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Disertaciones |
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1
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Camila de Jesus França
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The work of the Community Health worker in the face of the Covid-19 pandemic: Analysis of the production of technical and scientific
knowledge and of multiple cases in the Brazilian Northeast.
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Líder : NILIA MARIA DE BRITO LIMA PRADO
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MIEMBROS DE LA BANCA :
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ADRIANO MAIA DOS SANTOS
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ANA LUIZA QUEIROZ VILASBOAS
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CRISTIANE ABDON NUNES
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MÁRCIA VALÉRIA GUIMARÃES CARDOSO MOROSINI
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NILIA MARIA DE BRITO LIMA PRADO
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Data: 06-feb-2023
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Resumen Espectáculo
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This dissertation aimed to identify, systematize, and analyze the implications of the Covid-19 pandemic for community health work. This is a research that included an integrative synthesis review, two document reviews, and a multiple case study on the work of Community Health Workers (CHWs) in the pandemic context. The analysis was based on the reference of community orientation and work in health and the debate around the work process, for the understanding of the organization of actions in the pandemic context and the contextual challenges in the national socio-political scenario in the most recent conjuncture. The results were presented and discussed in four articles: The first is a quick synthesis of evidence in bibliographic bases, about the work of Community Health Workers (CHWs) during the pandemic period in different countries. The second is in the form of a book chapter and aimed to provide a brief critical overview of the current perspective on the conformation of the work of CHWs during the pandemic period, based on the recommendations issued by the Ministry of Health in Brazil. However, due to the scarcity of governmental publications in the initial period of the pandemic, the third article sought to identify and analyze the recommendations for the organization of the work of CHWs, based on the analysis of guidelines and governmental and non-governmental orientations aimed at delimiting the response of PHC in Brazil. We admitted documents conveyed and made available by teaching and research institutions and/or of non-governmental nature, including videos, newsletters, taken as a source for the understanding of the research problem. Finally, although there may have been changes in the activities related to the work of CHWs, the literature brought few elements to understand the central characteristics of the work of these professionals in the response to Covid-19. Given the above, the fourth article aimed to identify the organization and characterize the work of CHWs in three municipalities in the Northeast of Brazil, between January 2020 and August 2021. When considering the set of productions derived to answer the questions of this study, this dissertation raises reflections about the role of community health workers, as part of the frontline health workforce in fighting the pandemic in several countries, contributing to unveil the potential of actions directed to the social determinants of health, beyond the control and prevention of pandemics, and especially to reflect on the potential of community guidance in situations of health crises and how it may have been underused or neglected. It is evident in Brazil that the institutional support, training, and continuing education for CHWs during the pandemic were insufficient, which culminated in their leaving their territories. The lack of clear guidelines that are based on the strengthening of the attributes inherent in the work of CHWs, according to community and territorial orientation, is a concern in face of the impossibility of carrying out resolutive actions for the consolidation of a strong and robust PHC, to adequately respond to the needs arising from localized or comprehensive health crises or the premises of the care model prioritized in Brazil. It is observed the need for research to better understand the real potentialities of community orientation, and more cost-effective forms of intervention, to evaluate the results achieved so far and to direct the reorganization of necessary processes, given the configurations of work in PHC currently, in rural and urban Brazilian territories.
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2
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PABLO MACIEL BRASIL MOREIRA
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Optimizing hypertension treatment in the older people through home blood pressure monitoring by pharmacists in primary care: MINOR Clinical Trial
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Líder : MARCIO GALVAO GUIMARAES DE OLIVEIRA
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MIEMBROS DE LA BANCA :
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RODRIGO SILVEIRA PINTO
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ANTONIO CARLOS BEISL NOBLAT
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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Data: 03-mar-2023
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Resumen Espectáculo
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Introduction: Home blood pressure monitoring (HBPM) is more reliable than ambulatory blood pressure monitoring (ABPM). However, the combination of HBPM with collaborative drug therapy management (CDTM) has not been studied yet. Purpose: This study aimed at assessing the efficacy of combining HBPM with CDTM in optimizing antihypertensive treatment in the elderly population. Methods: This open-label, parallel-group, randomized clinical trial included hypertensive elderly patients. In the control group, the participant received a BP meter and instructions on how to perform HBPM. Provided with a report with the BP values, the general practitioner (GP) decide on any change in treatment. In the intervention group, the pharmacist subjected the participant to a drug therapy management protocol and provided the GP with suggestions to optimize the antihypertensive drug therapy, in addition to the report with BP values. The following outcomes were considered: the proportion of participants with deprescription of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between groups 45 days after performing HBPM. Findings: In each group, 161 participants completed the trial. Antihypertensives were deprescribed in 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (p=0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (p=0.52). The mean ambulatory systolic BP and HBPM were lower in the intervention group (p-value=0.22 and 0.28, respectively). Implications: Combining HBPM with a CDTM protocol effectively optimizes antihypertensive treatment in the elderly in primary health care.
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3
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Maria de Lourdes Lacerda Lemos
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Assistance trajectories of women in remote rural municipalities in northern Brazil: experiences of care based on the condition that traces cervical cancer.
