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Submitted by Adriana Aparecida Ferreira (dryferreira1@hotmail.com) on 2019-04-10T12:55:06Z No. of bitstreams: 1 TESE FERREIRA, A.A..pdf: 1539721 bytes, checksum: 4477f9b1ebef9fcc9ac6b210aa5dc667 (MD5) Approved for entry into archive by Jacqueline de Almeida null (jacquie@franca.unesp.br) on 2019-04-10T13:36:39Z (GMT) No. of bitstreams: 1 Ferreira_AA_te_fran.pdf: 1539721 bytes, checksum: 4477f9b1ebef9fcc9ac6b210aa5dc667 (MD5) Made available in DSpace on 2019-04-10T13:36:39Z (GMT). No. of bitstreams: 1 Ferreira_AA_te_fran.pdf: 1539721 bytes, checksum: 4477f9b1ebef9fcc9ac6b210aa5dc667 (MD5) Previous issue date: 2019-03-28 O tema envelhecimento da população constitui uma preocupação mundial e especialmente na realidade brasileira, onde é necessário entender como se tem construído a gestão para a efetivação de direitos da população idosa, as limitações e os eventuais avanços legais, bem como o comprometimento políticosocial de governantes, da sociedade e do setor privado. Objetivo: Investigar os impactos do Fundo do Idoso, pela gestão realizada por meio do Conselho Municipal do Idoso na cidade de Ribeirão Preto/SP, buscando entender as facilidades e dificuldades de sua implantação como garantia dos direitos da pessoa idosa. Metodologia: Com base na teoria crítica marxista, observam-se as categorias da realidade, com aproximações e a constituição de totalizações provisórias, lançando mão de dados que ampliam as possibilidades de análise, dando sentido e explicação à realidade observada. Numa perspectiva dialética, intenta-se captar o movimento permanente no processo de construção histórica, em busca da superação de uma visão estagnada e que dificulta concretizar o devir: o movimento que traz possibilidades de grandes mudanças. É uma pesquisa inovadora, com aporte bibliográfico, documental e de campo, de caráter investigativo, com abordagem de análise quantitativa e qualitativa. Os dados foram apreendidos por meio da participação de representantes do Conselho Municipal do Idoso de Ribeirão Preto/SP- CMIRP/SP: conselheiros municipais, conselheiros da sociedade civil, das entidades sociais e participante ativo da sociedade. Resultados: Os resultados apontam que os projetos aprovados pelo CMIRP/SP atendem à política de promoção, proteção, defesa e atendimento dos direitos dos idosos, entretanto o estudo revela que o valor arrecadado anual ainda é muito baixo em relação ao potencial da cidade de Ribeirão Preto/SP. Quanto ao doador/destinador dos recursos financeiros, muitos acompanham os projetos sociais, mas a maioria desconhece a existência de algum programa que reforça esse direito pelo CMIRP/SP. Da amostra pesquisada, a maioria concorda que a população tem o CMI como um recurso importante na construção de políticas públicas de qualidade, embora ressalte que precisa de melhorias, como, por exemplo, quanto à capacitação dos membros do CMI. Conclusão: Espera-se que esta pesquisa contribua para os avanços da gestão do Fundo do Idoso sob a responsabilidade do CMI e que motive refletir os desafios no alcance de maior impacto nos projetos voltados à população idosa. The theme of aging of the population is a worldwide concern and especially in the Brazilian reality. It is necessary to understand how management has been constructed for the realization of rights of the elderly population, the limitations and the possible legal advances, as well as the social political commitment of the rulers of the private sector. Objective: Investigate the impacts of the Elderly Fund, through the management carried out through the Municipal Council of the Elderly in the city of Ribeirão Preto/SP, seeking to understand the facilities and difficulties of its implementation as a guarantee of the rights of the elderly. Metodology: Based on the critical Marxist theory, we observe the categories of reality, with approximations and the constitution of provisional totalizations, using data that expand the possibilities of analysis, giving meaning and explanation to the observed reality. In a dialectical perspective, it is tried to capture the permanent movement in the process of historical construction, in search of overcoming a stagnant vision that makes difficult to