Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-04-11T19:41:14Z No. of bitstreams: 1 FernandaJulyannaSilvaDosSantos_TESE.pdf: 1717917 bytes, checksum: a4bfae9bd4101298f8a24e381407df54 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-04-12T23:55:01Z (GMT) No. of bitstreams: 1 FernandaJulyannaSilvaDosSantos_TESE.pdf: 1717917 bytes, checksum: a4bfae9bd4101298f8a24e381407df54 (MD5) / Made available in DSpace on 2018-04-12T23:55:01Z (GMT). No. of bitstreams: 1 FernandaJulyannaSilvaDosSantos_TESE.pdf: 1717917 bytes, checksum: a4bfae9bd4101298f8a24e381407df54 (MD5) Previous issue date: 2018-03-02 / A escassez de m?dicos e os desequil?brios geogr?ficos destes profissionais s?o problemas em sistemas de sa?de de diversos pa?ses. Em 2013, no Brasil, verificava-se uma raz?o de dois m?dicos por mil habitantes e uma distribui??o desigual destes nas regi?es do pa?s. Para reverter este cen?rio, foi institu?do o Programa Mais M?dicos para o Brasil, estruturado em tr?s eixos: o provimento emergencial de profissionais m?dicos denominado de Projeto Mais M?dicos (PMM); o investimento na Rede de Servi?os B?sicos de Sa?de; e o desenvolvimento da forma??o m?dica no Brasil. A presente tese busca analisar o impacto do PMM para o Brasil na aten??o b?sica da sa?de. Para tanto, inicialmente, foi feita uma descri??o da distribui??o e perfil dos profissionais participantes do Projeto no territ?rio brasileiro a partir de estat?sticas descritivas. O PMM aumentou o n?mero de m?dicos por habitantes no pa?s e, em regi?es e munic?pios mais necessitados de sa?de b?sica, esse acr?scimo se deu por m?dicos cubanos. Em seguida, foi estimada a probabilidade de munic?pios participarem do Projeto Mais M?dicos e terem suas vagas solicitadas preenchidas, por meio de modelos probit e logit multinomial. Os munic?pios que est?o classificados no perfil de 20% de pobreza, apesar de considerados priorit?rios pelo PMM, possuem chances menores de solicitarem m?dicos e de participarem do programa, em rela??o aos munic?pios da categoria Demais Localidades os quais n?o tem perfil priorit?rio para o programa; j? os munic?pios da categoria G100, composta pelos100 munic?pios com mais de 80.000 habitantes, com os mais baixos n?veis de receita p?blica per capita e alta vulnerabilidade social de seus habitantes, no geral, possuem chances maiores de participar do programa e receber m?dicos; os munic?pios em Regi?o Metropolitana apresentam probabilidades menores de preenchimento de todas as vagas solicitadas ao programa. Por fim, foi mensurado o efeito do Projeto Mais M?dicos sobre indicadores estrat?gicos de sa?de, relativos ? cobertura, acesso e resolutividade dos servi?os de sa?de, que possam ser potencialmente impactados pela interven??o desenvolvida pelo PMM e usados frequentemente na literatura. Para tanto, utilizou-se o m?todo de diferen?a em diferen?as com Propensity Score Matching, para o per?odo de 2012 a 2015. No geral, os resultados n?o identificaram efeitos do programa sobre o n?mero de consultas m?dicas realizadas na aten??o b?sica, n?mero de nascidos vivos de m?e sem consultas do tipo pr?-natal, mortalidade neonatal e mortalidade neonatal tardia; ressalta-se uma diminui??o de 3,6 pontos percentuais no n?mero de nascidos vivos com 1 a 6 consultas durante o pr?-natal e um aumento de 4,13 pontos percentuais na categoria de 7 ou mais consultas para modelos com todos os munic?pios; houve um aumento na cobertura das equipes de Estrat?gia de Sa?de da Fam?lia e no n?mero de visitas domiciliares realizadas pelos m?dicos, e uma diminui??o na taxa de mortalidade geral, entretanto todos estes efeitos apresentaram magnitudes pequenas. O modelo apenas para os munic?pios da categoria Demais Localidades indicou que o PMM reduziu as interna??es por condi??es sens?veis, mas tamb?m com coeficiente estimado de magnitude pequena. Conclui-se que o Projeto Mais M?dicos atingiu seu objetivo inicial, de aumentar o provimento de m?dicos no Brasil, entretanto sem alterar a concentra??o de m?dicos em algumas regi?es e sem conseguir a inser??o de m?dicos em regi?es consideradas priorit?rias ainda que os impactos na sa?de da popula??o s?o incipientes, mostrando a necessidade de aprimoramento e redirecionamento de algumas a??es do Programa. / The shortage of physicians and geographical imbalances are professionals in many health systems, constituting a global crisis. In 2013 Brazil there was a ratio of 2 doctors per 1000 inhabitants, and a poor distribution of these regions of the country. In an attempt to develop the scenario for the development of the Mais M?dicos Program for Brazil, structured in three axes: emergency provision of medical professionals called Mais M?dicos Project (PMM), investment in the basic health services and development of medical training Brazil. This thesis aims to analyze the impact the impact of PMM for Brazil on basic health care. To this end, we described the distribution and profile of the participants of the Project in Brazilian territory by descriptive statistics. The PMM increased the number of doctors per inhabitant in the country, in regions and municipalities most in need of basic health care for Cuban physicians. After, it was estimated a probability of participation in the municipalities of the More Doctors Project achieved by probit and multinomial logistic regression. Municipalities that are classified in the 20% poverty profile, despite being considered a priority by the PMM, have smaller chances of requesting physicians and, consequently, of participating in the program, in relation to the municipalities considered in other localities, without defined priority profile. The municipalities participating in the G100 have a greater chance of participating in the program and receiving doctors. The municipalities that are in the Metropolitan Region to present smaller chances of having all as requested vacancies to the program completed. Finally, it was measured to the effect of the More Doctors Project on strategic health indicators, selected according to the research criteria. It was used a difference-in-differences with Propensity Score Matching approachs for the period from 2012 to 2015. In general, there were no impacts on the number of medical consultations, number of live births of mothers without prenatal care, neonatal mortality and late neonatal mortality. A decrease of 3.6 percentage points was observed in the number of live births with 1 to 6 visits during the prenatal period and an increase of 4.13 percentage points in the category of 7 or more visits for estimates with all municipalities. There was an increase in the coverage of the Family Health Strategy units and the number of home visits performed by physicians, and a decrease in the overall mortality rate, however showed small magnitudes. The estimation for the municipalities of other localities presented a decrease in the ICSAB, of magnitude also small. the Mais Medicos Project increased the number of doctors in Brazil, but, was observed a concentration of doctors in some regions and a low availability of doctors in priority areas. On the other hand, the health impacts of the population are still incipient, showing a need for improvement and redirection of some actions of the Program.

