Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-09T15:27:57Z No. of bitstreams: 2 kelly_rocha_neves.pdf: 4277604 bytes, checksum: 2a8f478e082e5ba639c91f2f4367399e (MD5) license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-09T15:28:31Z (GMT) No. of bitstreams: 2 kelly_rocha_neves.pdf: 4277604 bytes, checksum: 2a8f478e082e5ba639c91f2f4367399e (MD5) license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-09T15:29:00Z (GMT) No. of bitstreams: 2 kelly_rocha_neves.pdf: 4277604 bytes, checksum: 2a8f478e082e5ba639c91f2f4367399e (MD5) license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) / Made available in DSpace on 2015-01-09T15:29:00Z (GMT). No. of bitstreams: 2 kelly_rocha_neves.pdf: 4277604 bytes, checksum: 2a8f478e082e5ba639c91f2f4367399e (MD5) license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) Previous issue date: 2013 / Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG) / O acompanhamento do crescimento e desenvolvimento infantil ? uma das cinco a??es b?sicas de sa?de voltadas para as crian?as, preconizadas pela Organiza??o Mundial de Sa?de e pelo Minist?rio da Sa?de brasileiro. O objetivo deste estudo foi investigar a influ?ncia de condicionantes biol?gicos, socioecon?micos e ambientais no crescimento antropom?trico e desenvolvimento neuropsicomotor de crian?as de 24 a 36 meses, frequentadoras de creches do sistema p?blico de um munic?pio do Alto Vale do Jequitinhonha. Para tanto, foram adotados par?metros antropom?tricos como peso e estatura como medidas de crescimento e o teste Bayley III para avalia??o do desenvolvimento infantil nos dom?nios: motor, cognitivo e linguagem expressiva. Os ambientes casa e creche foram avaliados aplicando-se os instrumentos: Home Observation for Measurement of the Enviroment e Infant Tolddler Environment Rating Scale Recised. O perfil econ?mico da popula??o foi determinado por meio do question?rio Associa??o Brasileira de Empresas de Pesquisa. As caracter?sticas s?cio-demogr?ficas e de hist?rico de sa?de materno-infantil, foram recolhidas atrav?s de um question?rio semi-estruturado. A qualidade da vizinhan?a tamb?m foi investigada por meio de um question?rio pr?prio, formulado ? partir da literatura. Com o intuito de geoprocessar as informa??es recolhidas, os domic?lios e as creches fequentadas pelas crian?as do estudo foram georreferenciadas. Dentre os ?ndices que avaliaram o crescimento, o d?ficit de estatura mostrou-se o desvio nutricional mais prevalente da mesma forma que os dom?nios de cogni??o e linguagem expressiva foram os que apresentaram maior preval?ncia de crian?as com desempenho abaixo da m?dia. Os condicionantes que melhor explicaram os resultados encontrados no ?ndice estatura por idade foram os aspectos relacionados ? sa?de da crian?a e nos dom?nios do desenvolvimento, infantil estudados, os condicionantes ambientais. Atrav?s do geoprocessamento das informa??es p?de-se identificar as ?reas de maior preval?ncia de d?ficit de crescimento e desenvolvimento abaixo da m?dia, bem como a distribui??o das creches e domic?lios do estudo. Espera-se que os dados encontrados nesta pesquisa possam servir como ponto de partida para a cria??o de estrat?gias e ou programas em sa?de que promovam o monitoramento do crescimento e desenvolvimento de crian?as frequentadoras de creches, bem como propiciar a??es conjuntas entre sa?de e educa??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 attendance of the growth and development of a child is one of the basic actions of health turned to the children preconized by the OMS and by the Brazilian Health Department. The objective of this study has been to investigate the influence of biological, socioeconomical and environmental condition in the antropometric growth and the neuro-psychomotor development of children from 24 to 36 months of age, frequenters of a day care in a public system of a municipality in the Alto Vale do Jequitinhonha. Therefore, we adopted anthropometric parameters as weight and stature as measures of growth and the BAYLEY test III for evaluation of the infantile development in the motor, cognition and expressive language. The environments home and day care were evaluated applying the following instruments: Home Observation for Measurement of the Environment e Infant Toddler Environment Rating Scale Recised, both standardized. The economic profile of the population was determined by questionnaire of the Brazilian Association of the Research Enterprise. The socio-demographic characteristics and history of maternal and child health, were collected through a semi-structured questionnaire.The quality of the neighborhood was also investigated by questionnaire itself, formulated from the literature. With the intent of georeferencing the gathered information, the domiciles and the frequented day care frequented by the children of this study were georreferenced. Among the indexes that evaluated the growth, the deficit of stature has shown the nourishing deviation more prevalent of the same way that the dominion of cognition and expressive language were the ones that have presented a bigger prevalence of children with performance below the average. The condition that mostly explained the found results in the index stature of age were the aspects connected to the health of the child and in the dominions of the development, studied, the environment conditions. Throughout the geoprocessing of the information we can identify the areas of highest prevalence of stunting and development below average and the distribution of childcare and household study. It is hoped that the deeds found in this research may serve as a starting point to the creation of strategies and or programs of health that promote the monitoration of growth and development of children frequenters of day care as well as to appropriate conjunct actions between health and education.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-12-18T13:14:22Z No. of bitstreams: 1 476596 - Texto Completo.pdf: 1409753 bytes, checksum: bc4ccb55ef8bdedcc327d5131ce5571b (MD5) / Made available in DSpace on 2015-12-18T13:14:22Z (GMT). No. of bitstreams: 1 476596 - Texto Completo.pdf: 1409753 bytes, checksum: bc4ccb55ef8bdedcc327d5131ce5571b (MD5) Previous issue date: 2015-03-31 / Background: Obesity represents a global epidemic in both adults and children. Several factors associated with the parents seem to affect the offspring weight. In addition, maternal overweight and obesity seem to be associated with a series of comorbidities and negative outcomes in offspring. Objective: This thesis has two main objectives: (1) To conduct an overview of reviews, it means, to summarize the evidences from systematic reviews on the association between maternal overweight and obesity and offspring outcomes; and (2) To conduct an observational study to assess the effects of maternal overweight and obesity on offspring BMI. Secondarily, we aimed to evaluate the impact of diabetes, gestational diabetes, hypertension and gestational hypertension on the BMI of children aged between 6 and 10 years. Methods: To address the objectives of this thesis, we conducted two