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Dissertations |
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1
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LARISSA SOARES DA SILVA CUNHA
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INTEGRATION BETWEEN EPIDEMIOLOGICAL SURVEILLANCE OF DISEASES IMMUNOPREVENIBLE AND FAMILY HEALTH STRATEGY: EVALUATION TOOL PROPOSAL
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Advisor : JUAREZ PEREIRA DIAS
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COMMITTEE MEMBERS :
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JUAREZ PEREIRA DIAS
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MONIQUE AZEVEDO ESPERIDIAO
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ALCINA MARTA DE SOUZA ANDRADE
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GERLUCE ALVES PONTES DA SILVA
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Data: Feb 3, 2021
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Show Abstract
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This research aimed to develop a tool for future integration assessments between the Epidemiological Surveillance of Immunopreventable Diseases (VEDI) services and the Family Health Strategy (FHS) in Primary Care (AB). As services also aim the decrease in the incidence rates of vaccine-preventable diseases in children under one year of age and thus, the reduction of infant mortality rates, it is necessary that they act integrated way to achieve and optimize results. Therefore, it is relevant to Health Public assess this integration. This is a study for modeling one of the stages of the evaluability study (EA), built with the following methodological steps: analysis epidemiological analysis of secondary data on vaccination coverage and health teams from Family in Bahia and other states in the Northeast, made available by the Surveillance Directorate Epidemiological Research (DIVEP) of the State Health Department of Bahia and the Department of SUS Informatics (DATASUS) respectively; documentary analysis of Ordinances Ministerial, Annual Management Reports, Health Conference Reports; quiz self-applied with stakeholders containing sociodemographic and integration information between VEDI and ESF; Logical Model (ML) design focused on the structure dimensions, process and result contemplating a quantitative and qualitative approach; and elaboration of tool proposal: Analysis and Judgment Matrix (MAJ).
From participating stakeholders survey, the vast majority were female, mean age 47.6 + 8.6 years, were health and had postgraduate courses, most of them in health public / collective. Concerning the methodological steps, the ML was produced, from which MAJ items were constructed, consisting of 28 criteria, of which six were related to the structure dimension, 14 with process and eight with the result dimension. That study allowed the elaboration of the first stage of an EA - modeling the integration between the VEDI and ESF, identification of practices developed at the institutional level, of the main facilitating and hindering aspects of stakeholder proposals for effective integration aiming to identify the constituent elements of the intervention, as well as possible focuses of future evaluations. To this end, the research contributed to the construction of two tools: ML and MAJ, which can be used for future assessments of the degree of integration between the VEDI and the ESF both at the state and municipal levels.
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2
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PAULO CÉSAR OLIVEIRA SOBRINHO
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APPLICABILITY OF PLATELET-RICH PLASMA-PRP IN THE TREATMENT OF FOOT ULCERS IN DIABETIC PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS
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Advisor : GILDASIO DE CERQUEIRA DALTRO
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COMMITTEE MEMBERS :
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GILDASIO DE CERQUEIRA DALTRO
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MARIA LIGIA RANGEL SANTOS
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ADEMARIO GALVAO SPINOLA
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JANE MARY DE MEDEIROS GUIMARÃES
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Data: Mar 5, 2021
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Show Abstract
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Platelet-rich plasma (PRP) is an innovative, promising technique with significant results in several areas of medicine. The aim of this study is to carry out an evaluation of the results on the applicability of PRP in the treatment of foot ulcers in diabetic patients. Method: This study consists of a systematic review of the specialized literature and meta-analysis of randomized clinical trials in the application of PRP in diabetic foot ulcers. For the elaboration of the research question, the acronym PICOS was used as well as in the orientation in the search strategies. The protocol for this study was registered in the PROSPERO database to register protocols for systematic reviews. The methodology proposed by the Cochrane Collaboration manual was adopted and the PRISMA checklist was used. The AMSTAR 2 tool was used to assess the quality of the review. Inclusion criteria were prospective, randomized clinical studies with no date limit. The forest plot graph was adopted for statistical analysis. Results: Of the 154 articles found in the search engine databases, 87 were excluded due to duplication, 58 because they did not meet the inclusion criteria and ended with 09 articles included. Two analyzes were performed, using the outcomes of treatment efficacy and reduction of ulcer size. Seven of the nine articles (408 patients) specified the outcome of treatment effectiveness, with a significant increase in cured patients. The other three articles (224 patients) specified a reduction in the size of the ulcer, being statistically significant in reducing the size of the ulcer. Conclusion: In conclusion, the sample analyzed from the systematic review of randomized clinical trials indicated that the use of platelet derivatives proved to be a good, safe and effective treatment option to accelerate the healing process of chronic foot ulcers in patients with diabetes mellitus, with no treatment-related complications. In view of the small sample of these studies, more randomized clinical studies are needed with a greater number of diabetic patients and patients with foot ulcers and with a greater follow-up.
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3
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ROSANE SOUSA BARRETO
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Evaluation of the quality of abortion care: support for improving the QualiAborto-Pt
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Advisor : GREICE MARIA DE SOUZA MENEZES
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COMMITTEE MEMBERS :
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ESTELA MARIA MOTTA LIMA LEAO DE AQUINO
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GREICE MARIA DE SOUZA MENEZES
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MARIA TERESA SEABRA SOARES DE BRITO E ALVES
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MICHAEL EDUARDO REICHENHEIM
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Data: Mar 30, 2021
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Show Abstract
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The criminalization of abortion leads women to perform unsafe practices of terminating pregnancy, which forces them to seek health services later to deal with complications resulting from the procedure. The attention to these women, however, is based on technicality and impersonality, with reports of mistreatment and discrimination, distancing attention from that recommended by international and national standards based on scientific evidence. Evaluating this assistance is essential to identify problems and indicate measures to improve care. In Brazil, the evaluation of abortion care remains a gap in the national scientific production. In 2020, one survey “GravSus-NE” carried out in 19 public health services in three cities in the northeast evaluated the care through a structured instrument applied through face-to-face interviews with women hospitalized for abortion, spontaneous and induced. The instrument was submitted to a psychometric assessment that indicated changes. The present study aimed to propose adjustments to the QualiAborto-Pt prototype and test it after adjustments. After reviewing the scientific literature on indicators of the quality of abortion care from the perspective of women, in which items to be added to the instrument were identified, it was subjected to three pretests. The original instrument was initially tested. After insertion of new questions and adjustments in the text of the questions poorly understood, two more pre-test steps were performed. In the three stages, 77 women with abortion were interviewed, with a similar profile to the original study. In the first stage, one item presented comprehension problems, in the second stage, 26 new items were included based on the suggestions of the psychometric analysis, literature review and expert opinion, of which seven presented problems and were readjusted; in the third testing stage, two items presented comprehension problems. The readjusted QualiAborto-Pt instrument was well evaluated and may be useful for studies evaluating abortion care. New tests are suggested to validate the instrument, so that it can be applied to larger samples and diverse populations.
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4
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LARISSA CELESTE ARAUJO PAIVA
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DIFFERENTIAL COSTS OF THE ADMISSION TO THE DELIVERY OF PREGNANT WOMEN WITH DIABETES IN A PUBLIC MATERNITY OF SALVADOR
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Advisor : ERIKA SANTOS DE ARAGAO
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COMMITTEE MEMBERS :
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ERIKA SANTOS DE ARAGAO
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CLAUDIA SILVA MARINHO
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VINICIUS DE ARAUJO MENDES
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Data: Mar 31, 2021
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Show Abstract
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In Brazil, diabetes is considered the main metabolic disease during pregnancy. Gestational Diabetes is defined as any degree of glucose intolerance, whose diagnosis occurs at the beginning of pregnancy, and may or may not persist after delivery. The lifestyle habits of pregnant women and / or the hereditary burden are considered important factors for the development of the disease. Pregnant women with diabetes tend to have greater complications in pregnancy and there are greater possibilities of complications, reflecting a higher cost for health services and an impact on families. The general objective of the study is to estimate the average differential of direct hospitalization costs for the delivery of pregnant women with diabetes and without the disease, in a public maternity hospital in Salvador / Bahia, in 2016 from the perspective of the Unified Health System. it is an observational study, with a test of difference of means between two retrospective paired groups, of disease cost assessment, with a quantitative approach. For the collection of data from the epidemiological clinical profile, information from the records of the 135 patients and data from their hospital systems were used. In order to estimate the costs of patients in each group, data were collected regarding the number of tests and medication used, delivery mode, hospitalization of pregnant women in the ward and newborns in the ICU. Descriptive statistical analysis was performed with a mean difference test to obtain the average cost and check the significance of the difference. The results for the case and comparison groups were found respectively: Type of delivery: cesarean section - 81.4% vs 24.6%, normal delivery - 18.6% vs 75.4%; Hospitalization of pregnant women for clinical complications: only those in the case group admitted, which corresponds to 30% of pregnant women in the group; NB admitted to the ICU: 23.2% vs 4.61%. The average total cost was R $ 9,463.4 x R $ 5,986.53,30
case and comparison, respectively. All items had higher values in the case group. The cost item that contributed to a greater difference between the groups was the admission to the pregnant woman and what reduced this difference was the admission of the NB to the ICU. The average incremental cost can be up to 58.8% more for pregnant women with diabetes. This higher proportion corresponded to an average incremental differential of R $ 3,476.9 for pregnant women with diabetes hospitalized for childbirth in 2016. It is evident that the delivery of pregnant women with gestational diabetes, in addition to being more costly for SUS, also implies greater possibility of unfavorable outcomes, therefore reinforcing preventive measures and early diagnosis is necessary and urgent to minimize the health impacts of women and their children.
