Dissertations / Theses on the topic 'GCCA'

Thesis (MEng)--Stellenbosch University, 2014.
Construction projects have developed over several decades through the advancement of technology, increased scarcity of resources and the ever increasing pressure of time and cost constraints. Because of new technology and modern construction methods, construction projects have become increasingly complex. These complexities inherently bring new risks that must be dealt with accordingly. A contract is the primary method through which risks are allocated between the Employer and the Contractor. The conditions allocating the risks legally bind both parties to accept responsibility of those risks, therefore it is important to understand the aspects of law that has bearing on contracts. In this thesis the scope is restricted to construction contracts. Because of the role that a contract plays, especially in the construction industry context, it is important to know the requirements of a modern contract to ensure the successful completion of projects and the continued sustainability of Employer-Contractor relationships. In South Africa, the Construction Industry Development Board (CIDB) is a body that monitors developments in the construction industry. The CIDB has the authority to enforce legislation to ensure that contracts conform to a standard that protects the interests of both the Employer and the Contractor. One of the procurement documents endorsed by the CIDB is the General Conditions of Contract for Construction Works published by the South African Institution of Civil Engineering (SAICE). The first edition of the GCC was published in 2004 (GCC 2004) and a revised second edition was published in 2010 (GCC 2010). In this study the GCC 2010 and the GCC 2004 are compared first through a content analysis, to establish the effect the revisions on the bias of the document (or favouring a particular party) and then by means of a survey. The objectives are: a. To test whether revisions to the GCC from the 2004 edition to the 2010 edition resulted in a change in bias (assuming it exists) and compliance with the requirements of the modern contract; b. To determine the extent and effect of alterations to standard clauses of the GCC 2010 on the way in which the contract favours a particular party; c. Providing recommendations for future revisions that would potentially improve project success, relationship building and reduce the need for significant alterations to the standard clauses. Although a construction contract is undertaken between the Employer and the Contractor, the Consultant (who is not party to the contract) commonly drafts the contract on behalf of the Employer. The findings of the study show that the revision had a significant impact on improving the clarity of the roles of the Employer and the Contractor. A marginal improvement was found in the area of payment operating mechanisms. The perceived fairness of the document neither increased nor decreased. Clauses on claims and disputes and risk and related matters were the two areas that respondents identified as having the most bias that may be detrimental to the success of a construction project. Despite survey respondents finding the GCC 2010 procurement document to be fair, clauses are still altered by Employers (probably through Consultants) resulting in a biased contract favouring the Employer. Employers and Consultants should thus be educated more on bias and fairness in contracts and on the implications of shifting more risk to Contractors by altering clauses. Ultimately, the success of any construction project is dependent on the attitudes of the participants. Even the most fair procurement document is not a substitute for a relationship built on honesty and trust.

The subject of this thesis is to study the existing development toolchain for the microprocessor LPC23xx in course MPOA. Main goal is to explore the feasibility of new development toolchain, based on the GCC. The outcomes of this thesis are demo applications with the microprocessor LPC2378 and the GCC. Parts of the outputs are also tutorials for the students, how to implement these demo applications. The demos include basic applications, RTOS and Ethernet

This thesis explores the EU-GCC relationship and tests the hypothesis that if the EU and the GCC states share interests and grand goals, to the extent that these are prioritised by the EU and its member states, then value-driven differences are subordinated to interests and as a result (i) the EU and the GCC states enhance their relationship towards a “strategic partnership” and (ii) the EU’s (self-) image as a foreign policy actor is weakened in terms of its normative (self-)image and enhanced in terms of its effectiveness as a useful ‘strategic partner’ in a multipolar and interdependent world. In doing so, the thesis attempts to provide a comprehensive conceptualisation of a ‘strategic partnership’ and to test it within the broader context of EU foreign policy, exploring the role of interests, values and (self-)images in the shaping of EFP. The framework of ‘strategic partnership’ is applied in two case studies of economics and politics; the EU-GCC negotiations for establishing a Free Trade Area and the cooperation of the EU and the GCC states in dealing with the crises in Yemen. The findings of the research suggest that the EU and the GCC states, to the extent that they prioritise their common interests and respond to each other’s (self-) images deriving from the current symmetrical power balance, are moving towards a strategic partnership. Despite the wide gap in the value systems of the parties, this factor has not been the most decisive for the development of this relationship. This conclusion calls for further exploration of the shaping and application of EFP, especially having in mind on one hand the ‘normative power’ argument and on the other hand the need of the EU to negotiate interests, values and perceptions when dealing with emerging powers. Regarding the concept of ‘strategic partnerships’ the research confirms the central role of the symmetrical power balance between the parties and their interdependency. It has identified a level of division of labour between the EU and the GCC states regarding regional challenges and it has highlighted the role of non state actors. It has also underlined the need for flexibility, questioning the role of cohesiveness and institutionalisation of interactions as prerequisites for a ‘strategic partnership’.

This thesis analyses the cost and profit efficiencies of the GCC banking sector over the period 1995-2000. Efficiencies are estimated using the most recent frontier technique, the Fourier Flexible form. The thesis also uses a logistic regression model to estimate the determinants of GCC banking efficiency. The findings show that the level of inefficiencies in the GCC banking industry ranges between 8 and 10% for costs, and 30 and 32 % for profits. There are no major differences in banks inefficiency levels among GCC countries. Moreover, inefficiencies show almost stable trends over 1995-2000. Comparisons of inefficiency levels across bank ownership type and assets size reveal that national banks are more cost efficient but less profit efficient than foreign banks. In terms of bank size, large banks are found to be more cost efficient but less profit efficient than other sized banks. The results also indicate that foreign banks have on average been operating with higher scale diseconomies than national banks. Moreover, scale diseconomies decline as the assets sizes of both national and foreign banks increase. The main results from our logistic regression are that the strengthening of financial capital is a central element explaining bank efficiency in the GCC region; however, the erosion in loan quality reduces banking sector efficiency. The main policy conclusion from this thesis is that GCC governments need to continue to implement financial reform packages that strengthen banking system soundness, foster banking competition, and also devise incentive schemes to improve managerial efficiency in order that GCC banks are better placed to meet the challenges of greater openness.

Funktionsexpansion är ett viktigt koncept inom mjukvaruoptimering, det ämnar att minska programmets körtid till kostnad av programmets storlek. Denna rapport presenterar möjligheter för hur användare kan justera expansionen i GCC samt redovisar resultaten i körtid och programstorlek. Två GCC-flaggor för funktionsexpansion har studerats och testats vid kompilering av fyra olika Unix-verktyg. Resultat visar att det är svårt att uppnå förbättringar vid justering av flaggorna och att antalet iterationer av de tidiga expansionsfaserna i GCC bör öka i takt med att optimeringsnivån ökar.
Function expansion is an important concept in software optimisation, its goal is to decrease execution time at the cost of an increase of the program binary size. This report presents options for fine tuning of function expansion in GCC aswell as the performance profit that can be achieved in execution time and binary program size by adjusting these parameters. Two GCC-flags for function expansion has been studied and tested with four different Unix tools. Results show that it is difficult to achieve improvements by adjusting the parameters and that the amount of iterations in the early inliner in GCC should increase as you increase the level of optimisation.

Thesis (M.A. in National Security Affairs)--Naval Postgraduate School, December 2002.
Thesis Advisor(s): James A. Russell, Glenn E. Robinson. "December 2002." Includes bibliographical references (p. 79-85). Also available in print.

This dissertation consists of the three essays; in these three essays I study different areas of trade integration among Gulf Cooperation Council Countries (GCC) by examining the effect of GCC Free Trade Agreement (GCC FTA) on trade among GCC countries during the 1983-2010 period. In the three essays, different variations of the gravity model of international trade are applied to a set of bilateral trade flows among 54 countries representing GCC countries and their major trade partners during the 1978-2010 period. The first essay is presented in chapter two, where I investigate the effect of GCC FTA on aggregate trade among GCC countries. The findings of chapter two suggest that GCC FTA has resulted in trade creation among GCC countries during the 1983-2010 period. The second essay is presented in chapter three, where I investigate the effect of GCC FTA on intra-industry trade among GCC countries. Investigating GCC FTA effects for disaggregate trade is important, as the aggregate results may suffer from aggregation bias. Also, it helps identify the sectors that benefit more from GCC FTA which is an important issue for GCC countries that are seeking diversification of their economies. Chapter three results suggest that GCC FTA trade creation was more concentrated in sectors that exhibit lower shares of GCC intra-trade during the 1983-2010 time period. The third essay is presented in chapter four where I investigate whether GCC FTA trade creation/destruction effect (aggregate and intra-industry trade) among GCC countries was attributed mainly to new trade relations (extensive margin) or to existing trade relations (intensive margin), and whether GCC FTA led to an increase in new trade relations among GCC countries. Chapter four results suggest that GCC FTA trade creation is attributed mostly to trade along the intensive margin while GCC FTA has a negative effect on trade along the extensive margin for most trade sectors. Overall, the results of the three essays suggest that trade integration among GCC countries is not very deep. Although GCC FTA is effective at the aggregate level, however GCC FTA failed to promote trade among GCC countries in larger intra-trade industries and failed in creating trade in new products among GCC countries. GCC countries have plans for a unified currency, since a unified currency requires deeper levels of economic integration than those needed for an FTA, the shallow level of trade integration maybe a sign that GCC economies are not yet ready to adopt a unified currency.

On suppose que des vecteurs de données de grande dimension arrivant en ligne sont des observations indépendantes d'un vecteur aléatoire. Dans le second chapitre, ce dernier, noté Z, est partitionné en deux vecteurs R et S et les observations sont supposées identiquement distribuées. On définit alors une méthode récursive d'estimation séquentielle des r premiers facteurs de l'ACP projetée de R par rapport à S. On étudie ensuite le cas particulier de l'analyse canonique, puis de l'analyse factorielle discriminante et enfin de l'analyse factorielle des correspondances. Dans chacun de ces cas, on définit plusieurs processus spécifiques à l'analyse envisagée. Dans le troisième chapitre, on suppose que l'espérance θn du vecteur aléatoire Zn dont sont issues les observations varie dans le temps. On note Zn_tilde = Zn − θn et on suppose que les vecteurs Zn_tilde forment un échantillon indépendant et identiquement distribué d'un vecteur aléatoire Z_tilde. On définit plusieurs processus d'approximation stochastique pour estimer des vecteurs directeurs des axes principaux d'une analyse en composantes principales (ACP) partielle de Z_tilde. On applique ensuite ce résultat au cas particulier de l'analyse canonique généralisée (ACG) partielle après avoir défini un processus d'approximation stochastique de type Robbins-Monro de l'inverse d'une matrice de covariance. Dans le quatrième chapitre, on considère le cas où à la fois l'espérance et la matrice de covariance de Zn varient dans le temps. On donne finalement des résultats de simulation dans le chapitre 5.

This diploma thesis discusses the applicability of GCC optimization algorithms for the TI TMS320C6x processor family. Conditional and Parallel Execution is used to speed up the resulting code. It describes the optimization framework of the GCC version 4.0 and the implementation details
Diese Diplomarbeit behandelt die Anwendbarkeit der verschiedenen GCC Optimierungsalgorithmen für die TI TMS320C6x Prozessorfamilie. Bedingte und parallele Ausführbarkeit werden zur Beschleunigung eingesetzt. Sie beschreibt den Rahmen in dem die Optimierungen in Version 4.0 des GCC stattfinden und Details zur Implementierung

This thesis addresses the gap in the literature of the Gulf Cooperation Council and its distinct relations with the European Union by identifying the obstacles preventing the development of GCC–EU interregionalism, in two case studies: energy security and economic cooperation in the Mediterranean. By bringing an empirical application of interregionalism to the study of GCC–EU relations, the thesis draws an original comparison that is based on a Hettne and Söderbaum typology of regionness (2000) to determine the GCC’s and the EU’s types, levels of actorness and the subsequent type of interregionalism resulting from the interaction between their kinds. The theoretical construct of the thesis underlines interregionalism as a tool for consolidating the organisations’ identities and actorness and increasing their capacities at exerting influence within the changing dynamics in the regional and global theatres. In addition, this thesis sheds light on the obstacles that impede the development of interregional cooperation and the mechanism to overcome them. As such, the thesis considers the dynamics instigating the renewed interest in deepening GCC–EU interregional relations; outlines the tools available at the GCC and the EU, and highlights the implications of the Arab Spring and GCC–Asia ties on GCC–EU relations. By avoiding benchmarking the EU as a model, the thesis purports that cooperation in energy security is ongoing and is opening avenues for promising partnerships in renewables, energy sustainability and efficiency. On the other hand, the divergence in the organisations’ levels of actorness, economic strategies and the unwillingness to assess policies are major hindrances against a successful partnership in the Mediterranean. Asymmetries in actorness, bilateralism, the American influence and the growing GCC–Asia ties do impact the development of the relations; albeit, they do not impede the multilateral framework from producing unintended outcomes in other areas of the relations.