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Líder : PATTY FIDELIS DE ALMEIDA
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MIEMBROS DE LA BANCA :
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PATTY FIDELIS DE ALMEIDA
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ADRIANO MAIA DOS SANTOS
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MARCIA CRISTINA RODRIGUES FAUSTO
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Data: 23-mar-2023
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Resumen Espectáculo
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Worldwide, when there is a correlation with urban populations, access to health services becomes more difficult when we consider the rurality factor. When we shed light on rural and remote regions, an abyss is perceived between what is idealized in health policies with regard to access, promotion and prevention in health, and what is put into practice in practice. The North region of Brazil, as well as other remote rural regions of the world, face adversity to guarantee equity, completeness and universality of access. In this sense, this dissertation has the general objective of rebuilding the care trajectory of women from the Cervical Cancer (CC) tracer event in the scenario of Remote Rural Municipalities (MRR) in Northern Brazil. The attempt is to analyze the access and organization of Primary Health Care actions using the CC as a tracer event, identifying strategies for accessing the Health Care Network from the perspective of users and proposing strategies for improving care and prevention of CC in rural context. This is a multiple case study, exploratory, of a qualitative nature, having as the unit of analysis the MRR in the north of the country, where family health teams work, and is part of a larger research project entitled "Primary Health Care in rural and remote territories in Brazil”. Municipalities in the territory Norte Estradas and Norte Águas were elected. In the first area, three municipalities were selected for convenience – Jacareacanga-PA, Rurópolis-PA and Assis Brasil-AC –; and seven municipalities in the second area – Aveiro-PA; Curuá-PA; Melgaço-PA; Prainha-PA; Boa Vista do Ramos-AM; Maués-AM and Vitória do Jari-AP. In all, 17 interviewees were distributed across the territory studied. The results are presented by two moments of the care journey of these women through the network: “Primary Health Care in remote rural municipalities: where does the journey begin” and “Specialized and hospital care: care must continue”. The women demonstrated that access to the Pap smear collection is facilitated, but without criteria of prioritization and necessity. Obstacles arose concerning access to test results and guidance on the researched problem, suggesting deficiencies in the organizational process and health education. In general, the users made a positive assessment of the teams' service, but from the perspective of the courtesy with which they were treated by the professionals. When there was a need for specialized care, difficulties in accessing and dismantling the network became evident, exacerbated by the lack or even lack of sanitary transport, increasing the social vulnerability already rooted in this territory, leading these women to compromise their family income and their daily lives. It is necessary to use the characteristics of the territory to develop and/or adapt health policies and practices that are consistent with the needs of remote rural populations, with adjustments in financing and promotion of technologies capable of mitigating the structural inequalities found.
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4
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ELIZÂNGELA DE MORAIS SANTOS
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Psychodynamics of the work of the Community Health Workers in the period of the covid-19 pandemic
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Líder : ADRIANO MAIA DOS SANTOS
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MIEMBROS DE LA BANCA :
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ADRIANO MAIA DOS SANTOS
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HELCA FRANCIOLLI TEIXEIRA REIS
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JULIANA ALVES LEITE LEAL
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NILIA MARIA DE BRITO LIMA PRADO
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Data: 13-jul-2023
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Resumen Espectáculo
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Community Health Workers (CHW) have been going through an arduous path in search of recognition and strengthening of their professional identity and their attributions, intensified, specifically, during the covid-19 pandemic. During the pandemic, the CHW were recruited to carry out routine activities already recommended in territorial health care, with some adaptations, as well as having to accumulate other responsibilities related to controlling the pandemic in the territory. This study aims to analyze the psychodynamics of the work of the CHW, in the context of the covid-19 pandemic. For this purpose, the theoretical framework of the psychodynamics of health work was used. For the psychodynamics of work, work is a constitutive factor of the subject's psychic formation, and it can cause suffering or pleasure. This is a study with a qualitative approach developed in the municipality of Vitória da Conquista, Bahia. The research subjects were eighteen CHW who worked in family health units in the rural area. Data production was carried out through semi-structured interviews. Data interpretation was based on thematic content analysis and was organized into six thematic categories: a) The meanings of being CHW; b) Work in the pandemic: suffering and pleasure; c) Creation process: the prescribed and the real; d) The encounter with the reality of the pandemic: fear; e) Defense strategies: experience of work in the pandemic; and f) Recognition: a sense to continue the work in the pandemic. The main results indicate that: 1) being CHW was not a desired profession and the motivator was achieving financial stability, especially since they did not have other opportunities for employment. Thus, adaptation, learning and professional identity took place in the daily work process in the community; 2) “Non-positive” feelings were externalized, such as, for example, the psychological suffering caused by the practice, impotence in the face of adversity, staying at work due to lack of option to have another professional occupation, interference in their family nucleus, for there is no limit “respected” by the community between working day/time and rest time; 3) Working as an CHW was a challenging activity, particularly during the pandemic. In some situations, the CHW has to be a “psychologist” to be able to accommodate the demands of the community. Such a need required a cognitive effort and a permanent search to maintain a balance in relations with the population and, often, attempts to put oneself in the other's shoes to understand the complexity of the health-disease-care process. In addition, they highlighted that, sometimes, they were blamed on all sides by the community and the service, for not being able to meet the various demands of users. Finally, the CHW recognized the relevance of their work for the success of the actions developed by the primary health care team, with special emphasis on rural territories. Not by chance, they highlighted the importance of the link they develop between techno-scientific knowledge and popular knowledge, the link of trust and information between the service and the population, and they perceive themselves as fundamental for the Unified Health System, even in the context of the pandemic.
