Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-05T00:11:26Z No. of bitstreams: 1 AdrianoDeAguiarFilgueira_DISSERT.pdf: 2315845 bytes, checksum: f736f00f9cc7dec73b02712d122dd203 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-16T21:31:00Z (GMT) No. of bitstreams: 1 AdrianoDeAguiarFilgueira_DISSERT.pdf: 2315845 bytes, checksum: f736f00f9cc7dec73b02712d122dd203 (MD5) / Made available in DSpace on 2017-10-16T21:31:00Z (GMT). No. of bitstreams: 1 AdrianoDeAguiarFilgueira_DISSERT.pdf: 2315845 bytes, checksum: f736f00f9cc7dec73b02712d122dd203 (MD5) Previous issue date: 2017-07-26 / A garantia do acesso universal definido pela Constitui??o brasileira de 1988 e os recentes avan?os alcan?ados com a implanta??o da Pol?tica Nacional de Sa?de Bucal trouxeram resultados positivos em rela??o ao acesso e uso dos servi?os odontol?gicos, entretanto essa evolu??o aconteceu de forma desigual entre os diferentes grupos populacionais do pa?s. Apesar de diversos modelos te?ricos tentarem explicar a influ?ncia de diferentes fatores no uso dos servi?os de sa?de, lacunas importantes ainda persistem e exigem novas pesquisas com diferentes abordagens para um melhor entendimento das rela??es entre os determinantes sociais de sa?de e o acesso e uso dos servi?os odontol?gicos. Este estudo tem por objetivo analisar o uso dos servi?os de sa?de bucal e os principais fatores determinantes associados em jovens na faixa et?ria de 17 a 21 anos no munic?pio de Sobral, Cear?, a partir de diferentes desenhos metodol?gicos. O primeiro desenho trata-se de uma abordagem transversal e relacional distintos desfechos ao uso dos servi?os odontol?gicos com determinantes individuais. O segundo tamb?m desenvolveu um estudo seccional, por?m abordou os fatores contextuais e as rela??es com o uso dos servi?os de sa?de bucal. Nesse segundo momento, tamb?m foram elaborados mapas tem?ticos para uma melhor visualiza??o da distribui??o espacial das vari?veis contextuais e dos desfechos utilizados. O terceiro desenho consistiu em um estudo de coorte, onde foram criados perfis de trajet?rias referentes ao uso dos servi?os odontol?gicos e, posteriormente, foram relacionados com fatores individuais em dois momentos distintos da vida: inf?ncia e juventude. A amostra para todos os desenhos teve origem em uma coorte de sa?de bucal realizada no munic?pio de Sobral com dados coletados nos anos de 2000, 2006 e 2012. Os resultados apontam a influ?ncia dos fatores socioecon?micos, principalmente nos primeiros anos de vida, no acesso e uso dos servi?os de sa?de bucal, bem como no tipo de servi?o utilizado. A dor de dente em algum momento da vida esteve associada com a ida ao consult?rio odontol?gico em algum momento da vida e de ter sofrido nega??o ao acesso. A presen?a de condi??es indicativas de tratamento odontol?gico esteve relacionada com o maior uso dos servi?os odontol?gicos e com o acesso oportuno a eles. A visita n?o regular ao cirurgi?o-dentista parece aumentar a probabilidade de problemas bucais na juventude. Pensar pol?ticas p?blicas que visem uma melhor distribui??o de renda e inclus?o social, bem como a??es de promo??o e preven??o em sa?de bucal, podem contribuir com a melhoria dos aspectos relacionados ao uso dos servi?os odontol?gicos. / The assurance of universal access defined by the Brazilian Constitution of 1988 and the recent advances achieved with the implementation of the National Oral Health Policy have brought positive results in relation to the access and use of dental services, however this increase occurred unequally between the different population groups all over the country. Although several theoretical models have been trying to explain the influence of several factors on the use of health services, important gaps still persist and require new research with different approaches to a better understanding of the relationships between the social determinants of health and the access and use of dental services. This study aims to assess the use of oral health services and the main associated factors in young people aged 17 to 21 years in the city of Sobral, Cear?, based on different methodological designs. The first design is a cross-sectional approach relating the different outcomes related to the use of dental services with individual determinants. The second one also developed a cross-sectional study, but it addressed the contextual factors and the relationships with the use of oral health services. Thematic maps were also made for a better visualization of the spatial distribution of the contextual variables and the outcomes used. The third study consisted of a cohort study, where trajectory profiles were created regarding the use of dental services and how they are related to individual factors in two different moments of life: childhood and youth. The sample for all the designs was originated from a cohort of oral health performed