Disponibiliza??o do trabalho em conte?do parcial, conforme Termo de Autoriza??o. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-03-14T18:22:05Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) jucimere_fagundes_duraes_rocha_parcial.pdf: 471264 bytes, checksum: 80ddabe1957f2ae1dc9b8f908bc0c288 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-03-30T18:26:18Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) jucimere_fagundes_duraes_rocha_parcial.pdf: 471264 bytes, checksum: 80ddabe1957f2ae1dc9b8f908bc0c288 (MD5) / Made available in DSpace on 2017-03-30T18:26:18Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) jucimere_fagundes_duraes_rocha_parcial.pdf: 471264 bytes, checksum: 80ddabe1957f2ae1dc9b8f908bc0c288 (MD5) Previous issue date: 2016 / Criado em 2013, o Programa Mais M?dicos integra um conjunto de pol?ticas de forma??o de recursos humanos para a sa?de com pol?ticas educacionais nos cursos m?dicos, est?mulo ? pesquisa aplicada ao Sistema ?nico de Sa?de e implementa medidas que asseguram a distribui??o de m?dicos em regi?es priorit?rias por meio da chamada imediata de m?dicos brasileiros e estrangeiros. No entanto, desde a cria??o e implanta??o, os ?rg?os de classe m?dica se posicionam de maneira contr?ria, situa??o esta amplamente divulgada na m?dia. Nesse sentido, o presente estudo teve o objetivo de compreender as representa??es sociais da m?dia, dos m?dicos brasileiros, gestores e usu?rios das Estrat?gias de Sa?de da Fam?lia sobre o Programa Mais M?dicos. Para a realiza??o do estudo optou-se pelo estudo tipo b?sico, documental e de campo, explorat?rio, descritivo, transversal com abordagem quantiqualitativa cujo referencial te?rico foi a Teoria das Representa??es Sociais. O cen?rio do estudo foi um munic?pio do norte de Minas Gerais. Os participantes do estudo foram 50 m?dicos brasileiros, 84 gestores e 208 usu?rios das Estrat?gias de Sa?de da Fam?lia e o corpus de an?lise da m?dia televisionada foi composto por 55 mat?rias dos Jornais Nacional e SBT Brasil exibidas no per?odo de janeiro de 2013 a janeiro de 2015. A coleta de dados foi feita utilizando teste de evoca??o de palavra e perguntas abertas. Os dados foram analisados por meio dos Softwares Ensemblesde Programmes Permettant l?Analyse des Evocations 2005 (EVOC?) e Classification Hi?rarchique Classificatoire et Coh?sitive - CHIC? (Vers?o 4.1). Os dados coletados por meio das perguntas abertas foram analisados pela t?cnica de an?lise do conte?do de Bardin. Diante dos achados deste estudo, percebe-se que o Programa Mais M?dicos tem suscitado pol?micas, acirrado debates, controv?rsias, resist?ncia e conflitos ideol?gicos entre os atores sociais. Esse contexto motivou rea??es e provocou a constru??o de representa??es sociais nos atores sociais implicados em sua trama, com interesses diversos e contradit?rios, o que levou ? elabora??o de representa??es sociais sobre o Programa Mais M?dicos divergentes de aceita??o e reprova??o pelos atores sociais envolvidos. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Created in 2013, the Mais M?dicos program encloses a set of policies of health?s human resources training with educational policies in the medical courses, incentivation of applied research on the Sistema ?nico de Sa?de and it implements measures that assure the distribution of doctors in the regions with more priority through the immediate calling of Brazilian and foreign doctors. However, since its creation and implementation, the agencies of the medical class placed themselves in opposition, a situation that was widely shown in the media. In this sense, this present study had as an objective to reveal the social representation of the media, of the Brazilian doctors, the managers, the users of the Estrat?gias de Sa?de da Fam?lia about the Mais M?dicos program. It was opted the basic, documental and field, exploratory, descriptive, transversal study with a quantitative and qualitative approach which the theoretical reference was the Theory of Social Representation. The scenery of the study was a city of the north of Minas Gerais. The participants of the study were 50 Brazilian doctors, 84 managers and 208 users of the Estrat?gias de Sa?de da Fam?lia, and the corpus for the television media analysis was made of 55 news of the National News and the SBT Brazil shown in the period of January of 2013 to January 2015. The data collection was made using the calling forth of words and open questions. The data were analyzed through the Softwares Ensemblesde Programmes Permettant l?Analyse des Evocations 2005 (EVOC?) and Classification Hi?rarchique Classificatoire et Coh?sitive - CHIC? (Version 4.1). The data collected through open questions were analyzed through the technique of content analysis of Bardin. Through the findings of this study, it is noticed that the Mais M?dicos Program has raised controversies, strong debates, polemics, resistance and ideological conflicts among the social actors. This context motivated reactions and provoked the construction of social representations in the social actors involved in the plot, with diverse and contradictory interests what led to the elaboration of a more dichotomy social representations about the Mais M?dicos Program of accepting and reproval of the social actors involved.

Made available in DSpace on 2015-04-14T13:54:03Z (GMT). No. of bitstreams: 1 449407.pdf: 1162279 bytes, checksum: 9434884510ef61af6e2cf460a487ed03 (MD5) Previous issue date: 2013-03-22 / Changes in bone mass occur with aging and are related to lifestyle, such as physical activity and occupational activity professional. OBJECTIVES : Evaluate the variation in bone mass at the lumbar spine and proximal femur of S?o Lucas Hospital (HSL) doctors of Pontif?cia Universidade Cat?lica do Rio Grande do Sul (PUCRS), Brazil related to the study released in 2006. METHODS : Longitudinal and observational study with male doctors. It was applied a questionnaire with data on changing lifestyle habits in relation to physical activity for the 2006 study. This study used the DXA equipment HOLOGIC WI with analysis of the lumbar spine, femoral neck and total femur. For the analysis this study used the Student t test and chi-square. Values were significant of p&#8804;0,05. RESULTS : A total of 22 physicians with an average age of 64,0?4,9 yeras. Regarding to physical activity 14 (63.6%) perform 2x/week or less and 8 (36.4%) perform physical activity greater than or equal to 3x/week. There was a gain from 2006 to 2012 in T-score of the lumbar spine of -0.26 ? 