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5
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ANDRESSA DE ANDRADE SANTOS
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Therapeutic itinerary of people affected by amputation due to diabetic foot: plots of (lack of) care
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Líder : ADRIANO MAIA DOS SANTOS
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MIEMBROS DE LA BANCA :
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ADRIANO MAIA DOS SANTOS
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DEISE LISBOA RIQUINHO
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JOSE ANDRADE LOUZADO
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Data: 14-jul-2023
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Resumen Espectáculo
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Introduction: Excessive illness requires continuous care from individuals and taxes that health care modes include interprofessional and intercultural actions. Thus, they submit them to their therapeutic itineraries, both via the institutionalized sphere of health services, and through the “informal” field, such as religious practices and homemade medications. In this plot, the biomedical model is predominant in the ways services are organized, in the professionals' work processes and in the way users build their paths in the health care network – formal or informal. In this context, diabetes brings with it motivation that often changes in daily activities, in social, family and work relationships. In addition, when not controlled, it is responsible for several complications, among which the diabetic foot. Diabetic foot is a very serious problem, since it is responsible for greater chances of lower limb amputation. This study analyzes the therapeutic itineraries of individuals with lower limb amputation due to diabetic foot. Methodology: This is a qualitative research, developed with 20 people who had amputation of lower limbs due to diabetic foot, living in rural and urban areas of Vitória da Conquista, Bahia. Data production involved in-depth semi-structured interviews and data were analyzed using Thematic Content Analysis, with the Holistic Analysis of Therapeutic Itineraries as theoretical-methodological support. Results: Four dimensions were evidenced: 1) Facing the illness - senses and meanings lead behaviors. The understanding of the health-disease-care process, influenced by the sociocultural context, defined the starting moment of the search for care. The absence of symptoms delayed the search for assistance and limited knowledge about the disease conditioned the reluctant behavior. In addition, the illness brought suffering to the subjects who felt powerless when facing the complications of the disease. 2) Dealing with vulnerabilities – economic and social aspects mark therapeutic itinerary decisions. The subjects lived in socioeconomic vulnerability and this condition worsened with the amputation. The long waiting periods in the public network led the subjects to search for private services, negatively affecting the financial capacity of the families, once aggravating the health situation due to the economic impossibility of continuing the care in this way. In addition, geographic and economic barriers made it difficult to access health care in a timely manner, since there was a lack of health transport; 3) Mishaps along the way – the search for assistance in the care arenas. The search for care in the formal network was undertaken mostly by the user himself. However, the lack of guidance and referrals by primary health care (PHC) professionals to other points of care may have delayed timely care. This scenario led users to look for other gateways. Furthermore, the lack of counter-referral to the family health unit led users to seek PHC only in the face of occasional needs after the amputation. Along with care in the formal arena, the subjects concomitantly used informal care, which ranged from religious practices to domestic care; 4) Experiencing illness – assessments of care experiences. Long queues for appointments and exams delayed timely care, generating user dissatisfaction. The absence and turnover of physicians compromised longitudinality in PHC, leading users to look for these professionals in the private sector. The pandemic was also an important limiting factor in access. These obstacles generated judicialization processes, evidencing access difficulties present in therapeutic itineraries, pointing to dysfunctions in the health system. Final Considerations: The therapeutic itinerary of different people signaled the multiplicity of experiences and the (lack of) care that permeates the different arenas. The symbolic aspects constructed from the sociocultural experiences of the subjects, composed understandings about health-disease-care, defining choices and behaviors along the way. Living conditions surrounded by vulnerabilities widened the gaps in access to health, placing subjects in even more unfavorable social situations. The pathways also exposed important obstacles related to fragile arrangements in the health care network, with incipient coordination of care by the PHC, leaving users at the mercy of building their own care map.
