Programa de Pós-Graduação em Saúde Coletiva - FACISA
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Master Thesis Avaliação do efeito de palmilhas adaptadas em chinelos no tratamento da fasciopatia plantar: um estudo com moradores do semiárido potiguar(2019-11-29) Costa, Ana Rafaella Araújo; Souza, Marcelo Cardoso de; Lins, Caio Alano de Almeida; ; ; ; Nogueira, Matheus Figueiredo; ; Câmara, Saionara Maria Aires da;Introduction: Plantar fasciitis (PF) is a subcalcaneal painful syndrome, which was firstly described in 1812. It is the most common cause of pain in the plantar heel region. Estimates highlight that one out of every 10 people will have pain in the lower calcaneal region at some point in life. Most patients report poor quality of life, since pain prevents the accomplishment of activities of daily living (ADL) and the performance of physical activities. Conservative treatments account for 90% of hindfoot pain resolutions and are associated with therapies including joint mobilization, stretching, insoles, shock wave therapy and laser therapy. Nevertheless, the use of insoles is restricted to the application in closed footwear such as shoes and sneakers, and this can be an obstacle to the treatment in cities with hot weather. Objective: To assess the effectiveness of insoles adapted for slippers in pain and function in individuals with PF. Method: Randomized, double-blind, controlled and clinical study involving 66 pa-tients diagnosed with PF, who were randomized into two groups: insole slipper (IS) group (n=34), which received a custom-made slipper (flip-flop) with foot devices and smooth beige synthetic leather cover. The flat slipper group (FS) (n=34) received a slipper (flip-flop) cov-ered with smooth beige synthetic leather, identical to the one used by the intervention group, but without the foot devices. Patients were instructed to wear the slipper at least 4 hours a day for 12 weeks. We held two assessments: one before the intervention protocol (T0) and the second after the 12 weeks of intervention (T12). As the primary outcome, we considered the pain measured through the Visual Analogue Scale (VAS). The secondary outcomes were: foot function by FFI questionnaire Foot Function Index; foot and ankle functionality by FAAM questionnaire Foot and Ankle Ability Measure (FAAM); functional capacity by 6-minute walking test (6MWT); patient’s expectation and satisfaction with treatment by Likert scale; the blinding questionnaire to ascertain patients’ blinding, besides a daily diary to note the hours they wore the slipper every day. Results: The IS group significantly improved morning pain through the morning VAS variable (p=0,016); without differences between groups for end-of-day VAS (p = 0,31), 6MWT (p = 0,45) and FAAM (p = 0,062). Another statistically significant value obtained was from FFI variable, where the IS group unveiled results (p=0,023), thereby showing improvements in foot func-tion after wearing the slipper. Conclusion: Insoles adapted for flip-flops as a 12-week treat-ment for PF-related pain were effective in improving morning pain and foot function.Master Thesis Percepção dos profissionais das equipes de saúde da família acerca dos elementos de seu processo de trabalho(2019-11-25) Linhares, Marllon Sousa; Távora, Rafaela Carolini de Oliveira; ; ; Guedes, Dimitri Taurino; ; Vieira, Camilla Araújo Lopes;Assuming that the work process is formed by objectives or purposes, object, means and conditions, agent or subject, this project aims to analyze the perception of professionals of the Family Health teams of Santa Cruz-RN about of the elements of your work process. This is a qualitative, descriptive and exploratory research, with 12 participants, half of the urban area and the others of the rural area. Given the elements presented and the discussions conducted with a view to elucidating the proposed objectives, it was noticed that the year of training of professionals covered the 2000 and 2010, most of professionals perform their work activities only in ABS, with the regime 40 hours per week, bound by public tender. From the transcriptions and analysis from the interviews four categories emerged: misunderstanding between objects, instruments and purposes; miscellaneous goals; everyday tensions; quality of the work process. These statements were analyzed following the guidelines of Critical Discourse Analysis. It was observed that many professionals did not know how to differentiate objects, instruments and objectives in their work process, as well as having different purposes, such as the restoration of oral health, including those that prevent disease and promote health. The lack of instruments, inadequate structure, poor communication and the link, or lack thereof, with users were