Dissertations/Thesis

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2024
Dissertations
1
  • VANESSA MARINHO GONÇALVES DE SOUZA
  • EFFECT OF FAMILY HEALTH STRATEGY COVERAGE ON MORTALITY FROM CERVICAL CANCER IN BRAZILIAN MUNICIPALITIES
  • Advisor : ILA ROCHA FALCÃO
  • COMMITTEE MEMBERS :
  • AMINE FARIAS COSTA
  • EMANUELLE FREITAS GOES
  • FLÁVIA JÔSE OLIVEIRA ALVES
  • ILA ROCHA FALCÃO
  • Data: Jan 17, 2024


  • Show Abstract
  • Introduction: The mortality rate (MT) due to cervical cancer (CC) in Brazil shows a trend towards a significant reduction, but it is unequally distributed throughout the country, with higher rates in regions with lower socioeconomic development. Studies show that regions with effective screening programs have significantly reduced incidence and mortality rates, with the occurrence of this type of cancer being highly preventable in the population of people with a uterus. Primary Care, especially the Family Health Strategy (FHS), develops actions to control cervical cancer and plays a significant role in expanding the tracking and monitoring of the target population. Objective: The objective of the present study was to evaluate the effect of ESF coverage on reducing mortality from cervical cancer in Brazilian municipalities, between 2010 and 2019. Methodology: This is an ecological study, including 4548 Brazilian municipalities, in the period from 2010 to 2019. Crude mortality rates were calculated for the total population and for the age group of the target population for screening (25 to 64 years), the crude mortality rates for the total population and for the age group of the target population of screening (25 to 64 years old) according to FSH coverage levels and coverage of the screening indicator for each municipality per year. FSH coverage was categorized into three levels: without ESF and incipient (<30%), intermediate (>=30% and <70% or >= 70%, for less than the previous four years) and consolidated (>= 70%, for the minimum period of 4 previous years). Multivariate regression analyzes were performed using panel data, using negative binomial regression models with fixed effects, and adjusted for socioeconomic and demographic covariates considered relevant. Analyzes were also carried out stratified by population size, ratio indicator of cervical cytopathological examinations and HDI. Results: The average crude mortality rates for the total population and for the age group of the target population decreased by 7.92% and 16.53%, respectively, in the period studied. The increase in ESF coverage was associated with a reduction in the mortality rate for the total population and for the age group of the screening target population in some of the crude models, but the effect was not maintained after adjustment for confounding variables, further studies are needed to verify these associations. Conclusion: The findings of this study suggest that the expansion of municipal coverage of the ESF can influence reducing mortality from cervical cancer through control actions developed within the scope of Primary Care, such as adequate screening of the target population, education and awareness of the target audience about the importance of adhering to the exam at appropriate intervals, in addition to increasing vaccination coverage against the HPV virus.

2
  • RIZIA CLAUDIA OLIVEIRA SILVA
  • EVALUATION OF THE PNI TARGET FOR VACCINE AGAINST COVID-19 IN CHILDREN AGED 5 TO 11 IN BAHIA
  • Advisor : KIONNA OLIVEIRA BERNARDES SANTOS
  • COMMITTEE MEMBERS :
  • MARIA MADALENA DE SOUZA MATOS
  • KIONNA OLIVEIRA BERNARDES SANTOS
  • MARCIO SANTOS DA NATIVIDADE
  • Data: Mar 6, 2024


  • Show Abstract
  • Brazil's National Immunization Program (PNI) stands out as an efficient public policy, with an important impact on morbidity and mortality with modifications to the vaccination schedule according to the profile of the population, as well as the emergence and severity of new diseases. The COVID-19 pandemic triggered a rapid search for the development of vaccines adopted as a strategy to reduce hospitalizations and deaths. For Vaccination in Brazil, the National Operationalization Plan for COVID 19 was published in order to guide planning and execution of vaccination against the disease. However, there is variation in vaccination coverage (VC) in Brazil and therefore, it is necessary to evaluate vaccination targets in children aged 5 to 11 years, in the State of Bahia, in the year 2022. An exploratory study was carried out to estimate associated actors achieving goals using the strategies in the PNI in the operationalization of the vaccine against COVID 19 in the age group of 05 to 11 years, the relationship between the variable of interest (CV) and the independent variables was analyzed to safely make a prediction of the conditions that can contribute to achieving PNI goals for the COVID 18 vaccine in the State of Bahia. Among the 417 Municipalities in Bahia, it is observed that 2nd dose coverage is low, with only 22.7% (n=94) achieving this coverage. Variations are observed between health regions regarding the concentration of municipalities by Health Regions and Human Development Index (HDI). The demographic analysis of children aged 5 to 11 years found that 58.7% of Municipalities (n=245) have up to 2000 children. Regarding health, the occurrence of hospitalization in the Municipalities due to SARS is 13.4% (n=56), indicating a non-negligible proportion of cases that required hospitalization. To evaluate the factors associated with achieving vaccination targets established by the PNI, multiple linear regression was used to verify whether the variables “General Population”, “% of Children in the Population”, “HDI”, “PHC Coverage” and “SARS Hospitalization by COVID” are able to predict the “% of 2nd dose coverage”. The analysis resulted in a statistically significant model [F (3, 411) = 38.777; p< 0.001; R2 = 0.215]. In the final model we found the variables “% of Children in the Population”, “HDI” and “PHC Coverage” as predictors of “% of 2nd dose Coverage”. The influence of PHC is highlighted in explaining the behavior of vaccination coverage with the greatest impact among the variables. As for the HDI, when evaluated in isolation it did not obtain a significant correlation, however, accompanied by the other variables, it influences the behavior of the CV. The study achieved the objective of identifying factors associated with the percentage of vaccination coverage in children aged 5 to 11 years in the state of Bahia. However, further research is necessary to highlight the other reasons that influence VL against COVID 19 in children, thus overcoming the challenge of achieving homogeneous coverage in the state. The results highlight the diversity and complexity of demographic and health conditions in the sample, highlighting areas of focus for health policies, specific interventions, planning and coordination of actions favoring the implementation of the PNI

3
  • JOELDSON FERREIRA GUEDES
  • STRATEGY TO RELEASE THE DISPENSATION RULES OF AQUI TEM POPULAR PHARMACY AND ITS EFFECT ON LOW-INCOME POPULATION WITH HYPERTENSION AND DIABETES MELLITUS
  • Advisor : MARCIO SANTOS DA NATIVIDADE
  • COMMITTEE MEMBERS :
  • BENILSON BOLETI BARRETO
  • MARCIO SANTOS DA NATIVIDADE
  • VINICIUS DE ARAUJO MENDES
  • Data: Mar 21, 2024


  • Show Abstract
  • Objective: The present study aims to analyze the effects of the regulatory change related to the dispensing of medicines in private pharmacies linked to the “Aqui Tem Farmacia Popular Program” (ATFP), during the COVID-19 pandemic, aimed at low-income individuals registered in the Single Registry for Social Programs in Brazil (CADÚNICO). Methods: This study, of an ecological nature, was based on secondary data covering the period from 2018 to 2020, relating to the dispensing of medications for hypertension (AH) and diabetes mellitus (DM) in municipalities belonging to the Integrated Development Region of the Federal District and Surroundings (RIDE-DF). The data were provided by the Department of Monitoring, Evaluation and Dissemination of Strategic Health Information of the Brazilian Ministry of Health. Linking the registration numbers of individuals between the ATFP and CADÚNICO databases allowed an interrupted temporal analysis to be carried out, evaluating changes in the levels and trends of weekly dispensing before and after the regulatory change that occurred on March 19, 2020. Results: Of the population assisted by ATFP during the study period, 15.89% (n=92,643) was registered with CADÚNICO at the time of dispensation for the treatment of AH and DM. The greatest demand was observed for the treatment of AH (79,169 users; 65.28%), followed by DM (40,095 users; 34.71%). The majority of users were female (average of 73.34%), predominantly for both pathologies, aged over 59 years (median). The analysis of the Time Series Index (STI) applied after the regulatory change showed a significant increase in the dispensing of medicines for AH (+1,907,391 pharmacotechnical units) and DM (+966,265 pharmacotechnical units) between the 115th and 120th epidemiological week, followed by a reduction to levels lower than those prior to the intervention. In the results of the post-intervention period, in the subsequent 41 weeks, the model showed a decrease of 1,149,707 pharmacotechnical units (realized = 12,020,409; counterfactual = 13,170,116) for DM and an increase of 529,252 pharmacotechnical units (realized = 25,058 .344; counterfactual = 24,529,092) for HA. Conclusion: The intervention carried out by ATFP during the pandemic period in Brazil had a positive impact, in the short term, on the number of medicines dispensed for the treatment of AH and DM in the RIDE-DF population registered with CADÚNICO, remaining an effective Pharmaceutical Assistance (AF) program.

4
  • LUCIANA OLIVEIRA BARBOSA DE SANTANA
  • IMPACT OF ROUTINE VACCINATION AND FOLLOW-UP CAMPAIGNS ON VACCINATION COVERAGE AND MEASLES INCIDENCE IN BRAZIL, FROM 2010 TO 2019.
  • Advisor : FLORISNEIDE RODRIGUES BARRETO
  • COMMITTEE MEMBERS :
  • ANA CATARINA MELO ARAÚJO
  • FLORISNEIDE RODRIGUES BARRETO
  • SAMILLY SILVA MIRANDA
  • Data: Apr 4, 2024


  • Show Abstract
  • Introduction: Measles is a viral exanthematous disease, potentially serious, highly contagious and vaccine-preventable using a safe and effective vaccine. Despite advances in controlling this disease around the world, the maintenance of endemic transmission of the virus raises concerns about its re-establishment in regions where the disease had already been considered eliminated, especially in situations where vaccination coverage is below ideal. Objective: To evaluate the impact of routine vaccination and follow-up campaigns against measles on vaccination coverage and measles incidence in Brazil from 2010 to 2019. Methodology: Quantitative descriptive study based on vaccination coverage of the triple viral vaccine, applied in routine services health and follow-up campaigns, and incidence of measles in Brazil, from 2010 to 2019. Vaccination coverage was analyzed, according to State and region, and homogeneity according to region. The association between vaccination coverage and the incidence of measles and the impact of vaccination on increasing vaccination coverage and decreasing incidence were analyzed. Results: 32,032 cases of measles were confirmed in Brazil (incidence of 1.58/100.00 inhabitants), of which the years 2018 and 2019 accounted for 30,655 (95.7%) of the cases for the entire period studied. São Paulo with 18,065 cases (56.40%) and Amazonas with 8,795 (27.46%) record the highest number of cases. The region had the highest coefficient of 5.52/100,000 inhabitants, followed by the southeast region (2.20/100,000 inhabitants). The age group of children under 1 year of age had the highest incidence, 20.16/100,000 inhabitants, followed by children aged 1 to 4 years, 3.60/100,000 inhabitants. Low and heterogeneous vaccination coverage was observed for most of the period, with a sharp drop from 2016 onwards. For D2, the target was not achieved in any year of the period. In 2014, the goal of the monitoring campaign was not achieved, and there was an increase in the number of measles cases. Conclusion: There was a reduction in vaccination coverage, a susceptible population, mainly between 15 and 29 years of age, a record of measles cases in all age groups and an increase in incidence. Low homogeneity demonstrated vaccination weaknesses and influenced measles behavior. Knowing the factors that affect the achievement of vaccination
    coverage, and identifying risk groups, measuring results and evaluating the impact are extremely important for reorienting and prioritizing vaccination strategies.

5
  • RAQUEL DE NAZARE NUNES E SOUZA
  • Influence of multi-professional treatment for obesity and analysis of expenditure on hospital admissions attributable to obesity in the SUS

  • Advisor : MARCOS PEREIRA SANTOS
  • COMMITTEE MEMBERS :
  • EDUARDO AUGUSTO FERNANDES NILSON
  • MARCIO SANTOS DA NATIVIDADE
  • MARCOS PEREIRA SANTOS
  • RENATA DE OLIVEIRA CAMPOS
  • Data: Apr 5, 2024


  • Show Abstract
  • Cardiovascular diseases, diabetes, neoplasms, and obesity account for 75% of the causes of death and illness in the world. Chronic non-communicable diseases are a major burden on health systems, society and the economies of families and countries. In 2016, the prevalence of obesity in the Federal District was 15%, while a target of 10% was set for 2022 in the Plan to Combat CNCDs. This study, in two articles, analyzed the influence of multi-professional treatment on anthropometric variations in patients at the Centro Especializado em Diabetes, Obesidade e Hipertensão - CEDOH (Specialized Center for Diabetes, Obesity and Hypertension) in the Federal District; and estimated federal spending on hospital admissions attributable to obesity in the context of the SUS, for the years 2018 and 2021. The first study, a retrospective cohort, analyzed data from the electronic medical records of 371 individuals of both sexes aged between 19 and 75 years. The economic analysis was carried out using a top-down estimate of the costs of hospitalizations in the SUS attributable to obesity and associated conditions, based on the relative risks of associated diseases and the prevalence of obesity in 2018 and 2021. Among the main findings was that dropout was 1.44 times higher among men and individuals ≤29 years old, of whom 72.2% abandoned follow-up. Higher age groups showed a greater accumulation of comorbidities associated with remaining in treatment. The practice of physical activity was positively related to staying in the groups, and among those who did not practice physical activity, 64.8% dropped out. In 2018, the prevalence of obesity in adults was 44% higher than predicted in the Plan to Combat CNCDs; in 2021, the prevalence was 2.11 times higher. In the second study, for the selected diseases, it was observed that in 2018 the costs would have been 25% lower, and in 2021, 44.7% of hospitalization costs could have been avoided if the prevalence of obesity had reached the target proposed in the Plan, which was 10.7%. Multi-professional treatment has achieved positive results, and adherence to the groups needs to be improved. Adequate planning and preventive actions for obesity and CNCD complications are essential if public health spending is not to become unsustainable.

6
  • AMANDA COSTA MELO
  • IMPACT OF THE HEALTHY MOTHER'S STATE PLAN IN ADDRESSING CONGENITAL SYPHILIS IN THE STATE OF BAHIA
  • Advisor : MONIQUE AZEVEDO ESPERIDIAO
  • COMMITTEE MEMBERS :
  • DANDARA DE OLIVEIRA RAMOS
  • DJANILSON BARBOSA DOS SANTOS
  • MARCOS PEREIRA SANTOS
  • MONIQUE AZEVEDO ESPERIDIAO
  • Data: Apr 11, 2024


  • Show Abstract
  • Introduction: In 2017, the Healthy Mother State Plan (PEMS) was launched by the Bahia State Health Department (SESAB) with the purpose of mitigating the impacts of the congenital syphilis (CS) epidemic, a disease of high magnitude and transcendence in the state. Objective: To carry out an assessment of the impact of PEMS in combating SC in Bahia. Methods: This investigation integrates two studies: 1- descriptive and 2- quasi-experimental study. For the first, we used epidemiological analysis of congenital syphilis in the state in a time series, between October 2014 and December 2019. In the quasi-experimental study, an impact assessment of the PEMS was carried out, using the series analysis method Interrupted temporal measurements (ITS) with Poisson segmented linear regression. Impact assessment and changes in trends were calculated, before and after general actions for non-priority municipalities (n=395) and specific actions for priority municipalities (n=22). The period was clearly defined as the beginning of the intervention, May 2017, totaling 32 months pre-intervention, October 2014 to April 2017, and 32 months post-intervention, May 2017 to December 2019. Results: They were presented in two articles: Article 1- Epidemiological analysis of CS in the state in a time series, between October 2014 and December 2019. It was possible to analyze that syphilis is not the same for everyone, and there are sensitive aspects to the Plan. The incidence of CS was, in addition to being high, increasing in Bahia until 2018, after 1 year of PEMS implementation, and in 2019, it showed a tendency to reduce for the first time in the state. The TVS proportion indicator showed a decreasing trend throughout the entire time series analyzed and may present variations due to flaws in the notification process on Sinan and case investigation. Article 2- Assessment of the impact of PEMS in combating SC in the state. Non-priority municipalities showed a greater reduction (change in level and trend) compared to the state's priority municipalities. The Poisson linear regression model revealed level changes after the intervention, with both indicators in non-priority municipalities, there was a reduction in the average monthly number of cases per 1,000 live births, with a decrease of 17% (- 0.17; RR 0.831; 95% CI 0.827- 0.836) and records a reduction in the proportion of vertical transmission of syphilis of 39% (RR 0.61; 95% CI 0.603- 0.623). Conclusion: The time series survey made it possible to demonstrate the evolution of SC in the Bahian territory before and after the implementation of PEMS actions in the state. The Plan's impact assessment made it possible to verify that after 32 months of intervention there was a reduction in the level and a change in the trend in the course of congenital syphilis in non-priority municipalities in the state of Bahia.

7
  • MARIANNA SILVA DOS SANTOS
  • EFFECTS OF THE COVID-19 PANDEMIC ON HOSPITALIZATIONS FOR SENSITIVE CONDITIONS IN PRIMARY HEALTH CARE IN SALVADOR, BAHIA
  • Advisor : ELZO PEREIRA PINTO JUNIOR
  • COMMITTEE MEMBERS :
  • DANDARA DE OLIVEIRA RAMOS
  • ELZO PEREIRA PINTO JUNIOR
  • LEANDRO ALVES DA LUZ
  • Data: May 28, 2024


  • Show Abstract
  • The COVID-19 pandemic had significant impacts on society, strongly influencing the organization of health services and producing repercussions on different morbidity and mortality indicators. In this challenging scenario, there are still few studies that evaluate the relationship between the pandemic and hospitalizations for conditions sensitive to Primary Care-Sensitive Condition Hospitalizations (PCSCH), given that this indicator is related to both Primary Health Care services and hospital services. In this context, the present study aimed to evaluate the effect of the COVID-19 pandemic on Hospitalizations for Sensitive Conditions in Primary Health Care, in Salvador-BA. This is an ecological study, with public hospitalization data available in the Hospital Information System of the Unified Health System (SIH-SUS). Hospital admissions that occurred from January 1, 2017 to December 31, 2022 were analyzed, for all causes and those whose basic cause were conditions sensitive to Primary Health Care carried out in the city of Salvador. Bahia. Initially, a descriptive analysis was carried out based on the characteristics of PCSCH (main cause groups, age group and sex) during the study period and the proportions of hospitalizations for diseases sensitive to primary care and their 19 components were calculated, as well as the proportion use of ICU beds. To evaluate the effect of the COVID-19 pandemic and its repercussions related to mobility restriction measures and reorganization of health services, an interrupted time series (ITS) analysis was carried out, which compares the trends in hospitalization indicators before and after the beginning of the pandemic. 854,525 hospitalizations were analyzed, of which 12.81% were considered PCSCH. PCSCH were more common among males, under five years of age or over 70 years of age. There was an important reduction in the number of hospitalizations in the first year of the pandemic (2020), however the lower proportion of PCSCH was only observed in 2021. Among the PCSCH group, hospitalizations for cerebrovascular diseases ranked first in all years of the study and the proportion of these hospitalizations remained relatively stable in 2017 (21.48%) and 2019 (15.95%), showing important growth in 2020 (21.48%) and 2021 (23.23%). This behavior was similar to that observed in the percentage variation in hospitalization for heart failure. The proportion of hospitalizations for hypertension showed a considerable reduction in the period, reaching 1.85% in 2121, growing again in 2022 (5.99%). The analysis of the use of ICU beds among PCHCH showed that from 2020 onwards, but especially in 2021, there was a considerable increase in the severity of these causes, especially cerebrovascular diseases, bacterial pneumonia and heart failure, in addition to hypertension. While the proportion of PCSCH reduced immediately after March 2020, the proportion of ICU bed utilization increased substantially after this period. The analysis of interrupted time series showed that the COVID-19 pandemic and its repercussions modified the pre-pandemic trends in the number of PCSCH and their proportions, causing a reduction in these indicators from March 2020 to June 2021, returning to growth after this period. However, for the indicator of % of ACSCs requiring ICU beds, the pre-pandemic stability trend was followed by a substantial increase after March 2020 and a subsequent drop after December 2021. The results of this study indicate that the pandemic of COVID-19 caused changes in the profile of hospitalizations, with an increase in the severity of PCSCH. Furthermore, it is possible to assume that the consequences of the pandemic will still be observed in the medium and long term, given that the repercussions of “long COVID-19” have not yet materialized in an increase in hospitalizations in the population of Salvador-BA.

