Interrelationships between the structural and functional aspects of social relationships, comorbidity and health related quality of life in breast cancer survivors

It is widely acknowledged in theoretical and empirical literature that social relationships, comprising of structural measures (social networks) and functional measures (perceived social support) have an undeniable effect on health outcomes. However, the actual mechanism of this effect has yet to be clearly understood or explicated. In addition, comorbidity is found to adversely affect social relationships and health related quality of life (a valued outcome measure in cancer patients and survivors). ^ This cross sectional study uses selected baseline data (N=3088) from the Women's Healthy Eating and Living (WHEL) study. Lisrel 8.72 was used for the latent variable structural equation modeling. Due to the ordinal nature of the data, Weighted Least Squares (WLS) method of estimation using Asymptotic Distribution Free covariance matrices was chosen for this analysis. The primary exogenous predictor variables are Social Networks and Comorbidity; Perceived Social Support is the endogenous predictor variable. Three dimensions of HRQoL, physical, mental and satisfaction with current quality of life were the outcome variables. ^ This study hypothesizes and tests the mechanism and pathways between comorbidity, social relationships and HRQoL using latent variable structural equation modeling. After testing the measurement models of social networks and perceived social support, a structural model hypothesizing associations between the latent exogenous and endogenous variables was tested. The results of the study after listwise deletion (N=2131) mostly confirmed the hypothesized relationships (TLI, CFI >0.95, RMSEA = 0.05, p=0.15). Comorbidity was adversely associated with all three HRQoL outcomes. Strong ties were negatively associated with perceived social support; social network had a strong positive association with perceived social support, which served as a mediator between social networks and HRQoL. Mental health quality of life was the most adversely affected by the predictor variables. ^ This study is a preliminary look at the integration of structural and functional measures of social relationships, comorbidity and three HRQoL indicators using LVSEM. Developing stronger social networks and forming supportive relationships is beneficial for health outcomes such as HRQoL of cancer survivors. Thus, the medical community treating cancer survivors as well as the survivor's social networks need to be informed and cognizant of these possible relationships. ^

Electron intensity modulation for mixed-beam radiation therapy with an x-ray multi-leaf collimator

The current standard treatment for head and neck cancer at our institution uses intensity-modulated x-ray therapy (IMRT), which improves target coverage and sparing of critical structures by delivering complex fluence patterns from a variety of beam directions to conform dose distributions to the shape of the target volume. The standard treatment for breast patients is field-in-field forward-planned IMRT, with initial tangential fields and additional reduced-weight tangents with blocking to minimize hot spots. For these treatment sites, the addition of electrons has the potential of improving target coverage and sparing of critical structures due to rapid dose falloff with depth and reduced exit dose. In this work, the use of mixed-beam therapy (MBT), i.e., combined intensity-modulated electron and x-ray beams using the x-ray multi-leaf collimator (MLC), was explored. The hypothesis of this study was that addition of intensity-modulated electron beams to existing clinical IMRT plans would produce MBT plans that were superior to the original IMRT plans for at least 50% of selected head and neck and 50% of breast cases. Dose calculations for electron beams collimated by the MLC were performed with Monte Carlo methods. An automation system was created to facilitate communication between the dose calculation engine and the treatment planning system. Energy and intensity modulation of the electron beams was accomplished by dividing the electron beams into 2x2-cm2 beamlets, which were then beam-weight optimized along with intensity-modulated x-ray beams. Treatment plans were optimized to obtain equivalent target dose coverage, and then compared with the original treatment plans. MBT treatment plans were evaluated by participating physicians with respect to target coverage, normal structure dose, and overall plan quality in comparison with original clinical plans. The physician evaluations did not support the hypothesis for either site, with MBT selected as superior in 1 out of the 15 head and neck cases (p=1) and 6 out of 18 breast cases (p=0.95). While MBT was not shown to be superior to IMRT, reductions were observed in doses to critical structures distal to the target along the electron beam direction and to non-target tissues, at the expense of target coverage and dose homogeneity. ^

Improving the Quality of Life of spousal caregivers of stroke survivors: A cost effectiveness analysis

