PPG Saúde Coletiva

Indetectabilidade sem intransmissibilidade: fragmentações do conceito entre a clínica e a vivência

Wed, 27 Aug 2025 00:00:00 GMT

Indetectabilidade sem intransmissibilidade: fragmentações do conceito entre a clínica e a vivência Cruz, Jeneson Tavares da This dissertation is the result of a study on the concept Undetectable = Untransmittable (U=U) in the lives of gay and bisexual men living with HIV (GBMLWH) who have achieved an undetectable viral load, as well as from the perspective of healthcare professionals working in two specialized HIV services located in Porto Alegre, Brazil, and its metropolitan region. The main objective was to investigate the meanings and interpretations attributed to U=U in the lives of GBMLWH, and to understand how this concept has been constructed and communicated within clinical contexts. U=U is a prevention strategy which states that people living with HIV who adhere to antiretroviral therapy (ART) and reach an undetectable viral load do not transmit the virus through sexual contact. Brazil is internationally recognized for offering ART free of charge through its public healthcare system called Sistema Único de Saúde (SUS) since 1996. In 2019, the country issued an informational note reinforcing the importance of recognizing U=U, affirming that such knowledge contributes positively to the interpersonal relationships of people living with HIV, opens new possibilities for life with the virus, and helps to combat stigma. The field research was qualitative in nature and based on the narratives of 18 participants — 11 GBMLWH and 7 healthcare professionals — which led to the development of two scientific articles. The first article, focused on the narratives of GBMLWH, discusses the meanings and interpretations of U=U in the experiences of those with an undetectable viral load. The study reveals that understanding “undetectability” does not always consistently translate into an understanding of “untransmittability.” In order for the transformative potential of the U=U message to be fully realized in combating HIV-related stigma, the article emphasizes the need for improved communication, even suggesting that the message be reframed as “U=0” to better highlight the notion of zero sexual transmission risk. The second article examines, based on the narratives of both GBMLWH and healthcare professionals, how knowledge about U=U is constructed, interpreted, and negotiated between these two groups. The study reveals a fragmented and frequently misaligned understanding of the concept, highlighting the urgent need for clearer communication and for validating the term "untransmittable" as a strategy to empower patients, promote sexual autonomy, and confront stigma. The findings suggest that although U=U is a prevention strategy capable of improving quality of life and well-being for people living with HIV, its effectiveness is limited by stigma and misinformation. Even in settings where the concept should be more solidified — such as among people with an undetectable viral load and in patient-provider relationships within specialized services — distrust and misalignment with scientific knowledge persist. There is a clear consensus regarding the goal of achieving an undetectable viral load through ART, as this preserves the immune system and prevents progression to aids. However, the second part of the equation — the condition of being untransmittable — remains poorly understood, insufficiently internalized, and ineffectively communicated in clinical environments, as if, in the end, the equation were U≠U.

Uso de cigarro eletrônico e fatores associados entre universitários da área da saúde de uma universidade de goiás: um estudo transversal

Tue, 01 Jul 2025 00:00:00 GMT

Uso de cigarro eletrônico e fatores associados entre universitários da área da saúde de uma universidade de goiás: um estudo transversal Andrade, Hélio Pinheiro de This doctoral thesis in Public Health, developed within the Graduate Program in Public Health at the University of Vale do Rio dos Sinos – UNISINOS – aimed to assess the prevalence of electronic cigarette (EC) use among university students from an institution in the state of Goiás, Brazil, and to investigate associated factors, including the relationship with the use of psychoactive substances. This was a cross-sectional, university-based study conducted using a self-administered questionnaire between October 2022 and May 2023. The results revealed a high prevalence of EC use in the past 30 days (69.1%), with a higher frequency among males and students aged 22 to 24 years. Factors such as alcohol consumption, illicit drug use (including marijuana), psychotropic medication use, and conventional cigarette smoking were strongly associated with EC use, both lifetime and recent use. Students enrolled in clinical cycle courses also showed a higher prevalence of EC experimentation. Adjusted analyses indicated significant prevalence ratios and odds ratios for these associations, reinforcing the multifactorial nature of this behavior. In conclusion, EC use among university students is part of a broader pattern of polysubstance use, highlighting the need for more effective prevention and control measures by health authorities and higher education institutions.

Treino parental e sua influência sobre os marcos do desenvolvimento em crianças no transtorno do espectro do autismo atendidas em caps infantil

Wed, 30 Jul 2025 00:00:00 GMT

Treino parental e sua influência sobre os marcos do desenvolvimento em crianças no transtorno do espectro do autismo atendidas em caps infantil Moura, Conceição de Maria Aguiar Barros This PhD thesis of the Postgraduate Program in Collective Health at UNISINOS aimed to analyze the effectiveness of parental training interventions of basic skills in the developmental milestones of autistic children treated at a children's CAPS. The aim was to verify whether the training carried out with the participants was effective and to analyze the developmental milestones of autistic children aged two to six, using the Operationalized Portage Inventory (IPO), before and after the interventions conducted by the parents. Article 1 presented the methodological aspects of a non-randomized clinical trial on the implementation and adaptation of an intervention protocol mediated by parents of autistic children treated at the CAPSij in a city of Maranhão. Regarding the results, it is noteworthy that the reference protocol is an appropriate instrument to guide health professionals in advising parents of autistic children, as it covers the basic skills to be taught, presented in a simple and illustrative manner and, more importantly, because it indicates the development of the target skills in children with ASD. Article 2 analyzed the effectiveness of parental basic skills training interventions on the developmental milestones of children with autism spectrum disorder (ASD) treated at a children's CAPS. Two groups were investigated (an intervention group (Group A) and a control group (Group B)), balanced in terms of the child's developmental age, race/color, family income, and the primary caregiver's level of education. The study demonstrated that children in group B presented significant differences in the comparison of scores before the beginning of the study and after the follow-up period only for the language domain (T0 = 1.32 vs. T1 = 1.53; p = 0.036). On the other hand, in group A, all development domains showed significant improvements after follow-up. In summary, the results of this thesis corroborate the effectiveness of parental training in improving the developmental milestones of children with ASD who received educational interventions over six months, demonstrating that this type of intervention can be replicated both within the SUS (Brazilian Unified Health System) and in private services that take care of autistic children. Children in the intervention group experienced significant improvements in socialization, language, cognition, self-care, and motor skills, demonstrating that parent-mediated interventions, even in public settings (SUS), are effective and can contribute to improving the lives of autistic children and their families.

Experiências de sofrimento psíquico na adolescência

Wed, 22 Oct 2025 00:00:00 GMT

Experiências de sofrimento psíquico na adolescência Nied, Camila This doctoral thesis, developed within the Graduate Program in Public Health at the University of Vale do Rio dos Sinos (UNISINOS), focused on the experiences of psychological suffering among adolescents. The research aimed to understand how adolescents experience psychological suffering and the meaning of their actions in the life-world, grounded in the sociological phenomenology of Alfred Schutz. The qualitative study was conducted in a public school in Rio Grande do Sul, Brazil, through individual interviews with 20 students aged 16 to 19, carried out in 2023. The analysis interpreted adolescents’ experiences through concepts such as biographical situation, stock of knowledge, motivations, and typifications. The project was approved by the Research Ethics Committee of UNISINOS under opinion number 6.186.778. The results unfold into two articles: the first discusses adolescents’ motivations for work — a theme that emerged significantly during interviews and analysis — while the second focuses on experiences of psychological suffering and the meaning of action in the face of such experiences. Findings from the first article revealed that adolescent work, although marked by challenges, is understood by adolescents as a possibility for autonomy, belonging, and social recognition, thus constituting a situated social action shaped by multiple motivations. The second article showed that psychological suffering mainly arises from fragile family and school relationships and is expressed through “unspeakability,” often silenced or trivialized by others. The actions mobilized in response to these experiences ranged from silence and self-injury to seeking support and developing personal ways of resignification. The convergence of the thesis findings demonstrates that adolescence should be understood as an experience situated in the life-world, rather than merely as a normative stage of development, recognizing adolescents as subjects of social action. By problematizing phenomena often treated in normative or pathologizing ways, this thesis contributes to broadening the debate on adolescence and mental health in the field of Public Health, offering insights for future research, public policies, and care practices that value adolescents’ uniqueness, strengthen qualified listening, and expand intersectoral support networks.