1.41 to 0.04 ? 1.47 (p = 0.015). There was no change in BMD of the lumbar spine. In the femoral neck BMD was reduced from 0.79 ? 0.10 to 0.74 ? 0.11 (p <0.001) and T-score of -1.75 ? 0.93 to -1.33 ? 0 , 82 (p <0.001) and total femur from 0.96 ? 0.10 to 0.92 ? 0.10 (p <0.001) and T-score of -0.90 ? 0.75 for -0, 64 ? 0.70 (p <0.001). There was no difference regarding the variation of BMD and frequency of weekly physical activity (&#8804; &#8805; 2x/week or 3x/week) of the values of BMD at lumbar spine (0.01 ? 0.04 vs 0.03 ? 0.09; p = 0.547), femoral neck (-0.05 ? 0.05 vs. -0.06 ? 0.06, p = 0.759) and total femur (-0.04 ? 0.04 vs. -0.06 ? 0 , 04, p = 0.256). There was an association between age and variation of total T-score of lumbar spine and proximal femur (r = 0.500, p = 0.018). CONCLUSION : Regarding the 2006 study there was a reduction in BMD of the femoral neck and total femur and increased total T-score. There was no variation in BMD in relation to physical activity weekly. / INTRODU??O : Altera??es da massa ?ssea ocorrem com o envelhecimento e est?o relacionadas a quest?es individuais como, estilo de vida, falta de atividade f?sica, envolvendo tamb?m, atividade ocupacional profissional. OBJETIVO : Avaliar a varia??o da massa ?ssea da coluna lombar e f?mur proximal em um grupo de m?dicos. M?TODOS : Estudo longitudinal e observacional com m?dicos masculinos do Hospital S?o Lucas (HSL) da Pontif?cia Universidade Cat?lica do Rio Grande do Sul, (PUCRS), Brasil em rela??o ao estudo realizado em 2006. Foi aplicado question?rio com dados relativos ? mudan?a de estilo de vida em rela??o ao h?bito de atividade f?sica para o estudo de 2006. Utilizou-se o equipamento DXA HOLOGIC WI com an?lise da coluna lombar, colo do f?mur e f?mur total. Para a an?lise foi utilizado o teste t de Student e o teste do Qui-quadrado. Foram significativos os valores de p&#8804;0,05. RESULTADOS : Foram avaliados 22 m?dicos com idade m?dia de 64,0?4,9 anos. Com rela??o ? atividade f?sica 14 (63,6%) realizam 2x/semana ou menos e 8 (36,4%) realizam atividade f?sica maior ou igual a 3x/semana. Houve um ganho de 2006 para 2012 no T-score da coluna lombar de -0,26?1,41 para 0,04?1,47 (p=0,015). N?o houve mudan?a na BMD da coluna lombar. No colo do f?mur houve redu??o da BMD de 0,79?0,10 para 0,74?0,11 (p<0,001) e do T-score de -1,75?0,93 para -1,33?0,82 (p<0,001) e no f?mur total de 0,96?0,10 para 0,92?0,10 (p<0,001) e do T-score de -0,90?0,75 para -0,64?0,70 (p<0,001). N?o houve diferen?a em rela??o ? varia??o da BMD e freq??ncia de atividade f?sica semanal (&#8804; 2x/semana ou &#8805; 3x/semana) nos valores da BMD da coluna lombar (0,01?0,04 vs 0,03?0,09, p=0,547), colo do f?mur (-0,05?0,05 vs -0,06?0,06, p=0,759) e f?mur total (-0,04?0,04 vs -0,06?0,04, p=0,256). Houve associa??o entre a idade e varia??o do T-score total da coluna lombar e f?mur proximal (r=0,500; p=0,018). CONCLUS?O : Em rela??o ao estudo de 2006 ocorreu uma redu??o na BMD do colo e f?mur total e aumento do T-score total. N?o houve varia??o na BMD em rela??o ? atividade f?sica semanal.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-28T11:22:05Z No. of bitstreams: 1 469523 - Texto Completo.pdf: 2017969 bytes, checksum: 65a18438020d006a68eb9d88965fefd4 (MD5) / Made available in DSpace on 2015-05-28T11:22:05Z (GMT). No. of bitstreams: 1 469523 - Texto Completo.pdf: 2017969 bytes, checksum: 65a18438020d006a68eb9d88965fefd4 (MD5) Previous issue date: 2015-03-04 / The general objective of this very present dissertation is to assess the agreeableness of medical students through validation of the Big Five Inventory - 10 (IBGFP-5) in Brazil. The IBGFP-5 is a brief self-report inventory, composed by 11 items and designed to assess dimensions of personality based upon Big Five Personality Factor model, which are: Openness to Experience, Conscientiousness, Extroversion, Agreeableness (in this study, as a synonym of empathy) and Neuroticism. Such model has been replicated in several countries in the world, including Brazil. The specific objectives of this study are: (1) validating IBGFP-5 through test and retest analysis (time reliability); (2) to do crossed correlation of the IBGFP-5 as a shorter version of the IGFP-5; (3) to do convergent validaty with the Interpersonal Reactivity Index of Davis (EMRI), which assess only empathy; (4) to assess the internal consistence of the five dimensions of the IBGPF-5 in the total sample of respondents and subsets represented by the five cohorts of students, from the first to the sixth year; (5) evaluate evidences of agreeableness based upon differences of IBGFP-5 factors scores, in social and demographic variables and concerning another personality traits; and (6) discuss possible factors that may influence the development of empathy along medical school at FAMED/PUCRS. The total sample, after eliminating missing data, was composed by 200 respondents, medical students at PUCRS, most of them are female (60,5%), with mean age of 22 years old. Using confirmatory factor analysis, the IBGFP-5 comes down to a 0,256 Cronbach?s alpha. According to time reliability, convergent validity and concurrent validity, data averaged in a general fashion low reliable psychological parameters. Concerning empathy features, in post hoc tests it were noticed differences between gender and spirituality level and empathy scores (p<0,05). Results in this study tend to construct validity of the Portuguese version of the IBGFP-5, even though it has restrictions and adjustment needs. Thus, results suggest the need of further investigation of empathy among students, since empathy is a multifactorial trait, and also communication skill training in medical school. Considering the fact that the IBGFP-5 is a brief inventory with a short application time it can easily be used in transcultural studies. The limitations of this study are featured, as well as a future research calendar. / A presente disserta??o tem como objetivo geral avaliar a empatia de alunos de gradua??o de Medicina atrav?s da valida??o do Big Five Inventory - 10 (Invent?rio Breve dos Cinco Grandes Fatores de Personalidade ? IBGFP-5) para o Brasil. O IBGFP-5 ? uma medida de auto relato breve, composta por 11 itens e designada a avaliar dimens?es da personalidade baseada no modelo dos Cinco Grandes Fatores da Personalidade, que s?o: ?Abertura?, ?Conscienciosidade?, ?Extrovers?o?, ?Amabilidade? (no estudo, tida como sin?nimo de empatia) e ?Neuroticismo?. Tal modelo tem apresentado replicabilidade em v?rios pa?ses do mundo, inclusive no Brasil. Os objetivos espec?ficos do estudo foram: (1) fazer a valida??o de teste e re-teste (consist?ncia temporal) do IBGFP-5; (2) fazer correla??o cruzada do IBGFP-5 enquanto fra??o do IGFP-5; (3) Fazer valida??o convergente com a Escala