Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-08-10T00:00:18Z No. of bitstreams: 1 MatheusFigueiredoNogueira_TESE.pdf: 4719783 bytes, checksum: f8e02f38460b71c10b2013161eae4784 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-08-15T23:34:03Z (GMT) No. of bitstreams: 1 MatheusFigueiredoNogueira_TESE.pdf: 4719783 bytes, checksum: f8e02f38460b71c10b2013161eae4784 (MD5) / Made available in DSpace on 2016-08-15T23:34:03Z (GMT). No. of bitstreams: 1 MatheusFigueiredoNogueira_TESE.pdf: 4719783 bytes, checksum: f8e02f38460b71c10b2013161eae4784 (MD5) Previous issue date: 2016-02-29 / O acelerado crescimento da popula??o idosa ? uma realidade mundial, configurando-se um dos maiores desafios para a sa?de p?blica contempor?nea. Considerando o envelhecimento um fen?meno multidimensional e a amplia??o da expectativa de vida, p?e-se em evid?ncia a necessidade de investigar se o prolongamento da longevidade est? acompanhado de n?veis satisfat?rios de qualidade de vida (QV). Objetivou-se neste estudo avaliar a QV facetada e global de idosos da microrregi?o do Curimata? ocidental paraibano, explicada por suas condi??es de vida e sa?de. Consta de um estudo observacional transversal com desenho quantitativo realizado com 444 idosos de cinco munic?pios: Barra de Santa Rosa, Cuit?, Nova Floresta, Rem?gio e Sossego. Para obten??o das informa??es, foram utilizados os seguintes instrumentos: I) Question?rio para coleta de dados pr?-idoso, para as caracter?sticas sociodemogr?ficas, cl?nicas e comportamentais; e II) Question?rio WHOQOL-Old, para mensura??o e avalia??o da QV. Os dados foram processados no software IBM-SPSS Statistics 20.0 por meio dos testes ANOVA (one-way), t-Student, Mann-Whitney, Kruskal-Wallis e correla??o de Pearson, sendo p-valores<0,05 aceitos como estatisticamente significativos. Os resultados apontam uma boa QV global (ETT=65,69%), com melhor avalia??o por idosos do sexo masculino, com idade entre 60 e 74 anos, casados, morando com c?njuge e filhos, sem cuidador, praticantes de exerc?cios f?sicos, com at? um problema de sa?de diante de um aspecto de multimorbidade e com muito boa e/ou boa avalia??o das necessidades b?sicas. O estresse autorreferido apresentou uma correla??o significativa negativa diante da QV global, onde quanto maior a percep??o do estresse, pior a avalia??o da QV. Na avalia??o facetada da QV, o Funcionamento Sens?rio apresentou o melhor desempenho (ETF=68,86%) e a Participa??o Social (PSO) o pior (ETF=60,37%). No modelo de regress?o linear m?ltipla, a PSO isoladamente ? respons?vel por 51,8% (R2=0,518) de explica??o da QV global. Na intercorrela??o entre as facetas do WHOQOL-Old, apenas Morte e Morrer n?o revelou signific?ncia. A harmonia evidenciada entre as facetas suscita a necessidade de assegurar uma aten??o integral ? sa?de do idoso, em especial na compreens?o da participa??o social como elemento intr?nseco ? QV e que demanda a rediscuss?o e reconstru??o de a??es individuais e coletivas, familiares e comunit?rias, pol?ticas e governamentais. Logo, garantir um envelhecimento ativo, saud?vel, participativo e com QV ? o grande desafio. / The fast growth of the elderly population is a reality throughout the world and has become one of the greatest challenges for contemporary public health. When considering the increased life expectancy and the aging as a multidimensional phenomenon, one should highlight the need to investigate if the increase of longevity is associated with satisfactory levels of Quality of Life (QOL). This study has the objective of assessing the QOL of elderly people from the Para?ba?s Western Curimata? microregion, explained by its health and living conditions. This is a cross-sectional and observational study with quantitative design held with 444 elderly people from five cities: Barra de Santa Rosa, Cuit?, Nova Floresta, Rem?gio e Sossego. In order to obtain information, the following instruments were used: I) Questionnaire for collection data related to the elderly population, for sociodemographic, clinical and behavioral characteristics; and II) WHOQOL-Old