This dissertation explores economic integration in the context of the Gulf Cooperation Council countries (GCC), which planned to form a monetary union, by assessing three different but related empirical research questions regarding GCC financial markets and monetary policies. Chapter 2 presents the first essay, which empirically investigates the pairwise linkages and volatility spillovers between GCC stock markets. In particular, the goal of Chapter 2 is to investigate the extent to which past volatility is transmitted from one GCC stock market to another GCC market at the aggregate level (e.g., the general stock markets' price indices), and to determine whether a past volatility in one GCC market affects the current volatility in another GCC market. Furthermore, Chapter 2 attempts to extend the investigation of the volatility spillover at a more disaggregated level by capturing the intra-sectoral linkages and volatility spillover effects among equivalent sectors across the GCC stock markets, namely the banking, industrial and insurance sectors. Empirically, Chapter 2 exploits the causality-in variance test pioneered by Cheung and Ng (1996) and developed by Hong (2001), who introduced a class of asymptotic N(0,1) tests for volatility spillover between two time series that exhibit conditional heteroskedasticity and may have infinite unconditional variances. The second essay, Chapter 3, aims to examine the effect of the recent global economic and financial crisis originating in U.S. stock markets on the stock markets of the GCC countries and to determine whether the sharp falls in these markets were due to the existence of the phenomenon \contagion" or whether they just reflect the continuation of the strong economic and financial linkages between the GCC economies and the U.S. economy, which exist in all states of the world during good and bad times. In particular, Chapter 3 investigates whether contagion exists from the U.S. stock market to the stock markets of the GCC by comparing two sub periods before (stable) and after (turmoil) the collapse of Lehman Brothers, which is the largest bank to fill for bankruptcy in U.S. history and has been widely used by many economists as a benchmark for the U.S. economic and financial crisis (see Bekaert et al. (2012) and Mishkin (2010)). Empirically, Chapter 3 investigates the existence of contagion using the cross-market correlations tests pioneered by King and Wadhwani (1990) and developed by Forbes and Rigobon (2002), who criticized previous studies for their use of unadjusted correlation coeffcients to investigate the presence of contagion across stock markets due to the heteroskedasticity resulting from the bias in stock market returns of the crisis country. Hence, Forbes and Rigobon (2002) introduced the adjusted cross-market correlation coeficient, which does not depend on the volatility (variance) of the crisis country, especially during the turmoil period. The last essay is presented in Chapter 4, in which I investigate the implications of fixing exchange rate on monetary policy in the context of the GCC countries whose exchange rate regimes have been fixed to the U.S. dollar for a long time. In particular, Chapter 4 aims to assess the sensitivity of the GCC countries' interest rates to the U.S. rate, since the theory of interest parity suggests that fixing GCC exchange rates to the U.S. dollar should force GCC domestic interest rates to equal the U.S. interest rate. In addition, Chapter 4 interestingly attempts to assess the stability of this sensitivity across time and to investigate whether there exists a pronounced decoupling for some GCC countries over some sub-periods. Furthermore, the fact that some of the countries' exchange rates have pegged to the U.S. dollar over specific sub-periods, then moved away from the peg over some other sub-periods (e.g., Kuwait) also gives us a rich setting through which to investigate the implications of fixing the exchange rate on monetary policy and to determine whether a country's interest rate has a stronger association with a base country's rate under a pegged period than under a non-pegged period. Empirically, this is done by testing the Uncovered Interest Parity (UIP) of each individual GCC country's interest rate, using the U.S.'s interest rate as the base country. Chapter 4 considers the time series properties of the data and uses unit root and co-integration tests. For each GCC country, it also utilizes a level regression for each interest rate episode throughout the entire sample under investigation; uses the Quandt (1960) Likelihood Ratio statistic (QLR) to determine the timing of any potential structural break during which the country's interest rate sensitivity to the U.S. interest rate changes; and applies the Error Correction Model (ECM) to capture long-run dynamic behaviours between the GCC and U.S. interest rates.

The aim of this study is to investigate empirically the extent of mandatory disclosure with International Financial Reporting Standards (IFRSs) and the level of voluntary disclosure by firms in the Gulf Co-Operation Council (GCC) member states — namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE) — over the period 2010 to 2013, and to explain why some firms disclose more than others. It aims to investigate the determinants of mandatory disclosure and voluntary disclosure in the annual reports of GCC listed firms. It seeks to assess the relationship between a number of firm-specific characteristics such as corporate characteristics, ownership structure factors, corporate governance factors and cultural factors (manager’s personal characteristics) and the extent of mandatory and voluntary disclosures. In addition, the impact of voluntary disclosure level on mandatory disclosure level, the impact of mandatory disclosure level on voluntary disclosure level and sub-sample country groups. The extent of mandatory disclosure and the level of voluntary disclosure are examined using two different disclosure indices. The former disclosure index contains 325 mandatory disclosure items and the latter disclosure index comprises 129 voluntary disclosure items. The empirical approach is applied to the financial statements of 120 listed firms. Multivariate regression analysis is employed to explore the relationships between the extent of mandatory and voluntary disclosures and firm characteristics of the firms and year dummy variables. The firm characteristics include corporate characteristics, ownership structure factors, corporate governance factors and cultural factors (managers’ personal characteristics). In addition, to the impact of voluntary disclosure level on mandatory disclosure level, the impact of mandatory disclosure level on voluntary disclosure level and sub-sample country groups. The average level of mandatory disclosure requirements with the 24 IFRSs investigated across firms and years was 0.73, with a range from 61% to 87%. The level of mandatory disclosure increased from 0.71 in 2010 to 0.73 in 2013, indicating that the level of mandatory disclosure has been improving in the region over the study period. However, no firm throughout the study period fully satisfied the benchmark index created. The level of mandatory disclosure varies across the GCC listed firms. The highest average mandatory disclosure level for all years was in the UAE (0.77) followed by Qatar (0.76) Kuwait (0.73) Oman (0.71), Saudi Arabia (0.71) and Bahrain (0.69). Several firm characteristics helped to explain the level of mandatory disclosure. The extent of mandatory disclosure increased with firm size, international presence (international listing and international sales), group firms, firm age, the proportion of state share ownership, the degree of board independence, and the education level of the board directors and financial controllers. In addition, the level of mandatory disclosure also varied by industry type. In contrast, the level of mandatory disclosure decreased with profitability, the proportion of institutional share ownership, board size, CEO role duality, and the level of voluntary disclosure. In addition, there were significant differences in the level of mandatory disclosure through time and across country groups. The level of mandatory disclosure is higher in sub-sample country group (grouped by high level of exports). However, liquidity was found not a significant factor in explaining variations in mandatory disclosure levels. The average level of voluntary disclosure, for the GCC listed firms as a whole, across the 13 groups of information categories examined for all years was 0.31; that is, on average firms disclosed 31% of the voluntary disclosure items, with a range from 9% to 68%. The voluntary disclosure mean levels for all years were as follows: Saudi Arabia: 0.45, Oman: 0.36, Bahrain: 0.32, Qatar: 0.32, the UAE: 0.24 and Kuwait: 0.21. The level of voluntary disclosure increased by 1% over the sample period, from 0.31 in 2010 to 0.32 in 2013, indicating that the extent of voluntary disclosure has improved slightly in the GCC listed firms. However, no sample firm fully disclosed the full list of benchmark voluntary information items. The level of voluntary disclosure varies by the type of information, consistent with existing studies. The highest group scores were for general information (0.66), information about directors (0.57), foreign currency information (0.48) and market-based information (0.42), whereas the lowest group scores were for future prospects (0.08), research and development (0.11), employee information (0.18) and social policy and value added information (0.26). The findings show that GCC listed firms disclose significantly more general information, directors’ information, foreign currency information and market information than future prospect information, research and development information, employee and social information. The level of voluntary disclosure increased with firm size, leverage, profitability, the proportion of assets in place, multiple listing status, firm age, the proportion of state share ownership, board size and CEO role duality. In addition, the level of voluntary disclosure also varied by industry type. In contrast, the level of voluntary disclosure was lower for service sector firms, and in relation to the proportion of director ownership, the proportion of family members on the board and the extent of mandatory disclosure. In addition, the level of voluntary disclosure is higher in sub-sample country group (developed stock markets). The results show no significant differences in the level of voluntary disclosure through time. However, liquidity, the proportion of institutional share ownership, and the degree of board independence do not evidence a significant association with the level of voluntary disclosure.

Práce charakterizuje současnou ekonomickou situaci států GCC a jejich budoucí rozvoj v závislosti na úbytku ropy. Práce se zaměřuje na cestovní ruch, odvětví ekonomiky, které by se mohlo zásadním způsobem podílet na rozvoji těchto států. Popisuje základní předpoklady pro cestovní ruch a jaké postavení v současnoti cestovní ruch zaujímá v ekomonikách států GCC. Na příkladu Spojených arabských emirátů ukazuje jednu z možných cest, kterou by se mohly tyto státy vydat.

Le langage d'assignation statique unique, SSA, est l'une des représentations intermédiaires les plus communément utilisées dans les compilateurs industriels. Cependant l'intérêt de la communauté d'analyse statique de programmes est minime, un fait dû aux faibles fondations formelles du langage SSA. Cette thèse présente une sémantique dénotationelle du langage SSA, permettant des définitions formelles des analyses statiques du langage SSA en se basant sur les méthodes classiques de l'interprétation abstraite. D'un point de vue pratique, cette thèse présente l'implémentation des analyseurs statiques définis formellement dans un compilateur industriel, la Collection de Compilateurs GNU, GCC.

This thesis investigated the municipal solid waste management in GCC states. An investigation of the GCC municipal solid waste legislation's was conducted and compared and some comments and proposed changes were pointed. The main issue of municipal solid waste management in GCC states is the absence of regional co-operation on government level. Therefore recycling and composting that could have a major role in the enhancement of the environment in the GCC states were examined and several actions that could be taken by the GCC government were proposed. The government's role in helping to increase the participation of the public in waste management activities was discussed. A regional recycling scheme was investigated and proposed including some financial aspects. Composting facilities in GCC states were investigated and especially composting as an alternative in Kuwait. Some recommendations on composting were presented. Investigation of construction and demolition waste recycling opportunity in Kuwait was examined.

Anthropology
Ph.D.
This work analyzes the genetic basis of three neurodegenerative diseases using several thousands of individuals of European descent to determine a range of phenotypic heritability outside of what has been identified by prior methods. By measuring additive genetic variance genome-wide, measures of its contribution to the phenotypic variance of these diseases were substantially increased, in some instances by a factor of 10 or more. Additionally, regional-mapping methods identified segments of the genome exhibiting significantly high heritability estimates associated with one of the neurodegenerative diseases, Amyotrophic lateral sclerosis. This resulted in the detection of novel candidate regions and provided conclusive evidence for the polygenic architecture of this disease. Lastly, novel risk variants associated with Parkinson's disease were identified on the X chromosome, a previously ignored genomic region. Overall, the employment of new analytic methods produced robust and novel results, adding substantial information to the neurodegenerative disease literature and connecting the anthropological perspective with growing informatics-based methods.
Temple University--Theses

Globalisation has always been researchers' main concern and interest over a long period of the time. One effect of globalisation is that the composition of project teams had become increasingly diverse. The differing national cultural backgrounds of members increases the complexity of team composition, which regulates the success of the project performance. Research has shown that diverse teams outperform homogenous ones. Other studies have investigated the impact of national culture on projects. But our knowledge of how effectively companies can manage a complex, multicultural team project is inadequate and limited. Furthermore, theoretical and empirical studies concerning how the national cultural diversity of teams can impact project performance are limited. Most of the studies are qualitative, either focusing on one country or discussing one aspect of culture, and mainly considering team performance. To fill this gap, this study investigates the national cultural factors that influence multicultural project teams and determine the cultural dimensions that impact on project performance. In particular, it examines the influence of five national culture dimensions developed by Hofstede on multicultural team complexity variables including integration, communication, trust and knowledge-sharing, and to recognise how these factors are related to project performance. The territory chosen for this study was the Gulf Cooperation Council (GCC) countries, as all of these nations rely intensely upon an expat workforce because of the lack of both skilled and unskilled manpower in the local market. A survey instrument was extracted and developed from previously validated questionnaire scales. Pilot testing was conducted to ensure the scales, format and contents of the survey instrument were appropriate. A range of project team members were targeted, and 329 valid questionnaires were returned. The data obtained was analysed by using two widely used statistical software tools, SPSS and AMOS. The data analysis steps included reliability (Cronbach's alpha) and validity (Confirmatory Factor) analysis. Structural Equation Modelling (SEM) was used to test the entire model. By using SEM, it was possible to test the parsimonious nature of the model, identify the model, determine whether it makes theoretical sense, and examine its fit to the data. The relationship between national culture, team performance and project performance was analysed using path analysis as part of the SEM. The research outcome showed that national culture has a significant impact on the team performance, especially on integration, communication, trust and knowledge sharing, which will also moderate the relationship between national culture and project performance. The finding of this research study confirmed that there is a relationship between national cultural differences and project success. Understanding the cultural differences among team members, who are from different national cultural backgrounds, is an essential aspect of managing projects successfully. Moreover, mismanaging or ignoring cultural differences of the team members may lead to project failures. Furthermore, the outcomes have obviously shown that the optimal project performance is accomplished when the entire project team is thoroughly integrated and incorporated with the project purpose. This study contributes to the literature by delivering a deeper understanding of the cultural issues that influence the performance of multicultural project teams in GCC countries. In addition, it provides greater insight into national culture within projects context, in particular providing empirical evidence that different nationalities have different cultural orientations and that these different cultural orientations are associated with different levels of performance. In practice, the findings will assist project directors and managers in similar countries to further recognise the role of national culture in the context of enhancing project performance. In particular, project directors and managers can undertake an assessment of their teams' national cultural background and based on that, forecast the probable team and project performance. Where necessary, action can be taken to manage or even change the cultural orientation in terms of the attitudes and behaviours of project teams. This research expressed the views of professionals who work in a multicultural environment on the extent to which national cultural dimensions may affect the outcome of a project.

This thesis empirically investigates two important aspects of the benefits of currency (monetary) union - the beneficial impact of eliminating exchange rate volatility on trade and the possibility of consequent economic growth - in the context of the Gulf Cooperation Council (GCC) countries. Researchers on the GCC monetary union have mostly been busy in analyzing the viability of the proposed GCC monetary union and they focus on convergence criteria. In contrast to those studies, empirical estimates obtained in this study would provide valuable information to the policy makers who have been working towards the realization of the GCC monetary union. As such this study provides significant contribution to the literature of the GCC monetary union. Chapter 2 thoroughly reviews the optimum currency areas (OCA) literature (both theoretical and empirical) starting with the theories advocated by the pioneers of the OCA. Literature on the European Monetary Union (EMU), monetary unions and integration from African, Latin America, Asian and the prospects from the GCC countries are also reviewed. Chapter 3 empirically investigates convergence criteria and shock synchronization of the GCC countries. Results show positive correlation of the structural shocks (synchronized shocks) among the countries except Qatar. Chapter 4 estimates the impact of exchange rate volatility on bilateral trade between the GCC countries. Results obtained using the panel Generalized Method of Moments (GMM) estimator indicates that the bilateral trade among the GCC countries will increase about 6.2 - 8.7 percent (depending on the volatility measure used) with the elimination of the exchange rate volatility. In the second part of the chapter 4 discusses the role of trade on economic growth (income) of a country and estimates the impact of trade on per capita growth rates of the GCC countries. Results based on the preferred sample period and using the panel GMM estimator indicate that a one-standard deviation increase in the trade (or openness) ratio would increase the growth rate per capita on impact by 2 - 3%. Based on these results we may conclude that the monetary union of the GCC countries would enhance trade which in turn would promote economic growth of the region.