concretize the becoming: the movement that brings possibilities of great changes. It is an innovative research, with a bibliographical, documentary and field contribution, of investigative character, with quantitative and qualitative analysis approach. The data were seized through the participation of representatives of the Municipal council of the Elderly of Ribeirão Preto/SP-CMIRP/SP: municipal councilors, civil society councilors, social entities and active participants of the society. Results: The results show that the projects approved by the CMIRP/SP comply with the policy of promotion, protection, defense and fulfillment of the rights of the elderly. However, the study reveals that the anual amount collected is still very low in relation to the potencial of the city of Ribeirão Preto/SP. As for the donor of financial resources, many follow social projects, but most are unaware of any program that reinforces this right by the CMIRP/SP. From the sample surveyed, most agree that the population has the CMI as an important resource in the construction of quality public policies, althoug it points out that it needs improvements, such as, for example, the training of CMI members. Conclusion: It is expected that this research contributes to the advancement of the management of the Elderly Fund under the responsibility of the CMI and motivates the reflection on challenges aimed at the elderly population. El envejecimiento sujeto de la población constituye especialmente una preocupación mundial y en la realidad brasileña, donde está necesario entender como si haya construido a gerencia para el efetivação de las derechas de la población envejecida, de las limitaciones y de los avances legales eventual, así como el comprometimento politicosocial de gobernar, de la sociedad y del sector privado. Objetivo: Investigar los impactos del Fondo del Anciano, por la gestión realizada por medio del Consejo Municipal del Anciano en la ciudad de Ribeirão Preto / SP, buscando entender las facilidades y dificultades de su implantación como garantía de los derechos de la persona anciana. Metodología: En base de la teoría crítica marxista, las categorías de la realidad se observan, con acercamientos y la constitución de totallings provisory, lanzando la mano de los datos que amplían las posibilidades de análisis, dando el fieltro y la explicación a la realidad observada. En una dialéctica de la perspectiva, una se prepone coger el movimiento permanente en curso de construcción histórica, en busca de la superación de una visión del estagnada y eso hace difícil de materializar el devir: el movimiento que trae posibilidades de grandes cambios. Es una investigación innovadora, con llega en bibliográfico portuario, documentary y de campo, del carácter del investigativo, con subir del análisis cuantitativo y cualitativo. Os dados foram apreendidos por meio da participação de representantes do Conselho Municipal do Idoso de Ribeirão Preto/SP- CMIRP/SP: municipal, aconsejando miembros de consejo de la sociedad civil, las entidades sociales y el activo del participante de la sociedad. Resultados: Los resultados señalan que los proyectos aprobaron para el cuidado de la toma de CMIRP/SP a la política de la promoción, de la protección, de la defensa y de la atención de las derechas envejecidas, no obstante el estudio divulga que la publicación anual recogida del valor sigue siendo muy baja en lo referente al potencial de la ciudad de Ribeirão Preto /SP. Cuánto al destinador giver/of los recursos financieros, muchos siguen los proyectos sociales, pero la mayoría es inconsciente de la existencia de un cierto programa que consolide la esta derecha para el CMIRP/SP. De la muestra buscada, la mayoría conviene que la población tiene el CMI como recurso importante en la construcción de la política pública de la calidad, sin embargo standes hacia fuera que necesita las mejoras, as, por ejemplo, cuánto a la calificación de los miembros de el CMI. Conclusión: Uno cuenta con que esta investigación contribuya para los avances de la gerencia de la profunda de envejecida bajo responsabilidad de el CMI y que motiva para reflejar los desafíos en el alcance de un impacto más grande en los proyectos se vuelve a la población envejecida.

