329 resultados para IPS


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Dissertação de Mestrado, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2015

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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2015.

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Biomechanical adaptations that occur during pregnancy can lead to changes on gait pattern. Nevertheless, these adaptations of gait are still not fully understood. The purpose was to determine the effect of pregnancy on the biomechanical pattern of walking, regarding the kinetic parameters. A three-dimensional analysis was performed in eleven participants. The kinetic parameters in the joints of the lower limb during gait were compared at the end of the first, second, and third trimesters of pregnancy and in the postpartum period, in healthy pregnant women. The main results showed a reduction in the normalized vertical reaction forces, throughout pregnancy, particularly the third peak. Pregnant women showed, during most of the stance phase, medial reaction forces as a motor response to promote the body stability. Bilateral changes were observed in hip joint, with a decrease in the participation of the hip extensors and in the eccentric contraction of hip flexors. In ankle joint a decrease in the participation of ankle plantar flexors was found. In conclusion, the overall results point to biomechanical adjustments that showed a decrease of the mechanical load of women throughout pregnancy, with exception for few unilateral changes of hip joint moments.

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Biomechanical adaptations that occur during pregnancy can lead to changes on gait pattern. Nevertheless, these adaptations of gait are still not fully understood. The purpose was to determine the effect of pregnancy on the biomechanical pattern of walking, regarding the kinetic parameters. A three-dimensional analysis was performed in eleven participants. The kinetic parameters in the joints of the lower limb during gait were compared at the end of the first, second, and third trimesters of pregnancy and in the postpartum period, in healthy pregnant women. The main results showed a reduction in the normalized vertical reaction forces, throughout pregnancy, particularly the third peak. Pregnant women showed, during most of the stance phase, medial reaction forces as a motor response to promote the body stability. Bilateral changes were observed in hip joint, with a decrease in the participation of the hip extensors and in the eccentric contraction of hip flexors. In ankle joint a decrease in the participation of ankle plantar flexors was found. In conclusion, the overall results point to biomechanical adjustments that showed a decrease of the mechanical load of women throughout pregnancy, with exception for few unilateral changes of hip joint moments.

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The overall objective of this thesis was to study the effects of regular and high (super-) doses of phytase in the gut of broilers, with the aim of documenting the mechanism of their action leading to improvements in animal health. Phytase is often supplemented to commercial broiler diets to facilitate the hydrolysis of plant phytate and release of phosphorus for utilisation. Although not the original intention of its addition, phytase supplementation leads to improvements in growth performance parameters and enhanced nutrient utilisation. Further benefits have also been observed following the addition of super-doses of phytase which are not explained by an increase in phosphorus release, and thus have been termed ‘extra-phosphoric effects’. Using diets formulated to be adequate or marginally deficient in available phosphorus (aP; forming the negative control, NC), phytase was supplemented at 1,500 and 3,000 FTU/kg phytase in the first study (both super-doses) and the partitioning of nutrients within the body was investigated. It appeared that there were some metabolic changes between 1,500 and 3,000 FTU/kg, switching between protein and fat accretion, potentially as a consequence of nutrient availability, although these changes were not reflected by changes in growth performance parameters. However, the loss of the NC treatment without phytase on day 12 limits the comparison of the phytase within the NC treatment, but does allow for comparison of each dose at adequate or low dietary aP levels. As expected, a greater degree of phytate hydrolysis was achieved with 3,000 than with 1,500 FTU/kg phytase, but changes in carcass accretion characteristics were greater with 1,500 than 3,000 FTU/kg. Using these findings and the observation that there were no further changes in the parameters measured by increasing phytase from 1,500 to 3,000 FTU/kg (aside from phytate hydrolysis), 1,500 FTU/kg phytase was selected as the super-dose to be used in subsequent studies. The next study considered the influence of regular (500 FTU/kg) and super doses (1,500 FTU/kg) of phytase from within the gut. Overall, it was observed that changes were occurring to the gut environment, which ultimately would influence the absorptive capacity and conditions for further phytate hydrolysis. Dietary treatment influenced gut conditions such as pH, intestinal morphology and bacterial populations which can subsequently influence nutrient utilisation and potential for growth. The subsequent study was designed to investigate the effects within the gut in more detail. The release of nutrients from phytate hydrolysis and their bioavailability within the digesta can influence conditions within intestine, facilitating enhanced absorption. One of the parameters investigated was the expression of genes involved in the transport of nutrients in the intestine. Overall, there were few significant dietary treatment influences on gene expression in the intestine, however there was a dose-dependent response of phytase on the expression of the jejunual divalent mineral transporter. This indicates a change in divalent mineral bioavailability in the intestine, with correlations with inositol phosphate esters (IPs) being identified. This is likely explained by the IPs produced by phytase hydrolysis and accumulating in the digesta, differing between regular and high doses of phytase. It became apparent that interactions between the products of phytate hydrolysis (IP3, IP4) and minerals in the digesta had the potential to influence the gut environment and subsequent nutrient bioavailability and overall phytase action. The final study was designed to increase the content of the IPs, and investigate the influence of phytase under these conditions. As the complete hydrolysis of phytate to myo-inositol has been reported to be beneficial due to its proposed insulin mimetic effects, myo-inositol was also supplemented to one of the diets to see if any further benefits would be observed when supplemented alongside super-doses of phytase. Neither increased concentrations of the higher IP esters (IP6, IP5 and IP4) nor myo-inositol (myo-) had any effect on broiler growth performance, however there were still apparent beneficial influences of phytase supplementation. The results suggest considerable and important interactions between minerals and IP esters within the digesta, which ultimately have the potential to influence gut conditions and thus nutrient utilisation and growth performance. Reduced concentrations of blood glucose in the high IP ester diet with additional phytase supplementation suggest some insulin-like effects of myo- production. Additionally, the lack of effect of myo- supplementation on blood glucose and insulin concentrations suggests a difference between the structure of phytase-produced myo- and supplemented myo-. Although there were no improvements in growth performance by increasing phytase from 500 to 1,500 FTU/kg, there were changes occurring at the level of the gut and expression of genes in the intestine, influencing nutrient utilisation and the partitioning of nutrients within the body. There are many factors to be considered when supplementing phytase, with dietary nutrient content and nutrient release and IP production during phytate hydrolysis having an influence on phytase action, nutrient absorption and conditions within the gut. Super-doses of phytase may be beneficial for maintaining optimal gut conditions, clearing IP esters from the digesta, reducing their potential to form complexes with minerals and other nutrients, ultimately influencing the efficiency of production.

