PPGSCOL/CCS - Doutorado em Saúde Coletiva
Permanent URI for this collectionhttps://repositorio.ufrn.br/handle/123456789/12053
Browse
collection.page.browse.recent.head
Now showing 1 - 20 of 129
Doctoral Thesis Avaliação da morbidade e mortalidade hospitalar por câncer de mama e de colo do útero em mulheres no Brasil no período de 2010 a 2022(Universidade Federal do Rio Grande do Norte, 2024-10-25) Ferreira, Haryelle Naryma Confessor; Andrade, Fábia Barbosa de; https://orcid.org/0000-0002-7055-8726; http://lattes.cnpq.br/0315846984480655; http://lattes.cnpq.br/3004243177207613; Costa, Cintia Bezerra Almeida; https://orcid.org/0000-0002-1179-5852; http://lattes.cnpq.br/6281513299605740; Mendes, Cristina Katya Torres Teixeira; Machado, Flávia Christiane de Azevedo; Nobre, Thaiza Teixeira XavierBreast and cervical cancer are a serious public health problem worldwide. Early screening, identification and treatment are generally the most widely used means of reducing morbidity and mortality. In Brazil, difficulties in accessing the public health system lead to diagnoses at more advanced stages of cancer and therefore require more aggressive therapeutic approaches that can result in functional, emotional and social sequelae. This study aims to evaluate hospital morbidity and mortality from breast and uterine cancer in relation to Brazilian regions between 2010 and 2022. This is an ecological time series study carried out from 2010 to 2022 using data on hospital admissions and deaths, both in the public domain and stored in the Ministry of Health's DATASUS. The data was analyzed using the Joinpoint Regression program to obtain linear regression and temporal analysis of the variables. In relation to screening for these diseases, it was observed that mammograms and preventive exams showed similar behavior, with a greater supply of these exams until 2019 and a drop during the pandemic period. The results show that between 2010 and 2022, mammography rates ranged from 36 to 71 exams, while Pap smear rates ranged from 126 to 226 cytopathological exams per 1,000 women. Hospitalizations for breast cancer accounted for 147 hospitalizations per 100,000 women and for cervical cancer peaked in 2019, with 48 hospitalizations for the same population. For both, in the years of the pandemic, between 2020 and 2022, there is a drop in hospitalizations in Brazil and in all its regions. Mapping the spatial and temporal distribution of these neoplasms is directly related to human interventions and contributes to cancer control measures. In addition, an increasing trend was observed in the number of deaths related to breast cancer in the Southeast and South regions, as well as cervical cancer in the North and Northeast regions, probably reflecting poorer living and health conditions, less availability of resources and lower primary care coverage. We believe it is important to rethink the priorities in clinical practice and management of the SUS, considering the work process beyond the discussion of therapeutic improvement strategies, but also including the biopsychosocial aspects of women with breast and uterine cancer in the local context, in order to guarantee equity and comprehensive health care. We conclude that although Brazil has several public policies for screening for these diseases, there is still instability in the supply of these tests, reinforcing the weaknesses of the care network and the changes needed in the organization and quality of the services provided.Doctoral Thesis Sífilis gestacional: análise de séries temporais e completude de dados de notificação(Universidade Federal do Rio Grande do Norte, 2025-07-21) Raimundo, Dhyanine Morais de Lima; Mendonça, Ana Elza Oliveira de; Silva, Richardson Augusto Rosendo da; https://orcid.org/0000-0002-9723-705X; http://lattes.cnpq.br/1620761600111705; Deca Júnior, Aurean; Menezes, Harlon França de; Santiago, Janmilli da Costa Dantas; Nobre, Thaiza Teixeira XavierObjective: To analyze the temporal trends, case projections, and completeness of gestational syphilis reporting. Methods: Both articles used secondary data from SINAN. The first article analyzed time series from 2019 to 2022 and projections with data from the state of Rio Grande do Norte until 2025, including all reported cases of gestational syphilis. Analyses were performed using Pearson's chi-square test (χ²) to verify the existence of an association between the categorical variables of the study, with a significance level of 5% (p < 0.05). The assessment of the completeness of gestational syphilis cases was performed using a longitudinal design between 2008 and 2024 in Brazil. Each completeness rate was classified according to data quality as excellent (<5%), good (5-10%), fair (10-20%), poor (20-50%), and very poor (≥50%). Completeness analysis was based on reports from 2008 to 2024 in Brazil, assessing the percentage of missed reports and classifying completeness as excellent, good, or poor. Results: The time trend study revealed a high percentage of late diagnoses, especially in the third trimester of pregnancy, indicating possible failures in prenatal care. The analysis points to a significant association between gestational syphilis cases and the clinical classification of the syphilis stage, the therapeutic regimen, and the lack of adequate treatment for pregnant women's partners. Regarding completeness, the variables education level and clinical classification showed a consistent pattern of high incompleteness throughout the series, classifying them as poor. Despite this, race and clinical classification showed a significant downward trend in incompleteness, indicating progressive improvement in the completeness of this information. The non-treponemal test, however, showed worsening trends, with a significant increase in incompleteness. Conclusion: The findings of this study emphasize the need for a multidisciplinary and intersectoral approach to addressing gestational syphilis in Rio Grande do Norte. Furthermore, the country lacks better reporting to effectively manage actions aimed at preventing gestational syphilis.Doctoral Thesis Avaliação longitudinal da condição periodontal em idosos institucionalizados e não institucionalizados(Universidade Federal do Rio Grande do Norte, 2019-10-11) Costa, Anderson Nicolly Fernandes da; Lima, Kenio Costa de; Freitas, Yan Nogueira Leite de; https://orcid.org/0000-0002-5843-4878; http://lattes.cnpq.br/2433847214117166; https://orcid.org/0000-0002-5668-4398; http://lattes.cnpq.br/5835673385014578; http://lattes.cnpq.br/0874839877343975; Piuvezam, Grasiela; https://orcid.org/0000-0002-2343-7251; http://lattes.cnpq.br/0391780760729166; Lins, Ruthineia Diógenes Alves Uchôa; https://orcid.org/0000-0002-0047-5976; http://lattes.cnpq.br/4462076152744400; Godoy, Gustavo Pina; https://orcid.org/0000-0002-7648-0683; http://lattes.cnpq.br/5655149996985928; Cavalcanti, Yuri Wanderley; https://orcid.org/0000-0002-3570-9904; http://lattes.cnpq.br/1303695205442802As changes in the oral cavity that occur in aging lead to physiological changes that predispose the elderly to develop periodontal diseases, which is the most common condition. Given the above, this research sought to investigate a periodontal condition in institutionalized and non-institutionalized elderly from philanthropic and private institutions. This research is characterized by a prospective cohort (four years) qualified for 128 elderly, 94 non-institutionalized and 34 institutionalized elderly. Most of the elderly were diagnosed with periodontics in cases I/II and grade A. The periodontal condition of the elderly worsened the lesions of institutionalized use or not with reduced gingival bleeding, dental calculus, shallow and deep periodontal pocket. As latent variables created from the periodontal condition were periodically affected, sequelae of periodontal disease and advanced periodontal disease. There was a significant relationship (p <0.05) between functional capacity and the factors Initial periodontal disease and Advanced periodontal disease. The worsening of the periodontal disease factor was associated with the variables institutionalization, diabetes and cognitive ability. It was concluded that in relation to periodontal diagnosis, most of the elderly presents a higher prevalence of periodontics in recent groups and granules, as well as the elderly who were not institutionalized, non-diabetic and oriented to stamp related to the worsening of the advanced periodontal disease factor.Doctoral Thesis Avaliação das