presented as tensions in the daily practice of health practices. These may be elements that compromise the work process of teams. This research built spaces of speech in which the members of the health teams could reflect on their work process from their own perceptions, which may have caused discomfort to the subjects, and also contributed to the deconstruction of forms of work found.Master Thesis Distribuição espacial dos casos de Zika Vírus no RN e sua relação com determinantes que refletem a desigualdade social(2019-12-02) Cunha, Lizailma Silva; Pereira, Silvana Alves; Medeiros, Wilton Rodrigues; ; ; ; Moran, Cristiane Aparecida; ; Mirabal, Isabelle Ribeiro Barbosa; ; Câmara, Saionara Maria Aires da;Introduction: Aedes aegypti-transmitted arboviruses are currently considered a worldwide public health problem, with the hypotesis that socioeconomic and environmental factors would be involved in the increased incidence of arboviruses coirculate in Brazil, and Rio Grande do Norte is one of the northeastern states with the highest number of cases of ZIKV. Objective: To verify the possible relationship of indicators that reflect social inequality on the spatial distribution of ZIKV cases in a Northeastern Brazilian state in the 2015-2016 Biennium. Methods: an ecological study with data from case reports of ZIKV and sociodemographic indicators of the state of Rio Grande do Norte calculated from data from the State Department of Public Health (SESAP-RN), DATASUS and the Brazilian Institute of Geography (IBGE). Data were analyzed in Terraview version 4.2.2, GeoDa version 1.12 and IBM SPSS Statistics 21. Results: Both the Mean Incidence Rate (IMR) of ZIKV cases in the 2015-2016 biennium (Moran = 0.139; p = 0.03) regarding violence IMR (Moran = 0.295; p = 0.02), mean income (Moran = 0.344; p = 0.01), unemployment rate (Moran = 0.231; p = 0.01) and home density (Moran = -0.073; p = 0.01) obeyed a geographical pattern of spatial distribution. In the multiple linear regression analysis the variables IMR of violence incidence in 2014, mean income in 2010 and population density explained 61.2% of the ZIKV IMR variation in the 2015-2016 biennium (adjusted R2 = 0.612). In this study, municipalities with more reports of violence and favorable mean income, such as the capital, have higher IMR of ZYKV cases, a phenomenon possibly mediated by the existence of health services more sensitive to notification in these municipalities.Master Thesis Produção e validação do índice de oferta da atenção psicossocial no Brasil(2019-09-09) Maia, Murielly Priscilly de Medeiros; Mirabal, Isabelle Ribeiro Barbosa; Freitas, Yan Nogueira Leite de; ; ; ; Guedes, Dimitri Taurino; ; Sobreira, Maura Vanessa Silva;INTRODUCTION: In Brazil, the public health system is organized into thematic care networks, territorially arranged by the Health Regions. One of these thematic networks is the Psychosocial Care Network (RAPS), intended for the care / reception of those in severe and mental suffering. persistent or abusive use of alcohol and other drugs. The RAPS is composed of services of Primary Care, Specialized Psychosocial Care and Tertiary Care, with offer recommended for the entire Brazilian territory, according to the criteria of Health Regionalization. OBJECTIVE: To produce and validate the Psychosocial Care Offering Index in Brazil. METHODS: An ecological study, which analyzed 36 variables that reflect the structure and human resources of RAPS distributed by Immediate Urban Articulation Regions, for which Descriptive and Spatial Analysis were performed using Moran Global and Local techniques. For the production and validation of the indicator, the exploratory and confirmatory factor analysis technique was applied, based on criterion and construct validations. RESULTS: The spatial distribution of the variables UBS, General Hospital, Family Physicians, Psychiatrist, Psychologist, ACS and Occupational Therapists showed spatial autocorrelation (I> 0.4; p <0.05), registering higher concentrations in certain areas in the Central regions. West, Southeast and South, where the rates of these elements were higher. Bartlett's sphericity test obtained p <0.05, the KMO was 0.732, the commonalities had a load higher than 0.6. Seven factors were extracted: Factor 1 (RAPS Primary Care Profile); Factor 2 (RAPS Support Team Profile); Factor 3 (RAPS Psychiatric Care Profile); Factor 4 (Profile of Residential Regime in RAPS); Factor 5 (CAPS Profile); Factor 6 (Profile of Therapeutic Residences in RAPS) and Factor 7 (Hospital Care Profile of RAPS), explaining together 70.5% of the Total Variance. The spatial distribution of the indicator shows that psychosocial care is very precarious in the northern region; from Precarious to Regular in the Northeast Region; and Good or Very