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5
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CATARINE HEITER MORAES BONESS
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Preceptorship in speech therapy: profile and proposal of permanent education actions in a teaching center in Salvador-Bahia
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Advisor : JOSE LUCIO COSTA RAMOS
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COMMITTEE MEMBERS :
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JOSE LUCIO COSTA RAMOS
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CATHARINA LEITE MATOS SOARES
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PATRÍCIA FRANCESCA LIMA DE PINHO
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Data: Apr 12, 2021
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Show Abstract
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The preceptorship in health is a pedagogical practice of teaching-service integration that takes place in the space of health services and that is conducted by assistance professionals called preceptors. The reflection on the preceptorship practice, at the extent to the skills and competences required to its exercise, is configured as an important learning instrument for the health care professionals while educators coresponsible for the professional formation within the precepts of SUS. This work had as purpose to prepare a proposal of permanent education actions in health, focused on the inpatient preceptorship practices developed at Centro Docente Assistencial de Fonoaudiologia (CEDAF), in Salvador – BA. From the virtual holding of semistructured interviews with the preceptor phonoaudiologists of the service, it was possible to know the preceptorship developed in such scenario focused on the competence areas of Health, Management, and Education. Weaknesses and strengths of such practice were also observed, based on the Preceptor’s Competence Profile, which culminated in the preparation of a set of recommendations to the service and of an educational action proposal considering the main needs of the team; focused on a dynamic and collective approach in line with the permanent education principles.
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6
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HELEN INGRID BARRETO AMORIM
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WORK MANAGEMENT IN THE STATE'S BASIC CARE FROM BAHIA
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Advisor : MARILUCE KARLA BOMFIM DE SOUZA
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COMMITTEE MEMBERS :
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CATHARINA LEITE MATOS SOARES
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CÉLIA REGINA RODRIDES GIL
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ISABELA CARDOSO DE MATOS PINTO
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MARILUCE KARLA BOMFIM DE SOUZA
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Data: Apr 16, 2021
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Show Abstract
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The study analyzes Work Management in Primary Health Care according to health macro-regions of the state of Bahia through the National Program of Improved Access and Quality of Primary Care (PMAQ-AB) in 2016 to 2017. A descriptive and exploratory study was carried out, based on the results of the external evaluation of the PMAQ in 408 municipalities in the state of Bahia. The chosen variables were the forms of admission and hiring, type of bonds, position plan and career and continuing education actions. The analyzed data is in the public domain, not being submitted to the Ethics Committee for consideration. It is noteworthy that the universe of sample corresponded to 70% of the Family Health teams in the state, with predominance of the nursing profession; 57.7% of the forms of entry into the state and between macroregions are by other unspecified ways; 78.3% of agents contractors is from the direct municipal administration and then from the private sector, and Centro Leste has 41.8% of contracts with outsourced, surpassing all macro-regions of the state; 33.3% of contracts are temporary, although
in the macro-regions West (40.6%), East (36.3%), North (35.1%) the bond predominates statutory; only 13% of participants have a Career, Position and Salary Plan in the state, however, the North (24.9%), East (23.3%) and West (15.7%) surpassed the reality of Bahia and other macros; in relation to permanent education actions, 80% claim to exist and point out that these actions address the needs of professionals. The findings highlight the need to rescue the management policy of the health work, proving to be a new and old challenge that needs to join efforts to strengthen and ensure the sustainability of ABS in the state and among the macro-regions of health
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7
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VINICIUS DA COSTA CARVALHO RIBEIRO
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IMPERFECT OSTEOGENESIS: NEW TECHNOLOGIES IN FRACTURE PREVENTION - A SYSTEMATIC LITERATURE REVIEW
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Advisor : GILDASIO DE CERQUEIRA DALTRO
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COMMITTEE MEMBERS :
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GILDASIO DE CERQUEIRA DALTRO
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MARIO CASTRO CARREIRO
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VINICIUS DE ARAUJO MENDES
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JANE MARY DE MEDEIROS GUIMARÃES
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Data: Apr 26, 2021
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Show Abstract
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This research aims to identify new technologies in the literature: surgical / drug treatment to prevent fractures in individuals affected by osteogenesis imperfecta. To do so, the following objectives were outlined: to analyze the biochemical aspects of OI, in line with the differential diagnosis and diagnosis of the pathology; to identify, in the national literature, the perspectives of the use of gene therapy and cell therapy, regarding the advances and incorporation in public services in the Unified Health System (SUS) and private health, investigating the barriers / limitations; and to discuss what has already been described in the international literature about those that involve future perspectives of gene therapy and cell therapy. There is a discussion in the literature about OI in relation to what currently exists for the prevention of fractures, as well as showing which drugs, orthoses and surgical techniques that can be used, emphasizing the importance of discussing the use of new technologies used in this prevention and treatment of fractures, possibility of using gene and stem cell therapy in OI therapy. Seeking to answer the question of how much to prevent fractures in imperfect osteogenesis, what has been indicated in the national and international literature, which drug treatments are used today? Use of orthoses, surgical treatments and use of intramedullary nails have been used to prevent fractures and if gene therapy and cell therapy are options for the future, the methodology adopted was the systematic review of literature, using the database of the Library Virtual Health (VHL), PubMed and Cochrane Library, for collection between July and September 2020, with studies from the last ten years, along with 359 articles published in Portuguese, English, French and Spanish. 227 articles were duplicated, 45 were rejected, 87 were accepted. Of these, after reading the full text, 26 were included for systematic research. It is an exploratory, descriptive and explanatory research, of a qualitative nature. The results obtained led to the conclusion that the analyzed authors mentioned that the diagnosis can still occur in utero with complementary exams. The clinical picture of OI is characterized by elasticity with capsule-ligament laxity, bone fragility, increased bleeding tendency, triangular facies, skin changes, inguinal hernia, late birth defects, mental retardation, bluish sclera color, deafness, among others, it is necessary to understand the type of skeletal deformities in order to proceed with the most appropriate treatment. They unanimously concluded that even though the use of bisphosphonate-based medications is routine in the treatment of OI, other potential treatment modalities may include gene therapy or mesenchymal cell transplantation, where there is unanimity by the analyzed authors that therapy surgeries are shown as a treatment possibility that focuses not only on symptomatic control, but on effective treatment of pathology.
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8
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LIVIO MATHEUS OLIVEIRA DA SILVA
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EFFECT OF THE FAMILY HEALTH STRATEGY ON COLLECTION OF THE FIRST TEST SAMPLE OF THE PEZINHO IN BAHIA BETWEEN 2011 AND 2018
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Advisor : VINICIUS DE ARAUJO MENDES
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COMMITTEE MEMBERS :
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MARCIO SANTOS DA NATIVIDADE
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TATIANA REGIA SUZANA MATTOS DE AMORIM
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VINICIUS DE ARAUJO MENDES
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Data: Apr 30, 2021
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Show Abstract
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In this work, we sought to investigate the possible effect of the Family Health Strategy (ESF) on the National Neonatal Screening Program in Bahia in one aspect particular, that is, the moment of collection of the first sample of the heel test, recommended between the 3rd and 5th days of life of the newborn according to the Ministry of Health. For the investigation, a data analysis was carried out in a longitudinal panel that evaluated the performance of health units in collecting the exam in relation to existence or not of FHS team active in the establishment. The search found an effect of improvement in the average number of days on which the collection was evolution directly related to the time the health unit had functioning FHS teams.
In addition, the presence of the FHS in the health unit was related to an increased likelihood that the test collection would be performed in the recommended period. The magnitude of this effect, however, proved to be practically null within a context of public health intervention, since, in order to reduce one day in the average collection time, the health facility would need, approximately six years of operation as a Family Health Strategy. It is proposed that the research result does not show an intrinsic limitation of power reach of the FHS; on the contrary, it can point to a performance of the Health Strategy of the Family below its potential, as well as reveal possible failures in actions programmatic, such as visiting the newborn in the first week after delivery.