RISC-V is a new open-source instruction set architecture (ISA) that in De-cember 2016 manufactured its rst mass-produced processors. It focuses onboth eciency and performance and diers from other open-source architec-tures by not having a copyleft license permitting vendors to freely design,manufacture and sell RISC-V chips without any fees nor having to sharetheir modications on the reference implementations of the architecture.The goal of this thesis is to evaluate the performance of the GCC andLLVM/clang compilers support for the RISC-V target and their ability tooptimize for the architecture. The performance will be evaluated from ex-ecuting the CoreMark and Dhrystone benchmarks are both popular indus-try standard programs for evaluating performance on embedded processors.They will be run on both the GCC and LLVM/clang compilers on dierentoptimization levels and compared in performance per clock to the ARM archi-tecture which is mature yet rather similar to RISC-V. The compiler supportfor the RISC-V target is still in development and the focus of this thesis willbe the current performance dierences between the GCC and LLVM com-pilers on this architecture. The platform we will execute the benchmarks onwil be the Freedom E310 processor on the SiFive HiFive1 board for RISC-Vand a ARM Cortex-M4 processor by Freescale on the Teensy 3.6 board. TheFreedom E310 is almost identical to the reference Berkeley Rocket RISC-Vdesign and the ARM Coretex-M4 processor has a similar clock speed and isaimed at a similar target audience.The results presented that the -O2 and -O3 optimization levels on GCCfor RISC-V performed very well in comparison to our ARM reference. Onthe lower -O1 optimization level and -O0 which is no optimizations and -Oswhich is -O0 with optimizations for generating a smaller executable code sizeGCC performs much worse than ARM at 46% of the performance at -O1,8.2% at -Os and 9.3% at -O0 on the CoreMark benchmark with similar resultsin Dhrystone except on -O1 where it performed as well as ARM. When turn-ing o optimizations (-O0) GCC for RISC-V was 9.2% of the performanceon ARM in CoreMark and 11% in Dhrystone which was unexpected andneeds further investigation. LLVM/clang on the other hand crashed whentrying to compile our CoreMark benchmark and on Dhrystone the optimiza-tion options made a very minor impact on performance making it 6.0% theperformance of GCC on -O3 and 5.6% of the performance of ARM on -O3, soeven with optimizations it was still slower than GCC without optimizations.In conclusion the performance of RISC-V with the GCC compiler onthe higher optimization levels performs very well considering how young theRISC-V architecture is. It does seems like there could be room for improvement on the lower optimization levels however which in turn could also pos-sibly increase the performance of the higher optimization levels. With theLLVM/clang compiler on the other hand a lot of work needs to be done tomake it competetive in both performance and stability with the GCC com-piler and other architectures. Why the -O0 optimization is so considerablyslower on RISC-V than on ARM was also very unexpected and needs furtherinvestigation.

This study uses airborne data from multiple field campaigns off the California coast to determine the extent to which a size distribution parameter and a cloud water chemical measurement can capture the effect of giant cloud condensation nuclei (GCCN), specifically sea salt, on marine stratocumulus cloud properties. The two GCCN proxy variables, near-surface particle number concentration for diameters >5 mu m and cloud water chloride concentration, are significantly correlated (95% confidence) with each other, and both exhibit expected relationships with other parameters (e.g., surface wind) that typically coincide with sea salt emissions. Factors influencing the relationship between these two GCCN proxy measurements include precipitation rate (R) and the standard deviation of the subcloud vertical velocity owing likely to scavenging effects and improved mixing/transport of sea salt to cloud base, respectively. When comparing 12 pairs of high and low chloride cloud cases (at fixed liquid water path and cloud drop number concentration), the average drop spectra for high chloride cases exhibit enhanced drop number at diameters exceeding 20 mu m, especially above 30 mu m. In addition, high chloride cases coincide with enhanced mean columnar R and negative values of precipitation susceptibility. The difference in drop effective radius between high and low chloride conditions decreases with height in cloud, suggesting that some GCCN-produced raindrops precipitate before reaching cloud tops. The sign of cloud responses (i.e., R) to perturbations in giant sea salt particle concentration, as evaluated from Modern Era Retrospective Analysis for Research and Applications version 2 reanalysis data, is consistent with the aircraft data.

The main source of energy in the Gulf Cooperation Council (GCC) remains fossil fuels (oil and gas). The massive and accelerated used of such sources of energy not only depletes the traditional energy sources in those states and thus undermines exports and long-term prosperity; it also causes devastating damages to the environment and to human health. The nature of the Arabian Peninsula is very suitable for renewable energy sources (RES), thus many GCC states have started to consider those resources for their future energy plans. Like any technology, renewable energy technologies (RET) face many challenges such as economic, technical, social and environmental. This research analyses renewable energy (RE) possibilities and barriers in the GCC states in depth, using Kuwait as a case study. Questionnaires were distributed to three different groups to measure their attitudes and knowledge with regard to RE. Moreover, this research investigates the economic and environmental implications of RES adoption for Kuwait. A cost analysis between the traditional energy generated by the Ministry of Electricity and Water (MEW) using oil and gas, and RE energy generated by Al- Shagaya project has been carried out. It was found that most participants were environmentally aware of fuel issues and supported RE; they were prepared to forego subsidies on traditional energy to promote RE, but they doubted the government’s ability to implement RE successfully. Although Al-Shagaya Project was targeted to contribute up to 15% of Kuwait’s total power production by 2030, the cost analysis presented in this thesis revealed that the energy generated from the Al-Shagaya Project accounts for only 2% the energy needs projected at 2030, therefore current plans would only reduce CO2 emissions by 2% by 2030, but a program was proposed whereby larger investment would cause a 92% reduction in costs and reduce CO2 emissions to zero within the same timeframe.

This qualitative study adopted a phenomenological approach and aimed to understand the meaning of health professionals care delivery to adolescents in the basic health network. The research was carried out at two health centers in Belo Horizonte/MG. Study participants were fifteen Family Health Team professionals, including nurses, physicians, nursing auxiliaries and community health agents. Data were collected through an open interview, guided by the following question: What does it mean, for you, to deliver care to adolescents? The subjects discourse was analyzed according to comprehensive ideographic analysis in line with Martins and Bicudo (1989). Categories were initially interpreted in the light of Alfred Schutz, the precursor of Social Phenomenology. The comprehensive analysis of participants testimonies converged to three large categories that indicate how adolescents receive care in the basic health network: 1- Care delivery to the adolescent: experienced contradictions. Shows what challenges are met and limitations in care delivery to adolescents; 2- Care delivery to the adolescent: being in the world with the other. Deals with the relation between the health professional and the adolescent; 3- Care delivery to the adolescent in basic care: picture of a practice. Emphasizes adolescents and health services and the need to organize the service with a view to care delivery to this public. When reflecting about the meaning of this care for the professionals, we could apprehend that it is permeated by challenges in terms of their professional training and limitations imposed by the adolescent phase itself, leading to a sometimes conflicting, sometimes pacific relation between professionals and adolescents. This research appoints possible roads for care delivery to adolescents in basic health care, mainly focusing on health promotion and disease prevention. Interdisciplinary and multiprofessional work with adolescents, based on a welcoming and humanistic proposal, represents the main challenge for health professionals.
Estudo de natureza qualitativa com abordagem fenomenológica que teve como objetivo compreender o significado do atendimento ao adolescente pelos profissionais de saúde na atenção básica. A pesquisa foi realizada em dois centros de saúde da cidade de Belo Horizonte/MG. Participaram do estudo quinze profissionais da Equipe de Saúde da Família, incluindo enfermeiro, médico, auxiliar de enfermagem e agente comunitário de saúde. Os dados foram coletados por meio de entrevista aberta guiada pela questão norteadora: O que é, para você, atender o adolescente?. Os discursos dos sujeitos foram analisados segundo a análise ideográfica compreensiva de Martins e Bicudo (1989), e as categorias interpretadas, incipientemente, à luz de Alfred Schutz, precursor da Fenomenologia Social. A análise compreensiva dos depoimentos confluiu para três grandes categorias que sinalizam o atendimento ao adolescente na atenção básica de saúde: 1- Atender o adolescente: as contradições vivenciadas. Mostra os desafios em atender o adolescente e as limitações enfrentadas nesse atendimento; 2- Atender o adolescente: ser-nomundo com o outro. Fala da relação do profissional de saúde com o adolescente; 3- Assistência ao adolescente na atenção básica: retrato de uma prática. Focaliza a relação adolescente - serviços de saúde e a necessidade de organização do serviço para atender o adolescente. Ao refletir sobre o significado desse atendimento para os profissionais, foi possível apreender que este é permeado por desafios relacionados à sua formação e às limitações da fase da adolescência, levando a uma relação ora conflituosa, ora pacífica entre profissional e adolescente. A pesquisa aponta caminhos possíveis no atendimento ao adolescente na atenção básica tendo por foco principal a promoção à saúde e a prevenção de agravos. O trabalho interdisciplinar e multiprofissional com adolescentes, sedimentado em uma proposta acolhedora, humanística, constitui o grande desafio para os profissionais de saúde.

The objective of this study was to evaluate the relationship between helminthiasis, nutritional status and anemia in a group of 212 children and adolescents from 2 to 17 years old living in an endemic area in the Jequitinhonha Valley, Minas Gerais. The prevalence of schistosomiasis was 75,9% and the geometric mean egg count per gram of feces (epg) was 128,82 (CI 95% = 100,92-148,53). The prevalence of hookworm was 22,2% with a geometric mean egg count of 93,32 epg (CI 95% = 53,70-158,48). Only two individuals (0,9%) were infected with Ascaris lumbricoides.The prevalence of anemia was 13,3% and was significantly associated with age group, no latrine in the house, family income and chronic malnutrition. No statistical association was found between helminthiasis and anemia. The prevalence of acute malnutrition was 6,1% and of chronic malnutrition was 29,7%. No electricity, no latrine in the house and the hookworm intensity of infection were associated with chronic malnutrition. In the multivariable analysis anemia remained significantly related to age group, family income and chronic malnutrition. Only children that lived with families that had no electricity in the house were significantly associated with chronic malnutrition. We concluded that helmintoses were not a risk factor for anemia and malnutrition but smaller children with chronic malnutrition that lived with families with low income had a higher chance to get anemia.
Este estudo teve como objetivo avaliar a relação entre helmintoses, estado nutricional e anemia em um grupo de 212 crianças e adolescentes de 2 a 17 anos moradoras de uma área endêmica no Vale do Jequitinhonha, Minas Gerais. A prevalência de esquistossomose na localidade foi de 75,9% e a média geométrica de ovos por grama de fezes (opg) 128,82 (IC 95% = 100,92-148,53). A prevalência de ancilostomíase foi de 22,2% com média geométrica de 93,32 opg (IC 95% = 53,70-158,48). Apenas dois indivíduos (0,9%) estavam infectados com $VFDULV OXPEULFRLGHV. A prevalência de anemia foi de 19,3% e foi significativamente associada à faixa etária, à ausência de banheiro na casa, a renda familiar e a presença de desnutrição crônica. Não houve associação estatística entre helmintoses e anemia. A prevalência de desnutrição aguda foi de 6,1% e de desnutrição crônica de 29,7%. A ausência de eletricidade e de banheiro na casa assim como a intensidade de infecção por ancilostomíase foram associados à desnutrição crônica. Na análise multivariada a anemia permaneceu significativamente associada à faixa etária, renda familiar e desnutrição crônica. Em relação à desnutrição crônica, apenas a ausência de eletricidade permaneceu significativa. Concluiu-se que as helmintoses não podem ser consideradas como fator de risco para anemia e desnutrição de crianças e adolescentes, mas que crianças mais novas, com desnutrição crônica e cujas famílias são de baixa renda possuem maior predisposição para adquirir anemia.

Pressure Ulcer (PU) is a health problem well known to health care professionals. In the context of the Intensive Care Unit (ICU). the role of the nursing crew in the prevention and treatment of this condition is paramount. Excess workload may be one of the causes of PU cases in ICU, especially when the nursing team is not adequately dimensioned to cope with the demand. This work develops an analytical observational cohort study with the objective of understanding the relationship between nursing workload and the occurrence of pressure ulcers in patients of ICUs. This research was developed in the ICU of a major hospital in Belo Horizonte, Minas Gerais, Brazil. Data concerning 66 patients was collected from August to November 2011. We used the Nursing Activities Score (NAS) to measure the number of care hours required for the patients and the Braden scale to assess the risk of PU development. The patients were observed until release, death. transfer from the ICU or PU occurrence. The data was obtained through daily analysis of patient sheets, daily visits and interviews with the nurses. We performed descriptive and inferential statistical analysis of the data using the R software package version 2.13.0. We used a Generalized Estimation Equation (GEE) with a fixed working correlation matrix. the Forward-backward algorithm and Spearmans test. Elders represented the majority of the patients (60.6%) with 66.7% developing PU with Odds Ratio (OR) = 1.04 (p=0.057). Males represented 54.5% of the patients and 77.8% of the PU occurrences. Women were less prone to developing PU with an OR = 0.19 (p=O.O17). The 14 patients who died during the period represented 44% of the PU cases with OR=3,53 (p=O.O29). Elevation of the Braden score reduced the probability of PU development (p=O.002). Using multivariate regression analysis, we show that for each 10 point increase in the Braden score. the probability of PU development increased 1.07 tirnes (p=0.009) which represents a strong evidence of the correlation of nursing workload with PU development in ICU patients.
A Úlcera por Pressão (UP) é reconhecida como um problema de saúde que envolve toda a equipe de profissionais. mas principalmente a enfermagem no contexto da Unidade de Terapia Intensiva (UTI). que visa o atendimento integral ao paciente grave, incluindo-se o diagnóstico. intervenções e avaliação (los cuidados especítïcos de enfermagem. O excesso da carga de trabalho pode ser um dos fatores desencadeantes da UP, principalmente quando o dimensionamento da equipe de enfermagem não é feito conforme a demanda de cuidados de enfermagem. Este estudo observacional do tipo analítico com delineamento de coorte, teve como objetivo geral analisar associações entre carga de trabalho de enfermagem e ocorrência de úlceras por pressão em pacientes internados em unidade de terapia intensiva. Esta pesquisa foi desenvolvida na UTI geral de um hospital de grande porte de Belo Horizonte. Minas Gerais. Brasil. A coleta de dados foi realizada nos meses de agosto a novembro de 2011. constituindo uma amostra de 66 pacientes. Foi aplicado o índice Nursing Activities Score (NAS) para medida de horas de cuidados requeridas pelos pacientes. a Escala de Bru1eu para medir o risco de desenvolvimento de Ulcera por Pressão (UP) e os pacientes foram acompanhados até a alta, óbito, transferência da UTI ou ocorrência da UP. Os dados desta pesquisa foram obtidos através da análise diária dos prontuários, da visita diária ao leito dos pacientes e consulta aos enfermeiros assistenciais. Os dados foram submetidos a análise descritiva e inferencial sendo utilizado o software R versão 2.13.() para análise estatística. utilizando a Equação de Estimação Generalizada (GEE) com matriz de trabalho simétrica composta. algorítimo de Backward e teste de Spearman. Os Resultados mostraram que os 'idosos constituíram a maioria (60.6%), representando 66.7% daqueles que desenvolveram UP com Odds Ratio (OR) = 1.04 (p=0.057). O sexo masculino predominou (54,5%), representando 77,8% das ocorrências da LIP. As mulheres apresentaram fator de proteção para UP com OR = 0.19 (p=0.01 7). Os pacientes que evoluíram a óbito (14) representaram 44% dos acometidos com OR =3.53 (p= 0.029). A elevação no escore de Braden mostrou fator de proteção para UP (p= 0.002). Em análise de regressão multivariada foi demonstrado que para cada 10 pontos acrescidos no escore do NAS eleva-se a chance de ocorrência de UP em 1.07 vezes (p=O.009) caracterizando associação entre carga de trabalho de enfermagem e ocorrência de UP nos pacientes internados na UTI.