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6
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KAMILLA SANTOS SILVA AZEVEDO
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SPECIALIZED CARE FROM THE PERSPECTIVE OF INTEGRATION TO THE HEALTH CARE NETWORK: AN ANALYSIS BASED ON THE REGIONAL POLYCLINIC OF VITÓRIA DA CONQUISTA
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Líder : PATTY FIDELIS DE ALMEIDA
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MIEMBROS DE LA BANCA :
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ADRIANO MAIA DOS SANTOS
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DANIELA GOMES DOS SANTOS BISCARDE
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PATTY FIDELIS DE ALMEIDA
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Data: 21-jul-2023
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Resumen Espectáculo
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The objective of this research was to analyze the offer of Specialized Care (SA) and health transport of the regional polyclinics implemented in Bahia, through the Interfederative Health Consortia, focusing on the experience of the Regional Health Polyclinic of Vitória da Conquista and Itapetinga, considering the attributes of the Specialized Care offer according to the molding of the Health Care Networks, from the perspective of the subjects who participated in the implementation process of the same, as well as those who work in the management and direct assistance to the user. This is an exploratory and instrumental case study, with a qualitative approach, covering two stages of research, the first being between May and June 2021, aimed at interviewing managers and managers, totaling 19 people. The second stage took place between October and November 2022, and consisted of interviewing 09 workers from the polyclinic and health transport. The collection instrument used was a semi-structured script. Thematic content analysis was carried out based on the following dimensions: Planning of EC supply and health transport based on regional health needs; Elective sanitary transport; Regulated access and care coordinated by the APS; Integration with other RAS points and professionals in the health region; Multiprofessional care in the EC; Electronic medical records, clinical protocols and access to EC shared with municipalities and APS; Integration and communication between AE and social/population control; Matrix function, Continuing Education, teaching-service integration and research in the AE; Referral and counter-referral flows; Permanent education and space for professional training; Role of the regional polyclinic in the production of specialized care. Among the results found in the two phases of the research are advances such as the expansion of the supply of EC, with guaranteed medical transport; enabling the retention of qualified professionals; monitoring of AE provision; advances in regulation through the operating system; existence of initiatives such as the Caminhos do Cuidar Project, which aims to monitor compliance with the sixty-day law for cancer patients; care aimed at patients with complications from diabetes; permanent education aimed at professionals in partnership with institutions such as the Center for Attention and Support to Life (CAAV), Health Department of the State of Bahia (SESAB). As challenges, difficulties emerged in the referral and counter-referral process; lack of electronic clinical records that are shared between the polyclinic and other points of care; need for greater incentives aimed at permanent education and teaching-service integration and research; construction of communication channels between AE and APS, among others. Based on this, it was concluded that even with important advances in the process of expansion of the EC, adjustments are still necessary that allow its functionality in a resolute and integrated way, based on the PASA model, articulating with the other points of attention and to Therefore, strengthening PHC would be one of the most urgent aspects to be conquered.
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7
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INGRID OLIVEIRA CHAVES
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TEACHING CRITICAL THINKING ABOUT HEALTH MEDIATED BY DIGITAL TECHNOLOGIES: QUALITATIVE ANALYSIS OF THE BRAZILIAN CONTEXT
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Líder : DANIELA ARRUDA SOARES ALVES
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MIEMBROS DE LA BANCA :
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DANIELA ARRUDA SOARES ALVES
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JOANA BISOL BALARDIN
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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Data: 25-ago-2023
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Resumen Espectáculo
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Introduction:People who are more engaged in their health are more inclined to seek and use information to support their health decisions, and Critical Thinking (CP) emerges as an element capable of assisting in the analysis of health information and decision-making from an individual perspective and collective. The teaching of critical thinking favors an emancipatory education and contextualizes the individual with the environment and society around him, gives protagonism to the student, and hopes to form citizens capable of understanding and intervening in social contexts. Objective: To analyze the context of teaching critical thinking about health, mediated by Digital Information and Communication Technologies (TDIC) in the school and health context in Brazil. Method: This is a qualitative, descriptive study, whose data were collected between February and July 2020, in Vitória da Conquista and Foz do Iguaçu, based on semi-structured interviews and document review. National documents were intentionally selected from specific government websites for the areas of health and education. The interviews followed a script developed by the research team, which was specific for each professional category. A total of 17 interviews were carried out, 12 in Vitória da Conquista and 5 in Foz do Iguaçu. The collected data were compiled and combined, from a research approach applied to public policies. Results: The inclusion of critical thinking in curricula and official documents is present, but there are difficulties in its practical application. Learning resources to teach critical thinking about health are scarce, and they focus on promoting healthy behaviors. There is great variability in the access and use of digital equipment for teaching and learning in national schools, and the main intervening factors are the stability of connections, the technological skills and attitudes of professionals in relation to the use of Digital Information and Communication Technologies (TDIC) for teaching. Although improvements in different contextual elements in Brazilian schools are being planned by local governments, these are still incipient. Conclusion: The teaching of critical thinking about health mediated by the use of TDCI is not deliberate in the Brazilian context, but there are possibilities for its insertion given its expressed potential.