Back ground and Purpose. There is a growing consensus among health care researchers that Quality of Life (QoL) is an important outcome and, within the field of family caregiving, cost effectiveness research is needed to determine which programs have the greatest benefit for family members. This study uses a multidimensional approach to measure the cost effectiveness of a multicomponent intervention designed to improve the quality of life of spousal caregivers of stroke survivors. Methods. The CAReS study (Committed to Assisting with Recovery after Stroke) was a 5-year prospective, longitudinal intervention study for 159 stroke survivors and their spousal caregivers upon discharge of the stroke survivor from inpatient rehabilitation to their home. CAReS cost data were analyzed to determine the incremental cost of the intervention per caregiver. The mean values of the quality-of-life predictor variables of the intervention group of caregivers were compared to the mean values of usual care groups found in the literature. Significant differences were then divided into the cost of the intervention per caregiver to calculate the incremental cost effectiveness ratio for each predictor variable. Results. The cost of the intervention per caregiver was approximately $2,500. Statistically significant differences were found between the mean scores for the Perceived Stress and Satisfaction with Life scales. Statistically significant differences were not found between the mean scores for the Self Reported Health Status, Mutuality, and Preparedness scales. Conclusions. This study provides a prototype cost effectiveness analysis on which researchers can build. Using a multidimensional approach to measure QoL, as used in this analysis, incorporates both the subjective and objective components of QoL. Some of the QoL predictor variable scores were significantly different between the intervention and comparison groups, indicating a significant impact of the intervention. The estimated cost of the impact was also examined. In future studies, a scale that takes into account both the dimensions and the weighting each person places on the dimensions of QoL should be used to provide a single QoL score per participant. With participant level cost and outcome data, uncertainty around each cost-effectiveness ratio can be calculated using the bias-corrected percentile bootstrapping method and plotted to calculate the cost-effectiveness acceptability curves.^

Quality of life, symptom experience, and use of complementary and alternative medicine among women with ovarian cancer

The objectives of this dissertation were to determine the quality of life in women with ovarian cancer and the association of their physical and emotional well-being with the number of symptoms, duration of symptoms, and the scores of common symptoms of ovarian cancer; to study the prevalence of complementary and alternative medicine techniques for symptom relief and its association with the number of symptoms, age, education, insurance, comorbidity, and satisfaction with medical care they received, and their pre-diagnostic experience of symptoms.^ This study was based on a secondary data analysis of a study of early detection of ovarian cancer. A sample of 139 women with ovarian cancer was recruited and was administered a questionnaire comprised of questions on their quality of life, their symptoms and what they did about the symptoms, whether they used any complementary and alternative medicine techniques, and other medical conditions they had. Out of this sample, 53 patients underwent in-depth interviews relating to their symptoms before the diagnosis and their experiences with the health care system leading to the ovarian cancer diagnosis. ^ In article #1, ovarian cancer patients were observed to have significantly poorer quality of life on all subscales and summary scores except pain, compared to that of the general population of US women. Physical well-being scores were negatively associated with the number of symptoms before diagnosis and a significant negative association of comorbidity index was observed with physical well-being. Higher education and increase in time since diagnosis was found to have better physical scores. Emotional well-being scores showed marginally significant associations with number of symptoms and bloating. ^ In article #2, a thematic content analysis of the ovarian cancer patients’ interviews revealed that on recognition of their symptoms women first assumed their symptoms to be a normal transient occurrence due to a pre-existing disease condition, or due to some other disease. A series of misattributions of their symptoms on their and their doctors’ part impacted their health care seeking.In article #3, a significantly greater likelihood of CAM use with an increase in the number of symptoms was observed.^ Based on the foregoing results, it is important to educate women on possible signs of ovarian cancer and also to educate doctors about the results of current research regarding ovarian cancer diagnosis. This will help to avoid a delay in getting a diagnosis and improve women’s quality of life. It emphasizes the diagnosis of ovarian cancer in earlier stages by more sensitive screening techniques. This study emphasizes the importance of consideration of comorbidity in any quality of life research. Additionally, educating women in the safe use of CAM techniques carries immense significance because the efficacy and safety of many of the currently advertized CAM products has not been scientifically validated. Further research is needed to confirm the findings of this study. ^

