O Ministério da Saúde define Saúde da Família como estratégia de reorientação do modelo assistencial, operacionalizada mediante a implantação de equipes multiprofissionais em unidades básicas de saúde. Esta equipe oferece Assistência Integral, levando em consideração o meio ambiente e os comportamentos interpessoais. Segundo a Organização Mundial da Saúde (OMS), Assistência Domiciliar é entendida como oferta de serviços de saúde por prestadores formais e informais para promover, restaurar e manter o conforto e saúde das pessoas em nível máximo, incluindo cuidados para uma morte digna. Neste contexto, a Atenção Domiciliar (AD) é valioso instrumento de monitorização da situação de saúde das famílias pelas equipes de saúde, favorecendo o acompanhamento clínico e melhores prognósticos, evitando a hospitalização e suas consequências, sendo considerada importante recurso de humanização do atendimento. Assim, o objetivo deste estudo foi avaliar o perfil clínico-epidemiológico dos indivíduos atendidos em AD pelas equipes dos Núcleos de Saúde da Família ligados à Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, localizados no Distrito de Saúde Oeste do Município de Ribeirão Preto/SP. O estudo se deu entre janeiro de 2015 e dezembro de 2016 com vistas a nortear estratégias de aprimoramento do atendimento através do planejamento e organização do trabalho do profissional executor da visita domiciliar (VD), favorecendo maior resolubilidade da(s) demanda(s) e maior satisfação do usuário. Realizou-se um estudo de corte transversal coletando informações sobre os usuários assistidos por esta modalidade de cuidado e sobre o processo de AD, através de questionários elaborados com base na literatura sobre o assunto. Entre os 150 pacientes visitados, 106 (70,7%) eram mulheres, 66 (44%) eram casados, 84 (56%) eram aposentados, 101 (67,3%) pertenciam a famílias anciãs, 84 (56%) possuíam ensino fundamental e 102 (68%) tinham cuidadores. Com relação à média de idade, o NSF 2 apresentou a maior média de idade (72,5) e o NSF 5 a menor média (59,9). Os diagnósticos mais encontrados foram Acidentes Vasculares Cerebrais [21(14%)] e Demência [16(10,7%)] e as classes de medicamentos mais utilizadas foram anti-hipertensivos [93(62%)]. Com relação às modalidades de AD, 128 (85,3%) visitas foram classificadas como AD1, 13 (8,7%) como AD2 e somente 9 (6%) como AD3. Também foram avaliadas outras características da AD e observou-se que 137 (91,3%) das VD\'s realizadas foram agendadas, 65 (43,33%) estavam em acompanhamento domiciliar e somente 30 (20%) foram busca ativa. Após as VD\'s, 83 (55,3%) pacientes mantiveram-se em acompanhamento domiciliar e 65 (43,3%) pacientes retornaram para seguimento na Unidade. Por fim, os resultados permitem delinear o perfil de vida e saúde dos pacientes, sendo a maioria idosos, mulheres, aposentados, pertencentes à famílias anciãs, possuindo cuidadores e os diagnósticos prevalentes foram doenças crônicas degenerativas. Ademais, identificou-se a necessidade de fortalecimento de ações de prevenção e promoção de saúde, reduzindo-se complicações e internações desnecessárias. Assim, políticas públicas específicas voltadas principalmente para a população mais idosa devem ser consideradas prioridades. Além disto, as AD se realizavam de forma quase intuitiva, provavelmente em decorrência da alta demanda que as unidades precisam atender, evidenciando a necessidade de sistematização da atividade. / The MS defines Family\'s Health as a strategy for reorganize the care model, operationalized through the implantation of multiprofessional teams in basic health units. This team offers Integral Assistance, taking into consideration the environment and interpersonal behavior. According to the World Health Organization (WHO), home care is understood as providing health services by formal and informal providers to promote, restore and maintain the comfort and health of people at the highest level, including care for a dignified death. In this context, Home Care (HC) is a valuable tool for monitoring the health situation of families by health teams, favoring clinical follow-up and better prognoses, avoiding hospitalization and its consequences, being considered an important humanization resource. Thus, the objective of this study was to evaluate the clinical and epidemiological profile of individuals assisted in HC by the teams of the Family Health Centers connected to the Medical School of Ribeirão Preto of University of São Paulo, located in the Western District of the Municipality of Ribeirão Preto/SP. The study was conducted between January 2015 and December 2016 with a view to guiding strategies for improving care through the planning and organization of the work performed by the home visiting professional, favoring greater resolubility of the demands and greater user satisfaction. A