospital das Clínicas - FMUSP por via de caracterização Sociodemográfica, da Escala Filadélfia de Mindfulness (EFM) e de um Questionário de Saúde Geral (General Health Questionnaire -12). Todos os questionários foram aplicados no período de fevereiro/novembro de 2014. RESULTADO: Na EFM, o escore médio apresentado foi maior para o componente \"Consciência\" (média 29,9; desviopadrão 0,62) do que para \"Aceitação\" (média 15,7; desvio-padrão 0,86), sendo a média 45,6 e desvio-padrão 1,1 para o Escore Total (componente \"consciência\" somada a \"aceitação\"); Verificou-se número significativo de indivíduos (41%) com suspeita de transtornos mentais comuns (TMC), aqueles que apresentaram um escore de três ou mais no GHQ-12. Em análise mais detalhada (Teste t e ANOVA) observou-se associações fortemente significantes (p < 0,01) entre maiores níveis de mindfulness autopercebido com o gênero masculino, estado civil casado/amigado, maior satisfação no trabalho, negar uso de medicamentos, sono satisfatório, lazer frequente e ausência de TMC. Na análise da associação GHQ-12 com Mindfulness estratificada por profissão verificou-se escores menores no grupo das categorias \"psicólogo, assistente social, profissional de educação física, biólogo, fisioterapeuta, farmacêutico e profissional administrativo\" com TMC; na análise da associação GHQ-12 com Mindfulness estratificada por tipo de doença concluiu-se que existem diferenças significantes (p < 0,01) no grupo das categorias \"mais de uma doença, neurológica ou psiquiátrica\", das quais o escore \"Total\" e \"Aceitação\" foram menores para quem apresenta TMC. A presença de TMC (referido pelo GHQ-12) está associada a menores escores de Mindfulness, indicando uma possível correlação negativa que se deve ao domínio de \"Aceitação\" CONCLUSÃO: Os níveis de comportamentos autopercebidos à atenção plena apontaram associações significantes com uma variedade de indicadores das condições de vida e saúde nos profissionais de saúde. Sugerindo assim, uma mesma direção de evidências científicas recentes de que mindfulness pode fazer parte de fatores de proteção à saúde favorecendo também o autocuidado e a qualidade de vida / INTRODUCTION: The Mental Health Promotion interventions advance and non-drug activities gain ground. In this case, studies show meditation as an opportunity to cope with stress and the common mental disorders, as well as to obtain self-care. Mindfulness is referred in contemporary laic context as a present mental state in all individuals in greater or lesser degree which can be daily cultivated through meditative practices. OBJECTIVE: This study aimed to describe the self-perceived level of Mindfulness-related behaviors in health care professionals of a tertiary care hospital as well as to analyze the association of self-perceived mindfulness levels with certain indicators of living conditions and health. METHOD: A cross-sectional study is proposed with 97 health professionals who make up the University Hospital complex - FMUSP via Socio Demographic characterization, a study of the Philadelphia Mindfulness Scale (PMS) and a Questionnaire of General Health (General Health Questionnaire -12). All interviews were conducted between February and November/ 2014. RESULT: In PMS, the average score was higher for the component \"awareness\" (mean 29.9, SD 0.62) than for \"acceptance\" (mean 15.7, SD 0.86), with an average 45.6 and SD 1.1 for the Total Score (component \"awareness\" added to \"acceptance\"); There was a significant number of individuals (41%) with suspected common mental disorders (CMD), those with a score of three or higher in the GHQ-12. In a more detailed analysis (T-Test and ANOVA) it was observed strongly significant associations (p < 0.01) with higher levels of self-perceived mindfulness in the masculine gender, married / living together unmarried, greater job satisfaction, not in use of medicinal drugs, satisfactory sleep, frequent leisure and no presence of CMD. In the analysis of the GHQ-12 association with Mindfulness stratified by profession it was observed that the scores were lower for the group of the categories \"psychologist, social worker, physical education professional, biologist, physiotherapist, pharmacist and administrative professional\" with CMD; in the analysis of the GHQ-12 association with Mindfulness stratified by disease type the results showed that there are significant differences (p < 0.01) for the group of the categories \"more than one disease, either neurological or psychiatric\", of which the score \"Total\" and \"Acceptance\" were lower for those who had CMD. The presence of CMD (referred by the GHQ-12) is associated with lower scores of Mindfulness, indicating a possible negative correlation due to the domain of \"Acceptance\". CONCLUSION: The levels of self-perceived behaviors to mindfulness showed significant associations with a variety of indicators of living conditions and health among health care professionals. Suggesting, thus, the same direction of recent scientific evidences that mindfulness may be part of health protective factors also favoring self-care and quality of life