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Objetivo: Identificar las barreras para la unificación de una Historia Clínica Electrónica –HCE- en Colombia. Materiales y Métodos: Se realizó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a profesionales y expertos de 22 instituciones del sector salud, de Bogotá y de los departamentos de Cundinamarca, Santander, Antioquia, Caldas, Huila, Valle del Cauca. Resultados: Colombia se encuentra en una estructuración para la implementación de la Historia Clínica Electrónica Unificada -HCEU-. Actualmente, se encuentra en unificación en 42 IPSs públicas en el departamento de Cundinamarca, el desarrollo de la HCEU en el país es privado y de desarrollo propio debido a las necesidades particulares de cada IPS. Conclusiones: Se identificaron barreras humanas, financieras, legales, organizacionales, técnicas y profesionales en los departamentos entrevistados. Se identificó que la unificación de la HCE depende del acuerdo de voluntades entre las IPSs del sector público, privado, EPSs, y el Gobierno Nacional.

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Los factores de riesgo psicosocial se pueden definir como las condiciones del individuo, del medio extra laboral o del medio laboral, que bajo determinadas condiciones de intensidad y tiempo de exposición, generan efectos negativos en el trabajador y en la organización. Objetivo: Determinar la relación entre los factores de riesgo psicosocial intralaboral, extra laboral y los síntomas de estrés en médicos de una institución prestadora de servicios de salud en la ciudad de Bogotá, durante el año 2014. Metodología: Se llevó a cabo un estudio de corte transversal, en una muestra constituida por 202 registros pertenecientes a médicos generales de una IPS de la ciudad de Bogotá. Las variables incluidas fueron socios demográficos, ocupacionales, intralaborales, extra laborales y sintomatología asociada al estrés. Se contó con la información de la batería de riesgos psicosociales elaborada por el Ministerio de la Protección Social (Actualmente Ministerio del Trabajo) y la Universidad Javeriana la cual esta validada en el país. Para las variables de tipo cuantitativo, se obtuvieron medidas de tendencia central y de dispersión. Para identificar los factores relacionados con el riesgo psicosocial y síntomas asociados al estrés, se utilizaron pruebas de asociación Chi cuadrado o análisis de correlación según la naturaleza de las variables. El nivel de significancia para cada prueba fue 0.05. Para analizar las diferencias entre dichas categorías se utilizó la prueba Anova de una vía. Se consideró un nivel α<0.05 como significativo para las pruebas de hipótesis. Para el análisis de la información se utilizó el paquete estadístico SPSS versión 22.0 de IBM. Resultados: La edad promedio de los participantes fue de 41.3 años (IC 95 % 40.1-42.5), siendo el género predominante el femenino con el 58,6%. Se encontró una asociación significativa entre el estado civil y la presencia de sintomatología asociada al estrés (p= 0,031). Al relacionar los valores de estrés con los riesgos intralaborales, se encontraron diferencias significativas en el 100% de estos y entre estrés y riesgos extralaborales se obtuvieron diferencias significativas (p<0.05) en cada una de las dimensiones evaluadas. Conclusiones Los médicos incluidos en el estudio tienen riesgo muy alto tanto a nivel intralaboral como extralaboral, reflejándose en el desarrollo de niveles incrementados de respuestas asociadas al estrés. Por lo anterior, se propone la realización de acciones de mejora dirigidas a la prevención, así como a la intervención de los factores de riesgo, encaminadas a promover la salud y controlar los factores de riesgo psicosocial, con el fin de mejorar las condiciones laborales de los trabajadores participantes en el estudio.