cross-sectional study was carried out, collecting information about the users assisted by this modality of care and about the HC process, through questionnaires elaborated based on the literature on the subject. Among the 150 patients visited, 106 (70.7%) were women, 66 (44%) were married, 84 (56%) were retired, 101 (67.3%) belonged to elderly families, 84 (56%) had elementary school and 102 (68%) had caregivers. Regarding the mean age, NSF 2 had the highest mean age (72.5) and NSF 5 had the lowest mean (59.9). The most frequent diagnoses were Cerebral Vascular Accidents [21 (14%)] and Dementia [16 (10.7%)] and the most used classes of drugs were antihypertensive [93 (62%)]. Regarding HC modalities, 128 (85.3%) visits were classified as HC1, 13 (8.7%) as HC2 and only 9 (6%) as HC3. Other characteristics of the HC were also evaluated, and 137 (91.3%) of the HVs performed were scheduled, 65 (43.33%) were under housekeeping and only 30 (20%) were active. After the HVs, 83 (55.3%) patients were followed up at home and 65 (43.3%) returned for follow-up at the Unit. Finally, the results allow to delineate the life and health profile of the patients, being the majority elderly, women, retired, belonging to the elderly families, having caregivers and the prevalent diagnoses were chronic degenerative diseases. In addition, it was identified the need to strengthen health prevention and promotion actions, reducing unnecessary complications and hospitalizations. Thus, specific public policies aimed primarily at the older population should be considered priorities. In addition, the HCs were performed in an almost intuitive way, probably due to the high demand that the units need to attend, evidencing the need to systematize the activity.

Magister Curationis - MCur / The use of health education during antenatal care of pregnant women has been a commonly used strategy in improving maternal health worldwide. However the health education strategy sometimes does not prove to be effective in promoting maternal health, especially in Sub-Sahara Africa.

Captain Stormfield, the main character in Mark Twain's last book, Extract from Captain Stormfield's Visit to Heaven (1909), appears numerous times--under either the Stormfield name or some other--in Twain's published and unpublished works. Scholar's since Train's death have given only passing or slight notice to the Stormfield character. His numerous appearances, however his pivotal function among several unfinished works, and his essential optimism must lead to an awareness of his significant role in Twain's fiction.

Introducción: Se describe que las características de la vivienda son un factor importante para llevar a cabo adecuadamente el tratamiento de diálisis peritoneal, sin embargo, no se conoce la real relación entre las características de la vivienda y el desarrollo de la peritonitis. Métodos: Se realizó una cohorte retrospectiva que incluyó a todos los pacientes mayores de 18 años de edad que iniciaron el tratamiento de diálisis peritoneal dentro del periodo enero 2002 - diciembre 2011 en el Hospital Nacional Guillermo Almenara Irigoyen. Se describió los tiempos de seguimiento según la fecha de inicio de DP y la primera peritonitis u otros eventos (paso a hemodiálisis, trasplante, muerte o abandono). Las variables fueron evaluadas según su tipo, utilizando estadística descriptiva e inferencial. Resultados: El análisis incluyó a 218 pacientes con una media de edad de 54 años ± 16. El principal lugar donde se realiza el procedimiento de diálisis peritoneal es el dormitorio (77,3%), en su mayoría se encuentra limpio (54,3%), ordenado (71,3%) y despejado (61,8%). Los insumos para el procedimiento se almacenan bajo techo (95,7%) y el mismo paciente ejecuta el tratamiento en la mayoría de los casos (73,1%). La incidencia encontrada fue de 0,17 episodios/paciente-año. La media del tiempo de seguimiento fue de 975 días ± 750. De acuerdo al análisis realizado no se encontró resultados significativos que muestren la relación entre las variables de vivienda y el desarrollo de la primera peritonitis. Conclusión: No se encontró asociación entre las condiciones de vivienda y el desarrollo de peritonitis en pacientes en tratamiento de diálisis peritoneal. Es necesario evaluar y mejorar el programa de visitas domiciliarias / Background: The features of housing are an important risk factor to properly carry out the treatment of peritoneal dialysis. However, the actual situation is that it doesn’t know the real relationship between the characteristics of housing and the development of peritonitis. Methods: A retrospective cohort was made including all patients over 18 years who started PD between the period January 2002 and December 2011 at the Hospital National Guillermo Almenara Irigoyen. The follow-up times was described as the beginning date