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8
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VANESSA RODRIGUES DE OLIVEIRA
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CRITICAL THINKING IN HEALTH: ANALYSIS OF PERCEPTIONS AND KNOWLEDGE BETWEEN HEALTH AND EDUCATION PROFESSIONALS TO PROMOTE A TRAINING PROCESS
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Líder : DANIELA ARRUDA SOARES ALVES
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MIEMBROS DE LA BANCA :
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DANIELA ARRUDA SOARES ALVES
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JOANA BISOL BALARDIN
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POLIANA CARDOSO MARTINS
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Data: 28-ago-2023
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Resumen Espectáculo
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Knowledge about critical thinking among health and education professionals is important as it presents itself as a powerful tool in promoting social transformation and citizen engagement. However, mapping their knowledge among health and education professionals to propose training processes represents a challenge given the multifaceted character that permeates the rationalities and epistemic practices adopted by them. Thus, the general objective was to analyze the perception of health and education professionals about critical thinking in health and health literacy levels, based on a training process to promote critical thinking in health. The design used was of mixed methods. The sample included health professionals working in the Family Health Program and elementary school education professionals, both members of the Health at School Program. Data collection was carried out from March to April 2022. Qualitative data were collected through semi-structured interviews recorded in audio and later transcribed, which underwent categorical content analysis. Quantitative data were obtained through a questionnaire and analyzed inferentially. The qualitative results showed a variety of conceptions about critical thinking, which points to the conceptual polysemy that the term carries. Four main conceptions of critical thinking were identified in this research: directed to skills and competences; coming from logic/reason and science; focused on social justice; focusing on the emancipation of the subjects involved. Quantitative results indicated that the level of health literacy was sufficient for a large number of participants (84.3%), especially for health professionals (89.3%). Black and brown, married and living with a partner, with graduation/specialization, longer time in the position, were associated with insufficient levels of health literacy. It is concluded that the promotion of critical thinking is a global theme that needs to be worked on, both in academic and work training, based on permanent government actions that encourage it, in order to support strategic management, political decision and practical actions. in the areas of health and education.
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9
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Daiane Borges Queiroz
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HEALTH FAIRS AS A SCREENING AND MONITORING STRATEGY FOR ARTERIAL HYPERTENSION AND DIABETES MELLITUS IN THE SCOPE OF PRIMARY HEALTH CARE
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Líder : DANIELLE SOUTO DE MEDEIROS
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MIEMBROS DE LA BANCA :
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CAMILA SILVEIRA SILVA TEIXEIRA
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DANIELLE SOUTO DE MEDEIROS
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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Data: 01-sep-2023
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Resumen Espectáculo
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Objective: To describe the tracking and monitoring of people with Hypertension (AH) and Diabetes Mellitus (DM) through health fairs within the scope of Primary Health Care in the city of Vitória da Conquista-Bahia. Methods: a cross-sectional study, part of the HealthRise project, with data collected at 23 health fairs in Family Health Units and Basic Health Units, from May/2017 to April/2018. People with AH, DM and their family members were included. In data collection, an interview was conducted and blood pressure, capillary blood glucose, glycated hemoglobin and anthropometric measurements were collected. For the analysis of article 1, a stratification by the gender variable was carried out, and descriptive analyzes of the population were carried out. A bivariate analysis was also carried out between the presence of comorbidities and the variables under study. Then, the analysis was divided into two groups: one for tracking AH and DM and one for monitoring these conditions. For the second article, a descriptive analysis of the risk score and an assessment of its internal consistency were performed. Sensitivity and specificity were calculated for three different compositions in the patient group. The Positive (PPV) and Negative (NPV) Predictive Values were also calculated. Results: 23 health fairs were held, with a greater participation of women (70.0%). Of the participants, 43.6% had only AH, 3.9% only DM and 18.2% had both diseases. Screening showed a large number of alterations suggestive of DM and AH, since 81.8% of men with AH referred for glycated hemoglobin (HbA1c) collection showed altered values, and among men with DM, 75.5% had altered BP values. In the analysis of DM monitoring in men, 65.6% of those with DM only did not have HbA1c control, and in females, there was no control in 66.0% of users with DM. In the monitoring of AH in males, it was observed that more than 60% of participants did not have control of blood pressure levels, and in the female stratum, more than 58% of users did not have this control. According to the test result, the risk of developing DM2 was present in 62.6% of the participants. Sensitivity was 86.2% when using HbA1c with values covering pre-diabetes, and specificity was 39.7% when using self-reported information. The PPV was 79.1% when considering pre-diabetes levels in the patient group, and the NPV was 68.8% when considering only DM values in the patient group. Conclusions: With the good number of participants in health fairs, and with the identification of several users with alterations in blood pressure and glycated hemoglobin, with or without prior knowledge of the disease, it is possible to confirm the importance and usefulness of health fairs. It was possible to identify users chosen for prevention and treatment measures, in a single place and time, with better management of the resources available in the SUS. It was also observed that the application of a type 2 diabetes mellitus risk test is a good tool for screening in collective approaches, such as in participants of health fairs in Primary Care. It was observed that they can identify individuals at greater risk and refer them to biochemical measurements.