Currently the world is faced with an global aging of the population. With that arise challenges related to the quality of life for seniors, due to functional decline, chronic diseases, greater dependency, loss of autonomy and social isolation. It is of fundamental importance the study of the quality of life among the elderly in order to understand the determinants of the successful aging. OBJECTIVE: To verify the association of sociodemographic, economic, clinical and behavioral factors with the quality of life in elderly ascribed in the Northwest Sanitary District of Belo Horizonte, Minas Gerais. METHODS: Analytical study correlational cross-sectional, involving a sample of 401 elderly with 60 aged or more accompanied in the 20 basic health units of the Northwest Sanitary District, Belo Horizonte. During data collection, we used the WHOQOL-bref to evaluate of the quality of life and a questionnaire containing information on sociodemographic, economic, clinical and behavioral aspects. Data were entered, typed and analyzed using SPSS version 20.0. Analysis was performed stepwise backward conditional logistic regression to adjust for confounding factors and multivariate logistic regression, with models binomial said "zeroinflated" to evaluate of the likelihood of association of the quality of life with variables of interest. The final multivariate analysis data were presented with their Odds Ratio (OR) and confidence intervals of 95% (95% CI). In this analysis, a p<0.05 was considered statistically significant. Also a ROC curve was constructed to assess the diagnostic ability of different cutoffs do OQL obtained by WHOQOL-bref and point the best critical value that predicts good / satisfied QL (group G5) or bad / dissatisfied QL (group G6). RESULTS: The factors that significantly associated with good perception of quality of life and satisfaction with health were PHQ-total < 3, practicing physical activity, study time > five years, male, household income U.S. $ 1,100.00, floor without aid of accessory, service time retirement, alcohol consumption, areas of the WHOQOL-bref and OQL. While depression, diabetes mellitus and disability retirement remained inversely associated and independent to group G5. The ROC curve analysis indicated the critical value 60 as the best cutoff point for assessing of the perceived of quality of life and satisfaction with health. CONCLUSION: The study population presents a perception of quality of life and satisfaction with health median in the various fields of scale WHOQOL-bref. Among the variables most strongly associated with quality of life stood out low score for diagnosing depression, practicing physical activity and higher level of education. The diagnostic interpretation of the ROC curve allowed to say that the cutoff point OQL < 60 obtained excellent sensitivity and negative predictive value for screening of elderly with probable QL bad / dissatisfied with health. The appropriation of the perceptions of quality of life of the elderly can be interpreted differently, according with the field structural and multidimensional of this process. Develop concepts of quality of life brought by the elderly and contrasted with their perceptions of dialogic form allows substantiate the concepts of a new model of care given to the elderly
Atualmente o mundo se depara com o envelhecimento global da populacao. Com isso surgem desafios relacionados a qualidade de vida dos idosos, devido ao declinio funcional, doencas cronicas, maior dependencia, perda da autonomia e isolamento social. E de fundamental importancia o estudo da qualidade de vida entre os idosos a fim de se conhecer os determinantes do envelhecimento bem-sucedido. OBJETIVO: Verificar a associacao de fatores sociodemograficos, economicos, clinicos e comportamentais com a qualidade de vida em idosos adscritos no Distrito Sanitario Noroeste de Belo Horizonte, Minas Gerais. METODOLOGIA: Estudo analitico correlacional de corte transversal, envolvendo uma amostra de 401 idosos com 60 anos ou mais acompanhados nas 20 unidades basicas de saude do Distrito Sanitario Noroeste, Belo Horizonte. Na coleta de dados, foram utilizados o instrumento WHOQOL-bref para avaliacao da qualidade de vida e um questionario contendo informacoes sobre aspectos sociodemograficos, economicos, clinicos e comportamentais. Os dados foram inseridos, digitados e analisados utilizando-se o programa SPSS versao 20.0. Foi realizada analise de regressao logistica condicional stepwise backward para ajuste dos fatores de confusao e regressao logistica multivariada, com modelos binomiais ditos gzeroinflatedh, para avaliacao da probabilidade de associacao da qualidade de vida com as variaveis de interesse. Os dados da analise multivariada final foram apresentados com os respectivos Odds Ratio (OR) e seus intervalos de confianca de 95% (IC 95%). Nesta analise, um p<0,05 foi considerado estatisticamente significativo. Tambem foi construida uma curva ROC para avaliacao da capacidade diagnostica de diferentes pontos de corte do QVG obtidos pelo WHOQOL-bref e apontar o melhor valor critico que prediz QV boa/satisfeito (grupo G5) ou QV ruim/insatisfeito (grupo G6). RESULTADOS: Os fatores que se associaram significativamente com boa percepcao de qualidade de vida e satisfacao com a saude foram PHQ-total < 3, pratica atividade fisica, tempo de estudo > cinco anos, sexo masculino, renda familiar . R$1.100,00, andar sem auxilio de acessorio, aposentadoria por tempo de servico, consumo de bebida alcoolica, dominios do WHOQOL-bref e QVG. Enquanto depressao, diabetes mellitus e aposentadoria por invalidez mantiveram-se inversamente associadas e independentes ao grupo G5. A analise da curva ROC indicou o valor critico 60 como o melhor ponto de corte para avaliacao da percepcao de qualidade de vida e satisfacao com a saude. Conclusão: A populacao estudada apresentou uma percepcao de qualidade de vida e satisfacao com a saude mediana nos diversos dominios da escala WHOQOL-bref. Dentre as variaveis mais fortemente associadas a qualidade de vida destacaram-se baixo escore para diagnostico de depressao, pratica de atividade fisica e maior nivel de escolaridade. A interpretacao diagnostica da curva ROC permitiu dizer que para o ponto de corte QVG < 60 obteve otima sensibilidade e valor preditivo negativo para rastreamento de idosos com provavel QV ruim/insatisfeito com a saude. A apropriacao das percepcoes de qualidade de vida do idoso pode ser interpretada de forma distinta, de acordo com o campo estrutural e multidimensional desse processo. Desenvolver conceitos da qualidade de vida trazidos pelos idosos e contrapostos com suas percepcoes de forma dialogica permite fundamentar as concepcoes de um novo modelo de cuidado dispensado a terceira idade.

Introduction: One of the most frequent sequelae, and the one that interferes the most in the life of women treating for cancer is the lymphedema. This side effect may have its onset during any phase of breast cancer treatment; although, in general, it isn't life-threatening. However, it may decrease survivors life quality due to aesthetics deformities, physical discomfort and loss of functional ability. Studies indicate that educating breast cancer survivors about how to prevent and control lymphedema is important to improve the functionality and to promote life quality. To prevent and control the lymphedema progression it is important that the woman has the basic knowledge about this sequela. General objective: Studying the development of lymphedema among women undergoing treatment for breast cancer treated at the oncology clinic of a hospital in Belo Horizonte. Materials and Methods: This is a quantitative, sectional study. It was accomplished in the oncology ambulatory of a large hospital in Belo Horizonte, in which 125 women, in breast cancer treatment, were interviewed at the time of the medical follow-up appointment or before the chemotherapeutics administration. The interviews were conducted using questionnaires translated and adapted from English. Also, the medical records were consulted to collect data related to the patient's clinical history. Results: 34.4% of women were diagnosed with lymphedema, with an average age of 53.3 ± 10 years old, married, with less than four years of education and family income from one to three minimum wages. The prevalence of lymphedema in the study period was 34,4%.The knowledge level about lymphedema and how to prevent it was considered low and only 69.6% of patients report having received orientation about how to prevent lymphedema, being the nurses not very involved in this process. Conclusion: It is understood as essential the role of the nurse as an educator, since receiving orientation was considered a protective factor to lymphedema. It is important to these professionals to be aware of the necessity to improve themselves to help this women population.
Introdução: Uma das frequentes sequelas e a que mais interfere na vida da mulher em tratamento para câncer de mama é o linfedema. Este efeito colateral pode ter seu início durante qualquer fase do tratamento para câncer de mama, apesar de geralmente não oferecer risco de vida, ameaça a qualidade de vida da sobrevivente por causar deformidade estética, desconforto físico e perda da habilidade funcional. Estudos mostram que a educação para prevenção e controle do linfedema entre sobreviventes de câncer de mama é importante para melhorar a funcionalidade e promover qualidade de vida. Para que o desenvolvimento do linfedema seja prevenido e controlado, é importante que a mulher possua conhecimentos básicos sobre esta sequela. Objetivo geral: Analisar o desenvolvimento de linfedema entre mulheres submetidas a tratamento de câncer de mama atendidas em ambulatório de oncologia de um hospital de Belo Horizonte. Material e Método: Trata-se de um estudo quantitativo, seccional. Foi desenvolvido no ambulatório de oncologia de um hospital de Belo Horizonte, onde 125 mulheres, em tratamento para câncer de mama, foram entrevistadas durante consulta de segmento ou previamente a administração de quimioterápicos, utilizando-se de questionários traduzidos e adaptados da língua inglesa. Foi realizada consulta ao prontuário para coleta de dados referentes a história clínica da paciente. Resultados: 34,4% das mulheres tinham diagnóstico de linfedema, com média de idade de 53,3 ± 10 anos, casadas, com menos de quatro anos de estudo e renda familiar entre um e três salários mínimos. A prevalência de linfedema no período do estudo foi de 34,4%. O nível de conhecimento sobre linfedema e como preveni-lo foi considerado baixo e somente 69,6% das pacientes relatam haver recebido orientação acerca de como prevenir o linfedema, sendo o enfermeiro pouco envolvido nesse processo. Conclusão: Entende-se como essencial a atuação do enfermeiro como educador, uma vez que receber orientação foi considerado fator de proteção contra linfedema. É importante que esses profissionais enfermeiros tenham consciência de que é preciso aprimorar-se para atender a essa população.

Hospitals stand out as a convergence center of several knowledge and practical health service systems. As a complex institution, crossed by multiple interests, hospitals suffer permanent and continuous discussion about the municipal manager, workers and users expectation related to its role in integral care production with quality, efficiency and costs control. In this context, the HOSPITAL DAS CLÍNICAS DA UNIVERSIDADE FEDERAL DE MINAS GERAIS (HC-UFMG), a public university institution, has introduced, in 1999, a new management proposal based on decentralization of administrative actions, creating the Functional Units (UF). The new management model proposes to reorganize the logical of hospital management, in order to obtain better results and better performance in health services. But, in 2005, the HC-UFMG surgical center has organized itself as a Functional Unit and also has started to be responsible for management of human, financial and material resources, processes and results, the evaluation of assistance, the teaching and the research developed in this sector. The surgical center unit is a great creator of costs to hospitals and, because of that, the development of programs which guarantee quality is a necessity in terms of efficiency and an obligation of ethical and moral point of view. In 2008 the results of a performance evaluation has pointed inefficiency and low productivity, requiring adjustments. This study has as objective to analyze the surgical center organization and functioning, in order to understand its management process, the factors that help and those that difficult the work process and the relationship between the different professionals who act in the unity. It has been done a qualitative case study, in which the data were collected through semistructured interviews carried out with 19 professionals, of different areas, who act in the HCUFMG surgical center. The results were subjected to the analysis of content, using the identification of thematic units, grouped into categories by affinity empirical. The analysis of data shows that the surgical center is a sector which the work is stressful, there is a great time for the completion of surgery, interpersonal relationships and between professions are conflicting and there is predominance of medical power on the other professionals. The management of the sector lacks the autonomy needed to put in place the necessary changes, due to the strength of corporate professionals, especially medical doctors. The surgical center did not incorporate, in its practice, the decentralized management model proposed to HCUFMG, keeping itself in a management format, parallel to the directives of the hospital, crossed by multiples powers which exist inside the service. The relationship between the different professionals who act in the unity and the new management model and the organizational changes proposed happens formatted by the corporative logic of professions. The data show that the planning, as an instrument of management, does not exist. It also shows that the initiative of organization and efficiency suffers interference of the medical power, because they requires from the directorship the same power of decision that they have on surgical procedures, not recognizing the organizational standards. The difficulties for the organization and operation of the surgical center are related to the shortage of managerial strategies able to consider the various powers, seeking a team work in which the respect to the various workers and the hospital rules predominate. Is important also to seek integration with other sectors of the hospital as a way to organize the daily work, minimizing external interference.
As instituições hospitalares se destacam como um centro de convergência dos diversos saberes e práticas na prestação de serviços de saúde. Consideradas instituições de alta complexidade, atravessadas por múltiplos interesses, vivenciam permanente e contínuo debate sobre as expectativas dos gestores, trabalhadores e usuários quanto ao seu papel na produção do cuidado, na busca pela qualidade, eficiência, controle de custos e integralidade. Neste contexto, o Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), instituição pública e universitária, implantou em 1999, uma proposta gerencial de descentralização das ações administrativas, as Unidades Funcionais (UF´s). O novo modelo propõe reorganizar a lógica gerencial do Hospital, visando melhores resultados dos serviços. No entanto, o Centro Cirúrgico do HC/UFMG (CCI do HC-UFMG) somente se organizou como UF em 2005, passando a ser responsável pela gestão dos recursos humanos, financeiros e materiais, processos e resultados, avaliação da assistência prestada e ensino e pesquisa no setor. A UF Centro Cirúrgico e Anestesiologia do HC-UFMG é grande geradora de receitas para o hospital e necessita do desenvolvimento de programas que garantam a qualidade e eficiência como obrigação ética e moral. Em 2007, os resultados de uma avaliação de desempenho nesta UF apontaram algumas deficiências e baixa produtividade, que necessitam ser corrigidas. Este estudo tem como objetivo analisar a organização e o funcionamento do CCI do HC-UFMG, a fim de compreender seu processo de gestão, os fatores que facilitam e dificultam o processo de trabalho e as relações entre os diferentes profissionais que atuam na unidade. Para tanto, foi realizado um estudo de caso de natureza qualitativa, no qual os dados foram coletados por meio de entrevistas semiestruturadas, realizadas com 19 (dezenove) profissionais de diferentes categorias profissionais que atuam no CCI do HC-UFMG. Os resultados foram submetidos à análise de conteúdo, utilizando a identificação de unidades temáticas, agrupadas por afinidade em categorias empíricas. Eles mostram que o CCI do HC-UFMG é um setor no qual o trabalho é tenso, há tempo ótimo para a realização do ato cirúrgico, as relações interpessoais e interprofissionais são conflituosas e há predominância do poder médico sobre os demais profissionais. A gerente do setor não possui autonomia suficiente para colocar em prática as mudanças necessárias, em decorrência da força das corporações profissionais, principalmente dos médicos. A unidade ainda não incorporou, de fato, o modelo de gestão descentralizada do HC-UFMG, mantendo um modelo tradicional paralelo às diretrizes do hospital, permeado pelos muitos poderes existentes no interior do serviço. A relação entre os diferentes profissionais que atuam na unidade é precária e moldada pela lógica corporativa das profissões. Os dados revelam, ainda, que o planejamento como instrumento gerencial não foi implementado. As iniciativas de organização e otimização dos recursos sofre a interferência do poder médico que exige na administração o mesmo poder de decisão que tem nos procedimentos cirúrgicos, desconhecendo as normas organizacionais. As dificuldades para a organização e funcionamento do CCI do HC-UFMG estão relacionadas à escassez de estratégias gerenciais capazes de equacionar os diversos poderes, visando um trabalho de equipe no qual predomine o respeito aos diversos trabalhadores e às normas do hospital. Há que se buscar, também, a integração com os outros setores do hospital como forma de organizar o trabalho cotidiano, minimizando as interferências externas.