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9
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CLÁUDIA CRISTIANE MOURA SILVA SOUZA
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REGIONALIZATION AND NETWORKING FOR THE STRENGTHENING OF HEALTH EDUCATIONAL ACTIONS
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Advisor : LILIANA SANTOS
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COMMITTEE MEMBERS :
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ANA ANGELICA RIBEIRO DE MENESES E ROCHA
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CÉLIA REGINA RODRIDES GIL
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LILIANA SANTOS
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Data: Jun 14, 2021
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Show Abstract
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The development of educational processes in a regionalized manner requires the involvement of the spheres of state, regional and municipal management in the perspective of networking. This is a qualitative research, which aimed to strategically analyze the regionalized offer and network work as a device for strengthening the educational actions promoted by ESPBA, focusing on the composition of the Health Education Network. Nine interviews were conducted semi-structured with reference technicians from the Regional Health Centers of Bahia. Data analysis was carried out through thematic analysis technique, guided by the following categories: Democratization of access and capillarity; Interdependence; Sharing experiences and collaboration; Respect for diversity; Meaningful learning and communication. The results found are presented in the SWOT Matrix format. It was found that the regionalization of educational actions enabled the situational diagnosis of the territories, facilitating the identification of priorities and needs of health workers
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10
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ARLENE MARIA DE JESUS
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NORMATIVE ASSESSMENT OF COVID-19'S EPIDEMIOLOGICAL SURVEILLANCE ACTIONS DEVELOPED BY THE HEALTH SURVEILLANCE STRATEGIC INFORMATION CENTER OF THE STATE OF BAHIA
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Advisor : ANA LUIZA QUEIROZ VILASBOAS
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COMMITTEE MEMBERS :
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ANA LUIZA QUEIROZ VILASBOAS
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CATHARINA LEITE MATOS SOARES
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MARCIA SAO PEDRO LEAL SOUZA
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Data: Jul 30, 2021
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Show Abstract
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According to the 2005 International Health Regulations, a public health emergency of international importance is an extraordinary event for the international spread of a disease that constitutes a public health risk for other States. Declared by the World Health Organization as a pandemic, COVID-19 determines the carrying out of epidemiological surveillance actions, attributed to the Network of Strategic Information Centers in Health Surveillance, which acts as a focal point for the International Health Regulations in Brazil. The realization of these actions has caused changes in the way in which the work of the Center for Strategic Information in Health Surveillance in Bahia is organized with a view to the timely generation of information on the magnitude and distribution of cases and deaths from this disease in Bahia. Such modifications lack systematization, an initiative prior to a necessary assessment with a view to improving the epidemiological surveillance actions of COVID-19 under the responsibility of this institution. Thus, the present study aims to evaluate the development of coronavirus epidemiological surveillance actions by the Center for Strategic Information in Health Surveillance in Bahia, according to the International Health Regulations. It is an evaluative study of the normative appreciation type. A logical model and respective judgment matrix adapted from the State Contingency Plan for Coping with the New Coronavirus and the studies by Costa (2013) and Santos (2014) were prepared. For the production and analysis of the data, documental analysis and semi-structured interviews were carried out with technicians and managers of the Center for Strategic Information in Health Surveillance-Bahia who carry out epidemiological surveillance actions by COVID19. In the analysis and judgment matrix, the following dimensions were evaluated: inputs; management and development of the actions of the Center for Strategic Information in Health Surveillance and quality of health information systems. In general, CIEVS-Bahia carries out its actions in accordance with the International Health Regulations, having a specialist coordinator in public health, exclusive teams for the bulletin and for the investigation of confirmed cases and deaths with experience in epidemiological surveillance, administrative support staff, in addition to a reference laboratory, sufficient standards and materials and equipment. The management produces epidemiological bulletins and carries out annual planning activities, educational activities, monitoring meetings and / or actions with other programs on COVID-19. For the monitoring of rumors about the occurrence of suspected cases of COVID-19, the main national and international sites that originate the clippings of CIEVS or the notifications sent to e-mails or institutional telephone, social network applications or official information systems are investigated. Regarding the quality of the systems, the team considers the FORMSUS, GAL and SIVEPGRIPE systems to be functional and reliable, the FORMSUS easy, efficient and of good maintenance and the FORMSUS and SIVEPGRIPE with portability. To improve the work process, it is worth emphasizing the need to hire more professionals, discuss with the team the importance of the International Health Regulations 2005 and with Lacen; propose strategies to disseminate the results in a timely manner and also report the difficulties encountered in the SIS to the Ministry of Health.
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11
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CAMILA MOITINHO DE ARAGÃO BULCÃO
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TEAM WORK AND COLLABORATION IN TIMES OF PANDEMICS: POSSIBILITIES AND CHALLENGES IN THE SCOPE OF WORK MANAGEMENT
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Advisor : LILIANA SANTOS
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COMMITTEE MEMBERS :
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MARINA PEDUZZI
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ISABELA CARDOSO DE MATOS PINTO
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LILIANA SANTOS
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Data: Aug 11, 2021
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Show Abstract
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The COVID-19 pandemic triggered the need to develop actions aimed at the health of health workers. This study aimed to analyze the perceptions of professionals involved in the management of actions aimed at health workers, given the need to develop the Contingency Plan for Health Workers (PCTTS) within a State Health Department 11 workers who acted strategically in the preparation and execution of the PCTTS were interviewed. A semi-structured interview script was developed, covering topics related to teamwork and collaboration, associated with relational, procedural, organizational and contextual factors. To treat the material, thematic content analysis strategy was adopted, considering the concept of interprofessional collaboration as central, given its adaptability to contingency situations, such as a pandemic. The team members' perceptions indicate that in contingency situations, collaborative actions are favored and leave significant legacies for the reconfiguration of work processes. Perspectives open up for other studies, especially with regard to reflection on work processes and innovation, deepening analyzes of these aspects, such as teamwork and intersectorial action, in addition to the need to value work management, workers' health and the humanization of health workers' health. These actions favor the establishment of interprofessional relationships, promoting the reduction of borders and integrated planning, and encourage continuous dialogue between the various intra and inter-institutional instances, in order to expand innovations in favor of intersectoral collaboration in networks and with the community.
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12
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LARISSA PIMENTEL COSTA MENEZES SILVA
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PERCEPTION OF MANAGERS AND PROFESSIONALS ABOUT THE PROBLEMS AND CHALLENGES OF THE “MAIS DOCTORS FOR BRAZIL” PROJECT IN THE CORONAVÍRUS PANDEMIC SCENARIO: A CASE STUDY IN A MUNICIPALITY IN THE SOUTH OF BAHIA Dissertation
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Advisor : CARMEN FONTES DE SOUZA TEIXEIRA
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COMMITTEE MEMBERS :
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CARMEN FONTES DE SOUZA TEIXEIRA
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CATHARINA LEITE MATOS SOARES
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EDNIR ASSIS SOUZA
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Data: Aug 12, 2021
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Show Abstract
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He objective of this work is to analyze the perception of managers and professionals involved in the Mais Médicos Project about the challenges of providing and reorganizing the medical work process in light of the Coronavirus pandemic scenario in the city of Ilhéus/BA in 2020. This is a case study of insertion and performance in primary care units of doctors hired by the Mais Médicos program in the city. Data production was carried out through document review and interviews with municipal health managers and four medical professionals hired by the program. The analysis of the results included the perception of managers about the medical provision in the city, as well as the actions of monitoring, supervision and evaluation of the performance of professionals carried out by the coordination of primary care. The analysis of the medical work process, in turn, took as a reference the theory of the health work process, seeking to identify if there were changes in the objects, means of work used by professionals and forms of work organization in the daily life of practice before and during the outbreak of the Covid-19 pandemic. The conclusions point out that despite the number of places being insufficient to meet the needs of the city, with regard to the increase in the coverage of Primary Care, the provision and retention of doctors through the PMMB, presents important advances in terms of access to the population to the network and humanization of care and meeting health needs related to precarious socioeconomic conditions and the epidemiological profile of the population, characterized by the high prevalence of chronic diseases, malnutrition, domestic violence and, more recently, with the outbreak of the pandemic of Covid-19.
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13
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ANA GABRIELA PRAZERES OLIVEIRA
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COST-EFFECTIVENESS OF INHALED NITRIC OXIDE IN THE TREATMENT OF PERSISTENT PULMONARY HYPERTENSION IN THE NEWBORN
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Advisor : FABIANA RAYNAL FLORIANO
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COMMITTEE MEMBERS :
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CAROLINA THÉ MACEDO
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ERIKA SANTOS DE ARAGAO
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FABIANA RAYNAL FLORIANO
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IVAN RICARDO ZIMMERMANN
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Data: Aug 26, 2021
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Show Abstract
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Persistent Pulmonary Hypertension of the Newborn (PPPN or PPHRN) is a clinical syndrome characterized by severe hypoxemia, lability of oxygenation with minimal handling and generalized cyanosis, defined by the presence of high pulmonary vascular resistance and right-to-left shunt through the ductus arteriosus and/ or foramen ovale. This disease is associated with high morbidity rates, mainly due to neurological damage in 15 to 20% of cases. The treatment of this pathology must be carried out in the Neonatal Intensive Care Unit and consists of decreasing pulmonary vascular resistance in the use of pulmonary vasodilators, the gold standard treatment being the use of inhaled nitric oxide (iNO), which has a high cost and the possibility of therapeutic failure. The aim of this study was to analyze the cost-effectiveness of using inhaled nitric oxide in the treatment of PPHN compared to standard care offered by SUS. A cost-effectiveness evaluation (ACE) was carried out in a decision tree analytical model, based on secondary data, and with the help of the statistical program TreeAge Pro Healthcare, the calculation of the incremental cost-effectiveness ratio was performed. When calculating the ICER, treatment with iNO had a cost of R$13,585.47 per life saved and a cost of R$240.50 per potential life years gained compared to treatment without iNO. The results obtained demonstrate that nitric oxide therapy in neonates is more cost-effective.
