Doutorado em Saúde Coletiva
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- ItemA gestão do trabalho na Estratégia Saúde da Família : o governo de si e do outro sob a ótica do gestor(Universidade Federal do Espírito Santo, 2016-09-02) Galavote, Heletícia Scabelo; Lima, Rita de Cássia Duarte; 1º membro da bancaThe process of healthcare work management in the scenario of the Family Health Strategy is highlighted as an analytical intention founded on the concepts proposed by Foucault about the apparatuses of power and the techniques for the care of self and others as the foundtion of a political power exercise. The analysis unity transits between the space of macro-politics and that of the micro-politics of the management of work in healthcare, which permeated the teritory of imanence between what is taken as the norm and re-normalization. The objective it to analize the management of work in the Family Health Strategy in the state of Espirito Santo, starting from the discourse of the managers, as well as identifying the pratices involved by the managers in the constitution of the government of self and others. This is a descriptive and exploratory study, with a qualitative approach. To achieve this objectives, managers from 36 municipalities of the state of Espirito Santo were invited to participate: the Municipal Health Secretary; the Municipal Coordinator for the Family Health Strategy; and the Municipal Coordinator for Primary Health Care. A semi-structured interview and participant observation were used for the collection of data. The discourse analysis was the basis for data analysis, and the cartography was used as a complementary method of research. There are elements in the discourse that are highlighted for signaling to a practice of management through discipline and control over the workers, through the attainement of results, founded in mandatory acts and in the normalization of the work, which is called prescribed, dead, amputating the autonomy and creativity of the worker. For the managers, to innovate means to mobilize the workers based on a political centralization that warrants for the manager the final decision and the definition of the directions, once the teams have little governability relating to the definition of goals and indicators. The managers produce self practices, but are inprisoned by the normalizations of the healthcare organiztion itself through the marks that are inscribed on their bodies and that determine a healthcare manager with serialized discourses and actions. They are stultus managers, since they don't exercize the self care as freedom, and bare a subordinate will, which is not free
- ItemBullying, características psicossociais e sociorrelacionais entre adolescentes(Universidade Federal do Espírito Santo, 2019-04-11) Sarlo, Andressa Reisen; Santos Neto, Edson Theodoro dos; 1º membro da bancaabstract
- ItemComunicando o risco: um olhar sobre a epidemia de zika(Universidade Federal do Espírito Santo, 2018-07-17) Antunes, Michele Nacif; Oliveira, Adauto Emmerich; Pimenta, Denise Nacif; Goveia, Fábio Gomes; Maciel, Ethel Leonor Noia; Figueiredo, Túlio Alberto Martins deRisk communication is defined as a process of planning communication of public institutions to face situations of crises or risks, which almost always become media events. Nowadays, more and more, they can also become social media events. And, therefore, social media must be considered when planning communication in the face of emergencies. The purpose of this thesis is to understand the aspects that involve the relationships between a public health emergency, the media and society, and public institutions responsible for risk management, taking as its central axis the role of social media in contemporary society. To take a look at the zika epidemic, some aspects and elements help us. We start from the issued warnings and the declaration of the public health emergency, from the epidemic of meanings in which zika is surrounded, mainly by the context of uncertainty in which it arose. And before society that experiences uncertainty daily, we make brief considerations about the risk. From risk, we move to risk communication and the emergency in public health and the influences that social media operate on this equation. Four studies were developed. In the first one, metassynthesis was performed, in which topics such as the post-truth and the challenges faced by public institutions in this context were also discussed. In the second, a survey of the main communication actions was carried out, based on the official documents that deal with risk communication and the survey of the high resources spent on advertising during the zika epidemic. We concluded that advertising, among other actions, was considered a priority and occupied a prominent place in communication strategies. In the third one, we discuss the use of Facebook as a risk communication tool of public institutions in the response to the zika epidemic. A survey of the postings of the pages of the Ministry of Health and the Government of the State of Espírito Santo related to the topic was carried out, and soon after that, they were categorized according to the subject addressed. It was observed that during the emergence of the zika epidemic, the strategies used in social media do not differ from practices in other media: an invitation to combat mosquitoes. In the fourth study images that aroused more interest and more number of shares on the part of the Internet users from the device in the social network Instagram were analyzed. In the study, we used ImageCloud, an application developed by the Laboratory of Image and Cyberculture Studies (Labic). In summary, we conclude that the current model adopted by risk communication and public health emergencies points to the need for changes that incorporate new strategies and practices that take into account the diverse spaces, scenarios, contexts and existing social processes. In this way, the following question arises: is it possible another form of risk communication and public health emergencies in Brazil? A kind of communication that is anchored in the integration and articulation of several actors in facing the risk?