This is a retrospective and descritive epidemiological study, which was carried on the Intensive Care Unity (ICU) for adult patients at Hospital das Clínicas from the Federal University of Minas Gerais State, its goals are to characterize the patients with hospital infections, determine the infections predominance and identify factors of risck related to the occurrence of the infections on the ICU. The study was carried on from the information gathering of the database (Epi-info, version 6.04), of the Hospital Infection Control Comission of HC/UFMG, where a new database was created from the gathered information, containing information about patients with hospital infection on the ICU, on the period between the years of 2000 and 2004. The sample was constitued of 282 patients corresponding to a predominance rate of 15%. Studies show that this population is even when related to sex and there was a predominance of patients with ages between 41 and 65. Concerning the basis illness, heart diseases presented a higth percentage, followed by stomach and intestines ilnesses and neoplasias. Concerning the gravity of the clinical pathology classification, it was found that 98,2% of the evaluations corresponded to the higther gravity categories (D, C and E). The highter predominance of HI sires were pneumonias, followed by urinary system infections, arteriais infections and septicemias. On the cultivations Pseudomana aeruginosa, Staphylococcus epidermidis and Acinectobacter baumanii predominated. The risk factors strongly related to the hospital infections occurrence were the use of previous antimicrobial, the gravity of the basis illness, the invasive procedures and the time spend at the hospital before the moving to the ICU and the time spend at the ICU.
Trata-se de um estudo epidemiológico retrospectivo e descritivo, realizado no Centro de Terapia Intensiva para pacientes adultos do Hospital das Clínicas da UFMG, com os objetivos de caracterizar os pacientes acometidos por infecção hospitalar; determinar a prevalência de infecção hospitalar e identificar fatores de risco relacionados a ocorrência das infecções hospitalares. O estudo foi realizado a partir da coleta de informações no banco de dados (Epi-info, versão 6.04) da Comissão de Controle de Infecção Hospitalar do HC/UFMG, onde a partir dos dados coletados foi construído um novo banco de dados com informações acerca dos pacientes acometidos por IH no CTI, referentes ao período entre os anos de 2000 e 2004. A amostra foi constituída de 282 pacientes correspondendo a uma taxa de prevalência de 15%. Os resultados mostram que essa população distribuiu-se de forma eqüitativa em relação ao sexo e quanto a idade houve uma predominância de pacientes na faixa etária de 41 a 65 anos. No que se refere a patologia de base foi elevada a porcentagem de internações por doença cardiovascular, seguida das gastrintestinais e neoplasias. Com relação a classificação da severidade clínica da patologia de base verificou-se que 98,2% das avaliações corresponderam às categorias de maior gravidade (D, C e E). Os sítios de maior prevalência de IH foram as pneumonias, seguidas das infecções do trato urinário, das infecções arteriais e das septicemias. Nas culturas realizadas predominaram Pseudomonas aeruginosas, Staphylococcus epidermidis e Acinectobacter baumanii. Os fatores de risco fortemente correlacionados com a ocorrência de infecção hospitalar no CTI foram o uso de antimicrobiano prévio, a gravidade da da doença de base, os procedimentos invasivos, o tempo de permanência prévio a internação no CTI e o tempo de permanência no CTI.

This is a qualitative study, based on the Social Representation Theory, aiming to understand the social representations of the health care professionals, involved with the practices of pregnant women aid that achieve the maternity status without anti-HIV serum result. There were 22 health professionals interviewed, 12 nurses and 10 physicians that worked in two public maternity clinics in Belo Horizonte municipality. The subjects were contacted in was: How is it for you to take care a pregnant woman that does not have an anti-HIV serum result? To the analysis it was used the Collective Subject Discourse technique suggested by Lefévre and Lefévre (2005). The interpretation of the data showed five thematic categories in which are organized the representations related to the assistance to the pregnant women status without anti-HIV serum result in the maternity clinic: Infection by the HIV/Aids; Infected woman; Infection diagnosis by the HIV in pregnancy; Ways of taking care of infected or in risk of being infected women by the HIV and Changes in the life of infected woman/mother by the HIV. The results point to lacks of permanence and chances in the social representation of the interviewed subjects, indicating that these representations interfere in the approach to the infected or in risk of being infected women by the HIV in the maternity clinic internment. It also indicates that a thinking moment, that cam be pointed to a model of nowadays attention procedure, the professional formation and construction or to the contradictions achieved by the experience in this face to face contact to the psycho-affective-social needs of the infected or in risk of being infected women by the HIV/Aids. This study also allowed to understand that the system of health care needs to be adapted to the daily needs, in order to afford the access and the integrality of the so aimed and fundamental quality in heath care as well as to the articulation between technicians, technologies an assisted women.
Trata-se de um estudo qualitativo, fundamentado na Teoria das Representações Sociais, com o objetivo de compreender as representações sociais dos profissionais de saúde, envolvidas na prática da assistência à gestante que chega à maternidade sem resultado da sorologia anti-HIV. Foram entrevistados 22 profissionais de saúde, 12 enfermeiras e 10 médicos que atuam em duas maternidades públicas no município de Belo Horizonte. Os sujeitos foram contactados em seus locais de trabalho e convidados a participar de entrevista. A questão norteadora foi: Como é para você atender uma gestante na maternidade sem o resultado da sorologia anti-HIV?. Para a análise foi utilizada a técnica do Discurso do Sujeito Coletivo proposta por Lefévre e Lefévre (2005). A interpretação dos dados apontou cinco categorias temáticas em que estão organizadas as representações relacionadas à assistência à gestante sem sorologia anti-HIV na maternidade: Infecção pelo HIV/Aids; Mulher infectada; Diagnóstico da infecção pelo HIV na maternidade; Maneiras de cuidar de mulheres em risco ou infectadas pelo HIV e Mudanças na vida da mulher/mãe infectada pelo HIV. Os resultados apontam para espaços de permanências e mudanças nas representações sociais dos sujeitos entrevistados, indicando que estas representações interferem na abordagem à mulher em risco/infectada pelo HIV no atendimento na maternidade. Indicam também um movimento de reflexão, esteja ele voltado para o modelo de atenção vigente, a formação e a construção profissional ou para as contradições levantadas pela experiência do contato face a face com as demandas psico-afetiva-sociais da mulher em risco/infectada pelo HIV/Aids. O estudo também permitiu compreender que o sistema de saúde precisa de ajustes cotidianos, para garantir o acesso e a integralidade do cuidado tão desejada e fundamental para a articulação entre técnicos, tecnologias e mulheres cuidadas.

The purpose of this study was to analyze the structures about being a nurse of nursing students social representations of five private Superior Education Institutions of Belo Horizonte created in the period between 2003 and 2004. It was adopted as a theoric methodological referential the Social Representation Theories proposed by Moscovici and by the Theory of the Central Nucleus elaborated by Jean-Claude Abric, in the Social Psychology perspective. Data were obtained by the use of two questionnaires. The first wanted to know the socio-demographic profile of these students, while the second, based on the free evocation technique, wanted to learn the social representation due to the induction term being a nurse. 430 students constituted the sample, distributed between the 1st and 6th periods of the nursing courses of the mentioned institutions, what consisted of 45,6% of the total population. The profile description of these students were analyzed by simple attendance, and the structures obtained by free evocations were processed by the software Ensemble de Programmes Permettant des Evocations (EVOC) and analyzed by the four house board technique created by Pierre Vergès. There was a major of young, female, single, and coming from public schools students. A considerable number of these students practice some kind of remunerated activity and almost half of the ones who worked, were working in the nursing area. The building of the structures starting from the students evocations leads us to possible central nucleus toward the elements caring and responsibility which were found strongly connected by elements that translate affectionate values and attitudes, as for the integrality of the rendered assistance, anchored in the historical, cultural and formatives contingencies of the studied individuals. Besides that, the evocations management, professionalism, work, realization, attention and respect, were found, providing them a peripheral role. In face of these image verify that the students perceptions related to being a nurse has been modified through time, even though it has been done slowly and gradually. Through this perspective its necessary to review concepts, update values and make choices to a critical-reflective professionals formation, socially committed with group and individual works in the health area.
O presente estudo teve como objetivo analisar as estruturas das representações sociais sobre ser enfermeiro de discentes de Enfermagem de cinco Instituições de Educação Superior privadas de Belo Horizonte criadas no período de 2003 a 2004. Adotou-se como referencial teórico-metodológico a Teoria das Representações Sociais proposta por Moscovici e pela Teoria do Núcleo Central elaborada por Jean-Claude Abric, na perspectiva da Psicologia Social. Os dados foram obtidos por meio de dois questionários. O primeiro buscou conhecer o perfil sociodemográfico desses discentes, enquanto o segundo, tomando por base a técnica de evocação livre, visou apreender as representações sociais frente ao termo indutor ser enfermeiro. A amostra foi constituída por 430 discentes, distribuídos entre 1º e 6º períodos dos cursos de Enfermagem das instituições acima citadas, o que consistiu num total de 45,6% da população. A descrição do perfil desses discentes foi analisada por meio de freqüência simples e as estruturas obtidas por meio das evocações livres foram processadas pelo software Ensemble de Programmes Permettant l'Analyse des Évocations (EVOC) e analisadas pela técnica do quadro de quatro casas, criado por Pierre Vergès. Houve predomínio de discentes jovens, do sexo feminino, solteiro e de procedência escolar pública. Considerável número desses acadêmicos exerce algum tipo de atividade remunerada e quase metade dos que trabalham já atuam na área de Enfermagem. A construção das estruturas a partir das evocações dos discentes apresentou como possíveis núcleos centrais voltados para os elementos do cuidar e responsabilidade, os quais se encontraram fortemente atrelados por elementos que traduzem valores afetivos e atitudes, quanto pela integralidade da assistência prestada, ancorados pelas contingências históricas, culturais e formativas dos sujeitos do estudo. Da mesma forma, foram encontradas as evocações gerenciar, profissionalismo, trabalho, realização, atenção e respeito, conferindo-lhes o papel de elementos periféricos. Diante dessas representações, verifica-se que a imagem dos discentes relativa ao ser enfermeiro vem sofrendo alterações ao longo dos tempos, mesmo que de modo lento e gradual. Nessa perspectiva, faz-se necessário rever concepções, atualizar valores e fazer escolhas em prol da formação de profissionais críticos e reflexivos, compromissados socialmente com o trabalho coletivo e individual em saúde.

