Dissertations / Theses on the topic 'Carte sante'

Les cartes à microprocesseur ont une faible capacité de stockage et sont généralement conçues pour le support de dossiers portables simples contenant peu d'information. Cette contrainte restreint leurs domaines applicatifs et rend hors de portée la mise en oeuvre de dossiers portables complexes comportant généralement une masse informationnelle importante. Dans cette étude, nous nous proposons d'élaborer des moyens logiciels qui permettront à la carte à microprocesseur de mettre en oeuvre des dossiers portables complexes. L'étude est divisée en cinq chapitres. Nous introduisons d'abord la technologie des cartes à microprocesseur. Nous définissons ensuite les problématiques associées à leur application dans le monde médical qui reflète bien le nature des dossiers portables complexes. Nous posons ensuite notre hypothèse de travail en préconisant que le concept de carte index intégrant la notion de génération de mémoire virtuelle pour la carte à microprocesseur est une solution pour résoudre la saturation de leur mémoire. L'ensemble de nos travaux permet ensuite d'expliquer la notion de dossiers portables complexes, d'élaborer le concept de carte index et de définir les composantes systématiques d'une telle approche. Nous proposons ensuite différentes mises en oeuvre de la technologie du point de vue du système d'exploitation. Nous verrons alors que l'utilisation du mode virtuel peut s'étendre au-delà des fonctionnalités mémoire de la carte. Nous présentons finalement une organisation conceptuelle de la carte index et nous terminons notre étude en présentant deux prototypes qui viennent appuyer la faisabilité technique de nos travaux
Smart Cards have little storage capacity and are generally made to support simple portable records that contain few information. This constraint restricts domain applications and do not provide a way to implement complex portable records that have generally huge amount of data. In this study, we propose to provide new software functionalities for smart card to enable implementation of complex portable records. The study is divided in five chapters. We first introduce smart card technology. After, we define problematic associated with smart card application in medical domain that is a real case of complex portable record. Then, we advance the hypothesis that index card technology integrating virtual memory system is a way to resolve smart card memory saturation. We after explain the notion of complex portable records, present the detail of index card technology and define systemic components of a such approach. We after propose different implementations of the index card technology in regard to operating system architecture. We will see that virtual mode operation can be apply more than memory functionality. Finally, we present a conceptual organization of index card and we terminate the study with the presentation of two software prototypes that prove technical feasibility of the concept

La loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de soins donne une définition unique des réseaux de santé. Ils représentent aujourd’hui une forme organisationnelle inscrite dans les politiques régionales de santé et sont soutenus financièrement par les agences régionales de santé (ARS). La recherche menée a pour objet la participation des personnes malades au fonctionnement et à l’activité d’un réseau de santé. En effet, si les textes législatifs consacrent la place de l’usager dans le système de soins et si la politique de santé proclame sa participation, qu’en est-il dans la réalité quotidienne des pratiques au sein d’un réseau de santé ? Cette recherche s’intéresse ainsi de manière plus spécifique aux interactions entre les professionnels et les usagers en envisageant le réseau comme un espace de coopération. L’étude comparative de deux réseaux de santé diabète montre comment – face à une double contrainte, celles des politiques de santé et celle d’une régulation économique dominante - ce dispositif est soumis à une logique gestionnaire le conduisant à devenir une réponse instrumentale aux dysfonctionnements du système de santé, tel que les cloisonnements multiples du système de santé, une pénurie démographique de professionnels médicaux ou encore une spécialisation technique croissante des activités en santé. Mais en même temps, ces réseaux constituent un espace expérimental propice à la mise en œuvre d’une pratique communautaire en santé. Le corpus de données a été constitué principalement à partir de 31 entretiens biographiques auprès des personnes diabétiques, d'entretiens thématiques auprès des professionnels salariés des réseaux et d’observations des pratiques d’éducation thérapeutique, une prestation de service proposée par les réseaux. Cette prestation de service interroge les modalités possibles d’un travail ensemble dans la gestion d’une maladie chronique entre les professionnels et les personnes malades. En fonction des conceptions en santé des professionnels et des logiques d’action en présence, l’étude montre deux tendances : une personne malade partenaire des soins et un patient auxiliaire de soins. Par ailleurs, les réseaux étudiés présentent des modalités organisationnelles différentes, un modèle linéaire et un modèle satellitaire où la coordination d’acteurs occupe une place majeure. Derrière ce terme de coordination se cache, dans les deux cas, un principe de rationalisation des activités en santé propre au système sanitaire actuel. Les réseaux sont ainsi soumis à une instrumentalisation économique, ils deviennent des prestataires de l’offre de soins sur un territoire. Cette instrumentalisation des réseaux de santé est mise en œuvre principalement par des procédures d’évaluation. Celles-ci s’appuient sur des données épidémiologiques et reposent sur une approche quantitative de résultats en santé. Dans une logique gestionnaire, la personne malade doit adopter des comportements conformes aux normes de santé pour permettre l’atteinte des objectifs organisationnels planifiés dans le cadre d’une politique de santé publique. Face au développement des maladies chroniques, le champ de la santé s’est modifié, mais le système de santé français reste organisé selon une logique biomédicale. L’évaluation prend appui sur des savoirs normatifs, et les pratiques des professionnels sont très imprégnées par cette logique biomédicale. Néanmoins, l’étude montre que les réseaux créent un espace propice à une pratique communautaire en santé par la création d’une proximité sociale. Les deux réseaux mettent en perspective une appropriation par les usagers des questions concernant leur santé. Une mise en mouvement des patients et des professionnels s’opère en marge des objectifs opérationnels affichés d’un réseau de santé. Ainsi, les réseaux constituent tout à la fois des espaces démocratiques réflexifs et un outil au service d’un processus de rentabilisation des activités en santé
The law of March 4th 2002 concerning patients' rights and the quality of the care system formalizes health networks and provides a single definition. They now account for an organizational form registered in regional politics of public health and are financially supported by the regional health agencies (RHA). The conducted research is about the sick's participation in a health network operation and activity. Indeed, if the legislation grants the user a thorough place in the health care system and if health policy proclaims his participation, what happens in the daily reality of practices within a health network? So this research deals more specifically with the interactions between professionals and users by considering the network as an area of cooperation. The comparative study of two Burgundy diabetes health networks shows how - facing a double constraint, those of public health policies and that of a dominant economic regulation - this device is subject to a managing logic leading to become an instrumental response to health system dysfunctions, such as multiple barriers of the health system, a demographic shortage of health professionals or even an increasing medical specialization of health activities. But even these networks constitute an experimental space favorable to the implementation of a community health practice.The data base has mainly been formed from 31 biographical interviews of diabetic people, thematic interviews of professionals employed in networks and observations of the patient's therapeutic education practices, a service offered by the two networks. This service examines the possible ways of working together in the management of chronic illness between professionals and the sick. According to the conceptions of health among professionals and logic of action involved, the study shows two trends: a sick person, either partner in patient care or in care giving.Moreover, the studied networks present two different organizational terms, a linear model and a satellite model where the coordination of actors plays a major role. Behind this term of coordination lies, in both cases, a principle of rationalization of health activities specific to the current health system. Networks are thus subject to an economic exploitation; they become providers of the offer of health care in a given territory. This instrumentation of health networks is mainly implemented by assessment procedures. It relies on epidemiological data and is based on a quantitative approach about health outcomes. In a managerial logic, the sick person should behave in accordance with health standards to enable the achievement of organizational goals planned as part of a public health policy.With the development of chronic diseases, the field of health has changed, but the French health system is still organized on a biomedical logic. The evaluation is based on normative biomedical knowledge, and professional practices are also very much imbued with biomedical logic. Nevertheless, the study shows that networks create a favorable space for a community health practice by creating a social proximity. Both networks put into perspective the idea that users have a hold on questions concerning their health. Patients and professionals become actors besides operational objectives displayed in a health network. Thus, networks are simultaneously democratic spaces of thought and a tool dedicated to the efficiency of health activities

Le monde dépense une part significative et en augmentation constante de ses ressources sur les soins de santé. Les débats sur les modèles de financement des soins de santé et sur les méthodes de paiement des praticiens se déroulent dans le monde. Néanmoins, il n’existe toujours pas de consensus sur le choix idéal des mécanismes de financement. Cette thèse vise à contribuer aux débats sur le financement des soins de santé et sur la politique des services de santé. Le chapitre premier examine la règle de compensation non-linéaire optimale des praticiens, le principe selon le paiement à la performance, le paiement à l’acte et la capitation en présence à la fois l’antisélection et l’aléa moral au niveau de l’offre. Nous avons trouvé que lorsque l’aléa moral est le seul problème, le paiement à l’acte ne peut que conduire à la substitution de la quantité de traitement par rapport à l’effort du praticien, ce qui est inefficace. En conséquence, le paiement à l’acte ne devrait être utilisé dans ce cas. Toutefois, lorsque l’aléa moral se combine au problème de l’antisélection, un screening efficace requiert une utilisation continue du système de paiement à l’acte pour les praticiens à faible productivité et un moindre recours au système du paiement à la performance. L’élaboration de l’utilisation du paiement améliore le screening. Nous apportons des arguments sur l’analyse critique des points faibles du paiement à l’acte. Et, plus important encore, nous établissons les raisons de l’utilisation continue du paiement à l’acte malgré le fait que de sérieux problèmes concernant ce système aient été largement reconnus. Le chapitre deux analyse le problème du contrat trilatéral entre le payeur, le patient et le praticien, lorsque le praticien et le patient peuvent s’entendre pour exploiter des opportunités avantageuses à l’un et à l’autre. En prenant pour hypothèse qu’un transfert secondaire entre le patient et le praticien est exclu, nous analysons le problème de la mise en place du mécanisme où le praticien et le patient soumettent la réclamation du diagnostic au payeur par un jeu de déclaration. Nous en déduisons aussi le schéma optimal de l’assurance et du paiement pour le patient et le praticien. Le schéma optimal de l’assurance et du paiement qui est collusion-proof (faible) est tel que l’un des deux dise la vérité ; mais l’arbitrage du payeur est différent selon les différentes manières qu’il choisit pour répartir les incitations entre le patient et le praticien. De plus, nous montrons que si le payeur parvient à demander aux deux parties de présenter le diagnostic de manière séquentielle, l’avantage du pouvoir de veto du second agent permet au payeur de réaliser le meilleur résultat. Mon domaine d’étude secondaire traite de l’économie du développement. Le troisième chapitre a pour but d’examiner si la migration des villages vers les villes entraîne une éviction des contrats informels de partage de risque et conduit des ménages à une moindre (auto-)assurance de consommation des villages Thai. Pour ce qui concerne la motivation théorique, notre idée est que la migration peut être utilisée comme un contrat d’investissement réalisé à l’avance entre le ménage et l’enfant. Le ménage investit en payant d’avance en échange de versements futurs dépendants des circonstances, ce qui change le processus de revenus du ménage. Pour l’estimation, nous avons utilisé le tableau de Townsend Thai Annual Surveys (1997-2010). L’hypothèse d’aucun biais de sélection est rejetée au niveau du marché de l’assurance du village, ce qui conforte notre conjecture selon laquelle la migration change le statut de partage des risques des ménages à l’intérieur du village. Lorsque les biais sont corrigés, nos résultats montrent que la migration entraîne une éviction du partage des risques informels dans le village et conduit même à une diminution de l’(auto)assurance de consommation des ménages Thai
The world spends a significant and increasing share of its resources on health care. The debates on the models of health care financing and the methods of payment for the physician continue all over the world. Nevertheless, there is still no consensus on the ideal choice of financing mechanisms. This thesis aims at contributing to the debates on the health care financing and health service policy. Chapter one examines the optimal non-linear compensation rule of physicians under pay-for-performance, fee-for-service and capitation in the presence of both adverse selection and moral hazard on the supply side. We found that when moral hazard is the only problem, fee-for-service can only lead to the substitution of treatment quantity to physician’s effort, which is inefficient. Consequently, fee-for-service payments should not be used in this case. However, when moral hazard is combined with the adverse selection issue, an efficient screening requires a continued use of fee-for-service for the lower productivity physicians and less pay-for-performance. The design of the use of fee-for-service effectively improves screening. We provide an argument for the criticism on the shortcomings of fee-for-service. More importantly, we also provide a rationale for the continued use of fee-for-service payment even though the serious problems with fee-for-service have been widely acknowledged. Chapter two analyzes the three-party contracting problem among the payer, the patient and the physician when the patient and the physician may collude to exploit mutually beneficial opportunities. Under the hypothesis that side transfer is ruled out, we analyze the mechanism design problem when the physician and the patient submit the claim to the payer through a reporting game. We also derive the optimal insurance payment scheme for the patient and the physician. The insurance payment scheme which is (weak) collusion-proof is such that it is sufficient that one of them tells the truth ; but the payer’s trade-offs are different when he chooses different manners of splitting incentives between the patient and the physician. Moreover, we show that if the payer is able to ask the two parties to report the diagnosis sequentially, the advantage of the veto power of the second agent allows the payer to achieve the first best outcome. My secondary field is Development Economics. The third chapter examines whether migration crowds out informal risk-sharing contracts and leads to less consumption insurance for households in Thai villages. For the theoretical motivation, our idea is that migration may be used as a cash-in-advance contract between the household and the child. The household invests upfront in exchange for future state-contingent remittance which changes the income process of the household. For the estimation, We use the panel from Townsend Thai Annual Surveys (1997-2010). The hypothesis of no selection bias is rejected at within village insurance market level, which supports our conjecture that migration changes the risk-sharing status of households within village. After the bias are corrected, our results show that migration crowds out informal risk-sharing within village and even leads to less consumption insurance for households in Thai villages

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas. Programa de Pós-graduação em Geografia
Made available in DSpace on 2012-10-24T02:51:35Z (GMT). No. of bitstreams: 1 259514.pdf: 4773812 bytes, checksum: 4bee9d97aff489064d63140652224942 (MD5)
Neste estudo, discute-se o processo de formação e representação do atual espaço agroindustrial de carnes de aves e suínos em SC, bem como suas principais características socioespaciais, tendo em vista o processo de ormação histórica, econômica, social e tecnológica. Nesse processo, as relações sociais estiveram permeadas pela presença de agentes hegemônicos que se beneficiaram com as condições gerais de produção implantadas em grande medida pelo Estado. Na divisão espacial da produção econômica brasileira, a Mesorregião Oeste de Santa Catarina constitui-se importante produtora de carnes de suínos e aves tendo por base a agricultura familiar e a produção integrada às grandes empresas agroindustriais. Essa produção teve origem já no início processo de colonização, entre as décadas de 1920 e 1940, quando os colonos criavam suínos para produzir banha. A criação desses animais era realizada à medida que a família também produzia produtos de origem vegetal, permitindo assim a diversificação na propriedade de forma autônoma. Com a integração, especialmente após a década de 1960, a relação dos produtores com as agroindústrias passou a ser marcada pela subordinação dos primeiros em relação a essas empresas. Os empresários agroindustriais tornam-se parte dos principais agentes hegemônicos regionais, inclusive na atualidade. No entanto, ao longo de todo o processo de formação da região agroindustrial, diferentes agentes contribuem para tornar desigual o espaço em questão, sendo os ervateiros, os madeireiros, os colonizadores, comerciantes e o Estado os principais agentes hegemônicos a conduzir essa formação. O Estado, por sua vez, teve participação efetivada pela viabilização de parte das condições gerais de produção # de uso coletivo # necessárias para que o capital se reproduzisse na região e fizesse desta a estrutura básica e também sua alavanca para, junto com os avanços tecnológicos do setor produtivo, conquistar o mercado nacional e externo com produtos a partir da suinocultura e da avicultura. Dans cette étude, il se discute le processus de formation et la représentation de l'actuel espace agro-industriel de viandes de volailles et de porcs dans Santa Catarina, ainsi que leurs principales caractéristiques socioespaciais, en vue du processus de formation historique, économique, sociale et technologique. Dans ce processus, les relations sociales ont été des permeadas par la présence d'agents hégémoniques qui se sont bénéficiés avec les conditions générales de production implantées dan économique brésilienne, à Mesorregião Ouest de Santa Catarina se constitue important producteur de viandes de porcs et de volailles en ayant par base l'agriculture familière et la production intégrée aux grandes sociétés agro-industrielles. Cette production a eu origine déjà dans le début processus de colonisation, entre les décennies de 1920 et 1940, quand les colons créaient des porcs pour produire baignent. La création de ces animaux était réalisée au fur et à mesure que la famille aussi produisait des produits d'origine végétale, en permettant ainsi la diversification dans la propriété de forme indépendante. Avec l'intégration, spécialement après la décennie de 1960, la relation des producteurs avec les agro-industries a passé à être marqué par la subordination de premiers concernant ces sociétés. Les entrepreneurs agro-industriels se rendent partie des principaux agents hégémoniques régionaux, de même dans l'actualité. Néanmoins, au long de tout le processus de formation de la région agro-industrielle, de différents agents contribuent pour rendre différent l'espace concerné, en étant les herbièrs, les marchands de bois, les colonisateurs, opérateurs et l'État les principaux agents hégémoniques à conduire cette formation. L'État, à son tour, a eu participation accomplie par la viabilisation de partie des conditions générales de production - d'utilisation collective - nécessaires pour que le capital se reproduise dans la région et faisait de la cette la structure basique et aussi son levier pour, conjointement les avances technologiques du secteur productif, conquérir le marché national et externe avec des produits à partir de la élevage de porcs et de l'aviculture.