políticas públicas de atenção à saúde da pessoa idosa(Universidade Federal do Rio Grande do Norte, 2025-03-25) Amorim, Margareth Santos de; Nobre, Thaiza Teixeira Xavier; Seixas, Clarissa Terenzi; http://lattes.cnpq.br/1559068124575826; https://orcid.org/0000-0002-8673-0009; http://lattes.cnpq.br/2813639308023253; http://lattes.cnpq.br/3796988113124978; Lima, Rachel Bernardes de; http://lattes.cnpq.br/5940745882162937; Mendonca, Ana Elza Oliveira de; https://orcid.org/0000-0001-9015-211X; http://lattes.cnpq.br/5531967242281430; Torres, Gilson de Vasconcelos; Reis, Luciana Araújo dos; http://lattes.cnpq.br/5865016290526865Introduction: The global demographic transition is increasing the elderly population, challenging health systems. The World Health Organization (WHO) predicts a significant rise by 2050. In Brazil, the elderly population is also growing, putting pressure on health and social security systems. Accessibility and comprehensiveness in healthcare are essential, yet they face several barriers. Evaluating public health policies for the elderly is crucial, using quality indicators. The COVID-19 pandemic has exacerbated the vulnerability of this population. Objective: This study aims to develop a diagnosis of strategies for assessing public health policies for the elderly, with a focus on improving the quality of healthcare. It seeks to identify existing models and instruments for analyzing public policies related to elderly healthcare quality in the literature and propose indicators to facilitate the evaluation and effective monitoring of the implementation of the Elderly Health Public Policy. Methods: This is a methodological development study in health, consisting of two phases: I - Scoping Review; II - Development of the Elderly Health Evaluation Indicator Matrix. The scoping review was conducted following the Joanna Briggs Institute manual and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches for articles were carried out in the following databases: Embase, Medline/PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, and Science Direct. Additionally, searches were conducted on Google Scholar and gray literature (www.opengrey.eu). The search strategy was executed in January 2024, with no language restrictions. A descriptive analysis of the mapped studies was conducted, categorizing them by analysis categories. Phase II involved the development of the evaluation indicator instrument, which was carried out in three distinct steps: defining the construct of interest, identifying its domains, generating and selecting indicators based on the defined domains through a systematic search of existing indicators from sources such as WHO, PAHO, MS, SISAP-Elderly, RIPSA, among others, and, finally, defining the operational aspects of the indicators and the instrument itself. Results: A total of articles were included, which identified instruments that assess the health conditions of the elderly, as well as demographic, socioeconomic, and epidemiological indicators, procedures, and healthcare services. All studies utilized a quantitative approach. The indicators were related to the evaluation and effective monitoring of the implementation of the Elderly Health Public Policy. Moreover, the thesis highlights the lack of robust qualitative evaluation of existing policies and programs, limiting the understanding of the needs and challenges faced by the elderly population. The absence of comprehensive qualitative evaluation may lead to a superficial understanding of the needs and challenges faced by the elderly, resulting in policies that do not fully address their demands. In response to these gaps, the thesis proposes an innovative indicator matrix, structured into 6 categories, 8 subcategories, and 24 indicators, aimed at evaluating the quality of elderly health policy and the integration of policies focused on this population. This matrix provides a comprehensive and systematic framework for evaluating quality, allowing for a more in-depth and targeted analysis of relevant aspects for the public policy in question, enabling a swift and technically grounded assessment of the general situation in each thematic area. Conclusion: In summary, the thesis contributes to the field of elderly health by synthesizing existing knowledge on instruments and indicators for evaluating public policies, as well as proposing a set of indicators for monitoring health policies directed at the Brazilian population, structured within relevant thematic areas. This effort aims to improve the quality of care and comprehensiveness of elderly healthcare in the Unified Health System (SUS).Doctoral Thesis Saúde mental dos profissionais de saúde das unidades de pronto atendimento de Natal/RN no contexto da pandemia de Covid-19(Universidade Federal do Rio Grande do Norte, 2023-09-22) Dantas, Ana Patrícia de Queiroz Medeiros; Ferreira, Maria Ângela Fernandes; https://orcid.org/0000-0002-6142-948X; http://lattes.cnpq.br/4036539286429296; http://lattes.cnpq.br/8546527003302670; Cavalcante, Elisângela Franco de Oliveira; https://orcid.org/0000-0002-3578-0153; http://lattes.cnpq.br/9020549482920149; Godeiro Júnior, Clecio de Oliveira; http://lattes.cnpq.br/6861574542099266; Medeiros, Anna Cecilia Queiroz de; https://orcid.org/0000-0002-7664-4959; http://lattes.cnpq.br/6897910777769874; Oliveira, Rosana Rosseto de; https://orcid.org/0000-0003-3373-1654; http://lattes.cnpq.br/0221609729509187; Bosco Filho, João; Salci, Maria AparecidaThe COVID-19 pandemic has triggered an overload on health systems around the world, especially affecting professionals in the urgency and emergency sectors who have higher levels of burnout, anxiety and depression than the general population. In this sense, the present study proposes to analyze the prevalence and factors associated with mental illness among workers at Emergency Care Units in Natal-RN in the context of the COVID-19 pandemic. This is a cross-sectional quantitative study, aimed at nurses, nursing technicians/assistants and physicians at the 04 Emergency Care Units in Natal-RN. The collection was carried out from July to December 2022 with the application of questionnaires, which contain sociooccupational data, personal clinical health data and personal and family history of mental disorders and specific questionnaires Maslach Burnout Inventory-Human Services Survey (MBI -HSS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). In the survey were included 172 participants . The sample consisted of 82% women, with a mean age of 39.63 years (SD 9.521). The prevalence of Burnout in the sample was 51,2%. Regarding to anxiety symptoms, 28.5% had moderate to severe anxiety symptoms and the prevalence of depressive symptoms was 16 .3%. n association was evident between the 03 burnout subscales and the youngest age group. In addition to this association, high exhaustion was associated with insufficient PPE and weekly working hours above 40 hours, high depersonalization was associated with daily working hours above 12 hours and low personal fulfillment was associated with absence or few breaks at work. From the results found, it is concluded that the mental health of health professionals in Emergency Care Units is significantly affected, even more than two years after the start of the pandemic, generating negative impacts on professionals and on the quality of care. provided to patients. In view of this, it is urgent to create government actions that act at a management, organizational and individual level to prevent new mental disorders in frontline health professionals and treat sick professionals.Doctoral Thesis Fatores associados à hesitação da vacina contra o Papilomavírus Humano na população brasileira: um estudo transversal(Universidade Federal do Rio Grande do Norte, 2025-06-30) Soares, Lygia Maria Costa; Mendonça, Ana Elza Oliveira de; https://orcid.org/0000-0001-9015-211X; http://lattes.cnpq.br/5531967242281430; http://lattes.cnpq.br/2444005829723356; Nogueira, Angélica Rodrigues; https://orcid.org/0000-0002-3405-8310; http://lattes.cnpq.br/0436689838972775; Melo, Andreia Cristina; https://orcid.org/0000-0002-1201-4333; http://lattes.cnpq.br/3735622521018762; Paulino, Eduardo; https://orcid.org/0000-0003-1080-1058; http://lattes.cnpq.br/6731301366131175; Diniz Júnior, José; https://orcid.org/0000-0002-2327-945X; http://lattes.cnpq.br/7913193754933633; Nobre, Thaiza Teixeira Xavier; https://orcid.org/0000-0002-8673-0009; http://lattes.cnpq.br/2813639308023253HPV related tumors continue to be a