studies, corresponding to the two aims mentioned above. Study 1: Overview of Reviews. An electronic search (from their inception date up to September 2014) was conducted in PubMed, Cochrane Database of Systematic Reviews, EMBASE and Lilacs. Limits and restrictions for date and language were not used. We conducted an analysis of references and citation of the included systematic reviews. Two reviewers independently extracted data and assessed the methodological quality of each systematic review according to the AMSTAR criteria. Quality was evidence was evaluated, and we provide a descriptive analysis of the findings. Study 2: Cross-sectional study derived from a cohort. We included 848 children aged 6 to 10 years. We evaluated weight, height and body mass index (BMI) of children and parents. A questionnaire was administered to parents to collect the following information: previous hypertension, hypertension during pregnancy, previous diabetes, gestational diabetes, education and socioeconomic level of the parents. The Research Ethics Committee approved the study and the parents signed the informed consent. Results: Study 1: Maternal overweight and obesity were demonstrated to be associated with stillbirth, fetal death and infant death. Being overweight or slightly obese seem to not modify the overall risk for preterm birth, the risk of induced preterm birth was increased in overweight and obese women. Congenital defects such as neural tube defect, spina bifida, cardiovascular anomalies, septal anomalies, cleft palate, cleft lip and palate, anorectal atresia, hydrocephaly, and limb reduction anomalies. The risk of gastroschisis among obese mothers was reduced. There was limited data on neurodevelopmental outcomes, anorectal malformations in offspring, and risk of testicular cancer. Maternal overweight and obesity are associated with risk of asthma and wheezing in children, and has a negative impact on the immediate postpartum care for both mother and baby. Study 2: We found that mothers with overweight and obesity have more often overweight and obese children than normal weight mothers. The same relationship was observed for fathers. Furthermore, it was found that mothers who develop hypertension during pregnancy have more often children with overweight and obesity. However, the association was not observed when other factors such as pre-gestational diabetes, gestational diabetes and pre-gestational hypertension were evaluated. Conclusion: Maternal overweight and obesity are associated with a number of complications for both the mother when the baby in the short, medium and long term. It is suggested that guidelines for weight maintenance for women who plan on becoming pregnant should definitely consider these results in order to reduce maternal overweight and obesity rates and its negative impact on children. / Introdu??o: A obesidade representa uma epidemia mundial tanto em adultos como em crian?as. Diversos fatores maternos e paternos parecem influenciar no peso das crian?as. Al?m disso, sobrepeso e obesidade maternos parecem estar associados com uma s?rie de comorbidades e desfechos negativos nos filhos. Objetivos: Esta tese possui dois objetivos principais: (1) Realizar uma overview of reviews, ou seja, reunir e avaliar evid?ncias provenientes de revis?es sistem?ticas e meta-an?lises, investigando a associa??o entre sobrepeso e obesidade maternos e defeitos/comorbidades nos filhos; e (2) Realizar um estudo observacional para avaliar os efeitos do sobrepeso e obesidade maternos sobre o IMC dos filhos. Secundariamente, pretende-se avaliar o impacto da diabetes melitus, diabetes gestacional, hipertens?o pr?gesta??o e hipertens?o gestacional sobre o IMC dos filhos entre 6 e 10 anos. M?todos: Para responder aos objetivos desta tese, foram elaborados dois estudos, correspondentes aos dois objetivos citados acima. Estudo 1: Overview of Reviews. Buscas eletr?nicas foram conduzidas nas seguintes bases de dados: PubMed, Cochrane Database of Systematic Reviews, EMBASE and Lilacs. N?o foram utilizados limites para data e idioma. Foi conduzida an?lise de refer?ncias e cita??es. Dois revisores selecionaram os estudos, extra?ram dados e avaliaram a qualidade dos estudos (crit?rios AMSTAR) de forma independente. A qualidade da evid?ncia foi avaliada, e foi realizada uma an?lise descritiva dos desfechos. Estudo 2: Estudo transversal aninhado a uma coorte. Foram inclu?das 848 crian?as com idade entre 6 e 10 anos. Foram avaliados peso, altura e ?ndice de massa corporal (IMC) das crian?as e dos pais. Foi aplicado um question?rio com os pais para coleta das seguintes informa??es: hipertens?o pr?via, hipertens?o durante a gesta??o, diabetes pr?via, diabetes gestacional, escolaridade e n?vel socioecon?mico dos pais. O estudo foi aprovado no Comit? de ?tica em Pesquisa e os pais assinaram o termo de consentimento livre e esclarecido. Resultados: Estudo 1: Sobrepeso e obesidade maternos est?o associados com natimortalidade, morte fetal e infantil. Sobrepeso e obesidade leve n?o parecem modificar o risco geral de nascimento prematuro, e o risco de nascimento prematuro induzido foi aumentado em mulheres com sobrepeso e obesidade. Defeitos cong?nitos como defeito do tubo neural, espinha b?fida, anomalias cardiovasculares, anomalias do septo, fenda palatina, l?bio leporino e fenda palatina, atresia anorretal, hidrocefalia, e anomalias de redu??o de membros est?o associados com sobrepeso e obesidade maternos. O risco de gastrosquise entre m?es obesas foi reduzida. N?o havia dados suficientes sobre os resultados do desenvolvimento neurol?gico, malforma??es anorretais em prole e risco de c?ncer testicular. Sobrepeso e obesidade maternos est?o associados com risco de asma e chiado nos filhos, e possui impacto negativo nos cuidados imediatos p?s-parto, tanto para a m?e quanto para o beb?. Estudo 2 ? Observou-se que m?es com sobrepeso e obesidade apresentam com maior frequ?ncia filhos com sobrepeso e obesidade do que m?es eutr?ficas. A mesma rela??o foi identificada para os pais. Al?m disso, observou-se que m?es que desenvolvem hipertens?o durante a gesta??o apresentam com maior frequ?ncia filhos com sobrepeso e obesidade. Todavia, a mesma rela??o n?o foi observada quando outros fatores como diabetes pr?-gestacional, diabetes gestacional e hipertens?o pr?-gestacional foram avaliados. Conclus?o: Sobrepeso e obesidade maternos est?o associados com uma s?rie de complica??es tanto para a m?e quando para o beb?, a curto, m?dio e longo prazo. Sugere-se que diretrizes para manuten??o de peso de mulheres que planejam engravidar deveriam definitivamente considerar estes resultados a fim de reduzir as taxas de sobrepeso e obesidade maternas e seus desfechos negativos nos filhos.