of use DP and the first peritonitis or other events (hemodialysis, transplant, death or abandonment). The variables were evaluated according to their type using descriptive and inferential statistic. Results: The analysis included 218 patients with a mean age of 54 years ± 16. The main place where the patients did the procedure of peritoneal dialysis is the bedroom (77,3%), most of it is clean (54,3%), organized (71,3%) and clear (61,8%). The inputs for the procedure are stored indoors (95,7%) and the person who executes the procedure is the patient in most cases (73,1%). The observed incidence was 0,17 episodes/patient-year. The mean follow-up time was 975 days ± 750. No significant results were found between the housing conditions and the development of the first peritonitis in patients who are treated by peritoneal dialysis. Conclusion: No association was found between the housing conditions and the development of the first peritonitis. It is necessary to evaluated and improve the home visit program in order to obtain better information of housing condition.

[pt] A presente dissertação tem por objetivo geral identificar os impactos provocados nas relações familiares quando ocorre determinação judicial da modalidade de Guarda Unilateral com Visita Livre. Quanto aos objetivos específicos, são os seguintes: conhecer os principais fatores que influenciam a escolha na guarda unilateral com visitas livres, abordando as legislações e características pertinentes; identificar as implicações emocionais provocadas pela guarda unilateral no cotidiano do país, contextualizando as características socioeconômicas dos casais de Manaus, que formam a clientela do EAJ; levantar o perfil das famílias com modalidade de Guarda Unilateral com Visitas Livres, atendidas no EAJ, no período de julho a dezembro de 2009. O sistema de guarda unilateral tem por objetivo fazer com que a criança fique sob a guarda de um dos cônjuges, enquanto ao outro é concedido o direito de visita e é atribuída a obrigação financeira para o sustento e educação desses filhos. O foco da pesquisa foi compreender, a partir dos relatos dos pais separados ou divorciados, que praticam a modalidade de Guarda Unilateral com Visitas Livres – que tiveram sentenças expedidas pelo Juízo de Direito das Varas de Família e do Núcleo de Conciliação de Família (TJAM), da cidade de Manaus. A coleta e análise foram feitas em dois momentos: Na fase inicial foi realizado contato com a coordenação do curso de Direito e Coordenação do EAJ, do Uninorte. Depois do levantamento do número total de atendimentos realizados no período descrito, foram selecionados 10% dos casos; esta seleção foi feita de forma aleatória. Num segundo momento, foi utilizada a entrevista semi-estruturada. As entrevistas foram gravadas, transcritas e posteriormente analisadas. Cabe salientar que os resultados encontrados nesta dissertação respondem ao escopo de pesquisa e possibilitaram algumas respostas sob importantes questões sobre a eficácia da guarda unilateral através do acolhimento do EAJ. / [en] This thesis aims at identifying the impacts on family relationships when there is judicial determination of the mode of Guard with Unilateral Visit Free. The specific objectives are: to ascertain the main factors influencing the choice in unilateral guard with free visits, addressing the pertinent laws and characteristics; identify the emotional implications caused by unilateral guard in the country day by day, contextualizing the socioeconomic characteristics of Manaus couples, who seek for the EAJ (Juridical Assistance Office); raise the profile of families with Free visits Unilateral Guard attending by EAJ (Juridical Assistance Office) in the period from July to December 2009. The unilateral guard system intend to cause the child to remain in the custody of one spouse, while the other one is given the right to visit and is given the financial obligation for the maintenance and education of these children. The focus of the research was to understand the reports of separated or divorced parents – who practice Unilateral Guard with Free Visits, who had sentences issued by Center for Family Conciliation Court Law Judge (TJAM) of Manaus. Data collection and analysis were done in two stages: In the initial phase it was made contact with the coordination of law course and EAJ Coordination of the Uninorte University. After lifting the total number of visits in the period described, we selected 10% of cases, this selection was made randomly. Secondly, we used semi-structured interview. The interviews were taped and transcribed and then analyzed. It should be noted that the results found in this work respond to the scope of this research and turn possible to answer important questions about the effectiveness of the unilateral guard with free visit through the EAJ patronage.