- ItemDiabetes mellitus, mídia impressa e gestão do trabalho em saúde: uma socioanálise(Universidade Federal do Espírito Santo, 2018-08-03) Coqueiro, Jandesson Mendes; Figueiredo, Túlio Alberto Martins de; 1º membro da bancaabstract
- ItemEfeitos subjetivos do processo de trabalho vivenciados por profissionais em um Centro de Atenção Psicossocial Álcool e Drogas(Universidade Federal do Espírito Santo, 2015-01-01) Wandekoken, Kallen Dettmann; Dalbello-Araujo, Maristela; Sodré, Francis; Figueiredo, Túlio Alberto Martins de; Borges, Luiz Henrique; Rasch, Scheila SilvaThis thesis presents the results of a research that aimed to analyze how workers experience the subjective effects produced by the work process in a Psychosocial Care Center Alcohol and Drugs (CAPSad in Portuguese). The research was conducted under a qualitative approach, in a service of Vila Velha, Espírito Santo State, Brazil . The data was collected through five steps: 1. Desk review of existing policies about drug use; 2. Analysis of medical records; 3. group interview with ten employees; 4. Eighty hours of observation of daily work; 5. In-depth interview with thirteen workers. For data analysis, we used the thematic analysis technique.We conclude that in the analyzed policies, has prevailed ideas related to the users repression, despite the attempt of the Ministry of Health (MS in Portuguese), which considers the harm reduction as a strategy that values the person and their uniqueness.The analysis also pointed out the difficulties faced by workers from that city to act in accordance to the MS guidelines, since the municipal actions has emphasized repression, religious approach and intimidation as a prevention strategy, with the agreement of justice and police. We emphasize that the ambiguities have repercussions at work and for the worker. We also point out other aspects that generate effects on workers: poor working conditions (due to the service structure, low wages and non-existent care network), lack of recognition (due to management failure and the lack of standards) and work overload (due the lack of professionals and conflicts in the activities division).These situations lead to subjective effects such as exhaustion, illness, fear, inability to act, apathy, devaluation, lack of motivation and worker's imprisonment.These effects are all negative and workers has experienced them through emotional detachment in work process, which negatively affects the possibility of producing an effective care.We suggest investments in employee training, with a focus on permanent education, since it causes learning encouragement and creative positioning in face of experienced effects in daily life.There is the needfor dialogue, between workers and management, between the workers themselves and between workers and users.
- ItemEpidemiologia da tuberculose resistente e multidroga resistente no estado do Espírito Santo(Universidade Federal do Espírito Santo, 2016-08-12) Carlesso, Geisa Fregona; Zandonade, Eliana; Maciel, Ethel Leonor Nóia; Dalcolmo, Maria Pretti; Falqueto, Aloísio; Miranda, Angélica Espinosa Barbosa; Prado, Thiago NascimentoThe emergence of resistant strains of Mycobacterium tuberculosis (Mtb) has been a major challenge for the control and elimination of the disease worldwide. In Brazil, the number of reported cases is still small if compared to other countries with high incidence; in Espirito Santo the information about this disease are insufficient. Objectives: To describe and to analyze the sociodemographic, clinical and epidemiological characteristics and factors associated with tuberculosis (TB) resistant to first-line drugs in the ES (a cross-sectional study); to describe the sociodemographic, clinical and epidemiological characteristics of cases of MDRTB (retrospective study described); to analyze factors associated with the occurrence of MDRTB (case-control nested within a cohort); and to analyze the causes of death between TBMDR cases (retrospective study described). Results: In a descriptive and comparative cross-sectional study of resistant TB cases and not resistant, we found a rate of 10.6% resistance to any antituberculosis drugs, among the cases tested. The multidrug-resistant tuberculosis rate (MDRTB) was 5%. After multivariate analysis, were identified the following independent factors associated with resistant TB: history of previous treatment for TB (relapse [OR = 7.72, 95% CI 4.24 to 14.05] and return after default [OR = 3.91; CI 95% = 1.81 to 8.43]), smoking (OR = 3.93; CI 95% = 1.98 to 7.79) and positive culture for Mtb at the time of the event notification (OR = 3.22; CI 95% = 1.15 to 8.99). Descriptive study of cases of MDRTB found respectively 1.1% of primary cases, 18.5% of acquired cases and 5.4% of combined cases. In the characterization of the population, we found an average age of 39 years (SD = 13.8), 79% male, 55% nonwhite and 75% with less education than 8 years of study. The co-infection rate of TB / HIV was 9%; 45% of the cases reported alcohol use, and 43% smoke. Other comorbidities were less frequent, such as diabetes, illicit drug use and mental illness, respectively 12%, 16% and 4%. About clinical and epidemiological history, 99% had the pulmonary form; 67%, bilateral pulmonary involvement, and 88% had evidence of cavitation damage. Sputum