Sensibilidade moral e a formação ética do estudante de medicina

Sun, 06 Apr 2025 00:00:00 GMT

Sensibilidade moral e a formação ética do estudante de medicina Abreu, Melissa Carvalho Martins de This thesis, developed in the Postgraduate Program in Public Health at the Universidade do Vale do Rio dos Sinos (UNISINOS), aimed to investigate the health conditions of university students in the health area at the Mineiros and Trindade campuses of the Centro Universitário Mineiros-UNIFIMES, Goiás, in 2022. All students signed a Free and Informed Consent Form. It is expected that the study will contribute to gathering information about the ethical formation of medical students and the influence of the hidden curriculum on their socialization so that they can avoid these events. Based on this, the thesis presents two articles: (I) Moral Sensitivity and the Ethical Formation of Medical Students, a qualitative study; (II) a cross-sectional study that explores the relationship between moral sensitivity and the hidden curriculum, through the application of statistical tests. The study sample consisted of 128 medical students who were taking the mandatory internship. The first article was a qualitative study, through focus group discussion, aimed at understanding the aspects that influence ethical training during college among medical students in the last two years of the course. In this study, it was observed that teaching was considered theoretical and abstract, not guided by reflection on clinical practice, and the methodologies used were not active. The ethical climate in the practice locations was demonstrated by competition with other professionals, with hostility and conflict. The attitude of the preceptor doctors was one of continuous criticism and devaluation of the students. These situations point to the influence of the hidden curriculum, hindering the formation of moral sensitivity in the ethical training of medical students. The second article, which is part of the umbrella project of the doctoral group, is university-based and whose data collection was through a self-administered, standardized and pre-tested questionnaire. Data collection took place in the classroom and the questionnaire included questions about moral sensitivity and the hidden curriculum. Training was provided to a team to help administer the questionnaire, unfortunately they did not fulfill the commitment. A pilot test was carried out. Afterwards, I applied the questionnaires at the Mineiros Unit, in practically all classes, and another colleague applied them to two classes. A third colleague applied the questionnaires at the Trindade Unit. All data was coded. Data entry was done using EpiData version 3.1 software, in double entry. Afterwards, the typing was compared with original forms in order to eliminate typing errors. Data consistency and analysis were performed using Statano software. In July 2024, we performed a statistical analysis of the data. The results were not satisfactory, that is, p was insignificant. Therefore, we raised the hypothesis of submitting the collection of more data to the ethics committee again. In other words, applying the questionnaire again to current medical internship students and thus adding them to the previous group. The ethics committee approved it and the questionnaires were applied and coded. However, typing was not performed and this information was not entered into the database. To develop this second article, we used a cross-sectional study, with a quantitative approach, with the application of two selfadministered questionnaires: the Moral Sensitivity Questionnaire (MSQ) and the Hidden Curriculum Questionnaire (C³), answered by 128 students enrolled in the 9th semester or later. The data were subjected to descriptive statistical analysis (mean and standard deviation), internal consistency assessment by Cronbach's alpha and bivariate correlation tests, with the aid of SPSS software. This research did not show significant data. It will be necessary to increase the N in order to achieve significance. Therefore, we decided to conduct a study of the demographic profile of the Moral Sensitivity of Medical Students in internships. We used data from the database to conduct this survey. This study indicated that the demographic profile is predominantly female, white, single, without children and without paid work, and identifies as Catholic. The mean moral sensitivity was 3.581 (SD +/- 0.42) and was correlated with religion (p = 0.0009), with greater sensitivity among non-Catholics, with a mean of 3.76 (SD +/- 0.39). The questionnaire was divided into six dimensions: “Respect for patient autonomy” with a mean of 4.49 (SD +/- 0.5), “Modified autonomy” with a mean of 3.792 (SD +/- 0.82), “Moral conflict” with a mean of 2.896 (SD +/- 0.69), “Professional knowledge” with a mean of 2.810 (SD +/- 0.83), “Moral meaning” with a mean of 3.884 (SD +/- 0.65), “Teamwork” with a mean of 3.618 (SD +/-0.72). The variables that demonstrated an association were students who have children in relation to the “modified autonomy” dimension, and religion in relation to “modified autonomy”, “moral conflict” and “teamwork”. The study concluded that among the six dimensions assessed by the MSQ questionnaire, the one that presented the greatest moral sensitivity was “Respect for Patient Autonomy”, while “Professional Knowledge” obtained the lowest average, which suggests that technical mastery is not yet sufficiently integrated with ethical principles in the training process. Among the sociodemographic variables analyzed, religion was the one that was most associated with moral sensitivity, with an impact on three dimensions of the questionnaire, indicating that personal values interfere in the ethical construction of students. These findings reinforce the need for curricula that articulate technical knowledge and ethical training in an inseparable way, incorporating personal experiences, listening spaces and reflective practices in the clinical environment.

Sono e obesidade em mulheres trabalhadoras no sul do Brasil: comparação temporal entre dois estudos transversais (2017/2022)

Thu, 24 Apr 2025 00:00:00 GMT

Sono e obesidade em mulheres trabalhadoras no sul do Brasil: comparação temporal entre dois estudos transversais (2017/2022) Silva, Janaína Cristina da Objective: To investigate and compare the association between poor sleep quality and night work, as well as the association between sleep deprivation and obesity in working women, a comparative study between the years 2017 and 2022. Methods: This is a repeated survey comparing two independent samples of working women within the same company group, located in Southern Brazil, with a five-year interval (2017: n = 399; 2022: n = 399). Poor sleep quality was identified using the Pittsburgh Sleep Quality Index (PSQI > 5), sleep deprivation was determined by usual sleep duration (≤ 5 hours) with or without self-reported use of sleep medications in the past month, while obesity was assessed and defined through the measurement of Body Mass Index (BMI ≥ 30 kg/m²). Prevalence ratios (PR) and their 95% confidence intervals (CI 95%) were obtain using Poisson regression with robust variance. Results: The mean age of the samples was 35.7 ± 9.1 years in 2017 and 34.2 ± 9.9 years in 2022. The prevalence of poor sleep quality increased (p = 0.007) from 2017 (58.3%, 95% CI: 53.4–63.2%) to 2022 (67.7%, 95% CI: 63.0–72.3%), while the prevalence of sleep deprivation was 27.6% (95% CI: 23.2–32.0) and 24.3% (95% CI: 20.1–28.5), respectively, in 2017 and 2022, with no significant difference between the periods. The prevalence of obesity was 29.0% (95% CI: 24.5–33.5) and 30.6% (95% CI: 26.0–35.1). Night shift workers had a 30% higher likelihood of poor sleep quality in 2017 and a 25% higher likelihood in 2022, compared to day shift workers. Moreover, workers with sleep deprivation had a 70% higher likelihood of being obese compared to those without sleep deprivation. Conclusion: Our findings demonstrated a high prevalence of poor sleep quality, sleep deprivation, and obesity in working women. Promoting research on sleep-related factors in the occupational environment, especially among shift-working women, should be consider in the development of strategies for the prevention and control of health issues such as obesity.

Mortalidade em pessoas vivendo com HIV e AIDS no Rio Grande do Sul no período de 2011 a 2021: tendência e causas básicas de morte

Wed, 30 Apr 2025 00:00:00 GMT

Mortalidade em pessoas vivendo com HIV e AIDS no Rio Grande do Sul no período de 2011 a 2021: tendência e causas básicas de morte Soares, Cassiana Borges

Narrativas (auto)biográficas de mulheres negras doutoras: estilhaçando a máscara e escancarando o racismo, o sexismo e a branquitude na saúde coletiva

Fri, 12 Jan 2024 00:00:00 GMT

Narrativas (auto)biográficas de mulheres negras doutoras: estilhaçando a máscara e escancarando o racismo, o sexismo e a branquitude na saúde coletiva Ferreira, Rose Mari Black women demarcate writing as a political act. Narratives make it possible to understand the experiences of black women who intersect the personal and the social, producing knowledge that goes beyond the rigid, closed and quantifiable lines of modern science. Racism is a structural system that constitutes social relations in this country, underpinning inequalities based on race or ethnicity. The general aim of this research is to analyze the trajectories of black women doctors, considering their positions in the academic and scientific space of public health. The research has a qualitative design, at an exploratory level, and was submitted to and approved by the Research Ethics Committee. The instruments used to produce the data were a sociodemographic identification questionnaire, biographical narrative interviews and notes in a field notebook. Hermeneutics was used to interpret the data, in the light of Conceição Evaristo's concept of writing. Three black women were interviewed, two self-declared black and one brown, between August and October 2023. The interviews took place in locations chosen by the research participants, two coffee shops/bookstores, located in a neighborhood in the city of Porto Alegre/RS and one interview via Google meet. The narratives were recorded and after recording, they were transcribed into a Word file. The three women built their academic careers in health courses, with doctorates and/or post-doctorates in Public Health. They are currently lecturers at higher education institutions, work in social movements, in black collectives and carry out other activities in addition to teaching. The dense narratives, full of striking situations, revealed episodes of racism in their academic careers. From their formative years to postgraduate studies, the interviewees were victims of racism, which was presented in different ways during their academic career, a characteristic of "Brazilian racism". As teachers, they were mistaken for the staff responsible for cleaning the building and sometimes for undergraduate students. The professors reported that, because of their choices regarding the theoretical framework adopted in their research, their academic productions were called into question. Although they have been victims of sexism and racism during their careers, they have not given up and have continued to open doors for other black people. They produce knowledge, demarcating their academic positions and occupying positions as project coordinators. The fight against racism must be extended to all social demands and academia is no different. There is an urgent need to implement affirmative action in all postgraduate programs and to comply with the law on reserving places for black people in higher education competitions.