global leading cause of cancer mainly due tocervicalcancer (CC) burden. In Brazil, CC is the third most common cancer and the fourthhighestcancer mortality rate among women. HPV vaccine mass immunization represents thecurrentmost promising intervention for CC prevention. It was first implemented in the Brazilianpublic health system in 2014, however, despite a history of excellent coverage for othervaccines, HPV vaccine uptake is below the necessary threshold for CC elimination. Theaimof this study is to know whether or not Brazilians are resistant to HPVvaccinationandtodetermine the factors and variables that influence this decision. This is a population-basedcross-sectional study which used quantitative methodology through personal interviews. Atotal of 2.010 interviews were planned to result in error margins of 2 percentage points, moreor less considering a 95% confidence level, encompassing all five Brazilian regions. Theresearch was carried out with the Brazilian population aged 16 and over, intervieweeswereapproached at points of population flow. Between June 12 th and 16 th 2023, a total of 2.010personal interviews were done, with participants from all five Brazilian regions. Theprevalence of vaccine resistance was 5.97% (95% confidence interval [CI], 4.93–7.23) amongthose interviewed. A multivariate analysis demonstrated greater resistance to thevaccineamong men (prevalence ratios (PR): 1.58; 95%CI, 1.06–2.34; p: 0.023) and residentsinthe South region of the country (PR: 1.77; 5%CI, 1.06–2.94; p: 0.028). The threemainreasons for refusing the vaccine reported by the participants were: lack of knowledgeaboutthe HPV vaccine; difficulty in accessing the vaccine; and lack of vaccine prescriptionbyhealth professionals. Safety was the main reason not to vaccinate, cited by 10 %. DespiteHPV vaccine availability in Brazil at the public health system, vaccination coverageremainsbelow the target for both genders. However, according to this analysis, there is a lowrateofHPV vaccination hesitancy in the country, being lack of knowledge, difficulty inaccessingthe vaccine and lack of vaccine prescription by health professionals the main obstaclestoadequate adherence. The COVID-19 pandemic doesn’t seem to have affectedHPVvaccination resistance in the country. Proper strategies for vaccine implementation, includingschool-based programs, patient-provider communication and education, andintegratedmonitoring and evaluation strategies are needed, otherwise, HPV vaccine programsriskrepeating problems like other cancer prevention programs in low- and middle-incomecountries. The HPV vaccine is an efficient tool for preventing cancer, which saves lives, butin Brazil it is being underused.Doctoral Thesis A interprofissionalidade na formação e na prática do bacharel em saúde coletiva(Universidade Federal do Rio Grande do Norte, 2025-04-28) Oliveira, Nathalia Hanany Silva de; Castro, Janete Lima de; https://orcid.org/0000-0003-1823-9012; http://lattes.cnpq.br/9530544825874259; https://orcid.org/0000-0002-8454-910X; http://lattes.cnpq.br/8614355120152256; Magnago, Carinne; https://orcid.org/0000-0001-8799-3225; http://lattes.cnpq.br/9875118235955534; Regis, Cristiano Gil; https://orcid.org/0000-0002-6024-6032; http://lattes.cnpq.br/3007783082079822; Souza, Dyego Leandro Bezerra de; https://orcid.org/0000-0001-8426-3120; http://lattes.cnpq.br/9953301230987878; Villar, Rosana Lucia Alves de; http://lattes.cnpq.br/3310631449276616Introduction: The undergraduate degree in Collective Health recognizes that the field of Collective Health lacks professionals with a broad education, who treat health in its global and integrative vision and who are able to dialogue with other health professionals. From this perspective, the Bachelor in Collective Health (BCH) is expected to articulate and create opportunities with the team of health professionals with a view to interprofessionality. Objective: To analyze interprofessionality in the education and practice of the BCH with a view to its sustainability. Method: descriptive-exploratory research, with a qualitativequantitative approach. Data collection was carried out in three stages, namely: a scoping review, which began with the construction, registration and publication of the Protocol through the article “Sustainability of Interprofessional Education: Protocol for a Scoping Review” and the subsequent Scoping Review developed according to the criteria of the JBI Institute Reviewer's Manual and guided by PRISMA-ScR. In this stage, the strategies for the sustainability of Interprofessional Education (IPE) were mapped. In the second stage, a self-administered form was used as a data collection tool, structured with closed questions and applied using Google Forms. Information was collected on the professional's profile, the activities carried out in health services and questions about their training and work in terms of interprofessionality from 107 BCH. In the third stage, the collection technique used was interviews. Conducted virtually with 29 BCH, via Google Meet, the interviews sought to capture the subjects' perception of the presence of interprofessionality in their training process, during graduation, and in their professional practice. Data from the forms was analyzed using Jamovi, using descriptive statistics; data from the interviews was analyzed using Bardin's content analysis technique, using the ATLAS.ti software. Results: The protocol (Article 1) guided the scoping review (Article 2), in which 57 productions were selected, mostly developed in the years 2021 and 2022, with a predominance in the United States of America. The World Health Organization's definition of IPE was the most widely used. Sustainability strategies were mapped at the micro, meso and macro levels. Article 3 showed that BCHs are mainly active in the areas of Health Planning and Management, Health Policy, Work Management and others. It showed that BCHs are in a position to foster interprofessionality in their health work processes. Article 4 showed that undergraduate courses in Collective Health are close to the principles of Interprofessionality and provide experiences in teaching, research and extension. Article 5 pointed out the factors that facilitate or hinder interprofessional work. More hindering elements were found than facilitating ones for the development of interprofessional work. Final considerations: In view of the research findings, it is argued that bachelors in Collective Health can be an agent for promoting interprofessional work in health services. However, for this to happen, it will be necessary, in addition to other measures, to have a training process and Permanent Health Education aimed at interprofessional education.Doctoral Thesis Ambientes alimentares e sua interface com a promoção da alimentação adequada e saudável(Universidade Federal do Rio Grande do Norte, 2025-01-30) Sousa, Layanne Cristini Martin; Lyra, Clelia de Oliveira; Lima, Severina Carla Vieira Cunha; https://orcid.org/0000-0001-8268-1986; http://lattes.cnpq.br/8818927353248941; https://orcid.org/0000-0002-1474-3812; http://lattes.cnpq.br/4264395963141865; http://lattes.cnpq.br/4235523665015001; Canella, Daniela Silva; http://lattes.cnpq.br/3074020679309873; Araújo, Fábio Resende de; https://orcid.org/0000-0001-8268-0078; http://lattes.cnpq.br/2159396359014027; Rocha, Maria Cecília; Câmara, Saionara Maria Aires da; https://orcid.org/0000-0002-3054-7213; http://lattes.cnpq.br/9021377225085393Introduction: The theme of food environments is becoming increasingly evident in studies in Brazil and around the world. Knowing its aspects and their possible influences on the promotion of adequate and healthy food for the population based on national food guidelines is of great relevance, especially in the local scenario. Objectives: To understand the food environments in the municipality of Natal/RN and their relationship with the promotion of adequate and healthy eating according to the population's eating practices and the recommendations of the Food Guide for the Brazilian Population (GAPB). Method: The thesis was prepared using different methods organized into three sections: 1) Methodological study on the applicability of the GAPB adherence scale as a marker of healthy eating practices, which compared the Food Guide adherence scale with the scale weighted by the level of adherence of the study population. For this purpose, the statistics used were the ROC curve and the Kappa test; 2) A cross-sectional study on the relationship between the food environments (food deserts and swamps) of Natal/RN and adherence to the GAPB. To analyze the association, multiple linear regression was carried out by “backward stepwise” to ascertain the relationship between the variables in question; 3) Methodological study for the development of an instrument to evaluate the food environment of popular restaurants, considering the recommendations of the GAPB and the legislation of the Popular Restaurants Program. The instrument was evaluated by a panel of experts using a checklist for content validity, considering the Content Validity Index (CVI). Two rounds of evaluation were carried out and the aspects of practical relevance and clarity of language of the instrument's items were analyzed. Results: 1) In the methodological study on the applicability of the Food Guide adherence scale, an accuracy of 98.7% (AUC = 0.987 and p<0.001; 95%CI 0.979-0.995) was observed for the new weighted indicator to correctly classify the individual in terms of their adherence to the GAPB, with almost perfect agreement between the scales (Kappa = 0.90; p<0.001). 