SOUZA, Daniel de Araújo. Características bioeconômicas de cordeiros Santa Inês e mestiços Dorper×Santa Inês no modelo precoce de produção. 2015. 123 f. Tese (doutorado em zootecnia)- Universidade Federal do Ceará, Fortaleza-CE, 2015.
Submitted by Elineudson Ribeiro (elineudsonr@gmail.com) on 2016-04-07T17:41:36Z No. of bitstreams: 1 2016_tese_dasouza.pdf: 1263945 bytes, checksum: e1a93153895a6a68288e0c37fc67a148 (MD5)
Approved for entry into archive by José Jairo Viana de Sousa (jairo@ufc.br) on 2016-05-24T23:50:54Z (GMT) No. of bitstreams: 1 2016_tese_dasouza.pdf: 1263945 bytes, checksum: e1a93153895a6a68288e0c37fc67a148 (MD5)
Made available in DSpace on 2016-05-24T23:50:54Z (GMT). No. of bitstreams: 1 2016_tese_dasouza.pdf: 1263945 bytes, checksum: e1a93153895a6a68288e0c37fc67a148 (MD5) Previous issue date: 2015
The experiment was conducted to evaluate the bioeconomic performance and the carcass and meat traits of Santa Inês and Dorper×Santa Inês lambs under the early biological model as to evaluate the correlations between traits obtained in vivo, in the carcass and in the meat. A total of twenty-four lambs were used in this trial under a fully randomized design. The lambs were housed and creep fed until weaning at 62 days of age. After weaning, they were sent to a feedlot for finishing with a high energetic diet until slaughter, which occurred when they reached 3 mm of subcutaneous fat thickness. From data of performance of 24 lambs was projected a feedlot for finishing of weaned lambs with static capacity for 100 animals by finishing cycle. The Dorper crossbreed lambs exhibited a higher daily gain (223.8 g/day) than the Santa Inês pure lambs (168.1 g/day) and also were faster in reaching the slaughter fat thickness (132 days). Significant differences were observed between the crosses and Santa Inês lambs for the carcass weight, rib eye area, carcass and leg compactness indexes, weight and dressing of commercial cuts and muscle:bone ration. The chest width and body compactness index obtained in vivo and muscle depth and rib eye area obtained by real time ultrasound present significant (P<0.001) and positive (0.72 ≤ r ≤ 0.94) association with primary carcass traits as rib eye area, conformation and carcass compactness index. There was moderate correlation (P<0.01) between body condition score and the fatness (r=0.54) of carcass and the intramuscular fat (r=0.56) of meat. The economic analysis showed positive results, profitability of 22.1% and the lower costs for the ¾ Dorper×Santa Inês feedlot. The compounds with highest influence on production costs of the feedlot were the purchase of weaned lambs and the feeding. According to the results obtained and under the described experimental conditions, it may be concluded that at the same maturity level, the growth performance, the age at slaughter and the main carcass characteristics were improved by crossbreeding of Santa Inês ewes with Dorper rams, making possible the use of local sheep breeds to meet efficiently the needs of domestic market. The real time ultrasound proved to be an efficient method to estimate the muscularity (r=0.78), rib eye area (r=0.72) and subcutaneous fat thickness (r=0.56) of the lambs. The finishing at feedlot is economically viable with lambs of greater biological potential for weight gain and for use of feeds, being the growth rate, feed conversion and finishing precocity the variables that have significant impact on the economic and productive efficiency of feedlot.
A presente pesquisa teve como objetivo avaliar o desempenho bioeconômico e as características de carcaça e de carne de cordeiros Santa Inês e mestiços Dorper×Santa Inês sob o modelo precoce de produção, assim como, estabelecer correlações entre características in vivo, na carcaça e na carne. Foram utilizados 24 cordeiros (Santa Inês, ½ Dorper×Santa Inês e ¾ Dorper×Santa Inês) sob um delineamento inteiramente casualizado. Na fase de cria, os cordeiros foram mantidos confinados sob sistema de creep feeding com amamentação noturna, a partir da 3a semana após o nascimento até a desmama aos 62 dias de idade, quando seguiram para a fase de terminação em confinamento com dieta de alto concentrado. A terminação foi concluída quando os cordeiros alcançaram 3 mm de espessura de gordura subcutânea para cada grupo genético, a qual foi monitorada e mensurada por meio de ultrassonografia. A partir dos dados de desempenho dos 24 cordeiros projetou-se um confinamento para terminação de cordeiros desmamados com capacidade estática de 100 animais por ciclo de terminação. Os mestiços Dorper exibiram um maior ganho médio diário (223,8 g/dia) em relação aos cordeiros Santa Inês (168,1 g/dia) e também foram mais precoces em alcançar o nível de acabamento determinado para o abate (132 dias). Observou-se diferenças significativas entre as cruzas e os cordeiros Santa Inês para peso de carcaça, área de olho de lombo, índices de compacidade de carcaça e de perna, peso e rendimento de cortes comerciais e relação músculo:osso. Dentre as medidas tomadas in vivo, a largura de peito, o índice de compacidade corporal, a medida B e a área de olho de lombo via ultrassom apresentaram associação significativa (P<0,001) e positiva (0,72 ≤ r ≤ 0,94) com as características de carcaça vinculadas ao peso dos cortes comerciais e ao rendimento muscular, como a área de olho de lombo, conformação e índice de compacidade de carcaça. O escore de condição corporal se correlacionou (P<0,01) com o acabamento (r=0,54) da carcaça e com o nível de gordura intramuscular (r=0,56) da carne. A análise econômica mostrou resultados positivos, rentabilidade de 22,1% e os menores custos para o confinamento com cordeiros ¾ Dorper×Santa Inês. Os componentes de maior influência sobre os custos de produção no confinamento foram a compra de cordeiros desmamados e a alimentação. Conforme os resultados obtidos e sob as condições experimentais descritas, conclui-se que, ao mesmo nível de maturidade, o crescimento, a idade de abate e as principais características de carcaça foram melhorados pelo cruzamento de ovelhas Santa Inês com carneiros Dorper, tornando possível o uso de raças nativas para atender eficientemente as exigências do mercado doméstico de carne ovina. A ultrassonografia se mostrou uma técnica eficiente para se estimar o nível de musculosidade (r=0,78), a área de olho de lombo (r=0,72) e a espessura de gordura subcutânea (r=0,56) em animais vivos. A terminação em confinamento constitui uma prática economicamente viável com cordeiros de maior potencial biológico para ganho de peso e para utilização dos alimentos, sendo a taxa de crescimento, a conversão alimentar e a precocidade de terminação as variáveis que possuem impacto significativo sobre a eficiência produtiva e econômica do confinamento.

Cette thèse examine différents aspects du financement de la santé et ses effets sur l'accumulation de variables stratégiques pour le développement. Le deuxième chapitre analyse les effets des risques de maladie sur l'éducation des enfants en utilisant un model théorique et empirique qui lie les risques (pour les parents) de tomber malade et le choix de l'éducation. Nous trouvons que, s'il est impossible pour les parents de demander plus d'argent en cas de maladie, une augmentation de la probabilité de tomber malade implique une réduction de l'éducation des enfants. Le chapitre trois étudie empiriquement l'effet de l'assurance maladie sur l’enfant en employons la méthode de scores de propension pour analyser l'effet moyen du traitement (chef de ménage ayant une assurance santé ou non) sur les traités. Nous trouvons que l'assurance maladie favorise l'éducation des enfants. Le chapitre quatre étudie, en utilisant le modèle de générations imbriquées, les effets du financement de la santé sur la croissance économique. Le gouvernement a deux possibilité: soit de co-financer la santé, soit la financer tout seul en utilisant une taxe sur la production. Nous trouvons que, s'il y a hétérogénéité des préférences des agents, le financement public domine le co-financement public-privé. Le dernier chapitre étudie les effets d’épidémies sur la pauvreté, dans un modèle de générations imbriquées continu. Nous trouvons que l'investissement dans les variables qui réduisent la transmission de la maladie est nécessaire pour pousser d'un état stationnaire avec faible consommation/niveau d'actifs vers un état stationnaire avec un mixe consommation-niveau d'actifs plus élevé
This thesis explores different aspects of the financing of health care and how it affects various facets of the economy. Chapter two we studies the relationships between health risks and education using both a theoretical and an empirical model. We find that considering a child's income as an insurance asset can reverse the usual negative relationship between disease prevalence and educational investment. Chapter three empirically looks at the impact of health insurance on the child using the propensity score matching technique. We find that while the health insurance status of the household has a positive effect on the enrolment of children, its effect on child work is negative. In chapter four we analyse the impact of health care financing on economic growth, focusing on the issue of joint public-private financing of health care using an overlapping-generations model with endogenous growth based on health human capital accumulation, where families pay for childhood preventive care and the government can either fully finance or co-finance adulthood curative care. From a growth maximising perspective, if agents are assumed have heterogeneous preferences, full public financing can become the best option. Finally in chapter five we study how health shocks in the form of epidemics affects the economy in a continuous OLG model by focusing on how the economy could be pushed to a higher consumption-assets combination. We find that it is necessary for the government to invest more in the reduction of transmission rates if its goal is to eradicate the disease from the economy, achieving a higher consumption-assets mix

Les difficultés que rencontre la Côte d'Ivoire pour la mise en place d'une carte sanitaire résultent du dysfonctionnement de son système de santé. La centralisation de l'administration sanitaire limite les compétences des services extérieurs du ministère de la santé et de ceux de l'État dans la gestion des infrastructures sanitaires dont ils ont la charge dans les régions ; la politique de création de l'ensemble de celles-ci laisse à chaque secteur de soin (secteur public et secteur privé) la liberté de mettre en œuvre sa propre politique de création de ses infrastructures sanitaires sans se soucier de la notion de service public hospitalier. Malgré les améliorations apportées au secteur de la santé ces dernières années, la politique sanitaire actuelle freine toute possibilité de régulation du système de santé. Elle a pour conséquences la baisse de la consommation médicale de la population et la disparité régionale des équipements sanitaires. Les solutions envisagées pour une répartition rationnelle de l'offre de soins suggèrent une adéquation entre l'offre de soin et les besoins sanitaires au niveau de chaque secteur sanitaire et soumettent la création de l'ensemble des infrastructures sanitaires à une législation hospitalière unique opposable aux deux secteurs de soins pour mieux contrôler et encadrer leur répartition
The difficulties experienced by Ivory Coast in the setting up of a healthcare map are a result of the malfunctioning of the country's health service, due to the centralisation of healthcare administration which restricts competent intervention from services outside the Ministry of Health and those of the State in the running of healthcare infrastructures for which they are responsible in the regions. Each healthcare sector, whether public or private, is free to set up its own infrastructures without taking into account the notion of public service in the hospital domain. In spite of improvements in recent years in the health sector, present-day healthcare policies prevent any hope of regulating the healthcare system, with the result that the population's access to care is falling and healthcare facilities vary from region to region. Proposed solutions for a rational sharing of healthcare take into account local needs within each sector and require that the creation of healthcare infrastructures as a whole be under the legislation of a central hospital system so that both sectors may be more efficiently controlled and more rationally shared out

AbstractThis study offers an investigation into the history and practice of a teletriage nursing service, Info-Santé. An overview of the Info-Santé service's historical evolution amid cut-backs to the Quebec health care system in the early-to-mid 1990s, with resulting structural changes to health care delivery situates the study within the wider social and political context. The division of labour within the health care system and the place of the Info-Santé nursing service within the health care network are also discussed with a resulting inquiry into an ‘ideal type,' that of ‘Real Nurse.' Two focus groups and in-depth open-ended interviews were conducted with a purposive sample of twenty nurses working in an Info-Santé call center in Sherbrooke, Quebec. In addition, participant observation took place over a period of several months at the same site. Foucault's notion of the clinical gaze is transformed in the absence of a physical ‘patient' in this exploratory case study. Results reveal that these nurses have developed a number of key strategies aimed at ‘hearing' the caller's health problem. In particular, various qualities of the voice as well as the ambient sounds available through the telephone are critical components in the nurses' constructions of the callers and their problems, resulting in the creation of a ‘disembodied' clinical gaze.
RésuméCette étude constitue une exploration de l'histoire et de la pratique d'un service infirmier de télétriage, Info-Santé. Un aperçu de l'évolution historique du service Info-Santé à la suite des coupures faites dans le système de soins de santé québécois vient situer l'étude dans les contextes social et politique élargis. Ce regard porte sur la période des coupures qui s'étend du début au milieu des années 1990; il prend en considération les changements structuraux qui en ont découlé sur le plan de la prestation des soins de santé. Il est aussi question de la division du travail dans le système des soins de santé et du rôle du service infirmier Info-Santé dans le cadre du réseau de soins. De cette discussion naît une réflexion sur le concept du « type idéal », c'est-à-dire de la « vraie infirmière ». Deux groupes de discussion et des entrevues ouvertes et approfondies ont été réalisés. L'étude portait sur un échantillon au jugé comportant vingt infirmières travaillant dans un centre d'appel Info-Santé de Sherbrooke, au Québec. De plus, l'observation participante s'est déroulée dans un même site sur une période de plusieurs mois. Dans cette étude de cas exploratoire, la notion de regard clinique définie par Foucault se transforme en l'absence d'un « patient physique ». Les résultats révèlent que ces infirmiers et infirmières ont développé nombre de stratégies clés visant à être « à l'écoute » du problème de santé de l'appelant. En particulier, les diverses qualités de la voix et les bruits ambiants audibles par l'entremise du téléphone sont des éléments essentiels permettant au personnel infirmier de se représenter les appelants et leur problème. Il en résulte la création d'un regard clinique « désincarné ».

This master thesis is focused on marketing of Santé, the private clinic. The first part is theoretical and has two main chapters. Marketing in the field of health care is the first chapter, including the differences between health care marketing and marketing in other fields and other characteristics of the medical system. Next a product is defined, in health care it is the provided service. Marketing mix is described not as 4P but as 4C. Then there is the practical point of view on the health care system. Very important is the patients' satisfaction, which is measured by many different surveys, such as the best hospital, or quality perceived by the patients. The other chapter discusses used methods, defines marketing research and the S-T-P strategy. The practical part of thesis introduces the company Santé followed by the description of their clientele, which is differentiated as individual and companies' clientele. Marketing mix of the company consists of the 4 components already mentioned higher. Next is the SWOT analysis. Analysis of the competition focused on the main competitors of Santé. Very significant moment is the research project created to suit the needs of this thesis only. A complex questionnaire researching the privet clinic market as a whole was prepared. Analysis of the data was complex as well. Open questions were analyzed separately, closed questions were processed with the help of SPPS computer program. By the end of the thesis there are some recommendations for the company that originate in the research project and also from the confrontation of the theory and practice. Last is the conclusion, bibliography and the annex, where you can find already mentioned questionnaire.