Tendência de mortalidade infantil e mortalidade infantil evitável em municípios da região metropolitana de Porto Alegre/RS

Mon, 31 Jul 2023 00:00:00 GMT

Tendência de mortalidade infantil e mortalidade infantil evitável em municípios da região metropolitana de Porto Alegre/RS Stahnke, Douglas Nunes Introduction: Infant mortality (IM) is one of the United Nations (UN) millennium development goals and a guide for public health policies in Brazil. The Ministry of Health created a list of preventable diseases in children under five years of age that has been used to monitor the most prevalent diseases and the quality of the care network. With a prominent role in the care of pregnant women, postpartum women and newborns, the Family Health Strategy (FHS) has consolidated itself as a priority entry point into the services offered by the Unified Health System. Despite this, the complexity of care for this population can needing hospital care, which demands greater investment from government managers. Therefore, knowing the health situation in the region becomes essential to invest financial resources efficiently in order to improve the quality of care provided and achieve improvements in health indicators. Thus, the objectives of the present study were to describe and analyze the trend in infant mortality and preventable infant mortality (PIM) in the municipalities of the metropolitan region of Porto Alegre from 1996 to 2021 and its association with FHS coverage and per capita public spending in health. The objectives were also to describe and analyze the trend in preventable early (ENM) and late (LNM) neonatal mortality, stratifying deaths by groups and specific causes. Methods: Ecological time series study in the municipalities of Novo Hamburgo, São Leopoldo, Sapucaia do Sul, Esteio, Canoas and Porto Alegre. Data were obtained from the Mortality Information System, Live Birth Information System, Department of Primary Care and Public Health Budget System. Information on mortality was presented in coefficients, FHS coverage in percentage and expenditure on health in Reais, corrected by the Extended National Consumer Price Index. The trend analysis used the Prais-Winsten method and its results were expressed as increasing, decreasing and stationary. The association analysis considered results with a p value <0.05 to be significant. Results: in article 1, all municipalities showed a decreasing trend in IM. In PIM, only Esteio differed from the decrease, presenting a stationary trend. Per capita public spending on health was associated with IM and PIM in Novo Hamburgo, Canoas and Porto Alegre. FHS coverage was associated with IM and PIM in Novo Hamburgo, Canoas and Porto Alegre. In IM, this association was also found in Sapucaia do Sul. In article 2, both ENM and LNM showed a decreasing trend in Canoas and Porto Alegre. At ENM this trend also occurred in Novo Hamburgo. In the ENM, an increasing trend was found in the group of causes reducible by adequate care for women during pregnancy in São Leopoldo and Sapucaia do Sul. In the LNM, an increasing trend was found in the group of causes reducible by care for the newborn in Canoas. Newborn respiratory distress syndrome, neonatal infections other than congenital rubella syndrome and congenital viral hepatitis were the main specific causes of early and late neonatal deaths respectively, with a decreasing trend. Conclusions: Even though the reduction in IM and PIM is an important result, it may be necessary to continue increasing investments in health in view of their impacts verified in the present study. Even though FHS coverage has increased since its implementation, it is essential that the focus can be turned to policies that reach comprehensiveness and longitudinality of care, women during pregnancy and the postpartum period, as well as newborns, to reduce ENM and LNM aiming to meet global, national and regional targets for these indicators.

Uso de plasma convalescente em pacientes com COVID-19

Tue, 29 Aug 2023 00:00:00 GMT

Uso de plasma convalescente em pacientes com COVID-19 Dal Bó, Andréa Gurgel Batista Leite This Collective Health doctoral thesis of the Collective Health Graduate Program at the University of Vale do Rio dos Sinos – UNISINOS – aimed to evaluate the prognostic indicators in critically ill patients with SARS-CoV-2 infection, hospitalized in an Intensive Care Unit (ICU) at Virvi Ramos Hospital in Caxias do Sul/RS, treated or not with convalescent plasma for COVID-19 (PCC). In addition, a survival analysis was also performed. This thesis is composed of two articles. The first makes a mini-review on the early use of convalescent plasma for COVID-19 as a potential low-cost treatment for patients in risk groups, especially in countries with little access to antiviral therapies and vaccines. The second article is a retrospective, propensity-matched cohort study of patients hospitalized in the ICU for severe COVID-19 who received PCC transfusion plus standard care, compared with controls who received standard care only. The primary outcome was mortality within 30 days of admission to the ICU. A total of 124 patients (62 in each group) were included. The median age for the entire series was 66 years (IQR: 55-73), and 89 (55.6%) were men. The median time from symptom onset to PCC was 10 days (IQR: 8-13 days). In total, 51 (41.1%) died within 30 days of admission. PCC transfusion was not independently associated with lower 30-day mortality (OR: 0.52, 95% CI: 0.23–1.16; p = 0.11) and also had no impact on mechanical ventilation or same time.

Aspectos psicossociais e consumo de frutas, verduras e legumes em adultos do sul do brasil: uma coorte prospectiva

Fri, 23 Jun 2023 00:00:00 GMT

Aspectos psicossociais e consumo de frutas, verduras e legumes em adultos do sul do brasil: uma coorte prospectiva Pelinson, Andressa

Aspectos individuais e contextuais e dor osteomuscular em adultos de uma cidade do sul do Brasil

Fri, 24 Mar 2023 00:00:00 GMT

Aspectos individuais e contextuais e dor osteomuscular em adultos de uma cidade do sul do Brasil Mattos, Cândido Norberto Bronzoni de Musculoskeletal pain can be a product of repetitive effort, excessive use and musculoskeletal disorders. Its impact reaches the quality of life, functional incapacity and productivity of individuals. Different individual factors may be related to the presence of pain, including sociodemographic, psychosocial, physical aspects and those related to health conditions. Psychosocial aspects can also play an important role in the occurrence of pain. In this regard, the general objective of this study was to investigate the individual and contextual factors associated with the occurrence of musculoskeletal pain in adults in São Leopoldo/RS. Method: cross-sectional analysis of a prospective cohort. Baseline data were obtained from collections carried out from January 2006 to July 2007, through interviews structured with a standardized and pre-tested questionnaire, in which 1,100 people at the age 18 or older, residents in 38 census tracts in the urban area of the municipality, were interviewed. Subsequently, between the years 2013/2018, the collections of the 2nd wave of the survey, the object of this study, were carried out, where about 573 people were interviewed. Musculoskeletal pain was assessed using the adapted and translated version for Brazil of the Nordic Musculoskeletal Questionnaire (NMQ). In the first scientific production, the prevalence of musculoskeletal pain was estimated through Pearson's chi-squared test, for the estimates of the crude and adjusted prevalence ratios (PR) and their respectives, Poisson regression was performed, using control for design effect by svy command. For the adjusted analysis, a strategy based on a hierarchical conceptual model was used, taking into account the two levels: contextual and individual. In the second study, this one evaluating the factor structure of the instrument, NMQ exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Results: the first scientific production found a high prevalence of musculoskeletal pain (71.1%; 95%CI: 66.4-75.4). In the adjusted analysis, the following were associated with greater musculoskeletal pain at the contextual level: lower income, lower social support from the neighborhood and lower social action. At the individual level, sex (female), older age, lower education, lower social support and higher number of morbidities were associated. In the second scientific production, EFA showed a similar adjustment in solutions with one or two factors in all indicators. The adjustment values in the confirmatory factor analysis for both models showed Chi-square p<0.001 and SRMR and RMSEA values indicating good adjustment. Conclusion: The results showed that contextual determinants can influence the presence of musculoskeletal pain and that the Nordic Musculoskeletal Questionnaire (NMQ) presented an adequate factorial structure for measuring pain in a population-based sample.