Introduction: The non transmissible chronic diseases (DCNT) are constituted in one of the main causes of death in spite of the fact that their risk factors are well known, evitable and easily mediated. For the DCNT prevention and control is necessary the continuum monitoring of their risk factors and protection. This is important for supporting information directed to the health promotion and injury prevention as well as to the action favoring healthier behavior and habits. General Aims: to identify the prevalence of the DNCT risk and protection factors in the general population and in the users of health insurances at Belo Horizonte and compare the evolution of the frequency of these factors in the 2006 up to 2008. Methodology: This is an epidemiological study, cross-sectional population-based descriptive data that were used side project "Surveillance of Risk Factors and Protection for chronic diseases through telephone survey (VIGITEL) of the Ministry of Health (MOH) for the Belo Horizonte, for the years 2006 to 2008. The data were presented by the frequency distribution of the variables of interest to the general population and users of health plans and their respective confidence intervals 95% (IC 95%). Results: In the general population, adults with low education present larger frequency of risky behavior: they smoked more, consumed more fatty meat and integral milk (3% fat), consumed less fruits, vegetables and legumes, did less physical activities in the leisure and protected less against ultraviolet radiation. The weight excess is larger for men, as well as the abusive consumption of alcohol and driving cars after its consumption. The women consumed more fruits, vegetables and legumes and protected themselves against the ultraviolet radiation. The percentage of hypertensive people increaseded with the age, as well as the diabetes, heart diseases and cholesterol awareness. The frequency of mammography and Papanicolau exams were larger between women with more years of study. The frequencies found in the users of health insurance were similar to the one found for the general population. The differences were related to the selfexam of the health as bad, in which was verified a smaller percentage of women users of health insurance. Concerning the mammography and papanicolau exams, the percentage found is larger for the women users of health insurance. With respect to the temporal analysis, it was verified the elevation of percentage of obesity in women, increased of consumption of fruits, vegetables and legumes, decrease in the consumption of visible fatty meats and integral milk (3% fat), decreased of the frequency of mammography and papanicolau exams, as also the protection against the ultraviolet radiation. Conclusion: In this context, actions might be directed for the population of low education and non user of health plans, in order to decrease the DCNT risk factors and the inequalities related to the access to the mamograph and papanicolau exams. New studies might be realized aiming to identify the faults in the process of adhesion to the mamography and papanicolau exams.
Introdução: As Doenças Crônicas Não Transmissíveis (DCNT) se constituem em uma das principais causas de morte, tendo seus fatores de risco conhecidos, evitáveis e passíveis de intervenção. Para a prevenção e controle das DCNT é necessário o monitoramento contínuo de seus fatores de risco e proteção visando apoiar intervenções direcionadas para a promoção da saúde e prevenção de agravos, como também ações que favoreçam comportamentos e hábitos de vida mais saudáveis. Objetivo Geral: Identificar a prevalência dos fatores de risco e proteção para DCNT na população geral e na população usuária de planos de saúde em Belo Horizonte e comparar a distribuição da frequência dos mesmos fatores nos anos de 2006 a 2008. Metodologia: Trata-se de um estudo epidemiológico, transversal, de base populacional, descritivo em que foram usados dados secundários do projeto Vigilância dos Fatores de Risco e de Proteção para Doenças Crônicas por Inquérito telefônico (VIGITEL) do Ministério da Saúde (MS) para a cidade de Belo Horizonte, referentes aos anos de 2006 a 2008. Os dados foram apresentados por meio da distribuição de freqüências das variáveis de interesse para a população geral e nos usuários de planos de saúde e de seus respectivos Intervalos de Confiança de 95% (IC95%). Resultados: Na população geral, adultos com baixa escolaridade apresentaram maior frequência para comportamentos de risco: fumavam mais, consumiram mais carnes com gordura excessiva e leite integral, consumiram menos frutas, verduras e legumes, praticaram menos atividade física no lazer e se protegeram menos contra a radiação ultravioleta. O excesso de peso foi maior entre os homens, assim como o consumo abusivo de álcool e a direção de veículos após o seu consumo. As mulheres consumiram mais frutas, verduras e legumes e se protegeram mais contra a radiação ultravioleta. O percentual de hipertensos aumentou com a idade, assim como o diabetes, doenças do coração e dislipidemias. A frequência de realização de mamografia e papanicolau foi maior entre as mulheres com mais anos de estudo. As freqüências encontradas na população usuária de planos de saúde foram semelhantes ao que foi encontrado na população geral. As diferenças foram em relação à autoavaliação do estado de saúde como ruim, em que foi verificado um menor percentual entre as mulheres usuárias de planos, e em relação à realização dos exames de mamografia e papanicolau, sendo encontrado um maior percentual entre as mulheres usuárias de planos. Em relação à análise temporal verificou-se elevação no percentual de mulheres obesas, aumento no consumo de frutas, verduras e legumes, diminuição no consumo de carnes com gordura visível e leite integral e diminuição na frequência de realização de mamografia e papanicolau, como também de proteção contra radiação ultravioleta. Considerações Finais: Nesse contexto, ações devem ser direcionadas para a população com baixa escolaridade e não usuária de planos de saúde, visando diminuir os fatores de risco para DCNT e as iniquidades em relação ao acesso a exames de mamografia e papanicolau. Novos estudos devem ser realizados buscando identificar as falhas no processo de adesão aos exames de mamografia e papanicolau.

This is a qualitative study case based on comprehensive sociology with the aim of understanding the daily work of health professionals in the patients air transportation. The study setting was a private company in Belo Horizonte, Minas Gerais State, specialized in the air transportation of patients. Twenty-two health professionals were interviewed such as nurses and doctors who act or acted in the air transportation of patients. The data were collected between May and June 2009 through a semi-structured interview guide. They were processed and analyzed using content analysis. Five categories emerged from the analysis: 1.Joint construction: the stones path, 2.Teamwork, 3.The work: each day at a time, 4.The different care settings and 5.The hodgepodge of feelings. The first category deals with the beginning of the health professionals activities in the air transportation and the difficulties experienced in the companys building process. The second category considers relevant aspects of team work in an interdisciplinary way, the motivational aspects that lead these professionals to carry out this kind of jobs, the importance of a proper communication and the subjects interaction. The third category broaches the different meanings of the work that they carry out. The fourth category shows the various air transportations environments and the technologies that are reflected in patient care. The fifth and last category reveals the health professionals feelings towards the experienced situations in the work environment and the assistance provided to patients during the transportation. This study allowed understanding different looks into the work they do and the environments influence over the involved actors in relation to attitudes and behaviors. The work is complex, it presents unpredictable situations and the provided assistance and care to patients become differentiated. The subjectivity is present at anytime in daily life, there is a dialectical relationship between pleasure and pain, and health professionals reveal experienced feelings about work and the provided assistance during transportation. It is hoped that this study may promote the reflection of these individuals involved in this activity, raise new questions and bring forth further discussion and researches over the theme.
Trata-se de um estudo de caso qualitativo, fundamentado na sociologia compreensiva, com o objetivo de compreender o cotidiano de trabalho dos profissionais de saúde no transporte aéreo de pacientes. O cenário de estudo foi uma empresa privada de Belo Horizonte, Minas Gerais, especializada em transporte aéreo de pacientes. Foram entrevistados vinte e dois profissionais de saúde, enfermeiros e médicos que atuam ou atuaram no transporte aéreo de pacientes. Os dados foram coletados no período de maio a junho de 2009, por meio de um roteiro de entrevistas semi-estruturado. Os dados foram tratados e analisados pelo método de análise de conteúdo. Da análise, emergiram cinco categorias empíricas: 1. A construção conjunta: o caminho das pedras, 2. O trabalho em equipe, 3. O trabalho: cada dia um dia! 4. Os diferentes ambientes de cuidado e 5. A miscelânea de sentimentos. A primeira categoria trata do início das atividades dos profissionais de saúde no transporte aéreo e das dificuldades vivenciadas no processo de construção da empresa. A segunda categoria considera aspectos relevantes do trabalho realizado em equipe de forma interdisciplinar, os aspectos motivacionais que levam os profissionais a exercer esse tipo de atividade, a importância da comunicação adequada e a interação dos sujeitos. A terceira categoria aborda os diferentes significados em relação ao trabalho que realizam. A quarta categoria mostra os vários ambientes do transporte aéreo e as tecnologias que se refletem no cuidado ao paciente. A quinta e última categoria revela os sentimentos por parte dos profissionais de saúde frente às situações vivenciadas no ambiente de trabalho e a assistência prestada ao paciente durante o transporte. Este estudo permitiu compreender os diferentes olhares acerca do trabalho que realizam e a influência do ambiente sobre os atores envolvidos, em relação às posturas e comportamentos. O trabalho é complexo, apresenta muitas situações imprevisíveis, a assistência e o cuidado prestado ao paciente tornam-se diferenciados. A subjetividade está presente no cotidiano a todo instante, há uma relação dialética de prazer e sofrimento, os profissionais de saúde revelam sentimentos vivenciados a respeito do trabalho e na assistência prestada ao paciente durante o transporte. Espera-se que este estudo possa promover a reflexão dos sujeitos envolvidos nessa atividade, suscitar novos questionamentos e gerar novas discussões e pesquisas sobre o tema.

Women in reproductive age represent about 30% of the Brazilian population. The government actions directed to them are related to family planning ensuring full and open access to information and contraceptive methods. The Ministry of Health adopts clinical eligibilitycriteria (clinical procedures based on scientific evidence to guide the prescription and use those methods to ensure their effectiveness and to avoid damaging the health of those who use them) developed by the World Health Organization. Among methods for family planning, theworld's most used is the oral contraceptive (OC). OBJECTIVES: To know the using patterns of contraceptives in Brazilian women and evaluate the appropriate appliance of oral contraceptives according to the clinical eligibility criteria that ascertains the occurrence of iniquities. METHODS: A population-based epidemiological study, which used cross-sectionaldescriptive secondary data from the VIGITEL, which collects information on risk factors for chronic diseases and protection of the population through telephone interviews. It considers the Brazilian female population 18-49 years, living in 26 state capitals and the Federal District, attended by fixed telephone line on the year 2008 (n = 21074). The estimations were calculated by observing an accuracy range of 95%. Educational level was used as proxy of socioeconomic status for the inequities analysis. The inappropriate use of oral contraceptives is defined with the presence of the following factors: hypertension and / or smoking in womenover 35 years and / or cardiovascular disease. Due to the probabilistic nature of the samples, weights were used for correction and inferences. All information is self reported and informed consent was replaced by verbal consent. RESULTS: Approximately 70% of women use somekind of family planning method, the OC is the most used (33.8%). Hypertension (15.5%) and smoking (12.2%) were the main risk factors for cardiovascular disease presented in OC users and are also contraindications for its use. The contraindicated use was present in 13.1% of the population. There were no differences in the proportions between regions, however the analysis by capital, thirteen of them are above the overall national average and almost all of them concentrated in the Northeast and North region. The inappropriate use of OC is higheramong women with less education. Its proportion in Brazil should be considered high, therefore, actions related to health education and smoking cessation should be prioritized, especially on those specific group.
As mulheres em idade reprodutiva representam cerca de 30% da população brasileira. A elas são direcionadas ações governamentais referentes ao planejamento familiar que visam garantir acesso amplo e integral às informações e aos métodos contraceptivos. O Ministérioda Saúde adota critérios de elegibilidade clínica (diretrizes clínicas baseadas em evidências científicas para orientar a prescrição e o uso desses métodos a fim de garantir sua eficácia e de evitar danos a saúde de quem os utiliza) desenvolvidos pela Organização Mundial de Saúde.Dentre os métodos para o planejamento familiar, o mais utilizado no mundo é o contraceptivo oral (ACO). OBJETIVOS: conhecer os padrões de utilização de métodos contraceptivos na população feminina brasileira e avaliar o uso adequado dos contraceptivos orais segundo oscritérios de elegibilidade clínica averiguando a ocorrência de iniquidades. METODOLOGIA: estudo epidemiológico de base populacional, transversal e descritivo que utilizou dados secundários provenientes do VIGITEL, que coleta informações sobre os fatores de risco e proteção para doenças crônicas da população brasileira por meio de entrevistas telefônicas. Refere-se à população feminina brasileira de 18 a 49 anos residente nas 26 capitais e no Distrito Federal e servida por linha de telefonia fixa para o ano de 2008 (n=21074). Asestimativas foram calculadas observando-se um intervalo de confiança de 95%. A escolaridade foi utilizada como proxy de condição socioeconômica para a análise de iniquidades. O uso inadequado de contraceptivos orais foi definido como o uso de ACO na presença de um ou mais dos seguintes fatores: hipertensão e/ou tabagismo em mulheres com mais de 35 anos e/ou doença cardiovascular. Por se tratar de amostra probabilística foram utilizados pesos para correção e inferências. Todas as informações são autorreferidas e oconsentimento livre e esclarecido foi substituído pelo consentimento verbal. RESULTADOS: cerca de 70% das mulheres utiliza algum método de planejamento familiar; o ACO é o mais utilizado (33,8%). A hipertensão (15,5%) e o tabagismo (12,2%) foram os principais fatoresde risco para doenças cardiovasculares presentes em usuárias de ACO e que também se constituem contraindicações para seu uso. O uso inadequado esteve presente em 13,1% da população brasileira. Não houve diferenças nas proporções entre as regiões, mas na análisepor capitais, treze delas se encontram acima da média global nacional e quase a totalidade delas se concentra nas regiões Nordeste e Norte. O uso inadequado de ACO é maior entre mulheres com menor escolaridade. A proporção de uso inadequado de ACO no Brasil deveser considerada elevada, portanto, ações referentes à educação em saúde e cessação do tabagismo devem ser priorizadas, principalmente entre aquelas mulheres com menor escolaridade.