smear microscopy was positive in 87% of the cases, and the history of contact with TB case, in 45%. Most of these cases were treated under directly observed treatment (DOT), and the cure rate, default and failure were, respectively, 81%, 5% and 4%. The conversion rate of sputum culture to the 2nd month of treatment was 85%, with 38 days of time mean (SD = 16.0). In study of risk factors for MDRTB, we found that, independently, white and more educated individuals have more risk to be affected by MDRTB in ES, respectively OR 1.87 (CI 95% = 1.08-3.26; p = 0.026) and OR 2.75 (CI 95% = 1.21-6.25; p = 0.000). Variables such as alcoholism, diabetes, mental illness, to be institutionalized, and HIV infection have not been associated with cases of MDRTB (p > 0.005). When TB was the underlying cause of death, the greater mumber of mentions among individuals diagnosed with MDRTB it was respiratory disease. Conclusions: The characteristics of resistant TB cases and MDRTB reproduce the general profile of TB, in ES and Brazil. The factors associated with these cases should serve as a warning to health professionals so that appropriate action can be taken. About higher education and white among the cases of MDRTB, these characteristics should be taken into consideration by the clinical suspicion disease investigation and further investigation in the future. The diagnosis and early treatment should prevent the movement of Mtb strains, thereby providing a reduction in the number of primary cases, besides they may have a greater impact on mortality.
- ItemMetodologia de gestão do trabalho em saúde e a qualidade da assistência pré-natal e seus desfechos perinatais no município de Vitória, Espírito Santo(Universidade Federal do Espírito Santo, 2018-02-27) Ruschi, Gustavo Enrico Cabral; Zandonade, Eliana; Miranda, Angélica Espinosa Barbosa; Chambô Filho, Antônio; Sarti, Thiago Dias; Santos Neto, Theodoro Dos; Cade, Nágela ValadãoThe computerization of health and the implementation of Matrix Support (AM) in Women's Health are normative work processes adopted in the city of Vitória, Espírito Santo (ES), aiming to qualify and increase the resolubility of professionals inserted in the context of Primary Health Care (APS). Objectives: To evaluate the quality dimensions of data from patients' electronic patient records (PEP) followed in the APS of Vitória-ES, the influence of MA in determining the quality of prenatal care and to understand its effect on the determination of adverse perinatal outcomes. Material and Methods: Two cross sectional studies were carried out, with a quantitative approach, from a representative sample, previously calculated and randomly selected from the records of pregnant women enrolled in the basic health care units of Vitória, Espírito Santo, between January 2013 and December (coverage, non-duplicity, accessibility, timeliness, methodological clarity, completeness, consistency and reliability); the second analyzed the quality of prenatal care based on the number of visits, prenatal start, clinicalobstetric procedures and laboratory tests performed. The third study is a cohort with multilevel hierarchical analysis of records of newborns from mothers followed-up in the APS of Vitória-ES, during the same period from 2013 to 2014, evaluating adverse perinatal outcomes (prematurity, low birth weight and early neonatal death). Results: In the evaluation of the data quality dimensions of the PEP, prenatal coverage, considering the onset of prenatal care, was 80%. Despite the restriction of access, opportunity and lack of methodological clarity, the clinical record showed excellent consistency and completeness in the fields of obstetric procedures and laboratory tests. Reliability showed disagreements with the Live Birth Information System. When analyzing the quality of prenatal care, there is a decrease in the adequacy of care provided as the level of analysis becomes more complex. The variables that showed an association with the non-adequacy of care quality were: greater number of children (OR=0.63; IC=0.44-0.92), gestational risk (OR=1.86; IC95%=1.02-3.38) and absence of matrix support (OR=1.50; IC95%=1.10-2.06). The hierarchical analysis model inferred that the chance of a pregnancy to progress to an adverse perinatal outcome increases the higher the number of previous pregnancies (OR=4.39; IC95%=1,93-10,0) and the lower number of prenatal consultations performed (OR=4,99; IC95%=2,18-11,42). No effect of MA on outcomes was observed. Conclusions: There is potential of the electronic medical record as a source of epidemiological information on prenatal care. However, the data suggest that the presence of the Matrix Support does not significantly influence the completeness of the medical record. Greater emphasis on completing medical records and integrating with other levels of care is necessary. The implantation and valorization of strategies of reorganization of services and practices, such as AM, are determinants of quality improvement in prenatal care, and it is necessary to increase the degree of support. Although the proposed hierarchical model demonstrates direct determination of sociodemographic and obstetric characteristics on adverse outcomes, the particular characteristics of PHC in the city of Vitoria-ES reduce the positive effects of AM.