questionnaire, with a view to measuring and assessing QOL. Data were processed on the IBM-SPSS Statistics 20.0 software by means of the ANOVA (one-way), Student?s t, Mann-Whitney, Kruskal-Wallis and Pearson?s correlation tests, with p-values<0,05 accepted as being statistically significant. The results indicate a good global QOL (ETT=65,69%), with better assessment by elderly men, aged between 60 and 74 years, married, living with partner and children, without caregiver, physical activity practitioners, with up to one health problem before an aspect of multimorbidity and with very good and/or good assessment of basic needs. The self-reported stress showed a negative significant correlation before the global QOL, where the greater the perception of stress, the worse the assessment of QOL. In the faceted assessment of QOL, the Sensory Operation showed the best performance (ETF= 68,86%) and the Social Participation (SP) the worst (ETF=60,37%). In the multiple linear regression model, SP is singly responsible for 51,8% (R2=0,518) of explanation of the global QOL. In the intercorrelation among the WHOQOL-Old facets, only Death and Dying did not reveal significance. The harmony highlighted among the facets raises the need to ensure a comprehensive health care for the elderly population, especially in understanding the social participation as an intrinsic part of the QOL and that it requires the re-discussion and reconstruction of individual and collective, family and community, political and government actions. Hence, guaranteeing an active, healthy and participatory aging, with QOL, is the major challenge.

Made available in DSpace on 2014-12-17T15:45:09Z (GMT). No. of bitstreams: 1 MarsileneGF_DISSERT.pdf: 576820 bytes, checksum: 50d0a6cc8569e446eb2bf8e01a3989a2 (MD5) Previous issue date: 2013-12-19 / Universidade Federal do Rio Grande do Norte / The study aims to evaluate the quality of the work processes of the teams from the Family Health Strategy regarding the comprehensive health care for children, in the view of users in the state of Rio Grande do Norte. This is a cross-sectional observational evaluative research with quantitative approach. The primary data are part of the External Review from the Program of Improving Access and Quality of Primary Care (PMAQ) in 2012. 190 women were interviewed. The inclusion criteria was the presence in the clinic at the time of the survey, have attended the service in the last 12 months and be a mother or companion of a child up to two years old. A research protocol was developed in the dimensions of Growth and Development, Breastfeeding and nutrition, and health problems and its variables. The results revealed that mothers / companions who responded to the questionnaire 71% were aged between 18 and 35 years, 92.1% were literate, 96.3% had a monthly income and 62.6% received financial assistance from the government. As for the children, 39.4% were aged between 13 to 24 months. In promotion and prevention actions for children, 64.2% had consultation up to the 7th day of life, 91.1% underwent the screening test, 95.3% had a health handbook, 98.9% had a vaccine, 17.9% breastfed or breastfeed from 6 to 24 months. As for link and continuity of care, 86.8% of the children were accompanied by the same professional staff and 59.5% left with next consultation scheduled. In acute situations 42.4% of the children went to the health unit and 64% of these were attended. It is concluded that the actions involving prevention and health promotion of children in RN, are evaluated positively by the service users and meet the requirements of MS, as well as link and continuity of care. The weakness in access and reception of users is evident, indicating the need to adapt the service to the demand of health and planning actions to welcome all who seeks basic health unit-UBS / O estudo tem por objetivo avaliar a qualidade dos processos de trabalho das equipes da Estrat?gia de Sa?de da Fam?lia referentes ? aten??o integral ? sa?de da crian?a na vis?o dos usu?rios no Estado do Rio Grande