2) The cross-sectional study on food environments and adherence to the GAPB showed that living in a food desert reduces the adherence score to the Guide by 2.41 (p=0.014), regardless of income, age and gender; and reduces the adherence score by 1.39 (p=0.006) when considering practices contrary to the GAPB recommendations. Food swamps were not associated with the GAPB adherence score (p=0.886). 3) Regarding the study on the instrument developed, it was found that of the 46 checklist items assessed for practical relevance in the first round by the panel of experts, 6 were excluded for having a CVI < 0.8. The remaining 40 items were assessed for clarity of language and of these, 24 needed to be revised for having a CVI < 0.8. The experts also suggested adding 20 additional items to the instrument. Both the revised and additional items were assessed for clarity of language in the second round of the panel and obtained CVI ≥0.8. Conclusions: We conclude that the community food environment in the municipality of Natal/RN is unevenly shaped across the territory, negatively influencing access to healthy food and the adoption and promotion of an adequate and healthy diet for the population according to the GAPB. In this context, promoting healthy food environments in this municipality, such as public food and nutrition security facilities, is essential, as is having evaluation tools to monitor these spaces, such as the instrument developed to evaluate the food environment of popular restaurants. Given this scenario, it is essential that the actors responsible for intersectoral actions aimed at promoting adequate and healthy food act together.Doctoral Thesis Obesidade, insegurança alimentar, gênero e raça/cor: um estudo sobre interseccionalidade na população brasileira(Universidade Federal do Rio Grande do Norte, 2025-05-20) Brito, Renatha Celiana da Silva; Oliveira, Angelo Giuseppe Roncalli da Costa; Palmeira, Poliana de Araújo; http://lattes.cnpq.br/8298424599274496; https://orcid.org/0000-0001-5311-697X; http://lattes.cnpq.br/0023445563721084; http://lattes.cnpq.br/2808450974759387; Mirabal, Isabelle Ribeiro Barbosa; https://orcid.org/0000-0002-1385-2849; http://lattes.cnpq.br/0211762022010569; Araújo, Fabio Resende de; https://orcid.org/0000-0001-8268-0078; http://lattes.cnpq.br/2159396359014027; Ferreira, Aline Alves; https://orcid.org/0000-0001-5081-3462; http://lattes.cnpq.br/7897675631080409; Vianna, Rodrigo Pinheiro de Toledo; https://orcid.org/0000-0002-5358-1967; http://lattes.cnpq.br/3915051035089861Introduction: Obesity is a global public health problem, associated with comorbidities such as diabetes and hypertension, which has advanced rapidly in Brazil, where its prevalence more than doubled between 2006 and 2023. Along with this scenario, Food Insecurity (FI) has also grown, especially between 2017 and 2022, disproportionately impacting women and black populations, reflecting historical structural inequalities. Objective: From an intersectional approach, this thesis investigates how gender, race/color and socioeconomic factors are articulated in the relationship between obesity and FI. Methodology: Based on two types of studies, a systematic literature review and observational epidemiological studies, five articles were produced (two of a methodological nature and three dealing with the results of the research). The systematic review was registered on the PROSPERO platform and carried out following the PRISMA guidelines, with the aim of evaluating the association between food insecurity and excess weight (overweight and obesity) in the Brazilian population from the perspective of gender and race/color. The searches took place in the Virtual Health Library (Lilacs-BVS), PubMed, Web of Science and Embase databases, with the selection and extraction stages carried out by independent researchers. Secondary data from the National Health Survey (2019) was then analyzed to validate the classification of nutritional status based on self-reported anthropometric data and to assess the prevalence of obesity and its relationship with vulnerability indicators among Brazilian population groups. In addition, primary data from a population-based cross-sectional study of households in two municipalities in the northeastern semi-arid region (InqSAN-Semiárido) was used to analyze the relationship between obesity and food insecurity based on intersectional factors. Descriptive, bivariate and multivariate analyses were carried out using Stata software (version 15.0), using the variable of classification of Body Mass Index as Obesity as the outcome. As exposure variables, we used socioeconomic variables (income, schooling, occupation, housing), FI (assessed using the Brazilian Food Inadequacy Scale – EBIA) and gender and race/color factors by creating an intersectional variable (white man, black/brown man, white woman, black/brown woman). Results: From the analysis of 22 articles, the review showed that although the positive association between AI and overweight is consolidated in the literature, there is a gap in the discussion about how intersectionality permeates this association. As for the validation of self-reported data, all the analyses showed positive results, with greater reproducibility among adults (18 to 59 years old) when compared to the elderly and among men when compared to women, thus indicating a concrete possibility of carrying out observational studies of association with reported nutritional status as the outcome variable. As for cross-sectional studies, the PNS data showed that obesity affects intersectional groups unequally and is intensified by other vulnerability factors such as income, schooling and occupation, with black women being the most affected, while the InqSANSemiárido data reinforced the prevalence of this outcome and identified that in the presence of FI, social disparities are amplified. Final considerations: It is essential to implement public health and food security policies aimed at tackling structural and territorial inequalities. It is recommended, among other actions, to expand access to healthy food in areas of high vulnerability, strengthen food security policies with a focus on black women and low-income populations, integrate multidimensional approaches to tackling obesity and adopt affirmative policies that reduce gender and racial inequalities in access to education, work and health. Joint efforts between the state, civil society and the private sector are essential to transform eating environments, reduce privileges and discrimination and build a fairer and more inclusive society.Doctoral Thesis Políticas e estratégias para a qualidade em sistemas de saúde: lições globais e proposta de um instrumento para o Sistema Único de Saúde(Universidade Federal do Rio Grande do Norte, 2025-04-15) Pellense, Márcia Cunha da Silva; Gama, Zenewton André da Silva; https://orcid.org/0000-0003-0818-9680; http://lattes.cnpq.br/8885774273217562; https://orcid.org/0000-0001-9400-6160; http://lattes.cnpq.br/4479160332052840; Travassos, Cláudia Maria de Rezende; http://lattes.cnpq.br/5585204991017721; Louvison, Marilia; https://orcid.org/0000-0003-1630-3463; http://lattes.cnpq.br/4532645395293280; Sousa, Paulo; Nobre, Thaiza Teixeira Xavier; https://orcid.org/0000-0002-8673-0009; http://lattes.cnpq.br/2813639308023253The Unified Health System has adopted various initiatives to guarantee quality care, but