Multidimensional de Reatividade Interpessoal de Davis (EMRI); (4) avaliar a fidedignidade dos cinco fatores do IBGFP-5 a partir da amostra total de respondentes e de subamostras representadas pelas coortes de alunos do primeiro ao sexto ano; (5) verificar evid?ncias de amabilidade baseadas na diferencia??o de escores dos fatores do IBGFP-5 em vari?veis sociodemogr?ficas e em rela??o a outras caracter?sticas da personalidade; e (6) Discutir poss?veis fatores que influenciem no desenvolvimento de empatia na forma??o m?dica na FAMED/PUCRS. A amostra, ap?s a elimina??o dos dados ausentes, foi composta por 200 respondentes, alunos da Gradua??o em Medicina da PUCRS, a maioria do sexo feminino (60,5%), com idade m?dia de 22 anos. A partir da an?lise fatorial confirmat?ria, verificou-se que o IBGFP-5 mostrou um alfa de Cronbach de 0,256. Com base na valida??o de consist?ncia temporal, valida??o convergente e concorrente verificou-se, de forma geral, que os itens do IBGFP-5 apresentaram par?metros psicom?tricos pouco consistentes. Com rela??o ?s caracter?sticas e escores de empatia foram observadas em testes post hoc varia??es em rela??o ao g?nero e ao grau de espiritualidade em rela??o aos tra?os de empatia (p<0,05). Resultados obtidos neste estudo indicam a validade de construto da vers?o em L?ngua Portuguesa do Big Five Inventory para o Brasil ainda que com restri??es e necessidade de ajustes. Os resultados indicam ainda a necessidade de investiga??o adicional da empatia, dado que ? um atributo multifatorial. Por se tratar de uma medida reduzida e de r?pida aplica??o, ela pode ser facilmente utilizada em estudos transculturais. S?o explicitadas as limita??es do estudo, bem como uma agenda futura de pesquisa.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-08-13T19:35:39Z No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) / Made available in DSpace on 2015-08-13T19:35:40Z (GMT). No. of bitstreams: 1 473454 - Texto Parcial.pdf: 755327 bytes, checksum: 9e3264a8362ab0aeb4b4514a2de60490 (MD5) Previous issue date: 2015-07-02 / Objective: To compare the effectiveness of single-dose intramuscular bromopride, metoclopramide, and ondansetron for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency for the treatment of vomiting in a pediatric emergency department setting. department setting. department setting. department setting. department setting. department setting.department setting. Methods: Randomized controlled trial of children who presented with vomiting due to gastroenteritis at the pediatric emergency department of Hospital Universit?rio de Santa Maria from August 2013 to June 2014. Children aged 1 to 12 years were randomized to receive a single intramuscular dose of bromopride or metoclopramide (up to 10 mg) or ondansetron (up to 8 mg) 0.15 mg/kg. After administration of the antiemetic drug, children remained under observation for at least 1 hour. Children who were discharged after the observation period were subsequently monitored by their parents or caregivers at home for 24 hours and contacted via telephone for assessment of the results of antiemetic therapy. The following parameters were compared across treatment groups: time to cessation of vomiting within 1, 6, and 24 hours; acceptance of oral rehydration therapy; intravenous fluid replacement; return to hospital; and adverse effects attributable to the antiemetic. All parents or caregivers were given information on the antiemetic treatment that would be provided and signed an informed consent form authorizing the child's participation in the study. Results: Of 180 children randomized, 175 completed the trial. Within 1 hour of antiemetic administration, cessation of vomiting had been achieved in 96.6% of children given bromopride, 94.8% of those given metoclopramide, and 100% of those given ondansetron (p=0.312). Six hours after administration, bromopride was found to cease vomiting in 216?114 minutes, metoclopramide in 150?168 minutes, and ondansetron in 72?54 minutes (p=0.011). Cessation of vomiting at 24 hours was achieved in 67.8% of children given bromopride, 67.2% of those given metoclopramide, and 96.6% of those given ondansetron (p=0.002). Children in the ondansetron group accepted more fluid replenishment orally (200 ml) than those given bromopride or metoclopramide (150 ml and 100 ml respectively) (p=0.034). Eleven children ultimately required intravenous fluids: five in the bromopride group and six in the metoclopramide group. Within 1 hour of antiemetic administration, only 24.1% of children in the ondansetron group reported adverse effects (somnolence, diarrhea, fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) fatigue, restlessness, feeling hot)fatigue, restlessness, feeling hot) , whereas 42.4% and 44.8% of children in the bromopride and metoclopramide groups respectively reported somnolence (p=0.034). At 24 hours, there were no significant differences in adverse effects across the three groups (p=0.357). Conclusion: In a pediatric emergency department setting, ondansetron is superior to bromopride and metoclopramide for treatment of vomiting. Ondansetron was associated with cessation or reduction of vomiting both within 1 hour of administration and at 6 and 24 hours. Bromopride and metoclopramide were both effective, but were associated with somnolence, an adverse effect that can prolong observation time in the emergency department and thus increase hospital costs. / Objetivo: Avaliar os resultados dos antiem?ticos aplicados via intramuscular, bromoprida, metoclopramida e ondansetron em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o em dose ?nica para o tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto tratamento de v?mitos em um pronto socorro socorro socorro pedi?trico. pedi?trico. pedi?trico. pedi?trico. M?todos: Ensaio cl?nico randomizado e controlado, envolvendo crian?as que consultaram por v?mitos, devido ? gastroenterite, no servi?o de Emerg?ncia Pedi?trica no Hospital Universit?rio de Santa Maria, no per?odo de agosto de 2013 a junho de 2014. Foram randomizadas crian?as com idades entre 1 a 12 anos, para receber dose ?nica de bromoprida via intramuscular ou metoclopramida via intramuscular (m?ximo 10mg); ou ondansetron (m?ximo 8mg) na dose de 0,15mg/kg via intramuscular. A crian?a ap?s receber o antiem?tico permanecia em observa??o por no m?mimo 1 hora. Ap?s a reavaliac?o cl?nica as crian?as que recebiam alta eram monitorizadas pelo familiar no domic?lio durante 24 horas, e contactados por via telef?nica para avaliar o resultado do tratamento antiem?tico recebido. Os grupos foram comparados em rela??o a tempo para cessar os v?mitos dentro de 1, 6 e 24 horas; aceita??o de l?quidos orais; reidrata??o endovenosa; retorno ao hospital e efeitos colaterais relacionados aos antiem?ticos. Os familiares ap?s devidamente informados sobre o tratamento