8
  • PEDRO DE OLIVERA SILVA
  • EFFECTS OF THE COVID-19 PANDEMIC ON PERFORMANCE OF SURGERIES IN THE SINGLE HEALTH SYSTEM, SALVADOR-BA
  • Advisor : ELZO PEREIRA PINTO JUNIOR
  • COMMITTEE MEMBERS :
  • DANDARA DE OLIVEIRA RAMOS
  • ELZO PEREIRA PINTO JUNIOR
  • LEANDRO ALVES DA LUZ
  • Data: May 29, 2024


  • Show Abstract
  • Introduction: The World Health Organization (WHO) declared the COVID-19 pandemic an International Public Health Emergency in March 2020. COVID-19 is widespread worldwide, and Brazil is the fifth country with the highest number of cases accumulated in the world at the time of this study, and second in the ranking of deaths from the disease on the planet. Due to the pandemic, in addition to social distancing, one of the coping measures was the suspension of services related to elective surgical procedures. It is estimated that, worldwide, around 73% of surgeries were canceled during the peak of the pandemic, in its first 12 weeks. Objective: To evaluate the effects of the COVID-19 pandemic on surgical procedures carried out by the Unified Health System in Salvador, Bahia. Method: retrospective observational epidemiological study, carried out in the city of Salvador, Bahia, Brazil. Records were consulted for the period from January 1, 2018 to December 31, 2022, from the databases of the Hospital Information System (SIH), available at the Department of Informatics of the Unified Health System (DATASUS). To identify the legal/temporal milestones related to combating COVID-19, the mapping of ordinances, decrees and analysis of official journals were carried out. The Kruskal-Wallis test was used to compare means of three groups, which in this study refer to the three moments of the COVID-19 pandemic: before the pandemic (January 2018 to February 2020), initial phase of the pandemic (March to August 2020) and final phase of the pandemic (September 2020 to December 2022). Results: During the pandemic, technical notes and municipal and state decrees were published to minimize the impact of COVID-19, which affected the entire health service chain. After March 2020, with the start of the COVID-19 pandemic,
    19, and especially in its first months, a significant reduction in the number of surgical procedures was observed, with a reduction in elective procedures and an increase in the percentage of emergency surgeries. The average hospitalizations for surgical procedures in the first part of the pandemic, from March to August 2020, were lower in all indicators, except for obstetric procedures. The hospital lethality averages in the first part of the pandemic were higher in the indicator that measured all surgical procedures, and in more complex surgeries, such as those involving the circulatory system and oncology. Conclusion: The findings showed a significant drop in the performance of a series of surgical procedures in the first months of the pandemic, especially after the mobility restriction measures and the actions to reorganize hospital care in the municipality and the State. This backlog of care in the SUS caused difficulties in routine hospital procedures, which generated pent-up demand and greater hospital mortality in hospitalizations for more complex surgeries.
9
  • ANDERSON MOREIRA LIMA
  • EFFECT OF THE CEGONHA NETWORK ON MATERNAL MORTALITY IN BRAZIL FROM 2011 TO 2019
  • Advisor : FLÁVIA JÔSE OLIVEIRA ALVES
  • COMMITTEE MEMBERS :
  • FLÁVIA JÔSE OLIVEIRA ALVES
  • DANDARA DE OLIVEIRA RAMOS
  • ELZO PEREIRA PINTO JUNIOR
  • LEANDRO ALVES DA LUZ
  • Selton Diniz dos Santos
  • Data: Sep 19, 2024


  • Show Abstract
  • Introduction: Maternal death is a serious public health problem worldwide, being defined as the death of a woman during pregnancy or within 42 days after the end of pregnancy, regardless of the duration and place of pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes. In 2017, about 295.000 maternal deaths occurred in the world, being Brazil responsible for 1.700 maternal deaths in the same period, thus failing to meet one of the Millennium Development Goals (MDGs): to achieve by the year of 2015 a Maternal Mortality Ratio (MMR) of 35 maternal deaths per 100.000 live births. The implementation of programs and public policies, such as Rede Cegonha, which aims to expand access to prenatal examination and rapid pregnancy tests, could help change this scenario. Objective: To evaluate whether there is an effect of the Rede Cegonha on the reduction of Maternal Mortality in Brazil from 2011 to 2019. Methodology: Ecological study modeled from interrupted time series (ITS), considering a series of data from 1999 to 2019 in Brazil and regions (Midwest, Northeast, North, Southeast and South). All data were extracted for each Federative Unit (FU) and summarized for each year (replica) of the time series. Secondary data were accessed from the database of the Department of Informatics of the Unified Health System (DATASUS), using the Mortality Information System (SIM), the Information System on Live Births (SINASC), the National Registry of Health Establishments (CNES), the Primary Care Information System (e-Gestor AB) and the Database of Statistical Tables (SIDRA) to access data from the Brazilian Institute of Geography and Statistics (IBGE). Generalized linear models (GLS) with ARMA autocorrelation structure (p q) and regression of an interrupted time series were then selected for the present approach. In addition to the general model for Brazil, five other models for each region of the country were adjusted following the same procedures and structure. All models were adjusted in the R environment, using the nlme (gls function) and forecast (checkresidual function) packages. A "counterfactual" model was also computed to simulate a scenario where the Rede Cegonha was never deployed. Results: In the post-intervention period of Rede Cegonha, both an immediate and late effect was observed in the model for Brazil, the Midwest region and the South region, revealing a reduction in maternal mortality both at the beginning and over the years of the period of implementation of the Rede Cegonha. The Northeast region showed only a late effect, showing a reduction in maternal mortality over the years of the period of implementation of the Rede Cegonha. The Southeast region showed only an immediate effect, which shows a reduction in maternal mortality only in the first years of implementation of the Rede Cegonha in this region. The North region was the only region that did not present any effect, immediate or late, from the implementation of the Rede Cegonha, demonstrating a non-association between this policy and the historical trend of maternal mortality in the region. Conclusion: Brazil did not achieve the MDGs in 2015, however, the presence of the Rede Cegonha was crucial in reducing maternal mortality at the national level and in most Brazilian regions, as observed in the present study. The scenario is still challenging, however, achieving the goal of the Sustainable Development Goal (SDG) by the year of 2030, which is to reduce maternal mortality to 30 maternal deaths per 100 thousand live births, is still feasible if health policies and programs are involved in this goal.

2023
Dissertations
1
  • Cláudia Damasceno Pereira Caldeira
  • EVALUATION OF THE IMPACT OF THE RESOLUTION OF THE SUS OMBUDSMAN'S OFFICE IN THE JUDICIALIZATION OF MEDICINES FROM 2015 TO 2019 Brasilia
  • Advisor : BERENICE TEMOTEO DA SILVA
  • COMMITTEE MEMBERS :
  • TITO BELELCHIOR SILVA MOREIRA
  • BERENICE TEMOTEO DA SILVA
  • CATHARINA LEITE MATOS SOARES
  • Data: Sep 13, 2023


  • Show Abstract
  • The ombudsmen of the Unified Health System are an important tool in the field of democratic and participatory management, for guaranteeing the right to health, provided for in the 1988 Federal Constitution. difficulties in accessing health services. Thus, given the inability of the State to meet the demands of the population, there has been an exponential growth in lawsuits, the main cause of which is medication. In this sense, the aim of this research is to evaluate the impact of the resolution of the demands registered by the Ombudsman of the SUS in the judicialization of medication requests, from 2015 to 2019. For this purpose, an ecological, longitudinal research was carried out, with analysis of Quali-quantitative data, containing data and information from a secondary public source, based on time series, through data obtained through Excel spreadsheets, extracted from the OuvidorSUS System, by technicians from the SUS Ombudsman and the Bigdata Panel, referring to the years 2015 to 2019, using statistical analysis with Eviews software. In addition, data from “Justice in Numbers”, from the National Council of Justice, through the National Database of the Judiciary Power (DATAJUD), from 2015 to 2019 were used. The number of manifestations about medicines was increasing every year, especially when Law nº 13.460/2017 was created (historical landmark of the ombudsman), according to the graphs previously informed in the management reports. On the other hand, according to a report by “Justice in Numbers” (2021), since 2017 the number of new lawsuits on medicines has fallen, rising again in 2020. after the statistical analysis, it was observed that the effect of the resolution rates of the SUS ombudsman on the total number of new cases in the justice system was positive. Furthermore, there was an impact of Law nº 13,460/2017 on the resolution rate of the SUS Ombudsman, with a shorter deadline for closing demands for medication requests after the regulatory framework.

2
  • Aline Pereira Macedo
  • WHAT IS THE IMPACT OF AUDITS ON THE “AQUI TEM PHARMACIA POPULAR” PROGRAM IN RIO DE JANEIRO?
  • Advisor : EDUARDO LUIZ ANDRADE MOTA
  • COMMITTEE MEMBERS :
  • MARCIA ELIZABETH MARINHO DA SILVA
  • EDUARDO LUIZ ANDRADE MOTA
  • YARA OYRAM RAMOS LIMA
  • Data: Sep 28, 2023


  • Show Abstract
  • The study aims to carry out an an f the impact of the noncompliances found in the audit reports of the National Audit of the SUS, federal component, referring to the Popular Pharmacy Program of Brazil (PFPB) - "Aqui tem Farmácia Popular", in the State of Rio de Janeiro, from 2016 to 2022. This is a descriptive and documentary research with a quantitative and qualitative approach. Considering the outcomes of the descriptive analysis, the value of the proposals for the return of financial resources, the number of accredited establishments that presented irregularities and the nonconformities found in the audit reports. As an outcome of the impact assessment of non-conformities, exposure of the main irregularities and recommendations to public management to assist in decision-making. Thus, primary data from the 62 audit reports and institutional standards that guide the actions of the PFPB and the audit in the program were used. The noncompliances were
    identified and categorized, and of the 375 findings, 79.5% were non-compliant, with an average of six findings per report. These non-conformities resulted in the proposal for a return in the total amount of BRL 7,395,515.30, corresponding to 24.8% of the audited amount. Dispensing medication on behalf of deceased people was identified in 39% of audits. The most frequent noncompliance was non-proof of purchase of the medication registered for sale through invoices, followed by violations in copies of coupons and accompanying documents. Another relevant data was the frequency with which non-conformities were repeated in the sarne proportion throughout the analysis period of this study, among other results. The collect and improvement of the data will allow a more profound analysis to compare and identify the alterations, if they suffered positive or negative influences, transforming simple data into fundamental information for an efficient management.

3
  • INGLIDE DA SILVEIRA PEREIRA
  • EVALUATION OF THE EFFECT OF THE NATIONAL ORAL HEALTH POLICY ON THE PROVISION OF DENTAL PROSTHESIS IN PRIMARY CARE
  • Advisor : SAMILLY SILVA MIRANDA
  • COMMITTEE MEMBERS :
  • CRISTIANE ALVES PAZ DE CARVALHO
  • DANDARA DE OLIVEIRA RAMOS
  • SAMILLY SILVA MIRANDA
  • VINICIUS DE ARAUJO MENDES
  • Data: Nov 21, 2023


  • Show Abstract
  • Edentulism is considered an important problem for oral health, with biological and social precursors, generating a set of difficulties and limitations that impact the quality of life and daily life of the affected population. As a way of expanding and qualifying the services offered and moving towards overcoming the current situation, the National Oral Health Policy (PNSB) enables the inclusion of prosthetic rehabilitation in Primary Care (AB) through the installation of equipment in Regional Dental Prosthesis Laboratories (LRPD), in order to cover different regions of the country. The present study aims to evaluate the effect of the National Oral Health Policy on the provision of dental prostheses in PC in the state of Bahia considering the types of LRPD accreditation, from 2008 to 2019. The study was divided into two stages. In the first stage, a descriptive ecological study was conducted, describing the outpatient production of dental prostheses according to the quantity produced, in the state of Bahia, from 2008 to 2019 and the temporal evolution of municipalities with accredited LRPD in the state of Bahia, from the years 2008 to 2019. In the second stage, an evaluation of the effect of the PNSB on the supply of dental prostheses in the state of Bahia was carried out from 2008 to 2019, using a linear regression model. Greater production of prostheses was observed
    maxillary and mandibular, total and partial, and non-significant production values for coronary and temporary prostheses. In the analysis of the temporal evolution of municipalities with accredited LRPD, an increasing percentage was observed between 2010 and 2011, with a subsequent drop between 2012 and 2013. The percentage rose again from 2014, with 2019 being the year with the highest number of accreditations. There was an effect of the PNSB on the production of prostheses for municipalities accredited by the Ministry of Health (MS), with greater significance in the results, and in municipalities accredited by the MS and on the Expansion Plan list. A low magnitude effect was observed for municipalities with accreditation only through the Expansion Plan. The policy provided an increase in the provision of rehabilitation services using dental prostheses, mainly through accreditation through MS ordinances for adherence to the LRPD. However, the creation of the Expansion Plan as an additional tool to increase coverage participated to a lesser extent in this process.
4
  • PRISCILA CARVALHO SOARES
  • EVALUATIVE STUDY OF POLICIES RELATED TO SEXUAL EDUCATION AND PREGNANCY IN ADOLESCENCE, WITH EMPHASIS
     ON THE HEALTH AT SCHOOL PROGRAM - PSE
  • Advisor : EMANUELLE FREITAS GOES
  • COMMITTEE MEMBERS :
  • ANDRÊA JACQUELINE FORTES FERREIRA
  • DANDARA DE OLIVEIRA RAMOS
  • EMANUELLE FREITAS GOES
  • Data: Nov 27, 2023


  • Show Abstract
  • Introduction: Adolescence is a stage of life with specific health characteristics and needs. Access to Sexual and Reproductive Health (SRH) policies, which include Comprehensive Sex Education (CSE), is a means of realizing the sexual and reproductive rights that constitute the right to health for this population. Among the policies related to the sexual education of adolescents, the School Health Program (PSE) stands out for its reach and intersectoral approach. To optimize the program's results, an Evaluability Study can help determine its capacity to undergo an impact evaluation to demonstrate its cost-effectiveness. Objective: To conduct an evaluability study of the School Health Program (PSE) regarding Comprehensive Sex Education (CSE). Methodology: Documentary analysis of the Program to identify its characteristics and mode of operation. Expected Results: To determine the evaluability of the PSE regarding comprehensive sex education as recommended by UNESCO, recommending improvements to its design and implementation, if necessary, and encouraging further studies in the field. Conclusion: The Program does not meet the necessary requirements for impact evaluation in terms of comprehensive sex education. Normative improvements, stakeholder engagement, policy and pedagogical instruments, implementation means, and the availability of qualitative data are needed, which can be addressed through agreements among program managers.

5
  • THIAGO BORGES ARCANJO
  • Assessment of the impact of psychosocial care centers (CAPS) on psychiatric hospitalizations in Brazil from 2008 to 2019.

  • Advisor : FLÁVIA JÔSE OLIVEIRA ALVES
  • COMMITTEE MEMBERS :
  • FLÁVIA JÔSE OLIVEIRA ALVES
  • DÉBORAH SANTOS CONCEIÇÃO
  • WASHINGTON LUIZ ABREU DE JESUS
  • Data: Dec 14, 2023


  • Show Abstract
  • It is considered that approximately 50% of adults suffer from some mental and behavioral disorder at some point in their lives. More than half of these people experience moderate to severe symptoms. It is estimated that four of the ten main causes of disability in people five years of age or older are due to mental health disorders, with depression being the main cause of all diseases that cause disability. The triggering of a mental disorder is multifactorial and constitutes events and characteristics that act as predictors of emotional, physical and social problems throughout the life cycle, such as lack of family support, low socioeconomic status, experiences of victimization, etc., also including factors such as stress, genetics, nutrition, perinatal infections and exposure to environmental hazards. Unfortunately, the resources used in mental health care are still insufficient for all individuals with some type of mental disorder to have access to treatment, especially in low-income countries. In recent decades, in Brazil, Mental Health services have undergone some transformations over time, such as the creation of RAPS – Psychosocial Care Network, with CAPS (Psychosocial Care Center) and its different modalities, the units care strategies within RAPS, aiming at actions that aim to interact with the patient, rehabilitating them for social life, reintegrating them into the environment, providing adequate treatment. Currently Brazil
    has 2,755 CAPS units enabled, and between 2019 and 2021. The purpose of this research was to analyze the effect of Psychosocial Care Centers (CAPS) on hospitalizations for mental disorders in the country, motivating new studies and the improvement of policies public resources aimed at mental health. A longitudinal ecological study was carried out, using Brazilian municipalities as the unit of analysis, in the period 2008-2019. Data from 1,634 municipalities were considered, given the availability of data on psychiatric hospitalizations during this period. The period of the COVID-19 pandemic was excluded, due to the possible impact of this period on mental health. There were 3,889,568 hospital admissions due to psychiatric causes in Brazil between 2008 and 2019 in 1634 municipalities, with more than 40% due to disorders related to SCHIZOPHRENIA, followed by causes related to ALCOOL abuse. Male patients of white or mixed race/color make up the preponderant profile of those hospitalized throughout the data series in Brazil. Among Brazilian regions, the Southeast concentrated the majority of hospitalizations (52.53%), followed by the South (23.30%), Northeast (17.03%), Central-West (5.65%) and North (1 .49%). The south and northeast regions stood out for having average CAPS coverage higher than the values estimated in the present study for Brazil. In general, most municipalities in the present study presented, on average, CAPS coverage lower than 2.5 CAPS per 100 thousand inhabitants throughout the data panel considered (Figure 4). The Southeast region led in the number of hospitalizations for SCHIZOPHRENIA, ALCOHOLIC and PSYCHOACTIVES, totaling 1,344,104 hospitalizations, while the South had the highest hospitalization rates for HUMOR, with 207,615 
    hospitalizations. Considering the general hospitalization model for Brazil, a positive association was detected between hospitalization rates per 100 thousand inhabita mais internações. Por fim, analisando a parte binomial dos modelos por tipo de diagnóstico é perceptível que a relação da cobertura de CAPS com a probabilidade de taxas de internação igual a zero é semelhante ao observado no modelo geral para o Brasil, i.e., a probabilidade de um município não experimentar internações pelas quatro principais categorias de diagnósticos psiquiátricos reduz 15% em média para cada incremento de cobertura de CAPS. Uma exceção foi a região norte que mostrou que cada incremento da cobertura de CAPS foi associado com um aumento da probabilidade do município não experimentar internações nos quatros modelos por diagnóstico (Figura 5). O mesmo ocorreu para internações por ALCOOL na região sudeste. Em contrapartida, na Região Centro Oeste, para a cobertura de CAPS no modelo para HUMOR, observa-se que cada incremento de uma unidade está associado com um declínio de 14% (i.e. 0,86 – 1  100) nas taxas de internações dos municípios dessa região. Mesmo com a baixa cobertura de CAPS nos municípios brasileiros, regiões com as melhores coberturas entre os municípios, i.e. sul e nordeste (veja Tabela 3), apresentaram redução nas taxas de internação por HUMOR e ESQUIZOFRENIA a cada incremento de cobertura desses centros. Isso pode sinalizar que: a) CAPS são mais efetivos em reduzir internações dessas duas causas e b) há uma efetividade reduzida para a maioria das demais causas psiquiátricas. Assim: há uma necessidade de melhorar os serviços prestados pelos CAPS ou, o que pode estar acontecendo para os CAPS não afetarem significativamente outras causas, como ALCOOL e PSICOATIVAS. Há uma variação na análise quanto à implantação do CAPS e internações dependendo da região e o diagnóstico, o que pode estar relacionado também aos fatores de riscos e de proteção, citados neste trabalho, bem como uma baixa cobertura do CAPS em muitas regiões. Esse estudo evidenciou que o aumento da cobertura do CAPS esteve associado ao aumento das hospitalizações por transtornos psiquiátricos, mas com importante decréscimo das hospitalizações quando os municípios apresentam maiores coberturas sustentadas ao longo do tempo. Assim, novos estudos são indispensáveis para se buscar análises distintas, como gestão da rede, análise sobre a efetividade do CAPS através do matriciamento, acolhimento do usuário e família, adesão ao tratamento, qualificação profissional, entre outros aspectos. nts and CAPS coverage, i.e., each increase in CAPS coverage in the municipalities was related to 1.30 times more hospitalization rates. hospitalizations, that is, in general, considering all AIHs, a reduction in hospital admissions due to psychiatric diagnoses was not observed with the increase in CAPS coverage, a different result from previous studies carried out. It was evident that most municipalities have similar CAPS coverage, despite varying numbers of AIHs. Municipalities with low CAPS coverage (close to zero) have high numbers of hospitalizations, as well as those with the best rates. This may indicate a weak association between the two variables, although the positive effect observed in the models was significant. It is likely that increases in hospitalization rates with each increase in CAPS coverage are reflecting a characteristic of the health system or economic conditions of the municipality, given that, in general, the probability of zero hospitalizations occurring in a municipality is negatively related to the number of beds and GDP per capita. Thus, it is expected that where there are more beds available, larger populations and better economic conditions will occur


6
  • ANDREZZA BIROLO JOAQUIM
  • ASSOCIATION OF THE FEDERAL TRANSFER OF COSTS IN PRIMARY HEALTH CARE ON ADMISSIONS FOR PHC-SENSITIVE CONDITIONS IN BRAZILIAN MUNICIPALITIES IN THE YEARS 2010 TO 2019.
  • Advisor : RODRIGO VOLMIR REZENDE ANDERLE
  • COMMITTEE MEMBERS :
  • RODRIGO VOLMIR REZENDE ANDERLE
  • GRÉGORY DOS PASSOS CARVALHO
  • ANDRÉA FERREIRA DA SILVA
  • Data: Dec 15, 2023


  • Show Abstract
  • In the present study, we sought to analyze the association of federal funding transfers in Primary Care (PHC) for Brazilian municipalities, on PHC-sensitive conditions, in the period 2010-2019. It is assumed that a greater transfer of funding resources to primary care actions, and consequently their expansion, would affect the quality of health services. To this end, a contextualization of PHC was carried out based on a literature review, as well as a characterization of PHC and its scope, such as number of teams, federal funding transfers, municipal health expenditures, as well as information regarding hospitalizations due to ICSAP. The methodology chosen was the econometric model of panel data, with ICSAP as the dependent variable and the federal funding transfer as the variable of interest, added to control variables indicated in the literature capable of representing other factors that may have a significant influence on fluctuations in indicators of hospital admissions. The results of the estimated models indicate that all explanatory variables were statistically significant, and with expected results for the general and specific objectives that were intended to be studied, regarding the correlation of federal funding transfers for PHC on ICSAP. The result found indicates that the federal transfer of funding negatively affects ICSAP, to a greater or lesser extent, according to population size.

7
  • IVANILDO DE JESUS GAMA
  • PERCEPTIONS OF HEALTHCARE PROFESSIONALS ABOUT THE TRANSFUSION PROCESS IN A HOSPITAL UNIVERSITY OF BAHIA
  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • MARILUCE KARLA BOMFIM DE SOUZA
  • MARINHO MARQUES DA SILVA NETO
  • Data: Dec 15, 2023


  • Show Abstract
  • Hemotherapy Services (HS) bring together a diversity of health professionals who deal with the
    transfusion process, from recruiting donors, and extending to the transfusion of blood
    components into the recipient and post-transfusion monitoring. This study aims to develop the
    transfusion process by health professionals. The general objective of this study was defined as:
    analyzing the perceptions of health professionals regarding technical and managerial
    knowledge/knowledge and skills/practices for the development of the transfusion process
    suitable for the rational and safe use of blood. Specific objectives were set: to produce a
    synthesis of skills and abilities for health professionals involved in the transfusion process;
    characterize the profile of health professionals involved in the transfusion process carried out
    in a university hospital; identify the perception of health professionals involved in the
    transfusion process about their knowledge, skills, potential and limits. Exploratory study with
    a qualitative approach, carried out based on document review and application of a form to health
    professionals at a public university hospital in the state of Bahia. Using Google Forms, 30
    healthcare professionals voluntarily participated in the study. To analyze the findings, the
    content analysis technique was used. The project of this study was approved by the Research
    Ethics Committee. A synthesis matrix of competencies and skills of professionals involved in
    the transfusion process was produced, constituting content for technical material that guides
    health services and professionals on specific and common actions in the transfusion process.
    The findings from the participation of the interviewees generated five thematic categories: 1)
    Conceptions about the transfusion act and reasons for indicating transfusion of blood
    components, which were perceived in a restricted way from the moment of transfusion until the
    conception of a systematized process for which the indication must be careful and specific; 2)
    Knowledge for the development of the transfusion process, defined as: theoretical knowledge,
    current legal standards, transfusion practice, conditions for safe transfusion, rational use of
    blood and blood components and technical and managerial knowledge; 3) Transfusion reactions
    and conduct, the recognition of which is related to the practice and daily life of services that
    involve direct patient care, requiring that all professionals involved in the process are trained to
    recognition and action; 4) The skills and competencies were defined beyond practical
    knowledge, but with the articulation of personal attributes that in synergy build the necessary
    competencies; 5) The difficulties reported relate to structural aspects such as deficiencies in
    inputs, personnel and technical training, but present potential as mainly human resources,
    committed and cohesive with the work; 6) The challenge of maintaining the quality of processes
    and the need for improvement, technical and managerial training, personnel adaptation and
    process modernization aiming at the good development of the transfusion process. Therefore,
    the study sought to demonstrate the transfusion process through the perception of those who
    participate, and whether it is fundamental to therapeutic success or which may interfere in some
    way with the transfusion act. It was possible to verify the great concern of the respondents
    regarding multidisciplinary responsibility in the process considered technical, difficult,
    judicious, strictly standardized and, according to the participants, with challenges of structuring
    and disseminating knowledge for all professional categories involved. It is concluded that
    within the limits of each category involved in the transfusion process, professionals carry out
    their activities within normative and legal limits, the perspective and desire for training,
    accurate information, training so that the transfusion act can be carried out safely is unanimous.
    by the professional who performs it.

8
  • Luzimary Vieira Pereira
  • Implementation of the Rede Cegonha: challenges for reducing maternal mortality in Bahia.