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-07-12T18:58:42Z No. of bitstreams: 1 DIS_MORGANA_THAIS_CAROLLO_FERNANDES_PARCIAL.pdf: 412256 bytes, checksum: ed9b15670049bf6fd6c6f737d72389a7 (MD5) / Made available in DSpace on 2016-07-12T18:58:42Z (GMT). No. of bitstreams: 1 DIS_MORGANA_THAIS_CAROLLO_FERNANDES_PARCIAL.pdf: 412256 bytes, checksum: ed9b15670049bf6fd6c6f737d72389a7 (MD5) Previous issue date: 2016-03-31 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Objectives: The objective of this study is to analyze the effects of asthma and body mass on lung function in children. Methodology: Asthmatic children and healthy controls were recruited in public and private schools in Porto Alegre, Brazil. Spirometry, before and after bronchodilator was obtained in the Lung Function Laboratory (PUCRS) at the same time weight and height were measured. Lung function and body mass index were transformed to z-scoresfor all analysis using international equations. Results: 188 children (97 girls, 52%) were enrolled, 114(60%) with asthma and 85(45%) overweight. The mean and standard deviation of age, height and weight were 11.1+1.1, 146.7+8.4 and 44.2+12.3 respectively. There was a positive correlation between BMI and FVC and FEV1 and a negative correlation with FEV1/FVC. Children with asthmahad lower FEV1/FVC and FEF25-75 and higher FVC (p<0.05 for all). Overweight children had higher FVC and FEV1 and lower FEV1/FVC (p<0.05 for all). Stratifying the analysis by asthma (yes/no) and BMI (normal weight/overweight) we found significant differences between overweight asthmatic children and overweight/non-overweight controls for FEV1/FVC and FEF25-75 (ANOVA, p<0.01 for all comparisons). Overweight asthmatic children also had lower FEV1/FVC when compared to non-overweight asthmatic children (p<0.01 for all). There was a significant trend for higher FVC and lower FEV1/FVC and FEF25-75 in overweight children with asthma. (Jonckheere-Terpstra, p<0.01 for all analysis). Conclusion: It is noticed significant effect independent of asthma and overweight in lung function in schoolchildren. Both asthma and overweight reduce the FEV1 / FVC ratio / Objetivo: analisar o efeito de sobrepeso e da asma na fun??o pulmonar, avaliada por espirometria, em crian?as. M?todos: Crian?as asm?ticas e controles saud?veis foram recrutados em escolas p?blicas de Porto Alegre, Brasil. A espirometria foi obtida da fun??o pulmonar no Laborat?rio da PUCRS concomitante com a mensura??o do peso e altura. O ?ndice da fun??o pulmonar e a massa corporal foram transformados em z ? scores para todas as an?lises usando equa??es internacionais. Resultados: 188 crian?as (97 meninas, 52%) estavam matriculadas sendo 114 (60%) com asma e 85 (45%) com sobrepeso. A m?dia e o desvio padr?o da idade, altura e peso foram de 11,1 +/- 1,1; 146,7 +/- 8,4 e 44,2 +/- 12,3, respectivamente. Houve uma correla??o positiva entre IMC e CVF e FEV1 e uma correla??o negativa com FEV1/CVF. Crian?as com asma apresentaram menor FEV1/CVF e FEF25-75 e maior CVF (p<0,05). Crian?as com sobrepeso apresentaram maior CVF e FEV1 e menor FEV1/CVF (p < 0,05). Ao estratificar a an?lise por asma (sim/n?o) e IMC (peso normal/sobrepeso) encontramos diferen?as significativas entre as crian?as asm?ticas com sobrepeso e controles com sobrepeso para FEV1 /FVC e FEF25-75 (ANOVA, p <0,01 para todas as compara??es). Crian?as asm?ticas com sobrepeso tamb?m tiveram menor FEV1/CVF quando comparadas com crian?as asm?ticas eutr?ficas (p < 0,01). Houve uma tend?ncia significativa para uma maior CVF e inferior FEV1/ CVF e FEF25-75 em crian?as com sobrepeso asm?ticas (Jonckheere - Terpstra, P < 0,01 para todas as an?lises). Conclus?es: Percebe-se efeito significativo e independente de asma e sobrepeso na fun??o pulmonar de escolares. Tanto asma como sobrepeso reduzem a ?rela??o VEF1/CVF?.

Made available in DSpace on 2014-12-17T14:46:57Z (GMT). No. of bitstreams: 1 IsabelCAB_DISSERT.pdf: 1600486 bytes, checksum: ab229dc78da9cca193f0ec32c490887f (MD5) Previous issue date: 2012-11-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aimed to describe nurses' actions in the strategy of Integrated Management of Childhood Illness in the city of Natal, Rio Grande do Norte. This is a qualitative study with descriptive approach. The universe consisted of nurses from the Family Health Strategy, totaling 16 participants. For the research project was submitted for approval by the Ethics Committee of the Universidade Federal do Rio Grande do Norte, obtaining Opinion No. 187/2012. Data were obtained in two ways: a questionnaire survey to profile the training of nurses and an interview guided by a structured interview. Interviews were treated in the light of analysis of thematic category Bardin. The results showed the central thematic study "Integrated Management of Childhood Illness in the context of nursing activities" category and three analyzes: "Understanding the Integrated Management of Childhood Illness", "Difficulties invibializam use IMCI "and" Working conditions for nurses in the Integrated Management of Childhood Illness. " It is observed that nurses consider the Integrated Management of Childhood Illness useful, effective and important to keep sick children within the logic curative. However disregard the character of health promotion and disease prevention thereof. It was found that the participants still hold the attendance of crina?as within the biomedical model and that these same professionals are subjected to increasingly precarious working conditions and unhealthy due to lack of human and material resources. It was found that the interviewees do not follow the protocols of strategy because of barriers related to prescription medications by nurses, the medical, the lack of incentives, training and supervision by the municipal health and the Regional Nursing Council / A presente pesquisa teve como objetivo descrever a atua??o do enfermeiro na estrat?gia de Aten??o Integrada ?s Doen?as Prevalentes na Inf?ncia no munic?pio de Natal, Rio Grande do Norte. Trata-se de um estudo qualitativo com abordagem descritiva. O universo foi constitu?do por enfermeiros da Estrat?gia Sa?de da Fam?lia, totalizando 16 participantes. Para a realiza??o da pesquisa o projeto foi submetido ? aprova??o do Comit? de ?tica e Pesquisa da Universidade Federal do Rio Grande do Norte, obtendo Parecer n? 187/2012. Os dados foram obtidos de duas formas: um question?rio, para levantamento do perfil de forma??o das enfermeiras e uma entrevista guiada por um roteiro estruturado. As entrevistas foram tratadas ? luz da an?lise categorial tem?tica de Bardin. Os resultados permitiram identificar a tem?tica central estudo &#8213;A Aten??o Integrada ?s Doen?as Prevalentes na Inf?ncia no contexto da atua??o da enfermagem&#8214; e tr?s categoria de an?lises: &#8213;Entendimento sobre a estrat?gia Aten??o Integrada ?s Doen?as Prevalentes na Inf?ncia&#8214;, &#8213;Dificuldades que invibializam a utiliza??o da AIDPI&#8214; e &#8213;Condi??es de trabalho dos enfermeiros na Aten??o Integrada ?s Doen?as Prevalentes na Inf?ncia&#8214;. Observa-se que as enfermeiras consideram a Aten??o Integrada ?s Doen?as Prevalentes na Inf?ncia util, eficaz e importante para acompanhar crian?as doentes dentro da l?gica curativista. Entretanto desconsideram o carater de promo??o da sa?de e preven??o de doen?as da mesma. Constatou-se que as participantes ainda realizam o atendimento das crina?as dentro do modelo biom?dico e que essas mesmas profissionais s?o submetidas a condi??es de trabalho precarizadas e insalubres em virtude da falta de recursos humanos e materiais. Verificou-se que as entrevistadas n?o seguem os protocolos da estrat?gia em virtude de entraves relacionados a prescri??o de medicamentos pelo enfermeiro, o ato m?dico, a falta de incentivo, capacita??o e fiscaliza??o por parte da gest?o municipal de sa?de e do Conselho Regional de Enfermagem