Comportamentos de risco para transtornos alimentares em adolescentes da rede de ensino pública de Caxias do Sul, RS

Fri, 17 Mar 2023 00:00:00 GMT

Comportamentos de risco para transtornos alimentares em adolescentes da rede de ensino pública de Caxias do Sul, RS Donatti, Talita

Da necropolítica e biopolítica perversa à potência de vida: o cuidado integrativo em uma Associação de assistência a presos

Mon, 26 Aug 2019 00:00:00 GMT

Da necropolítica e biopolítica perversa à potência de vida: o cuidado integrativo em uma Associação de assistência a presos Lena, Marisangela Spolaôr This PhD thesis in Collective Health from the Graduate Program in Collective Health of the University of Vale do Rio dos Sinos (UNISINOS) aimed to analyze how integrative and complementary practices in health were used in health promotion and self-care of prisoners attending the Cultural Association of the Development of the Inmate and Egress (ACUDA), located in the prison complex of Porto Velho, state of Rondônia. ACUDA is a non-profit association that provides prisoners with integrative care: integrative and complementary practices in health (ICPH), work practices, learning workshops, spiritual and religious practices, and family and social encounters. The study was characterized as qualitative and ethnographic, involving the stay for four months in Porto Velho. It was approved by the Research Ethics Committee of UNISINOS, with the consent of the association. The researcher attended ACUDA daily making participant observations, applying questionnaires on general and health data of the prisoners who attended the association, as well as conducting in-depth interviews with six prisoners, four employees and the association's management team. The interviews were audio recorded and later transcribed. The fieldwork also involved extensive field journaling. The data analysis was performed based on exhaustive readings of the material, on the production of narratives about the trajectories of prisoners, and on dialogue with theoretical references, especially poststructuralists, circumscribing two articles that make up the thesis. In the first article, titled Necropolitics, perverse biopolitics and the subversion of integrative care for prisoners: ethnography of an assistance association in Porto Velho, we seek to discuss how biopolitical and necropolitical strategies coexist with actions of subversion of this logic through the articulation between institutions, the state and the insistence of prisoners to live their possible lives. In the second article, entitled (Re)Existence and power of life: Integrative and complementary practices in healthfor prisoners, the objective was to analyze how HPHC emerged as a life power in these precarious existences that needed care. From the analysis performed and presented in both articles, we conclude that the state used perverse necropolitical and biopolitical strategies as a way to manage the lives of prisoners, by offering life-sustaining subsidies (albeit precariously), but it continued to hurt and produce the death of the inmates. In contrast, despite having to respond to the state, ACUDA created mechanisms of subversion to necropolitics, through integrative care for participants. The ICPHs, situated within this context of integrality, were also understood as Practices of Affection, Care, Citizenship and Freedom,naked lives were enhanced so that they could survive the system,having spaces of freedom and citizenship (albeit circumscribed), where they could also glimpse possibilities beyond the walls of the association and the bars of prisons. Thus, the findings of this study indicate the need for more articulation between the state, the association and society,in a way that produces changes that can go beyond alterations in the individual, providing them with decent living conditions and alternatives to crime. Finally, we highlight the importance of new research involving the themes discussed here.

A transmissão vertical do HIV em Porto Alegre: o contexto e o caso

Tue, 16 Jul 2019 00:00:00 GMT

A transmissão vertical do HIV em Porto Alegre: o contexto e o caso Acosta, Lisiane Morelia Weide

Uso de medicamentos psicoativos e características associadas em acadêmicos da área da saúde de uma universidade do Centro-Oeste brasileiro

Wed, 29 Jun 2022 00:00:00 GMT

Uso de medicamentos psicoativos e características associadas em acadêmicos da área da saúde de uma universidade do Centro-Oeste brasileiro Domingues, Tiago Objectives: to evaluate the prevalence of psychoactive drugs (psychostimulants, anxiolytics and antidepressants) and their associated factors in a sample of academics in the health area of a university in the Brazilian Midwest. Methodology: school-based cross-sectional study (university), with a census sample of 2,295 university students in the health area (Nursing, Physiotherapy, Pharmacy, Physical Education, Dentistry and Medicine), of both sexes, aged 18 years or older, participants in a larger research project whose objective was to assess health conditions and associated factors in this population in 2018. Data were collected in October 2018 by a trained research team, using a standardized, pre-tested and self-administered questionnaire, composed of closed and open questions that were applied during the class period. Data were reported by participants, including demographic, socioeconomic, academic, behavioral and health variables. The study was approved by the Research Ethics Committee (CEP) of UNISINOS and UniRV and all participants signed an informed consent form (FICT). The thesis was divided into two studies: The first study entitled “Prevalence and factors associated with the use of psychostimulant drugs among academics from a university in the Brazilian Midwest” aimed to estimate the prevalence of the use of psychostimulant drugs in life, before and after the university admission and associated factors among university students in the Brazilian Midwest. The second study, called “Use of anxiolytics and antidepressants among academics in the health area: prevalence and factors related to university admission” aimed to characterize the use of anxiolytics and antidepressants among university students in the health area and to analyze the sociodemographic characteristics, academic, behavioral and health associated with use in life and after entering university. Both studies were stratified by sex and used multivariable regression analysis by Poisson regression with the use of medications (psychostimulants, anxiolytics and antidepressants) in life and after university entrance as dependent variables. Each variable was adjusted to the others at the same or more distal level based on a conceptual model of causality. Results: in the first study, a prevalence of use of psychostimulant drugs in life was observed, and after entering university they were 38.1% (95%CI: 34.5 - 41.7) and 43.8% (95%CI: 37, 4 to 50.2) in males and 29.5% (95%CI: 27.2 – 31.7) and 48.2% (CI 95% 43.5 to 52.9) in females, respectively. After adjustments, a higher probability of lifetime use occurred for university students studying medicine, with higher age at university entrance, who had already consumed illicit drugs in life and who reported a medical diagnosis of depression. For males, higher economic class and smoking increased the probability of use by 30%. Among women, not living with the family, having consulted a doctor and academic failure were also determinants of the use. In the second study, higher prevalences of lifetime use for the drugs investigated were found among academics (anxiolytics 33.4% vs 20.5%; antidepressants 28.1% vs 17.6%). Almost half of the university students who reported using it in their lifetime started using it after entering university (anxiolytics 43.6%, antidepressants 49.0%). After adjusting for confounders, greater probabilities of use were found for participants diagnosed with anxiety and depression. Late university entry increased the likelihood of lifetime use of anxiolytics. The likelihood of antidepressant use increased with age, and for medical students and smokers. For the outcome of use after university, there was a direct linear association with duration of the course and an inverse association with age of entry. Conclusions: there was a high prevalence of psychotropic drug use among university students in the Brazilian Midwest. In the first study, a higher proportion of use was observed for males and with onset before and close to university entrance. The beginning of academic life proved to be a determining factor for use in this population, especially for misuse. The second study observed that, among university students who entered university at a younger age, a lower probability of using anxiolytics and antidepressants in life was observed, but they were more likely to use these drugs after entering university.

Métodos contraceptivos e intenções reprodutivas em universitárias da área da saúde da Universidade de Rio Verde, Goiás

Tue, 29 Mar 2022 00:00:00 GMT

Métodos contraceptivos e intenções reprodutivas em universitárias da área da saúde da Universidade de Rio Verde, Goiás Alvarenga, Fernanda Rassi Objectives: to investigate the use of contraception, to verify the factors associated with the use of hormonal contraceptive methods and to analyze the reproductive intentions of university women in the center-west of Brazil. Methodology: cross-sectional school-based study with female health university students aged 18 years or older, with sexual activity, and regularly enrolled in the institution. The research instrument was the application of a standardized, pre-coded, self-administered questionnaire, and the fieldwork was carried out between October and December 2018. Data were entered in the Epi Data 3.1 program and analyzed in the STATA 12.0 statistical program. . The results were described using absolute and relative frequencies and Poisson regression with robust variance was used according to a conceptual model of analysis to verify associations with the use of hormonal contraceptives, and multinomial logistic regression to investigate the association of independent variables with reproductive intentions . Those who reached a p value of up to 0.20 entered the adjustment model, remaining in the model when they reached a significance level of 0.05. Results: The prevalence of the use of contraception in general was 85.9% (95%CI 83.3 to 87.2), and the most used contraceptive methods were the contraceptive pill (66.5%) and the male condom (43.9%). University students aged 23 to 24 years, living with friends, of economic class A and without religion, were more likely to use hormonal contraceptives. Most women reported the intention of having one or two children (65.1%), and the minority expressed a desire not to have children (9.6%). Among the women who responded that they wished to have one or two children, most were 25 years of age or older, white, low economic class, marital status with a partner, Catholic religion and not studying medicine or dentistry. Women in the medical school, Protestants/Evangelicals and contraceptive users reported a greater desire to have three or more children when compared with women who were studying dentistry or other health courses, with Catholics, and with non-users of contraceptive methods. Conclusions: in the university environment, contraceptive practices are still limited to a low diversity of methods, as well as many paradoxes in relation to reproductive intentions, therefore, current, prospective studies with representative samples are necessary to monitor trends and assist in the planning of actions. focused on sexual and reproductive orientation.

