Orientador: Fábio Luiz Mialhe / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T21:14:23Z (GMT). No. of bitstreams: 1 Goncalves_VanessaBarreiros_M.pdf: 956738 bytes, checksum: af2172a34eabfeea80308a2cfdff591d (MD5) Previous issue date: 2011 / Resumo: O Programa de Saúde da Família (PSF) tem se tornado nos últimos anos a principal estratégia para alavancar a reorganização dos serviços de saúde na atenção básica do nosso país e, desde 2000, a Odontologia foi inserida neste contexto visando à reestruturação de todas as ações e práticas em saúde bucal na Atenção Básica. O objetivo deste estudo foi avaliar a percepção de profissionais e usuários com relação à Odontologia no PSF. Para este fim, participaram 15 Cirurgiões-Dentistas (CDs) que faziam parte de equipes de saúde bucal do PSF de um município baiano e 308 usuários, conforme estabelecido por cálculo amostral. Foram utilizados questionários autoaplicáveis como instrumento de coleta dos dados para os dentistas e, para o grupo de usuários, um questionário foi aplicado pelo pesquisador principal. A análise dos dados foi realizada por meio de estatística descritiva e pelo uso do teste do qui-quadrado, teste exato de Fischer e análise de regressão logística. Os resultados demonstraram que a maioria (86,6%) dos CDS participantes afirmou realizar o atendimento clínico como atividade predominante dentre as ações de saúde bucal, enquanto que as atividades preventivas foram desempenhadas com menor frequência. A remuneração foi vista como negativa por 78,6% dos profissionais, apesar de 71,4% relatarem satisfação em trabalhar no PSF. Com relação aos usuários, apenas 39% relataram ter, em algum momento, procurado o serviço de Odontologia e, dentre estes, o grau de satisfação com o atendimento proporcionado pelas equipes de saúde bucal foi elevado (95%). Conclui-se que o acesso dos usuários aos serviços de Odontologia no PSF ainda não é expressivo, existindo a necessidade de se averiguar e resolver os motivos que contribuem para esta situação. Além disto, observa-se a necessidade de se investir em processos de educação permanente dos profissionais. Apesar das adversidades encontradas, verificou-se que tanto os profissionais como os usuários relataram estar satisfeitos com a inclusão das atividades de Odontologia na estratégia de saúde da família / Abstract: The Family Health Program has become in recent years the main strategy to improve the organization of health services in primary care in our country and, since 2000, Dentistry has been included in this framework to restructure all actions and practices Oral Health in Primary Care. The aim of this study was to evaluate the perception of professionals and users in relation to Dentistry in the Family Health Program (FHP). To this end, involving 15 dentists that are part of oral health teams from one city in Bahia State and 308 users, as required by calculated sample. The questionnaires were self-applied as an instrument of data collection for dentists and for the group of users, the questionnaire was administered by the principal investigator. Data analysis was performed using descriptive statistics and by using the chi-square, exact Fischer test and logistic regression analysis. The results showed that the majority (86.6%) of dentists had reported to realize clinical care as a mainstream activity among oral health actions, while preventive activities were performed less frequently. The payment is viewed as negative by 78.6% of professionals, despite 71.4% had reported satisfaction in working for the FHP. For users, only 39% of users reported to have sought, at some time, the service of Dentistry, and of these the degree of satisfaction with the service provided by oral teams was high (95%). We conclude that users' access to dental services for the FHP is not significant and there is a need to investigate and solve the contributing reasons for this situation. In addition, there is the need to invest in continuing education of professionals. Despite the hardships encountered, it was found that both professionals and users reported being satisfied with the inclusion of activities of Dentistry at the family health strategy / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