Good in the Midwest, Southeast and South Regions. Construct validation was achieved with 60% of the sample, for which the same factors were formed that explained 70.8% of the Total Variance. Criterion validation showed that the Good and Very Good offer categories were related to the best socioeconomic indicators. CONCLUSIONS: Based on the data collected and the methodological process used, it was possible to produce and validate the Psychosocial Care Supply Index in Brazil, whose spatial distribution shows the existence of inequality in the supply and organization of RAPS, with better levels of supply in the regions. most developed in the country. These findings may support public health management and planning regarding the equitable distribution of RAPS assistance points, also suggesting policies to optimize existing structural and human resources; or, also, training and financial incentive, especially in distant and inland regions.Master Thesis Efeito da estimulação transcraniana de corrente contínua (tDCS) em mulheres adultas com excesso de peso(2019-07-31) Figueirêdo, Heverton Araújo de Oliveira; Medeiros, Anna Cecilia Queiroz de; Freitas, Rodrigo Pegado de Abreu; ; ; ; Fassini, Priscilia Giácomo; ; Souza, Jane Carla de;Introduction: Neuromodulation by transcranial direct current stimulation (tDCS) has been investigated as a therapeutic possibility for obesity. It is believed that tDCS can act in cognitive areas related to typical excessive food intake behaviors. Objective: To evaluate the effect of the anode tDCS on the prefrontal cortex right lateral dorsum (CPFDL) in overweight women. Methodology: This was a randomized clinical trial, in which 50 volunteers, divided into two groups (Active [n = 25] and Sham / Control [n = 25]), participated in 10 sessions of the tDCS with a follow-up of 60 days. The anode (excitatory) electrode was placed over the right CPFDL and the cathode (inhibitory) was placed over the left, corresponding to F4 and F3 positions of EEG system 10-20, respectively. Treatment effects were evaluated on: food behavior (food cravings, emotional eating, uncontrolled eating and cognitive restriction); food intake (calories and macronutrients); emotional profile (anxiety, depression and stress); anthropometric and body composition variables (weight, body mass index, conicity index, waist circumference, waist-height ratio and body fat percentage. Results: Statistical analysis indicated no difference between groups, in sociodemographic and clinical characteristics, at baseline. Two factor mixed design ANOVA analysis showed no significant interaction between time versus group, in any variables investigated. The tDCS treatment was well tolerated, with no adverse effects in participants who completed the protocol. Conclusion: In the present study, no tDCS effect was observed in women with excessive weight, regarding food behavior and intake, emotional profile or anthropometric variables and body composition. Our findings point to the need for further research, including evaluating other possible brain areas to be modulated in overweight patients.Master Thesis Prejuízos na qualidade de vida e funcionalidade de adultos cronicamente afetados pela febre Chikungunya(2019-07-15) Dutra, Jéssica Isabelle dos Santos; Medeiros, Anna Cecilia Queiroz de; Souza, Marcelo Cardoso De; ; ; ; Knackfuss, Maria Irany; ; Câmara, Saionara Maria Aires da;Introduction: In 2016, Rio Grande do Norte recorded a major epidemic of chikungunya fever (FChik), with an incidence rate almost six times higher than national and 37 confirmed deaths the disease. In addition, One of the biggest challenges in the treatment of FChic is the possibility of symptom chronicity, since all the characteristics of the clinical phase are not well understood. Objective: To analyze the effect of chronicity of chikungunya fever on quality of life and functionality of those affected. Materials and methods: This is a descriptive and comparative cross-sectional study, carried out in two stages. The first was a descriptive study of 103 adults confirmed for FChik in Natal-RN, traced at least one year after getting sick. Clinical, sociodemographic and telephone data were collected through the Individual Notification Form (FNI) and the telephone survey was conducted to collect aspects of the chronic phase. There was success in the rescue of 33 patients who were interviewed, and of these 25 chronified. The second stage was a comparative study, conducted with 2 groups: chikungunya group (GChik), composed of 25 chronic patients of FChik (from stage 1); and the healthy group (GS), consisting of 25 healthy individuals, recruited for convenience and matched for gender and age. Both groups answered the Stanford HAQ 20-Item Disability Scale (HAQ) and SF-12v2 Short