Estudo de prevalência do uso excessivo de internet e fatores associados em uma amostra de estudantes universitários brasileiros

Tue, 22 Mar 2022 00:00:00 GMT

Estudo de prevalência do uso excessivo de internet e fatores associados em uma amostra de estudantes universitários brasileiros Fernandes, Gabrielly Cruvinel This Collective Health doctoral thesis of the Collective Health Graduate Program of the Universidade do Vale do Rio dos Sinos - UNISINOS aimed to evaluate the psychometric properties of the short version of the Internet Addiction Scale (IAT), including its internal consistency, construct validity and test-retest reliability in a sample of health students from a Brazilian university. In addition, the prevalence of excessive internet use (IA) and its associated factors in this population of college students were also assessed. This study is part of a larger cross-sectional school-based study (university), consisting of a representative sample of university students in the health area conducted in the municipalities of Rio Verde (southwestern region), Aparecida de Goiânia (metropolitan region of Goiânia) and Goianésia (northern region) located in the state of Goiás in the year 2018. The thesis is composed of 2 papers. In the first paper the construct validation of the scale was performed through factor analysis, through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of the 12 items of the IAT and for the evaluation of the internal consistency of the factorial model Cronbach's α alpha coefficient was used. The original scale has 20 items and assesses attitudes about the extent of Internet use. From a census sample of 1,582 medical students from the Brazilian Midwest, two random samples of 350 college students were selected for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Another 347 students participated in the test-retest stability evaluation. The two-factor solution with twelve items found in the EFA proved satisfactory, obtaining Cronbach's α of F1=0.84 and F2=0.81. The final model showed good fit (RMSEA=0.089; CFI=0.955; SRMR=0.049) and there was evidence of weak to moderate stability of the short scale. In paper 2 we assessed overuse using the short version of the Internet Addiction Test (AIT) Scale. Associated factors included sociodemographic, socioeconomic, academic, behavioral, and psychosocial characteristics. Poisson regression with robust variance was used to analyze the data. We observed, that in both female and male students, as age increases, excessive internet use decreases (IRR 1.67, 95% CI:1.30 - 2.14). Non-white male students (RP 0.96, 95% CI: 0.50-1.86), who lived alone (RP 0.77, 95% CI: 0.55-1.07), from economic class B (RP 0.91, 95% CI: 0.67-1.22), who failed (RP 0.96, 95% CI: 0.50-1.86) and who had very severe distress (RP 4.08, 95% CI: 2.76-6.02), used the internet more excessively. In female college students, those who were single (PR 1.39, 95% CI: 0.98-1.98), who were in medical school (PR 1.68, 95% CI: 1.25-2.26), who failed (PR 2.04, 95% CI:1.50-2.79), who were sedentary (PR 1.13, 95% CI: 0.93-1.36), who had made harmful use of alcohol (PR 3.12, 95% CI: 2.41-4.04), used the internet excessively. It was also observed that students who had very severe distress (RP 4.96, 95% CI: 3.15-7.82) and low support (RP 1.30, 95% CI: 0.95-1.78) used the web more excessively. Conclusions: The IAT short version showed evidence of validity and reliability, allowing the assessment of Internet use pattern in college adults with a reduced number of items. Moreover, we found a high prevalence of internet dependence among college students (23% in the overall sample) with significant association with younger age group, medical school, very severe distress measured by the K10 scale, and with low social support. When stratified by gender the associations were different for men and women.

Os espaços participativos na atenção primária brasileira

Mon, 28 Mar 2022 00:00:00 GMT

Os espaços participativos na atenção primária brasileira Buziquia, Sabrina Pontes This thesis analyzes social participation in the context of Brazilian Primary Health Care (PHC), for this purpose, we sought to map Brazilian empirical studies on formal experiences of social participation in PHC since the creation of the Health Unic System (SUS), in addition to understand the experiences of social participation in PHC in a municipality in the south of the country. The research had two methodological moments that gave rise to two scientific articles. The first one was a systematic review of the literature in the Lilacs, PubMed, PsycINFO and Sociological Abstracts databases, within the time frame from 1988 (creation of the SUS) to November 2020 (last search date), with 20 articles being located empirical studies addressing social participation and PHC. The second article was a qualitative, exploratory research using thematic content analysis, carried out in three Basic Health Units (BHU) through participant observation, interviews and a field diary, with its results discussed from the concept of social subject as an articulator of participatory actions. The articles produced revealed different experiences of social participation developed in the territories where PHC operates, highlighting the difficulties faced in the process of implementing the Local Health Councils (LHC). Based on the studies reviewed, most of which were qualitative, the profile of the participants and the competence to participate, the process of participating and the construction of participatory actions were discussed, in addition to the centrality of continuing education as a way of strengthening social participation in health. The second article described different arrangements in each BHU studied, especially about the plans of collective forces that were created, social organizations and partnerships and even the absence of these. In addition, the importance of legitimate representations within the spaces of the LHC, the role of health teams as promoters of participatory actions and the difficulties faced in the stoppage of the functioning of these spaces in the context of the Covid19 pandemic were discussed. The experiences of social participation in the PHC context studied here pointed to the relevance of a look that goes beyond the established spaces, involving the daily life of the territories and the micropolitics that are built in these specific and localized social relationships, being fundamental the continuity of research that go in the direction of rethinking the established practices of the SUS.

Acesso à rede de atenção à saúde por pessoas com deficiência intelectual

Wed, 17 Nov 2021 00:00:00 GMT

Acesso à rede de atenção à saúde por pessoas com deficiência intelectual Moretti, Patrícia Garmus de Souza This thesis analyzes the experiences lived by people with intellectual disabilities in accessing the Health Care Network and the answers given by the services, the needs demanded by this public. Methodology: This was a qualitative participant observation research that analyzed the narratives of eighteen neurodiverse people, twelve with mild intellectual disability, self-responsible and six people with severe or profound intellectual disability who, due to the degree of intellectual and physical impairment, were represented in the survey by their legal guardians, these being five mothers and a one grandmother. The production of data took place in two stages: the first, carried between 2019 and 2020, with the reading of the existing medical records at the institution providing intellectual rehabilitation services, in the single modality, by the Unified Health System, in order to identify possible participants for the search. The second stage, took place between 2020 and 2021, years for conducting interviews and monitoring participants in therapeutic itineraries. Data analysis took place after the transcription of the audios, readings and rereadings of the interviews and the notes made in the field diary, and thus, axes and sub-axes were classified for discussion with the literature. Results and Discussions: In the first article, the experiences lived by people with intellectual disabilities during access to health services were analyzed, emphasizing the social stigma and carelessness that enhance the structural and institutional violence they are subjected to in this context. The itineraries carried out by these people led to the data of the second article, which analyzed the trajectories of mothers of children with moderate to severe intellectual disabilities concomitant with refractory epilepsy, in the search for access to medications extracted from Cannabis Sativa L, emphasizing the formation of networks of solidarity around the components of the plant, with an analytical focus on the activism of these women in accessing oil extracted from marijuana, as well as for the legalization of self-cultivation. Final considerations: Based on the results, it is considered that access to the Health Care Network by people with intellectual disabilities is permeated by inequities, from the first consultation for the assessment of intellectual disability, to the stigmatization of care, causing neglect and carelessness as well as inequalities in the search for access to health services. It is considered imperative to broaden the view on the processes of stigmatization and institutional violence suffered by this public in order to reduce inequities in access to health care.