The present study aimed to understand the nurses social identity in the context of the Family Health Strategy (ESF) in a Health District in Belo Horizonte, with the assumption that the ideological and structural reorganization of the work process through the ESF had influenced the identity configuration of these nurses. The study was conducted with seven family health care teams in the city of Belo Horizonte, MG. The study subjects consisted of two groups: the core - seven nurses, and the side: seven community health agents, six practical nurses and four doctors, all working in family health team for at least five years, totaling twenty- four subjects. The study was approved by the UFMGs Ethics and Research Committee ( 0128.203.000-10) and the in the local Ethics and Research Committee of Belo Horizonte (PBH) (006.2012A). This is a qualitative research and for the data collection was used the semi-structured interview after the consent of the subjects and signing the inform consent (TCLE). For data analysis, we used the technique of content analysis in the light of Bardin (1977). The results were grouped into three dimensions, namely: Micropolitical Dimension that makes the analysis of the lived world of nurses, the Real and Virtual Social Identity and also Interpersonal Relationship and the Identity construction; Organizational Dimension which covers the progress and challenges of the ESF, and the Systemic Dimension in which he analyzes the Health Care Network (RAS) in Belo Horizonte, their strengths and weaknesses and the influence of this organizational arrangement in the daily practices of the ESF nurses. In the Micropolitical Dimension the data revealed that the world experienced by nurses of the ESF is marked by ambiguous situations in their daily work, transiting between greater autonomy of action and decision-making to impotence and lack of governance to transform realities and needs that they have identified. Nurses experience also feelings of pleasure considering the emancipatory possibilities of action that the ESF gives them, but they also feel anguish and suffering because of the little professional appreciation and recognition given to them by management. The nurses indicate that wages are not proportional to the load of responsibilities and demands that are impose to them. Their everyday life is characterized by the overload of different kinds of assignments, specific to the nurse or not, contributing to the ESF set of prescribed activities and the strategy not being priority in their work. Regarding to the Organizational Dimension, it was found that the structure of the health centers determines precarious working conditions that limit nurses' performance. The management determines inconsistent work processes with the logic of the ESF as is the case of the implementation of the Manchester's Protocol in the primary health care system (APS). Making the ESF work without providing conditions for its implementation can generate distortion in the logic of the working teams causing the user's protection by ESF rather than the emancipation of themselves as subjects. The imbalance of the spontaneous demand assistance strengthens the gap between the prescribed and real dimension of the ESF. Moreover, in the perspective of the ESF professionals, the nurse is the one who sets the tone and pace of work to the family health care team, reflecting the very identity of the strategy. The Systemic Dimension presents the RAS as an important device in the assistance's organization and that deserves a standout for being developed in a large capital, like Belo Horizonte. However, there are many challenges that must be overcome, like: the lack of continuity in care due to the bottleneck of secondary health care system, shortage of professionals for certain specialties and lack of services to assist some needs such as adolescent's drug abuse demands. Thus, the ESF professionals identify demands that are repressed, which compromises the resolution of care starts in APS. Given the structural weaknesses that ESF presents and compromise the quality of nursing work, it is notice that this professional recognizes its responsibilities in ESF, understands the need to change the logic of health interventions, but did not find enablers conditions to perform these transformations. The ESF nurses struggle, in their everyday, to be EFS's nurses and the distance between the prescribed and real in their professional endeavors generates feelings of grief, frustration and anguish. An alternative suggested by the nuclear and secondary subjects of this research to minimize this framework is the deployment of Support Teams of nurses in the health centers that would be responsible for the demands of the unit, enabling ESF's nurses to perform their duties within the ESF. The study allowed us to understand the reality experienced by nurses in the ESF, identify the singularities of this scenario and analyze their identity. Furthermore, it was possible to outline elements relate to complex forms of being and the doing of the nurses through which identity, training and work are related. Finally, the study revealed the interfaces between organizational arrangements and the identity configuration of the nurse in the ESF.
O presente estudo teve como objetivo compreender a identidade social do Enfermeiro no contexto da Estratégia de Saúde da Família (ESF) no Distrito Sanitário Centro Sul, no município de Belo Horizonte, tendo como pressuposto que a reorganização ideológica e estrutural do processo de trabalho por meio da ESF influenciou a configuração identitária desses Enfermeiros. O estudo foi realizado com sete equipes de saúde da família no município de Belo Horizonte, MG. Os sujeitos da pesquisa constituíram-se de dois grupos: os nucleares - sete enfermeiros; e os secundários: sete agentes comunitários de saúde, seis técnicos de enfermagem e quatro médicos, todos atuantes na saúde da família há pelo menos cinco anos, totalizando vinte e quatro sujeitos. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa da UFMG (Parecer: 0128.203.000-10) e da Prefeitura Municipal de Belo Horizonte (PBH) (Parecer 006.2012A). Trata-se de uma pesquisa qualitativa e para coleta de dados foi utilizada a entrevista com roteiro semi estruturado após o consentimento dos sujeitos e assinatura do Termo de Consentimento Livre e Esclarecido (TCLE). Para análise dos dados, utilizou-se a técnica de Análise de Conteúdo à luz de Bardin (1977). Os resultados foram agrupados em três dimensões, a saber: Dimensão Micropolítica que compõe a análise do mundo vivido dos enfermeiros, a Identidade Social Real e Virtual e também o Relacionamento Interpessoal e Construção Identitária; Dimensão Organizacional que aborda os avanços e desafios da ESF; e a Dimensão Sistêmica na qual se analisa a Rede de Assistência à Saúde (RAS) em Belo Horizonte, suas potencialidades e fragilidades e a influencia deste arranjo organizacional nas práticas cotidianas dos enfermeiros da ESF. Na Dimensão Micropolítica os dados revelaram que o mundo vivido pelos enfermeiros da ESF é marcado por situações ambíguas no seu cotidiano que transitam entre uma maior autonomia de intervenção e tomada de decisão à impotência e ausência de governabilidade para transformar realidades e necessidades por eles identificadas. Os enfermeiros experimentam, ainda, sentimentos de prazer tendo em vista as possibilidades de atuação emancipatória que a ESF lhes proporciona, mas também angústia e sofrimento pela pouca valorização profissional e reconhecimento que lhes são conferidos pela gestão. Apontam que os salários não são proporcionais à carga de responsabilidades e cobranças que a eles se impõem. Seu cotidiano é caracterizado por sobrecarga de atribuições de várias naturezas, específicas para o enfermeiro ou não, contribuindo para que na ESF o conjunto de atividades prescritas como da estratégia não sejam prioridade. Com relação à Dimensão Organizacional, constatou-se que a estrutura física dos centros de saúde determina condições de trabalho precárias que limitam a atuação do enfermeiro. A gestão determina processos de trabalho incoerentes com a lógica da ESF como é o caso da implantação do Protocolo de Manchester na APS. Fazer a ESF funcionar sem proporcionar condições para sua efetivação pode gerar deturpação na lógica de trabalho das equipes fazendo com que os usuários sejam tutelados pela ESF ao invés de emanciparem-se como sujeitos. O desequilíbrio no atendimento da demanda espontânea fortalece o distanciamento entre as dimensões prescrita e real na ESF. Além disso, na perspectiva dos profissionais da ESF, o enfermeiro é quem dá o tom e o ritmo do trabalho à saúde da família, refletindo a própria identidade da estratégia. A Dimensão Sistêmica apresenta a RAS como importante dispositivo de organização da assistência e que merece destaque por ser desenvolvida em uma capital de grande porte, com Belo Horizonte. Entretanto, muitos são os desafios que ainda precisam ser superados dentro os quais destaca-se a falta de continuidade no cuidado face ao estrangulamento da atenção secundária, carência de profissionais para determinadas especialidades e ausência de serviços para atender algumas necessidades de saúde como por exemplo demandas de adolescentes dependente químicos. Assim, os profissionais da ESF identificam demandas que ficam reprimidas ali, o que compromete a resolutividade do cuidado iniciado na APS. Perante as fragilidades estruturais que apresenta a ESF e comprometem a qualidade do trabalho do enfermeiro, percebe-se que este profissional reconhece suas atribuições na ESF, compreende a necessidade de mudar a lógica das intervenções em saúde, mas não encontra condições viabilizadoras para efetuar essas transformações. Os enfermeiros da ESF lutam, no cotidiano, para serem enfermeiros de ESF e a distância entre o prescrito e o real no seu exercício profissional lhes gera sentimentos de sofrimento, frustração e angústia. Uma alternativa sugerida pelos sujeitos nucleares e secundários desta pesquisa para minimizar esse quadro, é a implantação de Equipes de Apoio de enfermeiros nos centros de saúde que ficariam responsáveis pelas demandas da unidade, possibilitando aos enfermeiros da equipe da ESF realizarem suas atribuições dentro da ESF. O estudo possibilitou compreender a realidade vivida pelos enfermeiros da ESF, identificar as singularidades deste cenário bem como analisar sua construção identitária. Além disso, foi possível delinear elementos que dizem respeito às formas complexas do Ser e fazer do enfermeiro por meio das quais identidade, formação e trabalho se relacionam. Por fim, o estudo revelou as interfaces existentes entre os arranjos organizacionais e a configuração identitária do enfermeiro na ESF.

This work is about the implications of elderly health care at domicile, for the caregivers, in the city of Contagem, Minas Gerais, Brazil. With the increase of life expectations and the prevalence of chronic-degenerative diseases, facing the humanization and de-hospitalization politics, the need to replace the model of attention is verified. It is essential to implement differentiated assistance actions, at domicile, as a privileged space to health care, in the direction of taking care of the growing demand of attention of elderly with chronic-degenerative diseases, overcoming the rationalization logic. However, it is verified that neither the supplemental health system, nor the public services consider the cost of the relatives, when they take responsibility for domicile care. With this research, I try to contribute to the analysis of those costs. This study has a descriptive-exploratory character. It uses a quantitative and qualitative approach, instruments, and data analysis. The general goal was to analyze the implications of domicile health care, given to people over 60, for the caregivers. The specifics goals were to know the relations that exist among the execution of domicile health care, to identify both emotional and financial costs of the caregivers with domicile health care, given to people over 60. The scenery chosen for this study was Ressaca district, because it is, in the city of Contagem, the district with the biggest number of people that are taken care of at home, in the area of the Family Health Program. The participants were 17 caregivers of elderly that depend of someone for daily life activities. The data collection period was from July third of 2006 to October second of 2006. The instruments uses to collect data were: domicile interview with the main caregivers, caregivers diary, field diary of the researcher and the charts with the records of the familys expenses with domicile care. The interviews were analyzed through exhaustive reading of the speeches from which were extracted the main ideas that were grouped in the construction of four empiric categories: The person taken care of; Caregivers: giving, learning and constructing; Care: construction and deconstruction and Care and expenses expression for the family. From those categories were included the data from the charts, from the care takers diary and the data analysis was made. When analyzing the data I could observe that the relations between the caregivers and the person being taken care of interact and have as interception the care that is influenced by the dedication of the caregivers, that are, mostly, women and relatives. I noticed that there are aspects in the relation caregiver/ person being taken care of that facilitate or make difficult the execution of home care. Humanizing attitudes were observed in the domicile locus. The caregivers dedication to the person-taken-care-ofs tasks directly influences quality of life, with loss of work opportunities, of social conviviality and leisure time, with repercussions in both physical and emotional health. The data reveal that the family doesnt account the expenses with the people that are domicile taken care of. It was necessary to appeal to price consultancy and relate them to the notes in the charts in order to come to an approximate value of the expenses with food, medication, consumption items, domicile internment services and instruments to the care execution. The consultations availability, the medication supply, the emergency service lab and hospital utilization, and the removals made by the Mobile Urgency Attendance System are items that help to reduce the budget expenses, representing financial economy to the relatives of the person being taken care of. However, this support is discontinued. The alimentation of the people taken care of is done according to the financial-economical-social situation and there are caregivers that report difficulty to buy food. The geriatric disposable diaper is the item of biggest impact on the family budget in the category of consumption items. If the payment of the domicile internment was made by the family, this would be the biggest expense, that could get as high as R$2,325.00. In second place would be health insurance (R$450.00) and, in third place, medications (R$376.55). In general, the caregivers live in a tight budget. The biggest support comes from the family that is fundamental for the domicile care, as the executer of the care and as the financer of the expenses that exceed the governmental benefits of the person being taken care of. In conclusion: although all the exercises recognized as essentials in the domicile care, this cannot be recognized as a substitutive model yet.
Trata-se de estudo das implicações do cuidado de saúde do idoso, no domicílio, para as cuidadoras, no Distrito Ressaca, município de Contagem, Minas Gerais (MG). Com o aumento da expectativa de vida e da prevalência das doenças crônico-degenerativas, face às políticas de humanização e desospitalização, verifica-se a necessidade de se substituir o modelo de atenção à modalidade de assistência domiciliar. É essencial implementar ações assistenciais diferenciadas, no domicílio, como espaço privilegiado para o cuidado de saúde, no sentido de atender à crescente demanda de atenção aos idosos, de portadores de doenças crônicas e degenerativas superando a lógica da racionalização. Verifica-se, entretanto, que nem a assistência suplementar à saúde, nem os serviços públicos consideram as implicações do cuidado de saúde domiciliar, como os custos emocionais e financeiros, assumidos pelas cuidadoras, ao se responsabilizarem pelo cuidado. Com esta pesquisa, busco contribuir para a análise dessas implicações. Estudo de caráter descritivo e exploratório teve como orientação a triangulação de abordagens quantitativa e qualitativa, dos instrumentos e na análise dos dados. Teve como objetivo geral analisar as implicações do cuidado de saúde domiciliar, prestado à pessoa acima de 60 anos, para as cuidadoras, no Distrito Ressaca do município de Contagem, MG. Teve como objetivos específicos conhecer as relações que permeiam a execução do cuidado de saúde domiciliar, identificar o apoio utilizado pelas cuidadoras e identificar os custos emocionais e financeiros das cuidadoras com o cuidado de saúde domiciliar, prestado à pessoa acima de 60 anos. O cenário escolhido foi o Distrito Ressaca por ser, no município de Contagem, o de maior número de pessoas cuidadas no domicílio, na área adscrita pelo Programa de Saúde da Família (PSF). As participantes do estudo foram 17 cuidadoras dos idosos dependentes para as atividades da vida diária. O período de coleta de dados foi de 03 de julho de 2006 a 02 de outubro de 2006. Foram utilizados como instrumentos para a coleta de dados: entrevista no domicílio com as cuidadoras principais, o diário da cuidadora, o diário de campo da pesquisadora/observação e as planilhas para registro dos gastos da família com o cuidado no domicílio. As entrevistas foram analisadas por meio de leitura exaustiva dos discursos dos quais foram extraídas as idéias principais que foram agrupadas na construção de quatro categorias empíricas: A pessoa cuidada; Cuidadora: doando, aprendendo e construindo; Cuidado: construção e desconstrução e Cuidado e a expressão dos gastos para a família. A partir das categorias foram incluídos os dados das planilhas, dos diários das cuidadoras, do diário da pesquisadora e realizada a análise dos dados. Ao analisar os dados observei que as relações da pessoa cuidada e da cuidadora se interagem e tem como interseção o cuidado que é influenciado pela dedicação das cuidadoras que são, na maioria, mulheres e parentes. Percebi que existem aspectos na relação cuidadora/pessoa cuidada que facilitam ou dificultam a execução do cuidado no domicílio. Foram observadas atitudes humanizadoras no locus domicílio. A dedicação das cuidadoras às tarefas do cuidado influencia diretamente na qualidade de vida, com perdas de oportunidades de trabalho, de convívio social e de lazer, com repercussões na saúde física e emocional. Os dados revelaram que as famílias não contabilizam o gasto com as pessoas cuidadas no domicílio. Foi necessário recorrer à consulta de preços para relacioná-los com as anotações das planilhas para se chegar a um gasto aproximado com alimentação, medicamentos, artigos de consumo, serviço de internação domiciliar e instrumentos para a execução dos cuidados. A disponibilidade de consultas, o fornecimento de medicamentos, utilização do laboratório, do serviço de emergência e do hospital, bem como as remoções feitas pelo Serviço de Atendimento Móvel de Urgência (SAMU) são itens que auxiliam na redução dos gastos do orçamento representando economia financeira para os familiares das pessoas cuidadas. Esse apoio é descontinuado. A alimentação das pessoas cuidadas é realizada segundo a situação sócio-econômico-financeira e existem cuidadoras que relataram a dificuldade em comprar alimentos. A fralda geriátrica descartável é o artigo de maior impacto sobre o orçamento familiar no tema artigos de consumo. Se o pagamento de internação domiciliar da pessoa cuidada fosse realizado pelos familiares, esse seria o maior gasto com o cuidado no domicílio podendo atingir R$2.325,00. Em 2º lugar, o maior gasto das famílias refere-se aos planos de saúde (R$450,00) e, em 3º lugar, com os medicamentos (R$376,55). No geral, as cuidadoras vivenciam um orçamento apertado. O maior apoio é o da cuidadora e que se mostra fundamental para o processo do cuidado no domicílio, como executora desse cuidado e como financiadora das despesas que ultrapassam o benefício previdenciário da pessoa cuidada. Conclui-se que, apesar de todas as práticas reconhecidas como essenciais no cuidado no domicílio, ainda não se pode se reconhecê-lo como um modelo substitutivo.