  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • RODRIGO VOLMIR REZENDE ANDERLE
  • SONIA CRISTINA LIMA CHAVES
  • Data: Dec 19, 2023


  • Show Abstract
  • The maternal mortality rate is a public health indicator used throughout the world and in
    Brazil it presents worrying numbers. As a form of reduction in the country, the Rede
    Cegonha Strategy was established on June 24, 2011 through Law No. 1,459. Based on
    these data, the 417 municipalities in the state of Bahia joined the implementation of the
    Network and implemented the prenatal component. Despite the importance of this policy,
    few studies have evaluated the impact of implementing the Rede Cegonha in Brazil and,
    more specifically, no studies were found that evaluated the impact of implementing the
    Network in the state of Bahia. The present study aimed to analyze the possible impacts
    of the implementation of Rede Cegonha on the reduction of maternal mortality in the
    period from 2008 to 2019 in the state of Bahia. Public data made available by DATASUS
    from the state's 417 municipalities were used, calculating the MMR between time periods
    for each health macro-region. Data processing was carried out in two stages: the first was
    the descriptive analysis of the MMR and the sociodemographic characteristics of
    maternal deaths by health macro-region. The second stage consisted of statistical
    treatment based on the application of two techniques to evaluate the MMR trend carried
    out using two different programs: the R software and the Joinpoint Regression Program
    software. The results obtained through the historical series generated by the R software
    did not prove to be statistically significant in the mortality reduction rates in the
    municipalities of the State of Bahia, while the joinpoint analysis showed a tendency
    towards a reduction in the MMR in the state of Bahia, however, the majority of macroregions
    tended towards RMM stability during the developed period. Even with the
    downward trend through joinpoint analysis, there were high maternal mortality rates. This
    assessment may be influenced by the non-implementation of all components of the
    Cegonha Network as recommended by the Ministry of Health or by the limit presented in
    the selected time series. Over time, it was observed that only the prenatal component was
    implemented in the municipalities, with the need to implement the four components being
    relevant, as they are interconnected and are fundamental to achieving the effectiveness of
    the policy, that is, the reduction of maternal mortality in different regional contexts.

9
  • LEIDIANE BELLO FERREIRA DE JESUS
  • Assessment of the Impact of Self-Care for People with Diabetes on Reducing Hospital Admissions: Analysis of a Basic Health Unit in the Municipality of Porto Alegre between 2022-2023
  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • JOSE LUIZ MORENO NETO
  • MARCIO SANTOS DA NATIVIDADE
  • Data: Dec 20, 2023


  • Show Abstract
  • Diabetes Mellitus is a chronic non-communicable disease caused by multiple causes and risk factors that subject the person to a long period of latency and a prolonged stage of the problem until the onset of the first symptoms (DUTRA et. al., apud Brasil, 2015 ). Once detected, treatment must be started to prevent possible hospitalizations due to complications of the disease. This prevention can occur through basic and daily care such as healthy eating, physical activity and adherence to medication treatment, whose actions constitute the self-care process. This process is a preponderant factor in intervention on undesirable outcomes, such as hospitalizations, sequelae or deaths. Faced with this problem, the study sought to evaluate the impact of self-care practices on reducing hospital admissions due to diabetes mellitus, in the city of Porto Alegre/RS, in 2022-2023, the results of which showed significant effects on the probability of reducing possible hospitalizations.
2022
Dissertations
1
  • ANDRESSA MACARIO CARDOSO
  • EFFECTIVENESS OF POST-IMPLANTATION REHABILITATION OF AUTOLOGOUS MONONUCLEAR CELLS IN OSTEONECROSIS OF THE FEMORAL HEAD IN MULTI-CENTERS
  • Advisor : VINICIUS DE ARAUJO MENDES
  • COMMITTEE MEMBERS :
  • GILDASIO DE CERQUEIRA DALTRO
  • MANSUETO GOMES NETO
  • VINICIUS DE ARAUJO MENDES
  • Data: Feb 9, 2022


  • Show Abstract
  • This research aims to carry out an experimental pilot project, in the face of the Covid-19 pandemic, to test the effectiveness of a physiotherapy protocol for patient rehabilitation after implantation of autologous mononuclear cells in osteonecrosis of the femoral head, in order to supply a gap in the multicentres. The adopted methodology comprised a case study, with a quantitative and quasi-experimental approach, carried out in 19 patients, of both genders, children and adults, diagnosed with osteonecrosis of the femoral head by the orthopedics service of the Professor Edgard Santos University Hospital of the Federal University from Bahia (FUB), and selected for the surgical treatment of implantation of autologous mononuclear cells, in order to reduce joint pain and obtain better hip function. The selected patients were divided into treatment groups: Group 1 FUB Treatment (physiotherapy supervised by the FUB service), Group 2 Multicenter Treatment (physiotherapy performed in other Federation Units with remote support from the FUB service) and Group 3 Control (other than performed physiotherapy or other treatment unknown to the researcher). As results obtained, after the surgical procedure, patients started physical therapy from the first week after surgery, following a physical therapy protocol. But, to date, only one N=19 patients underwent surgery to implant autologous mononuclear cells in the hip due to the pandemic (COVID-19), which results in non-statistically significant. Within this context, it became an experimental pilot project, in which the justification for potential results, found so far, enabled studies and future application in a greater number of patients undergoing physical therapy treatment. However, success was achieved in 100% of patients who were instructed and treated with the experimental protocol in the multicenters. Thus, the conclusion reached was that, given the results obtained, even from incipient data, these proved to be promising for the use of a physiotherapy protocol in patients undergoing cell therapy for osteonecrosis of the femoral head, in partnership in multicenters, above all, because it understands that it will enable the physiotherapeutic medical service to improve the management process, which is linked to the contributions it will provide, on a large scale, with the implementation of new public policies with multicenters, minimizing operating costs and optimizing resources exist in all instances - municipal, state and federal - which, consequently, will facilitate the rehabilitation process of patients who qualify for the implantation of autologous mononuclear cells in osteonecrosis of the femoral head

2
  • JULIANA LAMOUNIER ELIAS
  • TELE-EDUCATION AS A SUPPORT FOR PERMANENT HEALTH EDUCATION IN PRIMARY CARE IN THE STATE OF BAHIA
  • Advisor : SONIA CRISTINA LIMA CHAVES
  • COMMITTEE MEMBERS :
  • SONIA CRISTINA LIMA CHAVES
  • MONIQUE AZEVEDO ESPERIDIAO
  • ERICA LIMA COSTA DE MENEZES
  • Data: Feb 25, 2022


  • Show Abstract
  • Public health system capable of assisting a heterogeneous population, with a multiple burden of diseases, requires the creation of public policies under different aspects, some of them aimed at valuing, training and qualifying human resources in health, in favor of a health care model based on integrality and solvability. Innovative teaching strategies through ICTs such as Telehealth have been configured as an opportunity for assistance and educational support for health professionals within the SUS. Thus, this qualitative study analyzed the Tele-education of Telessaúde Bahia as a support to the Permanent Education in Health of the health professionals of the Basic Attention of Bahia. The logical model of Tele-education was elaborated and later approved, which supported the formulation of questions and structured statements that composed the online form that was sent to the key informants' e-mail. A total of 238 responses were obtained, 193 from health professionals and 45 from municipal managers (primary care coordinators and municipal institutional supporters). Quantitative data were processed using the Microsoft Excel 2013 program, using the 5-point Likert Scale: totally agree, agree, indifferent, disagree, totally disagree and analyzed using the SPSS software (Statistical Package for Social Sciences). For the analysis of qualitative data, the content thematic judgment was used. The Logical Model of Tele-education pointed out the probable theory and practice of operation: the objectives, the interaction between the actors involved, the activities carried out and the expected effects in the short, medium and long term. Professionals and managers showed positive perceptions regarding the enhancement and qualification of learning through Health Information and Communication Technologies, in supporting clinical decision-making and diagnosis, and in providing up-to-date technical-scientific information based on difficulties experienced in the territories. Tele-education was considered a support for EPS, capable of contributing to the development of new care strategies, promoting a humanized view of the professional on the problems and needs of the population, improving the clinical capacity of the teams, resulting in probable benefits on the conditions health of the assisted population. However, it is necessary to improve structural elements and weaknesses pointed out in the organization of the work process, little autonomy and low stimulus from municipal management, and in the absence of discussions and exchange of knowledge between the members of the teams themselves in the municipalities. It is also appropriate to encourage health managers within the three spheres, the Telehealth Management Committee and other health and educational institutions to take on the responsibilities assigned to them by the PNAB, PNEPS and Telessaúde Brasil Redes e Bahia, in order to strengthen Teleeducation. and Permanent Health Education in the State.

3
  • Eduardo Machado de Santana
  • DATA QUALITY OF INTERPERSONAL AND SELF-PROVOCATED VIOLENCE NOTIFICATIONS FROM SINAN, SALVADOR, BAHIA (2015-2019).
  • Advisor : IRACEMA VITERBO SILVA
  • COMMITTEE MEMBERS :
  • IRACEMA VITERBO SILVA
  • JUAREZ PEREIRA DIAS
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: Mar 17, 2022


  • Show Abstract
  • Violence is a social phenomenon with devastating consequences to the victims and to society as whole, but it is still possible to find social groups an territories in which this impact is higher, hence the need of a surveillance system that provides data and good quality epidemiological information from health services notifications. The health department, with its work force and territorial and institutional presence, has potential and duty on approaching this social problem. Therefore, it was analyzed the quality of notifications of interpersonal and self-inflicted violence in Salvador-BA, aiming to assess the surveillance system data quality, with completeness and consistence as criteria, during the period of 2015 to 2019. Besides, this research aimed to understand the formative needs of work force from the act of notificating by assessing the quality of the information system. So, secondary data was used, of public access, via SINAN, from Health Department of Bahia (SESAB). The data quality was evaluated by its completeness and 16 variables were analyzed in the violence notification file, between mandatory and essential fields. It was also evaluated the consistence of data by selecting some variables in which they were analyzed by proportion of filling incompletion. Evaluation of 16 variables points out that, in the analyzed period, the notification of interpersonal and self-inflicted violence file filling was bad, for 42% of the information was ignored. The consistence evaluation among variables presented in this research showed up excellent performance, with 99,9% of satisfactory data proportion. The ignored data directly reflects the information quality, and it becomes necessary to stablish critical attention over de epidemiological results. Furthermore, understanding the work process in relation to violent situations in which one may analyze and intervene, making possible the educational process to health workers. The educational actions in the health department to assist and notificate violence must make one reflect upon sociocultural and economic relations, which are part of society and where health work happens, therefore stablishing more sense an intentionality on registering that data.

4
  • Abdon de Oliveira Brito
  • Management Contracts in Hospitals Under Indirect Management in Bahia: A Proposal for Health Indicators From the Perspective of Work Management
  • Advisor : ISABELA CARDOSO DE MATOS PINTO
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • ISABELA CARDOSO DE MATOS PINTO
  • KATIA REJANE DE MEDEIROS
  • THADEU BORGES SOUZA SANTOS
  • Data: Mar 29, 2022


  • Show Abstract
  • The Brazilian administrative restructuring throughout the Reform of the Brazilian State apparatus resulted in new ways of management, mainly in the health field. It contributed and legitimized the Social Organizations to manage basic services, previously executed by State. The management of the health services by Third Sector is justified by important elements such as efficiency, efficacy, low cost and a better administrative and financial dynamic of the resources for the public managers. As a result, the role of the State would be regulator and supervisory of the health services provided. It is necessary to establish a management contract that is a public administrative commitment instrument between the State and the social organization. This paper aimed to analyze sevenmanagement contracts of hospitals managed by social organizations in Bahia in order to contribute with news health indicators by management work perspective. The results revealed that , in the contract, most of the health indicators were quantitative, clinical procedures, numbers of clinical appointments. The health management and health workers were not approached. It is important to strengthen the monitoring and evaluation as management tools, because social organizations have been an international and national trend.

5
  • SÓCRATES COELHO CAMARGO
  • THE POTENTIALS OF PERMANENT HEALTH EDUCATION (EPS) TO PROMOTE SATISFACTION AT WORK
  • Advisor : MONIQUE AZEVEDO ESPERIDIAO
  • COMMITTEE MEMBERS :
  • DENISE VIEIRA DA SILVA
  • ISABELA CARDOSO DE MATOS PINTO
  • MONIQUE AZEVEDO ESPERIDIAO
  • Data: Apr 19, 2022


  • Show Abstract
  • This research analyzed satisfaction in the work process and its determinants, identifying the potential of continuing education in health in face of the issue. The economic, political and social context in Brazil is marked by an increase in unemployment, an increasingly accentuated pace and intensity of work, setbacks in workers' rights and achievements, more competitive and conflicting interpersonal relationships at work and increased exposure to environmental risks. at work. These circumstances have resulted in the worker's physical and emotional exhaustion. Such conditions are conducive to promoting dissatisfaction at work, which can cause illness and lack of ethical commitment on the part of the worker, factors that bring problems to the work process of this agent. Permanent Education in Health (EPS) aims at transforming health practices towards the principles of the SUS, starting from the analysis of the work process, identifying problems and formulating actions to solve them. Therefore, it is a function of the EPS to promote job satisfaction, which is a pleasant state for the worker in his work process. From this, a field research was developed, of an exploratory descriptive nature, using a questionnaire with open and closed questions. The sample consisted of 204 health workers. Data were analyzed using descriptive statistics, through the construction of a database in SPSS. The analysis of open questions was performed by grouping by proximity of content, presented through tables with absolute numbers and percentage. The results found showed that the highest levels of dissatisfaction are in the working conditions category, with the highest percentage being salary (64.7%). Furthermore, in this category, the highest percentage of satisfaction level was with the employment relationship (82.3%). In the category relationships at work, the highest percentage of dissatisfaction was the institution's concern with the well-being of workers (35.3%) and the highest levels of satisfaction are in relationships with co-workers (89.7%). In the category of significant content of work, the highest rates of dissatisfaction were with the recognition of their work by society (32.8%) and the highest levels of satisfaction were with the purpose of their work (85.3%). In the EPS category, the professional development opportunity had the highest dissatisfaction rate, with 30.4%, and the highest satisfaction rate is with the availability of EPS activities with 51%. Most of the determinants that are leading to job satisfaction are in the significant content of work category with 61.2% and in the work relationships subdivision it was mentioned by 17.6% of the sample. The determinants that are leading to job dissatisfaction are in the working conditions category with 38.8% of the responses. Based on this, the EPS can develop actions that bring discussions about respect, political participation, interpersonal relationships, recognition and appreciation of the worker, both internally and externally to the institution, build spaces for feedback and discussion about the political, economic and social context, anchoring these actions
    in the micropolitics of living work, the wheel method and in the problematization/meaningful learning.

6
  • GILVANIA LIMA NOGUEIRA
  • PATIENT SAFETY IN EMERGENCY CARE UNITS IN SALVADOR, BAHIA, BRAZIL
  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • ANA LUIZA QUEIROZ VILASBOAS
  • ANA PAULA SANTOS DE JESUS
  • ELIANA AUXILIADORA MAGALHÃES COSTA
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: May 2, 2022


  • Show Abstract
  • The concern with patient safety (SP) must involve all health services that are part of the Health Care Networks (RAS). The Emergency Care Units (UPA), as a point of attention of the RAS, are structures of intermediate complexity, and must operate 24 hours a day. This study has the general objective: To analyze the actions/practices of Patient Safety developed in Emergency Care Units in the city of Salvador, Bahia, Brazil. The specific objectives are: Identify patient safety practices developed in the UPAs; describe the challenges for patient safety in UPAs. Inclusion criteria were considered for the UPAS and an online questionnaire was applied through google forms to seven health professionals from December 2020 to February 2021, assigned to the Patient Safety Centers in the UPAs for more than six months. Documentary analysis was also performed. The collected data were systematized, organized and processed in a matrix and the contents were analyzed using the thematic analysis technique. All ethical aspects were respected. The results showed that the UPAs of the study constituted the Patient Safety Centers (NSP) by a multidisciplinary team, but most did not have the doctor and pharmacist as members. Most of SP's plans and protocols were implemented and implemented through continuing education and the promotion of SP culture. The UPAs implemented protocols that describe actions for the adoption of hand hygiene, patient identification, phlebitis, sepsis and allergies. The NSP actions performed were patient identification at the bedside, educational actions, informative posters on hand hygiene, decubitus change clock, electronic medical records. Due to the Covid-19 pandemic, educational actions were intensified, focusing on hand hygiene, Personal Protective Equipment (PPE) and control of health care-related infections (IRAS). As challenges, the need to problematize SP, instrumentalization of future professionals and offer support to the centers to act in the promotion of SP culture stand out. This study may contribute to encouraging managers and health professionals to reflect on the subject, bringing safety and quality of care in health services to the agenda of priorities, and the need to implement, implement, monitor and evaluate SP actions.

7
  • RENIVALDO FREITAS DOS SANTOS
  • Implementation of Professional Training for Community Health Agents from 2006 to 2008: the case of a Technical School of SUS-Ba
    Dissertation .

     

  • Advisor : SILVANA LIMA VIEIRA
  • COMMITTEE MEMBERS :
  • TELMA DANTAS TEIXEIRA DE OLIVEIRA
  • CATHARINA LEITE MATOS SOARES
  • ISABELA CARDOSO DE MATOS PINTO
  • SILVANA LIMA VIEIRA
  • Data: May 10, 2022


  • Show Abstract
  • General objective: to analyze how the professional training of Community Health Agents (ACS) was implemented by the Technical School of the Unified Health System - Bahia in the period from 2006 to 2008. The choice for this category is due to the qualitative and quantitative relevance of these professionals for actions in the field of primary care and support of the Unified Health System, in aspects of prevention, promotion and recovery of health. Method: exploratory, qualitative research, of the Single Case Study type, through semi-structured interviews with four relevant institutional actors in the implementation process and document analysis after release from the Research Ethics Committee. Thematic content analysis was performed, according to Bardin (year) and the theoretical framework used was the principles of Mintzberg (2010) and Mário Testa (1989) contextualized for the Training of Human Resources in Health for the SUS. Results: a historical review of the process of implementing the professional training of ACS by EFTS SUS-BA was carried out, identifying the interests and stakeholders, the responsible institutional actors, actions and proposals for implementation and the facilities, difficulties and conflicts related to the implementation process. Institutional actors proved to be essential for the implementation and execution of this project, with personal and political involvement throughout the process. It was possible to categorize four actions and proposals that enabled the implementation of the course: actions with actors and organized civil society, budgetary-financial, organizational and didactic-pedagogical. The facility was given by the support related to the period of the state government, the difficulties related to the financial execution, geographic aspects, operationalization of the course and political-party context. Conflicts were classified as ideological-ethical in training, financial and party interests. Conclusion: we conclude that the historical and political context was decisive for the implementation of the ACS training course, driven by the strengthening of the Unified Health System. We verified that the concepts of power and strategy permeated the decisions and implementation of this course, directly influencing the execution of public policies that reverberated in the training processes, health and in the world of work of ACS, SUS professionals and workers.
8
  • VINICIUS DE BRITO RODRIGUES
  • Isolated femoral head decompression versus conservative treatment for non-traumatic osteonecrosis: a systematic review with meta-analysis
  • Advisor : JOILDA SILVA NERY
  • COMMITTEE MEMBERS :
  • JOILDA SILVA NERY
  • GILDASIO DE CERQUEIRA DALTRO
  • VINICIUS DE ARAUJO MENDES
  • JANE MARY DE MEDEIROS GUIMARÃES
  • Data: Jul 1, 2022


  • Show Abstract
  • Introduction: Osteonecrosis of the femoral head (ONCF) is a condition that can lead to progressive destruction of the hip joint, common between the third and fifth decades of life, being the diagnosis responsible for 5 to 18% of total hip arthroplasties (THA). ). Among joint sparing treatments, the role of central decompression (CD) is still debated. Objective: To compare the effectiveness of central decompression (DC) and conservative treatment (CT) to save femoral heads in patients with avascular necrosis of the femoral head. Results: Four clinical trials and two cohorts involving 316 hips, with a mean follow-up of 22 to 48 months were included in this review. Our results suggested that patients undergoing CD were less likely to undergo total hip replacement surgery [OR = 0.42 (95% CI, 0.20–0.85); I 2 = 0.00%; p = 0.74]. In the analysis of the radiographic progression rate stratified by the stage of ONCF, the CD group had a significantly lower failure rate than the CT group at stages 0/I, [OR = 0.32 (95% CI, 0.11– 0.96); I 2 = 25.41%; p = 0.26], but not in stage II [OR = 0.68 (95% CI, 0.14–3.34); I 2 = 71.84%; p < 0.01] nor in stage III [OR = 1.21 (95% CI, 0.11–12.85; I 2 = 67.37%; p = 0.05)]. Conclusions: Performing CD is effective in preventing progression to femoral collapse in the early stages of ONCF in a short-term follow-up and reduces the chance of total hip arthroplasty. However, the short-term follow-up and small sample size of the current meta-analysis provide only limited quality of evidence. Randomized controlled trials with a larger sample size and longer follow-up are needed to provide further insights into the optimal treatment of ONCF.
9
  • Juliane Caires dos Santos Macêdo
  • INTERPROFESSIONALITY IN PRIMARY CARE IN THE CONTEXT OF COVID-19 IN A MUNICIPALITY IN THE INSIDE OF BAHIA
  • Advisor : EDNIR ASSIS SOUZA
  • COMMITTEE MEMBERS :
  • EDNIR ASSIS SOUZA
  • GISELLE ALVES DA SILVA TEIXEIRA
  • LILIANA SANTOS
  • SILVANA LIMA VIEIRA
  • Data: Jul 7, 2022


  • Show Abstract
  • Primary Health Care (PHC), a space for ordering care and coordinating the health care network, is responsible for the articulation between the points of care and the interaction between professionals. Above all, given the complexity imposed by the pandemic of the new coronavirus (SARS-CoV-2), which causes Covid-19, the quality of such articulation and interaction has become essential. In the search for efficiency in health services, the development and application of collaborative skills for teamwork is highlighted, where aspects that seek to ensure the quality of care, the optimization of resources, the avoidance of duplicity of actions and enable the safety of the user, are pointed out as a way to effect the production of care in a harmonious, orderly and resolute way, favoring the responses that the situation requires. Therefore, it is necessary that the normative instruments developed for the work of professionals in the context of the pandemic include such aspects, so that care practices reflect this direction. In this sense, the present study aimed to promote an analysis in the light of the theoretical methodological framework of Education and Interprofessional Practice from the perspective of collaborative competences, strategies for the production of health care, proposed in the Municipal Contingency Plan to Combat Human Infection by the New Coronavirus - (COVID-19), from the municipality of Jequié/Ba and other instruments used, as well as their application in the work of four Family Health Teams. It is concluded that the teaching-service integration, the quality of communication and the collaborative practices between the different professionals involved in the care were fundamental for the solvability of the services and the effectiveness of health care and constitute important factors for coping with the problem of health, as experienced today.

10
  • VALERIA RABELO OLIVEIRA DE FREITAS
  • Evaluability Study of the program Salvador Protege

  • Advisor : LILIANA SANTOS
  • COMMITTEE MEMBERS :
  • LILIANA SANTOS
  • CATHARINA LEITE MATOS SOARES
  • THAIS REGIS ARANHA ROSSI
  • Data: Sep 21, 2022


  • Show Abstract
  • In January 2020, the World Health Organization (WHO) declared the outbreak of the novel coronavirus disease (COVID-19) a Public Health Emergency of International Concern. The COVID-19 pandemic has become a challenge for science and society, demanding quick responses from health systems. In this perspective, the Municipal Health Department of Salvador implemented the “Salvador Protege” program, aimed at combating the coronavirus and which also aimed to serve to monitor other diseases presented by the population in the post-pandemic, using mainly the resources of telemedicine. The initiative's main objective is to protect and care for people, families and communities impacted by the Covid19 pandemic and to develop the work of the Basic Health Units (UBS), especially with family strategy teams, in addition to the activities already carried out by the agents. community health and endemic diseases. Another focus of the program is to protect and support healthcare workers during the pandemic. The present dissertation is an evaluability study of this Program. The evaluability analysis was based on the logical model of Salvador Protege prepared on September 25 and validated on September 29, 2020 and on documents prepared by the SMS of Salvador. The analysis carried out by this study pointed to the existence of a set of challenges for the implementation of the Salvador Protege Program. The program still presents difficulties in its operationalization and does not present, in its design, evaluation and monitoring strategies. For a Health Program to be evaluated, a proposal that considers the monitoring of professionals' activities, accessibility to services and health technologies is necessary. It is important that the formulation and execution of the Program be improved, highlighting the importance of the present study.