Form Health Survey (SF-12) questionnaires. Results: In the first stage, the most prominent joint symptoms in the acute phase were: arthralgia (77.66%), back pain (67.96%) and arthritis (63.10%); Already in the chronic phase were joint pain (92%), periarticular edema (56%) and limitation of movement (40%). Regarding work, 65.21% (n = 15) reported damages and 82.60% (n = 19) needed removal time off work, with absenteeism, mostly, between 7 and 30 days. In the second stage, significant differences were found between GChik and GS, both for functional capacity and quality of life (p <0.05). The most compromised aspects were HAQ Walking category, the Body Pain domain and SF-12 mental component summaries. Still, GChik presented a greater chance for the development of depression. Conclusions: FChik compromises the functionality and quality of life of those affected, with direct impairment in the autonomy to perform daily activities and risk of developing other morbidities, especially related to mental health.Master Thesis Análise do preenchimento da caderneta da gestante de adolescentes e adultas e registro do seguimento das recomendações do Ministério da Saúde(2019-07-29) Andrade, Raísa Barbosa de; Câmara, Saionara Maria Aires da; ; ; Valença, Cecilia Nogueira; ; Domingues, Marlos Rodrigues;Introduction: The pregnant’s prenatal card is an important tool that should be always with the pregnant woman. All health care during pregnancy must be recorded in the pregnant woman’s prenatal card, since this record and its quality reflect the clinical practice and serve as parameter to guide future decisions. Through these records, it is also possible to follow the compliance with prenatal care guidelines and identify policy needs that improve the quality of care. This is particularly important when pregnancy is associated with greater risks for the pregnant woman and the child, as during adolescence. Objective: To compare of the Pregnant Woman’s prenatal cards and following the recommendations of the Ministry of Health of first-time pregnant adolescents and adults who underwent prenatal care in the Sistema Único de Saúde (SUS) in municipalities from the Trairi Region of the Rio Grande do Norte state. Methodology: This is a cross-sectional analysis of a longitudinal study called AMOR (Adolescence and Motherhood Research), carried out in the municipalities of Santa Cruz, Lajes Pintadas, Tangará, Campo Redondo and São Bento do Trairi, located in the Trairi region of the Rio Grande do Norte state. The sample consisted of 76 women, 39 adolescents (13-18 years) and 37 adults (23-28 years) whose prenatal cards were evaluated between 4 to 6 weeks postpartum. The data collection followed a standardized protocol, in which sociodemographic data were collected. We also evaluated the record of information in the pregnant woman’s prenatal cards and the proportion of compliance with the Ministry of Health recommendations described in Rede Cegonha, such as a minimum of 6 consultations and participation in educational meetings, ultrasound (USG) exam and laboratory tests (ABO and Rh factor, uroculture, cervical-vaginal cytopathology, HBsAg, toxoplasmosis, glycaemia, VDRL, Hemoglobin/Hematocrit and Anti-HIV). The percentages of record of the items in the prenatal cards and compliance with the recommendations among adolescents and adults were compared using the Chi-square test. Both groups were compared in relation to the medians of record percentages for each item using the Mann-Whitney test. Results: None of the 11 categories analyzed were completely recorded for both groups. The groups were statistically different in relation to "information about USG", with a lower percentage of completion among adolescents (p=0,01). Of the 13 items analyzed regarding the compliance with Rede Cegonha, the adult group presented a greater proportion of record in 11 of them when compared to the adolescents, being statistically significant in relation two tests the glycaemia (p=0,004), VDRL (p=0,040) and hemoglobin/hematocrit (p<0,001). Conclusion: A lower proportion of adolescent mothers presents record of compliance with the recommendations of the Ministry of Health, which shows the need for health policies aiming to improve prenatal care for this population.Master Thesis Vivência integrada na comunidade: implicações de um internato longitudinal na formação médica(2019-06-05) Nunes, Waleska de Brito; Oliveira, Ana Luiza de Oliveira e; ; ; Spadacio, Cristiane; ; Melo, Lucas Pereira de;Introduction: The focus on the teaching model offered in the health area, especially that of the medical professional, has been pointing to insufficient training or incapacity to achieve health care that is resolvable and in harmony with the Unified Health System (SUS). In this