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2015-10-26T21:46:19Z No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) / Approved for entry into archive by Elisangela Moura (lilaalves@gmail.com) on 2015-10-26T22:27:05Z (GMT) No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) / Made available in DSpace on 2015-10-26T22:27:05Z (GMT). No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) Previous issue date: 2014-06-04 / O per?odo neonatal, que compreende os primeiros 27 dias p?s-parto, ? uma fase considerada de vulnerabilidade ? sa?de infantil, fazendo-se necess?rio uma maior vigil?ncia pelo profissional de sa?de atrav?s de a??es que valorizam o bin?mio m?e/filho e o atendimento integral ao rec?m-nascido. Para tanto, esse trabalho objetivou avaliar as a??es de aten??o, a partir das estrat?gias preconizadas pelo Minist?rio da Sa?de. Trata-se de um estudo de corte transversal realizado a partir do banco de dados da pesquisa nacional de base populacional intitulada ?Chamada Neonatal: avalia??o da aten??o ao pr?-natal e aos menores de um ano nas regi?es Norte e Nordeste?. Utilizou-se como unidade amostral as m?es e as crian?as menores de 1 ano que compareceram a campanha de vacina??o do dia 12 de junho de 2010 nos nove munic?pios potiguares priorit?rios para o Pacto de Redu??o da Mortalidade Infantil e Neonatal. Para compor as vari?veis de estudo foram selecionadas as quest?es/a??es referentes ao per?odo neonatal e aos fatores sociodemogr?ficos, seguidas de uma an?lise descritiva e inferencial. Obteve-se uma amostra de 837 pares m?e/filho, sendo 57,6% na capital e 42,4% no conjunto dos interiores, que foi ponderada para representar os munic?pios do Estado. Predominaram as m?es com idade entre 20-29 anos, ensino m?dio completo, n?o benefici?rio de programa de transfer?ncia de renda; e crian?as do sexo masculino (51,2%). A freq??ncia das a??es de ?mbito hospitalar variou de 35% a 96% e as realizadas na Unidade B?sica de Sa?de (UBS) de 57% a 91,2%. A maioria das a??es teve associa??o com os hospitais de natureza p?blica e com a capital do estado (p<0,05). Os resultados para a maioria das a??es est?o abaixo do preconizado nos programas e pol?ticas de aten??o ? crian?a, e revelam as iniq?idades regionais em sa?de e a necessidade de envolvimento dos servi?os e dos profissionais na busca da integralidade do cuidado para possibilitarem melhor assist?ncia atrav?s de pr?ticas humanizadas nesse per?odo de maior vulnerabilidade. / The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality?s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-10T16:23:05Z No. of bitstreams: 1 LarissaSoaresMarizVilarDeMiranda_TESE.pdf: 4535335 bytes, checksum: 48759bc42966aaeb7bd343ebe37c100a (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-10T20:48:39Z (GMT) No. of bitstreams: 1 LarissaSoaresMarizVilarDeMiranda_TESE.pdf: 4535335 bytes, checksum: 48759bc42966aaeb7bd343ebe37c100a (MD5) / Made available in DSpace on 2017-02-10T20:48:39Z (GMT). No. of bitstreams: 1 LarissaSoaresMarizVilarDeMiranda_TESE.pdf: 4535335 bytes, checksum: 48759bc42966aaeb7bd343ebe37c100a (MD5) Previous issue date: 2016-05-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O cuidado do enfermeiro ? crian?a obesa na Aten??o B?sica de Sa?de torna-se um desafio, uma vez essa aten??o requer participa??o ativa de todos envolvidos. Paralelamente, a obesidade ? um dos problemas de sa?de de maior crescimento em todo o mundo. Nesse ?mbito, o enfermeiro ? o profissional que pode atuar na preven??o, avalia??o e tratamento da obesidade. Para essa pr?tica se efetive com maior qualidade ? necess?rio tamb?m de investimento te?rico. O objetivo do estudo foi compreender os significados do cuidado da crian?as obesas atribu?dos pelo enfermeiro que atua na Aten??o B?sica e descrever o modelo te?rico. Utilizou-se o m?todo da Teoria Fundamentada nos Dados e o referencial te?rico/filos?fico de Virginia Henderson. A pesquisa foi realizada em Unidades B?sicas, Unidades de Sa?de da Fam?lia, e Servi?os Especializados localizados em Campina Grande/Para?ba, Brasil, com 24 participantes que formaram quatro grupos amostrais: 11 enfermeiros da Aten??o B?sica em Sa?de, quatro cuidadores de crian?as obesas, cinco profissionais da sa?de e quatro gestores de sa?de. Dados foram coletados por meio de entrevista semiestruturada, entre abril a outubro 2015, e analisados pelo m?todo de compara??o constante. A an?lise realizou-se pela codifica??o inicial, constru??o de diagramas e memorandos, codifica??o axial, codifica??o seletiva e reflex?o sobre o paradigma e a teoria emergente. Seis categorias emergiram dos dados: Identificando processos que determinam a descontinuidade do cuidado ? crian?a obesa nas unidades de sa?de ? condi??o causal; Caracterizando a fragilidade da corresponsabilidade dos pais no cuidado a crian?a obesa ? consequ?ncia; Interagindo com a equipe multiprofissional no cuidado ? condi??o interveniente; Vislumbrando novas perspectivas para o cuidado do enfermeiro e Atendendo a preocupa??o por novos processos do cuidado de enfermagem ? a??es/intera??es estrat?gicas; e Movendo-se nos cen?rios do cuidado de enfermagem ? contexto. Mediante as rela??es e intera??es das categorias, surgiu o modelo te?rico explicativo: O enfermeiro preocupando-se com o cuidado ? crian?a obesa como ?rea negligenciada na aten??o b?sica de sa?de. O modelo te?rico permite a compreens?o do cuidado de enfermagem ? crian?a obesa como uma rede de rela??es e intera??es complexas, permeada pela preocupa??o com o estado de sa?de da crian?a obesa, mas sem alcan?ar a??es efetivas e cont?nuas. Esse cuidado perpassa pela individualidade da assist?ncia, necessitando de corresponsabiliza??o de enfermeiros, profissionais especializados, gestores e familiares. Em meio a ?rea de sa?de negligenciada na Aten??o B?sica de Sa?de, o enfermeiro identifica a necessidade de prestar cuidado a uma popula??o que n?o possui prioridade de atendimento em meio ? prec?ria organiza??o f?sica, material e estrutural dos servi?os, bem como humana e te?rico dos profissionais. Como reflexo, os pais e cuidadores permanecem longe do entendimento da obesidade na inf?ncia e se distanciam da responsabilidade compartilhada. Conclui-se que o cuidado ? crian?a obesa, pelo enfermeiro, configura significados constru?dos a partir das experi?ncias vivenciadas da pr?tica, que refletem princ?pios intr?nsecos ao profissional e concep??es preestabelecidas. Em conjunto, direcionam a forma como o cuidado ? dispensado, de agir e de se comportar frente a crian?as obesas, estabelecendo rela??es com a multiplicidade de fatores contextuais e de sujeitos, interagindo em um processo complexo. / Obesity is a major problem worldwide. In children, its care is a challenge because it requires Nursing