antiem?tico que a crian?a seria submetida, assinaram o Termo de Consentimento Livre e Esclarecido, permitindo a participa??o do filho no estudo. Resultados: Das 180 crian?as randomizadas, 175 completaram o estudo. Na primeira hora ap?s medicar, a bromoprida teve 96,6% de efic?cia na cessa??o dos v?mitos, a metoclopramida, 94,8% e o ondansetron 100%, (p= 0,312). Em 6 horas, ? bromoprida cessou o v?mito em 216?114 minutos, ? metoclopramida em 150?168 minutos e o ondansetron 72?54 minutos, (p=0,011). Em 24 horas, a cessa??o dos v?mitos ocorreu em 67,8% com bromoprida, 67,2% com metoclopramida e 96,6% com ondansetron (p=0,002). O grupo ondansetron aceitou melhor os l?quidos orais, 200 ml, comparado ? bromoprida, 150 ml e ? metoclopramida, 100 ml (p=0,034). Onze crian?as necessitaram de hidrata??o endovenosa: 5 no grupo bromoprida e 6 no metoclopramida. Sessenta minutos ap?s medicar, apenas 24,1% do grupo ondansetron apresentaram efeitos colaterais (sonol?ncia, diarreia, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, cansa?o, inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor)inquieta??o, sensa??o de calor) inquieta??o, sensa??o de calor) , enquanto que os grupos bromoprida e metoclopramida apresentaram associa??o com sonol?ncia, 42,4% e 44,8%, respectivamente, p=0,034. Os efeitos colaterais em 24hs n?o apresentaram diferen?a estat?stica significativa entre os tr?s grupos, p=0,357. Conclus?o: Existem benef?cios nos resultados para tratamento de v?mito em pronto socorro pedi?trico com o uso do ondansetron em rela??o ? bromoprida e ? metoclopramida. O ondansetron mostrou-se associado na cessa??o ou redu??o dos v?mitos ap?s medicar tanto na primeira hora, quanto nas pr?ximas 6 e 24 horas. A bromoprida e a metoclopramida foram consideradas eficazes, mas apresentava associa??o com sonol?ncia, efeito colateral que pode determinar um maior tempo de observa??o em sala de emerg?ncia e aumentar os custos hospitalares.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-12-01T10:30:54Z No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5) / Made available in DSpace on 2015-12-01T10:30:54Z (GMT). No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5) Previous issue date: 2015-09-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Study the medical education process is part of a worldwide movement of health review, motivating important initiatives, represented in Brazil by the national curriculum guidelines of the courses in this area, presented by the Ministry of Education in 2001. In order to compare the effects of content learning/retention (outcome) of dialogued lecture (factor under study), we carried out a randomized controlled trial by groups, blinded to the research subjects with medical students from the 7th and 8 th semester from a private university in southern Brazil, with grade five assigned by the Higher Education Personal Improvement Commission (CAPES). 150 subjects were evaluated between March 2012 and June 2014, average age 24.7 years and a predominance of females (62.7%); 69 (46%) allocated for dialogued lecture (intervention group) and 81 (54%) to traditional lecture (control group). The performance of groups was evaluated by the same theoretical knowledge test administered before and after class, where students in the control group showed greater variation between the first and second test (8.6 vs. 6.7 p = 0.0001) result reinforced by the magnitude of the effect also higher in this group (2,526 vs. 1,350). In the pretest, without distinction by group, the overall student achievement was 50%, with a higher average score of the intervention group (p = 0.003) and those students tested in the 7th semester. In this study, the expository dialogue-class determined final results similar to traditional classroom (20.2 vs. 20.0 points in the final test) no impairment in short-term learning was noticed. / Estudar o processo de educa??o m?dica ? parte de um movimento mundial de revis?o da sa?de, motivando iniciativas importantes, representadas no Brasil pelas diretrizes curriculares nacionais dos cursos desta ?rea, apresentadas pelo Minist?rio da Educa??o no ano de 2001. Com o objetivo de comparar os efeitos de aprendizagem/reten??o de conte?do (desfecho) da aula expositiva dialogada (fator em estudo), realizou-se um estudo controlado randomizado por grupos, cegado para os sujeitos de pesquisa com alunos do 7? e 8? semestre do curso de medicina de uma Faculdade privada do sul do Brasil, com conceito cinco atribu?do pela Comiss?o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES). Foram avaliados 150 sujeitos, entre mar?o de 2012 e junho de 2014, m?dia de idade de 24,7 anos e predom?nio do sexo feminino (62,7%); 69 (46%) alocados para a aula expositiva dialogada (grupo interven??o) e 81 (54%) para aula expositiva tradicional (grupo controle). O desempenho dos grupos foi avaliado por um mesmo teste te?rico de conhecimento aplicado antes e ap?s a aula, onde os alunos do grupo controle demonstraram maior varia??o entre o primeiro e segundo teste (8,6 vs. 6,7 p=0,0001) resultado refor?ado pela magnitude do efeito tamb?m maior neste grupo (2,526 vs. 1,350). No pr?-teste, sem distin??o por grupo, o aproveitamento geral dos alunos foi de 50%, sendo maior a pontua??o m?dia do grupo submetido ? interven??o (p=0,003) e daqueles alunos testados no 7? semestre. Neste estudo, a aula expositiva dialogada determinou resultados finais similares ? aula tradicional (20,2 vs. 20,0 pontos no teste final) n?o sendo observado preju?zo na aprendizagem de curto prazo.

Made available in DSpace on 2015-04-14T13:36:01Z (GMT). No. of bitstreams: 1 462154.pdf: 1740830 bytes, checksum: 56d8885409aaa592e20907c78d4b44fe (MD5) Previous issue date: 2014-02-24 / In Brazil, in spite of humanism is an old topic in the history of medicine, including his medical education in Brazil is recent, officially legalized in Resolution CNE/CES in 4 of 7 November 2001, the Ministry of Education, National Council of education/Board of Higher education, which includes the National Curriculum Guidelines for Undergraduate Medical. However, the Ministry of Health have questioned as to the graduates listing, in relation to the supply of the health needs of the population. Given that there is urgency to appropriate and effective measures in vocational training, it is necessary to understand the aspects for improvement in the comprehensive care and more comprehensive information on medical education. In this light, the present study aims to describe and analyze the provision of humanistic disciplines in medical education in Brazil. For this, we carried out a descriptiveanalytic research with documented reference base, with qualitative and quantitative approach. The data analyzed was collected through the curriculum matrices, searched through information disseminated on the Internet