do Norte. Trata-se de uma pesquisa avaliativa observacional transversal com abordagem quantitativa.Os dados prim?rios fazem parte da Avalia??o Externa do Programa de Melhoria do Acesso e da Qualidade da Aten??o B?sica (PMAQ) em 2012. Foram entrevistadas 190 mulheres usu?rias. O crit?rio de inclus?o foi a presen?a na unidade de sa?de no momento da pesquisa , ter frequentado o servi?o nos ?ltimos 12 meses e ser m?e ou acompanhantes de crian?a at? dois anos de vida. Elaborou-se um protocolo de pesquisa com as dimens?es de Crescimento e Desenvolvimento , Amamenta??o e alimenta??o, e Problemas de sa?de e suas respectivas vari?veis. Como resultados observou-se que das m?es/acompanhantes que responderam ao question?rio 71% tinham idade entre 18 e 35 anos, 92,1% eram alfabetizadas, 96,3% possu?am alguma renda mensal e 62,6% recebiam bolsa fam?lia. Quanto as crian?as 39,4% estavam na faixa et?ria entre 13 a 24 meses. Nas a??es de promo??o e preven??o ? crian?a 64,2% fizeram a consulta at? o 7? dia de vida, 91,1% realizaram o teste do pezinho, 95,3% tinham a caderneta de sa?de, 98,9% tinham alguma vacina, 17,9% mama ou mamou no peito de 6 meses a 24 meses. Quanto ao v?nculo e continuidade do cuidado 86,8% das crian?as eram acompanhadas pelo mesmo profissional da equipe e 59,5% j? saiam com consulta subsequente marcada. Quantdo em situa??es agudas 42,4% das crian?as iam para unidade de sa?de e destas 64% eram atendidas. Conclui-se que as a??es que envolvem preven??o e promo??o ? sa?de da crian?a no RN, s?o avaliadas de forma positiva pelos usu?rios do servi?o e atendem as exig?ncias do MS, assim como o v?nculo e continuidade do cuidado. Sendo evidente fragilidades no acesso e acolhimento dos usu?rios, sinalizando a necessidade de adequa??o do servi?o a demanda das a??es de sa?de e planejamento das equipes para acolher a todos que procurarem a UBS

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T23:50:32Z No. of bitstreams: 1 RafaelSoaresChaves_DISSERT.pdf: 919425 bytes, checksum: 9de0144c3d14bd1f23ad957f686c3442 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-12T19:09:57Z (GMT) No. of bitstreams: 1 RafaelSoaresChaves_DISSERT.pdf: 919425 bytes, checksum: 9de0144c3d14bd1f23ad957f686c3442 (MD5) / Made available in DSpace on 2017-04-12T19:09:57Z (GMT). No. of bitstreams: 1 RafaelSoaresChaves_DISSERT.pdf: 919425 bytes, checksum: 9de0144c3d14bd1f23ad957f686c3442 (MD5) Previous issue date: 2016-12-19 / No Brasil, o uso e o desenvolvimento de instrumentos e tecnologias em sa?de para a garantia do acesso ? sa?de como direito de todos bem como a resolubilidade das diferentes e complexas demandas observadas nos territ?rios representam ponto-chave para o desenvolvimento do SUS em seus princ?pios fundamentais nas diferentes regi?es brasileiras. O Projeto Terap?utico Singular (PTS) ?, atualmente, uma pr?tica ainda n?o incorporada na rotina da maioria das equipes de sa?de na aten??o b?sica e ainda pouco difundida e desenvolvida, apesar de seu grande potencial na produ??o de novas realidades, sobretudo no que diz respeito aos casos complexos. Em virtude disso, justificam-se estudos no sentido de lan?ar luz sobre as realidades das equipes em rela??o ao uso do PTS como ferramenta de gest?o do cuidado em sa?de no ?mbito da ESF. Nesse sentido, o presente trabalho trata de uma pesquisa qualitativa explorat?ria a qual buscou investigar como uma equipe da ESF e uma equipe do NASF que a apoia utilizam o PTS no seu territ?rio, tendo como objetivos espec?ficos: conhecer os sentidos atribu?dos pelos profissionais (das equipes NASF e ESF) ?s no??es de Cl?nica Ampliada, de Apoio Matricial e de Projeto Terap?utico Singular; identificar como as equipes se comunicam e se vinculam para a constru??o do PTS e a realiza??o do apoio matricial; e identificar as potencialidades e dificuldades vividas pelas equipes para o uso do PTS como ferramenta de gest?o do cuidado. Para tanto, a abordagem metodol?gica foi desenvolvida atrav?s de entrevistas individuais semiestruturadas e Grupos Focais com os profissionais das equipes de um munic?pio de pequeno