Patient satisfaction in government health facilities in the state of Qatar

This study provides data which can contribute to improving services and delivering quality health care in government health facilities in the state of Qatar. To measure the satisfaction with current care of selected patients who receive care in Hamad General Hospital and the Khalifa Town Health Center in the city of Doha, a cross-sectional survey and a self-administered questionnaire were used.^ Analysis was performed on data from 444 patients on eight dimensions of patient satisfaction with medical care. These include: general satisfaction, availability of services, convenience of services, facilities, humaneness of doctors, quality of care, continuity of care, and aspects of the last visit. Patient satisfaction parameters were compared for males vs. females, for citizens vs. non-citizens, and for patients seen in the hospital vs. those seen in the health center.^ Results indicate that patients seen in the hospital were more satisfied with care than patients seen in the health center, that non-citizens were more satisfied than citizens, and that males were slightly more satisfied than females with medical services. ^

Improving adherence in African American women with uncontrolled primary hypertension

Background and Objectives: African American (AA) women are disproportionately affected with hypertension (HTN). The aim of this randomized controlled trial was to evaluate the effectiveness of a 6-week culturally-tailored educational intervention for AA women with primary HTN who lived in rural Northeast Texas. ^ Methods: Sixty AA women, 29 to 86 years (M 57.98 ±12.37) with primary HTN were recruited from four rural locations and randomized to intervention (n =30) and wait-list control groups ( n =30) to determine the effectiveness of the intervention on knowledge, attitudes, beliefs, social support, adherence to a hypertension regimen, and blood pressure (BP) control. Survey and BP measurements were collected at baseline, 3 weeks, 6 weeks (post intervention) and 6 months post intervention. Culturally-tailored educational classes were provided for 90 minutes once a week for 6 weeks in two local churches and a community center. The wait-list control group received usual care and were offered education at the conclusion of the data collection six months post-intervention. Linear mixed models were used to test for differences between the groups. ^ Results: A significant overall main effect (Time) was found for systolic blood pressure, F(3, 174) =11.104, p=.000, and diastolic blood pressure. F(3, 174) =4.781, p=.003 for both groups. Age was a significant covariate for diastolic blood pressure. F(1, 56) =6.798 p=.012. Participants 57 years or older (n=30) had lower diastolic BPS than participants younger than 57 (n=30). No significant differences were found between groups on knowledge, adherence, or attitudes. Participants with lower incomes had significantly less knowledge about HBP Prevention (r=.036, p=.006). ^ Conclusion: AA women who participated in a 6 week intervention program demonstrated a significant decrease in BP over a 6 month period regardless of whether they were in the intervention or control group. These rural AA women had a relatively good knowledge of HTN and reported an average level of compliance, compared to other populations. Satisfaction with the program was high and there was no attrition, suggesting that AA women will participate in research studies that are culturally tailored to them, held in familiar community locations, and conducted by a trusted person with whom they can identify. Future studies using a different program with larger sample sizes are warranted to try to decrease the high level of HTN-related complications in AA women. ^

Program evaluation for a summer science internship: Short and long term benefits as reported by interns

Undergraduate research programs have been used as a tool to attract and retain student interest in science careers. This study evaluates the short and long-term benefits of a Summer Science Internship (SSI) at the University of Texas Health Science Center at Houston– School of Public Health – in Brownsville, Texas, by analyzing survey data from alumni. Questions assessing short-term program impact were aimed at three main topics, student: satisfaction with program, self-efficacy for science after completing the program, and perceived benefits. Long-term program impact was assessed by looking at student school attendance and college majors along with perceived links between SSI and future college plans. Students reported high program satisfaction, a significant increase in science self-efficacy and high perceived benefits. At the time data were collected for the study, one-hundred percent of alumni were enrolled in school (high school or college). The majority of students indicated they were interested in completing a science major/career, heavily influenced by their participation in the program.^

Ocean temperature and salinity measured by CTD SRDLs deployed on southern elephant seals from King George Island with links to datasets