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14
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RODRIGO JORGE DE SOUZA DA FONSECA
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SOCIO-DEMOGRAPHIC CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH OSTEONECROSIS SECONDARY TO SICKLE DISEASE TREATED WITH CELL THERAPY IN THE UNIVERSITY HOSPITAL COMPLEX PROFESSOR EDGAR SANTOS
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Advisor : CLARICE SANTOS MOTA
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COMMITTEE MEMBERS :
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CLARICE SANTOS MOTA
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GILDASIO DE CERQUEIRA DALTRO
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YEIMI ALEXANDRA ALZATE LOPEZ
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Data: Aug 31, 2021
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Show Abstract
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Objectives: To analyze the sociodemographic and socioeconomic profile of children and adolescents with osteonecrosis secondary to DF and the social impact of treatment using CMMO in the studied population. Method: qualitative study with individuals with SCD of both sexes and aged between 8 and 19 years with SCD treated with cell therapy at Com - HUPES in 2019. Primary data were used through interviews and secondary data through medical records doctors. Results: Four adolescents were interviewed, two female and two male, with an average age of 14.5 (12-17) years, and with an average monthly income of two minimum wages, all with HbSS. Caregivers, all mothers of adolescents, are exclusively caregivers. Two participants have bilateral osteonecrosis with Ficat III in the right hip and Ficat I in the left hip, one participant has Ficat grade I osteonecrosis in the left hip and the other Ficat III in the right hip. Claudication was the most striking symptom for diagnostic suspicion, and pain the most restrictive symptom. School and recreational activities have been shown to suffer a strong negative influence due to pain or hospitalization. The postoperative results showed improvement in self-esteem, reduced pain and improved functionality of adolescents. Conclusion: The socio-demographic and socioeconomic profile of children and adolescents was between 12 and 17 years old, with an income of up to two minimum wages, the majority declared to have black or brown skin color, mothers are the main caregivers and have the exclusive activity of raising of the teenager. The treatment performed by SUS at HUPES and proved effective in treating pain and improving the self-esteem of the population studied.
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15
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IOLANDA NOGUEIRA DE SOUSA
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Educational practices of the Oral Health Teams, in the Sanitary District of Subúrbio Ferroviário, in Salvador, Bahia
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Advisor : CATHARINA LEITE MATOS SOARES
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COMMITTEE MEMBERS :
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CATHARINA LEITE MATOS SOARES
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MARIANGELA SILVA DE MATOS
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TEREZINHA DE LISIEUX QUESADO FAGUNDES
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Data: Aug 31, 2021
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Show Abstract
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The study consists of an investigation about the educational actions carried out by the Oral Health Teams, aimed at the population in a SD in the city of Salvador/Ba. This is a qualitative, exploratory research, which sought to characterize educational practices, recognizing the socio-educational and occupational profile of professionals, pedagogical strategies and health issues addressed in the midst of the social, political and cultural dimensions that permeate them. For data production, the municipal documents were consulted: the Municipal Health Plan, the Annual Management Report and the Annual Health Schedule, and interviews were conducted with the application of a semi-structured script for seven Dental Surgeons, five Oral Health Assistants, one Agent Community in Health and the District Dentist. The results showed that the main themes used are based on prevalent oral diseases and related risk factors, to the detriment of the social determination of the health-disease process. Pedagogical strategies prevailed in the transmission of knowledge and conditioning of techniques, but with signs of changes demonstrated by the use of more dialogic and participatory methodologies. The study revealed difficulties in the development of educational practices related to infrastructure needs and the provision of material resources and the facilities associated with teamwork and in a multidisciplinary way. Given the banking focus on the conduct of educational practices, it is considered important to propose qualification processes to educators regarding problematic educational knowledge and practices committed to the social reality, which contribute to the constitution of subjects capable of facing new challenges posed by the process of Brazilian Health Reform, in order to favor community involvement in health issues in pursuit of their quality of life
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16
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NEY CRISTIAN AMARAL BOA SORTE
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ANALYSIS OF NEONATAL SCREENING FOR GALACTOSEMIA IN STATE OF BAHIA: COST-EFFECTIVENESS STUDY
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Advisor : FABIANA RAYNAL FLORIANO
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COMMITTEE MEMBERS :
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FABIANA RAYNAL FLORIANO
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JOSÉ SIMON CAMELO JUNIOR
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IVAN RICARDO ZIMMERMANN
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Data: Sep 3, 2021
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Show Abstract
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BACKGROUND: Galactosemia, an inborn error of galactose metabolism, results on sepsis and acute liver failure in the neonatal period, with a high risk of death during this period. Given this, several European countries, Canadian provinces and American states (USA) perform universal neonatal screening (NS) for this pathology. In 2018, CONITEC considered that, for clinical diagnostic strategy, the existing evidence was insufficient to establish the appropriateness of newborn screening for galactosemia. However, in May 2021, an expanded list of diseases that will be compound of the National Newborn Screening Program (NNSP) was presented to include galactosemia. Health Technology Assessment procedures require real-life data and economic analyses. AIMS: To describe data from the pilot project of neonatal screening for galactosemia conducted in Bahia and to evaluate the cost-effectiveness of neonatal screening compared with a clinical diagnostic strategy. METHODS: A population screening study was carried out, followed by a follow-up cohort of patients, coupled with a cost-effectiveness study. Operational parameters of the newborn screening process were calculated. An analytical model was developed to estimate the incremental cost-effectiveness ratio (ICER) between neonatal screening strategies and clinical diagnosis (standard) from the National Health System perspective. The health outcomes evaluated were death averted and potential life-years gained. A 5% discount rate was applied. Costs were estimated from the SIGTAP table and government procurement data. Univariate deterministic and probabilistic sensitivity analyses were performed. Value of one Gross Domestic Product (GDP) per capita was used as a threshold of willingness-to-pay. RESULTS: Between November 2015 and March 2016, 77,148 newborns sequentially had galactose-1-phosphate (Gal-1-P) dosage in dried blood on filter paper in the state of Bahia. Of these, 184 (0.23%) were positive in the first screening and, 7.6% (14/184) remained with high Gal-1-P, and 5 cases were confirmed, with a birth prevalence of 1:15,429 live births. The incremental cost per death averted was estimated at R$259,052.37 and, R$4,143.31 for the potential gain of one year of life. The birth prevalence of galactosemia and the probability of making a clinical diagnosis were the variables with the greatest impact in the univariate deterministic analysis. For the outcome of potential years of life gained, the acceptability curve showed that for ICER values starting at R$7,034.40, the diagnostic strategy with neonatal screening becomes more likely to be cost-effective than the clinical diagnostic strategy. CONCLUSION: Among the population-based data available in Brazil, the state of Bahia has the highest birth prevalence of galactosemia. Still, given the low frequency of the disease, the neonatal screening strategy is not cost-effective at the willingness-to-pay threshold of 1 GDP per capita to avoid one death. However, considering potential years of life gained, at a WTP of R$10,561.60, neonatal screening was 100% cost-effective
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17
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CEANNY CRISTINA PINHO COSTA
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THE USE OF PROBLEMATIZATION METHODOLOGY: experience of the technical training of Community Health Agents carried out by the School of Public Health of Maranhão in the municipality of São Benedito do Rio Preto-MA
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Advisor : YARA OYRAM RAMOS LIMA
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COMMITTEE MEMBERS :
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DAYANA DOURADO DE OLIVEIRA COSTA
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LAISE REZENDE DE ANDRADE
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YARA OYRAM RAMOS LIMA
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Data: Sep 23, 2021
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Show Abstract
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The Community Health Agent (CHA) has a high importance for public health in Brazil, and training is essential to enable excellence in their performance, playing a key role in the implementation of policies aimed at adjusting the medical model since the creation of the SUS. From this perspective, this study aimed to analyze the use of the problematization methodology in the training process of the CHAs of ESP/MA and how the CHAs perceive the use of the problematization methodology during their training process, a descriptive-exploratory study was carried out, with descriptive analytical method and qualitative approach. The sample consisted of students and the facilitator from the city of São Benedito do Rio Preto-MA. Data collection took place from August to September 2020. The analyzed instruments consisted of a semi-structured questionnaire with open and closed questions and pedagogical instruments related to this class. The Content Analysis technique was used for data analysis with the aid of the EpiInfo ® software version 3.5.4. The results allowed us to conclude that the Problematization Methodology is used as a pedagogical strategy that can promote new knowledge from previous knowledge, stimulates curiosity and skills, making this professional have new individual and collective decision-making, dynamic and complex, exercising to praxis to form awareness of praxis. Therefore, this professional has become an important element in promoting changes in the care model and strengthening primary care. Given the context of the CHA's work, the results indicate more comprehensive, continuous and organized forms need to be adopted with methodologies that are capable of making them increasingly critical and reflective subjects and protagonists in this teaching-learning process, always seeking to respect the autonomy of the subjects.