in a fragmented way. The World Health Organization recommends integrating these actions into a national policy and strategy, evaluating their implementation throughout the system. This study aims to identify instruments for evaluating policies and strategies for quality in health systems and propose an instrument for analyzing their completeness adapted to the context of the Unified Health System. The specific objectives include: a) mapping studies on the evaluation of national policies and strategies for quality in health systems around the world; b) identify available instruments for analyzing strategic interventions for quality; c) describe policies and strategies for quality in health systems in light of the recommendations of the World Health Organization and d) cross-culturally adapt an instrument for measuring strategic interventions for quality of care in the Unified Health System. The research combines two designs: 1) Scoping Review and 2) Cross-Cultural Adaptation of a Measurement Instrument. The review follows the JBI guidelines and the Arksey and O'Malley model, updated by Levac et al.. with searches conducted in databases and gray literature in July 2024. The cross-cultural adaptation involved the translation of the “Questionnaire for Quality of Care Interventions in Health Systems” into Portuguese, conducted between August 2024 and March 2025, according to the updated model by Beaton et al.. The equivalence analyses usually used in crosscultural adaptations were replaced by face validity, content and feasibility analyses to better align them with the object of study and the Brazilian context. To assess the level of agreement, the Delphi Consensus Technique was used, applied to a panel of experts with recognized experience in the field. The review identified 14 documents, nine from databases and five from gray literature, on national quality policies and strategies in health systems. Experiences from various countries were highlighted, including North America, Europe, Africa and Asia. In addition to geographical diversity, the support of international agencies such as the World Health Organization and the World Bank was highlighted, especially in the countries of the Global South. For the adaptation study, an integrated theoretical model was developed which represents the perspective adopted in the questionnaire. The results in the first round indicated an average CVI of 0.93 for face validation and 0.90 for content validation. In the second round, the average CVI was 0.96 for both validations. Although most of the criteria were validated in conceptual terms, adjustments were necessary to ensure their applicability in the Unified Health System. The scoping review revealed variations between countries in the implementation of quality policies and strategies. The presence of governance structures in most of the experiences analyzed stands out, but so does the scarcity of evidence on their impact on health systems. The findings reinforce the need for an integrated model to evaluate and improve quality initiatives. The thesis presents the initial results of the adaptation and validation of the questionnaire which, after analysis by experts, was consolidated into 30 items, distributed into six strategic domains for quality. The purpose of this instrument is to monitor and evaluate quality in the Unified Health System. Given that the validation process takes place in multiple stages, future studies are recommended to improve its validity and reliability.Doctoral Thesis Construção e validação do instrumento de avaliação da linha de cuidado à pessoa com sífilis(Universidade Federal do Rio Grande do Norte, 2024-09-27) Correia, Rafaela Bezerra Façanha; Silva, Richardson Augusto Rosendo da; https://orcid.org/0000-0001-6290-9365; http://lattes.cnpq.br/2184669241700299; https://orcid.org/0000-0002-5229-849X; http://lattes.cnpq.br/3003321108673957; Marinho, Cristiane da Silva Ramos; Botelho, Eliã Pinheiro; Nobre, Thaiza Teixeira Xavier; Schlosser, Thalyta Cristina MansanoIntroduction: Health professionals face several barriers in the prevention, diagnosis, and treatment of people with syphilis, resulting from a fragmentation of care in the Unified Health System. In an attempt to integrate Health Services, there is an orientation to organize and operationalize the Lines of care. Thus, health professionals, social control, and managers are challenged to implement, monitor, and evaluate what is being proposed. To assess the Line of Care for People with Syphilis, a valid instrument is necessary. Objective: Build and validate the instrument for Assessment of the Line of Care for People with Syphilis. Methodology: This was a methodological study. The period of completion was from September 2023 to July 2024. The content validation stage was developed in four phases. In the first phase, an exhaustive search was conducted in the literature, and the contents of the instrument were selected. Next, the instrument was built. Its initial version had 74 questions. In the third phase, expert judges were selected, and finally, the content validation process was discussed. Thus, 39 judges participated in the 1st Delphi round, and 24 questioned the second. We used the Content Validity Index per item and the Global Content Validity Index to analyze the degree of agreement. In the 2nd round, an index equal to one was obtained for each item and the global instrument. Next, a protocol for a scoping review was developed based on the Joanna Briggs Institute manual and the PRISMA-ScR guide. Results: The instrument was validated with 58 items. The Mann-Whitney test showed evidence of a statistical difference between Delphi 1 and Delphi 2 in the dimensions of clarity and relevance, with Delphi 2 obtaining a better evaluation in all instrument items. The protocol for the scoping review presented the research question, the databases for data collection, and inclusion and exclusion criteria, and detailed how the data will be extracted, analyzed, and presented. Conclusion: The Syphilis Care Line Assessment Instrument was validated in terms of its content. This new tool for the management of the Unified Health System will contribute to improving care for people with syphilis from a comprehensive perspective, strengthening the Health Care Network.Doctoral Thesis Saúde LGBTQIA+ potiguar: diálogos no território na construção coletiva da pesquisa-ação(Universidade Federal do Rio Grande do Norte, 2025-01-28) Barra, Brígida Gabriele Albuquerque; Ferreira, Maria Ângela Fernandes; https://orcid.org/0000-0002-6142-948X; http://lattes.cnpq.br/4036539286429296; http://lattes.cnpq.br/6674557389748852; https://orcid.org/0000-0002-3902-6043; Guerra, Eliana Costa; Cavalcante, Elisangela Franco de Oliveira; Bosco Filho, João; Melo, Márcia Maria Dantas Cabral deIntroduction: Despite the existence of public policies, there are still numerous challenges when it comes to the health of the LGBTI+ population. Healthcare professionals often remain unaware of social changes and the specific care needs of this population. These issues may also reflect a health education system that fails to adequately prepare professionals, both in terms of attitudinal dimensions - developing skills in behavior, attitudes, and values - and in clinical competence. It is essential to develop actions and activities aimed at implementing the objectives outlined in legal frameworks. Objective: To understand the care, access, and health assistance available to the LGBTI+ population in Rio Grande do Norte and to develop strategies to strengthen public health policies for this population in the primary healthcare network in Natal. Methodology: This research adopts a qualitative approach and will utilize various methodological designs, depending on the research question, following the principles of action research. The study population comprises LGBTI+ individuals, representatives of social movements, managers, healthcare professionals, and other social actors working on LGBTI+ health issues. Results: The research identified the main strengths and challenges concerning the health of the LGBTI+ population in Rio Grande do Norte, focusing specifically on two primary healthcare services in Natal. Key issues included the lack of preparedness among professionals to care for LGBTI+ individuals, problems in healthcare assistance, and insufficient organization of the care network. These findings informed the organization of workshops at Basic Health Units. Final Considerations: The study’s main