care of the obese child is a challenge in Primary Health Care because it requires the active participation of all involved. In parallel to this concern, is the fact that obesity is a major health problem that is growing globally. In this context, the nurse can act in its prevention, identification, assessment, and treatment. Qualified practice in this area, however, requires theoretical investment. The objective of the study was to understand the meanings that nurses in Primary Health Care attribute to the care of obese children and to describe a theoretical model that explains the process. The study used the Grounded Theory method and Virginia Henderson?s theoretical/philosophical perspective. Data were collected in Primary Care Health Units, Family Health Units, and Specialized Health Services in Campina Grande, Paraiba, Brazil, during the months of April to October 2015. A total of 24 participants formed four theoretical sample groups: 11 Primary Health Care nurses, four caretakers, five health professionals, and four health service managers. Data were collected during the months of April to October 2015 by semi-structured interviews and analyzed by the constant comparison method. The analysis consisted of the initial coding, diagram and memorandum construction, axial and selective coding, and reflection of the emerging paradigm and theory. Six categories emerged from the data: Identifying processes that determined the discontinuity of care to the obese child in the health unit ? causal condition; Characterizing the fragile parental co-responsibility of care to the obese child ? consequence; Interacting with the multi-professional care team ? intervening condition; Envisioning new perspectives for the nurse?s care and Attending to the preoccupation for new processes of nursing care ? strategic actions/interactions; and Moving within the nursing care scenarios ? context. The categories? interrelations and interactions gave rise to the theoretical explicative model: The nurse worrying about the care of the obese child as a neglected area in Primary Health Care. The theoretical model provides a comprehension of the nursing care of the obese child as a web of complex relations and interactions that is permeated by the concern for the child?s health, but that is devoid of effective and continuous actions. The care surpasses individual attention and needs the shared responsibility of nurses, specialized professionals, health service managers and family. In midst of the Primary Health Care neglected area, the nurse identifies the need for care of a population that does not have priority attention in the health service units with precarious structural and human resources conditions. This reflects on the parents? and caretakers? lack of understanding of infantile obesity and on their distancing from the collective responsibility. It is concluded that the nursing care of the obese child configures meanings derived from the lived experience of practice and reflects intrinsic professional principles and pre-established concepts. As a whole, the meanings direct the way that care is provided, of action, and of its behavior with obese children, establishing relationships with the multiple contextual factors and the subjects, and interacting in a complex process.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-14T22:45:01Z No. of bitstreams: 1 JefersonMessiasDeAlencarCruz_DISSERT.pdf: 1509574 bytes, checksum: f35fc4a6f16bff7cfc084902e46bf307 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-16T21:19:29Z (GMT) No. of bitstreams: 1 JefersonMessiasDeAlencarCruz_DISSERT.pdf: 1509574 bytes, checksum: f35fc4a6f16bff7cfc084902e46bf307 (MD5) / Made available in DSpace on 2017-03-16T21:19:29Z (GMT). No. of bitstreams: 1 JefersonMessiasDeAlencarCruz_DISSERT.pdf: 1509574 bytes, checksum: f35fc4a6f16bff7cfc084902e46bf307 (MD5) Previous issue date: 2016-09-16 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O trabalho ocupa um importante espa?o na vida dos indiv?duos, assim muitas vezes pode contribuir de forma negativa na sa?de e qualidade de vida no trabalho (QVT) desses indiv?duos. O objetivo do estudo foi avaliar a QVT, a preval?ncia de ansiedade e sintomatologia depressiva entre os profissionais de sa?de que atuam em unidades hospitalares de pediatria e neonatologia, no munic?pio de Natal/RN. Trata-se de um estudo observacional de corte transversal, realizado entre dezembro de 2015 a abril de 2016. A amostra do tipo conveni?ncia foi composta por 102 profissionais da sa?de (m?dicos, enfermeiros, t?cnicos/auxiliares de enfermagem e fisioterapeutas). Para se verificar o perfil ocupacional e sociodemogr?fico foi utilizado uma ficha desenvolvida pelos autores, para a avalia??o da QVT e a preval?ncia de ansiedade e depress?o nessa popula??o, foram utilizados instrumentos e question?rios espec?ficos validados ? realidade brasileira. O perfil dos profissionais de sa?de foi caracterizado por uma idade m?dia de 36 (?8,3), do g?nero feminino (82,4%), solteiro (44,1%), com renda de at? 9 Sal?rios m?nimos (76,5%), atuavam em unidades de terapia intensiva (69,6%), em escalas de plant?o diurnas/12 horas (45,1%) e a maioria possu?a mais de um v?nculo empregat?cio em outras unidades hospitalares (53,9%). A m?dia de horas trabalhadas nos setores pesquisados foi de 33,6 (?8,4) horas/semanais e 56,0 (?20,9) horas /semanais somando todos os v?nculos. As principais causas de insatisfa??o com o trabalho apontadas foram remunera??o (30,4%), condi??es de trabalho (19,6%), pouco tempo destinado a atividades sociais (17,6%), escala e regime de plant?es (16,7%) e o reconhecimento profissional (6,9%). Apresentaram escore final m?dio quanto ? QVT de 65,76 (?11,6) e em rela??o aos dom?nios da QVT verificou-se 62,86 (?13,8) no dom?nio ?F?sico/Sa?de?, 66,83 (?16,2) no dom?nio ?Psicol?gico?, 75,31 (?14,46) no dom?nio ?Pessoal?, e 58,03 (?14,05) no Dom?nio ?Profissional?. Verificou-se preval?ncia de 17,6% de ansiedade e 12,7% de sintomatologia depressiva entre os profissionais de sa?de que atuam em unidades hospitalares na aten??o ? sa?de infantil. Concluiu-se, ent?o, que os profissionais da sa?de apresentaram QVT satisfat?ria em todos os seus dom?nios, e que a preval?ncia de ansiedade e depress?o se mostraram associadas ao dom?nio ?F?sico/Sa?de? da QVT, o que sugere que medidas voltadas ? preven??o e promo??o de sa?de, melhoria nas condi??es de trabalho, bem como a valoriza??o profissional devem ser incentivadas com o intuito de se resguardar a sa?de nessa popula??o. / The work plays an important role in the lives of individuals and can often contribute negatively on the health and quality of working life (QWL) of these individuals. The aim of this study was to assess the QWL, the prevalence of anxiety and depressive symptoms among health professionals working in hospitals of pediatrics and neonatology in the city of Natal / RN. This is an observational cross-sectional study, conducted from December 2015 to April 2016. We used a convenience sampling (or availability sampling) of 102 healthcare professionals (physicians, nurses, nursing assistants and physiotherapists). In order to check the occupational and sociodemographic profile was used a form developed by the authors. For the assessment of QWL and the prevalence of anxiety and depression in this population we used specific instruments and questionnaires validated for the Brazilian context. The profile of health professionals was characterized by a mean age of 36 (? 