porte do RN. Os dados produzidos pelas entrevistas e pelos Grupos Focais foram organizados e categorizados mediante a an?lise de conte?do proposta por Bardin. Os tr?s eixos de an?lise foram: 1) multiprofissionalidade, corresponsabilidade e resolutividade; 2) concep??es de PTS, dificuldades, falta de experi?ncia e desconhecimento sobre PTS; e 3) articula??o e planejamento das a??es. De modo geral, o estudo apontou a constru??o de PTS como uma pr?tica pontual, sendo uma ferramenta que pouco comp?e o cotidiano das equipes e dos servi?os de sa?de na aten??o b?sica, apesar de ser reconhecidamente importante para a amplia??o das a??es e resolutividade dos problemas dos usu?rios. Al?m disso, o PTS, mesmo n?o sendo uma ferramenta de uso cotidiano, ? desconhecido por muitos e as equipes s?o carentes de experi?ncias que potencializem o seu uso de forma sistem?tica e compartilhada nos espa?os de produ??o do cuidado em sa?de. Desse modo, coloca-se como importante que a??es de qualifica??o da aten??o sejam desenvolvidas junto ?s equipes para o uso do PTS entre outras ferramentas para gest?o do cuidado de forma integral e compartilhada. / In Brazil, the use and development of health instruments and technologies to guarantee the access to health as a right for all its citizens, as well as the solvability of the different and complex demands observed in the territories represent a key point for the development of Sistema ?nico de Sa?de (SUS) in its fundamental principles in different Brazilian regions. The Singular Therapeutic Project (STP) is a not yet currently incorporated practice into the routine of most health care teams in the basic health attention and it is still poorly widespread and developed, despite its great potential in the construction of new realities, especially with regard to complex cases. Taking this context into consideration, studies in this area are justified in order to shed some light on the realities of these teams in relation to the use of STP as a health care management tool within the Family Health Strategy (FHS). In this sense, this study presents an exploratory qualitative research that sought to investigate how a team of FHS and another one of a Family Health Support Nucleus (FHSN), which supports the team of FHS investigated, use the STP in its territory, with specific objectives of: getting to know the meanings assigned to the notions of Expanded Clinic, Matrix Support and Singular Therapeutic Project by the FHSN and FHS teams? professionals; identifying how teams communicate and team up for the construction of the STP and for the execution of matrix support; and identifying the potentialities and difficulties experienced by the teams in using STP as a care management tool. For this, the research methodological approach was developed through semi-structured individual interviews and focus groups with the professionals of the teams of a small city of the state Rio Grande do Norte. The data produced by the interviews and the focus groups were organized and categorized based on the content analysis proposed by Bardin (2011). The three axes of analysis were: 1) multiprofessionality, co-responsibility and resolvability; 2) conceptions of STP, difficulties, lack of experience and knowledge about STP; and 3) articulation and planning of actions. In general, the study pointed to the construction of STP as not being a regular practice, being a tool that does not take part in the daily life of the health teams and services in basic health attention, although it is recognized as important for the expansion of actions and solution of the users? problems. In addition to that, besides the STP is not seen as a tool of daily use, it is unknown by many professionals and the health teams lack experiences that potentialize STP use in a systematic and shared way in the health care production spaces. In this way, it is important that actions towards qualification on health attention for the use of STP are developed together with the teams, among other tools for care management in an integral and shared way.