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10
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GEOVANI MORENO SANTOS JUNIOR
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THE ROLE OF THE SMALL HOSPITAL IN ADDRESSING THE COVID-19 PANDEMIC
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Líder : POLIANA CARDOSO MARTINS
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MIEMBROS DE LA BANCA :
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JULIANA OLIVEIRA SANTOS
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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POLIANA CARDOSO MARTINS
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Data: 01-nov-2023
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Resumen Espectáculo
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This dissertation aims to discuss the limits, challenges and contributions of Small Hospitals (HPP) in facing the COVID-19 health emergency. The health emergency required a reorganization of health services, given the characteristics related to high transmissibility and lethality, which did not determine the reorganization of health services around the world. In Brazil, obstacles are added to social inequalities and vulnerabilities, in addition to the chronic problems of the SUS linked to financing and structure deficits. Considering Ministerial Ordinance GM/MS no. 1,044 of 2004, which seeks to define, characterize and adapt the operating profile of these hospitals within the command of decentralization of assistance mediated by the structuring of a hierarchical network, establishing the National Policy for Small Hospitals (PNHPP). They represent around 62% of healthcare establishments in Brazil. The first point of this interface concerns the potential of HPP in caring for patients with mild and intermediate respiratory symptoms, due to its high presence in Brazilian territory. Another perspective is the low technological capacity of this type of unit, which can compromise the line of care in those locations far from reference centers. The third point, which has represented a major challenge, concerns integration with the Urgency and Emergency Network, thus demonstrating a guiding element of new perspectives for the HPP. Another no less important point concerns the political role of this element in their small communities, where they demarcate their role-space in the political and assistance game. Preliminarily, the HPP have functioned as screening centers for COVID19, but not for hospital admissions. They have received more patients with other pathologies awaiting procedures and also palliative care. The COVID-19 pandemic demonstrated and reinforced the need to position HPP within care networks, resulting in better quality of care and also saving more lives.
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11
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PAULO HENRIQUE MARTINS DE OLIVEIRA
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THERAPEUTIC ITINERARIES IN ORAL HEALTH OF THE PERIPHERAL BLACK POPULATION IN THE CONTEXT OF THE COVID-19 PANDEMIC
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Líder : RAQUEL SOUZAS
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MIEMBROS DE LA BANCA :
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MARCIA PEREIRA ALVES DOS SANTOS
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DANIELA ARRUDA SOARES ALVES
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RAQUEL SOUZAS
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Data: 05-dic-2023
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Resumen Espectáculo
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This study analyzed therapeutic itineraries in oral health, in individuals belonging to black race/color, living in peripheral areas in the municipality of Vitória da Conquista – Ba, during the period of the COVID-19 pandemic. qualitative character, through the application of a semi-structured questionnaire, with 14 black and brown SUS-dependent people, attended at the study's reference UBS, during the month of October 2022. The responses were duly transcribed and subjected to content analysis and analysis lexical. The study highlighted the complexity of the therapeutic itinerary experienced by black and brown people, the structural challenges, the increase in disparities during COVID-19, the search for curative procedures, the existence of persistent barriers, underreporting in cases of structural and institutionalized racism, and the need to implement policies in favor of racial equity in health. In this context, it is concluded that the intricate relationship between race/color and access to oral health services reflects inequalities rooted in the health system, characterized by structural and institutional racism. Therefore, it is imperative that public policies and health strategies are reformulated to eliminate these disparities.
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12
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TALITA FARIAS CORREIA MACEDO
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FAMILY HEALTH STRATEGY IN THE PREVENTION, CONTROL AND CARE OF ARBOVIROSIS
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Líder : JOSE PATRICIO BISPO JUNIOR
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MIEMBROS DE LA BANCA :
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JOSE PATRICIO BISPO JUNIOR
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POLIANA CARDOSO MARTINS
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CEZAR AUGUSTO CASOTTI
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Data: 13-dic-2023
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Resumen Espectáculo
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The present dissertation aimed to analyze the work developed by the Family Health Strategy for the prevention and control of arbovirus diseases, as well as for the development of care actions for individuals affected by Dengue, Zika, and Chikungunya. It is a qualitative research conducted in Vitória da Conquista, based on 22 semi-structured interviews, participant observation in the territories, and document analysis. The theoretical-methodological framework was based on analytical matrices developed from the constructs of the Unified Health System (SUS), Health Surveillance, and actions and policies for the care and prevention of arbovirus diseases in Primary Health Care (APS). The results and discussion were presented through two scientific articles. The first article aimed to analyze the performance of the Family Health Strategy (ESF) in the care and prevention of arbovirus diseases in high-risk infection areas. The results showed limitations to care actions under the influence of activity overload and the adopted care model. Content-oriented and verticalized educational practices predominated, with community mobilization strategies being campaign-oriented and hygienist. The studied teams did not routinely assume surveillance and control actions. The second article aimed to analyze the performance and coordination of the work of Community Health Agents (ACS) and Endemic Disease Control Agents (ACE) in the prevention and control of arbovirus diseases. The results showed that ACS and ACE have fragmented and uncoordinated performance. There was a clear distinction of roles between the agents. The chemical control of vectors characterizes ACE performance. ACS does not feel responsible for active surveillance of arbovirus diseases. A weak coordination for collaborative work was evident. There are no regular mechanisms for coordinated action or sharing of information and tasks. Contexts of distrust and limited community mobilization mark the agents' relationships with the community. Weaknesses in the training process and the absence of a continuing education policy were identified. The study identified consistent limitations of the Family Health Strategy in preventing, controlling, and caring for arbovirus diseases. The APS must play a greater role in the surveillance of territories and take effective responsibility for the situation of dengue, zika, and chikungunya. There is a need to improve governance mechanisms and strengthen community mobilization strategies.