Made available in DSpace on 2014-06-11T19:33:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-14Bitstream added on 2014-06-13T19:23:35Z : No. of bitstreams: 1 moreno_gmb_dr_jabo.pdf: 487010 bytes, checksum: cda1d96d2a28d4346f707282fb91af36 (MD5)
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Os objetivos deste trabalho foram avaliar o desempenho, consumo e digestibilidade de nutrientes e a qualidade da carne de cordeiros Santa Inês alimentados com 30, 40, 50 e 60% de feno de erva-sal associado a concentrado. Utilizou-se 32 cordeiros castrados, com 8 meses de idade e peso inicial de 22 + 1,97 kg, confinados individualmente e abatidos após 60 dias de confinamento. Houve redução linear no consumo de matéria seca e ganho de peso à medida que o nível de feno de erva-sal aumentou na dieta. O consumo dos nutrientes digestíveis diminuiu com o aumento de feno, exceto de proteína bruta (120,09 g/dia), fibras em detergente neutro (242,85 g/dia) e ácido (90,80 g/dia), assim como a digestibilidade dos nutrientes, com exceção dos carboidratos não fibrosos (84,94%). Houve redução do nitrogênio excretado na urina e aumento dos nitrogênios absorvido e retido com a inclusão do feno na dieta. Os pesos de carcaça quente e fria decresceram linearmente com o aumento de feno de erva-sal na dieta, entretanto, não houve efeito para o rendimento verdadeiro de carcaça e dos cortes: paleta (19,26%), pescoço (8,52%), costelas (26,57%) e perna (33,88%). Houve efeito linear decrescente para área de olho de lombo e espessura de gordura à medida que o nível de feno na dieta aumentou. O pH final (5,46), cor (39,47 para L; 18,16 para a* e 5,55 para b*) e os teores de umidade (74,50%), proteína (21,15%) e colesterol da carne (36,76mg/100g) não diferiram entre os tratamentos. O percentual de minerais aumentou e o de gordura da carne diminuiu e a carne tornou-se mais dura com a inclusão de feno de erva-sal, entretanto, os provadores não detectaram diferença na análise sensorial, mas observaram maior intensidade de sabor de cordeiro na carne dos animais que receberam menos feno na...
The aims of this study were to evaluate the performance, nutrients intake and digestibility and the meat quality of Santa Inês lambs fed with 30, 40, 50 or 60% of oldman saltbush hay with concentrated. Were used 32 castrated lambs, with 8 month old and initial weight of 22 + 1.97 kg, housed individually and slaughtered after 60 days of feedlot. There was a linear reduction in dry matter intake and daily weight gain as the level of saltbush hay increased in the diet. The intake of all digestible nutrients decreased with the hay inclusion, except for crude protein intake (120.09 g/day), neuter detergent fiber (242.85 g/day) and acid detergent fiber intake (90.80 g/day), as well as nutrients digestibility, except for non-fibrous carbohydrates (84.94%). There was a reduction on nitrogen excreted in urine and increase nitrogen absorbed and retained with the inclusion of hay in the diet. The weights of hot and cold carcass decreased linearly as was the inclusion of saltbush hay in the diet, however, there was no effect for true yields and for cuts: shoulder (19.26%), neck (8.52%) ribs (26.57%) and leg (33.88%). There was linear decreased for rib eye area and fat thickness as the level of hay in the diet increased. The final pH (5.46), color (39.47 for L; 18.16 for a* and 5.55 for b*) and the moisture content (74.50%), protein (21.15%) and cholesterol of meat (36.76 mg/100 g) did not differ between treatments. The percentage of minerals increased, intramuscular fat decreased and the meat was harder with the addition of saltbush hay, however, the panellists no detected differences in sensory analysis, but observed a more intense taste of sheep meat in lambs that received less saltbush in the diet. The inclusion of saltbush hay in the diet increased the amount of saturated and unsaturated fatty acids and reduced the 6:3 ratio. The saltbush hay should be used as a supplementary resource in areas with salinity problems of water and/or soil

A maciez é um importante atributo de qualidade para os consumidores de carne. No entanto, não há dados específicos do impacto da maciez da carne ovina de Santa Inês sobre a percepção dos consumidores brasileiros. Portanto, o objetivo foi verificar a avaliação do consumidor de carne ovina apresentando diferentes forças de cisalhamento. Foram utilizados oito cordeiros da raça Santa Inês, que receberam a mesma dieta de terminação. Estes animais tinham 5 a 6 meses de idade e pesavam de 30 a 35 kg quando foram abatidos e suas meias carcaças foram utilizadas para obtenção de 16 amostras de Longissimus dorsi (LD). Estas foram distribuídas aleatoriamente entre quatro diferentes processamentos pós-abate (PA). Os LD usados para a obtenção da Carne Endurecida (CE) foram retirados logo após o abate (0h) e as amostras para os demais tratamentos foram retiradas na desossa às 24h PA. O tratamento para CE consistia em embalar o LD e mergulhá-lo em água a 0° C por duas horas, e logo após congelá-la. Para a obtenção da Carne Fresca (CF), o LD foi retirado na desossa (24h PA), embalado e congelado. E alguns dos bifes obtidos às 24 horas foram embalados a vácuo e maturados a 1°C durante três ou sete dias, que compõem a condição de Carne Maturada (CM) pós-morte, CM3 e CM7, respectivamente. Os principais dados obtidos foram de comprimento do sarcômero (CS), força de cisalhamento (FC), índice de fragmentação miofibrilar (IFM), bem como a aceitação de maciez, suculência e qualidade global por parte de 50 consumidores não treinados, usando escala hedônica de nove pontos. O CS foi de 1,44 μm para CE, significativamente (p<0,05) mais curto que observado para CF, CM3 e CM7, que não diferiram entre si, com valores de 1,84, 1,89, 1,85 μm (SEM=0,09), respectivamente. A CE alcançou FC média de 7,2 kgf, significativamente (P<0,05) mais alta que os três valores similares de 3,3, 3,1, 2,4 (SEM=0,44) observados para CF, CM3 e CM7, respectivamente. Quanto à IFM, os processos pós-abate tiveram diferença entre CE e CM7 (p<0,05), com IFM de 76,2 e 130,5, enquanto a CF e CM3 não diferiram entre os processos com valores de 97,9; 115,6; (SEM= 11,41), respectivamente. As amostras de CE receberam pontuação significativamente mais baixa (P<0,01) para todos os quesitos avaliados na análise sensorial, sendo textura 5,43, suculência 6,51 e qualidade global 5,92, os demais tratamentos tiveram notas acima de 7 para todas as características, mas não diferiram entre si (P<0,01). Os consumidores foram capazes de perceber e avaliaram negativamente a maciez da carne de cordeiro que apresentou alta força de cisalhamento quando comparada com carnes com valores que as caracterizariam como macias. As avaliações de suculência e qualidade global acompanharam a percepção da maciez. Concluiu-se que os consumidores percebem e avaliam negativamente carne de cordeiro com alto valor de força de cisalhamento. No entanto, os dados obtidos não foram capazes de elucidar impacto de diferenças menores na força de cisalhamento entre amostras duras e macias sobre a aceitação do consumidor não treinado.
Tenderness is an important meat quality trait for consumers. However, there is no specific data in the impact of Santa Inês lamb meat tenderness on Brazilian consumers perception. Therefore, objective was to verify the consumer evaluation of lamb meat with different shear force. We used eight Santa Inês lambs that were fed the same diet. These animals of 5 to 6 months of age and weighing 30 to 35 Kg were slaughtered and their half carcasses were used to obtain 16 samples of Longissimus dorsi (LD). These were randomly assigned among four diferent post-slaughter (PS) managements. The LD used for obtaining Toughened Meat (TM) were removed immediately after slaughter (0h ps) and samples for the other managements were obtained from boning at 24h PS. The samples from TM consisted in wrapping excised LD in plastic bag and dipping it into water bath with ice at 0°C for two hours, followed by freezing. Fresh Meat (FM) was obtained from LD removed at boning (24 hours postmortem), followed by wrapping and freezing. And some of steaks obtained at 24 hours were vaccumm packaged and aged at 1 °C for three or seven days, which compose the aging (A) postmortem, A3 and A7, respectively. The sarcomere length (SL), shear force (SF), myofibrillar fragmentation index (MFI), as well as sensory analysis of tenderness, juiciness and overall quality acceptance by 50 not trained consumers using hedonic scale of nine points, were obtained. The SL was 1.44 μm for TM, significantly (P<0.05) shorter than the other treatments. The values of 1.84, 1.89, 1.85 (SEM=0,09) μm for FM, A3 and A7, respectively, didn\'t differ and are values normally reported for post-rigor lamb meat. MT reached an average 7.2 kgf for SF, significantly (P <0.05) higher than 3.3, 3.1, 2.4 (SEM= 0,44) observed for FM, A7 and A3, respectively. As for the MFI, post-slaughter processes had difference between TM and A7 (P<0.05), with IFM 76.2 and 130.5, while FM and A3 did not differ between cases with values 97.9; 115.6; (SEM = 11.41), respectively. Samples from TM received the lowest scores (P<0.01) for all items assessed in sensory analysis, and texture 5.43, juiciness 6.51 and overall quality 5.92, the other treatments were notes above 7 for all traits, but not significantly different (P<0.01). Consumers were able to understand and evaluate negatively the tenderness of lamb that showed high shear force compared to meat with values at low levels, which characterize as tender. It was concluded that consumers will perceive and evaluate negatively lamb meat with high shear force value. However, the results are not conclusive whether smaller differences between tough and tender meat would still have impact on not trained consumer acceptance.

O Carste de Lagoa Santa e a Serra do Cipó, que compõem a área da pesquisa, abrangem parte da Região Metropolitana de Belo Horizonte-RMBH, centro do estado de Minas Gerais. Possuem inúmeros sítios arqueológicos em abrigos sob rocha calcária e de quartzito, com diversos tipos de grafismos rupestres; pintados, picoteados e incisos. Boa parte desses grafismos é atribuída à Tradição Planalto, elaborada nessa região, pelo menos, a partir do Holoceno Médio. Inúmeros conjuntos estilísticos sucessórios e temáticos atribuídos a essa tradição foram identificados e reorganizados, buscando, sempre que possível, realizar analogias e correspondências entre as duas regiões componentes. Foram ainda identificadas outras unidades ou expressões gráficas não-Planalto em níveis picturais, intermediários e recentes, que, em alguns casos, indicam possíveis influências de outras regiões do país. Também foram propostas para os conjuntos de figuras picoteadas, variações estilísticas que congregam repertórios temáticos peculiares. As incisões rasas, por sua vez, apresentam dimensões e visibilidades variadas, inclusive miniaturas que não haviam sido consideradas em estudos anteriores. A observação de padrões de exploração de utilização do espaço internos dos abrigos para a execução das figuras, levando em consideração os diferentes suportes rochosos, a interação das figurações com as preexistentes, além da distribuição das expressões gráficas de alta e baixa visibilidade nos sítios e na paisagem, foram fundamentais para a proposição de panorama crono-estilístico mais detalhado, levando em consideração as alterações, diferenças e similaridades estilísticas ao longo do tempo.
The Lagoa Santa Carste and the Serra do Cipó, comprises the research area, covering part of the metropolitan region of Belo Horizonte-RMBH, center of Minas Gerais state. Numerous archaeological sites have shelters in limestone and quartzite, with various types of rock art, painted perforated and incised. Much of this artwork is attributed to the Tradição Planalto, stablished in this region, at least from the Middle Holocene. Several sets stylistic and thematic succession assigned to this tradition have been identified and rearranged, seeking, where possible make analogies and correspondences between the two regions components. Other units or non-Planalto Intermediate and recent pictorial expressions levels were identified which, in some cases, indicated possible influences of traditions from other regions of the country. Combinations of dotted figures, stylistic variations that bring unique themed repertoires have also been proposed. The shallow incisions in turn, have varying sizes and visibility, including miniatures that had not been considered in previous studies. The observation of pattern of use of the internal space of shelters for the execution of the figures, taking into account the different rock media, the interaction of figurations with the background, beyond the distribution of graphic expressions of high and low visibility sites and landscapes, were fundamental to the proposed landscape of chrono-stylistic more detailed, taking into account the changes, stylistic differences and similarities over time.

Orientador: Hirasilva Borba
Coorientador: Gherman Garcia Leal de Araújo
Coorientador: Américo Garcia da Silva Sobrinho
Banca: Flávio Dutra de Resende
Banca: Márcia Helena Machado da Rocha Fernandes
Banca: Cledson Augusto Garcia
Banca: Francisco de Assis Fonseca de Macedo
Resumo: Os objetivos deste trabalho foram avaliar o desempenho, consumo e digestibilidade de nutrientes e a qualidade da carne de cordeiros Santa Inês alimentados com 30, 40, 50 e 60% de feno de erva-sal associado a concentrado. Utilizou-se 32 cordeiros castrados, com 8 meses de idade e peso inicial de 22 + 1,97 kg, confinados individualmente e abatidos após 60 dias de confinamento. Houve redução linear no consumo de matéria seca e ganho de peso à medida que o nível de feno de erva-sal aumentou na dieta. O consumo dos nutrientes digestíveis diminuiu com o aumento de feno, exceto de proteína bruta (120,09 g/dia), fibras em detergente neutro (242,85 g/dia) e ácido (90,80 g/dia), assim como a digestibilidade dos nutrientes, com exceção dos carboidratos não fibrosos (84,94%). Houve redução do nitrogênio excretado na urina e aumento dos nitrogênios absorvido e retido com a inclusão do feno na dieta. Os pesos de carcaça quente e fria decresceram linearmente com o aumento de feno de erva-sal na dieta, entretanto, não houve efeito para o rendimento verdadeiro de carcaça e dos cortes: paleta (19,26%), pescoço (8,52%), costelas (26,57%) e perna (33,88%). Houve efeito linear decrescente para área de olho de lombo e espessura de gordura à medida que o nível de feno na dieta aumentou. O pH final (5,46), cor (39,47 para L; 18,16 para a* e 5,55 para b*) e os teores de umidade (74,50%), proteína (21,15%) e colesterol da carne (36,76mg/100g) não diferiram entre os tratamentos. O percentual de minerais aumentou e o de gordura da carne diminuiu e a carne tornou-se mais dura com a inclusão de feno de erva-sal, entretanto, os provadores não detectaram diferença na análise sensorial, mas observaram maior intensidade de sabor de cordeiro na carne dos animais que receberam menos feno na... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The aims of this study were to evaluate the performance, nutrients intake and digestibility and the meat quality of Santa Inês lambs fed with 30, 40, 50 or 60% of oldman saltbush hay with concentrated. Were used 32 castrated lambs, with 8 month old and initial weight of 22 + 1.97 kg, housed individually and slaughtered after 60 days of feedlot. There was a linear reduction in dry matter intake and daily weight gain as the level of saltbush hay increased in the diet. The intake of all digestible nutrients decreased with the hay inclusion, except for crude protein intake (120.09 g/day), neuter detergent fiber (242.85 g/day) and acid detergent fiber intake (90.80 g/day), as well as nutrients digestibility, except for non-fibrous carbohydrates (84.94%). There was a reduction on nitrogen excreted in urine and increase nitrogen absorbed and retained with the inclusion of hay in the diet. The weights of hot and cold carcass decreased linearly as was the inclusion of saltbush hay in the diet, however, there was no effect for true yields and for cuts: shoulder (19.26%), neck (8.52%) ribs (26.57%) and leg (33.88%). There was linear decreased for rib eye area and fat thickness as the level of hay in the diet increased. The final pH (5.46), color (39.47 for L; 18.16 for a* and 5.55 for b*) and the moisture content (74.50%), protein (21.15%) and cholesterol of meat (36.76 mg/100 g) did not differ between treatments. The percentage of minerals increased, intramuscular fat decreased and the meat was harder with the addition of saltbush hay, however, the panellists no detected differences in sensory analysis, but observed a more intense taste of sheep meat in lambs that received less saltbush in the diet. The inclusion of saltbush hay in the diet increased the amount of saturated and unsaturated fatty acids and reduced the 6:3 ratio. The saltbush hay should be used as a supplementary resource in areas with salinity problems of water and/or soil
Doutor

This study aims to inventory the existing waterbird in the Environmental Protection Area Karst of Lagoa Santa (APA Karst); to understand its seasonal pattern of occurrence associating it to the characteristics of the seasonal lake system where it is inserted; to diagnose the environmental impacts in the region and its influence on the waterbird; and ultimately, gather the necessary information to propose the designation of the area as a Ramsar site. The research results might assist decision making processes to better preserve the area while bringing greater visibility to the region. To do so, the thesis is organised in six chapters, presented as articles, and an appendix. Chapter 1 presents the result of the waterbird inventory, indicating seasonal variations happening at the APA Karst and the birds sensitivity levels accordingly to environmental changes. Chapter 2 brings the record of two new species found in Minas Gerais State. The relationship between waterbird species richness and abundance, and the characteristics of the seasonal lake system of APA Karst are explored in Chapter 3. In chapter 4 waterbird pattern of occurrence and its seasonal variation is described, indicating variability associated factors. Chapter 5 presents a categorization of Lagoa Santas lake system from the regions existing environmental impacts viewpoint, associating the meeting of waterbird in APA Karst to these impacts. Ultimately, Chapter 6 presents a proposal for the designation of APA Karst Lagoa Santa as a Ramsar site. The appendix consists of the Field Guide of Waterbirds of Environmental Protection Area Karst of Lagoa Santa.
Neste estudo inventariamos as aves aquáticas na Área de Proteção Ambiental Carste de Lagoa Santa, compreender seu padrão de ocorrência sazonal, associar sua ocorrência às características do sistema lacustre temporário que ali ocorre, além de diagnosticar os impactos ambientais da região e sua influência sobre as aves aquáticas, e obter informações para propor a designação da área como sítio Ramsar. Os resultados dessa pesquisa poderão auxiliar na tomada de decisões para melhor preservação da área, além de trazer maior visibilidade para a região. Para tanto, a tese foi dividida em seis capítulos apresentados em formato de artigos e um apêndice. No capítulo 1 apresentamos o resultado do inventario das aves aquáticas, dando indicações das variações sazonais que ocorrem na assembleia da APA, e níveis de sensibilidade das espécies às alterações do ambiente. O capítulo 2 traz o registro de duas novas espécies ao estado de Minas Gerais. As relações entre a riqueza e a abundância das aves aquáticas com características das lagoas temporárias da Área de Proteção Carste de Lagoa Santa são exploradas no capítulo 3. No capítulo 4 descrevemos o padrão de ocorrência das aves aquáticas e sua variação sazonal, indicando fatores que causam tais variações. O capítulo 5 apresenta uma categorização do sistema de lagoas da região de Lagoa Santa do ponto de vista de impactos ambientais que ali ocorrem e associa a assembleia de aves aquáticas a esses impactos. E finalmente, no capítulo 6 trazemos uma proposta de designação da APA Carste como sítio Ramsar. O apêndice é composto pelo Guia de Campo das Aves Aquáticas da APA Carste de Lagoa Santa.