AIM: To conduct a systematic literature review on the existing literature on the prevalence of medication errors across the medicines management system in primary care; To explore the systems of error management in primary care; to investigate the prevalence and nature of medication errors in children, 0-12 years, and in older patients, ≥65 years, in primary care; and to explore community pharmacists' interventions on medicines-related problems. METHODS: 1) Systematic literature review; 2) Questionnaire survey of Primary Care Trusts (PCTs), Clinical Commissioning Groups (CCGs) and NHS Area Teams; 3) Retrospective review of the electronic medical records of a random sample of older patients, ≥65 years old, and children 0-12 years old, from 2 general practices in Luton and Bedford CCGs, England; 4) Prospective observation of community pharmacists' interventions on medicines-related problems and prescribing errors from 3 community pharmacies in Luton and Bedford CCGs in England. DATA ANALYSIS: Quantitative data from records review were analysed using Microsoft Excel on data extracted from an Access database. Statistical tests of significance were performed as necessary. Descriptive statistics were conducted on quantitative data from the studies and inductive qualitative analyses were conducted on aspects of the questionnaire survey. RESULTS: • The systematic literature review demonstrated that medication errors are common, and occur at every stage of the medication management system in primary care, with error rates between ≤1% and ≥90%, depending on the part of the system studied and the definitions and methods used. There is some evidence that the prescribing stage is the most susceptible, and that the elderly (over 65 years) and children (under 18 years) are more likely to experience significant errors, although very little research has focussed on these age groups. • The questionnaire survey of PCTS, CCGs and NHSE demonstrated that national and local systems for managing medication errors appeared chaotic, and need to be better integrated to improve error learning and prevention in general practice. • The retrospective review of patients' medical records in general practices demonstrated that prescribing and monitoring errors are common in older patients and in children. 2739 unique prescription items for 364 older patients ≥65 years old were reviewed, with prescribing and monitoring errors detected for 1 in 3 patients involving about 1 in 12 prescriptions. The factors associated with increased risk of errors were: number of unique medications prescribed, being ≥75 years old, being prescribed medications requiring monitoring, and medications from these therapeutic areas: corticosteroid, NSAID, diuretic, thyroid and antithyroid hormones, statins and ACE-I/ARB. 755 unique prescription items for 524 younger patients 0-12 years old were examined, with approximately 1 in 10 prescriptions and 1 in 5 patients being exposed to a prescribing error. Factors associated with increased risk of prescribing errors in younger patients were: being aged ≤10 years old, being prescribed three or more medications, and from similar therapeutic areas as above. Majority of the errors were of mild to moderate severity. • Community pharmacists performed critical interventions as the last healthcare professional defense within the medicines management system in primary care. However, this role is challenged by other dispensary duties including the physical aspects of dispensing and other administrative roles. CONCLUSION Prescribing and monitoring errors in general practice, and older patients and children may be more at risk compared to the rest of the population, though most errors detected were less severe. Factors associated with increased risk for errors in these age groups were multifaceted. The systems for periodic laboratory monitoring for routinely prescribed drugs, particularly in older patients, need to be reviewed and strengthened to reduce preventable hospital admissions. Antibiotic dosing in children in general practice needs to be regularly reviewed through continued professional developments and other avenues. As guidance on local arrangements for error reporting and learning systems are less standardised across primary care organisations, pertinent data from adverse prescribing events and near misses may be lost. Interventions for reducing errors should therefore explore how to strengthen local arrangements for error learning and clinical governance. Community pharmacists and/or primary care pharmacists provide an important defence within the medicines management system in primary care. Policy discussions and review around the role of the pharmacist in primary care are necessary to strengthen this defence, and harness the potential thereof.

Diabetes is a condition that is primarily self-managed and lifestyle modifications such as diet, exercise, and weight management are necessary to reduce morbidity and mortality. Motivation to implement lifestyle modifications through self management is an integral part of disease management and studies have shown group medical visits are more effective than individual appointments in this patient population. The purpose of this project was to develop, implement and evaluate an evidencebased group medical visit program for up to a maximum of 8 adult patients with type 2 diabetes in a family practice setting for six months. Seven participants with abnormal A1C results accepted the invitation to attend group medical visits. Here surrounded by peers with the same diagnosis, they were able to learn and discuss methods to self manage their type 2 diabetes. At the conclusion post survey results indicate positive change in some lifestyle behaviors and improvement with hemoglobin A1C. However there was no improvement in weight management. A cost analysis reveals group medical visits may generate a small profit when compared to individual visits. Group medical visits may offer an effective means to motivate patients to make lifestyle change to reduce risk.

Prostate cancer, the leading cause of cancer in men, has positive survival rates and constitutes a challenge to men with its side effects. Studies have addressed the bivaritate relationships between prostate cancer treatment side effects masculinity, partner relationship, and quality of life (QOL). However, few studies have highlighted the relationships among prostate cancer treatment side effects (i.e., sexual dysfunction, urinary incontinence), masculinity, and relationship with the partner together on QOL in men. Most studies were conducted with predominately Caucasian sample of men. Miami is a unique multiethnic setting that hosts Cuban, Columbian, Venezuelan, Haitian, other Latin American and Caribbean communities that were not represented in previous literature. The purpose of this study was to examine relative contributions of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and perception of the relationship with the partner on the quality of life in men diagnosed with prostate cancer. Data were collected using self administered questionnaires measuring demographic variables, sexual and urinary functioning (UCLA PCI), masculinity (CMNI), partner relationship (DAS), and QOL (SF-36). A total of 117 partnered heterosexual men diagnosed with prostate cancer were recruited from four urology clinics in Miami, Florida. Men were 67.47 (SD = 8.42) years old and identified themselves to be of Hispanic origin (54.3 %, n = 63). Findings demonstrated that there was a significant moderate negative relationship between urinary and sexual functioning of men. There was a significant strong negative association between men’s perceived relationship with partner and masculinity. There was a weak negative relationship between the partner relationship and QOL. Hierarchal multiple regression showed that the partner relationship (β = -.25, t (91) = -2.28, p = .03) significantly contributed overall to QOL. These findings highlight the importance of the relationship satisfaction in the QOL of men with prostate cancer. Nursing interventions to enhance QOL for these men should consider strengthening the relationship and involving the female partner as an active participant.