outcome was the strengthening of the care network, particularly in primary healthcare, for delivering qualified care to LGBTI+ individuals. This contributed to reducing health inequities and expanding rights by improving access to Brazil's Unified Health System (SUS). The choice of action research methodology, its emancipatory nature, and the participatory and collective format of planning and executing research actions allowed for greater autonomy among social actors. This, in turn, contributed to political education and the empowerment of the fight for rights, creating a strong foundation for the sustainability of actions.Doctoral Thesis Análise da epidemiologia espaço-temporal dos casos e óbitos por sífilis congênita e seus fatores associados(Universidade Federal do Rio Grande do Norte, 2024-09-26) Pinheiro, Yago Tavares; Silva, Richardson Augusto Rosendo da; Oliveira, Ângelo Giuseppe Roncalli da Costa; https://orcid.org/0000-0001-5311-697X; http://lattes.cnpq.br/0023445563721084; https://orcid.org/0000-0001-6290-9365; http://lattes.cnpq.br/2184669241700299; https://orcid.org/0000-0002-5882-4606; http://lattes.cnpq.br/3811482061077693; Santos Neto, Marcelino; Santiago, Janmilli da Costa Dantas; Galvão, Marli Teresinha Gimeniz; Nobre, Thaiza Teixeira XavierIntroduction: Congenital syphilis (CS) is an infection caused by the bacterium Treponema Pallidum, the incidence of which has increased significantly in recent years in several low-, middle-, and high-income countries, becoming a health problem that requires strategies to improve the identification, treatment, and monitoring of potential cases and deaths caused by this disease. Objective: To analyze the spatiotemporal epidemiology of cases and deaths from CS in different regions of the world and identify possible factors that may influence this process. Methods: This is a mixed-methods study divided into four studies. Study 1: Systematic review protocol to analyze the incidence/prevalence of syphilis in pregnant women and CS in Brazilian cities and their respective predictors, structured according to the PRISMA recommendations; Study 2: Scoping review protocol based on the Joanna Briggs Institute guidelines and guided by PRISMA-ScR, to map the spatiotemporal distribution of CS in the world and the social determinants of health involved in this process. Study 3: Ecological study to describe the spatial distribution of deaths from CS in Brazil, conducted using aggregated secondary data available in Brazilian government information systems, corresponding to the 482 Immediate Urban Articulation Regions; Study 4: Scoping review developed based on the recommendations of the Joanna Briggs Institute and PRISMA-ScR to describe the dynamics of the spatial-temporal distribution of CS cases in different regions of the world and identify the social determinants of health that influence this process. Study 5: This is an ecological study that considered cases and deaths from CS in Brazil between 2008 and 2022. The incidence rate and the infant mortality rate from congenital syphilis were considered the dependent variables of the study. In addition, the independent variables of the study were: quantity and value approved for health promotion and prevention actions in primary care, number of prenatal consultations for pregnant women, and number of prenatal consultations for the partner. Linear regression for panel data was applied to predict the effect that independent variables have on dependent variables, considering each municipality as the unit of analysis and each year as the unit of time. All analyses considered a 95% confidence interval. Results: Studies 1 and 2 described the respective research questions, as well as the methodological procedures by which each study should be conducted, which included definition of databases, inclusion criteria for studies, and collection and analysis of the information found. In study 3, we observed that the mortality rate for CS was 0.64 deaths per 1,000 live births. The distribution of deaths occurred heterogeneously, with the highest rates in the states of Pará, Acre, Rondônia, Rio de Janeiro, and part of Amazonas. We identified statistically significant spatial clusters throughout the country, with clusters with a high-high pattern in Pará, Rio de Janeiro, and Mato Grosso (p<0.05). We observed that the Gini index (p=0.008; 95% CI: 0.02–0.11), the number of nurses in primary care (p=0.027; 95% CI: 0.0005–0.00003), and the proportion of non-treponemal tests per pregnant women (p=0.016; 95% CI: 0.005–0.001) are variables that influence the occurrence of deaths. In study 4, we identified that countries in the American continent (Brazil, the United States, and Colombia) showed a growing trend in CS cases in recent years, while regions in Asia, especially provinces in China, showed a reduction in cases. In addition, Brazilian studies presented divergent incidence rates for the same region and period analyzed. We note that the factors that determine the occurrence of CS in the territory are homogeneous, that is, regardless of the location or country, the spatio-temporal dynamics of the disease are determined by the following factors: per capita income, population density, education, illiteracy rate, human development index, migration rate, social vulnerability index, water supply, basic sanitation, prenatal care, percentage of low birth weight babies, occurrence of AIDS co-infection, coverage of the supplementary health system and scope of primary care. Finally, in study 5, it was identified that during the analyzed period, the incidence of CS varied between 1.98 and 10.33 cases/1,000 live births, while mortality in the same period varied between 1.87 and 8.08 deaths/100,000 live births. It was observed that the quantity (p<0.001) and value approved (p<0.001) for actions and the number of prenatal consultations for pregnant women (p=0.003) influenced the incidence of the disease. However, there was no significant effect on mortality. The number of prenatal consultations of the partner was not able to influence any of the dependent variables. Final considerations: Despite the reduction in cases of CS in some regions of the world, there are still places more vulnerable to the occurrence of this disease, and an analysis of sociodemographic, economic and assistance factors is important to define effective control strategies.Doctoral Thesis (Sobre)vivências e percursos terapêuticos em saúde de mulheres com ideação e tentativa de suicídio: gênero como categoria analítica(Universidade Federal do Rio Grande do Norte, 2024-11-13) Dantas, Eder Samuel Oliveira; Amorim, Karla Patrícia Cardoso; http://lattes.cnpq.br/6339836465951509; http://lattes.cnpq.br/0933789405024284; Ceccon, Roger Flores; Sousa, Girliani Silva de; Guimarães, Jacileide; Bosco Filho, JoãoSuicide is a significant global public health issue and is characterized as a complex and multifaceted human phenomenon. In Brazil, the rates of this problem continue to rise each year. Suicidal behavior can be divided into fatal (completed suicide) and non-fatal, which manifests as suicidal ideation and suicide attempts. Although men die more frequently from this cause, women are more exposed to suicidal ideation and attempts. Additionally, women seek health services more often, and as a result, they are more subject to the attitudes of health professionals, depending on management strategies to access comprehensive care. This study aims to understand the sociobiographical experiences and therapeutic pathways in healthcare of women with suicidal ideation and attempts from a gender perspective. It is a qualitative study with a hermeneutic and dialectic approach, based on Gadamer's hermeneutic philosophy and Habermas' dialectics as a contemporary interpretive art. The study was conducted within the Psychosocial Care Network (RAPS) in Natal, Rio Grande do Norte. Data collection took place between June 2022 and July 2024, using a triangulation perspective with multiple data sources: semi-structured interviews, medical records, field notes, and drawings. Data analysis was performed using hermeneutic and dialectic interpretation with the aid of NVivo® software (version 14). Ten women with suicidal ideation or attempts, four healthcare professionals, and three managers from the network participated in the research. The majority of participants are young, with 60% between 18 and 35 years old. Half identify as white and the other half as Black. Most are single (40%) and have completed high school (40%). Regarding religion, 50% are Catholic. The majority live with family members (70%) and 40% have a family income of up to one minimum wage. The healthcare professionals include nurses, a psychiatrist, and a social worker, working in various Psychosocial Care Network services. The managers work at the central level of the Municipal Health Department and at the Psychosocial Care Centers, with backgrounds in psychology and nursing. The study explored various factors impacting the sociobiographical experiences of the women, such as gender stereotypes, socioeconomic vulnerability, mental health stigmatization, and intimate partner violence. Non-suicidal selfharm appears as an emotional relief mechanism. These women sought various services within the Psychosocial Care Network, including Psychosocial Care Centers, Primary Health Units, Urgent Care Units, and Psychiatric Hospitals. Healthcare professionals' perceptions of female suicidal behavior directly influence their attitudes, and building relationships is an effective care strategy. In conclusion, the study highlights that despite challenges faced by the Psychosocial Care Network, such as lack of infrastructure and human resources, the network has the potential to provide compassionate, comprehensive care to vulnerable women. The research also emphasizes the need for policies that incorporate gender aspects into psychosocial care strategies.Doctoral Thesis Pegadas ambientais do consumo alimentar, determinantes sociais em saúde e práticas alimentares de adultos e idosos: estudo Brazuca Natal(Universidade Federal do Rio Grande do Norte, 2024-10-07) Souza, Camila Valdejane Silva de; Lyra, Clélia de Oliveira; Seabra, Larissa Mont'Alverne Jucá; https://orcid.org/0000-0002-1878-4283; http://lattes.cnpq.br/1066492425111929; https://orcid.org/0000-0002-1474-3812; http://lattes.cnpq.br/4264395963141865; https://orcid.org/0000-0001-7146-3406; http://lattes.cnpq.br/1069586590831755; Ruiz, Eliziane Nicolodi Francescato; Piuvezam, Grasiela; Rolim, Priscilla Moura; Triches, Rozane MárciaIntroduction: The consequences of environmental deterioration caused by human actions have underscored the necessity for a unified approach to One Health, which encompasses the interrelated domains of human, animal, and environmental health. Food systems exert a significant influence on the capacity of planetary boundaries. It is therefore crucial to gain an understanding of the environmental impact of food consumption and the factors that can influence it if we are to promote healthy and sustainable diets. Objective: The objective of this study is to assess the environmental footprints of food consumption among adults and older adults, and to ascertain whether there is a correlation between these footprints and social determinants of health, as well as markers of adherence to the recommendations set forth in the Dietary Guidelines for the Brazilian Population. Methodology: This study employed a variety of methodological approaches. A systematic literature review was conducted to ascertain the environmental footprints of adults and older adults in population studies globally. In crosssectional studies, the carbon (PC), water (PH), and ecological (PE) footprints of food consumption of adults and older adults from Brazuca Natal/RN study were calculated based on the 24-hour dietary recall. A multinomial logistic regression was conducted to examine the relationship between environmental footprints and social determinants of health, as indicated by social and economic variables. To assess the relationship between the environmental impact of dietary habits and adherence to dietary recommendations, as assessed by a validated questionnaire, multiple regression analysis was employed. Results: The findings of the review showed that environmental footprints can be influenced by factors related to their measurement and were more significant among men and adults. In the first cross-sectional study, it was identified that males (CF: OR = 4.45; CI = 2.61 - 7.57; WF: OR = 5.18; CI = 2.99 - 8.96; EF: OR = 4.13; CI = 2.45 - 6.98) and the adult age group (CF: OR = 2.32; CI = 1.38 - 3.91; WF: OR = 2.64; CI = 1.55 - 4.49; EF: OR = 1.77; CI = 1.06 - 2.94) were associated with larger environmental footprints (CF, WF and EF). The data obtained show that having a lower income increases the chances of an intermediate in the diet (OR = 1.93; CI = 1.08 - 3.45), while not having daily access to treated water increases the chances of having higher WF (OR = 0.46; CI = 0.22 - 0.95). In the 2nd cross-sectional study, the increase in environmental footprints of food consumption was associated with the following markers: Frequenting snack bars and fast-food restaurants (CF: PR = 1.80; CI = 1.20 - 2.68), not participating in food preparation (WF: PR = 1.74; CI = 1.39 - 2.18; EF: PR = 1.40; CI = 1.48 - 2.40), and skipping main meals (EF: PR = 1.50; CI = 1.10 - 2.04). Final considerations: The environmental impact of diets is greater for men and adults. Lower income and limited access to clean water can directly impact these footprints, thereby exerting a significant influence on the environmental impact of dietary choices. Furthermore, the consumption of fast food, a lack of involvement in food preparation, and the skipping of meals have been identified as dietary practices that contribute to an increase in these footprints. This evidence underscores the necessity for policies and actions aimed at mitigating adverse environmental impacts to be informed by the imperative of ensuring access to nutritionally sound and sustainable foodstuffs.Doctoral Thesis Insegurança alimentar e programas governamentais de proteção ao direito humano à alimentação adequada: estudo de coorte no Semiárido Nordestino (2011-2022)(Universidade Federal do Rio Grande do Norte, 2024-10-08) Santos, Ana Beatriz Macêdo Venâncio dos; Oliveira, Ângelo Giuseppe Roncalli da Costa; Palmeira, Poliana de Araújo; https://orcid.org/0000-0001-5311-697X; http://lattes.cnpq.br/0023445563721084; http://lattes.cnpq.br/8037701388681491; Santos, Sandra Maria Chaves dos; Guerra, Eliana Costa; Araújo, Fabio Resende de; Vianna, Rodrigo Pinheiro de Toledo; Costa, Rosana Salles daDoctoral Thesis O componente saúde e cidadania nos currículos: um estudo de caso na formação em saúde à luz do pensamento complexo e das diretrizes curriculares(Universidade Federal do Rio Grande do Norte, 2024-10-04) Nunes, Waleska de Brito; Ferreira, Maria Ângela Fernandes; Noro, Luiz Roberto Augusto; https://orcid.org/0000-0002-6142-948X; http://lattes.cnpq.br/4036539286429296; http://lattes.cnpq.br/2986806262930186; Costa, Marcelo Viana da; Santos, Paula Fernanda Brandão Batista dos; Oliveira., Fabiana Maria Rodrigues Lopes de; Melo, Márcia Maria Dantas Cabral deThe theme related to professional training in the health area has been highlighted with different approaches in the literature. Although general aspects are presented, it is important that practical experiences of experiences in institutional settings are presented since they are real portraits of what happens in the practice of the teaching-learning process of students and have repercussions on the macro scope of the professional profile model of graduates and on the quality of the care services provided. The Federal University of Rio Grande do Norte presents in its curricular proposal for health courses, an integrated component between the different courses in the area, with experience in the territory taking place in different services and multidisciplinary teams with the community. The component is called Health and Citizenship (SACI). In this sense, this thesis aims to present the contributions of SACI in the consolidation of the general principles to be incorporated in the National Curricular Guidelines (DCN) of undergraduate courses in the health area as specified in Resolution 569 of the National Health Council of 2017, dialoguing with the theory of Complex Thinking and Problematizing Education. Thus, a case study research with a qualitative approach is used, which unfolds through two methodological designs: documentary analysis of portfolios constructed by students who took the curricular component, in addition to the application of questionnaires and online interviews applied to professors from different health courses at UFRN. The results showed that curricular components with didactic and pedagogical characteristics similar to those of SACI, based on theoretical and methodological frameworks such as complex thinking and problem-solving