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18
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GEISEANE LOPES DE GOIS SANTOS
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A LOOK AT THE WORK PROCESS OF ENDEMICS COMBAT AGENTS IN THE MUNICIPALITY OF CROSS OF THE SOULS/BAHIA
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Advisor : JOILDA SILVA NERY
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COMMITTEE MEMBERS :
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JOILDA SILVA NERY
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LILIANA SANTOS
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AROLDO JOSE BORGES CARNEIRO
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JANETE GONÇALVES EVANGELISTA
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Data: Sep 29, 2021
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Show Abstract
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Objective: This research aimed to describe and analyze the work process of Endemic Disease Combat Agents (ACE) in the city of Cruz das Almas, Bahia, based on the conceptions of Mendes Gonçalves who formulated the concept of the work process in health, characterizing it socially in constitutive elements (agents, objects, instruments and purpose). Methodology: This is a descriptive-analytical research, in which a cross-sectional study was carried out with the ACEs of the health surveillance structure, active in December 2020 in the city of Cruz das Almas. To produce data, a self-applied and semi-structured questionnaire was used, elaborated in the light of the current theoretical and political normative framework regarding the professional practice of the ACE. The database was structured in Excel Version 2016 software of the Microsoft Office professional Plus 2019 package and the variables of interest were analyzed using the statistical program Stata/MP 15.1 for Windows and represented through graphs and tables. Results: Among the participating ACEs, the age group between 35 and 39 years old, black race, male and complete high school predominated. All worked under the statutory regime, a workload of 40 hours per week and 91.89% with a salary range between one and two minimum wages. Arboviruses were the object of work by 100% of the agents surveyed. There was a lack of professional development, equipment, infrastructure, qualification, continuing education in health, integration with other professionals and sectors and incorporation in planning, monitoring and evaluation of actions, as well as gaps in their work practices. Conclusion: In view of the results found, it is essential that there are investments, surpassing the indicated limits, in the perspective that the strengthening of the work process of the ACEs increases the resolution of surveillance and control actions for vector-borne diseases in the city.
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19
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LUIZA SAMARA ABREU CARDOSO CARVALHO
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EFFECTS OF MEDICAL OUTSOURCING SERVICES ON THE PERCEPTION OF MANAGERS AND DOCTORS OF THE MARANHÃO STATE HEALTH SECRETARIAT.
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Advisor : ISABELA CARDOSO DE MATOS PINTO
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COMMITTEE MEMBERS :
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ISABELA CARDOSO DE MATOS PINTO
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ANA ANGELICA RIBEIRO DE MENESES E ROCHA
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KATIA REJANE DE MEDEIROS
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Data: Sep 29, 2021
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Show Abstract
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The study aims to analyze the effects produced by medical outsourcing in the management of work in the Maranhão Department of Health (SES/MA). A qualitative and exploratory case study was carried out on the hiring of outsourced physicians, taking into account the work management guidelines and health education. Data production involved bibliographic research, document analysis and semi-structured interviews with key informants by intentional sampling, based on a previously established script. The study population consisted of actors involved in the hiring process of outsourced managers and physicians. Document research involved six types of documents related to contracting via outsourcing. Interviews with managers and physicians were analyzed using the following analytical categories: a) facilities and advantages of outsourcing b) difficulties and disadvantages of outsourcing. The results highlight that the SES/MA has a diversity of employment relationships and that the number of active physicians has not corresponded to the needs of the state health system, which contributes to the advancement of outsourcing. In this sense, the State has used outsourcing to hire human resources and management of health units, through management contracts. The perceptions of managers regarding the advantages of outsourcing would be in the gain in quality and greater productivity, more agility and competitiveness. For the interviewed physicians, outsourcing was not evaluated as a disadvantage, but as an advantage, in terms of remuneration and working conditions.
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20
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JOELMA DE MEIRA FERREIRA
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PROFILE OF OFFERING AND USE OF SERVICES OF THE REGIONAL HEALTH POLYCLINIC OF ALTO SERTÃO BAHIA (2017-2019)
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Advisor : MARILUCE KARLA BOMFIM DE SOUZA
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COMMITTEE MEMBERS :
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ANA PAULA CHANCHARULO DE MORAIS PEREIRA
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CARMEN FONTES DE SOUZA TEIXEIRA
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JULIANA ALVES LEITE LEAL
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MARILUCE KARLA BOMFIM DE SOUZA
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Data: Oct 4, 2021
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Show Abstract
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This study aimed to analyze the profile of the offer and use of the services of the Alto Sertão Bahia Regional Health Polyclinic (2017-2019) from the description of the process of implementation and definition of the offer of services and characterization of this profile, correlating it with the health needs of the population. This is a retrospective, exploratory, descriptive and qualitative study. Data production was carried out through document analysis and interviews with key informants. The criteria for inclusion of participants considered their involvement in the discussion process that took place regionally, which preceded the implementation. Data analysis was performed using the Thematic Content Analysis technique. The study was submitted and approved by the Research Ethics Committee of the Instituto de Saúde Coletiva at UFBA. In terms of management, the importance of Integrated Regional Planning and the effective participation of regional governance bodies such as the CIR in all stages of the process of implementing regionalized health services was highlighted. In the care field, the influence of the hegemonic care model was demonstrated, as well as the weakness of Primary Health Care in identifying territorial health demands, reflecting the supply and use of specialized care services. The results on the supply profile revealed that this does not have a directly proportional relationship to the use of services, indicating a possible inadequacy of the supply and the emerging need for a reassessment of the regional scenario supported by a careful situational analysis of health in order to identify the real health needs of the population to adapt the services offered at the Alto Sertão Regional Health Polyclinic.
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21
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JOSICLÉIA OLIVEIRA DE SOUZA
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Contributions of a Multiprofessional Residency Program in Mental Health for the formation of critical subjects in the field of psychosocial care: a case study of the Multiprofessional Residency Program in Mental Health at UNIVASF
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Advisor : MONIQUE AZEVEDO ESPERIDIAO
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COMMITTEE MEMBERS :
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MONIQUE AZEVEDO ESPERIDIAO
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LILIANA SANTOS
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ROSANA TERESA ONOCKO CAMPOS
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Data: Oct 19, 2021
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Show Abstract
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Multiprofessional residency training in Mental Health is immersed in the scenarios of teaching-service for professional qualification and theoretical-practical construction of psychosocial care. Studies observe a narrow relationship between residency programs and the National Policy on Continuing Education, especially, as understood that the main tool is education in work. This is a case study, with the objective of analyzing the contributions of a Multiprofessional Residency Program in Mental Health for the formation of critical subjects in the field of psychosocial care. The notion of “critical subjects” was worked, with the conceptualization of “transformational subjects” (Testa, 1997), subjects of praxis (Paim, 2017), instituting subjects (Nunes, 2015), in addition to the dialogue with the organizational support (Oliveira-Castro, Pilati e Borges Andrade, 1999; 2005). It involved the combination of technics such as interviews with key insiders and documental assistance given by the residency program. This research complied with the resolutions of the National Health Council 466/2012 and 510/2016. Based on the collected data, it was detailed the results and discussion by dimensions elaborated in an analytical matrix, based by the theoretical framework of the research. The study brought conceptions about Mental Health, brazilian psychiatric reform and psychosocial care, on the perspective of the subjects involved with the program. It analyzed elements of the training process, including pedagogical approach, teaching-service integration and contributions to the work in RAPS, as well as the constitution of critical subjects of the graduates, including aspects of organizational support to the work. The contributions of the program are pointed out by the conceptions of mental health articulated with assumptions of the brazilian psychiatric reform, presenting in its documents a conducive pedagogical and evaluative plan so the residents recognize this conception and practice it in their work. The training process and the relationship with work on RAPS showed higher density, in the idea of transposing formative aspects to the current work of the graduates. The contrasts of responses, associated with the diversity of the participants' fields of work, allowed the recognition of residency training by the graduates, the appreciation of the program in the dimension of learning by practice and the autonomy. The challenges in the articulation between training and field of work were discussed, pointing out gaps in the theoretical axes of the program, in the support with tutoring, difficulties in organizing the program at the university, among others. It was analyzed the close relationship of the constitution of critical subjects and the organizational support, concluding that there is a perception from the graduates of organizational support by managers, however, there are difficulties for teamwork and, availability to perform practices in the institutional collective. Transformations operated by the subjects were pointed out, in the organization of work and in the clinic of psychosocial care, from the perspective of the subjects of praxis (Paim, 2017), indicating the existence of instituting practices (Nunes, 2015), modifying the rigid structures of the services; were identified subjects with reflective and dialogic capability, political-organizational articulation and criticality to recognize competences, limits and contradictions. Common to the search for knowledge, other issues emerged, standing-out: the necessity of studies about the relationship between the psychosocial care team and the disputes of antagonistic care models; the work process in mental health teams and preceptorship training in this field.