Introduction.

Le Rwanda a connu de nombreuses difficultés au cours des deux dernières décennies :la situation économique précaire, les guerres civiles, le régime politique défaillant, l’instabilité de la sous-région des Grands Lacs, la pandémie du VIH/SIDA ;tous ces bouleversements ont plongé le pays dans l’extrême pauvreté. Au lendemain de la guerre et du génocide, le ministère de la Santé avec l’appui de différents partenaires a canalisé tous ses efforts dans la reconstruction du système de santé. Une meilleure participation communautaire à la gestion et au financement des services de santé était un des objectifs retenus dans cette reconstruction du système de santé. Pour ce faire, le ministère de la Santé, en partenariat avec le PHR (Partnership for health reform) a mis en place des mutuelles de santé « pilote » dans trois districts sanitaires (Byumba, Kabgayi et Kabutare) sur les 39 districts que compte le pays. L’objectif du ministère de la Santé était de généraliser ce système d’assurance maladie après une évaluation de ce projet pilote. Cette initiative de mise en place des mutuelles s’est heurtée au début de sa mise en œuvre à différents problèmes :le faible taux d’adhésion, les problèmes de gestion de la mutuelle, une faible implication des autorités de base dans la sensibilisation, une mauvaise qualité de soins dans certaines formations sanitaires, une utilisation abusive des services par les mutualistes, etc. Malgré ces problèmes d’autres initiatives de mise en place de mutuelles de santé ont vu le jour et continuent de s’implanter ici et là dans les districts sanitaires du pays. Dans le souci de renforcer cette réforme de financement alternatif par les mutuelles de santé, nous avons évalué l’impact des mutuelles sur l’accessibilité aux soins et le renforcement de la participation communautaire aux services de santé et nous avons proposé des voies stratégiques susceptibles d’améliorer le fonctionnement des mutuelles de santé.

Méthodologie

Pour atteindre ces objectifs de recherche, nous avons combiné trois approches différentes :la recherche qualitative qui a permis d’une part, d’analyser le processus de mise en place des mutuelles de santé au Rwanda et d’autre part, de recueillir les opinions des bénéficiaires de services de santé sur ce processus. Ensuite la recherche quantitative nous a permis d’étudier les caractéristiques des membres et non-membres des mutuelles et l’utilisation des services de santé ;enfin la recherche action nous a permis d’expérimenter les axes stratégiques susceptibles de renforcer le développement des mutuelles de santé.

Cette approche méthodologique utilisée tout au long de notre travail de terrain a mené à une « triangulation méthodologique » qui est une combinaison de diverses méthodes de recherche. Dans chacune des méthodes citées, nous avons utilisé une ou plusieurs techniques :analyse de documents, observations et rencontres avec des individus ou des groupes, analyse et compilation des données de routine.

Résultats

Les résultats clés sont synthétisés selon les trois types de recherche que nous avons menés.

1. Processus de mise en place des mutuelles de santé au Rwanda et opinions des bénéficiaires

Dans les trois districts pilotes (Byumba, Kabgayi et Kabutare), les mutuelles de santé prennent en charge le paquet minimum d’activités complet offert au niveau des centres de santé. À l’hôpital de district elles couvrent :la consultation chez un médecin, l’hospitalisation, les accouchements dystociques, les césariennes et la prise en charge du paludisme grave. Pour bénéficier de ces soins une cotisation de 7,9 $ EU ($ des États-Unis) par an pour une famille de sept personnes est demandée, puis 1,5 $ EU par membre additionnel et 5,7 $ EU pour un célibataire. Le ticket modérateur est de 0,3 $ EU pour chaque épisode de maladie et la période d’attente d’un mois avant de bénéficier des avantages du système de mutualisation.

Des entretiens en groupes de concertation (focus groups) nous ont permis de confirmer que la population connaît l’intérêt des mutuelles de santé et qu’elle éprouve des difficultés pour réunir les fonds de cotisations pour adhérer aux mutuelles.

L’analyse critique du processus de mise en place des mutuelles dans les trois districts pilotes nous a permis de conclure que les autorités locales et les leaders d’opinions étaient peu impliqués dans le processus de mise en place des mutuelles et que la sensibilisation était insuffisante. L’appui au processus de mise en place par le PHR a été jugé insuffisant en termes de temps (18 mois) et de formation de cadres locaux qui devraient assurer la poursuite de ce projet. Les défaillances évoquées ont alerté le ministère de la Santé, qui a mis en place un comité de mise en place et de suivi des mutuelles de santé. Depuis ce temps, on observe une émergence des initiatives mutualistes. Le pays compte actuellement 21 % de la population totale qui possède une certaine couverture (partielle ou totale) d’assurance maladie.

2. Caractéristiques des membres et non-membres des mutuelles de santé et utilisation des services de santé par la communauté

Il a été constaté que la répartition selon le sexe, l’état civil et le statut professionnel des membres et non-membres de la mutuelle les caractéristiques ne diffèrent pas significativement entre les adhérents et les non-adhérents à la mutuelle de santé (p > 0,05). Parmi les membres, les proportions des ménages avec revenus élevés sont supérieures à celles observées chez les non-membres (p < 0,001). Quant à la « sélection adverse » que nous avons recherchée dans les deux groupes (membres et non-membres de la mutuelle), nous avons constaté que l’état de morbidité des membres de la mutuelle ne diffère pas de celui des non-membres (p > 0,05). Les personnes qui adhèrent à la mutuelle de santé s’y fidélisent au fil des années (> 80 %) et fréquentent plus les services de santé par rapport aux non-membres (4 à 8 fois plus pour la consultation curative et 1,2 à 4 fois plus pour les accouchements). Les non-membres ont tendance à fréquenter les tradipraticiens et à faire l’automédication. Bien que les mutualistes utilisent plus les services de santé que les non-mutualistes, ils dépensent moins pour les soins.

3. Axes stratégiques développés pour renforcer les mutuelles de santé

Pour mettre en place les stratégies de renforcement des mutuelles de santé, cinq types d’actions dans lesquelles nous avons joué un rôle participatif ont été menés.

D’abord la stratégie initiée pour faire face à l’exclusion sociale :il s’agit de l’entraide communautaire développée dans la commune de Maraba, district sanitaire de Kabutare. Ce système d’entraide, nommée localement ubudehe (qui signifie « travail collectif » en kinyarwanda), assure un appui aux ménages les plus pauvres selon un rythme rotatoire préalablement établi en fonction du niveau de pauvreté.

Une autre stratégie est celle du crédit bancaire accordé à la population pour pouvoir mobiliser d’un seul coup le montant de cotisation. Cette stratégie a été testée dans le district sanitaire de Gakoma. Un effectif de 27 995 personnes, soit 66,1 % du total des membres de la mutuelle de ce district ont souscrit à la mutuelle de santé grâce à ce crédit bancaire.

Les autorités politiques et des leaders d’opinions ont été sensibilisés pour qu’ils s’impliquent dans le processus de mise en place des mutuelles dans leurs zones respectives. Il a été constaté que les leaders d’opinions mobilisent plus rapidement et plus facilement la population pour qu’elle adhère aux mutuelles de santé, que les autorités politiques. Cette capacité de mobiliser la population est faible chez les prestataires de soins.

Certaines mesures ont été proposées et adoptées par les mutuelles de santé pour éviter les risques liés à l’assurance maladie. Il s’agit de l’adhésion par ménage, par groupe d’individu, par association ou par collectivité ;l’exigence d’une période d’attente avant de bénéficier des avantages des mutualistes ;l’instauration du paiement du ticket modérateur pour chaque épisode de maladie ;les supervisions réalisées par les comités de gestion des mutuelles de santé et les équipes cadres de districts ;l’utilisation des médicaments génériques ;le respect de la pyramide sanitaire et l’appui du pouvoir public et/ou partenaire en cas d’épidémie. Ces mesures ont montré leur efficacité dans l’appui à la consolidation des mutuelles de santé.

Enfin, l’« Initiative pour la performance » est la dernière stratégie qui a été développée pour renforcer les mutuelles de santé. Elle consiste à inciter les prestataires à produire plus et à améliorer la qualité de services moyennant une prime qui récompense leur productivité. Les résultats montrent que les prestataires de services ont développé un sens entrepreneurial en changeant leur comportement vis-à-vis de la communauté. Certaines activités du PMA (paquet minimum d’activités) qui n’étaient pas offertes ont démarré dans certains centres de santé (accouchement, stratégies avancées de vaccination, causeries éducatives, etc.). Des ressources supplémentaires ont été accordées aux animateurs de santé, aux accoucheuses traditionnelles et aux membres de comités de santé qui se sont investis plus activement dans les activités des centres de santé. L’intégration des services a été plus renforcée que les années précédentes.

Conclusions

Les mutuelles de santé facilitent la population à accéder aux soins de santé et protègent leurs revenus en cas de maladies.

Le modèle de mise en place des mutuelles de santé au Rwanda est de caractéristique dirigiste :à partir des autorités (politiques, sanitaires ou leaders d’opinions). Il ne serait pas le plus adéquat dans la participation communautaire, mais plutôt adapté à un contexte politique de reconstruction d’un pays.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

La préservation de la santé de la population constitue un des principes fondamentaux de l'Organisation Mondiale de la Santé. Ainsi, les atteintes aux objectifs de santé deviennent la préoccupation fondamentale de l'époque moderne. Cependant, dans des pays en développement comme le Sénégal, se pose l'épineux problème de l'offre et de l'accessibilité aux soins notamment pour les populations les plus démunies et celles habitant en milieu rural. Hélas, la plupart des structures de soins sont incapables d'assurer une offre de soins de qualité et de quantité suffisante aux usagers. En effet, beaucoup d'efforts ont été fournis et sont entrain d'être poursuivis en matière d'offre de soins. Malheureusement, le constat général reste toujours le même : la population souffre toujours du déficit d'accès aux soins. Il faudrait alors réfléchir sur des systèmes de santé qui prennent en charge toute la population en lui accordant l'accès aux soins de qualité et qui soient abordables. Pour ce faire, les autorités doivent résoudre d'abord les problèmes qui sont à l'origine de la dégradation de la santé de la population : la pauvreté, des difficultés d'accès à l'eau potable et aux logements propres et décents, l'analphabétisme etc. Également, parmi toutes les solutions préconisées, l'une des plus pertinentes est d'intégrer la médecine traditionnelle dans les systèmes de santé de tous les pays en développement
The protection of people health is one of the World Health Organization basic principles. Then, reaching health objectives has become the main concern of our time. However, in developing countries such as Senegal, it faces the tricky question of offer and access to treatment chiefly for the most destitute populations and for those living in rural area. Sadly, most of the health facilities cannot provide an effective and efficient care to their patients. Indeed, a lot of effort has been doing in the matter of care offer for years. Unfortunately, the general report is that: populations are still suffering from lack of care access. Authorities should think about health systems which take into account the whole population by granting them access to affordable care quality. To do so, they should solve the problems which are the causes of the degradation of people health among which poverty, illiteracy, and lack of access to drinking water and to adequate and clean accommodations. Among the recommended solutions, one of the most relevant is the integration of herbal remedy into all developing countries health system

Depuis 1969, l'enseignement de la carte aux élèves de 5 à 11 ans a connu de nombreux bouleversements. Les programmes officiels, les manuels, les cartes affichées ou utilisées en classe font apparaitre ces différents systèmes didactiques. Cette étude vise à éclairer ce processus d'apprentissage de la lecture et du dessin de cartes. Elle recherche les racines psychologiques et sociologiques du contraste entre les théories constructivistes pour qui les cartes à petite échelle sont un non-sens pour les jeunes élèves et les pratiques qui développent l'usage des cartes, même avec les enfants les plus jeunes. Les représentations cartographiques, points, lignes, surfaces, ne concrétisent pas seulement des styles de cartes, elles révèlent les processus d'apprentissage de la géographie et de la cartographie. Elles ne sont pas de simples habiletés techniques, elles traduisent et nécessitent le développement de la pensée scientifique. La cartographie et la géographie aident le jeune écolier à comprendre le monde, elles contribuent de façon importante au développement intellectuel de l'enfant
Since 1969, many didactical changes has upset map teaching at pupils from five to eleven. Official curriculum, handbooks, all the maps used in school give evidence of these different didactical systems. This study attempts to throw light on the learning process of mapping ability and map understanding. It tries to explain the psychological and sociological roots of the contrast between constructivists theories who present little-scale mapping has a no sense for young pupils and the practices devloping the uses of maps, even with the youngest children. Mapping abilities, points, lines, areas on maps, aren't only characteristics of map styles, they give evidence to the learning processes of geography and cartography. They aren't only technical skills, they show and they need the development of conceptualization. Cartography and geography help young schoolboys to understand the world, they strongly contribute towards intelectual development of child

Made available in DSpace on 2014-06-11T19:27:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-01-30Bitstream added on 2014-06-13T19:15:02Z : No. of bitstreams: 1 ricardo_ha_me_botfmvz.pdf: 253097 bytes, checksum: 0d65dce29afe2348168a2af169bae508 (MD5)
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Universidade Estadual Paulista (UNESP)
Foram utilizadas cinco meias-carcaças congeladas de cordeiros Santa Inês, obtidas 8 de um frigorífico comercial, abatidos com 35,0 kg de peso vivo, divididas em cinco cortes 9 comerciais: pescoço, paleta, costela, lombo e perna. Foram registrados o peso e as 10 porcentagens dos cortes, e avaliadas as propriedades químicas e físicas. Não houve 11 diferença entre os valores de pH para os cortes, com variação de 5,88 a 6,08. O lombo e a 12 perna apresentaram maior teor de proteína (20,79 e 20,66%), enquanto que pescoço e 13 costela apresentaram maior teor de extrato etéreo (4,44 e 4,95%). O teor de colesterol não 14 apresentou diferença entre os cortes, variando de 59,09 a 69,29 mg/100g. A composição de 15 ácidos graxos saturados e insaturados não apresentou diferença entre os cortes. Nos cortes, 16 o oléico foi o ácido graxo que mais contribuiu para o perfil total de ácidos graxos (47,55% 17 em média) enquanto que o ácido linoléico apresentou traços no pescoço, lombo e perna, 18 com teores de 0,33 e 0,35% para paleta e costela, respectivamente, e o ácido linolênico 19 apresentou traços no lombo e perna, e teores de 0,27, 0,28 e 0,14% para o pescoço, paleta e 20 costela, respectivamente. A perna apresentou maior força de cisalhamento em comparação 21 com a paleta e o lombo, enquanto que para cor, não houve diferença entre os cortes para 22 luminosidade (L*), a perna apresentou menor intensidade de vermelho (a*) e o lombo 23 maior intensidade de amarelo (b*).
Five halves frozen carcass of Santa Ines lambs, obtained from a commercial 7 slaughterhouse, slaughtered at 35.0 kg of live weight were separated in five commercial 8 cuts: neck, shoulder, ribs, loin and leg. There were recorded weight and cuts percentage 9 and evaluated chemical and physical traits. There wasn’t difference between pH values for 10 cuts, with variation of 5.88 to 6.08. Loin and leg had higher protein level (20.79 and 11 20.66%), while neck and ribs showed higher lipids levels (4.44 and 4.95%). Cholesterol 12 level wasn’t different between cuts, raging by 59.09 to 69.29 mg/100g. The composition of 13 saturated and unsaturated fatty acids didn’t showed difference between cuts. Oleic had 14 higher contribution for total fatty acid profile (mean of 47.55%), while linoleic had traces 15 in neck, loin and leg, showing for shoulder and ribs, levels of 0.33 e 0.35% respectively, 16 and linolenic showed traces in loin and leg, with levels of 0.27, 0.28 and 0.14% for neck, 17 shoulder and ribs respectively. Leg had higher shear force than shoulder and loin, and for 18 color, there wasn’t significative difference between cuts for luminosity (L*), leg showed 19 higher red intensity (a*) and loin higher yellow intensity (b*).