West Antarctic ice shelves have thinned dramatically over recent decades. Oceanographic measurements that explore connections between offshore warming and transport across a continental shelf with variable bathymetry toward ice shelves are needed to constrain future changes in melt rates. Six years of seal-acquired observations provide extensive hydrographic coverage in the Bellingshausen Sea, where ship-based measurements are scarce. Warm but modified Circumpolar Deep Water floods the shelf and establishes a cyclonic circulation within the Belgica Trough with flow extending toward the coast along the eastern boundaries and returning to the shelf break along western boundaries. These boundary currents are the primary water mass pathways that carry heat toward the coast and advect ice shelf meltwater offshore. The modified Circumpolar Deep Water and meltwater mixtures shoal and thin as they approach the continental slope before flowing westward at the shelf break, suggesting the presence of the Antarctic Slope Current. Constraining meltwater pathways is a key step in monitoring the stability of the West Antarctic Ice Sheet.

Pulse shortening of gain switched single mode semiconductor lasers using a variable delay interferometer

We propose a pulse shaping and shortening technique for pulses generated from gain switched single mode semiconductor lasers, based on a Mach Zehnder interferometer with variable delay. The spectral and temporal characteristics of the pulses obtained with the proposed technique are investigated with numerical simulations. Experiments are performed with a Distributed Feedback laser and a Vertical Cavity Surface Emitting Laser, emitting at 1.5 µm, obtaining pulse duration reduction of 25-30%. The main asset of the proposed technique is that it can be applied to different devices and pulses, taking advantage of the flexibility of the gain switching technique.

Crack width control in RC elements with recycled steel fibres and applications to integral structures : theoretical and experimental study