2021
Dissertations
1
  • LARISSA SOARES DA SILVA CUNHA
  • INTEGRATION BETWEEN EPIDEMIOLOGICAL SURVEILLANCE OF DISEASES IMMUNOPREVENIBLE AND FAMILY HEALTH STRATEGY: EVALUATION TOOL PROPOSAL
  • Advisor : JUAREZ PEREIRA DIAS
  • COMMITTEE MEMBERS :
  • JUAREZ PEREIRA DIAS
  • MONIQUE AZEVEDO ESPERIDIAO
  • ALCINA MARTA DE SOUZA ANDRADE
  • GERLUCE ALVES PONTES DA SILVA
  • Data: Feb 3, 2021


  • Show Abstract
  • 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.
2
  • PAULO CÉSAR OLIVEIRA SOBRINHO
  • APPLICABILITY OF PLATELET-RICH PLASMA-PRP IN THE TREATMENT OF FOOT ULCERS IN DIABETIC PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS
  • Advisor : GILDASIO DE CERQUEIRA DALTRO
  • COMMITTEE MEMBERS :
  • GILDASIO DE CERQUEIRA DALTRO
  • MARIA LIGIA RANGEL SANTOS
  • ADEMARIO GALVAO SPINOLA
  • JANE MARY DE MEDEIROS GUIMARÃES
  • Data: Mar 5, 2021


  • Show Abstract
  • 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.

3
  • ROSANE SOUSA BARRETO
  • Evaluation of the quality of abortion care: support for improving the QualiAborto-Pt

  • Advisor : GREICE MARIA DE SOUZA MENEZES
  • COMMITTEE MEMBERS :
  • ESTELA MARIA MOTTA LIMA LEAO DE AQUINO
  • GREICE MARIA DE SOUZA MENEZES
  • MARIA TERESA SEABRA SOARES DE BRITO E ALVES
  • MICHAEL EDUARDO REICHENHEIM
  • Data: Mar 30, 2021


  • Show Abstract
  • 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.

4
  • LARISSA CELESTE ARAUJO PAIVA
  • DIFFERENTIAL COSTS OF THE ADMISSION TO THE DELIVERY OF PREGNANT WOMEN WITH DIABETES IN A PUBLIC MATERNITY OF SALVADOR
  • Advisor : ERIKA SANTOS DE ARAGAO
  • COMMITTEE MEMBERS :
  • ERIKA SANTOS DE ARAGAO
  • CLAUDIA SILVA MARINHO
  • VINICIUS DE ARAUJO MENDES
  • Data: Mar 31, 2021


  • Show Abstract
  • 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.

5
  • CATARINE HEITER MORAES BONESS
  • Preceptorship in speech therapy: profile and proposal of permanent education actions in a teaching center in Salvador-Bahia
  • Advisor : JOSE LUCIO COSTA RAMOS
  • COMMITTEE MEMBERS :
  • JOSE LUCIO COSTA RAMOS
  • CATHARINA LEITE MATOS SOARES
  • PATRÍCIA FRANCESCA LIMA DE PINHO
  • Data: Apr 12, 2021


  • Show Abstract
  • 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.

6
  • HELEN INGRID BARRETO AMORIM
  • WORK MANAGEMENT IN THE STATE'S BASIC CARE FROM BAHIA
  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • CÉLIA REGINA RODRIDES GIL
  • ISABELA CARDOSO DE MATOS PINTO
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: Apr 16, 2021


  • Show Abstract
  • 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
7
  • VINICIUS DA COSTA CARVALHO RIBEIRO
  • IMPERFECT OSTEOGENESIS: NEW TECHNOLOGIES IN FRACTURE PREVENTION - A SYSTEMATIC LITERATURE REVIEW
  • Advisor : GILDASIO DE CERQUEIRA DALTRO
  • COMMITTEE MEMBERS :
  • GILDASIO DE CERQUEIRA DALTRO
  • MARIO CASTRO CARREIRO
  • VINICIUS DE ARAUJO MENDES
  • JANE MARY DE MEDEIROS GUIMARÃES
  • Data: Apr 26, 2021


  • Show Abstract
  • 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.

8
  • LIVIO MATHEUS OLIVEIRA DA SILVA
  • EFFECT OF THE FAMILY HEALTH STRATEGY ON COLLECTION OF THE FIRST TEST SAMPLE OF THE PEZINHO IN BAHIA BETWEEN 2011 AND 2018
  • Advisor : VINICIUS DE ARAUJO MENDES
  • COMMITTEE MEMBERS :
  • MARCIO SANTOS DA NATIVIDADE
  • TATIANA REGIA SUZANA MATTOS DE AMORIM
  • VINICIUS DE ARAUJO MENDES
  • Data: Apr 30, 2021


  • Show Abstract
  • 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.
9
  • CLÁUDIA CRISTIANE MOURA SILVA SOUZA
  • REGIONALIZATION AND NETWORKING FOR THE STRENGTHENING OF HEALTH EDUCATIONAL ACTIONS
  • Advisor : LILIANA SANTOS
  • COMMITTEE MEMBERS :
  • ANA ANGELICA RIBEIRO DE MENESES E ROCHA
  • CÉLIA REGINA RODRIDES GIL
  • LILIANA SANTOS
  • Data: Jun 14, 2021


  • Show Abstract
  • 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

10
  • ARLENE MARIA DE JESUS
  • NORMATIVE ASSESSMENT OF COVID-19'S EPIDEMIOLOGICAL SURVEILLANCE ACTIONS DEVELOPED BY THE HEALTH SURVEILLANCE STRATEGIC INFORMATION CENTER OF THE STATE OF BAHIA
  • Advisor : ANA LUIZA QUEIROZ VILASBOAS
  • COMMITTEE MEMBERS :
  • ANA LUIZA QUEIROZ VILASBOAS
  • CATHARINA LEITE MATOS SOARES
  • MARCIA SAO PEDRO LEAL SOUZA
  • Data: Jul 30, 2021


  • Show Abstract
  • 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.

11
  • CAMILA MOITINHO DE ARAGÃO BULCÃO
  • TEAM WORK AND COLLABORATION IN TIMES OF PANDEMICS: POSSIBILITIES AND CHALLENGES IN THE SCOPE OF WORK MANAGEMENT
  • Advisor : LILIANA SANTOS
  • COMMITTEE MEMBERS :
  • MARINA PEDUZZI
  • ISABELA CARDOSO DE MATOS PINTO
  • LILIANA SANTOS
  • Data: Aug 11, 2021


  • Show Abstract
  • 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.

12
  • LARISSA PIMENTEL COSTA MENEZES SILVA
  • 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
  • Advisor : CARMEN FONTES DE SOUZA TEIXEIRA
  • COMMITTEE MEMBERS :
  • CARMEN FONTES DE SOUZA TEIXEIRA
  • CATHARINA LEITE MATOS SOARES
  • EDNIR ASSIS SOUZA
  • Data: Aug 12, 2021


  • Show Abstract
  • 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.

13
  • ANA GABRIELA PRAZERES OLIVEIRA
  • COST-EFFECTIVENESS OF INHALED NITRIC OXIDE IN THE TREATMENT OF PERSISTENT PULMONARY HYPERTENSION IN THE NEWBORN
  • Advisor : FABIANA RAYNAL FLORIANO
  • COMMITTEE MEMBERS :
  • CAROLINA THÉ MACEDO
  • ERIKA SANTOS DE ARAGAO
  • FABIANA RAYNAL FLORIANO
  • IVAN RICARDO ZIMMERMANN
  • Data: Aug 26, 2021


  • Show Abstract
  • 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.

14
  • RODRIGO JORGE DE SOUZA DA FONSECA
  • 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
  • Advisor : CLARICE SANTOS MOTA
  • COMMITTEE MEMBERS :
  • CLARICE SANTOS MOTA
  • GILDASIO DE CERQUEIRA DALTRO
  • YEIMI ALEXANDRA ALZATE LOPEZ
  • Data: Aug 31, 2021


  • Show Abstract
  • 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.

15
  • IOLANDA NOGUEIRA DE SOUSA
  • Educational practices of the Oral Health Teams, in the Sanitary District of Subúrbio Ferroviário, in Salvador, Bahia
  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • MARIANGELA SILVA DE MATOS
  • TEREZINHA DE LISIEUX QUESADO FAGUNDES
  • Data: Aug 31, 2021


  • Show Abstract
  • 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
16
  • NEY CRISTIAN AMARAL BOA SORTE
  • ANALYSIS OF NEONATAL SCREENING FOR GALACTOSEMIA IN STATE OF BAHIA: COST-EFFECTIVENESS STUDY
  • Advisor : FABIANA RAYNAL FLORIANO
  • COMMITTEE MEMBERS :
  • FABIANA RAYNAL FLORIANO
  • JOSÉ SIMON CAMELO JUNIOR
  • IVAN RICARDO ZIMMERMANN
  • Data: Sep 3, 2021


  • Show Abstract
  • 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

17
  • CEANNY CRISTINA PINHO COSTA
  • 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
  • Advisor : YARA OYRAM RAMOS LIMA
  • COMMITTEE MEMBERS :
  • DAYANA DOURADO DE OLIVEIRA COSTA
  • LAISE REZENDE DE ANDRADE
  • YARA OYRAM RAMOS LIMA
  • Data: Sep 23, 2021


  • Show Abstract
  • 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.

18
  • GEISEANE LOPES DE GOIS SANTOS
  • A LOOK AT THE WORK PROCESS OF ENDEMICS COMBAT AGENTS IN THE MUNICIPALITY OF CROSS OF THE SOULS/BAHIA
  • Advisor : JOILDA SILVA NERY
  • COMMITTEE MEMBERS :
  • JOILDA SILVA NERY
  • LILIANA SANTOS
  • AROLDO JOSE BORGES CARNEIRO
  • JANETE GONÇALVES EVANGELISTA
  • Data: Sep 29, 2021


  • Show Abstract
  • 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.

19
  • LUIZA SAMARA ABREU CARDOSO CARVALHO
  • EFFECTS OF MEDICAL OUTSOURCING SERVICES ON THE PERCEPTION OF MANAGERS AND DOCTORS OF THE MARANHÃO STATE HEALTH SECRETARIAT.
  • Advisor : ISABELA CARDOSO DE MATOS PINTO
  • COMMITTEE MEMBERS :
  • ISABELA CARDOSO DE MATOS PINTO
  • ANA ANGELICA RIBEIRO DE MENESES E ROCHA
  • KATIA REJANE DE MEDEIROS
  • Data: Sep 29, 2021


  • Show Abstract
  • 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.

20
  • JOELMA DE MEIRA FERREIRA
  • PROFILE OF OFFERING AND USE OF SERVICES OF THE REGIONAL HEALTH POLYCLINIC OF ALTO SERTÃO BAHIA (2017-2019)

  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • ANA PAULA CHANCHARULO DE MORAIS PEREIRA
  • CARMEN FONTES DE SOUZA TEIXEIRA
  • JULIANA ALVES LEITE LEAL
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: Oct 4, 2021


  • Show Abstract
  • 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.

21
  • JOSICLÉIA OLIVEIRA DE SOUZA
  • 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

  • Advisor : MONIQUE AZEVEDO ESPERIDIAO
  • COMMITTEE MEMBERS :
  • MONIQUE AZEVEDO ESPERIDIAO
  • LILIANA SANTOS
  • ROSANA TERESA ONOCKO CAMPOS
  • Data: Oct 19, 2021


  • Show Abstract
  • 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.

22
  • Ana Clelia de Freitas Teixeira Góes
  • Lights on an invisible protagonism: the singularity of the work process of the SUS Bahia School's institutional supporter
  • Advisor : SILVANA LIMA VIEIRA
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • SILVANA LIMA VIEIRA
  • TANIA CELESTE MATOS NUNES
  • Data: Oct 22, 2021


  • Show Abstract
  • 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.

     

     

     

     

     

     

     

     

23
  • FLAVIA CARNEIRO DA SILVA
  • Access of SUS users to HIV Post-Exposure Prophylaxis (PEP) and the return to follow-up appointments in the city of Salvador – BA. 

  • Advisor : CARLOS ANTONIO DE SOUZA TELES SANTOS
  • COMMITTEE MEMBERS :
  • CARLOS ANTONIO DE SOUZA TELES SANTOS
  • MARIA APARECIDA ARAÚJO FIGUEIREDO
  • LAIO MAGNO SANTOS DE SOUSA
  • SANDRA ELY BARBOSA DE SOUZA
  • Data: Oct 25, 2021


  • Show Abstract
  • 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.

24
  • ANA CAROLINA SANTOS GOUVEIA
  • Social organizations as a way to hire health professionals: analysis of work management in a hospital case in the SUS Bahia network.
  • Advisor : THADEU BORGES SOUZA SANTOS
  • COMMITTEE MEMBERS :
  • ISABELA CARDOSO DE MATOS PINTO
  • KATIA REJANE DE MEDEIROS
  • THADEU BORGES SOUZA SANTOS
  • Data: Nov 8, 2021


  • Show Abstract
  • 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.
25
  • ELÂNIA SIRLEY DE OLIVEIRA MORAES SANT'ANA
  • Continuing Education for Prenatal Care: nurses' perception in the context of the family health strategy in a municipality in Bahia.

  • Advisor : CRISTIANE ABDON NUNES
  • COMMITTEE MEMBERS :
  • CRISTIANE ABDON NUNES
  • CATHARINA LEITE MATOS SOARES
  • LILIAN CONCEICAO GUIMARAES DE ALMEIDA
  • Data: Nov 9, 2021


  • Show Abstract
  • 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. 

26
  • VANESSA SANTOS ESTRÊLA
  • TELEDIAGNOSIS IN CARDIOLOGY IN PRIMARY CARE: EVALUATION STUDY IN THE STATE OF BAHIA Salvador BA 2021
  • Advisor : SONIA CRISTINA LIMA CHAVES
  • COMMITTEE MEMBERS :
  • ERICA LIMA COSTA DE MENEZES
  • MONIQUE AZEVEDO ESPERIDIAO
  • SONIA CRISTINA LIMA CHAVES
  • Data: Nov 30, 2021


  • Show Abstract
  • 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.

27
  • Keise Santos Souza Falheiro
  • DIGITAL TECHNOLOGY AS A SELF-CARE TEACHING STRATEGY FOR THE PREVENTION OF DIABETIC FOOT
  • Advisor : KIONNA OLIVEIRA BERNARDES SANTOS
  • COMMITTEE MEMBERS :
  • KIONNA OLIVEIRA BERNARDES SANTOS
  • MARCIO SANTOS DA NATIVIDADE
  • MILENA MARIA CORDEIRO DE ALMEIDA
  • SAMILLY SILVA MIRANDA
  • Data: Dec 1, 2021


  • Show Abstract
  • 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.

28
  • Luziane Rocha Macêdo Silva
  • KNOWLEDGE AND ACCESS TO HEALTH CARE TECHNOLOGIES FOR PEOPLE WITH SICKLE DISEASE.
  • Advisor : VINICIUS DE ARAUJO MENDES
  • COMMITTEE MEMBERS :
  • EVANILDA SOUZA DE SANTANA CARVALHO
  • JOILDA SILVA NERY
  • VINICIUS DE ARAUJO MENDES
  • Data: Dec 6, 2021


  • Show Abstract
  • 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
29
  • Lilian Paula Santos do Nascimento
  • PRODUCTION OF DIGITAL EDUCATIONAL CONTENT AIMED AT THE PREVENTION OF DIABETIC FOOT: ACTION PLAN FOR A SUS SCHOOL Dissertation
  • Advisor : MARCELO EDUARDO PFEIFFER CASTELLANOS
  • COMMITTEE MEMBERS :
  • JANE MARY DE MEDEIROS GUIMARÃES
  • LILIANA SANTOS
  • MARCELE CARNEIRO PAIM
  • MARCELO EDUARDO PFEIFFER CASTELLANOS
  • Data: Dec 6, 2021


  • Show Abstract
  • 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.

30
  • ELIANA BARBOSA PEREIRA
  • The Academic Supervision of Mais Médicos Program in the State of Bahia, Brasil: Strategy to strengthen teaching-service integration?

  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • LUIS EUGENIO PORTELA FERNANDES DE SOUZA
  • TANIA CELESTE MATOS NUNES
  • Data: Dec 16, 2021


  • Show Abstract
  • 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.

31
  • GLEISON ALVES DE SOUZA BATISTA
  • INSTITUTIONAL SUPPORT TO PRIMARY HEALTH CARE MANAGEMENT: A PARTICIPATORY STRATEGY UNDER CONSTRUCTION
  • Advisor : DENISE VIEIRA DA SILVA
  • COMMITTEE MEMBERS :
  • CARMEN FONTES DE SOUZA TEIXEIRA
  • DENISE VIEIRA DA SILVA
  • ISABELA CARDOSO DE MATOS PINTO
  • LYGIA MARIA FIGUEIREDO MELO
  • Data: Dec 16, 2021


  • Show Abstract
  • 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.

32
  • Edmilson Nascimento
  • PERMANENT EDUCATION IN THE FAMILY HEALTH STRATEGY: a possibility of constitution of subjects
  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • ISABELA CARDOSO DE MATOS PINTO
  • JOSE LUCIO COSTA RAMOS
  • Data: Dec 17, 2021


  • Show Abstract
  • 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.

33
  • TÚLIO ROMÉRIO LOPES QUIRINO
  • TEAMWORK IN THE CONTEXT OF FAMILY HEALTH: An analysis from the perspective of Interprofessional Collaboration in Recife, Pernambuco.
  • Advisor : ANA LUIZA QUEIROZ VILASBOAS
  • COMMITTEE MEMBERS :
  • MARCELO VIANA DA COSTA
  • ANA LUIZA QUEIROZ VILASBOAS
  • LILIANA SANTOS
  • Data: Dec 28, 2021


  • Show Abstract
  • 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.

2020
Dissertations
1
  • KELLIMILA SANTANA SILVA SODRÉ
  • Home-Care Program of the Health Department for the State of Bahia: a management perspective.

  • Advisor : ALCIONE BRASILEIRO OLIVEIRA
  • COMMITTEE MEMBERS :
  • ALCIONE BRASILEIRO OLIVEIRA
  • ISABELA CARDOSO DE MATOS PINTO
  • KENIA LARA SILVA
  • Data: Jan 28, 2020


  • Show Abstract
  • The study is a research of a qualitative nature, a single case study with a built-in focus, with the general objective of analyzing the operation of the State Home-Care Program under a management perspective. The research was approved by the Research Ethics Committee (CEP) of the Institute of Public Health (ISC) at Universidade Federal da Bahia, with co-participation of the CEP of SESAB (Bahia State Department of Health). The study was performed within the scope of the SESAB which, in 2018, promoted substantial changes in its process for offering and organizing this service, through the opening of a public offering process for the accreditation of private home-care companies. The research used documental analysis, secondary data and semistructured interviews with eight key-informants as methodological strategy. The collected data was sorted and consolidated to the analysis criteria defined and treated in accordance with the conceptual elements. The results demonstrated three moments in the handling of the Home-Care (HC) actions in Bahia: direct administration, FESF (State Family Health Foundation) and private enterprises. Included in the grounds for the choice of the provision of services by home-care companies was the influence of a central administration, justified by the need for increasing the high complexity hospital bed turnover rate, with a greater rationalization of financial resources. Among the changes, the de-hospitalization of users outside the HC criteria to smaller units or to the municipalities of origin, one of the pillars of the new Program, contributed towards the release of high complexity hospital beds. Despite the expansion of the healthcare coverage, a decrease was observed in the number admitted patients having a high number of readmissions due to deteriorating clinical condition (41%), during the period from May 2018 to May 2019. The change in the organization of the working processes implied in the loss of federal funding for the healthcare teams and, in turn, the lack of use of assessment parameters of the service evidenced a weakness in the operation and control of the program. It is concluded that the recent option for the provision of services by private enterprises seems to reinforce the fragmentation of the healthcare, not promoting the integration among the services, based on the precariousness of the work, with the continued underfunding of the public sector and the sub-regulation of the private sector. It is suggested that SESAB convene healthcare service user organizations, health professionals and academic specialists to broaden the HC feasibility analysis and expansion, based on the health perspective and in defense of the interests of SUS, and on the healthcare needs of the population.

2
  • NUBIA DE ARAUJO PAIVA
  • Development of an antimicrobial management program in a neonatal ICU
  • Advisor : LUIS EUGENIO PORTELA FERNANDES DE SOUZA
  • COMMITTEE MEMBERS :
  • IZA MARIA FRAGA LOBO
  • LUIS EUGENIO PORTELA FERNANDES DE SOUZA
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: Feb 3, 2020


  • Show Abstract
  • Health Care Related Infections (HAIs) are causes of high levels of morbidity and mortality. Antibiotics are among the most commonly prescribed drugs in the neonatal intensive care unit (NICU). The prolonged duration of empirical antibiotic therapy for early sepsis in extremely low-weight infants has been associated with an increased risk of death and necrotizing enterocolitis (NEC). Infections by resistant microorganisms in neonatology are also associated with increased morbidity and mortality and increased health costs.
    In order to guide health professionals in the design and implementation of programs to manage the use of antimicrobials in health services, Anvisa published in 2017 the National Guideline for the Development of a Management Program for the Use of Antimicrobials in Health Services. The objective of these studies was to develop an Antimicrobial Management Program at the NICU of Maternidade Climério de Oliveira. For this, a situational analysis of the use of antimicrobials was performed in the NICU of the Maternidade Climério de Oliveira measuring the use of antimicrobials by calculating the DOT (Days of Therapy) and LOT (Duration of Therapy in days) indicators. Subsequently, the objectives, implementation strategies and evaluation mechanisms of an Antimicrobial Management Program at the NICU of Maternidade Climério de Oliveira were defined.
    In order to guide health professionals in the design and implementation of programs to manage the use of antimicrobials in health services, Anvisa published in 2017 the National Guideline for the Development of a Management Program for the Use of Antimicrobials in Health Services. The objective of these studies was to develop an Antimicrobial Management Program at the NICU of Maternidade Climério de Oliveira. For this, a situational analysis of the use of antimicrobials was performed in the NICU of the Maternidade Climério de Oliveira measuring the use of antimicrobials by calculating the DOT (Days of Therapy) and LOT (Duration of Therapy in days) indicators. Subsequently, the objectives, implementation strategies and evaluation mechanisms of an Antimicrobial Management Program at the NICU of Maternidade Climério de Oliveira were defined.

3
  • ANGELICA ARAUJO DE MENEZES
  • The use of Workload Indicators of Staffing Need (WISN) to scale medical staff in a state maternity hospital in Bahia.