8.3) years old, female (82.4%), single (44.1%), with income of up to nine Brazilian minimum wages (76.5%), working in intensive care units (69.6%) in part-time (12 hours, day shift) (45.1%) and the mostly of health professionals had more than one job in others hospitals (53.9%). The average hours worked in the hospitals surveyed was 33.6 (? 8.4) hours per week and 56.0 (? 20.9) hours per week when all shifts were summed. The main causes of dissatisfaction with the work were ?income/salary? (30.4%), ?working conditions? (19.6%), ?few time for social activities? (17.6%),?shifts and work schedule? (16.7 %) and ?professional acknowledgment? (6.9%). The final score of QWL was 65.76 (?11.6) and about QWL?s domains was found 62.86 (? 13.8) for "Physical and Health?, 66.83 (?16 2) for "psychological", 75.31 (?14.46) for "Personal" and 58.03 (?14.05) for the "Professional". The prevalence of anxiety was 17.6% and 12.7% for depressive symptoms among healthcare professionals working in children?s hospitals. In conclusion, we observed in this study that healthcare professionals presented satisfactory QWL in all domains. However, the prevalence of anxiety and depressive symptoms was associated to low scores of "Physical and Health" field from QWL, which suggests that interventions towards prevention and health promotion, improvement of work conditions, as well as professional valorisation should be more encouraged to improve the quality of life in this population.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-05-08T23:23:44Z No. of bitstreams: 1 IlanaBarrosGomesMedeiros_DISSERT.pdf: 11041280 bytes, checksum: 0b0603616a969c799fa4b0b4aeb36253 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-05-08T23:32:51Z (GMT) No. of bitstreams: 1 IlanaBarrosGomesMedeiros_DISSERT.pdf: 11041280 bytes, checksum: 0b0603616a969c799fa4b0b4aeb36253 (MD5) / Made available in DSpace on 2017-05-08T23:32:51Z (GMT). No. of bitstreams: 1 IlanaBarrosGomesMedeiros_DISSERT.pdf: 11041280 bytes, checksum: 0b0603616a969c799fa4b0b4aeb36253 (MD5) Previous issue date: 2014-12-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O acompanhamento coletivo do Crescimento e Desenvolvimento (CD) da crian?a desponta como reorienta??o do modelo assistencial biom?dico e busca incentivar o uso de tecnologias leves e a melhoria da qualidade de vida dos usu?rios. Esta forma de cuidado constitui uma a??o em constru??o e expans?o para outras Unidades, o que o torna vulner?vel a um fazer aleat?rio, j? que n?o h? garantia de sistematiza??o que assegure sua legitima??o. Al?m disso, o pr?prio trabalho com grupo, na rede b?sica, de modo geral, corre o risco de centralizar suas a??es na doen?a, como reflexo ainda do modelo biom?dico vigente. O acompanhamento coletivo pode estar vulner?vel a estes problemas, o que demanda a necessidade de conhecer a sua operacionaliza??o. Objetivou-se analisar a pr?tica e a expans?o do acompanhamento coletivo do CD da crian?a em Estrat?gias de Sa?de da Fam?lia (ESF) do munic?pio de Natal/RN. Trata-se de uma pesquisa qualitativa, tendo como m?todo a pesquisa-a??o. Envolveu onze enfermeiras de quatro ESF do munic?pio de Natal, no per?odo de abril a outubro de 2014. Os dados foram coletados atrav?s de entrevista grupo focal e observa??o participante, e analisados de acordo com o direcionamento da an?lise tem?tica de Paulo Freire. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da UFRN, parecer n? 562.315, seguindo a Resolu??o N? 466/2012 do Conselho Nacional de Sa?de. Na etapa do diagn?stico situacional, que investigou a operacionaliza??o do acompanhamento coletivo do CD da crian?a pelas enfermeiras, percebeu-se que estas buscam realiz?-lo com base na organiza??o e planejamento pr?vios, de forma a ser o mais qualitativo poss?vel. Compreendem a import?ncia e os benef?cios desta atividade, sobretudo no tocante ao emponderamento dos usu?rios. Entretanto, identificou-se a falta de sistematiza??o deste acompanhamento em virtude dos modos distintos de sua operacionaliza??o por parte das profissionais. Percebeu-se ainda a aus?ncia do apoio da equipe de sa?de, o que gera insatisfa??o nas mesmas. Mediante a necessidade de mudan?a desta realidade, decidiu-se, conjuntamente, a constru??o de um instrumento que sistematizasse as a??es, bem como a realiza??o de capacita??es para sensibilizar o apoio por parte das equipes. Na etapa de implementa??o, as enfermeiras demonstraram grande interesse pelo check-list constru?do atrav?s de roda de conversa, entretanto, em rela??o ?s capacita??es, a pesquisadora n?o conseguiu implement?-las de maneira satisfat?ria, devido a indisponibilidade das equipes e de algumas enfermeiras. Constatou-se que estas avaliaram positivamente sua participa??o na pesquisa, a qual favoreceu a troca de experi?ncias e a mudan?a nos pontos negativos, al?m de ter instigado a parceria entre os cuidadores e os profissionais. Como sugest?es para o futuro, as enfermeiras elencaram o incentivo ? realiza??o de mais pesquisas nesse campo e o constante apoio da UFRN, e reivindicaram uma especializa??o em sa?de da crian?a. Como principais dificuldades, destacam-se o alto ?ndice de enfermeiras faltosas nos grupos focais; a pouca motiva??o de algumas participantes, bem como da diretoria de uma ESF e a falta de participa??o da equipe de sa?de na a??o de capacita??o. Assim, constata-se que diante das expans?es desordenadas desta abordagem grupal, pesquisas nesta ?rea devem ser constantemente incentivadas para o seu maior aperfei?oamento. / The collective monitoring of the child?s growth and development (GD) stands out as redirection of the biomedical health care model and seeks to encourage the use of soft technologies and improve the quality of life of users. This way of care is an action for construction and expansion to other units, which makes it vulnerable to a random practice, since there is no guarantee of systematization to ensure its legitimization. In addition, the group work itself, within the primary network, in general, runs the risk of of focusing its actions on the disease by reflecting the biomedical model still prevailing. The collective monitoring may be vulnerable to these problems, which requires the need to know its operationalization. This study had the objective of analyzing the practice and expansion of the collective monitoring of the GD of children in Family Health Strategies (FHS) from the municipality of Natal/RN. This is a qualitative research that had the research-action as its method. It encompassed eleven nurses of four FHS from the municipality of Natal in the period between April and October 2014. Data were collected through focus group and participant observation, and they were analyzed in accordance with the direction of the thematic analysis of Paulo Freire. The study was