learning, have the potential to promote critical and reflective training capable of meeting the numerous and varied demands of the Unified Health System. Furthermore, SACI proved to be a model of curricular component that unfolds in a manner consistent with the recommendations of the National Curricular Guidelines. Despite these positive findings, there are difficulties to be overcome so that the implementation of the component achieves its educational objectives to its fullest potential. A contribution is perceived in terms of promoting reflections on possibilities for remodeling curricular structures with the insertion of components that better bring students closer to the reality of the SUS. Furthermore, there is a need to seek improvements that enable both educational institutions and health services to integrate so that they collaborate intersectorally in the training of professionals who are closer to what the current health system recommends.Doctoral Thesis Residências multiprofissionais em saúde mental no Brasil: formação para saúde mental na atenção básica(Universidade Federal do Rio Grande do Norte, 2024-09-17) Ferreira, Thayane Pereira da Silva; Noro, Luiz Roberto Augusto; https://orcid.org/0000-0001-8244-0154; http://lattes.cnpq.br/2335211528795775; https://orcid.org/0000-0002-2581-4970; http://lattes.cnpq.br/6643139152542265; Severo, Ana Kalliny de Sousa; Soares, Catharina Leite Matos; Zilbovícius, Celso; Costa, Marcelo Viana da; Ferigato, Sabrina HelenaMultiprofessional Residency Programs in Mental Health (PRMSM) are strategic in training for psychosocial care in the Unified Health System. The training in Mental Health in Primary Care by the Multiprofessional Residency Programs in Mental Health in Brazil was analyzed. The study was carried out in four stages: theoretical study of the dismantling of the National Policy on Mental Health, Alcohol and other Drugs (2016 to 2022) and its interfaces with training by the PRMSM in Brazil; documentary study of seventeen Pedagogical Projects of the PRMSM in Brazil; exploratory study through interviews with seventeen PRMSM coordinators; evaluability study with 20 experts to validate the Criteria Matrix through the Delphi Consensus. The results of this thesis are divided into four articles. Advances consist of dialogue with the National Policy on Mental Health, Alcohol and Other Drugs in defense of the human rights of people with mental health problems and/or who make harmful use of alcohol and other drugs, in addition to innovation in educational processes based on learning through experience. Trends are directed towards the decolonial debate on madness and training for practices in Mental Health in Primary Care. Challenges are part of the disputes over models of mental health care and the capitalist-colonial subjectivity that impact the implementation of interprofessionality. Residencies raise new subjectivities for work in the territory in search of the implementation of the sociocultural dimension of the Brazilian Psychiatric Reform. However, for such implementation, investments and public policies are necessary to guarantee the return of professionals trained by the PRMSM to the Psychosocial Care Network.Doctoral Thesis Elaboração e validação de conteúdo de instrumento para avaliação da qualidade dos serviços de acolhimento com classificação de risco em obstetrícia(Universidade Federal do Rio Grande do Norte, 2024-08-07) Oliveira, Dannielly Azevedo de; Nobre, Thaiza Teixeira Xavier; Lisboa, Lilian Lira; https://orcid.org/0000-0002-8673-0009; http://lattes.cnpq.br/2813639308023253; https://orcid.org/0000-0003-0108-3912; http://lattes.cnpq.br/1168811870043482; Mendonça, Ana Elza Oliveira de; Bay Júnior, Osvaldo de Goes; Galvão, Maria Helena Rodrigues; Schlosser, Thalyta Cristina MansanoObjective: to develop and validate the content of the instrument for evaluating the quality of the Reception service with Risk Classification in Obstetrics (ACCRO) with evaluation dimensions for users, health professionals, and managers. Methods: a methodological study with a quantitative that is divided into two stages: in the first, a study was developed to create an instrument divided into three modules: with a dimension for the user (module 1), for health workers (module 2) and for the manager (module 3). Content validation was then carried out by a committee of judges (experts) specialized in the area. The instrument was created based on the theoretical framework proposed by Donabedian and the objectives proposed by the World Health Organization and the Ministry of Health through the Prenatal and Birth Humanization Program. The analysis of this stage was carried out using the committee's agreement index (CI), Content Validity Index (CVI), and Kappa index to evaluate and reach the ideal parameters of agreement and content validity between the judges. Results: The instrument was validated for content in stage 1 of the study, after evaluation by the Committee of experts, considering values for CVI, CI, and Kappa equal to or greater than 0.8 for each item evaluated. Conclusion: The instrument reached a good level of content validation to be used to evaluate the quality of ACCRO care from the perspective of users, health professionals, and managers of maternal and child services and thus enable improvements to achieve compliance with Institutional actions. It is expected that the completion of the other validation stages (empirical and analytical pole) of this study will favor the safe use of the instrument to evaluate what is intended regarding the quality of Reception services with Obstetric Risk Classification.Doctoral Thesis Histórias em quadrinhos para educação em saúde de crianças escolares: construção e validação(Universidade Federal do Rio Grande do Norte, 2024-08-06) Soares, Amanda; Oliveira, Ângelo Giuseppe Roncalli da Costa; https://orcid.org/0000-0001-5311-697X; http://lattes.cnpq.br/0023445563721084; https://orcid.org/0000-0001-8063-4131; http://lattes.cnpq.br/5405038755711915; Medeiros, Gidyenne Christine Bandeira Silva de; Noro, Luiz Roberto Augusto; Paiva, Fábio da Silva; Silva, Cícera Renata Diniz VieiraHealth education causes changes in the early stages of life, but also throughout the life course until adulthood. By implementing health education strategies, it is possible to contribute to the understanding of ways to develop healthy lifestyle habits. When the target audience is children, adapting educational components and strategies such as comic books expands the possibilities of effectively passing on knowledge to children. Therefore, the objective of this study was to develop and validate comic books as a health education tool on healthy eating and physical habits for school children. The methodology is described in a collection of articles and organized into four stages. The first was a scoping review that aimed to characterize the bibliographic scope of experiences with comic books aimed at schoolchildren. The results presented the main characteristics of the studies found, such as year of publication, country of origin, target audience, and type of study. The second article aimed to characterize the epidemiological scope of consumption, eating habits and nutritional status in schoolchildren. The results highlight a dichotomy between the consumption of healthy and ultra-processed foods, mainly in the Southeast region. The third article was dedicated to the process of construction and validation of twelve comic strips with sequenced dialogues that make up the collection “My Healthy Life”, aimed at children. In this case, validation was obtained through the Content Validity Index, using the cutoff point ≥ 0.78 defined as an acceptable agreement, and it was found that all items were above or equal to the defined parameter. Therefore, the comic strips were validated under the evaluated criteria, and a reassessment by the judges was not necessary. Finally, the fourth article presents an educational intervention protocol mediated by the collection “My Healthy Life” for school children, which aims to contribute to ensuring a better quality of life and promoting health in schoolchildren. It is concluded that this thesis will contribute to the creation of educational programs that contemplate the education-health axis, delivering the comic strips as a registered and validated product, and an intervention protocol in the testing process, ensuring the continuity of this study that will be carried out in stages and published as the phases are approved.