El presente trabajo trata de elementos reforzados con barras de armadura y Fibras Metálicas Recicladas (FMR). El objetivo principal es mejorar el comportamiento a fisuración de elementos sometidos a flexión pura y a flexión compuesta, aumentando en consecuencia las prestaciones en servicio de aquellas estructuras con requerimientos estrictos con respecto al control de fisuración. Entre éstas últimas se encuentran las estructuras integrales, es decir aquellas estructuras sin juntas (puentes o edificios), sometidas a cargas gravitatorias y deformaciones impuestas en los elementos horizontales debidas a retracción, fluencia y temperatura. Las FMR son obtenidas a partir de los neumáticos fuera de uso, y puesto que el procedimiento de reciclado se centra en el caucho en vez que en el acero, su forma es aleatoria y con longitud variable. A pesar de que la eficacia del fibrorefuerzo mediante FMR ha sido demostrada en investigaciones anteriores, la innovación que representa este trabajo consiste en proponer la acción combinada de barras convencionales y FMR en la mejora del comportamiento a fisuración. El objetivo es por tanto mejorar la sostenibilidad del proyecto de la estructura en HA al utilizar materiales reciclados por un lado, y aumentando por el otro la durabilidad. En primer lugar, se presenta el estado del arte con respecto a la fisuración en elementos de HA, que sucesivamente se amplía a elementos reforzados con barras y fibras. Asimismo, se resume el método simplificado para el análisis de columnas de estructuras sin juntas ya propuesto por Pérez et al., con particular énfasis en aquellos aspectos que son incompatibles con la acción de las fibras a nivel seccional. A continuación, se presenta un modelo para describir la deformabilidad seccional y la fisuración en elementos en HA, que luego se amplía a aquellos elementos reforzados con barras y fibras, teniendo en cuenta también los efectos debidos a la retracción (tension stiffening negativo). El modelo es luego empleado para ampliar el método simplificado para el análisis de columnas. La aportación consiste por tanto en contar con una metodología amplia de análisis para este tipo de elementos. Seguidamente, se presenta la campaña experimental preliminar que ha involucrado vigas a escala reducida sometidas a flexión simple, con el objetivo de validar la eficiencia y la usabilidad en el hormigón de las FMR de dos diferentes tipos, y su comportamiento con respecto a fibras de acero comerciales. Se describe a continuación la campaña principal, consistente en ensayos sobre ocho vigas en flexión simple a escala 1:1 (variando contenido en FRM, Ø/s,eff y recubrimiento) y doce columnas a flexión compuesta (variando contenido en FMR, Ø/s,eff y nivel de fuerza axil). Los resultados obtenidos en la campaña principal son presentados y comentados, resaltando las mejoras obtenidas en el comportamiento a fisuración de las vigas y columnas, y la rigidez estructural de las columnas. Estos resultados se comparan con las predicciones del modelo propuesto. Los principales parámetros estudiados para describir la fisuración y el comportamiento seccional de las vigas son: la separación entre fisuras, el alargamiento medio de las armaduras y la abertura de fisura, mientras que en los ensayos de las columnas se ha contrastado las leyes momento/curvatura, la tensión en las barras de armadura y la abertura de fisura en el empotramiento en la base. La comparación muestra un buen acuerdo entre las predicciones y los resultados experimentales. Asimismo, se nota la mejora en el comportamiento a fisuración debido a la incorporación de FMR en aquellos elementos con cuantías de armadura bajas en flexión simple, en elementos con axiles bajos y para el control de la fisuración en elementos con grandes recubrimientos, siendo por tanto resultados de inmediato impacto en la práctica ingenieril (diseño de losas, tanques, estructuras integrales, etc.). VIIIComo punto final, se presentan aplicaciones de las FMR en estructuras reales. Se discuten dos casos de elementos sometidos a flexión pura, en particular una viga simplemente apoyada y un tanque para el tratamiento de agua. En ambos casos la adicción de FMR al hormigón lleva a mejoras en el comportamiento a fisuración. Luego, utilizando el método simplificado para el análisis en servicio de columnas de estructuras sin juntas, se calcula la máxima longitud admisible en casos típicos de puentes y edificación. En particular, se demuestra que las limitaciones de la práctica ingenieril actual (sobre todo en edificación) pueden ser aumentadas considerando el comportamiento real de las columnas en HA. Finalmente, los mismos casos son modificados para considerar el uso de MFR, y se presentan las mejoras tanto en la máxima longitud admisible como en la abertura de fisura para una longitud y deformación impuesta. This work deals with elements reinforced with both rebars and Recycled Steel Fibres (RSFs). Its main objective is to improve cracking behaviour of elements subjected to pure bending and bending and axial force, resulting in better serviceability conditions for these structures demanding keen crack width control. Among these structures a particularly interesting type are the so-called integral structures, i.e. long jointless structures (bridges and buildings) subjected to gravitational loads and imposed deformations due to shrinkage, creep and temperature. RSFs are obtained from End of Life Tyres, and due to the recycling process that is focused on the rubber rather than on the steel they come out crooked and with variable length. Although the effectiveness of RSFs had already been proven by previous research, the innovation of this work consists in the proposing the combined action of conventional rebars and RSFs to improve cracking behaviour. Therefore, the objective is to improve the sustainability of RC structures by, on the one hand, using recycled materials, and on the other improving their durability. A state of the art on cracking in RC elements is firstly drawn. It is then expanded to elements reinforced with both rebars and fibres (R/FRC elements). Finally, the simplified method for analysis of columns of long jointless structures already proposed by Pérez et al. is resumed, with a special focus on the points that conflict when taking into account the action of fibres. Afterwards, a model to describe sectional deformability and cracking of R/FRC elements is presented, taking also into account the effect of shrinkage (negative tension stiffening). The model is then used to implement the simplified method for columns. The novelty represented by this is that a comprehensive methodology to analyse this type of elements is presented. A preliminary experimental campaign consisting in small beams subjected to pure bending is described, with the objective of validating the effectiveness and usability in concrete of RSFs of two different types, and their behaviour when compared with commercial steel fibres. With the results and lessons learnt from this campaign in mind, the main experimental campaign is then described, consisting in cracking tests of eight unscaled beams in pure bending (varying RSF content, Ø/s,eff and concrete cover) and twelve columns subjected to imposed displacement and axial force (varying RSF content, Ø/s,eff and squashing load ratio). The results obtained from the main campaign are presented and discussed, with particular focus on the improvement in cracking behaviour for the beams and columns, and structural stiffness for the columns. They are then compared with the proposed model. The main parameters studied to describe cracking and sectional behaviours of the beam tests are crack spacing, mean steel strain and crack width, while for the column tests these were moment/curvature, stress in rebars and crack with at column embedment. The comparison showed satisfactory agreement between experimental results and model predictions. Moreover, it is pointed out the improvement in cracking behaviour due to the addition of RSF for elements with low reinforcement ratios, elements with low squashing load ratios and for crack width control of elements with large concrete covers, thus representing results with a immediate impact in engineering practice (slab design, tanks, integral structures, etc.). Applications of RSF to actual structures are finally presented. Two cases of elements in pure bending are presented, namely a simple supported beam and a water treatment tank. In both cases the addition of RSF to concrete leads to improvements in cracking behaviour. Then, using the simplified model for the serviceability analysis of columns of jointless structures, the maximum achievable jointless length of typical cases of a bridge and building is obtained. In XIIparticular, it is shown how the limitations of current engineering practice (this is especially the case of buildings) can be increased by considering the actual behaviour of RC supports. Then, the same cases are modified considering the use of RSF, and the improvements both in maximum achievable length and in crack width for a given length and imposed strain at the deck/first floor are shown.