In the US, one in every eight deaths is due to an obesity-related chronic health condition (ORCHC). More than half of African American women (AAW) 20 years old or older are obese or morbidly obese, as are 63% of menopausal AAW. Many have ORCHC that increase their morbidity and mortality and increase health care costs. In 2013, 42.6 percent of AAs living in South Carolina (SC) were obese. The purpose of this cross-sectional study was to identify the cognitive, behavioral, biological, and demographic factors that influence health outcomes (BMI, and ORCHC) of AAW living in rural SC. A sample of 200 AAW (50 in each of the 4 groups of rurality by menopausal status), 18-64 years, completed the: Menopausal Rating Scale (symptoms); Body Image Assessment for Obesity (self-perception of body); Mental Health Inventory; Block Food Frequency Questionnaire; Eating Behaviors and Chronic Conditions, Traditional Food Habits, and Food Preparation Technique questionnaires – and measures for Body Mass Index. Most rural, and premenopausal AAW were single and not living with a partner. Premenopausal women had significantly higher educational levels. Sixty percent of AAW had between 1 and 5 ORCHC. Most AAW used salt based seasonings, ate deep fried foods 1 to 3 times a week, and ate outside the home 1 to 3 times a month. Few AAW knew the correct daily serving for grains and dairy, and most consumed less than the recommended daily serving of fruits, vegetables and dairy. Morbidly obese AAW used more traditional food preparation techniques than obese and normal-weight AAW. Rural, and menopausal AAW had significantly higher morbid obesity levels, consumed larger portions of meats and vegetables, and reported more body image dissatisfaction than very rural AAW, and premenopausal AAW, respectively. Controlling for socioeconomic factors the relationships between perceptions of body images, psychological distress, and psychological wellbeing remained significant for numbers of ORCHC

In 2010, men who have sex with men (MSM) represented 4% of the population in the United States (US) and accounted for 78% of all new Human Immunodeficiency Virus (HIV) infections among Hispanic men. Hispanic men who have sex with men (HMSM) accounted for the third largest number of new HIV infections (6,700 cases). This dissertation explored the effects of age, loneliness, substance use, depression, and social support on high risk sexual behaviors that predispose middle aged HMSM to sexually transmitted infections (STIs) and HIV infection risk. A sample of 150 urban HMSM aged 40 to 65 were surveyed in this study. Singer’s Syndemics Theory (1996) provided this study’s theoretical framework. Data was analyzed using a variety of parametric and non-parametric statistics. Loneliness, social support, depressive symptoms, alcohol/drug use, and sexual risk behaviors were found to have an influence on HIV infection status in this study. Partner status, religious affiliation and age did have an influence on alcohol use in this study’s participants. Also, participants with increased age had increased depressive symptoms in this study. Lastly, depressive symptoms, substance use, social support, and loneliness did have an influence on sexual risk behaviors in this study’s participants, specifically alcohol use and illicit drug use. The findings from this study should be used to assess, diagnose, plan, implement and evaluate prevention strategies geared to reduce STI and HIV infection in this population. Future research should build on these findings and develop tailored risk reduction interventions addressing HMSM, with particular attention to the understudied age group of the middle aged HMSM.

The purpose of this research was to determine relationships among depression, anxiety, self-rated physical and mental health, self-advocacy, internalized homophobia, and quality of patient-provider communication to satisfaction with health care interactions. These were measured while controlling for select demographic variables: age; ethnicity; urban or rural domicile; relationship status; household income; highest educational attainment; health insurance; disclosure to health care provider as a gay man; reason for last healthcare visit; and, general health self-rating. The specific aims of this study were to: 1) identify general characteristics of gay men in this sample; 2) examine how levels of satisfaction with health care differed by each characteristic; 3) assess relationships between each potential predictor of satisfaction and the level of satisfaction; and, 4) determine the relationship between each predictor and satisfaction after controlling for the most significant covariate(s). A quantitative study was conducted in which 42 adult gay men participated. The author hypothesized that gay men who reported lower levels of depression, higher self-rated physical and mental health, lower levels of anxiety, higher self-advocacy scores, lower levels of internalized homophobia, and stronger evaluations of patient-provider communication would report more positive satisfaction with health care interactions. The hypothesis was supported by results of this research. This research established that variables with the strongest effect on gay men’s satisfaction with health care interactions were whether the patient had revealed his sexual orientation to the provider, how he rated his anxiety, and how he rated the quality of communication with his provider. These results emphasize the importance of health care providers’ awareness of specific psychosocial factors that influence communication during care of gay men, who understand their sexual orientation places them at a disadvantage when receiving health care services. Despite the pursuit of equitable, high quality, and satisfying health care, its achievement has been hampered by barriers that gay men encounter. Understanding those barriers while addressing health related needs of gay men will be important for providers who seek to improve satisfaction with health care interactions.