Enquête épidémiologique effectuée sur 500 appelés au Centre de sélection n° 1 de Vincennes. Les sujets sont identifiés. Un entretien directif permet d'évaluer leur comportement (habitudes alimentaires et dentaires, niveau des connaissances dentaires). L'état de la denture est appéciée selon l'indice C. A. O. Modifié (présentation de l'état des dents et des causes éventuelles de leur absence). Les données sont saisies et traitées selon le programme EOLE 6 de la Société QUAD INFORMATIQUE dégageant l'analyse biostatistique des résultats et une analyse unidimensionnelle des variables entre elles. La typologie comportementale, illustrée par l'analyse factorielle fait ressortir le rôle des variables puires de connaissance pour la santé dentaire, autorisant l'identification de strates "à risque" pour lesquelles les catégories socio-professionnelles jouent un rôle évident.

L'accès aux services de santé et les longs délais d'attente sont l’un des principaux problèmes dans la plupart des pays du monde, dont le Canada et les États-Unis. Les organismes de soins de santé ne peuvent pas augmenter leurs ressources limitées, ni traiter tous les patients simultanément. C'est pourquoi une attention particulière doit être portée à la priorisation d'accès des patients aux services, afin d’optimiser l’utilisation de ces ressources limitées et d’assurer la sécurité des patients. En fait, la priorisation des patients est une pratique essentielle, mais oubliée dans les systèmes de soins de santé à l'échelle internationale. Les principales problématiques que l’on retrouve dans la priorisation des patients sont: la prise en considération de plusieurs critères conflictuels, les données incomplètes et imprécises, les risques associés qui peuvent menacer la vie des patients durant leur mise sur les listes d'attente, les incertitudes présentes dans les décisions des cliniciens et patients, impliquant l'opinion des groupes de décideurs, et le comportement dynamique du système. La priorisation inappropriée des patients en attente de traitement a une incidence directe sur l’inefficacité des prestations de soins de santé, la qualité des soins, et surtout sur la sécurité des patients et leur satisfaction. Inspirés par ces faits, dans cette thèse, nous proposons de nouveaux cadres hybrides pour prioriser les patients en abordant un certain nombre de principales lacunes aux méthodes proposées et utilisées dans la littérature et dans la pratique. Plus précisément, nous considérons tout d'abord la prise de décision collective incluant les multiples critères de priorité, le degré d'importance de chacun de ces critères et de leurs interdépendances dans la procédure d'établissement des priorités pour la priorisation des patients. Puis, nous travaillons sur l'implication des risques associés et des incertitudes présentes dans la procédure de priorisation, dans le but d'améliorer la sécurité des patients. Enfin, nous présentons un cadre global en se concentrant sur tous les aspects mentionnés précédemment, ainsi que l'implication des patients dans la priorisation, et la considération des aspects dynamiques du système dans la priorisation. À travers l'application du cadre global proposé dans le service de chirurgie orthopédique à l'hôpital universitaire de Shohada, et dans un programme clinique de communication augmentative et alternative appelé PACEC à l'Institut de réadaptation en déficience physique de Québec (IRDPQ), nous montrons l'efficacité de nos approches en les comparant avec celles actuellement utilisées. Les résultats prouvent que ce cadre peut être adopté facilement et efficacement dans différents organismes de santé. Notamment, les cliniciens qui ont participé à l'étude ont conclu que le cadre produit une priorisation précise et fiable qui est plus efficace que la méthode de priorisation actuellement utilisée. En résumé, les résultats de cette thèse pourraient être bénéfiques pour les professionnels de la santé afin de les aider à: i) évaluer la priorité des patients plus facilement et précisément, ii) déterminer les politiques et les lignes directrices pour la priorisation et planification des patients, iii) gérer les listes d'attente plus adéquatement, vi) diminuer le temps nécessaire pour la priorisation des patients, v) accroître l'équité et la justice entre les patients, vi) diminuer les risques associés à l’attente sur les listes pour les patients, vii) envisager l'opinion de groupe de décideurs dans la procédure de priorisation pour éviter les biais possibles dans la prise de décision, viii) impliquer les patients et leurs familles dans la procédure de priorisation, ix) gérer les incertitudes présentes dans la procédure de prise de décision, et finalement x) améliorer la qualité des soins.
Access to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care.

Orientador : Prof. Dr. Paulo Rossi Junior
Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Zootecnia. Defesa: Curitiba, 28/03/2016
Inclui referências : f. 41-45-58-59-62-64
Área de concentração : Nutrição e Produção Animal
Resumo: Com a queda do poder aquisitivo da população, o consumo de carnes tende a diminuir e o preço torna-se a principal influência no comportamento do consumidor. Esta pesquisa tem como objetivo interpretar o perfil e as preferências dos consumidores de carne bovina nos estados do Paraná e Santa Catarina, indicar o responsável pela compra doméstica, o fator de decisão de compra nos supermercados, a frequência de consumo e os cortes bovinos mais comprados. E com estas informações, explanar as semelhanças e diferenças entre os perfis dos consumidores dos Estados. Com este fim, foram entrevistados 876 consumidores de carne bovina nas principais e mais populosas cidades dos estados do Paraná e Santa Catarina: Curitiba/PR, Blumenau/SC, Florianópolis/SC e Joinville/SC. A pesquisa coletou dados relativos ao perfil e comportamento dos consumidores, que processados e analisados, poderão ser utilizados como base na tomada de decisões comerciais, ou ainda, como parâmetros para novas pesquisas de cunho social e econômico. O número de consumidores de carne bovina por gênero é semelhante, o que também ocorre na população nacional, conforme Censo do IBGE. Na maioria dos domicílios, a mulher é a responsável pela compra, com exceção da cidade de Florianópolis, em que este cenário se inverte. Entretanto, não há diferença de gastos entre os gêneros na compra de carne bovina. O principal fator de decisão de compra é o preço, seguido de aparência do produto. A frequência de consumo mais comum é de 3 a 4 dias por semana e o corte mais consumido é o coxão mole. As famílias dos estados do Paraná e Santa Catarina tem comportamentos semelhantes quanto ao consumo médio em quilogramas, o aumento do consumo nos fins de semana e feriados, o preço como o fator de decisão de compra, cortes mais consumidos e fidelidade ao supermercado. E comportamentos diferentes quanto ao montante gasto semanalmente, a preferência na escolha da segunda fonte de proteína animal e o responsável pela compra doméstica. Palavras-chave: Agronegócio; Bovino de Corte; Marketing; Pesquisa do consumidor; Survey
Abstract: With the fall of purchasing power of the population, meat consumption tends to decrease and the price becomes the main influence on consumer behavior. This research aims to interpret the profile and preferences of beef consumers in the states of Paraná and Santa Catarina state, the responsible for domestic purchase, the purchase decision factor in supermarkets, the frequency of consumption and the most purchased beef cuts . And with this information, explain the similarities and differences between the profiles of consumers of States. To this end, we interviewed 876 consumers of beef in the main and most populous cities in the states of Parana and Santa Catarina: Curitiba / PR, Blumenau / SC, Florianópolis / SC and Joinville / SC. The survey collected data on the profile and behavior of consumers, which processed and analyzed, they may be used as a basis for making business decisions, or as parameters for further research of social and economic nature. The number of beef consumers by gender is similar, which also occurs in the national population, according to IBGE Census. In most households, women are responsible for the purchase, with the exception of the city of Florianópolis, in this scenario is reversed. However, there is no difference between the genders when buying beef. The main purchase decision factor is price, followed by appearance of the product. The most common frequency of consume is 3 to 4 days per week and the most consumed is the Coxão mole cut. The families of the states of Paraná and Santa Catarina has similar behavior as the average consumption in kilograms, increased consumption on weekends and holidays, the price as the purchase decision factor, consumed more cuts and fidelity to the supermarket. And different behaviors on the amount spent each week, the preference in choosing the second source of animal protein and responsible for domestic purchase. Keywords: Agribusiness; Beef Cattle; Consumer Research; Marketing; Survey

Made available in DSpace on 2014-06-11T19:32:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-17Bitstream added on 2014-06-13T21:05:25Z : No. of bitstreams: 1 pinheiro_rsb_dr_botfmvz.pdf: 178440 bytes, checksum: c198bd55cd85d176c0d2e0aa0ed2fbf4 (MD5)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Universidade Estadual Paulista (UNESP)
O experimento foi conduzido no intuito de avaliar ovelhas de descarte abatidas em diferentes estágios fisiológicos e terminadas em confinamento, quanto aos rendimentos de carcaça e seus cortes, assim como dos percentuais de cada não componente da carcaça e o resultado econômico da preparação destes animais para abate. Utilizou-se 21 ovelhas da raça Santa Inês, com idade média de seis anos, que foram distribuídas nos respectivos tratamentos: OL = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e abatidas um dia após o desmame dos mesmos; OSC = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros, no intuito de recuperar o peso corporal perdido durante o período de amamentação e posteriormente abatidas; e ONP = ovelhas que permaneceram por 60 dias em confinamento e que não pariram durante o ano. Os resultados obtidos nesta pesquisa evidenciaram que as ovelhas do ONP apresentaram maiores rendimentos de carcaça quente (45,00%) e fria (44,73%) em comparação às fêmeas do OL (40,80% e 40,66%). O rendimento verdadeiro foi próximo entre as fêmeas dos diferentes tratamentos, com valor médio de 50,10%. Os rendimentos dos cortes da carcaça (paleta, pescoço, costelas, lombo e perna) foram similares entre todas as ovelhas abatidas nas distintas condições fisiológicas, com valores médios de 18,78%, 9,34%, 27,36%, 7,77%, e 34,70%, respectivamente. Os rendimentos dos não componentes da carcaça foram similares entre as ovelhas abatidas em diferentes estágios fisiológicos, com exceção dos valores do fígado, do sangue, do úbere e da gordura interna. O resultado econômico foi positivo para todos os tratamentos experimentais, no entanto o melhor retorno financeiro foi obtido para os animais do tratamento OSC e o pior para os do tratamento ONP.
The experiment was carried out aiming to evaluate discard ewes slaughtered in different physiological stages and terminated in confinement, as for carcass yields and its cuts, as well as the percentages of each non-component of the carcass and the economical result of the preparation of these animals for slaughtering. 21 Santa Inês ewes were used, with average age of six years old, distributed into the following treatments: EL = ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning of the lambs; EWL = ewes that remained in lactation for 60 days with their respective lambs and other 30 days approximately without lambs, aiming to recover lost body weight during breastfeeding, and, subsequently, slaughtered; and ENC = ewes that remained in confinement for 60 days and did not deliver during the year. The results obtained in this research showed that ewes from ENC presented higher hot (45.00%) and cold (44.73%) carcass yields, compared to females from EL (40.80% and 40.66%). True yield was proximate between females from the different treatments, with average value of 50.10%. Carcass cuts (shoulderblade, neck, ribs, loin and leg) yields were similar among all ewes slaughtered in the distinct physiological conditions, with average values of 18.78%, 9.34%, 27.36%, 7.77% and 34,70%, respectively. Carcass non-components yields were similar among ewes slaughtered in different physiological stages, except for liver, blood, udder values and internal fat. The economical result was positive for all experimental treatments; however, the best financial return was obtained for animals from treatment EWL and the worst for animals from treatment ENC.

Resumo: O experimento foi conduzido no intuito de avaliar ovelhas de descarte abatidas em diferentes estágios fisiológicos e terminadas em confinamento, quanto aos rendimentos de carcaça e seus cortes, assim como dos percentuais de cada não componente da carcaça e o resultado econômico da preparação destes animais para abate. Utilizou-se 21 ovelhas da raça Santa Inês, com idade média de seis anos, que foram distribuídas nos respectivos tratamentos: OL = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e abatidas um dia após o desmame dos mesmos; OSC = ovelhas que permaneceram por 60 dias em lactação com seus respectivos cordeiros e mais um período aproximado de 30 dias sem os cordeiros, no intuito de recuperar o peso corporal perdido durante o período de amamentação e posteriormente abatidas; e ONP = ovelhas que permaneceram por 60 dias em confinamento e que não pariram durante o ano. Os resultados obtidos nesta pesquisa evidenciaram que as ovelhas do ONP apresentaram maiores rendimentos de carcaça quente (45,00%) e fria (44,73%) em comparação às fêmeas do OL (40,80% e 40,66%). O rendimento verdadeiro foi próximo entre as fêmeas dos diferentes tratamentos, com valor médio de 50,10%. Os rendimentos dos cortes da carcaça (paleta, pescoço, costelas, lombo e perna) foram similares entre todas as ovelhas abatidas nas distintas condições fisiológicas, com valores médios de 18,78%, 9,34%, 27,36%, 7,77%, e 34,70%, respectivamente. Os rendimentos dos não componentes da carcaça foram similares entre as ovelhas abatidas em diferentes estágios fisiológicos, com exceção dos valores do fígado, do sangue, do úbere e da gordura interna. O resultado econômico foi positivo para todos os tratamentos experimentais, no entanto o melhor retorno financeiro foi obtido para os animais do tratamento OSC e o pior para os do tratamento ONP.
Abstract: The experiment was carried out aiming to evaluate discard ewes slaughtered in different physiological stages and terminated in confinement, as for carcass yields and its cuts, as well as the percentages of each non-component of the carcass and the economical result of the preparation of these animals for slaughtering. 21 Santa Inês ewes were used, with average age of six years old, distributed into the following treatments: EL = ewes which remained in lactation for 60 days with their respective lambs and slaughtered one day after weaning of the lambs; EWL = ewes that remained in lactation for 60 days with their respective lambs and other 30 days approximately without lambs, aiming to recover lost body weight during breastfeeding, and, subsequently, slaughtered; and ENC = ewes that remained in confinement for 60 days and did not deliver during the year. The results obtained in this research showed that ewes from ENC presented higher hot (45.00%) and cold (44.73%) carcass yields, compared to females from EL (40.80% and 40.66%). True yield was proximate between females from the different treatments, with average value of 50.10%. Carcass cuts (shoulderblade, neck, ribs, loin and leg) yields were similar among all ewes slaughtered in the distinct physiological conditions, with average values of 18.78%, 9.34%, 27.36%, 7.77% and 34,70%, respectively. Carcass non-components yields were similar among ewes slaughtered in different physiological stages, except for liver, blood, udder values and internal fat. The economical result was positive for all experimental treatments; however, the best financial return was obtained for animals from treatment EWL and the worst for animals from treatment ENC.
Orientador: André Mendes Jorge
Coorientador: Hirasilva Borba Alves de Souza
Banca: Francisco de Assis Fonseca de Macedo
Banca: Nivea Maria Bracacci Lopes Zeola
Banca: Cledson Augusto Garcia
Banca: Ciniro Costa
Doutor

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnologico
Made available in DSpace on 2012-10-16T05:34:14Z (GMT). No. of bitstreams: 0Bitstream added on 2016-01-08T18:07:26Z : No. of bitstreams: 1 93561.pdf: 2768378 bytes, checksum: 7e9248327e779994984d0d6ff7d256ed (MD5)
O propósito deste trabalho é analisar o setor suinícola catarinense, através da descrição de suas relações técnico-econômicas, evidênciando-se, assim, as interações entre seus agentes. Inicialmente, é apresentada a metodologia utilizada, a análise de Filière, sua aplicabilidade enquanto ferramenta de análise de sistemas industriais e as etapas para a implementação da mesma. Seguindo a metodologia, primeiro é descrita a evolução histórica do setor suinícola catarinense, o que permite identificar as suas lógicas de desenvolvimento. Posteriormente, são desenvolvidas as análises técnica e econômica do setor. Destacando-se, na leitura técnica, os aspectos relacionados com processamento e os respectivos setores auxiliares envolvidos com a atividade suinícola. Na leitura econômica, trata-se dos aspectos referentes aos mercados consumidores (interno e externo), evidênciando-se pontos fortes e fracos do setor e suas respectivas estratégias presentes e futuras. Na conclusão são apresentadas as perspectivas para o setor suinícola catarinense.