INTRODUÇÃO: As intervenções de promoção da saúde mental avançam e atividades não medicamentosas ganham espaço. Neste sentido, estudos apontam a atenção plena (mindfulness) como estratégia integrativa para o enfrentamento do estresse e de transtornos mentais comuns, bem como para obtenção do autocuidado. Mindfulness é referido no contexto laico contemporâneo como um estado mental presente em todos os indivíduos em maior ou menor intensidade que pode ser cultivado diariamente através de práticas meditativas. OBJETIVO: Descrever o nível da autopercepção de comportamentos relacionados à Mindfulness em profissionais da saúde de um Hospital Terciário e analisar a associação dos níveis de mindfulness autopercebidos com determinados indicadores das condições de vida e saúde. MÉTODO: Foi realizado um estudo transversal com 97 profissionais da saúde que compõem o complexo do Hospital das Clínicas - FMUSP por via de caracterização Sociodemográfica, da Escala Filadélfia de Mindfulness (EFM) e de um Questionário de Saúde Geral (General Health Questionnaire -12). Todos os questionários foram aplicados no período de fevereiro/novembro de 2014. RESULTADO: Na EFM, o escore médio apresentado foi maior para o componente \"Consciência\" (média 29,9; desviopadrão 0,62) do que para \"Aceitação\" (média 15,7; desvio-padrão 0,86), sendo a média 45,6 e desvio-padrão 1,1 para o Escore Total (componente \"consciência\" somada a \"aceitação\"); Verificou-se número significativo de indivíduos (41%) com suspeita de transtornos mentais comuns (TMC), aqueles que apresentaram um escore de três ou mais no GHQ-12. Em análise mais detalhada (Teste t e ANOVA) observou-se associações fortemente significantes (p < 0,01) entre maiores níveis de mindfulness autopercebido com o gênero masculino, estado civil casado/amigado, maior satisfação no trabalho, negar uso de medicamentos, sono satisfatório, lazer frequente e ausência de TMC. Na análise da associação GHQ-12 com Mindfulness estratificada por profissão verificou-se escores menores no grupo das categorias \"psicólogo, assistente social, profissional de educação física, biólogo, fisioterapeuta, farmacêutico e profissional administrativo\" com TMC; na análise da associação GHQ-12 com Mindfulness estratificada por tipo de doença concluiu-se que existem diferenças significantes (p < 0,01) no grupo das categorias \"mais de uma doença, neurológica ou psiquiátrica\", das quais o escore \"Total\" e \"Aceitação\" foram menores para quem apresenta TMC. A presença de TMC (referido pelo GHQ-12) está associada a menores escores de Mindfulness, indicando uma possível correlação negativa que se deve ao domínio de \"Aceitação\" CONCLUSÃO: Os níveis de comportamentos autopercebidos à atenção plena apontaram associações significantes com uma variedade de indicadores das condições de vida e saúde nos profissionais de saúde. Sugerindo assim, uma mesma direção de evidências científicas recentes de que mindfulness pode fazer parte de fatores de proteção à saúde favorecendo também o autocuidado e a qualidade de vida / INTRODUCTION: The Mental Health Promotion interventions advance and non-drug activities gain ground. In this case, studies show meditation as an opportunity to cope with stress and the common mental disorders, as well as to obtain self-care. Mindfulness is referred in contemporary laic context as a present mental state in all individuals in greater or lesser degree which can be daily cultivated through meditative practices. OBJECTIVE: This study aimed to describe the self-perceived level of Mindfulness-related behaviors in health care professionals of a tertiary care hospital as well as to analyze the association of self-perceived mindfulness levels with certain indicators of living conditions and health. METHOD: A cross-sectional study is proposed with 97 health professionals who make up the University Hospital complex - FMUSP via Socio Demographic characterization, a study of the Philadelphia Mindfulness Scale (PMS) and a Questionnaire of General Health (General Health Questionnaire -12). All interviews were conducted between February and November/ 2014. RESULT: In PMS, the average score was higher for the component \"awareness\" (mean 29.9, SD 0.62) than for \"acceptance\" (mean 15.7, SD 0.86), with an average 45.6 and SD 1.1 for the Total Score (component \"awareness\" added to \"acceptance\"); There was a significant number of individuals (41%) with suspected common mental disorders (CMD), those with a score of three or higher in the GHQ-12. In a more detailed analysis (T-Test and ANOVA) it was observed strongly significant associations (p < 0.01) with higher levels of self-perceived mindfulness in the masculine gender, married / living together unmarried, greater job satisfaction, not in use of medicinal drugs, satisfactory sleep, frequent leisure and no presence of CMD. In the analysis of the GHQ-12 association with Mindfulness