sense, public policies in the areas of health and education have been stimulating fundamental changes. To meet this demand, higher education institutions are restructuring their pedagogical projects and curricula betting on methodological proposals and the early insertion of students in the medical practice environments of SUS. The Multicampi Medical Sciences School of the Federal University of Rio Grande do Norte (EMCM / UFRN), bases the process teaching learning in active methodologies and with the longitudinal insertion of medical students in the public health network of municipalities of the interior of the RN - Caicó, Currais Novos and Santa Cruz - through the longitudinal internship modules Integrated Community Experience (VIC). Objective: To understand students' perceptions of the 1st to 8th period of the EMCM medical course about the formative role of VIC and how this strategy can impact their future professional practice. Method: This is a descriptive, exploratory study with a qualitative approach. The data collection was done through semi-structured interviews conducted individually with 25 medical students who carry out the VIC modules in the municipality of Santa Cruz. To analyze the data, we used the Bardin Content Analysis, from which five categories emerged: i) Community Based Training in Health Care Networks as a paradigm shift; ii) The difference in learning from theory and practice in reality; (iii) interprofessional work in medical training; and iv) The pursuit of specialty as sequels of a biomedical culture? Results: It was mentioned that the students recognize the VIC as practical experiences that previously provide the contact with the health services, valuing the Primary Health Care in the implementation of the Family Health Strategy; experience the interprofessional work and begin to understand the sense of Network of attention to Health. It was also pointed out the recognition of the potentialities and fragilities of the SUS, and obstacles in the articulation between services, preceptors and the teaching institution. Conclusions: It was made explicit that the early insertion of the students in the SUS practice scenarios with FHP appreciation is perceived as fundamental in the formation, so that the future medical practice is consistent with the reality of the people to be assisted and with the SUS, but they persist problems inherited from the biological model of health care that are related both to the idealization of the professional practice of students and to the posture of medical preceptors who act according to the biomedical model culminating in difficulties of broad performance in the FHS. The EMCM has a transformative potential and studies on the implementation of its teaching proposal must be carried out in order to evaluate the evolutionary process of its goals.Master Thesis “Ou eu luto, ou eu morro": ativismo em HIV/aids e processos de subjetivação na experiência da Coletiva Loka de Efavirenz(2019-04-26) Cortez, Lumena Cristina de Assunção; Melo, Lucas Pereira de; Silva, Merces de Fátima dos Santos; ; ; ; Fontes, Flávio Fernandes; ; Gutiérrez, Mônica Lourdes Franch;Introduction: The Acquired Immunodeficiency Syndrome (aids) pandemic caused by human immunodeficiency virus (HIV) has overwhelmingly broken geographic barriers in the world and has raised discussions about sexual identities and practices that were considered as morally promiscuous and divergent. This condition, which is permeated by social markers of difference, has repercussions on the life experience of those living or dealing with HIV/aids, and on the agenda of their demands, personal engagement and collective mobilizations. In the current scenario, recent political and institutional demands have been based on the optimism of considering the advances in antiretroviral therapies as the only measure of treatment and as a definitive answer in the field of prevention, leaving aside issues such as human rights, social inequalities, among others. Objectives: To understand the relationship between HIV/aids activism in networks and social media and the production of the "person living with HIV/aids" (processes of subjectivation) from the Coletiva Loka of Efavirenz. Methodology: This is a research anchored in the theoretical-methodological framework of Ethnography. Data were collected through individual interviews, socioeconomic questionnaire, insider participant observation on the social network Facebook. Fieldwork took place from March 2017 to July 2018. The interlocutors were six activists, mostly blacks and browns, from the outskirts and/or countryside, with dissident sexual orientations and gender identities, and that were university students. The analysis took place through thematic categorization. Results: The performance