Purpose LGBTQ patients experience marginalization and discrimination when seeking healthcare in the Southern Region of the United States. As a result, they experience negative healthcare outcomes. Collecting sexual orientation/gender identity (SOGI data) is vital in decreasing health disparities and improving hospitalized LGBTQ patients’ quality of care. Providers cannot adequately assess health risk factors or deliver culturally competent care without SOGI data knowledge. Aims The aim is to collect SOGI data during intake to implement a standard of care to promote LGBTQ health outcomes and decrease marginalization. Processes To understand how to provide high-quality care to LGBTQ patients, providers receive instruction on the importance of collecting SOGI data and cultural competency training using the Gay and Lesbian Medical Association (GLMA) guideline. After IRB determined the project as not research involving human subjects, SOGI data questions (your current gender identity is and describe your sexual orientation) were added to the EHR demographic health history section. Provider adoption of collecting SOGI data is measured by extracting data from the EHR. Results Results will determine the providers’ responsiveness to implementing SOGI data questions into the EHR. Limitations Provider having a choice of collecting SOGI data, the small sample size of providers, and the project’s location are limitations. Conclusions LGBTQ individuals have more health inequities and face marginalization when accessing healthcare. SOGI data collection is essential for assessing health risk factors, improving health outcomes, and creating a safe and inclusive healthcare environment for LGBTQ patients.

Over the years, graduate medical education has changed in order to create learning environments to best prepare physicians. The present system of residency and hospital affiliation was the model adopted to give students opportunities for active learning along with lecture and observation. This study investigated the varied ways residents learn the knowledge, skills, and dispositions necessary for family practice. A within-site case study approach was used since this was a study of peer learning among family practice residents at a single community based hospital in a university affiliated network having an opposed program. A purposeful and typical case sampling strategy was used so that key participants provided information about their experiences with how the peer interactions among residents contributed to learning. The study had a sample of 11 residents progressing through this program and each participant was interviewed twice. Additional data were collected through observations of the morning and teaching rounds, an observation of the orientation session for new residents, and from program requirement documents. Each interview, observation, and document underwent content analysis for the identification of any emerging central themes or patterns and patterns were grouped according to recurring categories. Of particular interest were the themes that flowed from the interview and observation analysis for each resident class and the application of these themes to major learning theories. Matrix displays of themes that emerged between resident classes, of themes within the same resident class, and of the themes demonstrating relevant learning theories were developed and presented. Data analysis revealed themes categorized by learning process, achievement, identity as a physician, competence, and program improvement. The learning process consisted of various strategies, peer interactions, and use of resources. The within class analysis found varying degrees of strategies and peer interactions for each of the classes and the between class analysis found a progression of strategies, skills, achievement, identity, and changing peer interactions. Themes analyzed according to major learning theories demonstrated similarities to activity theory, social learning theory, and communities of practice. This study revealed that peer mentoring, coaching, and learning occurred within the context of a community of practice.

Independent from initial severity, many patients develop persistent symptoms after infection with SARS-CoV-2, described as long COVID syndrome. Most of these patients are treated by general practitioners (GPs). As evidence-based treatment recommendations are still sparse, GPs must make their therapy decisions under uncertainty. We investigated (1) the most frequently observed long COVID symptoms in general practices and (2) GPs' applied treatment and rehabilitation plans for these symptoms. In total, 143 German GPs participated in an online-based survey between 05/2021 and 07/2021. We found that each GP practice was treating on average 12 patients with long COVID symptoms. Most frequently seen symptoms were fatigue and reduced performance. Current therapy options were rated as poor and loss of smell and taste, fatigue, or lack of concentration were perceived to be especially difficult to treat. The use of drug and non-drug therapies and specialist referrals focused primarily on physiological and less on psychosomatic/psychological rehabilitation and followed guidelines of similar conditions. Our results provide first insights into how GPs approach a newly emerging condition in the absence of guidelines, evidence-based recommendations, or approved therapies, and might inform about GP preparedness in future pandemics. Our results also emphasize a gap between the current knowledge of the long COVID manifestation and knowledge about effective rehabilitation.