Submitted by Natalie Mendes (nataliermendes@gmail.com) on 2015-07-25T15:33:44Z No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) / Made available in DSpace on 2015-07-25T15:33:44Z (GMT). No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) Previous issue date: 2014-03-14 / The access to health services in a global, equal and comprehensive way constitutes itself a civil right legally granted in the Brazilian Federal Constitution of 1988 which regulates and establishes the Unified Health System (SUS). However it is noticeable that the comprehensive access to health services has not been effectively put into practice, especially, in actions of medium and high complexity. Hence, this study aims to understand the organizational dynamic of the access of users of the Family Health Program (PSF) to the healthcare services of medium and high complexity of the SUS network and to analyze health practices performed by the primary care team, medium and high complexity for the feasibility of this access. We have analyzed the organizational dynamic of access to medium and high complexity healthcare services based on the guidelines of the dimensions of a political, technical and symbolical access analysis bounded by Giovanella and Fleury (1995) and supplemented with the theoretical model proposed by Assis et alii (2011). In the theoretical framework we discuss ways for the effectuation of the access to the healthcare services as a citizenship right as well as the organization of healthcare services in medium and high complexity under the focus of healthcare assistance models. This is a qualitative study, of critical and analytical approach in an approximate view of the dialectic method, which has as field of work the Family Health Units (USF), the Polyclinics and the Public Hospitals of Feira de Santana city in the State of Bahia. The participants of the study consisted of three groups: (1) healthcare professionals, (2) users and (3) managers/coordinators of healthcare services totaling 26 participants. We have used techniques such as data collection through semi-structured interviews, systematic observation and document analysis. The data analysis was an approximation of the hermeneutic-dialectic method. From the comparison of the studied data three categories rose up: (1) ORGANIZATIONAL DYNAMIC OF THE ACCESS OF THE USERS AND THE MATERIALITY OF ITS SENSES AND MEANINGS: the transversality of the political, technical and symbolical dimensions; (2) THE WORK PROCESS OF THE HEALTH PROFESSIONALS IN BASIC HEALTHCARE OF MEDIUM AND HIGH COMPLEXITY: an interweaving among healthcare; (3) THE ACCESS OF THE USERS TO THE SERVICES AND THE PRACTICES OF HEALTH OF MEDIUM AND HIGH COMPLEXITY: public/private relationship. The results make the senses/meanings of access to healthcare services that cross the political, technical and symbolical dimensions abundantly clear. The individual and collective practices, held by professionals working in primary care of medium and high complexity to promoting the access of the user to the SUS network, involve committed and welcoming actions by instituting bonds and enhancing the subjectivity of the users in some moments, and in other moments it involves a centered professional model geared towards the patients? concerns/conduct, medicalization and technicism co-existing dialectically an intertwining of lightweight, soft-hard and hard technologies in this process. Within the difficulties and limitations that the users have found to access healthcare services of medium and high complexity the demand was cited once these services are offered on a wider scale than its supply. We have come across several inputs used by users to access the health services of medium and high complexity. Furthermore the relationship between public and private is constitutive of the organization of this reality. The access of the user of the PSF to the practices of medium