stratified by profession it was observed that the scores were lower for the group of the categories \"psychologist, social worker, physical education professional, biologist, physiotherapist, pharmacist and administrative professional\" with CMD; in the analysis of the GHQ-12 association with Mindfulness stratified by disease type the results showed that there are significant differences (p < 0.01) for the group of the categories \"more than one disease, either neurological or psychiatric\", of which the score \"Total\" and \"Acceptance\" were lower for those who had CMD. The presence of CMD (referred by the GHQ-12) is associated with lower scores of Mindfulness, indicating a possible negative correlation due to the domain of \"Acceptance\". CONCLUSION: The levels of self-perceived behaviors to mindfulness showed significant associations with a variety of indicators of living conditions and health among health care professionals. Suggesting, thus, the same direction of recent scientific evidences that mindfulness may be part of health protective factors also favoring self-care and quality of life

Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacterium of epidemiologic importance in Canadian healthcare facilities. The contact between MRSA colonized or infected patients with other patients, healthcare workers (HCWs) and/or the healthcare environment can result in MRSA transmission and healthcare-associated MRSA (HA-MRSA) infections in hospitals. These HA-MRSA infections are linked with increased length of hospital stay, economic burden, morbidity and mortality. Although infection prevention and control programs initiated in 2009 in Canada and other developed countries (e.g., UK, France, Belgium, Denmark, etc.) have been relatively successful in reducing the rate of HA-MRSA infections, they continue to pose a threat to patients, especially to the more vulnerable in long term care and geriatric institutions. Historically, MRSA was a problem mainly in hospital settings but after mid-1990s new strains of MRSA have been identified among people without healthcare-related risks and have been classified as community-associated MRSA (CA-MRSA). Furthermore, the distinction between HA-MRSA and CA-MRSA strains is gradually waning due to both the introduction of HA-MRSA in communities, and the emergence of CA-MRSA strains in hospitals. The purpose of this thesis was to explore the feasibility of constructing healthcare networks to evaluate the role of healthcare providers (e.g., physicians) and places (e.g., patient rooms) in the transmission of MRSA in a large tertiary care facility. Method of investigation: a secondary data case-control study, using individual characteristics and network structure measures, conducted at The Ottawa Hospital (TOH) between April 1st, 2013 and March 31th, 2014. Results: It was feasible to build social networks in a large tertiary care facility based on electronic medical records data. The networks' size (represented by the number of vertices and lines) increased during the outbreak period (period 1) compared to the pre-outbreak period (period 0) for both groups and at all three TOH campuses. The calculated median degree centrality showed significant increase in value for both study groups during period 1 compared to period 0 for two of the TOH campuses (Civic and General). There was no significant difference between the median degree centrality calculated for each study group at the Heart Institute when compared for the two reference periods. The median degree centrality of the MRSA case group for period 0 showed no significant difference when compared to the same measure determined for the control group for all three TOH campuses. However, the median degree centrality calculated for period 1 was significantly increased for the control group compared to the MRSA case group for two TOH campuses (Civic and General) but showed no significant difference between the two groups from the Heart Institute. In addition, there was a correlation between the two network measures (degree centrality and eigenvector centrality) calculated to determine the most influential person or place in the MRSA case group networks. However, there was no correlation between the two network’s measures calculated for physicians included in MRSA case group networks. Conclusions: It is feasible to use social network analysis as an epidemiologic analysis tool to characterize the MRSA transmission in a hospital setting. The network's visible changes between the groups and reference periods were reflected by the network measures and supported also by known hospital patient movements after the outbreak onset. Furthermore, we were able to identify potential source cases and places just prior of the outbreak start. Unfortunately, we were not able to show the role of healthcare workers in MRSA transmission in a hospital setting due to limitations in data collection and network measure chosen (eigenvector centrality). Further research is required to confirm these study findings.