Estudio numérico de flujo turbulento cargado con partículas sólidas a través de canales y tuberías de sección variable

La presente Tesis Doctoral tiene como objetivo el estudio de flujo turbulento cargado con partículas sólidas a través de canales y tuberías de sección constante usando un enfoque Euleriano-Lagrangiano. El campo de flujo de la fase de transporte (aire) se resuelve usando simulación de grandes escalas (LES), implementada en un programa de volúmenes finitos mientras que las ecuaciones gobernantes de la fase dispersa son resueltas por medio de un algoritmo de seguimiento Lagrangiano de partículas que ha sido desarrollado y acoplado al programa que resuelve el flujo. Se estudia de manera sistemática y progresiva la interacción fluido→partícula (one-way coupling), a través de diferentes configuraciones geométricas en coordenadas cartesianas (canales de sección constante y variable) y en coordenadas cilíndricas (tuberías de sección constante y sección variable) abarcando diferentes números de Reynolds y diferentes tamaños de partículas; todos los resultados obtenidos han sido comparados con datos publicados previamente. El estudio de flujo multifásico a través de, tuberías de sección variable, ha sido abordada en otras investigaciones mayoritariamente de forma experimental o mediante simulación usando modelos de turbulencia menos complejos y no mediante LES. El patrón de flujo que se verifica en una tubería con expansión es muy complejo y dicha configuración geométrica se halla en múltiples aplicaciones industriales que involucran el transporte de partículas sólidas, por ello es de gran interés su estudio. Como hecho innovador, en esta tesis no solo se resuelven las estadísticas de velocidad del fluido y las partículas en tuberías con diferentes tamaños de expansión y diferentes regímenes de flujo sino que se caracteriza, usando diversas formulaciones del número de Stokes y el parámetro de arrastre, el ingreso y acumulación de partículas dentro de la zona de recirculación, obteniéndose resultados coincidentes con datos experimentales. ABSTRACT The objective of this Thesis research is to study the turbulent flow laden with solid particles through channels and pipes with using Eulerian-Lagrangian approach. The flow field of the transport phase (air ) is solved using large eddy simulation ( LES ) implemented in a program of finite volume while the governing equations of the dispersed phase are resolved by means of a particle Lagrangian tracking algorithm which was developed and coupled to principal program flow solver . We studied systematically and progressively the fluid interaction → particle ( one- way coupling ) , through different geometric configurations in Cartesian coordinates ( channel with constant and variable section) and in cylindrical coordinates ( pipes with constant section and variable section ) covering different Reynolds numbers and different particle sizes, all results have been compared with previously published data . The study of multiphase flow through, pipes with variable section has been addressed in other investigations predominantly experimentally or by simulation using less complex models and no turbulence by LES. The flow pattern is verified in a pipe expansion is very complex and this geometry is found in many industrial applications involving the transport of solid particles, so it is of great interest to study. As an innovator fact , in this Thesis not only finds fluid velocity statistics and particles with different sizes of pipe expansion and different flow regimes but characterized, using various formulations of the Stokes number and the drag parameter are resolved, the entry and accumulation of particles within the recirculation zone , matching results obtained with experimental data.