and high complexity still needs, for its embodiment, an all-embracing commitment of users, health professionals and health managers so as to operationalize it as a citizenship right. / O acesso aos servi?os de sa?de de forma universal, equ?nime e integral, se constitui em um direito de cidadania, garantido legalmente na Constitui??o Federal de 1988, a qual regulamenta e institui o Sistema ?nico de Sa?de (SUS). Contudo, percebemos que o acesso universal aos servi?os de sa?de n?o tem sido traduzido efetivamente na pr?tica, em especial nas a??es de m?dia e alta complexidade. Assim, este estudo teve como objetivos compreender a din?mica organizativa do acesso dos usu?rios do Programa Sa?de da Fam?lia (PSF) aos servi?os de sa?de de m?dia e alta complexidade da rede SUS e analisar as pr?ticas de sa?de realizadas pelos profissionais da aten??o b?sica, de m?dia e alta complexidade para a viabiliza??o deste acesso. Analisamos a din?mica organizativa do acesso aos servi?os de m?dia e alta complexidade, tendo como bases orientadoras as dimens?es de an?lise de acesso pol?tica, t?cnica e simb?lica, delimitadas por Giovanella e Fleury (1995) e complementadas com o modelo te?rico proposto por Assis e outros (2011). No referencial te?rico discutimos os caminhos para a efetiva??o do acesso aos servi?os de sa?de enquanto direito de cidadania, bem como a organiza??o dos servi?os de sa?de de m?dia e alta complexidade sob o enfoque dos modelos assistenciais em sa?de. Trata-se de um estudo qualitativo, de abordagem cr?tico-anal?tica, numa perspectiva aproximada do m?todo Dial?tico, tendo como cen?rio as Unidades de Sa?de da Fam?lia (USF), Policl?nicas e Hospitais p?blicos de Feira de Santana-BA. Os participantes do estudo foram constitu?dos de tr?s grupos: profissionais de sa?de (Grupo I), usu?rios (Grupo II) e gestores/ coordenadores dos servi?os de sa?de (Grupo III), totalizando 26 participantes. Utilizamos como t?cnicas de coleta de dados a entrevista semi-estruturada, a observa??o sistem?tica e a an?lise documental; a an?lise de dados foi uma aproxima??o do m?todo Hermen?utico-dial?tico. A partir do confronto dos dados emergiram tr?s categorias: 1) DIN?MICA ORGANIZATIVA DO ACESSO DOS USU?RIOS E A MATERIALIDADE DOS SENTIDOS E SIGNIFICADOS: a transversalidade das dimens?es pol?tica, t?cnica e simb?lica; 2) O PROCESSO DE TRABALHO DOS PROFISSIONAIS DE SA?DE NA ATEN??O B?SICA, DE M?DIA E ALTA COMPLEXIDADE: um entrela?amento entre as tecnologias de sa?de; 3) O ACESSO DOS USU?RIOS AOS SERVI?OS E ?S PR?TICAS DE SA?DE DE M?DIA E ALTA COMPLEXIDADE: rela??o p?blico x privado. Os resultados explicitam que os sentidos/ significados de acesso aos servi?os de sa?de transversalizam as dimens?es pol?tica, t?cnica e simb?lica. As pr?ticas individuais e coletivas realizadas pelos profissionais que atuam na aten??o b?sica, de m?dia e alta complexidade para a promo??o do acesso do usu?rio ? rede SUS envolvem a??es compromissadas, acolhedoras, com institui??o do v?nculo e a valoriza??o da subjetividade dos usu?rios em alguns momentos, e em outros passam pelo modelo profissional centrado, voltado para a queixa-conduta, medicaliza??o e tecnicismo, co-existindo dialeticamente um entrela?amento das tecnologias leve, leve-dura e dura nesse processo. Dentre as dificuldades e limites que os usu?rios t?m encontrado para acessar os servi?os de sa?de de m?dia e alta complexidade foi citada a demanda por esses servi?os ser maior que a sua oferta. Deparamo-nos com diversas portas de entradas utilizadas pelos usu?rios para acessar os servi?os de m?dia e alta complexidade. Al?m disso, a rela??o entre o p?blico e o privado ? constitutiva da organiza??o desta realidade. O acesso do usu?rio do PSF aos servi?os e ?s pr?ticas de m?dia e alta complexidade ainda necessita para a sua concretiza??o de um comprometimento dos usu?rios, profissionais e gestores da sa?de de modo a operacionaliz?-lo enquanto um direito de cidadania.