Orientador: Roberto de Oliveira Roça
Banca: André Mendes Jorge
Banca: Francisco Assis F. de Macedo
Resumo: Foram utilizadas cinco meias-carcaças congeladas de cordeiros Santa Inês, obtidas 8 de um frigorífico comercial, abatidos com 35,0 kg de peso vivo, divididas em cinco cortes 9 comerciais: pescoço, paleta, costela, lombo e perna. Foram registrados o peso e as 10 porcentagens dos cortes, e avaliadas as propriedades químicas e físicas. Não houve 11 diferença entre os valores de pH para os cortes, com variação de 5,88 a 6,08. O lombo e a 12 perna apresentaram maior teor de proteína (20,79 e 20,66%), enquanto que pescoço e 13 costela apresentaram maior teor de extrato etéreo (4,44 e 4,95%). O teor de colesterol não 14 apresentou diferença entre os cortes, variando de 59,09 a 69,29 mg/100g. A composição de 15 ácidos graxos saturados e insaturados não apresentou diferença entre os cortes. Nos cortes, 16 o oléico foi o ácido graxo que mais contribuiu para o perfil total de ácidos graxos (47,55% 17 em média) enquanto que o ácido linoléico apresentou traços no pescoço, lombo e perna, 18 com teores de 0,33 e 0,35% para paleta e costela, respectivamente, e o ácido linolênico 19 apresentou traços no lombo e perna, e teores de 0,27, 0,28 e 0,14% para o pescoço, paleta e 20 costela, respectivamente. A perna apresentou maior força de cisalhamento em comparação 21 com a paleta e o lombo, enquanto que para cor, não houve diferença entre os cortes para 22 luminosidade (L*), a perna apresentou menor intensidade de vermelho (a*) e o lombo 23 maior intensidade de amarelo (b*).
Abstract: Five halves frozen carcass of Santa Ines lambs, obtained from a commercial 7 slaughterhouse, slaughtered at 35.0 kg of live weight were separated in five commercial 8 cuts: neck, shoulder, ribs, loin and leg. There were recorded weight and cuts percentage 9 and evaluated chemical and physical traits. There wasn't difference between pH values for 10 cuts, with variation of 5.88 to 6.08. Loin and leg had higher protein level (20.79 and 11 20.66%), while neck and ribs showed higher lipids levels (4.44 and 4.95%). Cholesterol 12 level wasn't different between cuts, raging by 59.09 to 69.29 mg/100g. The composition of 13 saturated and unsaturated fatty acids didn't showed difference between cuts. Oleic had 14 higher contribution for total fatty acid profile (mean of 47.55%), while linoleic had traces 15 in neck, loin and leg, showing for shoulder and ribs, levels of 0.33 e 0.35% respectively, 16 and linolenic showed traces in loin and leg, with levels of 0.27, 0.28 and 0.14% for neck, 17 shoulder and ribs respectively. Leg had higher shear force than shoulder and loin, and for 18 color, there wasn't significative difference between cuts for luminosity (L*), leg showed 19 higher red intensity (a*) and loin higher yellow intensity (b*).
Mestre

Dans un contexte de vieillissement rapide de la population, cette thèse explore les liens existants entre santé et modes de prise en charge des personnes âgées dépendantes et s'intéresse à la question du financement de la dépendance.La satisfaction des besoins d'aide des personnes âgées dépendantes constitue un objectif central de politiques publiques. Le Chapitre 1 estime l'effet de l'aide informelle (i.e. familiale) et de l'aide formelle (i.e. professionnelle) à domicile sur la santé mentale des personnes âgées dépendantes en France. Les résultats montrent que l'aide informelle réduit le risque de dépression et que l'aide formelle peut améliorer la santé mentale générale.De récentes études reconnaissent qu'aider un proche dépendant a des effets négatifs sur la santé des aidants et soulignent l'importance de les soutenir. Le Chapitre 2 s'intéresse à l'effet du soutien social sur la santé des aidants informels. Il montre que l'aide formelle et le soutien informel réduisent les problèmes de santé mentale associés à l'activité d'aide.Enfin, étant donné la pression financière et fiscale qui pèse sur les systèmes publics, le Chapitre 3 étudie dans quelle mesure les Européens seraient capables de financer leurs périodes de dépendance sur la base de leurs revenus et de leur patrimoine financier et immobilier. Il s'intéresse également au rôle du prêt viager hypothécaire. Les simulations soulignent que seule une faible proportion des individus serait capable de financer l'ensemble de ses dépenses de dépendance. Par ailleurs, le patrimoine immobilier pourrait jouer un rôle important dans le financement de la dépendance
In the context of a rapidly aging population, this doctoral dissertation explores the relationship between health and long-term care arrangements and addresses the issue of the financing of long-term care.Meeting the needs of dependent elderly is an important objective of public policy. Chapter 1 estimates the effects of both informal (i.e. family) care and formal (i.e. professional) home care on the mental health of French dependent elderly. The results highlight that informal care decreases the risk of depression and that formal care can improve general mental health.Recent studies acknowledge that providing informal care has adverse health effects and emphasize the importance of supporting caregivers. Chapter 2 examines the effect of social support on caregivers' health. It shows that formal care and informal support limit the negative consequences of caregiving on mental health.Finally, given the increasing financial and fiscal pressure on public systems, Chapter 3 investigates to what extent Europeans elderly are able to pay for their periods of long-term care needs on the basis of their income, financial assets and home equity. It also studies the role of reverse mortgages. The simulations stress that only a small proportion of individuals would be able to finance totally their long-term care expenses and that housing assets may play an important role in long-term care financing

Quem cuida de quem cuida? Essa pergunta/incômodo nutre esta pesquisa, que tem como tema central compreender as estratégias adotadas pelos trabalhadores da Atenção Básica para cuidarem de si. Para suprir os objetivos da pesquisa, que compreendem diversos mecanismos (políticos, históricos, sociais...) que podem existir em torno do cuidar, foram criados três capítulos conceituais para fundamentar teoricamente a proposta: Proposições para o profissional da saúde cuidar de si: A Política Nacional de Humanização do Sistema Único de Saúde; A saúde do trabalhador da saúde; O cuidado, o autocuidado e o cuidado de si (subdivido em: O cuidado, O autocuidado e o Cuidado de SI; e “_ _ _ _ _ _ _ _ _” Correndo Riscos: Fugindo dos riscos na esteira da medicalização). Esta é uma pesquisa de abordagem qualitativa, que utilizou como metodologia entrevistas semiestruturadas, realizadas com profissionais da Atenção Básica da cidade de Porto Alegre, avaliadas pela análise de conteúdo proposta por Bardin (2011). Após a transcrição das entrevistas, as respostas foram distribuídas em cinco categorias: Cuidado: Acolhimento e escuta (categoria na qual revela-se a preocupação dos profissionais com as práticas de escuta e acolhimento nos serviços); Caminhando entre o vigilante autocuidado e a construção do cuidado de si (revelando as duas facetas do cuidar, sendo uma mais impositiva, ao passo que a outra pauta-se na construção conjunta com o usuário); Política/Gestão/Trabalhadores: três monólogos simultâneos (apontando a dificuldade de comunicação entre essas três estruturas); Fazendo milagres em condições precárias (indicando as más condições estruturais da Atenção Básica); O sujeito trabalhador tentando se cuidar e os “sumicídios diários” (que revela os caminhos do cuidado das trabalhadoras e a tentativa de sair do local de trabalho e esquecer o estresse e todas as lembranças do dia). Ao fim,realizou-se a “Devolutiva Cuidadora”, na qual os resultados foram apresentados a diversas pessoas e, ainda, onde ocorreram práticas de cuidado, como roda de conversa, danças circulares, práticas de respiração etc. Cuidar de si é também cuidar do outro, por isso é fundamental que o espaço do trabalho na saúde propicie esta reflexão, evitando que o dito popular, “Santo de casa não faz milagre”, que inspirou o título desta pesquisa, seja algo normalizado nos relatos dos profissionais de saúde.
Who looks after the ones that look after the others? This question/inconvenience nourished this research, which is focused on understanding the strategies adopted by the workers of Primary Care to look after themselves. To reach the research objectives, understanding the several (political, historical, social,…) mechanisms that may exist about caring, three conceptual chapters were created to support theoretically the hypothesis: Propositions for the health professionals look after themselves: The National Policy of Humanization of the Brazilian Unified Health System (SUS); The health of the person who works with health; The care, the self-care and the care for the self (subdivided in: The self, The self-care and the Care of the Self and “_ _ _ _ _ _ _ _ _”Taking Risks: Running away from risks on the heels of medicalization). This is a qualitative approach research which used semi structured interviews as methodology, which were performed with Primary Care professionals from Porto Alegre, evaluated by the content analysis proposed by Bardin (2011). After the interviews were transcribed, the answers were organized into five categories: Care: Shelter and listening (which reveals the worry professionals have with the listening and sheltering practices in the services); Walking between the self-care vigilant and the construction of the care of the self (revealing the two aspects of the care, when one is more imposing and the other is ruled by the shared construction with the user); Politics/Management/Workers: three simultaneous monologues (which shows the communication difficulty among these three structures); Making miracles in precarious conditions (which shows the poor structural conditions of the Primary Care); A worker trying to care for himself and the “daily suicides” (which reveals the ways workers care and the attempt to leave the workplace and forget the stress and all the day memories).At the end, it was also held the “Caring Feedback”, when the results were presented to many people and, besides, when there were care practices, like round of conversation, circular dances, breathing techniques etc. Looking after the self is also looking after the other, that is why it is essential that the workplace in health fosters this reflection, avoiding that the popular saying “No one is a prophet in their own land”, which inspired the title of this study, becomes something common in the reports of health professionals.

O Sistema de Saúde brasileiro contempla dois modelos de atendimento: Unidades Básicas de Saúde tradicionais (UBS tradicionais) e Unidades Estratégia Saúde da Família (ESF). Este último foi concebido como forma de reorganizar a Atenção Primária à Saúde (APS) no país, conforme os preceitos do Sistema Único de Saúde (SUS). A realização de um pré-natal com qualidade é protetor dos desfechos desfavoráveis à saúde das gestantes e de seus bebês. O presente trabalho tem por objetivo avaliar o processo da atenção pré-natal em um município da Região Central do Estado do Rio Grande do Sul, verificando se há diferença na qualidade do pré-natal entre os dois modelos de atenção. Foram utilizados quatro níveis de qualidade: nível 1, que consiste no índice de Kessner, modificado por Takeda; nível 2, que adiciona ao nível 1 procedimentos clínico-obstétricos; nível 3, que adiciona ao nível 1 exames laboratoriais; e, nível 4, que considera todos os parâmetros anteriores. Realizou-se um estudo transversal, no período no período de julho de 2009 a fevereiro de 2010. Foram entrevistadas 795 puérperas até 48 horas após o parto, atendidas em dois hospitais públicos do município, que realizaram seu pré-natal em UBS tradicional ou em ESF. A coleta de dados consistiu de questionário aplicado à puérpera, análise do cartão da gestante e do prontuário, sendo realizadas análises estatísticas descritivas. A qualidade do pré-natal, conforme o índice de Kessner modificado (nível 1), foi classificada como adequada em 58,7% dos casos. Ao comparar a assistência pré-natal por local de realização do pré-natal, a adequação foi de 56,0%, nas UBS tradicionais e de 65,0%, nas ESF. Acrescentados à qualidade do pré-natal outros parâmetros, além do número de consultas, a adequação do pré-natal diminuiu. Ao ser avaliado o nível 4, 7,3% das gestantes tiveram um pré-natal adequado, sendo 6,0% nas UBS tradicionais e 9,5% na ESF. As gestantes atendidas na ESF receberam mais orientações sobre aleitamento materno, anticoncepção pós-parto, retorno à consulta de puerpério, cuidados com o recém-nascido, tipo de parto e orientações sobre HIV. A adequação do pré-natal foi favorável à ESF, com significância estatística nos níveis 1 e 2. As gestantes que realizaram o pré-natal no município tiveram baixos percentuais de inadequação no pré-natal, nos dois modelos de atenção, resultado que pode ser decorrente, em parte, da exclusão da amostra das gestantes que não haviam realizado nenhuma consulta de pré-natal. O estudo tem uma valia importante para a gestão, ao demonstrar que a assistência às gestantes no município está longe da ideal, devendo ser repensado o processo de trabalho nos dois modelos; investir na sensibilização e educação permanente dos profissionais; implementar institucionalmente protocolo de assistência à gestante; e, buscar alternativas para o início precoce do pré-natal e seguimento pelas gestantes a consultas, exames e procedimentos e ações de promoção à saúde. A atenção pré-natal foi favorável à ESF, contudo deve ser melhorada em seus pontos fracos, como forma de organizar o modelo de atenção e fortalecer a APS.
Brazilian Health Care System contemplates two models of care: traditional Basic Health Care Units (traditional UBS) and Family Health Strategy Units (ESF). The latter was conceived as a way to reorganize Primary Health Care (APS) in the country, according to the precepts of the Unified Health System (SUS). The achievement of a quality prenatal is protective of unfavorable health outcomes regarding pregnant women and their babies. This study aims to evaluate the process of prenatal care in a city of the Central Region of Rio Grande do Sul, checking for differences in the quality of prenatal care between the two models of care. We used four quality levels: level 1, consisting of the Kessner index, modified by Takeda; level 2, which adds the clinical-obstetric procedures to level 1; level 3, which adds the laboratory tests to level 1; and, level 4, that considers all the above parameters. A cross-sectional study was carried out, from July 2009 to February 2010. Seven hundred and ninety-five mothers were interviewed, mothers within 48 hours after childbirth, attended to at two public hospitals, who made their prenatal in traditional UBS or in ESF. Data collection consisted of a questionnaire administered to postpartum women, analysis of prenatal care and medical records, and was analyzed with descriptive statistics. Quality of prenatal care, according to the modified Kessner index (level 1) was classified as adequate in 58.7% of cases. When comparing prenatal care considering the place where it happened, adequacy was 56.0%, in traditional UBS and 65.0%, in EFS. When other parameters were added to prenatal quality, in addition to the number of appointments, adequacy of prenatal care decreased. Assessment of level 4 showed that 7.3% of women had an adequate prenatal care, 6.0% in traditional UBS and 9.5% in EFS. Pregnant women attended to by ESF received more guidance on breastfeeding, postpartum contraception, puerperium appointment, newborns care, delivery type and HIV guidance. Adequacy of prenatal care was favorable to ESF, with statistical significance at levels 1 and 2. The pregnant women who were attended to in the city had a lower percentage of inadequate prenatal care, considering both models of care, a result which may be due, in part, to the exclusion of pregnant women who had not undergone any prenatal appointment from the sample. Such study is an important asset for management, demonstrating that care for pregnant women in the city is far from ideal and that the process of working should be rethought concerning both models; more investments should take place as regards raising awareness and professionals continuing education; implementing institutional assistance protocols for pregnant women; and, searching for alternatives regarding early prenatal care for pregnant women and follow-up appointments, tests and procedures, as well as actions to promote health. Prenatal care was favorable to ESF. However, it needs to improve on its weaknesses, as a way to organize the model of care and strengthen APS.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Objetivou-se determinar as caracterÃsticas de carcaÃas e da carne de cordeiros Santa InÃs em confinamento, submetidos a quatro tratamentos experimentais com uso crescente de farelo de mamona destoxificado (0%, 33%, 66% e 100%) com base na matÃria seca. O volumoso utilizado foi silagem mista de capim elefante, sorgo e cana-de-aÃÃcar. Foram utilizados 32 cordeiros machos nÃo castrados, abatidos com peso corporal mÃdio de 30 Kg. Os ensaios experimentais foram realizados num delineamento inteiramente casualizado com quatro tratamentos e oito repetiÃÃes (ovinos). Os dados foram submetidos ANOVA e as mÃdias comparadas pelo teste de Tukey a 5%. Os animais foram submetidos a jejum hÃdrico e alimentar de 24 horas, a sangria foi feita com secÃÃo da artÃria carÃtida e veia jugular, seguida da evisceraÃÃo. ApÃs o abate as carcaÃas foram resfriadas por 24 horas a 4 C e realizadas as leituras de pH no mÃsculo semimembranosus aos 45 minutos e 24 horas pÃs abate, e determinados o peso, rendimento da carcaÃa quente e fria e efetuado as mediÃÃes morfomÃtricas. A carcaÃa foi seccionada longitudinalmente em meias carcaÃas, sendo obtidos os cortes comerciais de perna, lombo, costilhar, serrote, pescoÃo e paleta na meia carcaÃa direita, seguidos de pesagem e congelamento da paleta e da perna para posterior avaliaÃÃo da composiÃÃo tecidual. Utilizou-se o mÃsculo longissimus dorsi para as avaliaÃÃes qualitativas da carne, perda de peso por cocÃÃo, forÃa de cisalhamento, teor de lipÃdios, perfil de Ãcidos graxos, teor de proteÃnas, cinzas e umidade alÃm da anÃlise sensorial. A dieta com 100% de farelo de mamona apresentou menor valor em rendimento de carcaÃa fria, perÃmetro de perna e profundidade de tÃrax. NÃo foi observada diferenÃa estatÃstica entre os tratamentos testados, para o peso e rendimento dos cortes, no entanto a dieta influenciou o rendimento do costilhar que apresentou menor valor para o tratamento com 66% de substituiÃÃo de farelo de mamona. A estimativa de musculosidade da carcaÃa sofreu efeito da dieta, na relaÃÃo mÃsculo:osso da perna, verificou-se menor mÃdia para aqueles alimentados com 100% de farelo de mamona. Houve diferenÃa entre os tecidos constituintes da perna, tecido muscular, Ãsseo e outros tecidos, na paleta diferiram os tecidos Ãsseos e outros tecidos. A Ãrea de olho de lombo foi similar entre os tratamentos. Verificou-se efeito significativo (p<0,05) entre os tratamentos para a composiÃÃo centesimal, com menor percentual de gordura, proteÃna e umidade nos nÃveis de substituiÃÃo 66, 100 e 33%, respectivamente. A substituiÃÃo do farelo de mamona proporcionou um perfil de Ãcidos graxos interessantes à saÃde do consumidor, apresentando os melhores Ãndices para as relaÃÃes avaliadas entre os Ãcidos graxos. NÃo foi observada diferenÃa estatÃstica entre os tratamentos para os parÃmetros pH e forÃa de cisalhamento no entanto verificou-se efeito dos nÃveis de substituiÃÃo na perda de peso por cocÃÃo apresentando menor percentual 24,42% (p<0,05) em 33% de substituiÃÃo. Avaliaram-se as caracterÃsticas sensoriais considerando os atributos dureza, suculÃncia, sabor, cor, aroma e aceitaÃÃo global. Foi evidenciado que a dieta com 33% de substituiÃÃo proporciona uma carne com maior dureza, sem, contudo, comprometer a sua aceitaÃÃo. NÃo se observou variaÃÃo dos demais atributos sensoriais da carne. Pode-se concluir que a utilizaÃÃo de dietas contendo farelo de mamona destoxificado em substituiÃÃo parcial ao farelo de soja nÃo interfere nas caracterÃsticas de carcaÃa de ovinos Santa InÃs, bem como nos pesos e rendimentos dos cortes comerciais e composiÃÃo tecidual, mantendo a qualidade fÃsico-quÃmica e sensorial.
The objective of this study was to determine the characteristics of carcass and meat of Santa InÃs lambs submitted to four experimental treatments with increasing concentrations of detoxified castor meal (0%, 33%, 66% and 100%) with dry matter basis. The bulk used consisted of mixed silage of elephant grass, sorghum and sugar cane. Thirty-two non-castrated male lambs were used and slaughtered with average body weight of 30 kg. Experimental tests were conducted in a completely randomized design with four treatments and eight replications (lambs). Data were submitted ANOVA and means compared by Tukey test at 5%. The animals were fasted of food and water for 24 hours and bleeding was performed with section of carotid artery and jugular vein, followed by evisceration. After slaughter, the carcasses were chilled for 24 hours at 4ÂC and pH was measured on the semimembranosus muscle at 45 minutes and 24 hours after slaughter, also determining weight, hot and cold carcass yield and morphometric measurements. The carcass was longitudinally sectioned into half carcasses, and retail cuts such as leg, loin, rib, rear, neck and shoulder on the right half carcass were obtained, followed by weighing and freezing of shoulder and leg for further evaluation of tissue composition. The longissimus dorsi muscle was used for the qualitative assessments of meat, weight loss due to cooking, shear force, fat content, fatty acid profile, protein content, ash, moisture and sensory analysis. Diet with 100% of castor meal showed the lowest cold carcass yield, leg circumference and chest depth. No statistical difference between treatments was observed for weight and cut yields; however, the diet influenced the rib yield, which showed the lowest value for treatment with 66% of castor meal. Carcass muscularity was affected by the diet, and in the muscle: bone ratio of the leg, a lower average for those fed with 100% of castor meal was observed. There were differences between tissue constituents of leg, muscle, bone and other tissues, and in the palette, bone and other tissues differed. The rib eye area was similar between treatments. There was a significant effect (p <0.05) between treatments for the centesimal composition, with lower percentage of fat, protein and moisture at substitution levels of 66, 100 and 33% respectively. The substitution of castor meal provided an interesting fatty acids profile for consumer health, featuring the best ratios for the evaluated relations between fatty acids. There was no statistical difference between treatments for parameters pH and shear force; however, there was an effect of the substitution in weight loss due to cooking, showing lower percentage 24.42% (p <0.05) in 33% of substitution. The sensory characteristics were evaluated considering attributes such as hardness, juiciness, flavor, color, aroma and overall acceptability. It was shown that diet with 33% of substitution provided meat with higher hardness but without compromising its acceptance. There was no change in the other meat sensory attributes. It could be concluded that the use of diets containing detoxified castor meal as partial substitution for soybean meal does not affect the carcass characteristics of Santa InÃs lambs, weight and yield of retail cuts and tissue composition, maintaining its physicochemical and sensory quality.