O Ministério da Saúde define Saúde da Família como estratégia de reorientação do modelo assistencial, operacionalizada mediante a implantação de equipes multiprofissionais em unidades básicas de saúde. Esta equipe oferece Assistência Integral, levando em consideração o meio ambiente e os comportamentos interpessoais. Segundo a Organização Mundial da Saúde (OMS), Assistência Domiciliar é entendida como oferta de serviços de saúde por prestadores formais e informais para promover, restaurar e manter o conforto e saúde das pessoas em nível máximo, incluindo cuidados para uma morte digna. Neste contexto, a Atenção Domiciliar (AD) é valioso instrumento de monitorização da situação de saúde das famílias pelas equipes de saúde, favorecendo o acompanhamento clínico e melhores prognósticos, evitando a hospitalização e suas consequências, sendo considerada importante recurso de humanização do atendimento. Assim, o objetivo deste estudo foi avaliar o perfil clínico-epidemiológico dos indivíduos atendidos em AD pelas equipes dos Núcleos de Saúde da Família ligados à Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, localizados no Distrito de Saúde Oeste do Município de Ribeirão Preto/SP. O estudo se deu entre janeiro de 2015 e dezembro de 2016 com vistas a nortear estratégias de aprimoramento do atendimento através do planejamento e organização do trabalho do profissional executor da visita domiciliar (VD), favorecendo maior resolubilidade da(s) demanda(s) e maior satisfação do usuário. Realizou-se um estudo de corte transversal coletando informações sobre os usuários assistidos por esta modalidade de cuidado e sobre o processo de AD, através de questionários elaborados com base na literatura sobre o assunto. Entre os 150 pacientes visitados, 106 (70,7%) eram mulheres, 66 (44%) eram casados, 84 (56%) eram aposentados, 101 (67,3%) pertenciam a famílias anciãs, 84 (56%) possuíam ensino fundamental e 102 (68%) tinham cuidadores. Com relação à média de idade, o NSF 2 apresentou a maior média de idade (72,5) e o NSF 5 a menor média (59,9). Os diagnósticos mais encontrados foram Acidentes Vasculares Cerebrais [21(14%)] e Demência [16(10,7%)] e as classes de medicamentos mais utilizadas foram anti-hipertensivos [93(62%)]. Com relação às modalidades de AD, 128 (85,3%) visitas foram classificadas como AD1, 13 (8,7%) como AD2 e somente 9 (6%) como AD3. Também foram avaliadas outras características da AD e observou-se que 137 (91,3%) das VD\'s realizadas foram agendadas, 65 (43,33%) estavam em acompanhamento domiciliar e somente 30 (20%) foram busca ativa. Após as VD\'s, 83 (55,3%) pacientes mantiveram-se em acompanhamento domiciliar e 65 (43,3%) pacientes retornaram para seguimento na Unidade. Por fim, os resultados permitem delinear o perfil de vida e saúde dos pacientes, sendo a maioria idosos, mulheres, aposentados, pertencentes à famílias anciãs, possuindo cuidadores e os diagnósticos prevalentes foram doenças crônicas degenerativas. Ademais, identificou-se a necessidade de fortalecimento de ações de prevenção e promoção de saúde, reduzindo-se complicações e internações desnecessárias. Assim, políticas públicas específicas voltadas principalmente para a população mais idosa devem ser consideradas prioridades. Além disto, as AD se realizavam de forma quase intuitiva, provavelmente em decorrência da alta demanda que as unidades precisam atender, evidenciando a necessidade de sistematização da atividade. / The MS defines Family\'s Health as a strategy for reorganize the care model, operationalized through the implantation of multiprofessional teams in basic health units. This team offers Integral Assistance, taking into consideration the environment and interpersonal behavior. According to the World Health Organization (WHO), home care is understood as providing health services by formal and informal providers to promote, restore and maintain the comfort and health of people at the highest level, including care for a dignified death. In this context, Home Care (HC) is a valuable tool for monitoring the health situation of families by health teams, favoring clinical follow-up and better prognoses, avoiding hospitalization and its consequences, being considered an important humanization resource. Thus, the objective of this study was to evaluate the clinical and epidemiological profile of individuals assisted in HC by the teams of the Family Health Centers connected to the Medical School of Ribeirão Preto of University of São Paulo, located in the Western District of the Municipality of Ribeirão Preto/SP. The study was conducted between January 2015 and December 2016 with a view to guiding strategies for improving care through the planning and organization of the work performed by the home visiting professional, favoring greater resolubility of the demands and greater user satisfaction. A cross-sectional study was carried out, collecting information about the