  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • ISABELA CARDOSO DE MATOS PINTO
  • MARIO ROBERTO DAL POZ
  • Data: Feb 13, 2020


  • Show Abstract
  • Operating health systems require qualified, affordable, equitably distributed FTS available to the entire population as these are foundations for ensuring access to health. It is noteworthy that there is a global FTS crisis and, in Brazil, expressed by the unequal distribution of health personnel, particularly in rural regions, urban peripheries or hard to reach places, such situation constitutes a major obstacle to ensuring access to health systems and services. It is noteworthy that the debate between the adequacy of FTS and the organization of practices in health services is a major challenge for management, since PFT is among the most complex types of planning. Based on the above, the sizing and analysis of workloads found for the CO and PA medical staff of a State maternity hospital is relevant to think about improvements in the work processes and future strategies for capturing, selecting and maintaining this type of workers in the unit, which may favor the improvement in the quality of health care for women and children at the state level. This scenario motivated the conception of this dissertation whose general objective was to analyze the workload of obstetric gynecologists, using the WISN method, who work in the IPERBA obstetric center, in 2019. This is an intervention study, descriptive exploratory study with a quantitative approach and qualitative elements, in which the methodological steps recommended by the WISN were used to calculate and analyze the workload of the obstetrician gynecologist medical professionals working in the CO and PA of IPERBA. The work indicated a deficit of 14 obstetricians on duty in the unit with a workload of 0.81. The study also pointed out that the quantitative insufficiency of obstetricians in IPERBA was due to precarious hiring and consequent, idleness of medical posts, associated with poorly structured work processes and a multidisciplinary team deficit. Finally, the dissertation, based on the FTS sizing of obstetricians, has the potential to contribute to the PFT in the health care network of women and children, however, it is advised to repeat the research in the same maternity and , if possible, for a longer period of observation, as in others of the same profile so that stronger recommendations can be made.

4
  • MARIANA DE PAIVA MOURA
  • NUTRITIONAL ATTENTION IN THE PRENATAL OF A UNIVERSITY MATERNITY IN A NORTHEAST CAPITAL: A NORMATIVE ASSESSMENT
  • Advisor : SONIA CRISTINA LIMA CHAVES
  • COMMITTEE MEMBERS :
  • SONIA CRISTINA LIMA CHAVES
  • LUIS EUGENIO PORTELA FERNANDES DE SOUZA
  • VALTERLINDA ALVES DE OLIVEIRA QUEIROZ
  • Data: Jul 15, 2020


  • Show Abstract
  • Objectives: The present study evaluated the adequacy of prenatal nutritional care practices in a university maternity clinic to the principles of the Instructional Manual of  Feeding and Nutritional Actions of the “Rede Cegonha” (Stork Network), Food and Nutritional Surveillance and programs and policies of the Ministry of Health regarding maternal and child care. Moreover, the socioeconomic, obstetric and nutritional profiles were outlined and the nutritional conditions of the pregnant women under care was analyzed. Methods: An evaluative study that used a narrative literature review and assessing the adequacy of nutritional care during prenatal nutritional attention, through a model developed by Avedis Donabedian. Results and Discussion: nutritional prenatal care is adequate according to most of the evaluated criteria of nutritional care. In the 12-criteria structure assessed, 7 (58.3%) presented good compliance.  On the other hand, in the process component, there was good compliance in the assessed standards, with exception to the beginning of the first consultation up until the 4th month of pregnancy and for the number of prenatal appointments. In the result component, there was also good compliance for most of the standards assessed, with exception to the number of registers in the practice of the promotion for exclusive breastfeeding. Additionally, a high prevalence of excess weight was verified for the pregnant women under care, both in the first as in the last nutritional consultation registered. Conclusion: the adequacy of the nutritional care practices of the evaluated maternity prenatal service was classified as partially adequate for most of the components evaluated by the regulations. The logical model proved to be a useful and feasible tool in the organization of evaluation processes. 

5
  • CAROLINA SANTOS SILVA
  • PARTICIPATORY EVALUATION OF THERAPEUTIC PROJECTS
    INDIVIDUALS IN TYPE II PSYCHOSOCIAL CARE CENTERS:
    CONSTRUCTION AND IMPLEMENTATION OF INDICATORS

  • Advisor : VANIA NORA BUSTAMANTE DEJO
  • COMMITTEE MEMBERS :
  • LILIANA SANTOS
  • ROSANA TERESA ONOCKO CAMPOS
  • VANIA NORA BUSTAMANTE DEJO
  • Data: Sep 3, 2020


  • Show Abstract
  • The general objective of the research is to build, in a participatory manner, with professional indicators for the evaluation of STP and specific to implement the indicators constructed; identify strengths and weaknesses in the construction of the PTS and contribute to the qualification of professionals regarding the construction of unique therapeutic projects and participatory evaluation. The development of indicators for the evaluation of the Unique Therapeutic Project (PTS) is justified by the lack of instruments in the management of the Unified Health System that enable a systematic assessment of this technology and the need to evaluate the Psychosocial Care Centers (CAPS) services that substitute for psychiatric hospitals, mitigating the possibilities of them producing contradictory or incompatible practices to the assumptions of psychiatric reform. The methodological framework was participatory evaluative research, covering the character of intervention, anchored in the assumptions of the fourth generation assessment. Representatives of 7 CAPS II from the city of Salvador from different professional categories participated in the research, composing the interest groups: assistance workers, managers, technical coordinator, institutional supporters in mental health and students of the Multiprofessional Residence in Family Health - FESF / SUS. Between the months of September and December 2019, a formal extension course was offered at the Institute of Psychology of the Federal University of Bahia, as part of the data collection process. In addition to the course, Shared Appraisal Groups (GAP) and consensus workshops were used to consolidate data collection. For data interpretation, the use of narrative theory and Paul Ricoeur's hermeneutic circle was used. As a product of the research, we obtained three technical productions: the extension course “Qualification of assistance in CAPS type II based on the evaluation of Unique Therapeutic Projects”, the “Methodological guide for the application of PTS evaluation indicators in CAPS II” and the “Form for Registration of Singular Therapeutic Project (PTS)”. The results were organized into three sessions. In the first, we present the reality of the CAPS II narrated by the participants. In the second, we have the process of building the 8 indicators: “Formulation of a unique therapeutic project”; "User cases by reference technician (TR) or reference team (ER)"; “PTS shared with Primary Care (AB)”; “PTS shared with the intersectoral network (except AB)”; "Joint discussion of PTS among the team"; “Systematic review of PTS by TR or ER”; “PTS with treatment only with medication” and “Investment in Permanent Education actions”. Finally, we present the challenges in the implementation of indicators, with the data obtained during the dispersion activity in services. The experience of the qualification course and the process of participatory elaboration of the indicators configured the integration between the experience of practical wisdom and theoretical knowledge. A collective construction in which it is believed that it will provide support so that there are consequences in the daily life of 11 services, generating an intervention effect expected by this research. The biggest challenge is to include the use of indicators and assessment in relation to work processes and not as merely technical expertise used by the manager. This becomes even more difficult when we are in a field where there is no tradition of using this tool

6
  • MARCELA ALMEIDA MUHANA
  • Evaluation of the accuracy of the Bahiafarma and Bio-manguinhos rapid tests for the diagnosis of arboviruses: dengue, Zika and chikungunya
  • Advisor : GUILHERME DE SOUSA RIBEIRO
  • COMMITTEE MEMBERS :
  • GUBIO SOARES CAMPOS
  • GUILHERME DE SOUSA RIBEIRO
  • MOYRA MACHADO PORTILHO
  • Data: Sep 11, 2020


  • Show Abstract
  • Since 2015 Brazil has been experiencing the simultaneous circulation of arboviruses dengue, Zika and chikungunya. In this way, it is essential to use tools that are sensitive, specific and timely to detect such infections and assist health professionals regarding treatment. The aim of this study was to assess the accuracy of the rapid diagnostic tests (TRD) of dengue, Zika and chikungunya of two companies that obtained registrations at Anvisa / Brazil: Bahiafarma (BF) and BioManguinho (BM). Serum samples collected during the acute phase and paired convalescent samples from a surveillance study sample for RT-PCR detection of arbovirus infections among patients with acute febrile illness in a health unit in Salvador-Bahia. As controls, samples of serum from patients with acute febrile illnesses identified by the same study of surveillance and with a result of negative RT-PCR for the three arboviruses and also samples of blood donors. To estimate the number of samples in the evaluation, it was considered an expected sensitivity and specificity for tests of 90%, an accuracy of 8% and with 95% confidence, with the need for 60 acute samples and 60 convalescent for each group of cases and controls. The final sample included 54 cases of dengue (53 acute samples and 41 convalescent), 12 cases of Zika (11 acute samples and 7 convalescent) and 60 cases of Chikungunya (60 acute samples and 60 convalescent) and two control groups: 60 arbovirus-negative febrile patients and 23 donors of blood. The sensitivity and specificity of the dengue, Zika and chikungunya of BF and BM and we present in the summary the IgM result of the sample convalescent considering that the tests assess the presence of antibodies. To the convalescent samples of dengue, chikungunya and Zika from Bahiafarma presented, respectively, a sensitivity of 51.2% (95% CI 32.9-60.9%), 56.7% (95% CI 44.1-68.4%) and 14.3% (95% CI 2.5-51.3%) and a specificity of 95.2% (95% CI 90.0-97.8%), 96.3% (95% CI 90.8-98.5%) and 96.3% (92.0-98.3%). The sensitivities of the BM TRD in convalescent samples were: dengue-60.0% (95% CI 44.6-73.7%), chikungunya-98.3% (95% CI 91.2-99.7%), Zika-100% (95% CI 64.6-100%) and the specificities were, respectively, 65.5% (95% CI 56.3-73.6%), 93.4% (95% CI 87.0- 96.8%) and 68.8% (95% CI 61.1-75.6%). Therefore, we recommend only using the 10 rapid bio-cuff chikungunya test, after the 10th day of symptom onset. The other tests had insufficient performance.
7
  • LEIDIANE ANDRADE BARRETO AZEVEDO
  • OFFER AND ACCESS TO IMAGE SERVICES: STUDY OF A HEALTH REGION IN BAHIA
  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • ANA LUIZA QUEIROZ VILASBOAS
  • DJANILSON BARBOSA DOS SANTOS
  • ERIKA SANTOS DE ARAGAO
  • MARILUCE KARLA BOMFIM DE SOUZA
  • Data: Sep 11, 2020


  • Show Abstract
  • This study is characterized as a production for the Professional Master's Degree in Health Technologies developed in the format of two articles, which present social and service contributions, as well as theoretical and scientific contributions for reflection on the offer and access to health technologies available to SUS specialized care, and its general objective is to analyze the characteristics and strategies that interfere with the supply and influence the access and use of diagnostic imaging services provided in a service contracted by SUS in a city in the region of health in Bahia. The purpose of Article 1 was to characterize the demographic and morbidity profile of the population using CT and MRI services offered by an image service contracted in the city that hosts the health region of the state of Bahia, in the period from 2015 to the first semester of 2019. Prepared from data from the information system, and complementary to reports by key informants, the main findings pointed out that women, population 50 to 59 years old, residents of the headquarters of the health region and the urban zone characterize the predominant profile of users of the services studied. Most of the procedures performed were related to joint and skull exams, with low back pain and headache being the most frequent complaints. There was also a reduction in the total number of consultations in 2019 in the contracted service, especially regarding the TC service, which can be attributed to the implementation of the Regional Polyclinic. As for Article 2, the objective of which was to describe the strategies and regulatory mechanisms for the provision of diagnostic imaging services (CT and MRI) in a regional headquarters, as well as to identify challenges for managers in contracting and allocating services. The findings from the reports of the key informants pointed out that there is an imbalance between the supply and demand of CT and MRI services at SUS and improved access to diagnostic services with the arrival of the Regional Polyclinic, especially regarding CT scans. In addition, underfunding in the SUS, the low resolution of Primary Health Care (PHC), the greater demand than the offer and the reduced number of places were identified as challenges for the allocation of services. Despite the expansion of access to imaging services in SUS, with the implementation of the regional polyclinic, there is still a repressed demand for MR services, which causes an increase in the waiting time for this procedure. Therefore, the study highlights the importance of the regulation sector to monitor the performance of services, as well as the expansion of supply, taking into account the availability of services and the needs for serving the population residing in the health region. Thus, the importance of regulating the provision of image services by managers becomes paramount.

8
  • LORENA PASTOR RAMOS
  • EVALUATION OF ACCEPTANCE OF THE INSTRUMENT OF IDENTIFICATION OF ADVERSE OBSTETRIC EVENTS IN A PUBLIC MATERNITY IN SALVADOR.
  • Advisor : GISELIA SANTANA SOUZA
  • COMMITTEE MEMBERS :
  • GISELIA SANTANA SOUZA
  • LENY ALVES BOMFIM TRAD
  • KIONNA OLIVEIRA BERNARDES SANTOS
  • LENICE GNOCCHI DA COSTA REIS
  • Data: Oct 8, 2020


  • Show Abstract
  • In general, it is estimated that about 2% of obstetric patients suffer any serious adverse event during childbirth, despite the absolute number be very significant, considering the number of women and children who are this assistance. Reis (2012) developed a specific instrument for use in obstetrics services called “Simplified Method for Identifying Adverse Events in Maternity Hospitals ”(MSIEAM), based and adapted from the module “Perinatal Trigger Tool”, from the Institute for Healthcare Improvement (IHI). Given the importance of this instrument, the present study aims to assess the acceptability of the MSIEAM, as well as discussing the possible incorporation of the method in a maternity hospital in Salvador. This is an evaluative research, using qualitative and quantitative approach. In the first part of the work, validated the instrument for data collection, the questionnaire for the assessment of acceptability of MSIEAM, with the participation of a committee of experts. At second part, the acceptability assessment itself was carried out in a maternity school in Salvador, with the application of the MSIEAM form in a random sample of 60 birth records at the institution for 19 health professionals, members of three commissions of the institution, totaling the target population of the study. In the analysis of the data, the distribution of absolute, relative frequencies, measures of centralization and dispersion of results obtained about opinions about the method. The SPSS Statistics program 23.0 was chosen for statistical analysis. The MSIEAM acceptability assessment was satisfactory since almost 90%
    responses were positive to the items components of the questionnaire used for this assessment. The percentage of acceptability among professionals in the study population reached almost 80%, with a percentage of 90% of completeness of the form used in MSIEAM. Conclude pertinent the implantation of the method in the study maternity, as well as the development of a multicenter pilot study, including other research institutions obstetric and neonatal care, where there is a possibility to extrapolate the implantation of the method given the similarities of context. However, it is suggested to carry out a previous stage of updating and validating the form for data collection in the with a panel of experts. Identify adverse events and implement Measures that reduce maternal and neonatal morbidity and mortality should guide the planning of patient safety actions in health institutions for this care.
9
  • GLEIDSON CARDOSO SPÍNOLA
  • Metformin for the treatment of diabetes mellitus in pregnancy: results of a retrospective study compared with current evidence.
  • Advisor : JANE MARY DE MEDEIROS GUIMARÃES
  • COMMITTEE MEMBERS :
  • JANE MARY DE MEDEIROS GUIMARÃES
  • LIDIA LIMA ARAGAO SAMPAIO
  • MARIA CRISTINA DE CAMARGO FONSECA
  • ROSEANNE MONTARGIL ROCHA
  • Data: Oct 8, 2020


  • Show Abstract
  • Introduction: With the current criteria for the diagnosis of diabetes mellitus (DM) in pregnancy, it is estimated an increase from 7.6% to 18% of its prevalence in Brazil. The lack of glycemic control increases the risk of unfavorable maternal-fetal and neonatal outcomes. Oral hypoglycemic agents appear as a therapeutic alternative before insulin therapy when behavioral changes (diet and physical activity) are not successful and metformin emerges as a safe and effective drug in pregnancy. Objective: To trace the sociodemographic profile of pregnant women attended at Maternidade Climério de Oliveira (MCO), diagnosed with gestational diabetes mellitus (DMG) and type 2 pre-gestational diabetes (DM2), treated with metformin, observing the convergence of the main gestational complications and of maternal-fetal outcomes with current evidence from the literature. Method: Retrospective cross-sectional observational study involving diabetic pregnant women (DMG or DM2) who used metformin alone or associated with insulin. Discussion: Data from 58 pregnant women and telephone interviews were analyzed in order to compare different maternal-fetal outcomes with current evidence selected in a systematic literature review. Sociodemographic data evaluated: race, education level, income and place of residence. Maternal-fetal and neonatal outcomes analyzed: prematurity; macrosomia or newborns large for gestational age; admission to the Neonatal Intensive Care Unit; neonatal hypoglycemia; Apgar of 5 minutes (> 7); dystocia; frequency of cesarean sections; instrumental deliveries; failure to induce vaginal delivery; maternal-fetal metabolic disorder; body mass index (BMI) at delivery and hypertensive disease specific to pregnancy (DHEG). Relevant clinical variables discussed: age, parity, abortions and comorbidities. Conclusion: This research with extensive literature review showed that in the analyzed population, mostly black, in unfavorable socioeconomic and cultural conditions and without other studies on the use of metformin in pregnancy, the results converged with the current evidence in the literature. Additionally, it aims to collaborate with the decision making of the managers and clinical staff of the maternity hospital on the use of metformin; with the development of indicators related to DM in pregnancy and professional qualification for specific DM care. It also intends to promote effectiveness studies on the impact of the use of metformin in high-risk pregnant women with diabetes mellitus.
10
  • ANA RITA CLEMENTE DE SANTANA CONCEIÇÃO
  • CHILDREN'S DEATH SURVEILLANCE AS A STRATEGY FOR THE IDENTIFICATION OF ATTENTION ACCESS BARRIERS CHILDREN'S MATERNAL IN THE MUNICIPALITY OF SALVADOR-BAHIA
  • Advisor : EDUARDO LUIZ ANDRADE MOTA
  • COMMITTEE MEMBERS :
  • EDUARDO LUIZ ANDRADE MOTA
  • JOILDA SILVA NERY
  • CONCEIÇÃO MARIA DE OLIVEIRA
  • Data: Oct 21, 2020


  • Show Abstract
  • Infant mortality remains a public health problem in Brazil due to the maintenance of preventable deaths, whose causes reflect the living conditions of a given population. The Child Death Surveillance (VOI) was instituted by the Ministry of Health in 2010 nationally, with the municipalities responsible for its operation. The objective of this study was to evaluate the contribution of VOI to identify possible barriers to access maternal and child care in the city of Salvador from 2015 to 2017. This is an exploratory and descriptive study based on the data contained in the Information System of Mortality (SIM) in the city of Salvador in the years 2015 to 2017. Quantitative data were subjected to statistical analysis of mean and proportion and organized in tables and graphs using Microsoft office Excel and the access barriers identified from the problems listed in Summary Form Conclusion and Recommendations, and the guidelines for the care line for pregnant women and newborns from the Ministry of Health are compared. As a result, it was observed that the proportion of deaths investigated in the municipality is low, varying between 22.8% ( 2015) to 33.7% (2017).VOI's activities are partially decentralized to 50% of the Health Districts (DS) that have a Technical Chamber District of Death. IMTs decreased in the period under study and disparities between SDs, with IMTs of 14.5 / 1000NV in 2017. There was a high proportion of preventable deaths with percentages of 59% (2015), 57% (2016) and 73 , 3% (2017), as well as problems in access to services, indicating as possible barriers: the low availability of services and coverage of Primary Health Care, especially for high-risk prenatal care and neonatal ICU vacancies; the acceptability of users related to the lack of welcoming and humanization of professionals and barriers to functional adequacy, with emphasis on the ICU beds. Despite the limitations identified, VOI proved to be potent in providing important information to support management in implementing measures to improve the quality of the Maternal and Child Network in the municipality, and provides a permanent space for discussion among those involved in the assistance provided in its various hierarchical levels to mother and newborn.

11
  • CRISTIANE DOS SANTOS SANTANA
  • Adaptation of the comfort scale for family members of people in critical health for the pediatric context

  • Advisor : FERNANDA CARNEIRO MUSSI
  • COMMITTEE MEMBERS :
  • FERNANDA CARNEIRO MUSSI
  • KATIA SANTANA FREITAS
  • LENY ALVES BOMFIM TRAD
  • Data: Oct 23, 2020


  • Show Abstract
  • Introduction: Family suffers from the admission of a member to an intensive care unit (UTI) and should be considered an object of attention by health professionals. This context justifies exploring what it promotes: how family comfort can be promoted and measured. However, there are no instruments to measure the comfort level of family members of children and adolescents in the ICU, which justifies the adaptation of the Comfort Scale for family members of people in critical health condition (ECONF) for the pediatric context. Main goal: This work aims to validate the content of ECONF for the pediatric context. Methods: The methodological study was developed according to the stages of the content validation process for cultural adaptation of scales: (1) Conceptual and item equivalence - composed of a literature review on comfort and family, analysis of the dimensions, items and theoretical bases of ECONF, adequacy of items to the pediatric context, reaching the first version of ECONF-PED, which was evaluated by the author of the original instrument; (2) Semantic equivalence - corresponded to the evaluation of the first version of ECONF_PED by the judges (specialists and target audience), the consolidation by the researchers of the data provided by the judges, allowing to arrive at the second version of the ECONF-PED, submitted to pre-test with 13 family members. The Content Validity Index (IVC) was applied to analyze the experts' responses regarding the relevance of the items to the construct and their dimensions and their language and clarity, considering an appropriate IVC ≥ 0.78. The agreement rate was applied to analyze the language and clarity of the items in the pre-test. (3) Operational equivalence - assessment of the degree of difficulty of the questions, the adequacy of the location, form of application and response options for the scale. Results: In the conceptual equivalence stage, ten items of ECONF (original scale with 55 items) were eliminated because they did not fit the pediatric context and 10 new items were prepared based on the literature. The items took the form of a question, some had their wording and terms changed for clarity and adequacy to the target audience. In semantic equivalence, the experts were unanimous regarding the pertinence of the four dimensions and respective operational definitions of the first version of ECONF-PED. After analyzing the IVCs, the qualitative considerations of the specialists and the target audience regarding the understanding and importance of the item for their comfort, it was decided to exclude eight items, 19 items remain with change in the wording and 28 without changes, arriving the second version of the ECONF-PED with 47 items was submitted to a pre-test with 13 family members. The pre-test analysis showed 36 items with a 100% agreement rate for language and clarity, six for 92.3% and five between 69.2 and 84.6. Thus, 11 items had their wording modified and underwent another pre-test with four family members, noting that only one reached a 75% agreement rate, being eliminated. Thus, the final version of ECONF-PED has 46 items distributed in the dimensions Safety (16), Support (14), Integration with you and the daily life (10) and Family interaction with the child or adolescent (6). It is a five-point Likert scale, ranging from 0 (never) to 4 (always), and can be self-applied. Conclusion: ECONFPED achieved content validity and is a valid tool to measure the comfort level of family members of children and adolescents in UTI-PED in the bahian context, and can be used to guide health care practices.