- ItemPrevalência de hipotensão ortostática e fatores associados no estudo longitudinal de saúde do adulto (ELSA-Brasil)(Universidade Federal do Espírito Santo, 2018-04-18) Velten, Ana Paula Costa; Benseñor, Isabela Judith Martins; Mill, José Geraldo; Chor, Dora; Oliveira, Elizabete Regina Araújo de; Zandonade, ElianaOrthostatic hypotension (OH) is a sustained reduction in blood pressure when the individual stands up from lying down. OH occurs as consequence of failure in compensatory mechanisms of reduced venous return. In population studies, OH has been associated with cardiovascular comorbidities such as coronary artery disease, atrial fibrillation, hypertension, heart failure, stroke, arterial stiffness and chronic kidney disease. Besides the risk factors for OH have been neglected in clinical practice, few epidemiological studies have dedicated to this subject. Moreover, studies in the Brazilian population are a missing. This thesis sought to estimate the prevalence of OH and its associated factors among participants of the Brazilian cohort "Longitudinal Study of Adult Health" (ELSA-Brazil). Data collected at baseline were used for 14,833 participants (both sexes, 35-74 years) who had complete data of postural maneuver. The postural maneuver was performed after 20 minutes rest in the supine position by active adoption of stand up posture. Blood pressure (BP) was measured at both supine and at 2, 3 and 5 minutes of orthostasis. OH was defined as a fall ≥20 mmHg in systolic BP and / or a fall ≥10 mmHg in diastolic BP at 3 minutes of orthostasis. The distribution of BP variation after the postural maneuver was determined in a subsample (N = 8,011) after exclusion of participants with cardiovascular morbidity and diabetes. Associated factors were determined by a cross sectional study. The covariates analyzed were gender, age range, race/skin color, schooling, nutritional status, waist circumference, changes in brachial ankle index, pulse wave velocity, heart disease, acute myocardial infarction (AMI)/revascularization, stroke, diabetes, hypertension, antihypertensive medication use, systolic and diastolic pressure, cholesterol, triglycerides, Chagas serology, presence of symptoms and variation of heart rate. The total prevalence of OH was 2.0% (95% CI: 1.8-2.3) and similar between sexes, with increasing frequency with age (1.2% at age <45 years and 3.4% at age > 65 years). When pressure drop in any time measured was used as criterion, the prevalence of OH increased to 4.3% (95% CI: 4.0-4.7). Symptoms as dizziness, visual changes and nausea were self-reported in 19.7% (95% CI: 15.6-24.6) of the participants with OH and only in 1.4% (95% CI: 1.2 -1.6) of the participants without HO. The -2 Z-scores of the pressure variations before and after the postural maneuver in the sub-sample were -14.1 mmHg in the systolic BP and -5.4 mmHg in the diastolic BP. OH was significantly associated with largest age group, OR: 1.83 (95% CI: 1.14-2.95); changes in brachial ankle index, OR: 2.8 (95% CI: 1.13-6.88), AMI/ revascularization, OR: 1.70 (95% CI: 1.01-2.87); self-reported heart disease, OR: 3.03 (95% CI: 1.71-5.36); increased systolic BP, OR: 1.012 (95% CI: 1.006-1.019); positive Chagas disease serology, OR: 2.29 (95% IC: 1.23-4.27) and self-reported symptoms in postural change, OR: 20.81 (95% CI: 14.81-29.24). The prevalence of OH varied substantially depending on the moment of pressure measurement. The current cutoff points adopted may underestimate the actual occurrence of OH in the population. The presence of OH could be very useful as an alert for potential cardiovascular impairment, and therefore a tool for screening and prevention.