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13
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CAMILA MOREIRA DE ALMEIDA MELO
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DETERIORATION OF ORAL HEALTH AND FRAILTY PHENOTYPE IN ELDERLY PEOPLE IN A MUNICIPALITY IN CENTRAL-SOUTH BAIANO
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Líder : DANIELLE SOUTO DE MEDEIROS
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MIEMBROS DE LA BANCA :
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CAMILA SILVEIRA SILVA TEIXEIRA
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DANIELLE SOUTO DE MEDEIROS
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MARCIO VASCONCELOS OLIVEIRA
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Data: 15-dic-2023
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Resumen Espectáculo
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Objectives: To describe the deterioration of oral health and the frailty phenotype of the elderly population in the city of Guanambi, Bahia. Methods: Cross-sectional, home-based study carried out between March and April 2023, through interviews and collection of objective measurements. To measure the deterioration of oral health were used the indicator of tooth loss (edentulism). The frailty phenotype was defined based on five characteristics: weight loss, weakness, limited mobility of the lower limbs, exhaustion, and a low level of physical activity. The prevalences of the different categories of tooth loss and the frailty phenotype were calculated, and the associations with the explanatory variables were evaluated using multinomial logistic regression, with estimates of the prevalence ratio (PR) and 95% confidence interval (95% CI). Results: Of the 449 respondents, 53.7% had total edentulism, 20.5% were partially edentulous, and 25.8% were dentate elderly people. This factors were associated with total tooth loss: age greater than or equal to 80 years (RP=2.50); being female (RP=2.62); never having studied (RP=6.25) and having 1 to 5 years of study (RP=3.43), assessment of oral health as fair (RP=0.34) and poor and very poor (RP=0.12); and the last dental appointment was 1 year or more ago (RP=2.04). Frailty was observed in 25.6%, 51.7% were pre-frail, and 22.7% were robust elderly people. The following were positively associated with frailty: living in urban areas (RP=3.51); age 70 to 79 years (RP=3.49) and 80 years and over (RP=24.60); never having studied (RP=3.14); self-reported health as fair (RP=2.91) and poor or very poor (PR=21.69); poor physical health on at least one day in the last 30 days (RP=2.61); and a report of a diagnosis of two or more morbidities (RP=2.85). Total edentulism (RP=2.81) and self-assessment of oral health as poor/very poor (RP=3.41) showed a significant increase in the prevalence of frailty after adjusting for the region of residence. Conclusions: The elderly in Guanambi show a high degree of deterioration in oral health, revealed through extensive tooth loss. Frailty also had a high prevalence, highlighting the vulnerability of the studied population. To maintain healthy teeth in the mouths of the young and adult population and to establish the functionality of lost elements in the elderly population, we need effective policies, mainly through prosthetic rehabilitation. Furthermore, these oral health policies cannot be debated in isolation, as tooth loss is also associated with greater frailty among the elderly. Oral health policies must aim to provide comprehensive care to individuals who will benefit from them, ensuring healthy aging in conditions of dignity.
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14
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JANNE JÉSSICA SOUZA ALVES
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FUNCTIONAL DISABILITY OF THE ELDERLY POPULATION OF THE MUNICIPALITY OF GUANAMBI, BAHIA, BRAZIL
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Líder : DANIELLE SOUTO DE MEDEIROS
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MIEMBROS DE LA BANCA :
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CINOELIA LEAL DE SOUZA
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CLAUDIO LIMA SOUZA
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DANIELLE SOUTO DE MEDEIROS
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Data: 18-dic-2023
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Resumen Espectáculo
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Population aging has gained increasing notoriety due to its dissipation across different regions of the planet. At an accelerated pace, it also advanced in countries with less economic development. And it is considered one of the most challenging phenomena in this century due to its multiple consequences. The objective of the present study is to evaluate functional disability and associated factors in the elderly population of the city of Guanambi, Bahia, Brazil. This is a cross-sectional, population-based study with a household approach. The sample consisted of 449 elderly people aged 60 and over. This study assessed functional disability through Basic Activities of Daily Living (BADL), measured by the Katz scale, Instrumental Activities of Daily Living (IADL), measured by the Lawton scale, and mobility, assessed by the difficulty or inability to walk 100 meters. For data analysis, simple and relative frequencies were calculated for all variables studied. The prevalence of the outcome was calculated and the associations with the explanatory variables were evaluated using Poisson regression with robust variance, with estimates of the prevalence ratio (PR) and 95% confidence interval (95% CI). Multivariate analyzes were performed, including in the initial models all variables that, in the bivariate analysis, showed an association with the outcome at a significance level of less than 20%. The prevalence of functional disability in BADL was 21.3%, in IADL it was 66.5%, and in mobility it was 48.2% of the total number of elderly people interviewed. Around 73.9% had functional disability in one of the three domains assessed (BADL, IADL or mobility). After multivariate analysis, the factors positively associated with a higher prevalence of functional disability were: living in an urban area (PR=1.40; 95%CI 1.20-1.64), age between 70 and 79 years old (PR=1.21 ; 95%CI 1.06-1.40) or 80 years and over (PR=1.33; 95%CI 1.17-1.52), not having worked in the last 30 days (PR=1.61; 95%CI 1.16-2.25), having had poor physical health in the last 30 days (PR=1.16; 95%CI 1.05-2.29), self-rated vision as bad or very bad (PR=1.20; 95%CI 1.08-1.33), report of frequently annoying pain (PR=1.23; 95%CI 1.11-1.35), presence of manual dynapenia (PR=1.14; 95%CI 1 .04-1.26) and having had a medical consultation in the last 12 months (PR=1.25; 95%CI 1.04-1.50). Functional incapacity is an important factor that can give elderly people a worse quality of life, being a relevant and harmful condition for active and healthy aging. These results can contribute to the knowledge of the functionality of the elderly, offering subsidies for managers, researchers and health professionals, with a view to directing integrated, transversal and intersectoral policies and actions in favor of healthy aging.