A profilaxia é o regime terapêutico de escolha para indivíduos com hemofilia grave. Entretanto sua efetividade pode ser limitada pela baixa adesão do paciente, comprometendo os resultados, a despeito dos altíssimos custos do tratamento. Os objetivos desse estudo foram: 1) validar a versão brasileira do questionário VERITASPro para avaliação da adesão à profilaxia e 2) avaliar os custos diretos médicos do tratamento da hemofilia, sob a perspectiva do Sistema Único de Saúde, destacando o incremento nos gastos públicos após a incorporação de modalidades terapêuticas como a profilaxia, a imunotolerância e uso de produtos recombinantes. O estudo foi realizado no Hemocentro Regional de Juiz de Fora, entre 2015 e 2016. Para a validação, o VERITAS-Pro, de origem americana, foi traduzido e adaptado para o português brasileiro e aplicado a 32 responsáveis pela profilaxia de pacientes com hemofilia e a 5 observadores do tratamento realizado. Medidas para validação incluíram resultados obtidos de escalas visuais analógicas de adesão, dispensações de medicamentos pela farmácia do hemocentro e porcentagem de doses recomendadas administradas, obtidas dos diários de infusão dos pacientes. A consistência interna foi muito boa para o escore total do VERITAS-Pro, excelente para os domínios “lembrança”, “omissão” e “comunicação”, boa para o domínio “dosagem” e aceitável para “rotina” e “planejamento”. Doze participantes responderam ao questionário em mais de uma ocasião para avaliação da reprodutibilidade. O coeficiente de correlação intraclasse mostrou-se excelente. Quanto à validade convergente, os escores do VERITAS-Pro foram moderadamente correlacionados à escala visual e aos diários de infusão, mas apresentaram correlação fraca com os registros de dispensação pela farmácia. Dessa forma, a versão brasileira do VERITAS-Pro revelou-se um instrumento válido e confiável, capaz de possibilitar a compreensão de fatores específicos relacionados à adesão e de permitir intervenções mais direcionadas. Para o estudo de análise de custos, foram coletados, de forma retrospectiva, dados sociodemográficos, clínicos e terapêuticos dos prontuários de 98 pacientes com hemofilia atendidos entre janeiro de 2011 e dezembro de 2015. Aos atendimentos, exames, hospitalizações e medicamentos foram atribuídos custos, conforme o Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Órteses, Próteses e Materiais e o Lista de Preços de Medicamentos da Agência Nacional de Vigilância Sanitária. Do total de pacientes, 43,3% apresentavam hemofilia grave e 32,7%, moderada; 36 aderiram à profilaxia, sendo 29 na forma terciária; dois apresentaram pesquisa de inibidor positiva e um recebeu imunotolerância. O número de consultas e o consumo de hemoderivados foram mais altos no grupo com hemofilia grave. As hospitalizações foram raras. A artropatia não foi estadiada e não houve cirurgias ortopédicas. Os custos diretos aumentaram 286,8% no período avaliado. O custo anual médio por paciente foi de R$ 57.416,43 (R$ 2.962,10 na hemofilia leve – R$ 89.467,77 na grave), sem diferença significativa entre hemofilia A e B. Os hemoderivados corresponderam a 99,46% do custo total. A implementação da profilaxia aumentou consideravelmente os custos diretos do tratamento da hemofilia. A inclusão de pacientes com artropatia não mensurada em regimes profiláticos impossibilita a avaliação da custo-efetividade dessa abordagem, dificultando a definição de prioridades diante da escassez de recursos financeiros. Prophylaxis is the therapeutic regimen of choice for individuals with severe hemophilia. However, its effectiveness may be limited by the patient's low adherence, compromising the results, despite the high costs of treatment. The objectives of this study were: 1) to validate the Brazilian version of the VERITAS-Pro questionnaire for assessing adherence to prophylaxis and 2) to assess the direct medical costs of hemophilia treatment from the perspective of the Unified Health System, underscoring the increase in public spending after the incorporation of therapeutic modalities such as prophylaxis, immunotolerance, and the use of recombinant products. The study was conducted at the Juiz de Fora Regional Blood Center between 2015 and 2016. For validation, the US version of the VERITAS-Pro was translated and adapted to Brazilian Portuguese and administered to 32 persons responsible for the prophylaxis of hemophilia patients, and to 5 observers of the treatment conducted. Measures for validation included results obtained from visual analogue scales of adherence, medications dispensed by the blood center pharmacy, and percentage of recommended doses administered, obtained from patient infusion diaries. The internal consistency was very good for VERITAS-Pro's overall score, excellent for the subscales "remember", "skip", and "communicate", good for the subscale "dose" and acceptable for "time" and "plan". Twelve participants answered the questionnaire on more than one occasion, to evaluate reproducibility. The intraclass correlation coefficient was excellent. Regarding convergent validity, the VERITAS-Pro scores were moderately correlated with the visual scale and with the infusion diaries, but showed poor correlation with pharmacy dispensing records. Thus, the Brazilian version of the VERITAS-Pro proved to be a valid and reliable instrument that can facilitate understanding of specific factors related to adherence and permit more targeted interventions. For the cost analysis study, sociodemographic, clinical, and therapeutic data were collected retrospectively from the medical records of 98 hemophilia patients treated between January 2011 and December 2015. Consultations, examinations, hospitalizations, and medications were assigned costs according to the Management System for the Table of Procedures, Medications, and Orthoses, Prostheses, and Materials, and the Medications Price List of the Brazilian Health Regulatory Agency. From the total number of patients, 43.3% had severe hemophilia and 32.7% had moderate hemophilia; 36 adhered to the prophylaxis, with 29 in the tertiary form; two presented positive inhibitor screening; and one received immunotolerance. The number of consultations and the consumption of blood products were higher in the group with severe hemophilia. Hospitalizations were rare. Arthropathy was not staged and there were no orthopedic surgeries. Direct costs increased 286.8% over the period evaluated. The mean annual cost per patient was 57,416.43 Brazilian Reais (2,962.10 BR in mild hemophilia - 89,467.77 BR in severe cases), with no significant difference between hemophilia A and B. Blood products corresponded to 99.46% of the total cost. The implementation of prophylaxis has considerably increased the direct costs of treating hemophilia. The inclusion of patients with unmeasured arthropathy in prophylactic regimens makes it impossible to assess the cost-effectiveness of this approach, making it difficult to define priorities given the scarcity of financial resources.