12
  • LÍVIA CORRÊA DA TRINDADE MASCARENHAS
  • EVALUATION OF THE FUNCTIONALITY OF THE CANDIDATE WITH DISABILITY THAT ENTERS UFBA BY AFFIRMATIVE POLICIES: INCORPORATION OF THE SOCIAL VULNERABILITY APPROACH

  • Advisor : CLARICE SANTOS MOTA
  • COMMITTEE MEMBERS :
  • ANA MARCIA DUARTE NUNES NASCIMENTO
  • CLARICE SANTOS MOTA
  • JOILDA SILVA NERY
  • Data: Nov 5, 2020


  • Show Abstract
  • The access of disabled people to Higher Education is a growing reality in Brazil. Through Affirmative Policies that population, historically neglected and stigmatized, has been getting access to Federal Institutions of Higher Education. Nevertheless, besides the access, it is necessary to construct solid bases in order to guarantee both the permanence and the inclusion of those students at the University. As a relevant component of the process of characterizing the disability for legal purposes  in relation to the eligibity for a vacancy in undergraduate courses at UFBA (the Federal University of Bahia), the Rubens Brasil Service of Promotion to Health (RBSPH) (SMURB in Portuguese), has been carrying out, through its multiprofessional team, the assessment of disabled candidates’ functioning. The assessment is based on the International Classification of Functioning, Disability and Health (ICF) (CIF in Portuguese) and aims to identify aspects of health, functioning and social vulnerabilities in that population. It is still a technology which is in its ongoing process as well as in its improvement. The main objective of this study was to generate subsidies which can improve functioning assessment of disabled candidates who wish to enter into a course at UFBA via affirmative policies starting from the analysis of social vulnerability. It is an exploratory and descriptive study with a quantitative approach performed at RBSPH (SMURB), which has, as a sample, 55 disabled candidates who had their functioning assessed between the two semesters of 2018. As its main sources, the secondary data gotten from the answers in the assessment sheets were considered by the RBSPH Inclusion Center. The data were analyzed and presented in tables and graphs according to the candidates’ socio - demographic, economic and functioning profiles having as its basis the theoretical reference of this study. Its results show the great social vulnerability of that population, which has an impact on the functioning and can have some implications relating to the students’ permanence and conclusion of the course at UFBA. It is necessary to build up constant communication among the various social actors involved in the elaboration of this support process given to disabled people at UFBA, having the functioning assessment as its starting point.

13
  • IJACIÁ DE CARVALHO RIBEIRO
  • COMPARATIVE STUDY BETWEEN EXPENDITURE ON CONVENTIONAL TREATMENT AND EXPENDITURE ON PLATELET RICH PLASMA IMPLANTATION, IN PATIENTS WITH TIBIA PSEUDARTHROSIS, FROM THE PERSPECTIVE OF THE UNIQUE HEALTH SYSTEM.
  • Advisor : GILDASIO DE CERQUEIRA DALTRO
  • COMMITTEE MEMBERS :
  • ADEMARIO GALVAO SPINOLA
  • GILDASIO DE CERQUEIRA DALTRO
  • MARCIO SANTOS DA NATIVIDADE
  • MARIO CASTRO CARREIRO
  • Data: Nov 26, 2020


  • Show Abstract
  • Fractures, especially those resulting from traffic accidents, and their complications, represent an important condition that has led to increasing costs for SUS, both in primary treatment and in the care of their injuries. One of them, pseudarthrosis, a well-known entity in orthopedics, is a complication of fractures where the bone does not present consolidation characteristics. Faced with a scenario, in which the increase in hospital costs in the surgical treatment of fractures is observed, as well as pension expenses embedded in the cost of pensions and retirements, resulting in loss of work activity with great repercussion in the country's economy, we decided to carry out a clinical trial comparing the expense of conventional surgical treatment for tibial pseudoarthrosis, using plates and screws, intramedullary nail or external fixators, with the use of a new technology: the injection of platelet-rich plasma in the focus of the referred lesion, in patients treated by the Unified Health System.

14
  • ELAINE CRISTINA DA LUZ DOS SANTOS
  • Profile of UFBA students submitted to health expert assessment: development of an instrument for monitoring academic absences.

  • Advisor : MONIQUE AZEVEDO ESPERIDIAO
  • COMMITTEE MEMBERS :
  • ALINE SANTOS SAMPAIO
  • MONIQUE AZEVEDO ESPERIDIAO
  • VANIA NORA BUSTAMANTE DEJO
  • Data: Dec 9, 2020


  • Show Abstract
  • University life can be a stress factor for many students and, when associated with other aspects, can lead to symptoms of psychological distress that compromises the student's mental health, to the point that he is unable to continue his studies and, therefore, enter with an academic process to lock enrollment for health reasons. Objective: To analyze the profile of students served by SMURB's medical expertise who entered the academic process for reasons of mental health, with a view to developing an instrument for monitoring student absence. Method: Exploratory and documentary case study that aims to develop a technology, tool, which is the monitoring instrument for students away from academic activities due to mental health problems in the SMURB automation system, based on the study and description of the profile of the expert students who enter the enrollment termination process for reasons of mental health at UFBA. Results: It found a predominance of students in the age group 25 to 34 years old, female who had no partner, no children, no job, born in Salvador -Ba and metropolitan region and who had no health insurance. The results related to academic and expert characterization revealed that the area of biological sciences and health professions and undergraduate courses in medicine and Bi Health cover the largest number of students who have an academic process due to mental health problems, while in graduate school were doctoral students with predominance in courses in architecture and urbanism and computer science. The justifications reported by the students as a trigger for psychological suffering were related to family problems and the academic context, such as overload of studies, difficulty in writing the writing of the Thesis / Dissertation, in addition to the competitiveness in the BI health course. Conclusion: The identification of the students' sociodemographic, clinical, expert and academic profile made it possible to objectify characteristics related to the mental suffering of academics and made it possible to build and validate a proposal for an instrument for monitoring and accompanying student absence. It is expected to collaborate with the organization of work processes at SMURB, allowing to qualify the situational analysis of academics with a view to proposing actions of mental health promotion and attention on campus and favoring the individual monitoring of the return of each student.

15
  • VALERIA LIMA BOTELHO
  • ANALYSIS OF EXPENDITURE ON TREATMENT OF HIP OSTEONECROSIS: CELL THERAPY AND TOTAL ARTHROPLASTY IN PEOPLE WITH ANEMIA FALCIFORM IN THE SUS PERSPECTIVE
  • Advisor : MARCIO SANTOS DA NATIVIDADE
  • COMMITTEE MEMBERS :
  • ERIKA SANTOS DE ARAGAO
  • GILDASIO DE CERQUEIRA DALTRO
  • MARCIO SANTOS DA NATIVIDADE
  • MARIO CASTRO CARREIRO
  • SUSANA BEATRIZ SNEIDERMAN
  • Data: Dec 9, 2020


  • Show Abstract
  • Sickle Cell Disease is defined as an autosomal recessive disorder characterized by the presence of abnormal hemoglobin S. Sickle Cell Disease is originating from the African continent. Due to the long historical process of intense enslavement of African peoples and colonization of Brazil, the black population is the most affected. The S gene is more prevalent in Bahia and Salvador. Approximately 50% of patients with Sickle Cell Disease have avascular necrosis, which mainly affects the head of the femur. The treatment of osteonecrosis of the femoral head is considered a challenge. Traditionally, the therapy used is total hip arthroplasty, which corresponds to an invasive procedure with high rates of morbidity and mortality and unsatisfactory results after 5 to 10 years. Cell therapy, with the use of stem cells, proves to be an important alternative to be incorporated into SUS in the treatment of hip osteonecrosis. Patients with Sickle Cell Disease present better prognosis with cell therapy, featuring a 5% failure rate. Considering the efficiency of cell therapy, the objective of the present work was to perform an analysis of the effective spending on this therapy in hip osteonecrosis in people with sickle cell disease, in the context of SUS. For this purpose, a descriptive, comparative and crosssectional study was developed of people assisted at the Professor Edgard Santos University Hospital Complex, with hip osteonecrosis secondary to Sickle Cell Disease and submitted to cell therapy, in the age group of 18 to 40 years old, in the period from 2015 to 2019. From the medical records of the patients, the expenses of cell therapy and total hip arthroplasty were estimated for analysis and comparison purposes. To evaluate health expenditures, the microcosting methodology was applied and the SUS perspective was used as the purchasing organization of public and private health services. All direct expenses were computed based on the coverage of the reimbursement tables of SUS procedures. In addition, data from DATASUS were consulted. Concerning cell therapy in hip osteonecrosis from 2015 to 2019, 74 patients were tended, with 88 surgical procedures being performed. The results showed that the expenses obtained with each procedure were R$ 3,265.22 for cell therapy and R$ 4,764.08 for total hip arthroplasty. Based on scientific evidence, the loosening of prostheses referring to primary total arthroplasty in Sickle Cell Disease, where the value of R$ 4,764.08 has an average useful life of 5 to 10 years, requires a total revision arthroplasty, a procedure with estimated expenses of R$ 6,365.18. Therefore, the expenses are even higher compared to cellular therapy, with an increase of R$ 7,864.04 per procedure. In this context, from the evaluation of the expenses considering the 74 patients analyzed, it was verified that, while cellular therapy generated an expense of R$ 287,339.36, if the traditional method was adopted, the amount spent would be R$ 979,374.88. Then, through the analysis carried out, cell therapy proved to be more economical, being a treatment that makes it possible to treat more people in less time.

16
  • THIAGO RHANGEL GOMES TEIXEIRA
  • COMPARATIVE STUDY BETWEEN TREATMENT EXPENSES OF SHOULDER OSTEONECROSIS IN PATIENTS WITH ANEMIA FALCIFORM, WITH THE USE OF STEM CELLS AND TOTAL ARTHROPLASTY
  • Advisor : GILDASIO DE CERQUEIRA DALTRO
  • COMMITTEE MEMBERS :
  • ADEMARIO GALVAO SPINOLA
  • GILDASIO DE CERQUEIRA DALTRO
  • JANE MARY DE MEDEIROS GUIMARÃES
  • MARIO CASTRO CARREIRO
  • Data: Dec 21, 2020


  • Show Abstract
  • The general objective of the research is to compare the costs of treating osteonecrosis of the shoulder in patients with sickle cell anemia treated with the use of bone marrow mesenchymal cells and patients treated in the conventional manner (arthroplasty) at the Professor Edgar University Hospital Complex. Santos (COM - HUPES) and, as specific objectives, describe clinical characteristics such as onset of symptoms, lesion laterality, location of osteonecrosis and restrictions on activities of daily living. Sickle cell disease is a public health problem, especially in the state of Bahia, due to its high prevalence, and for causing serious complications to the individual's health. Therefore, the need for research on less invasive, costly and better recovery treatment is justified. The use of the autologous CMMO implant appears as a new alternative, with good results and greater comfort and safety. What shows the importance of this study to analyze the advantages of the proposed treatment, in comparison to the conventional one (use of prostheses), so that we realize the difference in costs, length of hospital stay, recovery time and return to activities. The methodological framework is based on a retrospective cohort study, focusing on expenditures made with patients with SCD and followed up, over a period of 14 years, between 2005 and 2019, at Com-HUPES, with the selection of the population of the study, was performed by analyzing medical records and patient records, with osteonecrosis of the shoulder. Thus, we evaluated the cost of surgery for cell therapy by analyzing the data from the Com-HUPES cell therapy treatment project compared to the SUS table of values for the total shoulder arthroplasty procedure, which is still the standard treatment. - recommended gold. We analyzed the surgical / clinical data of 29 people diagnosed with sickle cell disease and with osteonecrosis, of both sexes, aged between 18 and 42 years. The results obtained show that the costs of surgery in which the humeral head is replaced with the use of prostheses (total of R $ 4,121.52), have a cost of at least R $ 965.85 (23.43%) more than surgery with the implantation of stem cells (total of R $ 3,155.67). We can conclude, in this way, that in addition to the indisputable advantage for the patient - such as shorter hospital stay (which indirectly brings numerous benefits, such as lower risk of infections, embolism, thrombi, etc.), better recovery, return to the daily activities of earlier, less local aggression and consequently less painful process, among other countless benefits - there is also an evident savings for public coffers and for the Unified Health System, where we realize savings of approximately 25% of the costs with the procedure using the stem cells in relation to conventional treatment with shoulder arthroplasty.

2019
Dissertations
1
  • HUMBERTO LAGO LIVRAMENTO
  • DEVELOPMENT OF NEW FUNCTIONALITY FOR THE HOSPITAL INFORMATION SYSTEM FOR REGISTRATION AND ANALYSIS BY SANITARY AND DISTRICT DISTRICT IN THE MUNICIPALITY OF SALVADOR
  • Advisor : ERIKA SANTOS DE ARAGAO
  • COMMITTEE MEMBERS :
  • ERIKA SANTOS DE ARAGAO
  • JANE MARY DE MEDEIROS GUIMARÃES
  • MARCIO SANTOS DA NATIVIDADE
  • SANDRA ELY BARBOSA DE SOUZA
  • Data: Mar 27, 2019


  • Show Abstract
  • The Health Information Systems subsidizes information, important for Analysis of Health Situations and Health Planning and Management for geographic population groups. In Brazil, among several systems, we have the Hospital Information System SUS (SIH-SUS), created for payments and auditing, but it has been used for studies related to epidemiology and hospital quality management analysis. Your system data is provided by DATASUS, through the disseminable files (DEF) and tabulated by the Tabwin application. One of the available variables is the postal address code of the boarding school. The present study proposes the use of the zone and district zoning functionality of residents of the city of Salvador of SIH / DATASUS data in Tabwin and Tabnet Salvador site and describe how the tool is. By adding functionality, it will be made available for both research and health planning purposes, the data more refined allowing a closer intervention of the health problem in and contribute to the construction of the Municipal Health Plan.

2
  • ADRIANA DE OLIVEIRA LIMA DOS SANTOS
  • PROMOTION OF HEALTH IN UFBA: CONCEPTIONS AND ACTIONS
  • Advisor : LILIANA SANTOS
  • COMMITTEE MEMBERS :
  • ANA LUIZA QUEIROZ VILASBOAS
  • LILIANA SANTOS
  • MONIQUE AZEVEDO ESPERIDIAO
  • ODETE MESSA TORRES
  • Data: Mar 28, 2019


  • Show Abstract
  • The Health Promoting Universities (UPS) are institutions that apply the principles of Health Promotion in your strategic planning transversally. In this research are analyzed conceptions and actions of Health Promotion existing in the Federal University of Bahia. A qualitative exploratory study was based through documentary analysis and semi-structured interviews with key informants. Health Promotion (PS) and Health Promoting Universities (UPS) Conceptions of health were identified and mapping was done by the PS actions mentioned by the participants, with a view to the analysis of the conceptions and actions regarding having an individual focus on the development of healthy habits or more collective, relating to the conditions of life, as well as the way they engage and translate into responses to the internal and external community of the University. The analysis of the data was performed seeking to identify relations between the speeches and documents and the principles of the PS and its fields of action proposed by OMS and in the Letter of Ottawa and theoretical reference about Health Promoting Universities. It was verified that the conceptions about PS in UFBA cover a lifestyle gradient of living and working conditions, which mainly include the creation of health-friendly environments, especially the relational environment, the empowerment of individuals, and reinforcement of community action. The principle of equity was little mentioned by the participants. Broader issues such as power relations and the health care model are scattered in the speeches. University autonomy and competence are potentialities and the development of a Health Promotion Policy and its implementation in an intersectoral manner appears as the main challenge for UFBA to advance as a UPS.

3
  • ELIENE DOS SANTOS DE JESUS
  • REGISTRATION OF BASIC CAUSE OF DEATH IN THE INFORMATION SYSTEM ON MORTALITY: OCCURRENCE OF LESS USEFUL CODES IN SALVADOR, BAHIA
  • Advisor : EDUARDO LUIZ ANDRADE MOTA
  • COMMITTEE MEMBERS :
  • EDUARDO LUIZ ANDRADE MOTA
  • ELISABETH BARBOZA FRANÇA
  • MARCIO ALAZRAQUI
  • Data: Apr 3, 2019


  • Show Abstract
  • The interest by studies in monitoring and evaluation of data quality in information systems has grown in the last years, but the initiatives are still isolated and no systematical. However, Ministry of Health is implementing qualification strategies to these data, as the “The Sixty Cities” Project. In that study, they tried to know the characteristics of variables of Obituary Declarations that had registries of codes of basic causes of death less useful to Health in Salvador County, Bahia, in 2017. These causes of death are called “Garbage” Codes by “Global Burden of Disease” and are less useful to analysis of health situations due to express health complications or damage that has started the chain of events that has led to death, but not the cause that, in fact, has led to death. This is a descriptive, quantitative study, using the secondary data from the Mortality Information Systems with deaths that record the codes that are useful, defined by the Ministry of Health as priorities. Salvador had, in 2017, 16,014 deaths of occurrence and residence in its territory. The most common causes were: Chapter II – Neoplasm (3,137 deaths), Chapter IX - Circulatory System Diseases (2,859 deaths), Chapter XX – External Causes of Morbidy and Mortality (2,281 deaths) and Chapter XVIII – Symptoms, Signals and Abnormal Findings of Clinic Exams and Laboratory ones do not classified (1,700 deaths). About deaths with less useful priority code records, there were 4,775 deaths that matched to 29.8 % of total deaths. Female subjects had a higher frequency (32.1%), indigenous skin color /race of the (71.4%), education level of 1 to 3 years of study (33.9%) and in the age group of 80 and + years (36.7%). As for the less useful codes, the ill-defined causes of Chapter XVIII were used more often (35.5%).

4
  • ANA ISABELA RAMOS FEITOSA DE ASSIS
  • MATERNAL OCCUPATION AND MORTALITY IN BRAZIL

  • Advisor : VILMA SOUSA SANTANA
  • COMMITTEE MEMBERS :
  • VILMA SOUSA SANTANA
  • GREICE MARIA DE SOUZA MENEZES
  • DAPHNE RATTNER
  • Data: Apr 16, 2019


  • Show Abstract
  • Objective: To estimate the maternal mortality ratio according to occupation in Brazil. Methods: This is a mortality study carried out with national data from the Mortality Information System (SIM) and the Information System on Live Births (SINASC) in the year 2015. The Maternal Mortality Ratios (MMR) were estimated according to with the maternal occupation registered in death certificates, using the Brazilian Classification of Occupations (CBO), version 2002. Results: There were 1,738 records of maternal deaths, corresponding to an MMR = 57.6 / 100,000 live births. The RMM varied among the occupational categories, being higher among service workers and agricultural workers, particularly for domestic workers (RMM = 123.2 / 100.000 live births), followed by agricultural workers in general (MMR = 88.3 / 100,000 live births). Maternal occupation was not reported in 17.0% of cases of SIM and 13.2% of SINASC, and inconsistent records were found as "housewives", the most common in SIM (35.5%) and in the SINASC (39.1%). Conclusions: Maternal mortality differs according to occupation, suggesting a contribution of the work, which requires additional research to identify occupational risk factors. Socioeconomic factors are closely related to occupation and its combination with exposures at work and access to health services needs to be addressed.

5
  • LAIZE DE CARVALHO CAJADO
  • SENSITIZATION OF HEALTH PROFESSIONALS FOR THE CARE OF TRANSEXUAL PERSONS.

  • Advisor : JORGE ALBERTO BERNSTEIN IRIART
  • COMMITTEE MEMBERS :
  • JORGE ALBERTO BERNSTEIN IRIART
  • CARMEN FONTES DE SOUZA TEIXEIRA
  • AILTON DA SILVA SANTOS
  • Data: Apr 29, 2019


  • Show Abstract
  • The reality of trans people and their health needs are still little known by the broader society and by health professionals. The objective of this work was to elaborate and carry out an educational intervention to sensitize these professionals about the care of the transsexual population. The field of study was a medical service of a public university, and its subjects were the components of the nursing team. It was qualitative work and brought a double proposal: production of knowledge and transformation of the reality investigated. For that, a workshop was organized in three meetings. An initial survey questionnaire, observation recorded in field diary, participant's written statements during the workshops, as well as a workshop evaluation questionnaire were used. Participants included eight professionals from the nursing team, five nurses and three nursing assistants or technicians, aged between 35 and 65 years and from 10 to 40 years of nursing practice.

    Despite this time of substantial professional activity only one participant declared to have undergone training on transsexuality. It was noted that participants did not distinguish between what gender is and what sex is. Some professionals demonstrated that they had contact with concepts related to transsexuality, however, they did not have mastery of them, with difficulty even of differentiation between sexual orientation and gender identity. A concern of the professionals in establishing a relation of cause and effect for the transsexuality was traversed crossing three conceptions so much: biologicist, spiritualistic and behavioral.

    There was a manifestation of the feeling of empathy directed at the trans person as well as their relatives by the participating professionals and of reflections on the prejudice / discrimination that involves transsexuality and its consequences. When reflecting on the health problems related to transsexuality the participants made a coherent list with the literature and cited psychological disorders, suicide, violence, indiscriminate use of hormone and industrial silicone. As for the transexualization process, the professionals brought as conclusions: the importance of the multiprofessional team and the priority of health actions for transsexual people that surpass the physical changes. Participants brought an extremely positive evaluation of the educational intervention, stated that they considered themselves to be safer and willing to care for the transgender person, and demonstrated a knowledge of the concept of transsexuality that is closer to what is found in the current literature. I would like to emphasize that no participant has been an expert in the subject, but rather with a greater breadth of knowledge, including the restlessness of the doubt that may foster the desire for further study on the subject

6
  • NATALIA VITAL DE SALES ANDRADE
  • CURRENT SITUATION OF THE TEACHING ASSISTANCE CENTER FONOAUDIOLOGY OF THE FEDERAL UNIVERSITY OF BAHIA: A focus on problems

  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • SONIA CRISTINA LIMA CHAVES
  • CATHARINA LEITE MATOS SOARES
  • VLADIMIR ANDREI RODRIGUES ARCE
  • REGINA YU SHON CHUN
  • Data: May 23, 2019


  • Show Abstract
  • This study consists of a situational analysis of the Speech-Language Pathology Teaching Assistance Center (CEDAF) of the Federal University of Bahia (UFBA) in relation to its operation and to its coordination with the municipal healthcare network of Salvador /BA. A descriptive case study, whereby the methodological strategy was based on the Problem Approach in the perspective of Carlos Matus’ Situational Strategic Planning. The investigation used as methodological strategy documental analysis, participant observation, semi-structured interviews and focal group with institutional actors. The results demonstrated issues associated to four of the five categories of analysis, these being: infrastructure, financing, organization and management, which refer to the weaknesses in the formation process of the students and in the integration of the Institution with the municipal healthcare network. Out of the twenty identified problems, ten were within the capacity of government and within the governability of the institutional actors, in other words, capable of intervention by the institutional actors. These issues included: lack of planning and programming of actions as a management practice, weaknesses in the teaching-service articulation, insufficient standardizing documents, frailness in the CEDAF articulation with the municipal healthcare network, inadequate management model, mismatching percentages of the agreed-to quantitative goals and the responsiveness of the service, lack of formalization of administrative and technical meetings, absence of meetings for discussing clinical cases as a part of the work process for speech therapists and disorganization of the work process of the secretaries. The conclusion is that CEDAF should institutionalize the strategic planning practice to address the improvisation of actions and efficiently achieve its important roles: education and service.