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22
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Ana Clelia de Freitas Teixeira Góes
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Lights on an invisible protagonism: the singularity of the work process of the SUS Bahia School's institutional supporter
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Advisor : SILVANA LIMA VIEIRA
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COMMITTEE MEMBERS :
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CATHARINA LEITE MATOS SOARES
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SILVANA LIMA VIEIRA
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TANIA CELESTE MATOS NUNES
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Data: Oct 22, 2021
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Show Abstract
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Institutional Support is an innovative management device in the field of Public Health. It is realized through the work of technicians called institutional supporters, who collaborate with projects and policies, while strengthening collectives. This study aims to analyze the work process of the institutional supporter of Escola do SUS Bahia, who works in the development of human resources in health through the decentralized management strategy. The study is exploratory, has an investigative and descriptive character and was developed through a qualitative approach. It is based on the theoretical framework of Mendes-Gonçalves about the work process in health. As a method for data production, documentary research was carried out, with exploration of institutional documents and current legislation and field research, for which interviews were conducted using a semi-structured script. The 12 research participants are professionals who have worked or are working in the function, selected based on 03 categories, according to inclusion and exclusion criteria, such as length of experience. The analysis categories were defined based on the elements of the work process and specific objectives. Resolution CNS/CONEP nº 466/2012 was complied with with regard to ethical aspects. The analysis process considered Bardin's content theme. The results revealed that this agent acts guided by the Policy of Continuing Health Education and by the Institutional Pedagogical Political Project. Through support and co-management strategies, it collaborates to democratize the access of health professionals to knowledge, qualify practices and services from the perspective of strengthening the SUS and comprehensive health care, while encouraging the autonomy and emancipation of subjects. In productive action, it articulates material instruments with specific knowledge, skills and attitudes to develop work that has a managerial and technical-pedagogical character and is oriented based on multiple dimensions (ethical, political, pedagogical, technical, administrative, anthropological and human), weaving a synergistic movement of interaction and collective learning, these being some of the specificities that show its uniqueness. It is concluded that despite the relevance of this work process, challenges are imposed to development, demanding investments in actions to strengthen the team and work qualification, such as: lack of institutionalization of the function and ordering guidelines, investments in permanent education actions, offer of technologies and structuring of support networks.
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23
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FLAVIA CARNEIRO DA SILVA
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Access of SUS users to HIV Post-Exposure Prophylaxis (PEP) and the return to follow-up appointments in the city of Salvador – BA.
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Advisor : CARLOS ANTONIO DE SOUZA TELES SANTOS
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COMMITTEE MEMBERS :
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CARLOS ANTONIO DE SOUZA TELES SANTOS
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MARIA APARECIDA ARAÚJO FIGUEIREDO
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LAIO MAGNO SANTOS DE SOUSA
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SANDRA ELY BARBOSA DE SOUZA
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Data: Oct 25, 2021
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Show Abstract
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The Post-Exposure Prophylaxis (PEP) of risk to HIV infection is a technology considered strategic in combined prevention programs in Brazil and worldwide. In addition to the preventive function, it is a method that has the possibility of linking people exposed to HIV to health services. This study aims to analyze the access of SUS users to PEP and the return to follow-up appointments in the city of Salvador - BA. The study population consisted of people who sought PEP in the city, from January to December 2018. Data collection was performed using information from the monitoring spreadsheets of the emergency care units (UPA) and through information collection in medical records at the specialized care medical service (SEMAE). Descriptive analyzes and a regestion model were used. In descriptive terms, absolute and percentage frequencies were obtained; in the bivariate analysis, using logistic regression, the odds ratio (OR) was obtained, with respective 95% confidence intervals (95%CI), for the outcome prescription of pep. A significance level of 5% (p ≤ 0.05) was adopted. For statistical analysis, Stata version 12.0 was used. The study was approved by the CAAE Research Ethics Committee: 25525719.6.0000.5030 ensuring the confidentiality and privacy of the participants. Of the 1525 people who sought PEP in the UPAs in Salvador, 1273 (83.5%) met eligibility criteria for PEP and 252 (16.5%) did not. Of this group of eligible people, 1166 (91.6%) were prescribed antiretrovirals (ARV) and were instructed to follow up with the protocol follow-up appointments, but 107 (8.4%) people, despite having the criteria of inclusion in the PEP, did not receive the prescription of ARVs. Men are the ones who most seek PEP, totaling 69.2% of the consultations. The predominant age group was 24 to 34 years old and the most frequent exposure was consenting sexual intercourse with 76.3%. Of the total number of people who received the PEP prescription, only 226 (19.4%) returned to the first appointment, 115 (9.9%) to the second appointment and 33 (2.8%) to the third appointment to complete the protocol. Most users who attended the first follow-up appointment at SEMAE were: male (64.6%), aged 34 years (37.2%) and with exposure through consenting sexual intercourse (70.4% ). The biggest obstacle in the PEP protocol was the lack of follow-up due to the non-attendance of the user to the service, revealing in this study as an important indicator of the need to restructure the implementation of the PCDT-PEP in the city. In addition, it is important to publicize this prevention tool, as well as its service locations, in an attempt to promote more access for people to prophylaxis and health care, overcoming prejudice, discrimination and ensuring the right of everyone to know and use the set of preventive methods, which suit your individual needs, to avoid new hiv infections and which are available in the single health system.Keywords: HIV, Post-exposure prophylaxis, Communicable disease prevention.
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24
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ANA CAROLINA SANTOS GOUVEIA
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Social organizations as a way to hire health professionals: analysis of work management in a hospital case in the SUS Bahia network.
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Advisor : THADEU BORGES SOUZA SANTOS
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COMMITTEE MEMBERS :
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ISABELA CARDOSO DE MATOS PINTO
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KATIA REJANE DE MEDEIROS
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THADEU BORGES SOUZA SANTOS
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Data: Nov 8, 2021
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Show Abstract
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With the expansion of health professionals working in hospital units of the Unified Health System (SUS) through Social Health Organizations (OSS), the aim of this study was to analyze work management in the relationships between SESAB, OSS and unit management , regarding the nursing professionals contractually linked via OSS in the HGRS. This is a qualitative, exploratory research on a hospital case from the SUS Bahia network. The data sources were primary, being analyzed as a document the Term of Reference (TR) and four interviews with strategic actors with the role of coordinating OSS contracts at the central level of SESAB, nursing coordination of these contracts, supervisor of the HGRS contract and director of nursing at the HGRS. The collected data were submitted to the content analysis plan, whose categories were pre-established from the theoretical framework about work management. The study was approved by CEP with CAAE nº 44808821.7.0000.5030.
As a result, it was recognized that there is a distancing from the contracting party in the recruitment process and a lack of guidelines for selection, monitoring of available resources or monitoring of the conditions to which workers are exposed. It was concluded that the type of employment relationship that prevailed in the analysis was the CLT, however, there was no reference to an information system that would enable the management of people and jobs. Furthermore, these results allowed the understanding of the obstacles in the management of work in an OSS, highlighting the importance of instrumentalizing monitoring by the SESAB to the management of hospital units, so that this monitoring is in line with SUS guidelines in the field of management from work.
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25
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ELÂNIA SIRLEY DE OLIVEIRA MORAES SANT'ANA
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Continuing Education for Prenatal Care: nurses' perception in the context of the family health strategy in a municipality in Bahia.
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Advisor : CRISTIANE ABDON NUNES
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COMMITTEE MEMBERS :
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CRISTIANE ABDON NUNES
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CATHARINA LEITE MATOS SOARES
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LILIAN CONCEICAO GUIMARAES DE ALMEIDA
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Data: Nov 9, 2021
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Show Abstract
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Objective: To analyze the perception of nurses from the Family Health Strategy in relation to Continuing Education actions for prenatal care developed in the city of Itaberaba/Bahia. Methodology: This is a descriptive, exploratory research with a qualitative approach. The 17 nurses from the Itaberaba Family Health Strategy who participated in permanent health education activities with a view to qualifying prenatal care, developed in 2018 and 2019, were invited to participate in this study. of which 16 accepted the invitation. Strategies for data collection were used: document analysis, questionnaire using Google Forms and conducting a focus group. Ethical aspects were respected, in accordance with the recommendations contained in Resolution No. 466 of the National Health Council. The collected data were organized based on content analysis. Results: With data analysis, the following steps emerged: Characterization of the research subjects; Permanent education actions for prenatal care developed with nurses and nurses of the family health teams in the period 2018 to 2019; Conception of permanent health education; Influence of EPS in professional practice; Permanent health education and improvement of prenatal care. Final considerations: The importance of reflecting on the work of nurses is noteworthy, as this category represents the largest workforce in the health area in our country in recent years. As well as the experience of this work, it showed potential for multiplication in other municipalities, as a way to reverse the serious health problems of pregnant women and newborns due to low quality maternal and child care.