Comportamento sedentário em mulheres adultas e sua associação com variáveis ambientais e individuais: um estudo de base populacional

Mon, 23 Apr 2018 00:00:00 GMT

Comportamento sedentário em mulheres adultas e sua associação com variáveis ambientais e individuais: um estudo de base populacional Cafruni, Cristina Borges In the past decade, a number of studies have investigated sedentary behaviour (SB), that is, activities performed while awake in a sitting or lying position and that involve reduced energetic expenditure. Its consequences for the health of individuals have also been examined. Results from prospective studies have shown that the longer the time spent on SB, the greater the risk of developing diabetes, cardiovascular disease, metabolic syndrome, and death. The general objective of this study was to evaluate the association of environmental and individual variables with SB in adult women living in the municipality of São Leopoldo, Rio Grande do Sul, Brazil. In order to meet the general objective, two sub-studies were developed, both with a cross-sectional design. The first study aimed to describe SB in the leisure time (LSB), occupational (OSB) and transport (TSB) domains and to determine the factors associated with excess sedentary behaviour (ESB) in those domains (ELSB, EOSB and ETSB, respectively). A representative sample of 1,126 women, aged 20-69 years, from the municipality of São Leopoldo was investigated. Information regarding SB and demographic, socioeconomic, behavioural and health-related variables was obtained using a questionnaire that was completed using an interview format. Values above the median were considered to be ESB. The associations were tested using Poisson regression with robust error variance. The mean and interquartile intervals, in min/day, for LSB, OSB and TSB were 163.9 (86.6-2,710.5); 54.1 (0-257.1) and 17.1 (5.7-37.3), respectively. The probability of ELSB increased with the level of education and was higher among women who were not employed, who had no children in the household and who were smokers. For EOSB and ETSB, probabilities increased inversely with age and were higher among white women; these probabilities also increased with economic class, level of education and income. The probability of ETSB also increased with the number of cars per household and was 30% lower among women who were not employed. The longest time spent in SB was observed in the leisure time domain. The associations differed by domain. In the second study (Article 2), the objective was to assess the association between environmental variables in the neighbourhood and excess transport (ETSB) and excess leisure time (ELSB) sedentary behaviours among study participants. Data from 1,079 women living in 44 neighbourhoods were considered. Each neighbourhood was determined by drawing a 400-m buffer around the median point of the participants’ homes. The evaluation of the neighbourhoods was performed through audits and the use of government data. The data on SB and the other variables used were obtained from the first study. A multilevel logistic regression analysis was conducted. In the adjusted analysis, women who lived in neighbourhoods with a higher percentage of terrain slopes and fewer public recreation areas per inhabitant had significantly (p ≤ 0.05) increased chances of exhibiting ETSB and ELSB, with increases of 50% and 40%, respectively. The results of the two studies demonstrated that a) interventions should be developed with consideration for the specifics of each SB domain, and b) some aspects of the neighbourhood environment, like terrain slopes and public recreation areas, may interfere with specific types of SB, indicating that neighbourhood improvements could reduce women’s SB.

Fatores associados à não adesão ao tratamento farmacológico em pacientes que hospitalizaram por condições cardiovasculares sensíveis à atenção primária e seu impacto financeiro para o sistema de saúde

Thu, 13 Jul 2017 00:00:00 GMT

Fatores associados à não adesão ao tratamento farmacológico em pacientes que hospitalizaram por condições cardiovasculares sensíveis à atenção primária e seu impacto financeiro para o sistema de saúde Schneider, Ana Paula Helfer Cardiovascular diseases (CVD) are among the leading causes of death in Brazil. They account for about 20% of all deaths in individuals over 30 years. Medication Adherence determines the success or otherwise of a treatment where the patient needs control of his or her health status. The main factors that may interfere in adherence, described by the World Health Organization (WHO), are socioeconomic conditions, personal characteristics, aspects related to the treatment and/or illness, the professional team involved and the health system to which it belongs. Studies demonstrate average percentages of compliance with pharmacological treatment of about 50 to 79%. This thesis aimed to evaluate factors associated with nonadherence to medications in adults with CVD. Two articles with different objectives emerged from this thesis. The first one aims to summarize the evidence regarding the relationship between characteristics of pharmacotherapy and nonadherence to medication in the CVD population through a systematic review with meta-analysis. Several characteristics of pharmacotherapy were examined and two associated modifiable factors resulted; (i) a 24% decrease in the risk of non-adherence among CVD patients who have insurance or another program that assists with medication and (ii) a 38% increase in the risk of non-adherence among CVD patients who take their medication in two or more daily doses. Another article aimed to evaluate the association between complexity of the therapeutic regimen and low adherence medications in adults hospitalized for Cardiovascular Conditions Sensitive to Primary Care (CCSAP) where there was an inverse association between the complexity of the therapeutic regimen and adherence to medications, with a 22% higher probability of low adherence in patients who used highly complex therapeutic regimens, even after adjustment for potential confounders (RP = 1.22, 95% CI 1.01-1.47). In the model adjusted for autonomy in the administration and organization of medicines, this effect loses statistical significance (RP = 1.16, 95% CI: 0.96-1.40). Thus, the adoption of strategies that promote user autonomy in the administration and organization of the therapeutic regimen are fundamental measures to increase the adherence of individuals to complex therapeutic regimens. Therefore, understanding the mechanisms underlying adherence behaviors may improve patient-specific approaches to improve adherence and this study contributes significantly to this area, pointing to modifiable factors that may improve adherence to the pharmacological treatment of adults with CVD.

Estresse e síndrome metabólica: estudo caso-controle em mulheres trabalhadoras de turnos e revisão sistemática da literatura

Tue, 28 Mar 2017 00:00:00 GMT

Estresse e síndrome metabólica: estudo caso-controle em mulheres trabalhadoras de turnos e revisão sistemática da literatura Garcez, Anderson da Silva Metabolic Syndrome (MS) is a complex clinical condition, defined by the concomitant presence, in the same individual, of at least three comorbidities (metabolic alterations): arterial hypertension, altered fasting glucose or diabetes mellitus, hypertriglyceridemia (high level of triglycerides) , low concentration of HDL (high density lipoproteins) and central/abdominal obesity (ALBERTI et al., 2009). The simultaneous occurrence of these factors is strongly associated with an increased risk of cardiovascular diseases (cardiometabolic) and with overall mortality (FARIAS, PEREIRA and ROSA, 2010; GALASSI, REYNOLDS and HE, 2006; GAMI et al., 2007; GRUNDY, 2007; LI, W. et al., 2008; MOTILLO et al., 2010; WU, LIU and HO, 2010). In addition, it is highlighted that gender is an important aspect in the relationship between MS and cardiovascular problems and mortality, as these are more significant in women than in men (KRAGELUND et al., 2007; REGITZ-ZAGROSEK, LEHMKUHL and MAHMOODZADEH , 2007; REGITZ-ZAGROSEK, LEHMKUHL and WEICKERT, 2006). MS has become one of the greatest health challenges of today, as estimates point to a prevalence of MS between 20% and 30% in the world population of adults (GRUNDY, 2008; OLADEJO, 2011). Brazil follows the trend observed in other countries in the world, considering that approximately 30% of the Brazilian population has MS (DE CARVALHO VIDIGAL et al., 2013). The growing number of MS cases may be related to changes in the lifestyle and dietary pattern of individuals, the aging of populations and, possibly, everyday stress situations (GOTTLIEB, CRUZ and BODANESE, 2008). As a result of these changes, there is an epidemiological transition in the morbidity and mortality profile of the population in recent decades, with a predominance of non-transmissible chronic diseases (CALDWELL, 2001; SCHRAMM et al., 2004).

Itinerários terapêuticos de surdos em busca de cuidados em saúde mental

Tue, 25 Sep 2018 00:00:00 GMT

Itinerários terapêuticos de surdos em busca de cuidados em saúde mental Francke, Ingrid D'Avila This thesis is the result of an ethnographic experience with three women and one man, all Deaf and Libras users, which enabled a seven-month follow-up in the research field. Several reports were seized, through interviews and participant observations, of their relations with a predominantly listening society. The main objective was to explore the perspective of Deaf people on mental health, their life trajectories and their search for health care. The first article aimed to discuss how stigma and notions of disability are articulated in family relationships and institutions in a social process that restricts the autonomy and citizenship of Deaf people based on a case study. Based on Sofia's narratives about her experiences with family, education and work, it is discussed how much the recognition of her identity as a Deaf woman involved a continuous and complex search for social belonging, challenged by the stigma of disability and threats to her mental health . Alternative paths for seeking citizenship were woven and supported by the possibility of participation and social belonging with Deaf groups and communities. The social challenge of broadening the understanding of citizenship from the perspective of diversity and respect was discussed, reflecting on scenarios in which the identity and dignity of the Deaf are constructed and reconstructed. The second article aimed to understand the health care trajectories of Deaf people, describing experiences and meanings associated with health problems and their support network. Narratives of four participants about their relationship with mental health care were analyzed. The data showed that the meaning of “mental health” is seen as synonymous with yet another deficiency or maladjustment often attributed to the deaf, generating very marked experiences of stigmatization, some already experienced in childhood. Experiences of lack of autonomy for health care, unpreparedness and distancing from the formal care networks regarding the Deaf culture and a generalized social listening center resulted in avoidance strategies, moving the Deaf away from care alternatives, particularly in mental health. On the other hand, Deaf communities proved to be an important resource among the Deaf, indicating that expanding the dialogue with health policies could be a way to expand their social participation and reduce inequities in access to care.