approved by the Research Ethics Committee from the UFRN, Opinion n? 562.315, and met the Resolution n? 466/2012 of the National Health Council. At the stage of situational diagnosis, which investigated the operationalization of the collective monitoring of the GD of children by nurses, we realized that they seek to accomplish it with basis on prior planning and organization, in such a way as to make it as qualitative as possible. They understand the importance and benefits of this activity, especially concerning the empowerment of users. Nevertheless, the lack of systematization of this monitoring has been identified because of the different modes of its operationalization on the part of professionals. Furthermore, the lack of support from the health team was realized, which leaves them unsatisfied. Due to the need to change this reality, we have decided to jointly construct an instrument able to systematize the actions, as well as to conduct training courses to sensitize the support on the part of teams. At the stage of the implementation, the nurses showed great interest in the check-list constructed through conversation circles; however, regarding training courses, the researcher has failed to implement them in a satisfactory way because of the unavailability of teams and of some nurses. We have found that they rated their participation in the survey in a positive manner, which fostered the exchange of experiences and the change of negative points, besides having instigated the partnership between caregivers and professionals. As suggestions for future, the nurses have listed the encouragement of further researches in this field and the constant support on the part of the UFRN, and called for a specialization in child?s health. As main difficulties, one should highlight the high rate of faults among nurses belonging to the focus groups; the little motivation of some participants, as well as of the board of directors of a FHS and the lack of participation of the health team in training actions. Accordingly, one can find that, given the disorganized expansion of this group approach, the researches in this area should be constantly encouraged to achieve a greater improvement.

Submitted by Natalie Mendes (nataliermendes@gmail.com) on 2015-07-23T01:15:43Z No. of bitstreams: 1 Disserta??o - Mayra da Silva Marques.pdf: 2679058 bytes, checksum: 0dd7829b60b919d6cf857fe899d69ee2 (MD5) / Made available in DSpace on 2015-07-23T01:15:43Z (GMT). No. of bitstreams: 1 Disserta??o - Mayra da Silva Marques.pdf: 2679058 bytes, checksum: 0dd7829b60b919d6cf857fe899d69ee2 (MD5) Previous issue date: 2014-03-31 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Exclusive breastfeeding is recommended by the World Health Organization from birth until six months of age since breast milk is the most complete food for nutrition at this stage in life and effectively contributes to reducing illnesses and deaths in children. However, expanding the membership of the practice of exclusive breastfeeding is still a major challenge for public health in Brazil today. Consequently, knowledge of the factors associated with the discontinuation of exclusive breastfeeding is critical to the development of actions to promote and protect children?s health. Objective: To investigate the frequency of exclusive breastfeeding and associated factors its interruption among mothers of infants 0?6 months old in Santo Ant?nio de Jesus, Bahia. Methods: This thesis is presented in the form of an article entitled ?The practice of exclusive breastfeeding and its associated factors its interruption?. This article employed the cross-sectional study design type involving 278 mothers of children under six months of age, all from the village of Santo Ant?nio de Jesus. Data were collected through a questionnaire administered through interviews. Results: It was found that the prevalence of exclusive breastfeeding was 39.6% in the sample studied. The interruption of associated exclusive breastfeeding was with the following variables: parity [RP=0,59; IC95% (0,44 ? 0,78)], race/color maternal [RP= 1,84; IC95% (1,03 ? 3,60)], an institution not supportive of breastfeeding [RP= 0,58; IC95%(0,43 ? 0,77)], lack of support for breastfeeding [RP= 0,57; IC95%(0,34 ? 0,95)], satisfaction with the act of breastfeeding [RP = 2,79; IC95%(1,12 ? 4,03)], birth weight of the child [(RP=0,57; IC95%(0,33 ? 0,98)], non-nutritive sucking habits [RP=0,55; IC95%(0,34 ? 0,95)] and medical care or nursing [RP=1,68; IC95% (1,03? 3,19)]. Conclusion: The findings point to an association between the interruption of exclusive breastfeeding and factors related to sociodemographic characteristics, maternal characteristics, and the child. / O aleitamento materno exclusivo (AME) ? recomendado, desde o nascimento at? os seis meses de idade, pela Organiza??o Mundial de Sa?de, vez que o leite materno ? o alimento mais completo para a nutri??o, nessa fase da vida, contribuindo efetivamente para redu??o da morbimortalidade infantil. Por?m, ampliar a ades?o ? pr?tica de AME representa, ainda hoje, um grande desafio para a sa?de p?blica brasileira. Consequentemente, conhecer os fatores associados ? interrup??o do AME ? fundamental para desenvolver a??es de promo??o e prote??o da sa?de infantil. Objetivo: Investigar a frequ?ncia de AME e os fatores associados a sua interrup??o entre m?es de crian?as de 0 a 6 meses de idade, no munic?pio de Santo Ant?nio de Jesus-BA. M?todos: A presente disserta??o apresentada em forma de artigo intitulado ?A pr?tica do aleitamento materno exclusivo e fatores associados a sua interrup??o? empregou o desenho de estudo do tipo corte transversal que envolveu 278 m?es de crian?as menores de seis meses de idade, todas da zona urbana do munic?pio de Santo Ant?nio de Jesus. Os dados foram coletados atrav?s da aplica??o de um question?rio, realizada mediante entrevista. Resultados: Verificou-se que a preval?ncia do AME foi de 39,6% na amostra estudada. Houve associa??o entre interrup??o do AME e os seguintes fatores: primiparidade [RP=1,45; IC95% (1,16 ?1,82)], ra?a/cor materna [RP= 0,75; IC95% (0,60 ? 0,93)], institui??o n?o incentivadora do aleitamento materno [RP=1,8 (1,12- 2,88);], aus?ncia de acompanhamento da crian?a por m?dico ou enfermeiro [RP=1,29; IC95% (1,04 ? 1,59)], falta de apoio familiar para amamenta??o [RP= 1,31; IC95% (1,08-1,60)], insatisfa??o quanto ao ato de amamentar [RP = 1,45; IC95% (1,17-1,79)], baixo peso ao nascer da crian?a [(RP=1,31; IC95% (1,07 - 1,60)] e h?bito de suc??o n?o nutritiva [RP=1,78; IC95% (1,19?2,67)]. Conclus?o: Os achados apontam para associa??o entre a interrup??o do AME e fatores relacionados a caracter?sticas sociodemogr?ficas, caracter?sticas maternas, bem como fatores relacionados ? crian?a. Estes dados refor?am a necessidade de realiza??o de diagn?sticos locais e pol?ticas p?blicas direcionadas ? prote??o e apoio ? amamenta??o exclusiva.