Foram realizados dois experimentos, conduzidos na Fazenda Escola e no Laboratório de Nutrição Animal da Universidade Estadual de Londrina. O primeiro experimento teve como objetivo avaliar o desempenho, características de carcaça e da carne de borregas Santa Inês alimentadas em pastagem cultivada de Capim Aruana (Panicum maximum cv. Aruana) recebendo níveis diferentes de suplementação concentrada. Foram utilizadas 36 borregas com 12 meses. O delineamento experimental foi inteiramente casualizado, onde foram testados dois níveis de suplementação concentrada a base de milho e farelo de algodão (0,2 e 0,7% do PV), com dezoito repetições por tratamento. O peso final, ganho de peso e a conversão alimentar não foram afetados pelos tratamentos. Os rendimentos de carcaça quente e fria, as medidas de carcaça como comprimento, perímetro e medidas do braço e perna não tiveram efeito da do nível de suplementação. Das medidas do músculo longissimus dorsi apenas o marmoreio diferiu no nível de suplementação no tratamento a 0,2% apresentando o maior valor escalonado, de 3. A cor da carne e perdas de água não foram afetadas, exceção apenas para a perda de água por cocção, onde a suplementação de 0,7% apresentou as menores perdas, de 24,9%, em comparação com a média geral de 28,5%. A força de cisalhamento e o marmoreio não tiveram efeitos dos tratamentos. Os valores de L*, a* e c* também não foram afetados pelo nível de suplementação. O segundo experimento teve como objetivo avaliar o desempenho, características de carcaça e da carne de cordeiros Santa Inês alimentados com silagem de grãos úmidos de Triticale (X. triticosecale Wittmack) com diferentes aditivos e feno de capim Aruana. Foram utilizados 24 cordeiros, machos inteiros e fêmeas, com cinco meses. O delineamento experimental foi inteiramente casualizado, em esquema fatorial 4 x 2, onde foram testados três tipos de aditivos na silagem de grãos úmidos (controle, enzimo-bacteriano, benzoato de sódio e uréia) e dois sexos. O peso final, ganho de peso e a conversão alimentar não foram afetados pelos tratamentos. Os rendimentos de carcaça quente e fria, as medidas de carcaça como comprimento, perímetro e medidas do braço e perna não sofreram efeito do tipo de aditivo utilizado. As medidas do músculo longissimus dorsi e a área de olho de lombo também não foram afetadas. A cor e perdas de água não foram afetadas, exceção apenas para a perda de água por cocção entre os sexos, na qual as fêmeas apresentaram enores perdas, de 19,96%, em comparação com os machos de 34,48%. A força de cisalhamento foi menor nos animais do tratamento controle, de 4,3 KgF para os machos. Os valores de L*, a* e c* também não foram afetados pelos diferentes tipos de aditivos. Pelo presente estudo, conclui-se que o baixo desempenho apresentado pelos animais se deve ao não atendimento das exigências nutricionais das dietas utilizadas, principalmente em função da baixa qualidade do volumoso de Capim Aruana.
Two experiments were conducted, conducted in the School Farm and Animal Nutrition Laboratory at the Londrina State University. The first experiment aimed to evaluate the performance, carcass characteristics and meat lambs of Santa Ines fed grazing on grass Aruana (Panicum maximum cv. Aruana) receiving different levels of concentrate supplementation. Thirty-six lambs with12 months were used. The experimental design was completely randomized, where were tested two levels of concentrated supplementation based on corn and cottonseed meal (0.2 and 0.7% LW), with eighteen replicates. The final weight, weight gain and feed conversion were not affected by treatments. Hot and cold carcass yields, carcass measurements such as length, circumference and measures of arm and leg had no effect of the level of supplementation. The measures of the longissimus dorsi muscle marbling differed only in the level of supplementation to 0.2% treatment having the highest scaled value of 3. The color of flesh and water loss were not affected, except only for the loss of water cooking, where supplementation of 0.7% showed the lowest losses of 24.9% as compared to the overall average of 28.5% . The shear force and the marbling had no effect of the treatments. The L *, a * c * were not affected by the level of supplementation. The second experiment aimed to evaluate the performance, carcass and meat characteristics of Santa Inês lambs fed high moisture corn silage of Triticale (X. triticosecale Wittmack) with different additives and Aruana grass hay. They were used 24 lambs, males and females, with five months. The experimental design was completely randomized in a factorial 4 x 2, where they were tested three types of additives in high moisture corn silage (control, enzyme-bacterial, sodium benzoate and urea) and two sexes. The final weight, weight gain and feed conversion were not affected by treatments. Hot and cold carcass yields, carcass measurements such as length, circumference and measures of arm and leg suffered no effect on the type of additive used. The measures of the longissimus dorsi muscle and rib eye area were not affected. The color and water loss were not affected, except only for the cooking water loss between the sexes, in which the females showed enores loss of 19.96% compared with 34.48% for males. The shear force was lower in the control treatment the animals, 4.3 kgf in males. The L *, a * c * were not affected by different types of additives. By this study, it is concluded that the poor performance displayed by animals is due to not meeting the nutritional requirements of the diets used, mainly due to the low quality of the bulky grass Aruana.

PEREIRA, Mônica Synthia Cirino. Características da carcaça e da carne de cordeiros Santa Inês alimentados com farelo de mamona destoxificado. 2011. 110 f. : Dissertação (mestrado) - Universidade Federal do Ceará, Centro de Ciências Agrárias, Departamento de Zootecnia, Fortaleza-CE, 2011
Submitted by Nádja Goes (nmoraissoares@gmail.com) on 2016-08-09T13:51:44Z No. of bitstreams: 1 2011_dis_mscpereira.pdf: 916233 bytes, checksum: 308779bc576dd4e96fc2c8ed32fd1977 (MD5)
Approved for entry into archive by Nádja Goes (nmoraissoares@gmail.com) on 2016-08-09T13:51:57Z (GMT) No. of bitstreams: 1 2011_dis_mscpereira.pdf: 916233 bytes, checksum: 308779bc576dd4e96fc2c8ed32fd1977 (MD5)
Made available in DSpace on 2016-08-09T13:51:57Z (GMT). No. of bitstreams: 1 2011_dis_mscpereira.pdf: 916233 bytes, checksum: 308779bc576dd4e96fc2c8ed32fd1977 (MD5) Previous issue date: 2011
The objective of this study was to determine the characteristics of carcass and meat of Santa Inês lambs submitted to four experimental treatments with increasing concentrations of detoxified castor meal (0%, 33%, 66% and 100%) with dry matter basis. The bulk used consisted of mixed silage of elephant grass, sorghum and sugar cane. Thirty-two non-castrated male lambs were used and slaughtered with average body weight of 30 kg. Experimental tests were conducted in a completely randomized design with four treatments and eight replications (lambs). Data were submitted ANOVA and means compared by Tukey test at 5%. The animals were fasted of food and water for 24 hours and bleeding was performed with section of carotid artery and jugular vein, followed by evisceration. After slaughter, the carcasses were chilled for 24 hours at 4°C and pH was measured on the semimembranosus muscle at 45 minutes and 24 hours after slaughter, also determining weight, hot and cold carcass yield and morphometric measurements. The carcass was longitudinally sectioned into half carcasses, and retail cuts such as leg, loin, rib, rear, neck and shoulder on the right half carcass were obtained, followed by weighing and freezing of shoulder and leg for further evaluation of tissue composition. The longissimus dorsi muscle was used for the qualitative assessments of meat, weight loss due to cooking, shear force, fat content, fatty acid profile, protein content, ash, moisture and sensory analysis. Diet with 100% of castor meal showed the lowest cold carcass yield, leg circumference and chest depth. No statistical difference between treatments was observed for weight and cut yields; however, the diet influenced the rib yield, which showed the lowest value for treatment with 66% of castor meal. Carcass muscularity was affected by the diet, and in the muscle: bone ratio of the leg, a lower average for those fed with 100% of castor meal was observed. There were differences between tissue constituents of leg, muscle, bone and other tissues, and in the palette, bone and other tissues differed. The rib eye area was similar between treatments. There was a significant effect (p <0.05) between treatments for the centesimal composition, with lower percentage of fat, protein and moisture at substitution levels of 66, 100 and 33% respectively. The substitution of castor meal provided an interesting fatty acids profile for consumer health, featuring the best ratios for the evaluated relations between fatty acids. There was no statistical difference between treatments for parameters pH and shear force; however, there was an effect of the substitution in weight loss due to cooking, showing lower percentage 24.42% (p <0.05) in 33% of substitution. The sensory characteristics were evaluated considering attributes such as hardness, juiciness, flavor, color, aroma and overall acceptability. It was shown that diet with 33% of substitution provided meat with higher hardness but without compromising its acceptance. There was no change in the other meat sensory attributes. It could be concluded that the use of diets containing detoxified castor meal as partial substitution for soybean meal does not affect the carcass characteristics of Santa Inês lambs, weight and yield of retail cuts and tissue composition, maintaining its physicochemical and sensory quality.
Objetivou-se determinar as características de carcaças e da carne de cordeiros Santa Inês em confinamento, submetidos a quatro tratamentos experimentais com uso crescente de farelo de mamona destoxificado (0%, 33%, 66% e 100%) com base na matéria seca. O volumoso utilizado foi silagem mista de capim elefante, sorgo e cana-de-açúcar. Foram utilizados 32 cordeiros machos não castrados, abatidos com peso corporal médio de 30 Kg. Os ensaios experimentais foram realizados num delineamento inteiramente casualizado com quatro tratamentos e oito repetições (ovinos). Os dados foram submetidos ANOVA e as médias comparadas pelo teste de Tukey a 5%. Os animais foram submetidos a jejum hídrico e alimentar de 24 horas, a sangria foi feita com secção da artéria carótida e veia jugular, seguida da evisceração. Após o abate as carcaças foram resfriadas por 24 horas a 4º C e realizadas as leituras de pH no músculo semimembranosus aos 45 minutos e 24 horas pós abate, e determinados o peso, rendimento da carcaça quente e fria e efetuado as medições morfométricas. A carcaça foi seccionada longitudinalmente em meias carcaças, sendo obtidos os cortes comerciais de perna, lombo, costilhar, serrote, pescoço e paleta na meia carcaça direita, seguidos de pesagem e congelamento da paleta e da perna para posterior avaliação da composição tecidual. Utilizou-se o músculo longissimus dorsi para as avaliações qualitativas da carne, perda de peso por cocção, força de cisalhamento, teor de lipídios, perfil de ácidos graxos, teor de proteínas, cinzas e umidade além da análise sensorial. A dieta com 100% de farelo de mamona apresentou menor valor em rendimento de carcaça fria, perímetro de perna e profundidade de tórax. Não foi observada diferença estatística entre os tratamentos testados, para o peso e rendimento dos cortes, no entanto a dieta influenciou o rendimento do costilhar que apresentou menor valor para o tratamento com 66% de substituição de farelo de mamona. A estimativa de musculosidade da carcaça sofreu efeito da dieta, na relação músculo:osso da perna, verificou-se menor média para aqueles alimentados com 100% de farelo de mamona. Houve diferença entre os tecidos constituintes da perna, tecido muscular, ósseo e outros tecidos, na paleta diferiram os tecidos ósseos e outros tecidos. A área de olho de lombo foi similar entre os tratamentos. Verificou-se efeito significativo (p<0,05) entre os tratamentos para a composição centesimal, com menor percentual de gordura, proteína e umidade nos níveis de substituição 66, 100 e 33%, respectivamente. A substituição do farelo de mamona proporcionou um perfil de ácidos graxos interessantes à saúde do consumidor, apresentando os melhores índices para as relações avaliadas entre os ácidos graxos. Não foi observada diferença estatística entre os tratamentos para os parâmetros pH e força de cisalhamento no entanto verificou-se efeito dos níveis de substituição na perda de peso por cocção apresentando menor percentual 24,42% (p<0,05) em 33% de substituição. Avaliaram-se as características sensoriais considerando os atributos dureza, suculência, sabor, cor, aroma e aceitação global. Foi evidenciado que a dieta com 33% de substituição proporciona uma carne com maior dureza, sem, contudo, comprometer a sua aceitação. Não se observou variação dos demais atributos sensoriais da carne. Pode-se concluir que a utilização de dietas contendo farelo de mamona destoxificado em substituição parcial ao farelo de soja não interfere nas características de carcaça de ovinos Santa Inês, bem como nos pesos e rendimentos dos cortes comerciais e composição tecidual, mantendo a qualidade físico-química e sensorial.