Análise das características químicas, físico-químicas, bacteriológicas e sanitárias da água usada para consumo humano nas comunidades Indígenas Maxakali da região nordeste de Minas Gerais/Brasil

Mon, 15 Aug 2016 00:00:00 GMT

Análise das características químicas, físico-químicas, bacteriológicas e sanitárias da água usada para consumo humano nas comunidades Indígenas Maxakali da região nordeste de Minas Gerais/Brasil Assis, Eliseu Miranda de The colonization process led to the extinction of many indigenous societies that lived in the dominated territory, whether through the action of weapons, enslavement of indigenous people, contagion by diseases brought from distant countries, or even through the application of policies aimed at the "integration" of the Indians to the new dominant society, with strong European influence. Data from the Indigenous Health Care Information System (SIASI, 2008) shows that in the Maxakalí population from 2000 to 2007, parasitic and infectious diseases represented the main cause of death (20.57%), with a risk of 3.18 for every 100 Maxakalí Indians. The absence of sanitary conditions, such as the inexistence of an infrastructure for the adequate disposal of waste and access to good quality water, demonstrate a scarcity or poor administration of public resources for the country's indigenous populations. In this context, when contaminated water can transmit pathogenic agents of bacterial diseases such as typhoid fever, paratyphoid fever, bacillary dysentery, enteroinfections in general and cholera, in addition to viral diseases such as infectious hepatitis and poliomyelitis. Thus, testing the water quality parameters and verifying that they are within the limits established for risk-free consumption, within the standards established by CONAMA (1986), represents both a service for these communities and a survey of a body of relevant data and necessary for research to characterize these locations from a social and environmental point of view.

A vigilância em saúde de um município da região metropolitana de Porto Alegre: uma análise institucional

Wed, 19 Sep 2018 00:00:00 GMT

A vigilância em saúde de um município da região metropolitana de Porto Alegre: uma análise institucional Silva, Claudia Maria Scheffel Corrêa da This work intends to know the methods of work used by the Health Surveillance Agency from a city located at the metropolitan zone of Porto Alegre (RS). We mean to analyze the institutionalization of these processes, for perceiving instituted and instituting questions – by also describing their logic – and understanding the way Health Surveillance experiences its work. The theoretical background chosen for this project is the institutional analysis, socioanalytical subdivision. The tools used in this research/intervention are participational observations and group discussions with the workers of Health Surveillance organs. We presume that this Health Surveillance organ intends to work in networking, since there are several interactive moves between workers and services. Educational actions are part of the work methods of these workers but they're made in a normative and vertical way. However, instituitive processes might be identified in these actions, specially on Sanitary Surveillance. Finally, we identify the low visibility of actions from Worker's Health Surveillance and of the importance of the naturalization of this praxis.

Institucionalização das práticas de atenção às condições crônicas e os processos de trabalho em um serviço de atenção primária

Thu, 15 Aug 2019 00:00:00 GMT

Institucionalização das práticas de atenção às condições crônicas e os processos de trabalho em um serviço de atenção primária Silocchi, Cassiane This study aimed at analyzing the institutionalization of practices of attention to chronic conditions on work processes in the Community Health Service of the Hospitalar Conceição Group of Porto Alegre (RS), in order to identify the instituted and instituting dynamics and the "critical nodes" that may be hindering or enhancing work processes. The chosen theoretical-methodological reference was the Institutional Analysis, in its socioanalytical aspect. The tools used in this intervention research were Participant Observation, the holding of Groups with health teams and semi-structured interviews with those responsible for research development and evaluation of group services. The results showed tension between the traditional model and the resistance of the subjects in face of the new modes of care; the lack of involvement of professionals, pointing to conflicts between the individual fulfillment of tasks and collective engagement and, finally, a tension between the goals required, based on productivity and the incorporation of innovative interventions.

Experiências femininas sobre a transmissão vertical da sífilis: um estudo qualitativo no município de Cachoeirinha/RS

Tue, 06 Jul 2021 00:00:00 GMT

Experiências femininas sobre a transmissão vertical da sífilis: um estudo qualitativo no município de Cachoeirinha/RS Tertuliano, Gisele Cristina This thesis in question analyzes the experience of women on the vertical transmission of syphilis, considering their social trajectory and the intersections of social markers of difference, as well as the assistance provided in the health network and the structure of public policies that assistance sexual and reproductive. In this work was analyzed the role of the Vertical Transmission Committee with a technical-scientific device and its potential as an articulator of the service network for the understanding of the determinism of syphilis in different healthcare spaces is also analyzed. Methodology: The qualitative research was utilized in this thesis that analyzed the biographical narratives of seven women who experienced syphilis during pregnancy and the resulting vertical transmission, in addition to the use of triangulation methods to understand the corpus of materials around the vertical transmission committee, which included document analysis, observation of meetings and conducting interviews with its members through a case study. Data production took place between May 2019 and December 2020; the analysis took place through transcriptions, reading and organization of the interviews, field notes and documents, with discussion axes being built in dialogue with theoretical dimensions. Results and Discussions: The experiences and life trajectories of women who experienced syphilis during pregnancy and vertical transmission were analyzed. The social pathways linked to sexuality and reproduction were analyzed, considering the effects of structural violence that combines gender, class and race inequalities in the lives of these women, with unique histories and subjectivations. These inequalities that affect their lives are not always considered in the production of health care for women and children, institutional vulnerabilities being (re)produced. In the second article, the constitution of the syphilis vertical transmission committee and its help to strengthen the care network in the prevention of vertical transmission and in the satisfactory outcome for the cases that are being followed were examined. Advances and weaknesses of this action were analyzed, considering everything from the way the Committee was organized to the forms of action. It is understood that VTCs have the potential to propose a new work process capable of playing a truly educational and transformative role, not traditionally investigative. Final Considerations: In these situations, it is essential to broaden the view on the social determination of illness from syphilis and the resulting vertical transmission, understanding and interfering in the social dynamics that involve the production of care in the health care of women and children and strengthening the roles of the committees as protagonists of a political and institutional repositioning, capable of covering the situations of social vulnerability that pervade the life of the triad (Mother-Baby-Father/Partner).

Morbidade cardiometabólica e fatores associados em homens e mulheres trabalhadores da indústria do Sul do Brasil

Tue, 30 Apr 2019 00:00:00 GMT

Morbidade cardiometabólica e fatores associados em homens e mulheres trabalhadores da indústria do Sul do Brasil Xavier, Paula Brustolin Work environments have undergone significant transformations in the 20th century. The insertion of technologies, time control, qualified labor, models and forms of organization and structuring of services, high productivity and no modified market as working conditions and, also, society. (MENDES; DIAS, 1991; SANTANA; SILVA, 2009). With these changes, they occur in the area of production and interfered in social contexts, especially in the area of health and work, as the country depends on a healthy population with a capacity for productivity. (ESCOREL; TEIXEIRA, 2008; SELIGMANN-SILVA et al., 2010). A phenomenon of this generation has generated a corresponding reaction in the working class in the face of the uneasiness of guaranteeing a working space, and the support of this modern society, which has become a risk factor for the occurrence of diseases in human beings. (FAN et al., 2013). With the demographic and epidemiological transition process, associated with the new productive processes (NEDER; BORGES, 2006; SCHRAMM et al., 2004), the conditions of morbidity and mortality in the population emerged. This new epidemiological profile demonstrates the predominance of chronic non-communicable diseases (NCDs) influenced by the diversity of risk factors, and by high prevalence of diseases and deaths. (OTTO et al., 2016).

Características do sono em mulheres adultas do sul do Brasil: estudo sobre a má qualidade e tempo inadequado do sono e os seus efeitos diretos e indiretos na associação com medidas antropométricas

Tue, 28 Jul 2020 00:00:00 GMT

Características do sono em mulheres adultas do sul do Brasil: estudo sobre a má qualidade e tempo inadequado do sono e os seus efeitos diretos e indiretos na associação com medidas antropométricas Leite, Heloísa Marquardt Objectives: to study sleep characteristics, poor quality and inadequate time (short and long sleep duration), as well as to explore ways of possible association of these characteristics with the Body Mass Index (BMI) and Waist Circumference (WC) in a sample of adult women living in the urban area of São Leopoldo/RS. In addition, a systematic review and meta-analysis of observational studies that verified the association between sleep quality and abdominal obesity in adults was carried out. Methodology: cross-sectional, population-based study, with women between 20 and 69 years of age. The characteristics of sleep, poor quality, short and long sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI-BR). Weight and body height, for the calculation of BMI, and WC were measured by trained interviewers. Practice of physical activity, sedentary behavior and consumption of fast foods were considered as intermediate variables in the association between poor sleep quality and WC and BMI. Results: The prevalence of poor sleep quality (PSQI> 5) was 42.8% (95%CI: 39.9-45.7). The prevalence of short sleep duration (<7 hours of sleep/day) and long sleep duration (> 9 hours of sleep/day) was 26.7% (95% CI: 24.1-29.4) and 17.9% (95%CI: 15.7-20.3), respectively. It was found that socioeconomic and occupational factors were those that were associated with the three outcomes. There was also an indirect effect on the association between poor sleep quality (numerical score) and increased WC via less weekly physical activity (β = 0.03; 95%CI 0.01-0.07). For the systematic review, 50 studies met the inclusion criteria. Thirty-two studies were included in the meta-analysis, which included 39 analyzes and 35,325 subjects. The analysis of random effects showed that individuals with poor sleep quality had a higher WC value compared to those without poor sleep quality (SMDs = 0.202; 95%CI = 0.131 - 0.273). Conclusions: The importance of investigating sleep characteristics emerges from the need to raise awareness that sleep deserves attention as a way of controlling and reducing chronic non-communicable diseases. It should also be considered that most people are unaware of how much sleep they should have per night and the impacts that poor quality sleep with inadequate time can have on health. This reinforces the need for this issue to be seen as a public health problem. Thus, the importance of monitoring the sleep characteristics of populations from specific realities is emphasized. In addition, strategies to prom with a view to covering not only individual and collective needs, but also the context in which they are inserted.