users assisted by this modality of care and about the HC process, through questionnaires elaborated based on the literature on the subject. Among the 150 patients visited, 106 (70.7%) were women, 66 (44%) were married, 84 (56%) were retired, 101 (67.3%) belonged to elderly families, 84 (56%) had elementary school and 102 (68%) had caregivers. Regarding the mean age, NSF 2 had the highest mean age (72.5) and NSF 5 had the lowest mean (59.9). The most frequent diagnoses were Cerebral Vascular Accidents [21 (14%)] and Dementia [16 (10.7%)] and the most used classes of drugs were antihypertensive [93 (62%)]. Regarding HC modalities, 128 (85.3%) visits were classified as HC1, 13 (8.7%) as HC2 and only 9 (6%) as HC3. Other characteristics of the HC were also evaluated, and 137 (91.3%) of the HVs performed were scheduled, 65 (43.33%) were under housekeeping and only 30 (20%) were active. After the HVs, 83 (55.3%) patients were followed up at home and 65 (43.3%) returned for follow-up at the Unit. Finally, the results allow to delineate the life and health profile of the patients, being the majority elderly, women, retired, belonging to the elderly families, having caregivers and the prevalent diagnoses were chronic degenerative diseases. In addition, it was identified the need to strengthen health prevention and promotion actions, reducing unnecessary complications and hospitalizations. Thus, specific public policies aimed primarily at the older population should be considered priorities. In addition, the HCs were performed in an almost intuitive way, probably due to the high demand that the units need to attend, evidencing the need to systematize the activity.

Over six million insured children belong to families where the parents in their household lack health insurance. Studies have indicated insured low-income children with uninsured parents are less likely to have physician visits and well-child visits than their counterparts with insured parents. However, self-selection may be responsible for the relationship found between parental insurance and well-child visits. No studies have been undertaken to examine the impact of parental insurance on the utilization of children with chronic conditions. Social Cognitive Theory was used to model children's health care utilization and explain the relationship between parental insurance and that utilization. The objectives of the study are to estimate the effect of health insurance for the primary parent on (1) insured children's well-child visits and (2) physician visits for asthma in insured children. This study used a cross-sectional design. The data source was the 2007 Medical Expenditure Panel Survey-Household Component. The sample consisted of children 17 years or less who were insured through the same source(s) for the entire year and had a primary parent who was either insured or uninsured the entire year. The dependent variable for the entire sample was whether or not the child had at least one well-child visit during the year. The dependent variables for the subsample of children with asthma were (1) whether or not the child had at least one asthma-related physician visit and (2) whether or not the child had at least two asthma-related physician visits. The independent variables were the same for the three analyses and were selected to represent the Social Cognitive Theory determinants. These included parent (insurance, sex, worry, education, language, employment, health use, health, risk aversion, and self care expectation), child (source of coverage, age, health, race, and oldest child), and household (Metropolitan Statistical Area, region, number of children, number of parents, and income) variables. Probit and bivariate probit models were estimated for each dependent variable. The percentage of children with insured parents that had a well-child visit during the year was significantly higher than the percentage of children with uninsured parents that had a well-child visit (50.6% vs. 42.8%, respectively). However, multivariate analyses revealed no significant relationship between parental insurance and well-child visits. The percentages of children with insured and uninsured parents that had an asthma-related physician visit were 29.6% and 32.6%, respectively. The percentages that had at least two asthma-related visits were 14.9% and 14.6%, respectively. No significant relationship was found between parental insurance and asthma-related physician visits. The region of the United States where the child lived and whether the child's parent was employed were associated with each type of utilization. Other determinants were also associated with children's utilization, but these varied with the type of utilization. In conclusion, insured children with insured parents are no more likely to have a well-child or asthma-related physician visit during the year than insured children with uninsured parents.