by HEIs. The sample was composed of subjects of Humanities and Medical Sciences, matrices belonging curriculum of undergraduate courses in Medicine in Brazil, considering the criteria for inclusion and exclusion. The study included 127 HEIs. The analysis of 7832 subjects showed that 22.8 % were humanistic disciplines. The state with the highest local rate of humanistic disciplines was Rio Grande do Norte, with 67.9% (n=129). Followed by Cear? with (51.6%, n=81) and Rond?nia (32.4%, n=34). When subdivided by the five regions of the country, 27.86% concentrated in the Northeast, followed by the southern regions (23.15%, n=394), Southeast (22.26%, n=882), north (17.85%, n=96), and Midwest (17.37%, n=66). There was a negative correlation between the mortality rate and the IES (n), r = -0.414 (p <0.001). There was a significant correlation of the humanistic disciplines and the mortality rate (r = 0.933, p <0.001). The movements and reform initiatives in medical education in Brazil has led to debates about the health needs unmet and profiles of professionals who are in front of the health system. Especially with regard to medical education, much has been questioned regarding the technicalities profile of medical education offered by the institutions. The geographical, socioeconomic, cultural, climatic, ethnic make the Brazilian a complex panorama for taking resolute action scenario. Importantly, this diversity requires dynamic actions so that they can effectively reach all. / No Brasil, apesar do humanismo ser um assunto antigo na hist?ria da medicina, a inclus?o dele no ensino m?dico brasileiro ? recente, oficialmente legalizado na Resolu??o CNE/CES no 4, de 7 de novembro de 2001, do Minist?rio da Educa??o, Conselho Nacional de Educa??o/ C?mara de Educa??o Superior, que cont?m as Diretrizes Curriculares Nacionais do Curso de Gradua??o de Medicina. Entretanto, o Minist?rio da Sa?de t?m questionado quanto ao perfil egressos, no que tange ao suprimento das necessidades de sa?de da popula??o. Tendo em vista, que h? urg?ncia em provid?ncias cab?veis e efetivas na forma??o profissional, ? necess?rio compreender os aspectos para melhorias no atendimento integral e obter informa??es mais abrangentes sobre a forma??o m?dica. Sob este prisma, o presente estudo tem como objetivo descrever e analisar a oferta de disciplinas humanistas no ensino m?dico do Brasil. Para isto, realizou-se uma pesquisa anal?tico-descritiva, com base referencial documental, com abordagem quali-quantitativa. Os dados estudados foram coletados atrav?s das matrizes curriculares, pesquisadas atrav?s de informa??es divulgadas na Internet pelas IES. A amostra desta pesquisa foi composta por disciplinas de Ci?ncias Humanas e Ci?ncias M?dicas, pertencentes as matrizes curriculares dos cursos de gradua??o em Medicina do Brasil, considerando os crit?rios de inclus?o e exclus?o. Participaram deste estudo 127 IES. A an?lise de 7832 disciplinas mostrou que 22,8% eram disciplinas humanistas. O Estado que apresentou a maior taxa local de disciplinas humanistas foi o Rio Grande do Norte, com 67,9% (n=129). Seguido pelo Cear? com (51,6%, n= 81) e Rond?nia (32,4%, n=34). Quando subdivididas pelas cinco regi?es do pa?s, 27,86% concentrou-se no nordeste, seguido pelas regi?es sul (23,15%, n= 394), sudeste (22,26%, n=882), norte (17,85%, n=96), e centro oeste (17,37%, n=66). Houve correla??o negativa entre a taxa de mortalidade e as IES (n), r=-0,414 (p<0,001). Houve expressiva correla??o das disciplinas humanistas e a taxa de mortalidade (r=0,933, p<0,001). Os movimentos e iniciativas de reforma no ensino m?dico do Brasil tem provocado debates a cerca das necessidades de sa?de n?o supridas e o perfil dos profissionais que est?o na frente do sistema de sa?de. Especialmente, no que diz respeito ao ensino m?dico, muito tem sido questionado com rela??o ao perfil tecnicista da forma??o m?dica ofertado pelas institui??es de ensino. A diversidade geogr?fica, socioecon?mica, cultura, clim?tica, ?tnica fazem do panorama brasileiro um cen?rio complexo para a tomada de a??es resolutas. ? importante ressaltar que, esta diversidade exige a??es din?micas para que se possam alcan?ar a todas efetivamente.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-01T14:15:10Z No. of bitstreams: 1 DIS_ALEXSANDER_BORGES_RIBEIRO_COMPLETO.pdf: 1525692 bytes, checksum: 8764c6213670fe6906ad40c5cb972f36 (MD5) / Made available in DSpace on 2016-06-01T14:15:10Z (GMT). No. of bitstreams: 1 DIS_ALEXSANDER_BORGES_RIBEIRO_COMPLETO.pdf: 1525692 bytes, checksum: 8764c6213670fe6906ad40c5cb972f36 (MD5) Previous issue date: 2016-03-18 / This paper recalls the history of various health professions, starting with the origins and reaching the professionalization processes, both in Brazil and worldwide. The overall objective of the study is to analyze emblematic process of demarcation of borders professionals in the health field , occurred in the last decade in Brazil, one known as Ato M?dico (Medical Act) and the other as Mais M?dicos (More Doctors). Presents the current rules of the boundaries setting game. Identifies the players, divided into individual and collective actors involved, as well as veto players. Identifies the strategies that the actors used in both episodes, in an effort to reach their goals. Shows the results of the games or processes of demarcating boundaries on the healthcare field in Brazil. Conjectures that the liberalization of professional services, within the Mercosur, will face the resistance of the Brazilian physicians. Concludes that the demarcations of professional boundaries are imperfect processes, susceptible to class pressures, that the enlargement of the public sphere in combination with previous studies may have more satisfactory results in relation to the search of a common good. / Resgata a hist?ria de diversas profiss?es de sa?de, come?ando pelas origens e alcan?ando os processos de profissionaliza??es, tanto em n?vel mundial como brasileiro. O objetivo geral do estudo ? analisar processos emblem?ticos de demarca??o de fronteiras profissionais no campo da sa?de, ocorridos na ?ltima d?cada no Brasil, sendo um conhecido como ?Ato M?dico? e outro como ?Mais M?dicos?. Apresenta as atuais regras do jogo da demarca??o de fronteiras. Identifica os jogadores, divididos entre atores individuais e coletivos envolvidos, bem como os veto players. Identifica as estrat?gias que os atores utilizaram nos dois epis?dios, no esfor?o de alcan?ar seus objetivos. Mostra os resultados dos jogos ou dos processos demarcat?rios no campo da sa?de brasileira. Conjectura que a liberaliza??o dos servi?os profissionais, no ?mbito do Mercosul, enfrentar? a resist?ncia da classe m?dica brasileira. Conclui que as demarca??es de fronteiras profissionais s?o processos imperfeitos, suscet?veis ?s press?es classistas, que o alargamento da esfera p?blica em combina??o com estudos pr?vios pode apresentar resultados mais satisfat?rios em rela??o ? busca de um bem comum.