Justice, emotions and satisfaction in complaint behavior in services

This study proposes a marketing approach to service recovery (SR) models in order to help to explain what factors affect cumulative satisfaction, loyalty and word-of-mouth following complaint behavior. The model has its base on the definition of perceived justice and its influence on satisfaction with service recovery (SSR) and on emotions (positive and negative). Trust acts as a central construct in the model, receiving influence from the affective and cognitive aspect and mediating the relationship between SSR and cumulative satisfaction and between positive/negative emotions and loyalty. The sample for this study consists of 303 Spanish B2C-EC users who made a complaint after an electronic transaction. Results from the analysis show the influence of perceived justice ?mainly interactional justice and procedural justice? on SSR, and the relevance of positive emotions as a key factor in SSR processes, in contrast to the major role which negative emotions have traditionally played in these models. Furthermore, trust mediates the relation between SSR and cumulative satisfaction, and is the factor which has a higher influence on loyalty, whilst cumulative satisfaction becomes the more relevant factor affecting WOM.

UMA VISÃO BASEADA EM RECURSOS COM DIRECIONAMENTO ESTRATÉGICO: UMA PROPOSTA ÀS INSTITUIÇÕES DE SAÚDE HOSPITALARES PÚBLICAS

Este trabalho investiga a utilização da Visão Baseada em Recursos, tendo por objetivo propor um modelo de gestão de pessoas que atenda a exigibilidade da qualidade de prestação de serviços à saúde. São observadas as relações de trabalho nesses serviços nas diversas modalidades, a sistematização do conhecimento sobre os elementos que figuram na gestão de pessoas e a verificação da necessidade de Gestão Operacional e Estratégica de Pessoas para trabalhadores das Instituições de Saúde Hospitalares Públicas. Trata-se de pesquisa de natureza empírico-exploratória, apoiada em múltiplos casos de hospitais públicos, entrevistando e registrando fatos observados nos locais pesquisados, aplicando-se o Protocolo de Observações. Para atingir o objetivo principal, são utilizados os fundamentos das obras de Marras (2001; 2003 e 2005): Relações Trabalhistas no Brasil: administração e estratégia; Administração de Recursos Humanos: do operacional ao estratégico; e Gestão de Pessoas em Empresas Inovadoras, respectivamente. Além das observações participantes, utilizaram-se entrevistas e questionários com os usuários e profissionais dos hospitais, com instrumentos adaptados para o contexto da instituição e dado tratamento estatístico para análise dos resultados, que se apresentam em tabelas para melhor visualização dos dados e análise. A Gestão de Pessoas nas ISHP permanecem no modelo tradicional e longe de qualquer movimento que possa torná-la estratégica. O nível de satisfação dos pacientes para com os profissionais de saúde é ótimo, mas quanto aos recursos e infra-estrutura, é baixo. Os profissionais de saúde na quase sua totalidade trabalham por vocação, espírito de humanização e por acharem gratificante, embora o nível de insatisfação com a remuneração recebida seja elevado.(AU)

UMA VISÃO BASEADA EM RECURSOS COM DIRECIONAMENTO ESTRATÉGICO: UMA PROPOSTA ÀS INSTITUIÇÕES DE SAÚDE HOSPITALARES PÚBLICAS