This research aimed to provide a set of suggestions of environmental actions and management with subsidies for the preservation of water resources and public health, in favor of the natural lakes system of the Carstic of Lagoa Santa Environmental Protected Area, using ecological metrics such as trophic indices, dissolved organic carbon content-DOC, phytoplankton assemblages, morphometric characteristics of the lakes and major uses soil occupation of the basin, in order to indicate the trophic state and environmental quality of these ecosystems. Basic limnological parameters were measured in four lakes (Confins, Olhos dÁgua, Sumidouro and Mares) during dry and rainy periods of 2009 and 2010. Surveys of land use and occupation and morphometric data were obtained specifically for Lake Sumidouro. The lakes trophic level ranged from oligotrophic to hypereutrophic according to the distinct trophic indices used which indicated Lake Confins as a hypereutrophic lake. The DOC concentration was higher in lakes Sumidouro and Confins. Moreover, it offered (through regression analysis) a logarithmic relationship with two of the evaluated trophic indices. The phytoplankton functional groups J, P, X1 e TC, which were associated with eutrophic environments, correlated positively with total-N, total-P, PO4-P and TSI, as well as most of the samples from lake Confins. DOC and phytoplankton assemblages proved to be valuable tools in evaluating trophic status, despite exhibiting limitations as any environmental evaluation methods, as demonstrated by the use of trophic indices in general. Morphology, land use and occupation of the basin and estimation of total phosphorus load indicted to be potential predictive tools to be used in environmental analyses of environments vulnerable to eutrophication events.
Esta pesquisa teve como objetivo contribuir com subsídios para uma política de gestão e de ações ambientais em prol dos ecossistemas lacustres da APA Carste de Lagoa Santa, visando à preservação do manancial e saúde pública, através da avaliação do potencial de ferramentas (índices tróficos, COD, assembleias fitoplanctônicas, características morfométricas do lago e uso e ocupação da bacia hidrográfica) na indicação do estado trófico e de qualidade ambiental destes ecossistemas. Parâmetros limnológicos básicos foram mensurados em 4 lagoas (Confins, Olhos dágua, Sumidouro e Mares) durante a chuva e a seca dos anos de 2009 e 2010. Levantamentos dos usos e ocupação do solo e dados morfométricos foram obtidos especificamente para a lagoa Sumidouro. O nível trófico das lagoas variou de oligo a hipereutrófico pelos diferentes índices utilizados, sendo a Lagoa de Confins a que apresentou os maiores graus de trofia. A concentração de COD foi maior em Sumidouro e Confins e apresentou, através de análise de regressão, uma relação logarítmica com dois dos índices tróficos avaliados. Os grupos funcionais fitoplanctônicos associados a ambientes eutróficos, J, P, X1 e TC correlacionam-se positivamente com N-total, P-total, PO4-P e IET, assim como a maior parte das amostras da lagoa Confins. O COD e as assembleias fitoplanctônicas demonstraram ser ferramentas eficientes na avaliação de estado trófico, no entanto, possuem limitações como quaisquer métodos de avaliação ambiental, como observado na utilização dos índices tróficos. A morfologia, uso e ocupação do solo da bacia e estimativa da carga total afluente de fósforo demonstraram ser potenciais ferramentas preditivas na análise ambiental de ambientes vulneráveis a eventos de eutrofização.

After the elections in 2006 there was a change of government in Sweden, when the Moderate Party with the right block took over the power from the Social democrats. The politics of the new government is more liberal than the politics of the Social democrats, which implied several changes of the Swedish social security system, in particular some important changes of the sickness benefit.

The objective of this essay has been to examinate the changes of the system, as well as the reasons for the changes, and also to compare the system in Sweden to the one in France, who has another structure.

The methods used are archive and corpus crossings in terms of collecting information from literature and websites of the social insurance offices in Sweden and in France. Further a qualitative method has been carried out in shape of an interview with the administrative official responsible of the sickness benefit at the social insurance office in Växjö.

The result has shown that there are several reasons for the changes in the Swedish system. It seems as if the most important reason is the big number of individuals on the sick-list which causes economical problems, since the employment rate is too low compared to the retired quotient of the population. The economical crises might have an influence on the changes of the systems, but not the present recession. Despite the rather big changes from a social system towards a more liberal one, the Swedish scheme has still kept its basic characteristics.

En 2006, la Suède a eu un changement de gouvernement. Les sociaux-démocrates ont été remplacés par l'alliance entre les partis à droite. Le nouveau gouvernement mène une politique plus libérale que les sociaux-démocrates, et ils ont introduit plusieurs changements dans le système de santé et particulièrement dans le règlement de l'indemnité journalière.

Ce mémoire a pour but d'examiner les changements dans le système, ainsi que les raisons de ces changements.

Les méthodes appliquées sont l'archive et le corpus, puisque j'ai étudié les ouvrages relatifs à la santé ainsi que les sites Internet des institutions responsables de l'indemnité journalière en Suède et en France. J'ai aussi eu un entretien avec un employé de la Caisse de Sécurité sociale à Växjö qui s'occupe particulièrement de l'indemnité journalière.

Les résultats de cette étude montrent qu'il y a plusieurs raisons à l'origine des changements dans le système suédois. Il semble que la raison la plus importante soit le nombre croissant de personnes en arrêt maladie ce qui génère des difficultés économiques, de même la proportion de la population active par rapport aux retraités est au cœur de la problématique. Enfin, les crises économiques peuvent influencer le système, mais la crise actuelle ne semble pas avoir eu une influence importante sur les changements.

Malgré les changements assez bouleversants vers un système plus libéral en Suède, qui tend à se rapprocher légèrement du système français, le système suédois reste plus social que le système français.

Aider à la décision de la mise en place d'un programme de dépistage en santé bucco-dentaire, tel est le thème abordé. Ce travail repose sur une approche en deux parties : la qualité de l'information sur laquelle repose l'analyse décisionnelle et l'étude d'une méthode fondée sur la théorie de l'utilité attendue. Une évaluation de la littérature internationale en santé bucco-dentaire, portant sur des études transversales avec mesure de l'indice carieux, aborde la qualité de l'information produite. Pour réaliser cette analyse critique de la littérature, une grille de douze critères a été constituée et deux méthodes complémentaires d'analyses utilisée : l'A. F. C. M. Et l'agrégation lexicographique. Sur les vingt-deux études incluse, issue de medline sur la période 1986-1996, aucune n'a pleinement satisfait nos critères. Cette approche s'accompagne d'un regard sur la méthode de production de l'information brute et plus particulièrement de l'échantillonnage avec la technique des quotas. Dans le cadre d'une étude internationale en santé bucco-dentaire réalisée en France en 1993, l'étude des différents facteurs source de variabilité montre que cette technique d'échantillonnage, utilisée avec rigueur, pourrait être plus employée en épidémiologie. Quand à l'aide décisionnelle en terme d'utilité attendue, elle nécessite la définition de loteries avec leurs utilités associées. Notre recherche a porté sur les conditions nécessaires et suffisantes à propos des coefficients d'utilité afin d'obtenir un dépistage préféré au non dépistage. La sensibilité de l'examen diagnostic joue un rôle essentiel. Une application de cette méthode a été présentée pour les jeunes Français de 15 ans. Ce travail met en évidence la nécessité d'améliorer le processus de diffusion de données épidémiologiques sur l'indice carieux et au-delà montre que l'analyse décisionnelle est une voie intéressante de nos jours à développer en santé publique.

A presente dissertação pretende contribuir para a compreensão dos processos de patrimonialização. Especificamente, exploram-se contextos quotidianos associados à prática do Cante Alentejano, delineando as suas reconfigurações e manifestações contemporâneas. A pesquisa é ancorada metodologicamente em investigação etnográfica na localidade de Santo Aleixo da Restauração (Moura). Neste contexto empírico, caracterizam-se os espaços sociais onde é desenvolvido o quotidiano do Cante Alentejano, de forma a perceber o dualismo entre a sua prática quotidiana e aquilo que é a sua patrimonialização, tal como é percepcionada pelos atores sociais locais; Abstract: This dissertation aims to contribute to the understanding of processes of heritagization. Specifically, we explore contexts of daily practice of Cante Alentejano and identify the current manifestations and reconfigurations of this practice. Methodologically, research is based in an ethnography conducted in the locality of Santo Aleixo da Restauração (Moura). In this empirical context, we analyse daily social spaces where Cante Alentejano has been developed, with the purpose of understanding the dualism between this daily practice and the process of patrimonialization, as i tis perceived by local social actors.

L'intégration de la santé mentale dans les soins primaires a été décrite comme une stratégie efficace pour s'attaquer au fardeau toujours croissant de la maladie mentale, faisant d’elle une priorité mondiale. Des expériences réussies sont rapportées dans plusieurs études aussi bien dans les pays en développement que dans les pays développés. En Guinée, une expérience d’intégration des soins en santé mentale dans des centres de santé est en cours depuis 20 ans. Initiée par l’Organisation Non Gouvernementale Fraternité Médicale Guinée dans le cadre du projet Santé Mentale en Milieu Ouvert Africain (SaMOA), cette expérience concerne actuellement 5 centres de santé associatifs et 5 centres de santé publics. Notre recherche doctorale analyse cette expérience et examine dans quelle mesure et par quels mécanismes l’intégration de la santé mentale en première ligne peut non seulement améliorer l’accès aux soins de santé mentale mais aussi renforcer la qualité des soins en général à travers une approche plus centrée sur le patient. Nous avons évalué l’expérience à travers plusieurs études, menées dans une approche d’évaluation basée sur la théorie. La première étude a permis de décrire minutieusement l’expérience menée, en l’organisant par une ligne du temps, sur base de la documentation rassemblée. Cette expérience pilote a trouvé un terreau favorable dans les centres de santé associatifs de Fraternité Médicale Guinée caractérisés par un fonctionnement peu bureaucratique. Elle a été ensuite étendue à d’autres centres de santé publics et associatifs.La seconde étude avait pour objectif d’appréhender les éventuelles attitudes de stigmatisation parmi les étudiants de première et dernière année en médecine à l’Université de Conakry, à partir de focus groups interrogeant leurs représentations de la maladie mentale, des malades mentaux et de la psychiatrie. Beaucoup regrettent la discrimination dont font l’objet les malades mentaux dans la société guinéenne, mais partagent néanmoins avec la population générale des attitudes de stigmatisation. Le stéréotype dominant est la grande folie, même si les étudiants de dernière année citent des troubles mentaux plus diversifiés. Il y a une forte adhésion aux modèles explicatifs profanes intégrant les forces occultes ainsi qu’au recours aux soins traditionnels pour les traiter, y compris parmi les étudiants de dernière année de médecine. La troisième étude analyse les effets de l’intégration de la santé mentale sur les attitudes du personnel :déstigmatisation de la maladie mentale d’une part, approche centrée sur le patient d’autre part. Elle repose sur des entretiens semi-structurés avec 27 soignants de centres ayant intégré la santé mentale (SM+) et 11 soignants de centres n’offrant pas de soins en santé mentale (SM–). Contrairement aux soignants SM– au discours stigmatisant, tous les soignants SM+ ont surmonté leurs peurs et développé des attitudes positives envers les malades mentaux, notamment grâce à l’expérience de succès thérapeutiques. Une partie des SM+ a en outre découvert et adopté une approche centrée sur le patient, tandis que d’autres restaient dans une logique biomédicale. Un facteur favorable à l’approche centrée sur le patient a été un dispositif de formation in situ (consultations conjointes, travail en équipe, action communautaire) prenant en compte les besoins émotionnels des soignants et proposant un modèle de rôle centré sur le patient. Mais ce dispositif n’a pu fonctionner de manière optimale que dans le contexte non bureaucratique d’un centre associatif à orientation communautaire, implanté dans la capitale et disposant d’une équipe stable et qualifiée.La quatrième étude évalue l’utilisation des soins en santé mentale dans les 5 centres ayant intégré ces soins à partir des données des registres de consultation et des dossiers individuels de malades. Dans ces centres, les problèmes de santé mentale représentent en moyenne 3% des premiers contacts. Toutes les pathologies mentales courantes sont rencontrées et prises en charge. L’utilisation des soins varie assez fortement d’un centre à l’autre.Enfin la cinquième étude a analysé 450 consultations menées par 18 prestataires dans des centres de santé, afin d’évaluer dans quelle mesure l’intégration des soins de santé mentale avait amélioré la qualité des relations soignants-soignés dans des soins de première ligne en général. Les données ont été recueillies par l’observation des 450 consultations sur base de l’outil Global Consultation Rating Scale (CGRS), des entretiens individuels avec les patients à la sortie de la consultation sur base du Patient Participation Scale (PPS) et des questionnaires auto-administrés par les prestataires. La comparaison des 175 consultations menées dans des centres ayant intégrés les soins de santé mentale avec les 275 consultations menées dans des centres non intégrés, met en évidence un score de participation plus élevé pour les patients consultant dans des centres intégrés. La qualité de la communication soignants-soignés est également meilleure pour les consultations menées dans ces centres. Le discours des soignants SM+ est plus centré sur le patient et se distingue du discours plus biomédical des SM-.L’expérience a donc montré que, dans des conditions favorables, il est possible d’intégrer la santé mentale dans la pratique des centres de santé, avec des bénéfices en termes d’accès aux soins, de pathologies prises en charge, de réduction de la stigmatisation, du renforcement d’une approche plus globale de la santé mentale et de l’évolution des soins de santé primaires en général vers une approche plus centrée sur les patients. Plusieurs pistes de réflexions pour l’élargissement et la poursuite de l’intégration de la santé mentale en Guinée et dans d’autres pays à faibles revenus sont discutées :(1) un processus de formation intégrant le transfert de connaissances et l’acquisition d’attitudes centrées sur le patient ;(2) un encadrement continu des soignants ;(3) une culture organisationnelle non bureaucratique encourageant l’initiative et la réflexivité ;(4) la disponibilité en médicaments psychotropes essentiels et génériques ;(5) l’établissement de ponts avec la médecine traditionnelle et (6) la mise en réseau des acteurs du domaine de la santé mentale. L’enjeu actuel pour la Guinée est le passage à échelle de manière à étendre significativement la couverture en soins de santé mentale tout en favorisant leur qualité. Les leçons que nous en tirons pourront guider les gestionnaires des systèmes de santé à développer des soins de santé mentale et d’en tirer les bénéfices en termes d’accès, d’utilisation et de qualité.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

Face à des injonctions éthiques et sociales, la formation des professionnels santé est devenue un défi en particulier dans la gestion des risques en situation critique. La simulation interprofessionnelle (SIP) est un dispositif de formation incontournable dans la formation des professionnels de santé. Cependant, le dispositif de SIP favorise les effets induits par l’asymétrie sociale (peur du jugement, conflits de pouvoir, rôles hiérarchiques) perturbant la régulation des conflits sociocognitifs à la base du processus d’apprentissage. Nous avons proposé une évolution du dispositif standard vers un dispositif de SIP avec un débriefing combiné (entretien individuel avant le débriefing collectif - CODIS). Une méthodologie de recherche mixte a été menée avec comme intention de « connaître pour objectiver » les effets du dispositif et de « connaître pour expliquer » les effets observés ou mesurés. L’hypothèse principale était que le dispositif CODIS était plus efficace que la SIP standard pour le développement des compétences des équipes de soins aigus dans la gestion de situation critique. Une approche multidimensionnelle a permis de conclure que CODIS était plus efficace dans la régulation des émotions, a amélioré les interactions sociales au moment du débriefing collectif et a diminué les tensions hiérarchiques avec comme résultante l’amélioration de la performance des équipes de soins aigus dans la gestion d’une situation critique en particulier dans les comportements liés au leadership. Une réflexion épistémologique nous a conduit à nous questionner sur les modèles d’évaluation des dispositifs de formation par simulation dans le domaine de la santé. Nous proposons une approche méthodologique différente suite à ce travail de recherche afin d’explorer les effets internes et externes du dispositif. De nouvelles recherches devront être menées dans une visée transformative
Considering the ethical and social injunctions, the training of health professionals has become a challenge especially crisis resource management. Interprofessional simulation (IPS) has become an essential tool in the training of healthcare professionals. However, the IPS promotes social asymmetry (fear of judgment, power conflicts, hierarchical roles) that disrupts the regulation of sociocognitive conflicts as the foundation of the learning process. We proposed an evolution from the standard debriefing to a combined debriefing (individual interview before the collective debriefing - CODIS). A mixed research methodology was conducted with the intention of "knowing to objectify" the effects of the method and "knowing to explain" the observed or measured effects. The hypothesis was that CODIS could be a more effective interprofessional training than the standard debriefing for developing the skills of acute care teams in crisis resource management. A multidimensional approach concluded that CODIS was more effective in regulating emotions, improved social interactions during collective debriefing and reduced hierarchical tensions combined with an improvement of acute care teams performance in critical situation management. An epistemological reflection led us to question the assessment of simulation-based training. We propose a different methodological approach to explore the internal and external effects of the device. Further researches should be carried out to evaluate this methodology