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T15:36:43Z No. of bitstreams: 2 cleya_silva_santana_cruz.pdf: 3196384 bytes, checksum: ab5bc76d3c89cdad0a8a51f5bad61c79 (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T15:37:58Z (GMT) No. of bitstreams: 2 cleya_silva_santana_cruz.pdf: 3196384 bytes, checksum: ab5bc76d3c89cdad0a8a51f5bad61c79 (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-08T15:38:17Z (GMT) No. of bitstreams: 2 cleya_silva_santana_cruz.pdf: 3196384 bytes, checksum: ab5bc76d3c89cdad0a8a51f5bad61c79 (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) / Made available in DSpace on 2015-01-08T15:38:17Z (GMT). No. of bitstreams: 2 cleya_silva_santana_cruz.pdf: 3196384 bytes, checksum: ab5bc76d3c89cdad0a8a51f5bad61c79 (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Previous issue date: 2013 / Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG) / Funda??o Diamantinense de Apoio ao Ensino, Pesquisa e Extens?o (Fundaep) / O Programa de Educa??o Permanente para M?dicos da Estrat?gia de Sa?de da Fam?lia foi implantado na Regi?o Ampliada de Sa?de Jequitinhonha em outubro de 2010, com a finalidade de melhorar o n?vel de resolubilidade da Aten??o Prim?ria ? Sa?de, tomando como ponto de partida a aprendizagem significativa e integrada das diversas compet?ncias cl?nicas necess?rias aos m?dicos das equipes de sa?de da fam?lia. O objetivo deste trabalho foi avaliar as a??es de planejamento, execu??o e resultados do PEP na Regi?o Ampliada de Sa?de Jequitinhonha de Minas Gerais em interface com os objetivos propostos pelo Programa. O estudo foi desenvolvido em 14 munic?pios desta Regi?o, que possu?am m?dicos da Estrat?gia de Sa?de da Fam?lia com frequ?ncia de participa??o no PEP igual ou superior a 60,0%. Participaram da pesquisa 14 gestores municipais de sa?de, 31 m?dicos e 383 usu?rios. Tratou-se de uma pesquisa de triangula??o descritiva, quantitativa e qualitativa. Utilizou-se como instrumentos de coleta de dados: 1) Question?rios estruturados dirigidos aos usu?rios, m?dicos e gestores de sa?de; 2) Relat?rios de supervisores dos GAPs para o levantamento dos temas estudados nos encontros e 3) Atestos de gestores municipais de sa?de para calcular a rotatividade profissional dos m?dicos. As entrevistas das consultas m?dicas foram filmadas e analisadas. Utilizou-se a an?lise descritiva dos dados, o teste do qui-quadrado e teste de Fisher (p = 0,05). A m?dia de idade dos m?dicos entrevistados foi de 39,5 anos, 67,7% eram do sexo masculino e 48,2% solteiros. Em rela??o ? titula??o, 45,2% dos m?dicos possu?am apenas gradua??o em medicina, sendo que 35,5% possu?am no m?ximo quatro anos de forma??o. A rela??o m?dicos inscritos/presentes nos encontros do PEP foi de 41,5% em 2011 e 38,4% em 2012. Os temas mais estudados nos encontros de GAP foram a metodologia do PEP (24,3%) e as doen?as cr?nicas n?o transmiss?veis (10,5%). Para os m?dicos participantes, o supervisor do GAP segue a metodologia proposta e os materiais atendem ?s necessidades dos grupos (100,0%). Os m?dicos (93,5% e 96,8%, respectivamente) relatam que ap?s a participa??o no PEP houve redu??o de encaminhamentos e de pedidos de exames desnecess?rios. Os m?dicos participantes (93,5%) afirmam ainda que suas consultas foram reestruturadas ap?s a participa??o no Programa. Segundo o ponto de vista de 35,7% dos gestores municipais de sa?de, os m?dicos vinculados a seus munic?pios participam do PEP apenas como forma de cumprir o Contrato do Programa Sa?de em Casa, mas para a maioria (62,5%) este n?o ? o motivo da participa??o, enquanto 50% dos Secret?rios Municipais de Sa?de afirmam que os m?dicos que s?o liberados para o PEP, n?o comparecem nos encontros. A maioria dos usu?rios (76,1%) relatou ter percebido melhora no atendimento ap?s a participa??o do m?dico no Programa. O ?ndice de rotatividade para os m?dicos que participam do PEP com frequ?ncia igual ou superior a 60,0% foi de 35,5%, enquanto para aqueles que n?o participam efetivamente do Programa o valor foi de 60,9%. Conclui-se, assim, que a Educa??o Permanente nos moldes do PEP pode melhorar o desempenho cl?nico dos m?dicos e envolver mais o usu?rio em seu tratamento, al?m de contribuir para a fixa??o de profissional na regi?o. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2013. / ABSTRACT The Permanent Education Program for Physicians in the Family Health Strategy was implemented in the Jequitinhonha Extended Health Region in October 2010 for the purpose of improving the level of resolution capability in Primary Health Care. It took as the starting point the significant and integrated learning of the various clinical skills that the physicians in the family health teams need. The objective of this paper was to assess the planning and execution actions, as well as the results of the PEP in the Jequitinhonha Extended Health Region, in Minas Gerais state, in interface with the objectives proposed by the Program. The study was developed in 14 municipalities in this Region, which had physicians from the Family Health Strategy whose participation rate in the PEP was equal to or greater than 60 percent. 14 health managers, 31 physicians, and 383 users participated in the research. The research used a descriptive, quantitative, and qualitative triangulation approach. The following data collection tools were used: 1) Structured questionnaires addressed to users, physicians, and health managers; 2) Reports by supervisors from the Professional Development Groups (PDGs) for an overview of the topics studied in the meetings, and 3) Statements by municipal health managers to calculate the professional turnover rate of medical doctors. The interviews during medical appointments were filmed and analyzed. Descriptive data analysis, the?chi-square test? and the Fisher Test (p = 0.05), and the Pearson Correlation Test (p = 0.0.5%) were used. The average age of the interviewed physicians was 39.5 years; 67.7% were males, and 48% were single. As far as academic degree was concerned, 45.2% of the physicians only had a degree in Medicine, and 35.5% of them had graduated no more than four years prior to these interviews. The percentages of physicians who signed up for / participated in the meetings of the PEP were 41.5% in 2011 and 38.4% in 2012. The most widely studied topics in the Professional Development Group meetings were the methodology of the Permanent Education Program (24.3%) and chronic non-communicable diseases (10.5%). For the participating physicians, the supervisor of the Professional Development Group follows the proposed methodology, and the materials meet the needs of the groups (100%). The physicians (93.5% and 96.8%, respectively) reported that, after participating in the Permanent Education