in the municipality of Sobral with data collected in the years 2000, 2006 and 2012. The results indicate the influence of socioeconomic factors, especially in the first years of life, in the access and use of oral health services, as well as the type of service used. The toothache at some point in life was associated with going to the dental office at some point in life and having been denied access. The presence of dental treatment needs was related to the greater use of dental services and early access to them. A non-regular visit to the dentist seems to increase the likelihood of oral problems in youth. To implement public policies that aim at a better distribution of income and social inclusion, as well as actions of promotion and prevention in oral health, can contribute to the improvement of aspects related to the use of dental services

Made available in DSpace on 2014-12-17T14:46:55Z (GMT). No. of bitstreams: 1 MagnaMPS_DISSERT.pdf: 1336445 bytes, checksum: 2998e1c0551bf591c5ce1acc115c4190 (MD5) Previous issue date: 2011-11-18 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / A quantitative, descriptive, cross-sectional and retrospective study, using technical procedures of document consultation from secondary sources and health household survey with application form for face to face inter views, with the assent n?.039/2011 from the Ethics Committee of the Federal University of Rio Grande do Norte. The aim of this study was to analyze the cervix cancer control in the area47 of the Health Family Centre Nova Natal II. The cancer cervix is the second most common cancer among women worldwide. In Brazil screening for early detection and treatment of disease has been poorly done and follow-up to reduce mortality has not been executed. From a total of1170women belonging to area 47, who under went screening by the Pap test in the period from 2005 to 2010,was elected a sample of 38 women with positive cervical changes, over 18 years old. The calculation of frequency analysis of socio demographic and clinical and epidemiological selected variables with the results of cervical changes, using the X2 test and taking as significance level of p<0.05 was not statistically significant. The predominant age range was 25 to 64 years (68.9%), most no white women (60.5%), predominantly with primary education (57.9%), most married (68.4%) and housewives (68.4%) with early age of sexual activity (86.8%), the minority smokers (13.2%), with a sexual partner (36.8%). At the time of interview, 42.1% of the women voiced complaint of discharge, while only 2.6% reported bleeding. In relation to the occurrence of STDs (including HPV), 10.5% of women reported being a carrier. The use of oral contraceptives was 32.3% of women, from 2 to 4 years (44.4%). The result of the last screening test performed, showed prevalence of immature squamous metaplasia (55.3%), followed by intraepithelial low- grade lesion (including the cytopathologic HPV effect and cervical intra epithelial neoplasia grade I) (31.6%); intraepithelial high-grade lesion (including cervical intraepithelial neoplasia grade II and III) (7.9%), atypical squamous non neoplastic cells (5.3%). There was no squamous cell carcinoma and adenocarcinoma. Most women received information about the action that should be done after the last screening test result (55.3%), but how to perform follow, most women did not report having done so (55.3%). The follow-up group of women studied, with varying degrees of cervical abnormalities, should only be completed with the discharge by cure, established inconsecutive negative cytology, a goal that is not being achieved in the area 47 of the Health Family Centre of Nova Natal II / Estudo quantitativo realizado por meio de pesquisa descritiva, transversal e retrospectiva, utilizando procedimentos t?cnicos de consulta documental a fontes secund?rias e inqu?rito domiciliar com aplica??o de formul?rio de entrevistas face a face, ap?s parecer favor?vel n? 039/2011 do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte. O objetivo dessa pesquisa foi analisar a resolutividade do controle da neoplasia maligna do colo de ?tero na ?rea 47 da Unidade de Sa?de da Fam?lia Nova Natal II. A neoplasia maligna do colo de ?tero ? o segundo tipo de c?ncer mais frequente entre as mulheres no mundo. No Brasil o rastreamento para detec??o e tratamento precoces da doen?a tem sido efetuado precariamente e o seguimento, para reduzir a mortalidade, n?o tem sido executado. De um total de 1170 mulheres pertencentes ? ?rea 47, que se submeteram a rastreamento por meio do exame de Papanicolau, no per?odo de 2005 a 2010, elegeu-se uma amostra de 38 mulheres com resultado positivo de altera??es cervicais, maiores de 18 anos. A an?lise do c?lculo da frequ?ncia de vari?veis sociodemogr?ficas e cl?nico-epidemiol?gicas selecionadas com os resultados das altera??es