BACKGROUND Studies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. OBJECTIVE This study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. METHODS The Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). RESULTS Thirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001). CONCLUSION Health-related quality of life in hemophilia, measured by the Hemophilia-Specific Quality of Life questionnaire, was influenced by the presence of arthropathy and infectious diseases transmitted by blood products. Rehabilitation measures should be encouraged in order to improve the quality of life of these patients.

BACKGROUND Studies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. OBJECTIVE This study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. METHODS The Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). RESULTS Thirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001). CONCLUSION Health-related quality of life in hemophilia, measured by the Hemophilia-Specific Quality of Life questionnaire, was influenced by the presence of arthropathy and infectious diseases transmitted by blood products. Rehabilitation measures should be encouraged in order to improve the quality of life of these patients.

Made available in DSpace on 2016-04-04T18:28:01Z (GMT). No. of bitstreams: 1 Adriana Ap Ferreira 1.pdf: 2671092 bytes, checksum: 52bffd7181072105e7e3c13a4ab6f2c7 (MD5) Previous issue date: 2004-12-14 With the increse of longevity and consequently the increase of scientific production about old age, it is necessary one analysis of the area's done knowledge. It was done a meta-analysis of the studies produced in the psychology area about old aged persons, in the PsycINFO database, on the first semester of 2003 (N=1281). It was analyzed: title, authors, type of work, themes, participants, reserch place, material used for data collection, and focus. In general, the titles presented a number of words within the recommended quantity, in 42,89% punctuation was not used and in 34,76% it was used colons. The authorship was predominantly multiple (90,1%), with majority male production. The reserch production is predominant (98,75%), and scientific journal is the most used vehicle for divulgation (98,4%). The most frequent themes were Social/Cultural Aspects, Psychological Aspects/ Chsrecte ristics and Diseases; there was a correlation botween the themes classified for the database anf the authors (r=0,98). The majorith of the studies compares old and adilt persons. America and Europe were the continents of major production. The majority of works were made in Health Services (37,71%) in which several types of instruments were used for data collection. The difference between the focus loss (21%) and gain (13,82%) was significant statistically. It is concluded that the area shows development signs. Com o aumento da longevidade e conseq?ente aumento da produ??o cient?fica sobre velhice, faz-se necess?ria uma an?lise do conhecimento gerado na ?rea. Foi feita uma meta-an?lise dos estudos realizados na ?rea de psicologia sobre idosos, inseridos na base de dados PsyclNFO, no primeiro semestre de 2003 (N=1281). Foram analisados: t?tulo, autoria, tipo de trabalho, tem?tica, participantes, locais de realiza??o das pesquisas, materiais usados para a coleta de dados e enfoque. No geral, os t?tulos apresentaram n?mero de voc?bulos dentro do recomendado, sendo que em 42,89% n?o foi feito uso de pontua??o e em 34,76% foi utilizado dois pontos. A autoria foi predominantemente m?ltipla (90,1%), com maior produ??o mascul ina. A produ??o de pesquisas ? predominante (98,75%), sendo o peri?dico cient?fico o ve?culo mais utilizado para divulga??o (98,4%). Os temas mais freq?entes foram Aspectos Sociais! Culturais, Aspectos! Caracter?sticas Psicol?gicas e Doen?as; houve correla??o entre a classifica??o feita pela base e pelos autores (r=0,98). A maioria dos estudos compara idosos e pessoas adultas. Am?rica e Europa foram os cont?nentes de maior produ??o. A maioria dos trabalhos foi realizada em Servi?os de Sa?de (37,71 %), tendo sido usados v?rios tipos de instrumentos para a coleta dos dados. A diferen?a entre o enfoque perda (21 %) e ganho (13,82%) foi estatisticamente significante. Conclui-se que a ?rea mostra sinais de desenvolvimento.