Program, there was a reduction in the number of unnecessary referrals and requests for medical examinations. The participating physicians (93.5%) also stated that their medical consultations were restructured after they participated in the Program. From the point of view of 35.7% of the municipal health managers, the physicians working in their municipalities attend the Permanent Education Program only to comply with the Home Health Care Program Agreement. However, for most of the municipal health care managers (62.5%), this is not the reason why physicians attend the PEP, while 50% of the Municipal Health Secretaries stated that physicians who are released to attend the PEP do not show up for the meetings. Most of the users (76.1%) reported that they noticed an improvement in the health care services after their doctor participated in the Program. The turnover rate was 35.5% for physicians whose participation in the PEP was equal to or greater than 60.0% , whereas for those who do not participate effectively in the Program the turnover rate was 60.9%. It is therefore concluded that permanent education, along the lines of the Permanent Education Program, can improve the clinical performance of the physicians and make users more involved in their treatment. Furthermore, it contributes to retaining professionals in the region.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-20T19:09:34Z No. of bitstreams: 1 EleniDeAraujoSalesCastro_DISSERT.pdf: 2226981 bytes, checksum: 604d29272bb7927dde8e89669d471ef4 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-21T19:05:40Z (GMT) No. of bitstreams: 1 EleniDeAraujoSalesCastro_DISSERT.pdf: 2226981 bytes, checksum: 604d29272bb7927dde8e89669d471ef4 (MD5) / Made available in DSpace on 2017-03-21T19:05:40Z (GMT). No. of bitstreams: 1 EleniDeAraujoSalesCastro_DISSERT.pdf: 2226981 bytes, checksum: 604d29272bb7927dde8e89669d471ef4 (MD5) Previous issue date: 2016-06-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / A altera??o no padr?o de sono e vig?lia, uma das consequ?ncias do trabalho em turnos e noturno, causa in?meras altera??es biopsicossociais que interferem nos processos sa?de-doen?a dos trabalhadores. Um dos impactos dessas altera??es ? observado no processo de tomada de decis?o, um dos construtos das Fun??es Executivas. No contexto de trabalho de urg?ncias e emerg?ncias em sa?de, a tomada de decis?o torna-se um dos elementos mais importantes, pois embora a maioria das decis?es possa ser resolvida com a equipe preparada, o cen?rio de imprevisibilidade e gravidade das interven??es exp?e a equipe m?dica a um estresse constante, que pode prejudicar atividades como planejar respostas apropriadas. Este estudo teve como objetivos gerais avaliar a rela??o entre sono e tomada de decis?o em 26 m?dicos de unidades m?veis de aten??o ?s urg?ncias, submetidos a esquemas de turnos e traduzir e adaptar para o portugu?s cen?rios hipot?ticos de tomada de decis?o baseados na Policy Capturing-Technique. Para avalia??o do sono, foram utilizados o ?ndice de Qualidade de Sono de Pittsburgh (IQSP), o Question?rio de H?bitos de Sono, a Escala de Sonol?ncia de Epworth e o Question?rio de Identifica??o de Cronotipo de Horne-Ostberg. Para avalia??o da tomada de decis?o foi utilizado o Iowa Gambling Task (IGT) e cen?rios hipot?ticos criados de acordo com a T?cnica Policy-Capturing. Para crit?rios de inclus?o/exclus?o, os participantes responderam ? Escala de Fadiga de Chalder, ao Invent?rio de Ansiedade de Beck (BDI), ao Invent?rio de Depress?o de Beck (BDI) e ao Invent?rio de Sintomas de Stress para Adultos de Lipp (ISSL). Os participantes foram divididos em turno diurno (N=6) e alternante (N=20). Os resultados mostraram uma boa qualidade de sono para os m?dicos do turno diurno e uma m? qualidade do sono para os m?dicos do turno alternante. Uma boa qualidade de sono e menor sonol?ncia foram correlacionados com melhores desempenhos na tomada de decis?o. Foi feita uma avalia??o com o objetivo de verificar rela??o entre os dois protocolos de tomada de decis?o e o resultado mostrou correla??o entre eles, indicando pior tomada de decis?o avaliada pelo IGT relacionada a preju?zos na tomada de decis?o avaliadas pelos cen?rios. Foi encontrada tomada de decis?o prejudicada quando avaliada ao longo do turno. Conclui-se que o esquema de trabalho em turnos alternantes pode ser prejudicial para a qualidade de sono dos m?dicos e que uma boa qualidade de sono pode contribuir para um melhor desempenho na tomada de decis?o. / The change in sleep-wake patterns, one of the consequences of shift work and night shifts, causes many biopsychosocial changes that interfere on the health-disease processes of workers. One of the impacts caused by these changes is observed in decision-making, one of the components of executive functioning. In the context of emergency care in health work, decision making becomes one of the most important elements, because although most decisions can be resolved with a prepared team, the unpredictability scenario and the severity of interventions exposes the medical team to a constant stress, which can impair activities such as plan appropriate responses. This study aimed to assess the relationship between sleep and decision making in 26 medical technicians of the emergency care units undergoing shifts schemes and to translate and adapt to Portuguese decision-making hypothetical scenarios based on Policy-Capturing Technique. To sleep evaluation, we used the Pittsburgh Sleep Quality Index (PSQI), the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire Horne-Ostberg. To evaluate the decision-making, was used the Iowa Gambling Task (IGT) and hypothetical scenarios created according to the Policy-Capturing Technique, which were translated into Portuguese and adapted according to the needs of our sample. For inclusion / exclusion criteria, the participants answered the Chalder Fatigue Scale, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Inventory of Stress Symptoms for adults of Lipp (ISSL). Participants were divided into day shift (N = 6) and alternating shift (N = 20). The results showed a good sleep quality for physicians of the day shift and poor sleep quality for the alternating shift. A good quality sleep and less somnolence were correlated with better performance in decision-making. An assessment was made in order to verify the relationship between the two decision-making protocols and the results showed a correlation between them, indicating worse decision-making evaluated by IGT related to losses in decision making evaluated by the scenarios. It was found impaired decision making when measured along the shift. It is concluded that the scheme of alternating shift work can be detrimental to the sleep quality of doctors and a good sleep quality can contribute to a better performance in decision-making.