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26
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VANESSA SANTOS ESTRÊLA
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TELEDIAGNOSIS IN CARDIOLOGY IN PRIMARY CARE: EVALUATION STUDY IN THE STATE OF BAHIA Salvador BA 2021
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Advisor : SONIA CRISTINA LIMA CHAVES
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COMMITTEE MEMBERS :
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ERICA LIMA COSTA DE MENEZES
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MONIQUE AZEVEDO ESPERIDIAO
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SONIA CRISTINA LIMA CHAVES
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Data: Nov 30, 2021
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Show Abstract
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Cardiovascular diseases are the main cause of morbidity and mortality in Brazil, causing a great impact on public health indicators. Telediagnóstico in cardiology of the Telehealth Brasil Redes National Program supports the consolidation of Health Care Networks ordered by Primary Care within the Unified Health System, using Information and Communication Technologies to perform diagnostic support services across geographic distances and temporal and qualifying health professionals, strengthening Primary Care, improving the quality of care and increasing resolvability. The objective of this research was to assess the evaluability of the telediagnostic service in cardiology of the Scientific Technical Nucleus of Telehealth, in Primary Care in the state of Bahia. This was a pre-assessment or evaluability study, with a qualitative approach, of the actions of the telediagnostic service in cardiology. The study also described the implementation of the service in the state of Bahia, characterized the program in its theory and practice from the modeling of the service, analyzed the objectives, activities and results observed in the concrete practice of the service, as well as identified and analyzed focuses for its improvement. Fifteen interviews were conducted with managers responsible for implementing the service in the city, with professionals involved in supporting the diagnosis and issuing of reports, in the request and execution of the electrocardiogram exam, in addition to users who used the service. The results revealed convergences between the objectives, activities and results proposed by the program among the key informants, with a broadening of the look at the objectives and reorganization of the results. They were: timely diagnosis and early intervention, better monitoring of patients with cardiovascular diseases, qualification of the clinic of non-specialist physicians, qualification of referrals to Specialized Care, faster regulatory processes, greater resoluteness in Primary Care, improvement of the process of work, improved access to the service and to the specialist, reduced costs for patients and the municipality, improved quality of life for patients and reduced mortality. It presented as a limitation the impossibility of conducting direct observation in the field, due to the moment of pandemic and the imposed measures of social distancing, in addition to being a case study in a small-population municipality and a health region in the state of Bahia, which does not constitute elements to extrapolate these results to other contextual characteristics. The study revealed that the telediagnosis service in cardiology developed by Telessaúde Bahia, in partnership with the Minas Gerais Telehealth Center, is sufficiently implemented to be the object of a systematic evaluation, focusing on future evaluations, a careful cost analysis. benefit through studies of economics, as well as effect from health indicators focused on cardiovascular diseases in the Bahia scenery.
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27
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Keise Santos Souza Falheiro
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DIGITAL TECHNOLOGY AS A SELF-CARE TEACHING STRATEGY FOR THE PREVENTION OF DIABETIC FOOT
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Advisor : KIONNA OLIVEIRA BERNARDES SANTOS
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COMMITTEE MEMBERS :
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KIONNA OLIVEIRA BERNARDES SANTOS
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MARCIO SANTOS DA NATIVIDADE
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MILENA MARIA CORDEIRO DE ALMEIDA
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SAMILLY SILVA MIRANDA
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Data: Dec 1, 2021
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Show Abstract
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Among the complications of diabetes mellitus (DM), those related to the feet and lower limbs affect 40 to 60 million people worldwide. Thus, prevention is considered the main element in the approach to the diabetic foot. Thus, it is valid to consider the use of information and communication technologies (ICTs) to provide conditions that enable health education through the use of mobile applications of mHealth (mobile health) technologies. The study aimed to develop an educational digital technology (mobile application) for self-care, with a view to preventing diabetic foot. In addition to validating and describing the application's usability, based on the opinion of specialists in nursing, physiotherapy and medicine in Primary and Secondary Health Care and teaching/research. This is a methodological study aimed at the development and evaluation of a health promotion tool for people with DM. The study was conducted in three distinct phases, namely: the first, consisting of planning activities and elaboration of the didactic content; the second, designed to build/develop the technology itself and store it on a mobile platform, and the third, aimed at evaluating the usability and validation of the application by experts. The construction was guided by the Contextualized Instructional Design model and conceived in the period from October 2020 to March 2021. The results are presented in the format of two products: a technical product and an academic product. The first enabled the development of the Application entitled "EducPé - Education for the Health of the Feet" for mobile devices, officially published on the virtual platform of the Google Play Store in May 2021. The second describes the validation and evaluation indicators of the technology's usability . In the validation, 15 experts validated the first version of the application, regarding its content, suitability and appearance, with a global Content Validity Index (IVC) of 0.90 and Cronbach's alpha from 0,84 to 0,94. The study showed a usability of 95.27 for the mobile application reaching the maximum level of assessment (Level 80). “EducPé” proved to be practical, easy to understand and to have a high level of satisfaction from the perspective of this clientele, with strong relevance to be evaluated and used by the target audience.
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28
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Luziane Rocha Macêdo Silva
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KNOWLEDGE AND ACCESS TO HEALTH CARE TECHNOLOGIES FOR PEOPLE WITH SICKLE DISEASE.
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Advisor : VINICIUS DE ARAUJO MENDES
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COMMITTEE MEMBERS :
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EVANILDA SOUZA DE SANTANA CARVALHO
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JOILDA SILVA NERY
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VINICIUS DE ARAUJO MENDES
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Data: Dec 6, 2021
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Show Abstract
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In this study, the proposal to expand the understanding of knowledge and access to health care technologies for people with sickle cell disease was brought forward. Based on the objectives of understanding the knowledge of people with PD about health technologies; characterize the modes of access to health technologies; analyze the extent to which social networks contribute to people with PD about health care technologies. This is a descriptive quantitative study that included the participation of 70 people diagnosed with sickle cell disease, from January to June 2021, in a reference center in Feira de Santana — Bahia. Of these respondents, 61.3% were women and 38.7% were men, with a higher prevalence of HBSC in 48.6%, all participants answered a semi-structured questionnaire developed by the author. Among the results, it was possible to verify that 51.4% obtained the diagnosis through the heel prick test, only 24.3% use Hydroxyurea. Despite the high rates of pain reporting in 78.6% of respondents, only 38.6% use the physiotherapy service as a therapeutic resource to relieve pain, limitations and dysfunctions. Six people were diagnosed with osteonecrosis, 2 people received guidance for referral at the Cell Therapy Center at Hospital das Clínicas, a reference point in the treatment of stem cells in osteonecrosis.
However, none underwent any treatment in the unit. Of the respondents, 95.7% (67) had never heard of this new technology. With the popularization of Smartphones, 90% said they have access to the 'internet' through the device. About 55.7% participate in social networks that discuss the disease. On the other hand, 52.9% said that social networks did not contribute to a greater understanding of the DF and only 14.3% said they had become aware of any new technology for health care through networks. It was possible to conclude that individuals with sickle cell disease, although connected, do not have the proper knowledge about health care technologies and are not properly oriented about the possibilities of technological innovations for the treatment of sickle cell disease. Thus, the creators of technologies should seek to shorten this gap, so that the therapy reaches the demanding population, thus promoting the improvement of the clinical condition and quality of life of people with sickle cell disease
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29
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Lilian Paula Santos do Nascimento
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PRODUCTION OF DIGITAL EDUCATIONAL CONTENT AIMED AT THE PREVENTION OF DIABETIC FOOT: ACTION PLAN FOR A SUS SCHOOL Dissertation
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Advisor : MARCELO EDUARDO PFEIFFER CASTELLANOS
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COMMITTEE MEMBERS :
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JANE MARY DE MEDEIROS GUIMARÃES
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LILIANA SANTOS
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MARCELE CARNEIRO PAIM
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MARCELO EDUARDO PFEIFFER CASTELLANOS
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Data: Dec 6, 2021
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Show Abstract
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This work aimed to plan the production of digital educational content aimed at preventing diabetic foot, aimed at nurses, technicians/nursing assistants and Community Health Agents who work in Primary Care in the state of Bahia, to be produced by a school of SUS. It is a qualitative research of descriptive character, which resulted in the presentation of an action plan, with characteristics of an integrated Project Plan, based on the recommendations of the Project Life Cycle and Instructional Design process; construction of management instruments for risk management, staff, stakeholders, acquisitions and educational planning and online data collection instrument for the characterization of the target audience, in order to identify the demographic, digital, motivation and learning needs profile related to the prevention of Diabetic Foot of nurses, technicians/nursing assistants and Community Health Agents who work in Primary Care in the state of Bahia. Given the importance of the planning process for Continuing Education in Health, this study seeks to contribute to the process of systematization and project management for the production of digital educational content in SUS Schools.
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30
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ELIANA BARBOSA PEREIRA
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The Academic Supervision of Mais Médicos Program in the State of Bahia, Brasil: Strategy to strengthen teaching-service integration?