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Introducción: Contar con un diagnóstico de las condiciones en seguridad y salud en el trabajo en el país permite crear estrategias para minimizar los problemas de la población trabajadora. En Colombia existe el observatorio del Instituto Nacional de Salud, sin embargo, no cuenta, en ninguno de sus tópicos, con información y análisis sobre la salud y seguridad de la población trabajadora. Objetivo: Determinar las condiciones de salud de la población atendida en la IPS SALUD OCUPACIONAL DE LOS ANDES LDTA en la ciudad de Bogotá, durante el año 2015. Materiales y métodos: Se realizó una prueba piloto del observatorio de salud y seguridad en el trabajo mediante un estudio de corte transversal, donde se tomó una base de datos de pacientes evaluados en la IPS SALUD OCUPACIONAL DE LOS ANDES LDTA, de la ciudad de Bogotá D.C. que contiene información de exámenes médicos ocupacionales realizados en el 2015 en la plataforma ISISMAWEB con una muestra representativa de 1923 registros. Se incluyeron variables sociodemográficas y laborales, los paraclínicos registrados como alterados más prevalentes, los diagnósticos y dictámenes emitidos en la población estudiada y las recomendaciones personales dadas por el sistema de gestión de la empresa. Se realizó un análisis descriptivo y para el estudio de las interacciones se empleó el Chi-cuadrado. Resultados: El 62,1% de la población fueron hombres con edad promedio de 34.8 años (DE 10,521). El 41.5% tuvieron estudios secundarios. La evaluación médica más realizada fue el examen de ingreso en el 30.5% de los casos. El cargo operadores de instalaciones y máquinas y ensambladores represento el 27.9% y en última medida los profesionales de nivel medio en operaciones financieras y administrativas con el 0.5%. El diagnostico CIE 10 emitido más frecuente fue con el 15,8% el código Z100 (Examen de salud ocupacional), seguido del Trastorno de la refracción no especificado (H527) con el 9,0%. En cuanto a las recomendaciones generales la que más se repitió fue examen periódico con un 30%. La recomendación preventiva más frecuente fue osteomuscular con el 36,5%. Las recomendaciones SVE de mayor prevalencia fueron ergonómicas con un 40,7%. Se encontraron asociaciones (p<0.05) entre las variables escolaridad, género y estrato. Conclusiones: Se deben optimizar los mecanismos de recolección del dato para ser más viable su evaluación y asociación. Hay un subregístro importante de segundos diagnósticos asociado al no registro de los paraclínicos. Este estudio plantea un modelo a seguir para poder desarrollar el observatorio nacional de salud y seguridad en el trabajo.

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Survival models are being widely applied to the engineering field to model time-to-event data once censored data is here a common issue. Using parametric models or not, for the case of heterogeneous data, they may not always represent a good fit. The present study relays on critical pumps survival data where traditional parametric regression might be improved in order to obtain better approaches. Considering censored data and using an empiric method to split the data into two subgroups to give the possibility to fit separated models to our censored data, we’ve mixture two distinct distributions according a mixture-models approach. We have concluded that it is a good method to fit data that does not fit to a usual parametric distribution and achieve reliable parameters. A constant cumulative hazard rate policy was used as well to check optimum inspection times using the obtained model from the mixture-model, which could be a plus when comparing with the actual maintenance policies to check whether changes should be introduced or not.