of the Loka de Efavirenz is decentralized and horizontal. The objectives of the interlocutors in the social network included reporting life experiences with illness, making it public and available, disseminating the material they produced, and enabling an intersectional discussion of the epidemic through claims that included local and global demands such as therapeutic management, adherence to treatment and institutional racism. The main mobilization strategies were: elaboration of virtual content, production and presentation of artistic performances, actions with posters in universities, participation in national and international events, seminars, debates, acts and public demonstrations. Through mediation between different worlds and realities, activists see the existence of two "aids": AIDS related to biomedical and epidemiological aspects, and Aid$ resulting from historical oppressions, subordination and economic interests that perpetuate social inequalities, inserted under the new effects of biopolitics or of a necropolitics. In addition, participants gathered key information on HIV/aids activism, such as social achievements in health and politics, coupled with the social, biological, and political impacts of the epidemic in the 1980s and 1990s. Conclusion: The current scenario presents itself as a political and social challenge to confront the HIV/aids epidemic and to strengthen activism. Thus, the results of this research can support intersectoral professional practices based on human rights and health needs of activists and people living with HIV/aids, in addition to increasing the political visibility of the topic and those involved, reinforcing the strategic and mediation between civil society and the state in the claim and maintenance of social rights.Master Thesis Constipação intestinal e funcionalidade em mulheres adultas no interior do nordeste brasileiro(2019-06-27) Dantas, Amanda Almeida Gomes; Dantas, Diego de Sousa; Mirabal, Isabelle Ribeiro Barbosa; ; ; ; Azevedo, Ingrid Guerra; ; Câmara, Saionara Maria Aires da;Introduction: Intestinal constipation (IC) is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments CI can cause are scarce in the literature. Objective: Verify the prevalence of intestinal constipation (IC) and the factors that are associated, as well as the implication of this condition in the functioning in adult women living in a municipality in the interior of the Brazilian Northeast. Methodology: This is a cross-sectional study carried out in the municipality of Santa Cruz-RN with women of reproductive age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed through the criteria of Rome III. According to this criterion for the diagnosis of constipation, the symptoms should begin six months before the evaluation, and be active for at least three months in at least a quarter of the bowel movements, and the individual should present two or more symptoms out of six contained in this questionnaire. The functioning measured by means of World Health Organization Disability Assessment Schedule 2.0 (WHODAS). This instrument records the level of functionality or deficiency in six domains related to the activity and participation component of the CIF, are: cognition, mobility, self-care, interpersonal relationships, life activities and participation. Data were analyzed by descriptive and inferential statistics. The inferential analysis involved Chi-square, Mann-Whitney U test, size of the effect determined through the square eta (η2), Multiple Linear Regression and Poisson Regression. For statistical significance the 95% Confidence Interval was calculated and the value of p≤0.05. The survey was approved under the CAAE number: 49237315.9.0000.5568. Results: A total of 195 women participated in the study, most of them between the ages of 25 and 39 (49,2%) and income up to 1 minimum wage (79,5%). The prevalence of IC was 35,4%. The factors that were associated with constipation were the clinical aspects hemorrhoids, pain and burning when evacuating and sexual dysfunction. The WHODAS scores showed that women with constipation present lower functioning, mild to moderate effect size, in the domains cognition (p<0,001), mobility (p<0,002), self-care (p<0,001) and participation (p<0,001), in addition to the total score (p<0,001). CI increases the WHODAS total score by nine points (p<0,001). Conclusion: The present study verified a high prevalence of intestinal constipation among adult women and is associated with functional impairment, presenting greater difficulty in performing cognitive activities, mobility, self-care and participation. Clinical factors such as hemorrhoids, pain and burning in bowel movements, and sexual dysfunction were associated with a higher prevalence of this condition.