Este trabalho investiga a utilização da Visão Baseada em Recursos, tendo por objetivo propor um modelo de gestão de pessoas que atenda a exigibilidade da qualidade de prestação de serviços à saúde. São observadas as relações de trabalho nesses serviços nas diversas modalidades, a sistematização do conhecimento sobre os elementos que figuram na gestão de pessoas e a verificação da necessidade de Gestão Operacional e Estratégica de Pessoas para trabalhadores das Instituições de Saúde Hospitalares Públicas. Trata-se de pesquisa de natureza empírico-exploratória, apoiada em múltiplos casos de hospitais públicos, entrevistando e registrando fatos observados nos locais pesquisados, aplicando-se o Protocolo de Observações. Para atingir o objetivo principal, são utilizados os fundamentos das obras de Marras (2001; 2003 e 2005): Relações Trabalhistas no Brasil: administração e estratégia; Administração de Recursos Humanos: do operacional ao estratégico; e Gestão de Pessoas em Empresas Inovadoras, respectivamente. Além das observações participantes, utilizaram-se entrevistas e questionários com os usuários e profissionais dos hospitais, com instrumentos adaptados para o contexto da instituição e dado tratamento estatístico para análise dos resultados, que se apresentam em tabelas para melhor visualização dos dados e análise. A Gestão de Pessoas nas ISHP permanecem no modelo tradicional e longe de qualquer movimento que possa torná-la estratégica. O nível de satisfação dos pacientes para com os profissionais de saúde é ótimo, mas quanto aos recursos e infra-estrutura, é baixo. Os profissionais de saúde na quase sua totalidade trabalham por vocação, espírito de humanização e por acharem gratificante, embora o nível de insatisfação com a remuneração recebida seja elevado.(AU)

INDICADORES DE SAÚDE POSITIVA: UM ESTUDO COM EMPREGADOS EXPATRIADOS

Os estudos sobre expatriados, tanto no âmbito nacional quanto internacional, normalmente tratam de aspectos administrativos relativos ao processo de expatriação, como, por exemplo, as dificuldades de adaptação do indivíduo e de sua família, bem como o prejuízo que um programa mal sucedido poderia trazer para a organização. O objetivo desse estudo foi descrever cinco indicadores psicossociais de saúde positiva (bem-estar subjetivo, bemestar no trabalho, percepção de suporte social, percepção de suporte organizacional e otimismo) em empregados expatriados. Foi utilizada uma amostra escolhida por conveniência, composta por 16 pessoas, sendo 8 do sexo masculino e 8 do sexo feminino e que já haviam participado ou estavam participando de programas organizacionais de expatriação. O instrumento de coleta de dados foi um questionário de auto-preenchimento composto por oito medidas que aferiram as variáveis incluídas no estudo (satisfação geral com a vida, afetos positivos e negativos, satisfação no trabalho, envolvimento com o trabalho, comprometimento organizacional afetivo, percepções de suporte social e organizacional e otimismo). Foram realizadas análises estatísticas descritivas, testadas diferenças entre médias, bem como calculados índices de correlação entre variáveis. Os resultados revelaram que os profissionais expatriados tiveram mais oportunidades de vivenciar sensações afetivas positivas do que negativas em suas experiências fora do seu país de origem, o que permite dizer que os expatriados tendem a níveis positivos de muito alegres, muito bem, muito felizes, muito satisfeitos, muito animados e muito contentes , logo eles mantiveram relativamente preservado o seu bem-estar subjetivo. Também foi possível observar que as suas maiores satisfações com a vida não eram advindas do trabalho e que eles pareciam demonstrar estar satisfeitos com suas relações interpessoais além de apresentar uma forte vinculação afetiva com o seu empregador. Resultado diferente foi obtido para envolvimento com o trabalho revelando que as tarefas não conseguiam manter o expatriado totalmente absorvido por elas durante o período de expatriação. O estudo revelou também que os expatriados percebem receber maior apoio emocional de seus familiares, amigos e parentes do que suporte prático. Quanto à percepção de suporte organizacional foi observado que eles não acreditam, incondicionalmente, no apoio da organização em que estão inseridos. Os resultados mostraram ainda que os expatriados mantêm uma expectativa positiva quanto ao futuro, sinalizando um senso levemente acentuado de otimismo. Foi possível observar também algumas correlações significativas entre as dimensões de BES e BET. Com base nestes resultados existem indícios de saúde positiva entre os profissionais pesquisados, visto que eles parecem estar de bem com a vida pessoal e relativamente bem no trabalho, mantendo crenças medianas de suporte social e organizacional. Os resultados do estudo poderão contribuir para a compreensão do quadro psicológico dos indivíduos expatriados e, ao mesmo tempo, oferecerem uma melhor fundamentação conceitual para estudiosos do tema, assim como suscitar nos gestores reflexões acerca de ações políticas para o monitoramento da saúde psíquica dos empregados que tenham participado ou estejam participando desse tipo de programa organizacional.(AU)