7
  • MARTA SUZIN CERCATO
  • HEMOVIGILANCE OF IMMEDIATE TRANSFUSION REACTIONS: ANALYSIS FROM A UNIVERSITY HOSPITAL OF THE STATE OF BAHIA
  • Advisor : MARILUCE KARLA BOMFIM DE SOUZA
  • COMMITTEE MEMBERS :
  • GISELIA SANTANA SOUZA
  • MARIA DE FATIMA ALVES FERNANDES
  • MARILUCE KARLA BOMFIM DE SOUZA
  • MARINHO MARQUES DA SILVA NETO
  • Data: Jun 18, 2019


  • Show Abstract
  • The main issue is the way the haemovigilance service works in the prevention and occurrence of transfusion reactions (RTs). In this sense, it is outlined as a general objective: To discuss the actions, methods and strategies of haemovigilance for the prevention, treatment and minimization of the damages of the occurrences of the transfusion reactions (immediate) in a university hospital of the state of Bahia in the period of 2012 to 2018 (HH) according to the constituent elements of the work process (object, agents, means / instruments and purpose); Identify the frequency of the immediate RTs occurring / reported in the hospital in this period; Relate the type of transfused blood component to the type of reaction; Identify the demand and the capacity of service of this UH; Identify methods and strategies used by UH to prevent RT and minimize harm. This is a retrospective, descriptive study of a qualitative and quantitative approach that adopts as a research strategy the case study. The field of this study is characterized as a hospital and outpatient unit, classified as a university hospital, whose collection was performed considering secondary data (Notivisa records, medical records, etc.), as well as other institutional documents such as clinical guidelines, hemoglobinopathies, hemoglobinopathies, hemoglobinopathies, hemoglobinopathies and hematopoietic stem cell counts. In addition, the primary data collection was done, based on the application of a semistructured interview script. From the data collected, a descriptive analysis of the

    frequencies and percentages of the occurrences and typologies of RTs, as well as the demand and the capacity of service of this UH. Also, the thematic (content) analysis technique was used as a strategy to evidence about the characterization of UH, as well as the components of the work process that characterize Hemovigilance in the case studied. All ethical aspects have been respected in accordance with the Resolution. The Hemotherapy Unit studied attends the University Hospital, which is part of the SUS Network, participates in the Sentinel Network and is contracted to the Hemoba Foundation. It is located inside the hospital, having as working agents several professionals, with different specific knowledges, in several areas of activity, having satisfactory number of working means, in conditions suitable for the current reality of this unit and to handle its product in accordance with the proposed purpose of ensuring the transfusion, preventing, treating and minimizing damage to the occurrence of (immediate) transfusion reactions. Frequency of 6.43% of immediate RTs per 1000 transfused blood components was verified. Hemolytic Febrile Reaction and Allergic Reaction were the two immediate RTs that occurred the most, reaching 97.7% of the total reactions, and 57.53% of the RTs occurred in the outpatient and hematology ward. The fever, the

    appearance of erythematous plaques and pruritus were the most frequent signs / symptoms. Regarding the gender variable for the occurrence of immediate transfusion reactions, it was observed that 51.9% occurred in women and 48.1% in men, and for the color variable, most of the recipient patients who developed a transfusion reaction declared themselves to be brown , followed by blacks and whites. There was a higher number of RTs with grade I (97.5%), with a higher occurrence of blood group O (+) group transfusions, with red blood cell counts (44.1%) and platelets (41 , 9%) were the most transfused blood components and the two most involved in most of the reported transfusion reactions. The strategies for the prevention, treatment of RTs and risk minimization identified compliance with the technical procedures in accordance with the POPs and current legislation, supervision of work agents, training and professional qualification and procedures 7 management. Therefore, the analysis of the results of this study showed that the development of the work process by the health professionals responsible for haemotherapy and haemovigilance is guided by the norms, procedures and current legislation, as well as by the adoption of strategies and methods that impact on the minimization of damages of the occurrences of the transfusion reactions, although challenges of the daily service of Hemotherapy persist, not only to the studied reality.

     

8
  • FÁBIA SAMUELA PORTO DE JESUS DA SILVA
  • BARRIERS AND DIFFICULTIES OF ACCESS TO DIALYSIS SERVICES BY PATIENTS WITH CHRONIC RENAL DISEASE: What do their therapeutic itineraries reveal?
  • Advisor : LENY ALVES BOMFIM TRAD
  • COMMITTEE MEMBERS :
  • LENY ALVES BOMFIM TRAD
  • RENI APARECIDA BARSAGLINI
  • YEIMI ALEXANDRA ALZATE LOPEZ
  • Data: Jul 4, 2019


  • Show Abstract
  • Chronic kidney disease (CKD), which is defined as the progressive and irreversible loss of kidney function, has been considered an important public health problem in Brazil. In cases of end-stage illness, it is necessary to indicate a renal replacement therapy (RRT) for the maintenance of life. The paths and choices adopted by the patients before the beginning of this therapy have been permeated by many difficulties to access it. This study aimed to analyze obstacles and difficulties to the access to dialysis services for patients with chronic kidney disease through their therapeutic itineraries. For this purpose, a qualitative study was carried out by means of semi-structured interviews and medical records review. Fourteen patients undergoing dialysis treatment who were enrolled in the nephrology sector of a University Hospital and in a hemodialysis clinic affiliated to the SUS, in the city of Salvador-Bahia, participated in this study. From the narratives using analysis inspired by interpretive anthropology, the following categories were structured: therapeutic itineraries discovery of the disease until the start of renal replacement therapy and obstacles and difficulties to access dialysis services. The results pointed to a late discovery of CKD, deficient primary care, dismantled and fragmented care network, geographical access difficulties for patients to undergo the therapy, socioeconomic and cultural barriers. It is concluded that most of the patients have a late diagnosis, initiate RRT as a matter of urgency and, in hospital units, there is access difficulties at all levels of care, especially in high complexity, which reflects that the care network to patients with kidney disease is defective. The findings point to the necessity to strengthen care for patients with kidney disease in care networks, thus seeking to guarantee access at all levels, from primary to high complexity care.

9
  • VERA MARIA SERGIO DE ABREU VIEIRA
  • REFLECTIONS ON MENTAL HEALTH, VULNERABILITY AND INTERSECCIONALITY BETWEEN STUDENTS IN A BRAZILIAN PUBLIC UNIVERSITY

  • Advisor : MONICA DE OLIVEIRA NUNES DE TORRENTE
  • COMMITTEE MEMBERS :
  • MONICA DE OLIVEIRA NUNES DE TORRENTE
  • LILIANA SANTOS
  • VLADIA JAMILE DOS SANTOS JUCA
  • Data: Jul 4, 2019


  • Show Abstract
  • B

    y reflecting the characteristics of the society in which it is inserted, the Brazilian public university has increasingly identified among its student public, factors that challenge its quality of life. These include challenges related to health, inequalities and social discrimination. In this context, this dissertation analyzes the relationship between vulnerability in health and the intersection of axes of oppression among undergraduate students who are receiving assistance from students who present experience of suffering / mental disorder. From the individual, social and programmatic categories of vulnerability, it presents results based on the narratives of the participants. It is a quantitative and qualitative approach in Collective Health that uses semi-structured interview techniques and documentary analysis. Of the 217 students established as a research population, 43 were excluded from incomplete or inaccessible documentation. With the remaining 174, the sociodemographic profile was analyzed. The definition of the group for conducting the interviews considered students who declare to live in conditions of inequality and oppression from the understanding of intersectionality. Of 12 students invited by e-mail, personal contact and / or telephone call, 7 responded positively and after scheduling, the interviews were conducted at different days and times. The results indicate that the vulnerability in the student's health is largely influenced by intersectionalised oppression, especially in the social perspective. Gender bias, affective-sexual orientation, poverty, color and stigma about their mental health conditions are highlighted. Institutional practices, based on the student vision, favor the overcoming of identified challenges, but, they need better planning in terms of disclosure and unbureaucratization of access to them.

10
  • LEIDA FREIRE DE OLIVEIRA SILVA
  • PROTOCOL OF CARE IN PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: A MULTIPROFESSIONAL APPROACH Dissertation
  • Advisor : ANA LUIZA QUEIROZ VILASBOAS
  • COMMITTEE MEMBERS :
  • ANA LUIZA QUEIROZ VILASBOAS
  • LUIS EUGENIO PORTELA FERNANDES DE SOUZA
  • VALDENIR ALMEIDA DA SILVA
  • Data: Jul 25, 2019


  • Show Abstract
  • Percutaneous endoscopic gastrostomy (PEG) is a safe surgical method for supplying enteral nutrition for patients with difficulty swallowing. The increase in the number of people with ostomies has brought the need to offer integral attention to these users and their relatives. In order to provide guidance to patients and / or caregivers and systematize the actions of professionals, this study is about an intervention project with the development of a protocol of multi-professional care protocol for patients who will undergo to PEG in the endoscopy department of the University Hospital Professor Edgard Santos (HUPES). In order to achieve this goal the following methodological steps were developed: The first one was the elaboration of a preliminary version of the multi-professional care protocol and a folder with home orientation, based on a review of the literature in order to know the care and recommendations about of gastrostomy, care according to multi-professional team intending to identify scientific evidences of good practices and information for home care; The second step consisted in the elaboration of a protocol validation strategy to be submitted later to the health professionals involved with HUPES gastrostomized patient care, for future implementation in the service. It is hoped that the elaborated protocol may contribute to the improvement of the technical quality of the care provided to the user and his companion in the pre, intra and post-procedure periods.

11
  • LUCIANA BOA MORTE DE SANTANA
  • PROFILE AND SOCIAL VULNERABILITY OF DISABLED DISEASE PEOPLE ATTENDED IN A UNIVERSITY HOSPITAL HEMATOLOGY AMBULATORY IN SALVADOR, BAHIA
  • Advisor : CLARICE SANTOS MOTA
  • COMMITTEE MEMBERS :
  • ALCIONE BRASILEIRO OLIVEIRA
  • CLARICE SANTOS MOTA
  • SILVIA LUCIA FERREIRA
  • YEIMI ALEXANDRA ALZATE LOPEZ
  • Data: Aug 30, 2019


  • Show Abstract
  • Sickle cell disease (SCD) is a most common genetic pathology in Brazil, with a greater emphasis on black people. This historically neglected population experiences the impact of social vulnerability on the clinical and psychosocial conditions of people living with this condition. The profile was analyzed in the socioeconomic profile of people with sickle cell disease treated at the hematology outpatient clinic of HUPES, identifying contexts of social vulnerability. This is a descriptive, exploratory study with a qualitative approach, which was conducted in a university hospital with users, aged 18 years or over, without outpatient hematology treatment for the treatment of PD. An interview with semi-structured script was used. Data were analyzed and presented in graphs and graphs according to the interviewees' socioeconomic profile and testimony.
    The research was approved by the research ethics committee. In the results it was possible to observe that the majority of the people had complete medium level, difficulty to keep jobs and the activities remained manual and with low salaries. These findings confirmed the situation of impoverishment, access difficulties, problems resulting from complications due to late diagnosis, among others. In conclusion, when considering the social vulnerability of people with PD, it is necessary for health services to be able to accommodate these social demands, complying with the guidelines of the Unified Health System, which advocates equity and comprehensiveness as guiding principles of health. caution.
12
  • CLAUDIA ISABEL BRITO DE JESUS
  • FEDERAL PUBLIC SERVER HEALTH AND SAFETY POLICY: A LOGICAL ANALYSIS
  • Advisor : SONIA CRISTINA LIMA CHAVES
  • COMMITTEE MEMBERS :
  • SONIA CRISTINA LIMA CHAVES
  • CATHARINA LEITE MATOS SOARES
  • THAIS REGIS ARANHA ROSSI
  • JOÃO CESAR DE FREITAS FONSECA
  • Data: Sep 19, 2019


  • Show Abstract
  • The magnitude of health issues and absenteeism due to illness in federal government workers suggests the need for health promotion interventions and the prevention of risks, health problems and diseases in this population. The Healthcare and Safety Policy for Federal Government Workers (PASS), which is operated through the Integrated Public Workers’ Healthcare Sub-System (SIASS), implemented as of 2009, arises as a strategy for addressing this situation. The SIASS Units (U-SIASS), are venues for articulation and consolidation of the actions recommended by the PASS, organized in the consolidation of technical cooperation agreements among the federal entities, where actions for health promotion, the prevention of risks and health problems, surveillance of environments, medical expertise and rehabilitation of federal government workers are developed.
    Objective: This study performed a logical analysis of the PASS implemented by the SIASS, perceived as an analysis of the merit of the theory which supports the intervention and of the capacity of the proposed activities in promoting the desired effects.
    Methodology: The study was an evaluative study of the direct logic analysis of the PASS, though documental analysis, preparation of the preliminary logic framework, the conceptual theoretical framework and finally of the comparison between both. The conceptual theoretical framework was formulated from evidences contained within the systematic review articles and other articles identified as relevant.
    Result: There were forty-three systematic review articles identified, of which 14 were meta-analyses with organizational, psychosocial and digital interventions, guided towards the individual, the collective and the environment, in aspect of health promotion practices and prevention of diseases in the workplace, mainly regarding mental health and musculoskeletal disorders, as well as occupational accidents and absenteeism management. The lack of explicit interventions was observed in the base-documents of the policy. In the comparison between the logic framework and the conceptual framework, it was observed that there are deficiencies in its design and in its causal links, especially in the non-explicit aspects of the standard, highlighting the lack of a single document for the Policy, becoming fragmented, the lack of the problem generating the need for the formulation of the Policy, of objectives and actions to be developed.
    Conclusion: The study concluded that the PASS is partially based on scientific evidence, lacking the strengthening of its causal links and corrections of the loopholes identified in the study, in order to assure the intended results in the dimension of its preventive practices and in health promotion, primarily for addressing mental and behavioral disorders. In this respect, a review of its scope is suggested, with the purpose of improving the definition of its structural and operational elements. The PASS lacks an action plan with a detailed description of objectives, timeframes and mainly of the budget.

13
  • FERNANDA VIANA FERNANDES
  • ANALYSIS OF THE PERCEPTIONS OF HIGHER EDUCATION STUDENTS OF A FEDERAL EDUCATION INSTITUTE, SCIENCE AND TECHNOLOGY ABOUT STUDENT EXPERIENCE AND MENTAL HEALTH

     
  • Advisor : LILIANA SANTOS
  • COMMITTEE MEMBERS :
  • CACILDA FERREIRA DOS REIS
  • LILIANA SANTOS
  • LUIS AUGUSTO VASCONCELOS DA SILVA
  • Data: Sep 24, 2019


  • Show Abstract
  • Experiences lived in university trajectory and support found are essential for the mental health of higher education students besides contributing their permanence and academic exercise. The specific expressions of university environment, such as built relationships, pressures, uncertainties and expectations are some of circumstances experienced by students. Research aimed analyze the perceptions of university students from a Federal Institute of Education, Science and Technology of Bahia-IFBA about the relationship between student life and their mental health conditions. Seeking identify the main difficulties experienced in the process of estrangement, learning and overcoming strategies, as well deepening knowledge about factors related their mental health conditions. The study had exploratory character of qualitative nature using focus group technique to enable production of data and as way to analyze them perspective of thematic content analysis was used. Thus units of meaning were constructed, which gave rise to three main categories: difficulties in trajectory and consequences for students' mental health; ease in student trajectory and its consequences for students' mental health and mental health promotion strategies.In summary, the main difficulties experienced in the university career affect the mental health of students refer to arrival at Institute and relations with new environment, as well the conflicting relations between teachers and students, the absence of socialization. As facilitating experiences of adaptation and improvement of mental health, there affiliation strategies. Through organization of time and activities, and factors such as establishment of affective bonds with colleagues. Appropriation of space and also positive relationships between teachers and students. Other actions are still necessary aiming at healthy insertion in university environment, contemplating dimension of mental health promotion. Main strategies cited were qualified listening, welcoming, establishment of living and leisure spaces within the Campus. Teachers with ability to understand individual, collective reality and with better didactic-pedagogical practices. Thus concluded higher education institutions are spaces of multiple facets, capable of causing great suffering and illness in subjects involved in teaching-learning processes. As well have potential to become health promoting environments through attitudes that have as guidelines the promotion of mental health their students and that guarantees student permanence.

14
  • LIVIA MARA BATISTA XAVIER
  • BULLEY EPIDERMOLYSIS: ORGANIZATION OF HEALTH CARE SERVICES AND EPIDEMIOLOGICAL PROFILE OF PATIENTS ATTENDED IN SALVADOR, BAHIA.

  • Advisor : JUAREZ PEREIRA DIAS
  • COMMITTEE MEMBERS :
  • JUAREZ PEREIRA DIAS
  • ALCIONE BRASILEIRO OLIVEIRA
  • ROSANA SANTOS MOTA
  • Data: Oct 2, 2019


  • Show Abstract
  • Bullous Epidermolysis (EB) is a rare non-contagious condition that has as its main characteristic the fragility of the skin and mucous membranes, leading to the appearance of blisters and lesions, due to minimal trauma, excessive heat or spontaneously. Very rare diseases are considered to be those of very low frequency in the general population. In Brazil, a rare disease is one that affects up to 65 people in every 100,000 individuals (BRAZIL, 2014). Despite having a low individual prevalence, the high number of rare diseases has a significant impact on the health budget, as they require care by specialized staff, technologies and high cost medicines, becoming a challenge to the public health system when seeking ensure universal coverage and comprehensive care. This study aimed to analyze the clinical and operational aspects of the care of patients with EB, by identifying the knowledge of professionals about the clinical and operational aspects of the disease, and sought to describe the socio demographic and clinical characteristics of patients treated in a service. Salvador-Bahia reference point. For this, an observational quantitative study was performed of descriptive type, through the application of a structured questionnaire to professionals and review of medical records. The study included 47 primary care and specialized health professionals and 30 outpatients at the referral service. The results indicated that most professionals knew the clinical aspects of EB, but were unaware of some important points in the management of the disease. reference, as the referral and instruments for regulation. Regarding the profile of patients, the dystrophic form was the most prevalent, being observed the need for psychosocial care and the strengthening of monitoring in Primary Health Care. Therefore, it is concluded that there are flaws in the care network for people with rare disease and The need to strengthen the care network for people with EB, through the construction of a care line, with definition of care flows and interdisciplinary follow-up at all levels of care, in addition to the permanent education of the teams, seeking to guarantee this population care. dignified and efficient and thereby promote a better quality of life.

15
  • ANARILDA PIMENTEL COSTA
  • CLINICAL, EPIDEMIOLOGICAL PROFILE AND TIME OF PERMANENCE IN AN INTENSIVE THERAPY UNIT: SUITABILITY FOR SUS GUIDELINES
  • Advisor : SUSAN MARTINS PEREIRA
  • COMMITTEE MEMBERS :
  • JOILDA SILVA NERY
  • ROSANA SANTOS MOTA
  • SUSAN MARTINS PEREIRA
  • Data: Dec 9, 2019


  • Show Abstract
  • Introduction: The Intensive Care Unit (ICU) has, among other functions, the objective of reestablishing the health of individuals with severe pathologies in order to remove them from the risk of death zone. To do so, it has a specialized professional apparatus and advanced technologies that aim to meet your health demands. Objective: To identify the clinical epidemiological profile of patients admitted to the Intensive Care Unit and the factors associated with long stay and its adequacy to SUS guidelines. Method: This is a quantitative descriptive retrospective study conducted with 105 ICU patients admitted to a public university hospital in Salvador, Bahia, Brazil. Data were collected between September 2017 and April 2018 and organized in Stata version 13 and analyzed descriptively from frequency distribution in order to characterize the subjects. For the bivariate analysis, contingency tables with X2 (chi square) were used. The study was also based on the criteria of length of stay in the hospital recommended by the Hospital Quality Control Program and Brazilian Intensive Care Association. Results: The study found that the profile of patients had as reasons for hospitalization postoperative 54.29% (n = 57), sepsis 11.43% (n = 12) and cardiovascular problems 5.71 (n = 06). ); most patients were hypertensive 53.34% (n = 56), 19.05% (n = 20) diabetic and 14.29% (n = 15) heart disease. Regarding lifestyle, 12.38% (n = 13) consumed alcoholic beverages and almost 10% (n = 10) were smokers. Regarding the use of invasive devices, 22.86% (n = 24) required mechanical ventilation, 50.48% (n = 53) central venous access, 41.90% (n = 44), invasive blood mean arterial pressure (MAP) and 58.10% (n = 61) made use of Foley bladder tube (SVF). The main clinical outcome was ICU discharge (83.81%) and most patients had a stay of less than six days (72.38%). Conclusion: Based on these findings, it is possible to direct preventive actions that contribute to a reduction in ICU stay, such as infection control through the use of aseptic techniques in the management of invasive devices. In addition, actions that can be disseminated to the scenarios of Primary Health Care, when it comes to the prevention of lifestyle, since, related to underlying diseases such as hypertension and diabetes, can predispose the patient to other health problems. .
16
  • ALMIRA MARIA SANTOS DO ROSARIO
  • ANALYSIS OF THE HEALTH CARE OF BAHIA FEDERAL UNIVERSITY HOSPITAL COMPLEX WORKERS
  • Advisor : ISABELA CARDOSO DE MATOS PINTO
  • COMMITTEE MEMBERS :
  • ELIANE CARDOSO SALES
  • IRACEMA VITERBO SILVA
  • ISABELA CARDOSO DE MATOS PINTO
  • PAULO GILVANE LOPES PENA
  • Data: Dec 10, 2019


  • Show Abstract
  • The context of administrative and financial crisis experienced by University Hospitals since the 1990s culminated in the creation of the Brazilian Company of Hospital Services (EBSERH), which brought the idea of a new management model with the premise of promoting efficiency and agility. in the processes of attention to the population's health, education, research and extension. The attention paid to the health of workers at the UFBA Hospital Complex, since the implementation of EBSERH, has been a point of discussion, since the managerial behavior implemented from this management model caused a drastic change in the work environment with the increase of complaints. of illness on the part of workers. This research aimed to analyze comparatively the way the workers of the two main employment ties (University-linked statutory and EBSERH-linked celetists) of the UFBA University Hospital Complex meet their health needs, possible causes of illness, services used to meet these needs, as well as identify strategies to prevent illness and injuries, and to promote worker health in the workplace after the implementation of EBSERH. This is a descriptive and analytical study, with a quantitative and qualitative approach, carried out in two moments: inquiry, sending electronic form to EBSERH public workers.
    and servants of the Unified Legal Regime of the Union (RJU) and interviews with key informants from both ties. It was observed through the data analysis a disarticulation between the services regarding the possibility of integral care to workers, making it explicit that the institutions involved in the health-work process should seek articulation among themselves, with the unions and with the workers in order to draw strategies for the improvement of integrality actions. It is worth mentioning the effects triggered by the alternative management models adopted in the Brazilian public administration and the challenges that need to be faced by managers in the conduct of work processes, increasingly permeated by diversification of bonds, compensation, labor rights, among other conditions. that weaken and make the health worker sick.