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Advisor : CATHARINA LEITE MATOS SOARES
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COMMITTEE MEMBERS :
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CATHARINA LEITE MATOS SOARES
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LUIS EUGENIO PORTELA FERNANDES DE SOUZA
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TANIA CELESTE MATOS NUNES
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Data: Dec 16, 2021
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Show Abstract
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The Mais Médicos Program (PMMB in Portuguese) was created in 2013 through the law 12.871, with the aim of eliminating the shortage of doctors in family health teams and making universal access to health care in primary care in the SUS effective. Among the actions planned to achieve the aims of the PMMB, the promotion of improvement of doctors working in Primary Health Care, in priority regions of the Unified Health System (SUS in Portuguese), through teaching-service-community integration. The physicians of the PMM are involved in professional improvement processes, from a perspective of permanent health education (EPS in Portuguese), through Academic Supervision offered by the Ministry of Education and training cycles offered by the Ministry of Health. This study analyzes the Academic Supervision practice of the Mais Médicos Program strengthens the teaching-service integration in the state of Bahia. These informations was collected through document analysis of reports posted by supervisors included in the survey in the UNASUS Webportfolio system, during the year 2019 and finding out of 12 supervisors linked to the supervisory institutions SESAB, UFOB and UNIVASF/BA and through the records the researcher's observation in the tutoring and supervision meetings. The results demonstrated that, while the possibility of building academic supervision based on territorial realities and the actors involved in its practice brings some power to the PMMB, the definition of guidelines and permanent education spaces for the actors who carry out the academic supervision, implications for weaknesses and commitment to the consolidation of teaching-service integration. The political instability around the federal government, and the coordination and staff at the central level constant changes, resulted in weaknesses in academic supervision. In this perspective, academic supervision is not capable of transforming medical practice, as it is constituted, above all, in a bureaucratic and managerial way, used far below what is expected from qualified supervision.
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31
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GLEISON ALVES DE SOUZA BATISTA
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INSTITUTIONAL SUPPORT TO PRIMARY HEALTH CARE MANAGEMENT: A PARTICIPATORY STRATEGY UNDER CONSTRUCTION
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Advisor : DENISE VIEIRA DA SILVA
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COMMITTEE MEMBERS :
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CARMEN FONTES DE SOUZA TEIXEIRA
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DENISE VIEIRA DA SILVA
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ISABELA CARDOSO DE MATOS PINTO
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LYGIA MARIA FIGUEIREDO MELO
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Data: Dec 16, 2021
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Show Abstract
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This study aims to analyze the contribution of Institutional Support (IS) for the management of Primary Health Care (PHC) in the city of Porto Seguro - Bahia. In addition, as specific objectives describe the vision of managers and health professionals of PHC about the IS; characterize the activities performed by the IS team in the PHC, and; analyze the limits and potentialities of the application of the IS model in Primary Health Care. This is a qualitative, descriptive and interpretive study, in which 23 interviews were conducted with health workers, including institutional supporters of PHC, directors of PHC, superintendent of PHC, nurses/coordinators of the Family Health Strategy (FHS) teams and Expanded Family Health Center (EFHC) professionals. The analysis of the results shows that the interviewees, at all levels, consider that IS contributes to PHC management, however, in activities of administrative nature that do not constitute the normative role defined for the IS in PHC, which are more appropriate for the role of supervisor. The lack of knowledge about the role, the high turnover and the working conditions were identified as limiting factors for the adequate exercise of the role, which ends up being configured much more as a management assistant, "a problem solver". Moreover, the professionals who play the role of IS are perceived to have low qualifications and are subjected to an overload of work that makes it difficult to develop the attributions related to the IS model of PHC. Despite this, it was found that the IS has created spaces for dialogue, listening and systematization of care and management practices and has been recognized as an important link between the FHS and the central administration. Thus, it was identified the need to rethink the IS model, its theoretical and methodological bases, working conditions, institutional role and implementation strategy in order to bring its practice closer to the different realities of Brazilian cities. We conclude that the IS is a powerful strategy for the re-signification of management practices, requiring the adoption of strategies that enable the implementation of the model in its fullness, strengthening the individual and collective subjects, building institutional democracy, promoting analysis and shared management of work, and may become an important tool to break the traditional model of administration. In this sense, the present study proposes, at the end of the data analysis and discussion, a proposal for the implementation of IS in PHC.
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32
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Edmilson Nascimento
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PERMANENT EDUCATION IN THE FAMILY HEALTH STRATEGY: a possibility of constitution of subjects
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Advisor : CATHARINA LEITE MATOS SOARES
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COMMITTEE MEMBERS :
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CATHARINA LEITE MATOS SOARES
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ISABELA CARDOSO DE MATOS PINTO
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JOSE LUCIO COSTA RAMOS
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Data: Dec 17, 2021
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Show Abstract
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Continuing Education in Health is a political-pedagogical proposal to transform health practices based on service problems. The debate gained strength in Brazil from 2004 onwards, with the publication of the National Policy on Permanent Education in Health, which reflected on scientific production, especially in the context of Primary Care. This study aimed to analyze whether the experiences of Continuing Education in Health developed in the Family Health Strategy of the city of Guanambi-Ba have enabled the constitution of subjects Transformers of Health Practices. This is a study with a qualitative, exploratory and descriptive approach, about the constitution of subjects/subjects through the processes of Continuing Education in Health. For this purpose, 03 teams of the Family Health Strategy were selected from a total of 24 teams , as they are units linked to the Medical Residency Program in Family Health and Multiprofessional Residency in Health. Eight health professionals were included as research subjects, distributed as follows: 06 higher education professionals from the ESF teams, 01 institutional supporter and 01 Primary Care coordinator. Data production took place through semi-structured interviews and a participant identification form. The analysis process was carried out using the technique of Content Analysis by Bardin (2016), anchored in the critical pedagogy of Freire (1987) and the constitution of subjects of Testa (2007). The results pointed out weaknesses in the EPS management process by the health department, such as: absence of a Center for Continuing Education in Health, fragmented and vertical planning, and lack of monitoring and evaluation. Differences in pedagogical choice were identified by the investigated teams: one of the teams uses a traditional pedagogy, using the methodology of transmission and knowledge that has not generated changes in health care; two teams prioritize critical pedagogy, anchored in active methodologies and correct learning, with results that seek to reframe processes and change practices. It is concluded that EPS, in the investigated context, has enabled the constitution of subjects and factors in teams that promote educational processes anchored in the problematization of everyday problems and in the collaborative practice of workers.
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33
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TÚLIO ROMÉRIO LOPES QUIRINO
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TEAMWORK IN THE CONTEXT OF FAMILY HEALTH: An analysis from the perspective of Interprofessional Collaboration in Recife, Pernambuco.
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Advisor : ANA LUIZA QUEIROZ VILASBOAS
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COMMITTEE MEMBERS :
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MARCELO VIANA DA COSTA
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ANA LUIZA QUEIROZ VILASBOAS
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LILIANA SANTOS
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Data: Dec 28, 2021
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Show Abstract
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The development of effective teamwork is now considered a pressing need to adhere to improvements in the results of care processes and optimization of global health systems. Interprofessionalism has been understood as a paradigmatic approach to promote greater integration in health work, whether in the sphere of professional training or in the production of care practices, enabling greater resoluteness and quality in the performance of multidisciplinary teams. In Primary Health Care (PHC), the literature has systematically pointed out the difficulties that teams demonstrate in the organization of integrated work processes, resulting in care fragmentation and discontinuity in care, which requires the strengthening of the perspective of collaboration. Given this, this dissertation sought to analyze the organization of health work developed by multidisciplinary teams within the scope of the Family Health Strategy (ESF) and the Expanded Center for Family Health and Primary Care (NASF-AB), in Recife, from the perspective of of Interprofessional Collaboration. A qualitative, exploratory-descriptive study was carried out, along the lines of everyday research (SPINK, 2007). The locus of realization was the APS network in Recife, from a territorial cut. Health professionals from a NASF-AB team and from the ESF teams supported by it participated, totaling 16 interlocutors. Data collection took place between April and July 2021, using semi-structured interviews and a focus group. The discursive analysis was guided by the Structuring Model of Interprofessional Collaboration, by D'Amour et al (2008), based on four dimensions (Shared Vision and Objectives, Internalization, Formalization and Governance), with subsidy in theoretical contributions. analysis of authors who discuss teamwork from the perspective of interprofessionalism. The results demonstrate how teamwork in PHC is permeated by several nuances, involving institutional and relational aspects, which interfere in the organization of care provision by teams and health services, as well as in the development of professional practices with greater or lesser integration each other. In the context of the difficulties, structural aspects and the lack of support from the municipal administration were emphasized, especially regarding institutional support. The lack of appreciation and recognition of the work performed are also difficulties. The existence of conflicts was reported, which constitute important barriers to the development of collaboration. Initiatives aimed at strengthening collaboration were identified, such as: matrix support developed by the NASF-AB team; the teaching-service-community integration, illustrated by the exercise of preceptorship; and continuing education in health. The adverse scenario of the Covid-19 pandemic also proved to induce interprofessional practices, due to adaptations in work processes that required professionals to help each other. The assessment of interprofessional collaboration based on the adopted model revealed weaknesses in all dimensions evaluated, and those related to organizational aspects (governance and formalization) presented the greatest difficulties. It is demonstrated that the health teams surveyed are still far from developing an effective integrated and collaborative work, requiring greater action from the managing bodies in the construction of institutional possibilities so that teamwork is in fact interprofessional.
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