Missed hospital appointments is a globally acknowledged problem. In order to minimize the cost associated with this, attempts have been made to predict what appointments will be missed using statistical models and machine learning. However, in all previous models, information about a patient’s previous appointments has been ignored to some extent. In this thesis, a novel way of incorporating previous appointment data in more detail is proposed. This is done by firstly estimating a prior attendance probability based on general data using an artificial neural network, and then updating it using Bayesian inference. In the updating process, the information about a patient’s previous appointments is used in order to capture eventual unique patterns and behavior. This is done by weighting the outcome of the past appointments according to how similar those appointments are to the appointment that is to be predicted. Additionally, different ways of measuring the uncertainty of predictions are evaluated. The results show that weighting the outcome of previous appointments differently improves the performance of the predictions, which indicates that the proposed model manages to capture patients’ individual patterns. This improvement is apparent regardless of what model used to estimate the prior attendance probability. Furthermore, the uncertainty measurements correlated well with incorrect predictions, suggesting that they can be used to determine the reliability of a prediction.

Denna studie behandlar fenomenet destinationsaktivitet på sociala medier genom en fallstudie av Visit Swedens Instagramkonto under COVID-19. Studien syftar till att undersöka hur kommunikationen mellan en destinationsorganisation och användare på Instagram sker under kris. Syftet besvaras genom en netnografisk metod där empiri samlas in via kommentarsfältet på Visit Swedens Instagramkonto. Resultatet som presenteras är att Visit Swedens krishantering på sociala medier frångår traditionella teorier gällande kriskommunikation. Organisationen har valt att ignorera användar-kommentarer kopplade till COVID-19. Istället fokuserar Visit Sweden på ett personligt relationsbyggande med Instagramanvändare, vilket under studiens gång ses ge positiva resultat. Visit Sweden arbetar även med att leverera en bild av Sverige som användare kommenterar positivt på Instagram. Slutsatsen är att den kommunikation som sker på Visit Swedens Instagramkonto är gynnsam för Sverige som destination. Sverige står därmed konkurrenskraftigt gentemot andra turistdestinationer som inte arbetat med liknande profil- och relationsbygge på sociala medier. Studien är högst relevant då den behandlar ett ämne som ännu inte utforskats. Vidare bjuder studien in till framtida forskning inom ämnesfältet.

BACKGROUND AND OBJECTIVES: Interprofessional education (IPE) is recommended by many as a means by which to prepare clinicians for collaborative practice and a mechanism by which to improve the overall quality of health care. The objective of this study was to determine the impact of an interprofessional medicine-pharmacy student home visit experience on students’ self-assessments of skills and abilities related to team-based care and identification of medication-related problems. METHODS: Third-year medical and fourth-year pharmacy students completed an interprofessional home visit centered on identification of medication-related problems. Students were surveyed before and after the IPE assignment to assess changes in self-assessed skills and abilities. Survey items consisted of Likert-type statements on a 5-point scale (1=strongly disagree, 5=strongly agree) and free-text responses. Students also completed reflection papers regarding their experiences. RESULTS: Twenty-two medical and 20 pharmacy students conducted medication-focused interviews of 22 patients at home as interprofessional teams. Medical and pharmacy student self-assessments of skills and abilities related to team-based care and identification of medication-related problems improved after completion of the assignment. Both groups of students perceived an improvement in confidence regarding communication skills, both with patients and with other health professions students. Changes were reported on 12 survey items. Student feedback on the IPE experience was positive. CONCLUSIONS: Students’ self-perception of skills and abilities related to interprofessional team-based care and identification of medication-related problems are improved after IPE medication-focused home visit assignment. Student feedback supports the value of interprofessional patient care clinical experiences.