Although the term environment is widely known and comprehends interactions among all nature components, including human beings, the complexity of the interactions may hinder people from recognizing that they are a part of the environment. Many ignore that they are responsible for the environment and can influence and contribute to decrease its problems, which surround us. Besides perceiving as part of the environment, people need to understand that health is closely related to it. The understanding of its many events and actions can be only through a system perspective. Therefore, there is a need to consider the changes in the physical environment, socioeconomic relations, people and their lives, as well as changes due to the development and other conditions. This Case Study aimed to analyze health related environmental conditions in Muzambinho, Minas Gerais, from the viewpoint of its social actors, using a qualitative approach. Representatives of the municipal government, of rural and urban borrows associations, and of health and environmental institutions participated in the study. Data were collected using focal groups and documental analysis. A total of six research groups were created and 43 representatives of the 54 invited institutions participated in the study. Theme-related documents quoted by the participants were used for document analysis, and their speech used in the thematic content analysis. Results showed two observed categories. The Meaning of Environment indicated that the majority see it fragmented, stressing problems of natural resources instead of the social. It became clear that these resources bring help for human beings and that the relation nature-man is an interaction dominated by humans. Still, in this category, it was found that, although all are responsible for environmental problems, farmers and local government were considered as the main responsible ones. The category Impact of agriculture and other human intervention on the environment and health brought evidence that the use of agrotoxics was the most damaging among all the environmental conditions. It is important to stress that water is the main vehicle for the agrotoxics. Cancer was the most prevalent environment-related disease. Nonetheless, intoxication, allergies, alcoholism and depression are important as well, and were referred as related to the work. Other situations responsible for causing health problems found in the study were deforestation and inadequate disposal of waste. The speeches revealed a repetition of thoughts and talking of the global society, and its behavior. We consider the development of other researches an urgent mater that can help to deepen findings of the present study, especially those which indicated a relation between cancer and agrotoxic use, alcohol, depression and work. We deem it necessary to find strategies which produce a more effective popular participation, mitigating or eliminating damage, and exploring local potentiality.
Embora no momento, a expressão meio ambiente seja amplamente conhecida e compreenda a interação entre todos os componentes da natureza, incluindo o ser humano, a complexidade dessa interação costuma trazer dificuldades para que as pessoas se percebam como parte integrante dela e, que, são elas responsáveis e capazes de influenciar e contribuir para a diminuição dos problemas ambientais que nos cercam. Além de se perceber como parte do meio ambiente é preciso entender que a saúde está íntimamente ligada ao ambiente e que a compreensão de muitos de seus eventos e ações sobre esses, só poderá ocorrer numa perspectiva sistêmica. Para tanto, deve-se considerar as alterações no ambiente físico, as relações socioeconômicas, a população e suas condições de vida, bem como as modificações introduzidas pelo processo de desenvolvimento, entre outros aspectos. A presente pesquisa teve como objetivo analisar as condições ambientais envolvidas na saúde e na doença da população de Muzambinho Minas Gerais, sob a ótica de atores sociais. Trata-se de um Estudo de Caso, com abordagem qualitativa. Participaram do estudo representantes da gestão municipal, das associações de bairros rurais e urbanas e das instituições das áreas ambiental e de saúde. A coleta de dados se deu por meio de grupos focais e análise documental. Foram realizados ao todo 6 grupos de pesquisa e participaram do estudo 43 representantes das 54 instituições convidadas. Os documentos relativos ao tema, citados nos discursos dos pesquisados foram objeto de análise documental e as falas submetidas à Análise de Conteúdo Temática. Os resultados constaram de duas categorias empíricas. O significado de meio ambiente mostrou que a maioria dos pesquisados o vê de forma fragmentada, enfatizando a problemática dos recursos naturais em detrimento ao social. Ficou claro também que esses recursos servem para auxiliar a humanidade e que a relação homem-natureza é de interação, porém há certo domínio humano. Nessa categoria, também se detectou que, apesar da problemática ambiental ser compreendida como uma responsabilidade de todos, ela é tida como sendo, sobretudo, uma responsabilidade dos agricultores e do poder público local. A categoria Impactos do trabalho agrícola e de outras intervenções humanas no ambiente e na saúde evidenciou que, de todas as condições ambientais existentes no município, a utilização de agrotóxicos é considerada a mais prejudicial. Destaca-se a água como a principal fonte de veiculação dos resíduos deste produto químico. No que tange às doenças ou agravos relacionados com o meio ambiente, o câncer foi o mais prevalente. Entretanto, as intoxicações, as alergias, o alcoolismo e a depressão também se mostraram importantes, sendo, nesse caso apontados como relacionados ao tipo de trabalho. Situações como o desmatamento, a disposição inadequada de resíduos também foram destacadas no estudo e são apontadas como responsáveis por problemas de saúde. Os discursos revelam uma reprodução não só dos pensamentos e discursos, mas também do comportamento da sociedade global. É urgente a realização de outras pesquisas que ajudem a aprofundar os achados do estudo, sobretudo os que indicam a relação entre câncer e uso de agrotóxicos, além do alcoolismo e depressão e trabalho. Acreditamos ser preciso criar estratégias que tornem a participação popular mais efetiva, a fim de tentar mitigar ou eliminar danos encontrados, explorando as potencialidades locais.

Nutritional counseling stands out among the strategies for the treatment of diabetes mellitus (DM), however, it is a challenge due to difficulties in adherence. The research objective was to analyze the nutritional counseling and adherence in patients wit
O aconselhamento nutricional se destaca entre as estrategias de tratamento do diabetes mellitus (DM), entretanto, ainda constitui desafio devido as dificuldades de adesao. Diante disso, objetivou-se analisar a adesao ao aconselhamento nutricional em pacie

This work aims to study caring strategies for mental health patients in the health service of the Health District in Pampulha neighborhood (DISAP), in the city of Belo Horizonte, M.G. It discusses the users insertion in this health network through the analysis of articulation/integration ways of the Mental Health actions in basic attention, taking the patterns proposed in the Psychiatric Reform as the starting point. It identifies strategies to introduce therapeutic actions in basic attention which can guarantee the patients reinsertion when back to their environment. It is a qualitative work based on the theoretical-methodological aspect of the dialectic-historic materialism. It considers that its purposes allow one to face the present reality in cultural and social-historical relations in the present development and the changes in the psychiatric assistance pattern to try to understand this reality through this focus. In this context Mental Health policy is the result of formulation and reformulation, each close look revealing contradictions and subsequent changes in assistance practice, as well as knowing how to deal with insanity. Two analytical categories marked the research accomplishment in all its phases: professionals practice of those who assist mental health patients and this subjects social reinsertion. This study took place at DISAP, which is in favor of the proposals commended in the Psychiatric Reform. There were 25 interviews with professionals at the Health Service and two focal groups with the patients. In order to build the empirical categories the speech analysis technique has been used to gather topics interviewees argued about. Some topics enabled the recognition of three empirical categories: a) the assistance pattern in mental health: a project and its difficulties; b) Mental Health and Basic Attention: the needed team articulation in caring work, aspects which were highlighted in two subcategories: caring work impasses and overcoming strategies and matrix support co-responsibilities and co-participation; and c) psychosocial reinsertion, a complex process which demands constant deals involving the family and the institutions for material and emotional exchanges that can put the patients back to their environment. In this process the symptom is taken into account as the way patients can transmit to others the meaning of their suffering. Due to the aspects, dimensions and complexities of the topic of this study, looking for strategies in government organizations and in society to create new social organization ways is imperative to guarantee the success of the Psychiatric Reform.
Este trabalho se propõe a estudar as estratégias de cuidado para os usuários da saúde mental na rede de serviços de saúde do Distrito Sanitário da Pampulha, no município de Belo Horizonte, MG. Discute a inserção do usuário nessa rede de serviços de saúde e analisa as formas de articulação/integração das ações de saúde mental na atenção básica, a partir dos princípios propostos pela Reforma Psiquiátrica, identificando as estratégias para a implantação de ações terapêuticas na atenção básica que potencializem a ressocialização do usuário no seu território. Trata-se de uma pesquisa qualitativa, fundamentada no referencial teóricometodológico do materialismo histórico e dialético, uma vez que seus pressupostos permitem olhar a realidade presente nas relações sócio-históricas e culturais, no atual desenvolvimento e transformação do modelo assistencial psiquiátrico, e compreendê-la nessa perspectiva. Na esfera dessa realidade, a política de saúde mental é resultante de formulações e reformulações, com sucessivas aproximações que revelam contradições e subsequentes mudanças na prática assistencial e nos saberes no trato com a loucura. A prática dos profissionais que assistem os usuários da saúde mental e a sua reinserção social são as duas categorias analíticas que balizaram a realização da pesquisa em todas as suas fases. O cenário utilizado para o estudo foi o Distrito Sanitário da Pampulha, que se posiciona favoravelmente às propostas preconizadas pela Reforma Psiquiátrica. Na coleta de dados, foram realizadas 25 entrevistas com os profissionais da rede e dois grupos focais com 18 usuários. Para a construção das categorias empíricas foi utilizada a técnica de análise de discursos, a partir da depreensão dos temas contidos nos discursos dos entrevistados. Nesse percurso, revelaram-se temas que possibilitaram o reconhecimento de três categorias empíricas: a) o modelo assistencial em saúde mental: um projeto e seus nós; b) a saúde mental e a atenção básica: a necessária articulação das equipes na rede de cuidados em que se evidenciaram duas subcategorias, a rede de cuidados - impasses e estratégias de superação e apoio matricial - corresponsabilizações e co-participações; e c) a reinserção psicossocial, processo complexo, que implica negociações constantes envolvendo a família e as instituições para a realização de trocas afetivas e materiais capazes de inserir o usuário em seu meio social, levando em conta o sintoma como expressão da tentativa do sujeito de dar significação ao seu sofrimento. Dadas às características, dimensões e complexidades do fenômeno deste estudo, a busca de estratégias nas instâncias governamentais e na sociedade civil e a criação de formas de organização social são prementes para o sucesso da Reforma Psiquiátrica.

Brazilians live daily with an overcrowding in the emergency room that is exacerbated by organizational problems such as care by order of arrival, no establishment of clinical criteria. The implementation of risk classification has been a measure taken by the Ministry of Health to organize the demand and humanization of care, in order to minimize the risk to patients waiting for medical attention. The nurse has been appointed as the professional most qualified to perform the risk assessment, and legally protected by a protocol to support the decision. The objective of this study was to assess the degree of agreement between an institutional protocol and the protocol of Manchester to the risk assessment of patients attended seen in the emergency room of a public hospital in Belo Horizonte - MG. This is a descriptive-comparative study, where 382 reports of patients in the emergency room were evaluated and the risk was classified using two protocols: the protocol established in the institution and the protocol of Manchester. To determine the degree of agreement between the protocols indices were calculated by weighted and unweighted kappa. Statistical tests were used to identify the factors that influenced the agreement and disagreement between the protocols. The results showed that the correlation between the protocols is average, when considering the classification errors occurred between neighboring colors (kappa = 0.48), and good when considering the classification errors occurred between extreme colors (kappa = 0.61). The protocol of Manchester increased the level of priority of patients when compared to the institutional protocol. The Manchester protocol has been proven to be more inclusive. The findings of ineffective breathing, severe pain, fever, pain and a no recent problem are decisive complaints for the classification of patients in both protocols in the colors red, orange, yellow, green and blue. The age and complete record of the complaint are the main factors influencing the outcome of the risk rating to the protocol established in the institution.
Os pronto-socorros brasileiros convivem diariamente com uma superlotação que é agravada por problemas organizacionais como o atendimento por ordem de chegada, sem estabelecimento de critérios clínicos. A implantação da classificação de risco tem sido uma medida adotada pelo Ministério da Saúde para organização da demanda e humanização do atendimento, no intuito de minimizar o risco para os pacientes que esperam por atendimento médico. O enfermeiro tem sido apontado como o profissional mais capacitado para realizar a classificação de risco, sendo legalmente amparado por um protocolo para subsidiar a tomada de decisão. O objetivo deste estudo foi verificar o grau de concordância entre um protocolo institucional e o protocolo de Manchester para a classificação de risco de pacientes atendidos no pronto-socorro de um hospital público de Belo Horizonte MG. Trata-se de estudo descritivo comparativo, onde 382 prontuários foram avaliados e foi realizada a classificação de risco utilizando dois protocolos: o protocolo estabelecido na instituição e o protocolo de Manchester, a partir do registro realizado pelos enfermeiros. Para determinação do grau de concordância entre os protocolos foram calculados os índices kappa ponderado e não ponderado. Testes estatísticos foram utilizados para identificar os fatores que influenciaram as concordâncias e discordâncias entre os protocolos. Os resultados mostraram que a concordância entre os protocolos é média, quando considerados os erros de classificação ocorridos entre cores vizinhas (kappa = 0,48), e boa quando considerados os erros de classificação ocorridos entre cores extremas (kappa = 0,61). O protocolo de Manchester aumentou o nível de prioridade dos pacientes quando comparado ao protocolo institucional, demonstrando ser um protocolo mais inclusivo. Os achados de respiração ineficaz, dor intensa, febre, dor e problema não recente foram as queixas determinantes para a classificação dos pacientes em ambos os protocolos nas cores vermelha, laranja, amarela, verde e azul. A idade e o registro completo da queixa principal são fatores que influenciam no resultado da classificação de risco para o protocolo institucional.