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15
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DANIELE ROCHA FROES VASCONCELLOS
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Negative feelings between students and teachers of higher education institutions in the context of the COVID-19 pandemic
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Líder : POLIANA CARDOSO MARTINS
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MIEMBROS DE LA BANCA :
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POLIANA CARDOSO MARTINS
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DANIELLE SOUTO DE MEDEIROS
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ROSEMARY DA ROCHA FONSECA BARROSO
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Data: 20-dic-2023
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Resumen Espectáculo
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ABSTRACT
COVID-19 is a flu-like syndrome caused by the SARS-CoV-2 virus, considered by the World Health Organisation to be a pandemic in March 2020 due to its high transmissibility, geographical extension, number of infected people and deaths. Following the WHO decree, measures to mitigate the transmission of the virus were adopted in all countries, including Brazil, such as social distancing and emergency remote teaching in primary, secondary, and higher education, where students began to take classes online from their homes. Emergency remote teaching has been a challenge for students and teachers who have had to adapt abruptly to digital technologies amid an unprecedented health crisis that has also caused mental health problems in the population. In the case of university teachers and students, the emergence or worsening of depression, anxiety, and stress during the pandemic has been observed in several international studies. This study analyzed the factors associated with negative emotional symptoms (depression, anxiety, and stress) during the COVID-19 pandemic among students and teachers at public and private higher education institutions in Brazil. It is a cross-sectional study including teachers and undergraduate students from public and private Higher Education Institutions (HEIs) in the 26 Brazilian states and the Federal District. The calculated sample was 2996 students and 2097 teachers who responded to the data collection instrument via the Survey Monkey platform during July and August 2020. The data collection form comprised the DASS-21 (Depression Anxiety Stress Scale) and socioeconomic, demographic, and lifestyle information. And Student. Mean scores were calculated for prevalence, and each participant was grouped according to severity. The cut-off point for severe symptoms was 90 percent, corresponding to a total DASS-21 score of 42 points. After this calculation, Poisson Regression was performed to analyze the prevalence ratio, using the final average DASS-21 score of each considered severe participant. The main results were that female students aged 18-39, with low incomes and low family incomes, had a higher prevalence of negative emotional symptoms, corroborating the existing literature. In the case of the group of teachers, the prevalence was observed in those participants whose income was between R$3,000.00 and R$10,000.00. This study demonstrated the importance of re-signifying higher education dynamics because of the pressures and demands on students and teachers and their repercussions on their mental health.
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16
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WLADIR BASTOS FERNANDES JUNIOR
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COMPARATIVE STUDY BETWEEN DIAGNOSED AND TREATED CASES OF HEAD AND NECK NEOPLASMS: AN ANALYSIS OF THE BRAZILIAN PUBLIC HEALTH SYSTEM
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Líder : MARCIO VASCONCELOS OLIVEIRA
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MIEMBROS DE LA BANCA :
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CLAUDIO LIMA SOUZA
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FABRICIO FREIRE DE MELO
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MARCIO VASCONCELOS OLIVEIRA
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Data: 21-dic-2023
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Resumen Espectáculo
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This work deals with a comparative study between diagnosed and treated cases of head and neck neoplasia, within an analysis perspective that contributes to the improvement and monitoring of the Brazilian public health system. The methodology applied summarizes in tables and graphs the consultations carried out on DATASUS, to obtain in absolute numbers the cases diagnosed and treated, and proposes in this investigation a treatment coefficient that divides the number of cases treated by the number of cases diagnosed, in the same unit. territory and in the same period of time. The objective is to know the ability to diagnose and treat the population, endorsed by their municipality of residence, or in the macro-region that their municipality is part of, or in the state, or in the administrative region, or in the country. The different scales of analysis or delimitation of the universe of research allow us to reinforce and create new policies and actions in the management of the public health system. Its applicability also lies in the fact that other coefficients and rates target values that do not directly address the relationship between those diagnosed and treated in the same period, in the same location, which in the universe of this research deal exclusively with head and neck neoplasms, but can be replicated to any other CID. This is an important point of analysis when you want to qualify services in search of improvements, from a perspective of meeting the SUS principles of universality, equity and decentralization, encouraging the health care network to reach the entire society.
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