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-01T18:29:01Z No. of bitstreams: 1 TES_ANDERSON_MOREIRA_ARISTIDES_DOS_SANTOS_COMPLETO.pdf: 2649410 bytes, checksum: 5f8d95108c2d9591253f391a37f3d5a4 (MD5) / Made available in DSpace on 2016-06-01T18:29:01Z (GMT). No. of bitstreams: 1 TES_ANDERSON_MOREIRA_ARISTIDES_DOS_SANTOS_COMPLETO.pdf: 2649410 bytes, checksum: 5f8d95108c2d9591253f391a37f3d5a4 (MD5) Previous issue date: 2016-04-11 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This doctoral dissertation presents three independent essays. At first, this paper analyzes the income-related inequalities and inequities in children?s health care, in the city of Pelotas, using longitudinal data from follows-up of 12 to 72 months. The methodology was based on concentration indexes (CI) and their decompositions. The main results showed that there are pro-rich inequalities and inequalities for all analyzed cases. The variables, which mostly contributed to the pro-rich inequity of health insurance and health insurance expenses, are income, asset index and mother?s education. In addition to these three variables, private health insurance (pro-rich) and child?s health variables (pro-poor) have a strong contribution in the CI of medicine use and expenses on medicines. There were reductions in inequality and inequity in the follow-up of 72 months. This reduction occurred with a higher gain or smaller decrease for the poor in health care variable. The second study analyzes the impact of Family Health Program (PSF) on the children?s health (under 12 years old) in Brazil?s rural area, using data from the PNAD (2008) and the PSM and OLS methods, applying sensitivity analysis proposed by Ichino et al. (2008) and Oster (2015). The results indicate that the PSF has statistically significant and high magnitude impact on the children?s health in Brazil?s rural area. However, it is concentrated in the North and Northeast regions, and, it is not significant in the Mid-South region. For the North region, this impact is independent of age, while in the Northeast is significant for younger age groups. The sensitivity analysis proposed by Ichino et al. (2008) reported robust results for the North region in all age groups, while in the Northeast region the robustness only occurred for children between 0 and 3 years old. Based on Oster?s (2015) approach, only the results of the North region in the smaller age groups were robust. Thus, there is confirmation of the hypothesis that this type of health care policy benefits the individuals of the poorest regions in the rural area. The aim of the third essay was to analyze the relationship between demand for imports of pharmaceutical chemicals and pharmaceutical and economic variables (exchange rate, import prices and aggregate income), using elasticities of the demand for imports, considering monthly data for the period 1997-2014 in Brazil. The regressions are estimated by Vector Error Correction model. The main results showed that increases in aggregate income and reductions in import prices have a positive and significant impact, respectively elastic and inelastic way, on imports. The exchange rate was significant only in the aggregate model. Thus, the aggregate income showed a very robust variable and with a strong impact on imports of pharmaceutical chemicals and pharmaceuticals. Considering the argumentation explained in the literature that the deficit in international trade of this industry has relationship with deficits in knowledge and technology, adding to the results found in this dissertation, there is evidence that, when the level of economic activity grows, a greater demand takes place for that type of product and there is no enough domestic production, there is the need for importations, which can generate pressures on the trade deficit in this segment. / Esta tese apresenta tr?s ensaios independentes em Economia da Sa?de. No primeiro, o objetivo ? analisar as desigualdades e iniquidades relacionadas ? renda dos cuidados em sa?de das crian?as na cidade de Pelotas, utilizando dados longitudinais dos acompanhamentos de 12 at? 72 meses. A metodologia foi baseada em ?ndices de concentra??o (IC) e suas decomposi??es. Os principais resultados mostraram que h? desigualdades e iniquidades pr?-rico para todos os casos analisados. As vari?veis que mais contribuem para a desigualdade pr?-rico do plano de sa?de e dos gastos com plano de sa?de s?o renda, ?ndice de posse e educa??o das m?es. Al?m dessas tr?s vari?veis, plano de sa?de (pr?-rico) e vari?veis de sa?de da crian?a (pr?-pobre) t?m forte contribui??o no IC do uso de medicamentos e dos gastos com medicamentos. Observou-se ainda que, houve redu??es na desigualdade e iniquidade no acompanhamento de 72 meses. Essa redu??o ocorreu com um maior ganho ou menor decr?scimo para os mais pobres na vari?vel de cuidados em sa?de. O segundo ensaio analisa o impacto do Programa Sa?de da Fam?lia (PSF) sobre a sa?de das crian?as (menores de 12 anos) da ?rea rural do Brasil com base nos dados da PNAD (2008). Para tanto, foram utilizados os m?todos Propensity Score Matching e M?nimos Quadrados Ordin?rios, aplicando an?lises de sensibilidade de Ichino et al. (2008) e Oster (2015). Os resultados indicaram que o PSF possui um impacto estatisticamente significativo e de magnitude elevada sobre a sa?de das crian?as da ?rea rural do Brasil. Contudo, ele est? concentrado nas regi?es Norte e Nordeste, sendo n?o significativo no Centro-Sul do pa?s. Na regi?o Norte esse impacto independe da idade, enquanto na regi?o Nordeste, ele ? significativo para as menores faixas de idade. A an?lise de sensibilidade proposta por Ichino et al. (2008) indicou que os resultados s?o robustos para o Norte em todas as faixas, enquanto para regi?o Nordeste a robustez ocorreu para as crian?as entre 0 e 3 anos de idade. Na abordagem de Oster (2015), apenas os resultados da regi?o Norte e das menores faixas de idade foram robustos. Por esses resultados, h? confirma??o da hip?tese de que as crian?as das regi?es mais pobres da ?rea rural s?o beneficiadas por esse tipo de pol?tica de cuidados em sa?de. Por fim, o terceiro ensaio analisa a rela??o entre a demanda por importa??es de produtos farmoqu?micos e farmac?uticos e vari?veis econ?micas (taxa de c?mbio, pre?o das importa??es e renda agregada), no Brasil, fazendo uso de dados mensais do per?odo 1997-2014. A regress?es foram estimadas via Vetor de Corre??o de Erros (VEC). Os principais resultados mostraram que aumentos na renda agregada e redu??es nos pre?os das importa??es t?m impacto positivo e significativo, respectivamente de forma el?stica e inel?stica, sobre as importa??es. A taxa de c?mbio foi significativa apenas no modelo mais agregado. Ent?o, a renda agregada se mostrou uma vari?vel bastante robusta e com forte impacto sobre as importa??es dos produtos farmoqu?micos e farmac?uticos. Considerando os argumentos explicitados na literatura de que o d?ficit no com?rcio internacional dessa ind?stria se relaciona com d?ficit em conhecimento e tecnologia, somando aos resultados encontrados nesta tese, h? ind?cios de que conforme o n?vel de atividade econ?mica cresce, ocorre uma maior demanda por esse tipo de produto, e, n?o havendo produ??o nacional suficiente, h? a necessidade de importa??es, o que pode gerar press?es no d?ficit comercial desse segmento.