Institucionalização das práticas de atenção às condições crônicas e os processos de trabalho em um serviço de atenção primária

Thu, 15 Aug 2019 00:00:00 GMT

Itinerários de cuidado e práticas de atenção à saúde das mulheres kaingang no período gravídico-puerperal na aldeia Kondá/SC

Mon, 18 Nov 2019 00:00:00 GMT

Itinerários de cuidado e práticas de atenção à saúde das mulheres kaingang no período gravídico-puerperal na aldeia Kondá/SC Girardi, Francielli This thesis analyzes the practices of health care, indigenous women, in the pregnancy-puerperal period in the Kondá Indigenous Land / SC, analyzing through the care itinerary as the Public Policies, as the PNSAI Indigenous Population Policy (2002), and the Stork Network Strategy (ERC), dialogue / intend to establish a differentiated assistance to indigenous pregnant women, considering the plurality and interculturality in health care. The care health systems in indigenous communities are different and singulars, the care interconnects environment, social network and spiritual beings in care practices. The several care systems were named by Menendez (2003) as models of health care, articulating plurality and interculturality. This one was a qualitative research with ethnographic approach. The techniques used for data production were: participant observation with field diary registry, open individual and group interviews, realized with indigenous women in the pregnancy-puerperal period, women from the community and midwife, using a guiding script. The study comprised the period from June to December 2018. The analysis occured during the transcriptions, reading and organization of interviews and field notes, being built axes of discussion that articulated the data produced and the literature of the area. In this perspective, it was noticed that the PNSAI’s practice cares are mostly guided by the biomedical model, which these are verticals, protocols and produces of the invisibility diversity of health care practices, carried out by indigenous women. We highlight the existence of Kaingang’s practices of attention to pregnant women that express a wide network of knowledge linked to the construction of the Kaingang’s person. Given these scenarios, it is essential to expand the studies on this theme and find dialogic strategies, seeking to articulate the various forms of health care, presents in the Kondá indigenous community.

Desenvolvimento de critérios explícitos adaptados à realidade brasileira para avaliação do uso de medicamentos potencialmente inapropriados para idosos

Tue, 20 Mar 2018 00:00:00 GMT

Desenvolvimento de critérios explícitos adaptados à realidade brasileira para avaliação do uso de medicamentos potencialmente inapropriados para idosos Motter, Fabiane Raquel The use of potentially inappropriate medications (PIMs) for older patients is a public health problem because it can compromise the effectiveness or safety of pharmacotherapy and is responsible for high rates of morbidity and mortality in this age group. Brazilian studies that investigated PIMs show that the prevalence of PIM use ranges from 28.0% to 82.6%. However, these studies used PIM lists developed in other countries in North America and Europe. The first Brazilian consensus on PIMs was published in 2016. Limitations reported by the authors included that the PIM list was based on previous versions of Beers (2012) and STOPP (2008), therefore, it did not include the most up-to-date versions published in 2015, and did not incorporate therapeutic alternatives. The aim of the present study is to develop and validate explicit criteria for the evaluation of PIMs prescribed to older patients in Brazil and their respective therapeutic alternatives. The development of this project comprises of two steps: 1- Elaboration of the preliminary PIM list for older patients based on a systematic literature review; 2 - Validation of the preliminary PIM list with the consensus of experts using modified Delphi technique; The elaboration of the preliminary list of MPIs was based on a systematic review of PIM lists published between January 1991 and April 2017. A qualitative analysis of the PIM lists was performed with the objective of verifying their applicability to the Brazilian market. This way, three lists of PIMs were selected: Beers’ 2015, STOPP 2015, and European Union (7) PIM. Thus, we obtained 153 explicit criteria distributed across seven instruments: PIMs–Pain and Inflammation, PIMs–Cardiovascular System, PIMs–Endocrine System, PIMs–Genitourinary, PIMs–Respiratory System, and PIMs–Central Nervous System. The first two were already validated using the modified Delphi technique. The items for which the lower limit of the 95% confidence interval (CI) was greater than or equal to 4.0 were considered to have been validated. The consensus on PIMs–Pain and Inflammation was formed by two rounds. A group of nine experts reached consensus on 98 (63.2%) of the 155 items. A consensus was reached for 31/34 concerns regardless of diagnosis, 4/4 dose concerns, 4/4 concerns about the duration of treatment, 19/20 concerns about use under specific conditions, 12/23 special considerations of use, and 28/68 therapeutic alternatives. In the consensus on PIMs–Cardiovascular System, a group of seven experts reached consensus on 84 of the 257 questions. A consensus was reached for 20/25 concerns independent of diagnosis, 4/4 concerns regarding dose, 37/57 concerns regarding use under specific conditions, 20/105 special considerations of use and 3/66 therapeutic alternatives. Although the development and validation of PIM lists based on expert opinion is a long and complex process, the development of PIM list based on recent consensuses will expand the knowledge about the PIMs in Brazil. Thus, this research will improve the understanding of the magnitude of PIM use in this country, and may contribute to the development of more effective strategies and interventions to reduce drug-related problems among older Brazilian patients.

Nível sérico de vitamina D e sua relação com a doença arterial obstrutiva periférica em usuários de um ambulatório de referência para doenças vasculares no Sul do Brasil

Mon, 25 Sep 2017 00:00:00 GMT

Nível sérico de vitamina D e sua relação com a doença arterial obstrutiva periférica em usuários de um ambulatório de referência para doenças vasculares no Sul do Brasil Bonatto, Simone Vitamin D plays a key role in bone metabolism, besides taking part in many body functions, for instance in the cardiovascular system. Low serum levels of this vitamin can predict the onset of peripheral arterial disease (PAD), a cardiovascular disease caused by atherosclerotic lesions in blood vessels. Evaluate vitamin D serum levels and their relation with PAD among users of a vascular disease outpatient clinic in Southern Brazil. Cross-sectional study with a consecutive sample of 144 individuals of both sexes, aged at least (≥) 40 years, between March 2016 and January 2017. We considered PAD patients those with ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Demographic, socioeconomic, and behavioral variables and comorbidities were obtained through standardized survey. Vitamin D serum level was biochemically assessed and rated as sufficient (≥30 ng/mL), insufficient (>20 a 29 ng/mL) and deficient (<20 ng/mL). A gender layered analysis was performed in the research of vitamin D serum level associated factors. Pearson's chi-square test was used for the bivariate analysis, Mann–Whitney U test for categorical variables, and T test for symmetries on numerical variables. Multiple linear regression was used to evaluate the relation between independent variables and vitamin D serum level and Poisson regression to analyze the association between this vitamin's serum levels and PAD. The participants presented 36.1% (CI95% 28-44) vit D insufficiency and 45.1% (CI95% 36-53) vit D deficiency. Age was inversely associated with vitamin D serum level (β = -0.22; CI95% -0.38; -0.07), while variables like sun exposure (β = 0.49; CI95% 0.13; 0.84) and vitamin D intake (β = 2.92; CI95% 0.84; 5.00) were positively associated. In a gender layered sample, an independent and inverse effect was demonstrated on age, a direct effect – although bordering – on sun exposure on vitamin D serum levels among men, and an independent and direct effect of vitamin D intake on women serum levels of this vitamin. PAD prevalence was 50.7% (CI95% 42-59). After adjustment for PAD, PRs were 1.08 (CI95% 0.66-1.76) for insufficient serum level and 1.57 (CI95% 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020). The present study found a high prevalence of vitamin D deficiency among the studied population. The vitamin D associated variables were age and sun exposure among men and vitamin D intake among women. Vitamin D serum level showed an inverse and significant dose-response relationship with PAD. Considering the high prevalence of lower vitamin D serum levels and the different body functions performed by this vitamin, including its effect on PAD, it is important to guide the population towards sun exposure and vitamin D rich food intake adequate.