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This paper presents a study related with measuring of radio frequency emissions. The purpose is to determine the level of interference generated by wireless power transfer equipment in a specific frequency range, and to compare those levels to the existing standards. The technology of wireless power transfer, especially for electric vehicles batteries charging, is rapidly developing in the recent years. An increasing use of this technology in industrial and consumer electronic products has raised concerns about the possible unfavorable health-effects onto the human being. Another concern is raised from the high intensity fields produced by wireless power transfer systems which will generate highly undesired influence on other electrical and electronic equipment. As a protection against the potential health effects, the governments imposed limits on the occupational and general public exposure to the radio frequencies. These limitations are set out in national and international safety guidelines, standards and regulations. The measurement and evaluation of the human exposure to electromagnetic fields are essential to guarantee occupational and general public safety.

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The literature shows that category management is an important concept and tool for retailers and suppliers, but that there is a trend to move to a more shopper-centric category management approach, linked to the shoppermarketing approach. However, the knowledge on this issue is scarce on some retailing sectors, like convenience stores. The present study is focused on convenience stores, with the main purpose of finding out to what extent non-major food retailers successfully adopt a shopper-centric category management. The study is relevant in order to evaluate if a more shopper-centric approach is adequate to smaller companies/stores. To accomplish that goal, an exploratory qualitative study was conducted among convenience store retailers and suppliers. Six semistructured face-to-face interviews were conducted with Commercial Directors and Trade Marketing Managers. This data was complemented with thirteen interviews with shopper marketing experts. The data was analyzed using thematic content analysis technique, identifying themes, categories, subcategories, units of meaning and relations. The results revealed that convenience store retailers use some of the principles and techniques of the shopper-marketing and shopper-centric category management approaches, which they do in a non-standardized and non-formal approach or process. Their suppliers (the manufacturers) do it in a more formal and structured manner, probably as a result of previous interaction with major supermarkets chains. Both direct and indirect evidences of a shopper-centric approach were found, which, however, were slight, discrete and not formal.

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As artes comunitárias têm dado um importante contributo na promoção de práticas participativas e inclusivas nas sociedades contemporâneas. Encontros académicos e Festivais realizados nos últimos anos apontam para uma maior presença e interesse no panorama de produções artísticas e reflexivas, mobilizando um número crescente de participantes. Neste artigo discute-se a pesquisa sobre/em processos laboratoriais participativos de criação que orientam as práticas dos projectos de teatro e comunidade na formação universitária em teatro.

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The strategic orientations of a firm are considered crucial for enhancing firm performance and their impact can be even greater when associated with dynamic capabilities, particularly in complex and dynamic environments. This study empirically analyzes the relationship between market, entrepreneurial and learning orientations, dynamic capabilities, and performance using an integrative approach hitherto little explored. Using a sample of 209 knowledge intensive business service firms, this paper applies structural equation modeling to explore both direct effects of strategic orientations and the mediating role of dynamic capabilities on performance. The study demonstrates that learning orientation and one of the dimensions of entrepreneurial orientation have a direct positive effect on performance. On the other hand, dynamic capabilities mediate the relationships between some of the strategic orientations and firm performance. Overall, when dynamic capabilities are combined with the appropriate strategic orientations, they enhance firm performance. This paper contributes to a better understanding of the knowledge economy, given the important role knowledge intensive business services play in such a dynamic and pivotal sector.

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Tujuan studi ini adalah memberikan gambaran tentang industri susu di Indonesia dan menganalisis pengaruh perubahan-perubahan kondisi eksternal industri susu terhadap perkembangan usaha sapi perah dan strategi bisnis koperasi sapi perah di Kabupaten Banyumas. Selanjutnya, studi ini bertujuan mengevaluasi strategi bisnis koperasi sapi perah “PESAT” dan memberikan rekomendasi tentang strategi bisnis baru yang sesuai dengan perkembangan industri susu di Indonesia. Studi ini dilaksanakan melalui studi pustaka dan survei lapangan di wilayah kerja koperasi “PESAT” (Banyumas). SWOT Analysis dan Porter’s Framework digunakan untuk mengevaluasi industri susu dan merumuskan strategi bisnis bagi koperasi. Hasil penelitian menunjukan bahwa persaingan di industri susu semakin ketat oleh karena pengaruh global maupun lokal. Studi ini merekomendasikan kepada Koperasi “ PESAT” untuk mengeksplorasi pasar yang lebih luas dan menerapkan strategi baru dengan sasaran yang lebih luas berdasarkan pembedaan produk (broad differentiation). Strategi ini diharapkan dapat mengurangi ketergantungan koperasi terhadap konsumen besar yaitu PT.Sari Husada yang bertindak sebagai industri pengolahan susu (IPS) (Animal Production 4(1): 36-43 (2002)Kata kunci : Industri susu, koperasi susu, strategi bisnis