17
  • DENIZ REIS DOS SANTOS MENEZES
  • THE PSYCHOSOCIAL CARE NETWORK IN SUICIDE CARE IN A SALVADOR / BAHIA HEALTH DISTRICT
  • Advisor : MARCELO EDUARDO PFEIFFER CASTELLANOS
  • COMMITTEE MEMBERS :
  • MARCELO EDUARDO PFEIFFER CASTELLANOS
  • MONICA DE OLIVEIRA NUNES DE TORRENTE
  • MONICA LIMA DE JESUS
  • Data: Dec 11, 2019


  • Show Abstract
  • Suicide is a complex phenomenon, considered a serious public health problem, as it is estimated that around 800,000 people commit suicide worldwide each year. In the Americas, according to data from the Pan American Health Organization (PAHO, 2014), 65,000 people commit suicide each year and this is the third leading cause of death in the 20 to 24 year old group, the fourth in the 10 to 19 year old group. 25 to 44 years. The population over 70 years old has the highest suicide rate. Actions proposed in the Strategic Actions Agenda for Suicide Surveillance and Prevention and Health Promotion of the Ministry of Health for the period from 2017 to 2020 point to the co-responsibility of care and articulation in the Psychosocial Care Network (RAPS). OBJECTIVE: To analyze the performance on suicide in the Psychosocial Care Network of the Brotas Sanitary District / Salvador (RAPS-Brotas), according to the coordinators and / or representatives of the health services that compose it. METHODOLOGY:
    This study took a qualitative approach (Minayo, 2002). The population consisted of managers and professionals representing the devices that make up the Psychosocial Care Network of a Sanitary District of Salvador. The instruments used for data collection were the semi-structured interviews applied to the managers and the focus group technique applied to the members of the RAPS Working Group. Thematic Content Analysis was performed using the NVIVO 12 software. RESULTS: Two main conceptions about suicide were found: One, markedly biomedical, that unfolded in two directions: 1) delimitation of suicide from a psychopathological perspective, cited by two managers trained in health sciences and only one professional; 2) Multicausal delimitation, which considered multiple and complex determinations, was the most cited subcategory by managers and professionals within the biomedical conception of suicide. A second conception, which addresses suicide as a social phenomenon, also unfolded in two directions: 1) one that considered the importance of social dynamics and relationships, more defended by managers compared to professionals; 2)
    another cited only by managers, who considered the role of social inequalities in this analysis. Regarding the most relevant contributions of RAPS, when comparing managers and professionals, the second category mentioned, as a priority, that the most relevant contribution of this health system is to offer continuous and integral attention from the various devices. The second contribution of RAPS: improving the quality of care from a multiprofessional perspective was mentioned only by managers. Among the participants of this study, we found a hierarchical network view organized by levels of attention, cited only by the category of managers, a polyarchic network view with non-hierarchical relationships and sharing common goals, cited by both categories and an organizational view. Network that reiterates the importance of the role played by primary care in accompanying people in psychological distress, also cited by the two categories. As for network articulation strategies, mentioned only by the 10 category of managers, we could observe: 1)estratégia de articulação dos dispositivos de saúde; 2) articulação a partir do apoio institucional e distrital. Segundo gestores e profissionais, não há fluxos estabelecidos para o cuidado específico de pessoas em risco de suicídio, que se apoiam principalmente nos serviços especializados e de urgência e emergência. A organização de um fluxo específico foi defendida por dois profissionais e três gestores. As principais dificuldades da atuação em rede relacionadas ao estado de saúde da população, citadas pelas duas categorias, foram o aumento de casos de sofrimento psíquico, com destaque para as situações de automutilações e tentativas de suicídios. Os elementos dificultadores e facilitadores do trabalho na RAPS, relacionados ao sistema de saúde foram assim categorizados: 1) relacionados à infraestrutura, mais citados por ambas as categorias; 2) à gestão; 3) ao modelo de assistência; 4) a organização dos recursos; além das estratégias de fortalecimento desta rede também assim identificadas. CONSIDERAÇÕES FINAIS: Diante da complexidade conceitual do suicídio, faz-se necessário reafirmar que atuar sobre este fenômeno, seus fatores de risco e de proteção não é uma ação simples, mas muito complexa e que exige a interface de vários atores e o entrelaçamento de distintos saberes no desenvolvimento de um compartilhamento de cuidado interdisciplinar e ações intersetoriais em rede de atenção que possibilite a integralidade da atenção.


2018
Dissertations
1
  • MARCELO TAVARES PEREIRA
  • SANITARY SITUATION OF MEDICINES IN BASIC CARE IN THE SUS, IN THE CAPITAL OF BRAZIL
  • Advisor : EDINA ALVES COSTA
  • COMMITTEE MEMBERS :
  • EDINA ALVES COSTA
  • GERALDO LUCHESE
  • PATRICIA SODRÉ ARAÚJO
  • Data: Apr 26, 2018


  • Show Abstract
  • Medicines are made up of chemical or biological substances, requiring a set of conditions in the manufacture, storage and transport, so that it has expected therapeutic activity and the quality and safety in its use is maintained. To carry out regulatory actions and sanitary surveillance this health input, as well as pharmaceutical assistance, with the provision of effective, safe and quality medicines, are some of the functions of Brazilian Unified Health System. This is a cross-sectional, evaluative study aiming to characterize the technical issues and conservation conditions of medicines in primary health care of Brazilian capitals. A total of 455 pharmacies/drug dispensing units of primary health care services in the capitals of Brazil were observed, regarding technical and sanitary requirements, storage conditions, fire safety and electrical safety items, environmental conditions, drugs, fractionation, waste management, regulation of advertising / promotion of medicines, actions related to pharmacovigilance and transportation. The data derived from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services). Failure to comply with the technical and sanitary requirements essential to the preservation of medicinal products, which may interfere in the maintenance of their stability, and thus in their quality, efficacy and safety, indicating problems of management, infrastructure organization and quality of pharmaceutical services, as well as increasing costs for the public system. The study revealed a poor sanitary situation of primary health care drugs in the capitals, although more favorable than the sanitary situation found in Brazil.

2
  • EDILMAR PEREIRA VILELA DOURADO
  • IMPLEMENTATION OF HEALTH SURVEILLANCE IN A MUNICIPALITY OF THE NORTHEAST REGION OF BRAZIL
  • Advisor : ANA LUIZA QUEIROZ VILASBOAS
  • COMMITTEE MEMBERS :
  • ANA CRISTINA SOUTO
  • ANA LUIZA QUEIROZ VILASBOAS
  • SILVONE SANTA BARBARA DA SILVA SANTOS
  • Data: May 11, 2018


  • Show Abstract
  • Since 1988 several initiatives have been taken to organize and implement at the federal, state and municipal levels of the VISA services, after this period there are advances and weaknesses in the implementation of VISA at the municipal level. The objective of this study is to estimate the degree of implantation of Sanitary Surveillance in a medium municipality of Northeast Brazil. The methodology used was an evaluation research, of type analysis of the degree of implantation. To compose the analysis material,
    Since 1988 several initiatives have been taken to organize and implement at the federal, state and municipal levels of the VISA services, after this period there are advances and weaknesses in the implementation of VISA at the municipal level. The objective of this study is to estimate the degree of implantation of Sanitary Surveillance in a medium municipality of Northeast Brazil. The methodology used was an evaluation research, of type analysis of the degree of implantation. To compose the analysis material, official documents and interviews were used. Results: The municipality was considered to have an advanced degree of 
    implementation since the Management dimension had a score of 71.90%, Practical dimension, 69.44%, with a general average of 70, 67%. The sub-dimensions evaluated for the Management Dimension "Popular Participation" and "Infrastructure" received the highest score, while the sub-dimensions of "Human Resources" and "Financial Autonomy" received lower scores, especially financial autonomy, which received only 33.33%. Conclusion: The study pointed to the need for adequacy in relation to the quantity of personnel and the accomplishment of training for the team. Regarding financial management, the study pointed to dependence of the municipal VISA in relation to the Municipal Secretary of Health. With the accomplishment of this study it was possible to evaluate the degree of implantation of the VISA in the municipality of Irecê and it was verified that even with difficulties and problems - in line with other studies - the municipal VISA service is organized, but the need to advance on strategic issues such as human resources, financial resources and service organization has been perceived so that the municipal VISA can effectively respond to the challenges the field of action. The logical model used was sufficient to analyze the criteria listed in the management dimension, however with respect to the dimension of practices it was observed that the established criteria did not contemplate the reality of the municipality investigated. Thus, for other investigations in which the researchers need to use this same methodology, it is advised to analyze the criteria of practices can be used and added qualitative indicators of each of the established criteria.

3
  • FERNANDA CAVALCANTE MALTA LIMA
  • ANALYSIS OF THE HEALTH SITUATION OF THE ORAL HEALTH SERVICES OF THE HEALTH UNITS OF THE FAMILY OF SALVADOR, BAHIA
  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • CATHARINA LEITE MATOS SOARES
  • DENISE NOGUEIRA CRUZ
  • EDINA ALVES COSTA
  • SANDRA DE CASSIA SANTANA SARDINHA
  • Data: Jul 31, 2018


  • Show Abstract
  • The study consists of an analysis of the sanitary situation of the dental health services offered by the family health units of the city of Salvador, Bahia, in which it was used from the perspective of the Strategic Situational Planning (PES) of Carlos Matus. This is a qualitative case study, which used as a methodological strategy, focal group technique - involving the dental health team and general service auxiliaries - and content analysis method, based on a matrix, formed from important categories to characterize the health conditions of the oral health services and based on federal regulations, wich are: standards, procedures and routines; technology management; people management; infrastructure conditions. The results demonstrated problems associated to the four categories of analysis, which refers to inadequate sanitary conditions, allowing to conclude that VISA should intervene in health problems using more effective models, seeking to ensure that health protection resources be used in the practice of all professionals involved in the processes.

4
  • KARINA LUZIA REYNALDO QUEIROZ
  • HEALTH SITUATION IN HEALTH CARE SERVICES BASIC IN SALVADOR-BAHIA
  • Advisor : ELIANA AUXILIADORA MAGALHÃES COSTA
  • COMMITTEE MEMBERS :
  • EDINA ALVES COSTA
  • ELIANA AUXILIADORA MAGALHÃES COSTA
  • LENICE GNOCCHI DA COSTA REIS
  • MARIA ENOY NEVES GUSMAO
  • Data: Aug 31, 2018


  • Show Abstract
  • The organization of the Unified Health System (SUS) defines basic care as a gateway to the
    health system. Health surveillance actions on health-related products and services associated
    with inadequacies are essential for the protection of the population's health and for the
    protection of users, health professionals and the environment, as a means of preventing and
    controlling risks and adverse events related to the provision of health services in general, as
    well as in Primary Care. The inadequacies in the technical and management conditions to
    promote the quality of care minimally required to run health services can pose health risks.
    The general objective of this study is to describe the health situation of the health services in
    basic care in SUS. This is a descriptive exploratory qualitative study with a sample of three
    basic units of the Cabula-Beiru Sanitary District. This study used three sources of data:
    observation of the services in the Basics Health Units through script, interview with
    professionals and analysis of documents issued by health surveillance. The inadequacies
    observed in the units were related to noncompliance with the technical, sanitary and legal
    requirements of health surveillance for the functioning of health services and were classified
    into six dimensions: infrastructure, items related to work processes, inputs, equipment,
    documentation and management Of Quality. The results present inadequacies in all
    dimensions with variations between them and between the studied units. Despite successive
    inspection and reinspection visits at these UBS and the concession of sanitary license at these
    sites, a large part of these inadequacies remained, including the relevant items related to the
    areas of Sterilization Material Center (CME) and pharmacy.

5
  • ELESSANDRA CORTES REBOUCAS
  • SANITARY SITUATION OF MEDICINES IN PSYCHOSOCIAL CARE CENTERS (CAPS) OF THE MUNICIPALITY OF SALVADOR - BA

  • Advisor : GISELIA SANTANA SOUZA
  • COMMITTEE MEMBERS :
  • EDINA ALVES COSTA
  • GISELIA SANTANA SOUZA
  • JOSLENE LACERDA BARRETO
  • Data: Nov 23, 2018


  • Show Abstract
  • The Psychosocial Care Centers (CAPS), based on interdisciplinary practices compose the Network of Psychosocial Care and are strategic in the deinstitutionalization of the asylum. CAPS provide medication as an activity inherent in the therapeutic plan, and must ensure guard, conservation and pertinent information in order to promote the effectiveness and rational use of these products. Inadequate storage and dispensing conditions are indicated as the high risk factors for changes in the pharmacological properties of drugs, representing serious problems, implying individual, social and economic costs. The objective of this study was to characterize the technical issues and conservation conditions of medicine in the pharmacies of the CAPS in Salvador / BA, seeking to identify and discuss situations of risks to the efficacy and safety of the drugs. The data were collected by direct observation of the researcher and through questionnaires presented to the CAPS employees and included physical structure, human resources, documentation, storage, stock control, psychotropic control, environmental conditions, pharmacovigilance and residue management. The results showed that 100% of the CAPs presented nonconformities related to the regularization of pharmacist responsible in the institutions of the State responsible for fiscalization. The data also showed irregularities related to the existence of Sanitary License (53.3%); inadequate shelves for medicines (86.7%); inadequate controls of temperature (40%) and humidity (93.7%); absence of psychotropic record information - bookkeeping (100%) and deficient pharmacovigilance (86.7%). Were verified also efficient procedures for collection of residues in health (86.7%), medications without contact with floor and/or walls (80%) and stock control computerized (100%). The research allowed the characterization of the conditions for the quality and safety of the drugs in the CAPS of the city of Salvador, and raised questions for future research.

2017
Dissertations
1
  • Renilton Delmundes Bezerra
  • Associations between Water Consumption Outside Potability Standards and Waterborne Diseases in the State of Tocantins

  • Advisor : FEDERICO COSTA
  • COMMITTEE MEMBERS :
  • FEDERICO COSTA
  • YUKARI FIGUEROA MISE
  • WILDO NAVEGANTES DE ARAÚJO
  • Data: Jul 28, 2017


  • Show Abstract
  • The access to potable water is a basic human right and an effective component of health protection policy. In the State of Tocantins, although the water supply is priority through a general network, maintain disabilities in the supply of potable water. The performance of the Drinking-Water Quality Surveillance (VQACH) provides the construction of important epidemiological and environmental indicators. The present study aimed to describe the supply and the quality of the water for human consumption in the municipalities of the State of Tocantins, in the year of 2015, as well as identify associations between the consumption of non-potable water and the incidence of Water-and Foodborne Diseases (DVHA). This is an ecological study with a territorial base, using secondary data, whose units of analysis were the municipalities of the State of Tocantins. Indicators of health vulnerability were used related to deficiencies in the supply and quality of water for human consumption (exposure variables) and related indicators of morbidity and mortality associated with DVHA (outcome variables). In order to verify associations between these variables was performed univariate logistic regression analysis, applying also the calculation of Pearson's correlation coefficient to a group of five municipalities with the best monthly data records, from 2014 to 2016. It was observed sampling of water in 122 (88%) of the 139 municipalities, with greater concentration in the Water Supply Systems – SAAs (87%). The percentage of non-standard samples was higher in the alternative solutions. Observed an average of 0% for the population supplied by untreated water, 1% for the population supplied by alternative solutions and 0% for the population served by sewage network. Were identified discrepant values for indicators such as the proportion of the population supplied by untreated water in municipalities Itaguatins (95,8%), Novo Alegre (37,1%) and Pium (34,2%), and the percentage of nonstandard samples in SAAs (E. coli), that was above 17% in the municipalities of Bom Jesus do Tocantins, Tupirama, Angico, Taipas do Tocantins, Pedro Afonso and Ananás. Taking the municipalities as a unit of analysis, there were no statistically significant associations between the exposures and the outcomes, except among the variables coverage by sewage network and deaths in children under five years. Considering the monthly data of the one same municipality over three years, we found positive correlations between the water-and foodborne diseases and the occurrence of nonconformities in water quality. The appreciation of the results of this research should consider the asymmetries in the records of the data used. We recommend prioritizing (VQACH) actions in municipalities with a high degree of inconsistency in SAAs, as well as in situations where water supply alternative are used.

2015
Dissertations
1
  • RENATA DO CARMO SILVA
  • Prevention of erythrocyte alloimmunization in the care of people with sickle cell disease

  • Advisor : EDUARDO LUIZ ANDRADE MOTA
  • COMMITTEE MEMBERS :
  • CLARICE SANTOS MOTA
  • EDUARDO LUIZ ANDRADE MOTA
  • GILDASIO DE CERQUEIRA DALTRO
  • Data: May 28, 2015


  • Show Abstract
  • Blood transfusion therapy is a common practice in the treatment and prevention of complications of sickle cell disease. Although they may contribute to reducing morbidity and improving the quality of life of these patients, there are risks associated with this therapy, among others, erythrocyte alloimmunization, a condition that limits the availability of compatible red blood cells for future transfusions, besides being a risk for late hemolysis and severe hyper-hemolysis. Thus, prevention of erythrocyte alloimmunization is essential to ensure greater transfusional efficacy and safety for these patients. The objective of this study was to investigate the occurrence of erythrocyte alloimmunization in the context of care practices for individuals with sickle cell disease, under the age of eighteen, who were followed at the outpatient clinic of the Hematology and Hemotherapy Foundation of Bahia (HEMOBA). An epidemiological, cross-sectional and quantitative approach was developed. A retrospective analysis was carried out in the medical records of the 221 patients diagnosed with sickle cell disease, under the age of eighteen who were registered in the unit transfusion book in the year 2013. Data analysis was performed using descriptive and analytical methods. The distribution of absolute and percentage frequencies and representation in graphs and tables was applied

    The prevalence of alloantibodies belonging to the Rh system (37.5%), followed by the MSN system (7.8%) and Kell (6.2%) was the frequency of erythrocyte alloimmunization found in this study. Statistical analysis showed that the frequency of alloimmunization was not influenced by sex, age, skin color, genotype and transfusion indication. The relationship between the number of transfusions and the occurrence of alloimmunization was statistically significant, revealing a higher frequency of alloimmunization among patients who had used more than 10 transfusions. It was observed that factors related to care practices also interfere in the alloimmunization process of these patients, such as: failure to perform or late erythrocyte immunophenotyping, use of non-phenotyped hemocomponents when assisted in hospital units, and limited availability of phenotyped hemocomponent. Finally, in the present study, a significant frequency of alloimmunization was identified, with a higher prevalence in patients who used ten more packed red blood cells. In order to prevent new cases of alloimmunization, it is recommended changes related to the care practices in the transfusion process, since they expose patients to a higher risk of alloimmunization.

2
  • QUEZIA OLIVEIRA SANTANA ALMEIDA
  • Surveillance of Work Related External Causes of Death:
    Strategy for Information and Action. 61f. Dissertation (Professional Master).
    Instituto de Saúde Coletiva. Universidade Federal da Bahia.

  • Advisor : CATHARINA LEITE MATOS SOARES
  • COMMITTEE MEMBERS :
  • FLORISNEIDE RODRIGUES BARRETO
  • LETICIA COELHO DA COSTA NOBRE
  • MARCO ANTONIO VASCONCELOS REGO
  • Data: Dec 2, 2015


  • Show Abstract
  • Injuries at work are considered a major public health problem presenting great social
    and economic impact for the country. However, the true magnitude of this problem is
    unknown due to its underreporting in official statistics, especially in health information
    systems (SIS). The purposes of this study were to know to what extent deaths due to
    work related accidents are underreported, and contribute to the external causes of
    deaths surveillance and to the improvement of quality of information of the SIS. The
    study specific objective was to investigate work related fatal accidents among
    external causes of death occurred with the resident population of Itaberaba’s Health
    Region, 10 or more years old, between the years 2007 to 2013. The epidemiological
    profile and socio-occupational characteristics of these cases were described.
    Methods: it consisted in a time series descriptive study of external causes of death
    registered in the Mortality Information System (SIM) and the Information System of
    Diseases Notification (SINAN). Also, cases occurring during the year of 2013 were
    investigated applying the verbal autopsy technique on home interviews. The
    information about death circumstances obtained from the deceased relatives was
    compared to that registered in the information systems. The applicability of verbal
    autopsy as a strategy to improve the quality of information was discussed. Results:
    from 2007 to 2013, 1,059 cases of external causes death on Itaberaba’s region were
    registered on SIM database, among people 10 or more years old; only 24 cases were
    identified as work related accidents (2.3%); in 84.8% of cases the information about
    Work Accident on Death Certificate was lacking, thus registered as unknown. For the
    year 2013, we detected an increase of 300% on the number of cases of work related
    accidents identified by the verbal autopsy, compared to the information registered in
    SIM. Deaths due to occupational injuries occurred mostly in men, young adults,
    colored mulatto or black, with none or low school level. The most common
    occupations were farm workers, followed by workers on trade and transport. The
    most frequent types of violence leading to death were transport accidents and
    homicides. It was concluded that the verbal autopsy technique helps to elucidate the
    violent circumstances of external causes of death, and to correct mortality estimates
    and the number of fatal work related accidents. Considering and adapted the local
    and regional context on health services, it may be an important strategy to achieve
    information quality improvement, and to ensure preventive measures and health
    surveillance on these cases.

2008
Dissertations
1
  • MARCELO YOSHITO WADA
  • HUMAN RABIES POS-EXPOSURE PROPHYLAXIS IN BRAZIL, 2005

  • Advisor : EDUARDO HAGE CARMO
  • COMMITTEE MEMBERS :
  • EDUARDO HAGE CARMO
  • JUAREZ PEREIRA DIAS
  • JACY AMARAL FREIRE DE ANDRADE
  • Data: Mar 14, 2008


  • Show Abstract
  • Introduction: Rabies is a viral infectious zoonosis with high importance for public health because the mortality-rate is 100%, preventable disease, high cost for assistance and efficient measures for control are available. Objectives: To evaluate the reported adopted pos-prophylaxis in service, according with the mainly epidemiologic, clinical and related characteristics with rabies prophylaxis, comparing to normative recognized by Brazilian Ministry of Health. Methods:  This study consists on secondary data evaluation of the reported prophylaxis done in SINAN during 2005. It was performed a correction of double report using the software reclink III, the data were clean, removing inconsistent data and no filled fields, which were not available for analyses. Pos-exposure prophylaxis was described analyzing frequency of the mainly variables. It was classified the type of exposure in direct contact, mild accident and severe accident, according to guidelines of epidemiology surveillance of ministry of Health. It was realized evaluation of the pos-exposure prophylaxis comparing to recognize by Ministry of Health. Data were analyzed using reclink III, SPSS 13.0 for windows, epiinfo 6.04d and excel version 2003. Results: During 2005 were reported 523.264 persons who looked for assistance for rabies prophylaxis distributed in all federal units. There were 4,2% of double report, therefore the analyses was performed with 501.123 persons. Among realized attendance, 65,1% were pos-exposure, where 81,2% occurred in  urban area and  Pará, Goiás, Rondônia e Alagoas presented the highest taxes by 1.000 inhabitants of reporting, 5,07%, 5,07%, 4,78% e 4,10% respectively. August was the month with more reported attendance, 9,5% reporting of this year.  About sex, 56% were male and the age rate until 35 years had 65.4% of the reporting. About the wound, 48% was superficial, 52% deep and 6,72% dilacerate. Dog was related with 80,39% of pos-exposure, followed by cats (11,99%), bats (3,45%), monkeys (1,02%), foxes (0,3%) and others species (2,51%). For exposure, it was classified in contact indirect, 92,1% received at least one dosis of vaccine and 23,3% was indicated immunoglobulin. For mild accident 90,14% received vaccine and 5,2% immunoglobulin and for severe accident 90,66% received between two and five dosis of vaccine, 9,3% received at least one dosis and 11,6% immunoglobulin. Conclusion: The tax of double report was 4.2%, considered low. There was a concentration of reported cases in southern region of Brazil, where the most reporting was in urban area and around 90% related dog or cat. Children and adolescent until 15 years had almost 40% of the attendance, showing importance to have education for this group. The main part of the body related with aggression was low member and hands or foot, showing the necessity of protection this areas when to deal with animals. It was demonstrated that contact indirect and mild accident, where it is not recognized immunoglobulin, the indications were done in service, disaccording with the Ministry Health orientations. For severe accidents, it was found indication of low dosis than it was needed, leaving persons in risk to become ill. Health education, as looking for assistance, necessity of prophylaxis and incentive to owner responsible and laws that make the owner to be careful with the animals, avoiding aggressions need to be done.

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