cervicais, utilizando-se o teste de X2 e adotando como n?vel de signific?ncia p<0,05 n?o mostrou signific?ncia estat?stica. A faixa et?ria predominante foi de 25 a 64 anos (68,9%); a maioria parda (60,5%); com escolaridade predominante at? o ensino fundamental (57,9%); a maioria casada ou em conviv?ncia marital (68,4%) e donas de casa (68,4%); com in?cio precoce da atividade sexual (86,8%), a minoria fumante (13,2%), com um parceiro sexual (36,8%). No momento da entrevista, 42,1% das mulheres verbalizou queixa de corrimento, enquanto apenas 2,6% referiu sangramento. Em rela??o ? ocorr?ncia de DSTs (inclusive HPV), 10,5% das mulheres declarou ser portadora. Verbalizaram o uso de contraceptivos orais, 32,3% das mulheres, por 2 a 4 anos (44,4%). Quanto ao resultado do ?ltimo exame preventivo realizado, prevaleceu a metaplasia escamosa imatura (55,3%), seguido de les?o intraepitelial de baixo grau (compreendendo efeito citopatol?gico pelo HPV e neoplasia intra-epitelial cervical grau I) (31,6%); les?o intra-epitelial de alto grau (compreendendo neoplasias intra-epiteliais cervicais de grau II e III) (7,9%); c?lulas at?picas escamosas de significado indeterminado, possivelmente n?o neopl?sicas, (5,3%). N?o foi observado carcinoma de c?lulas escamosas e adenocarcinoma. A maioria das mulheres recebeu informa??es sobre o seguimento que deveria ser realizado ap?s o resultado do ?ltimo exame preventivo (55,3%), mas, quanto a realizar o seguimento, a maior parte das mulheres n?o referiu t?-lo feito (55,3%). O seguimento do grupo de mulheres analisadas, com diferentes graus de altera??es cervicais, somente deveria ser finalizado com a alta por cura, estabelecido em citologias consecutivas negativas, meta que n?o est? sendo atingida na ?rea 47 da Unidade de Sa?de da Fam?lia Nova Natal II

Made available in DSpace on 2014-12-17T14:13:21Z (GMT). No. of bitstreams: 1 LuizRobertoAN.pdf: 339362 bytes, checksum: c8e88397fe9377768e4a6dfe9e85ecfc (MD5) Previous issue date: 2008-04-18 / The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Cear? and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Cear? . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Cear?, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health / Os objetivos do presente trabalho foram analisar o acesso da popula??o infantil ao servi?o odontol?gico, identificar a preval?ncia de c?rie, gengivite e maloclus?o em crian?as residentes no munic?pio de Sobral Cear? e avaliar a incid?ncia da c?rie dent?ria em adolescentes, associando-a a fatores relativos ? condi??o s?cio-econ?mica, acesso ? servi?os de sa?de e estilo de vida. O presente estudo teve como fator preponderante a multidisciplinaridade representada pela participa??o de profissionais de sa?de (m?dicos, cirurgi?es-dentistas, enfermeiros) na constru??o do referencial inicial da pesquisa, estudantes de cursos da ?rea de Ci?ncias Humanas, na aplica??o do question?rio estruturado para entrevista domiciliar; estat?sticos na orienta??o das an?lises a serem realizadas e equipe de sa?de da fam?lia (agentes comunit?rios de sa?de, cirurgi?es-dentistas e auxiliares de consult?rio dent?rio) no agendamento e realiza??o dos exames bucais domiciliares. A amostra foi definida a partir do cadastro de domic?lios que inclu?a crian?as nascidas entre 1990 e 1994 para desenvolvimento da pesquisa Condi??es de sa?de das crian?as no munic?pio de Sobral Cear? . A primeira amostra foi composta por 3425 pais de crian?as entre 5 e 9 anos de idade residentes no munic?pio de Sobral Cear?, visando identificar os principais fatores relacionados ao acesso a servi?o odontol?gico. A partir desta amostra, foram selecionadas 1021 crian?as, de forma sistem?tica, para realiza??o do levantamento epidemiol?gico de c?rie, gengivite e maloclus?o. Na terceira fase do estudo, visando ? composi??o da coorte a ser acompanhada, foram examinados e entrevistados 688 adolescentes, a partir da busca ativa dos 1021 indiv?duos que haviam sido preliminarmente examinados. Observou-se que 50,9% das crian?as tiveram acesso ao tratamento odontol?gico pelo menos uma vez na vida. Deste total, 65,3% o realizaram no decorrer do ?ltimo ano pesquisado, sendo que 85,4% destes na rede p?blica, o que permite identificar a import?ncia deste segmento no acesso aos servi?os odontol?gicos. Observou-se que os fatores que mais afetaram o acesso ao servi?o odontol?gico foram os vinculados ? condi??o s?cio-econ?mica como acesso ? plano de sa?de, posse de escova dent?ria, coleta de lixo, escolaridade da m?e, tratamento do esgoto e desnutri??o. Em rela??o ?s doen?as bucais observou-se um aumento do CPO-D com a idade, de 0,10 aos cinco anos para alcan?ar 1,66 aos nove anos de idade, ocorrendo o inverso em rela??o ao ?ndice ceo-d, uma vez que aos cinco anos o ?ndice de 3,59 decai para 2,69 aos nove anos. Quanto ?s altera??es gengivais, em m?dia, 32,7% das crian?as apresentavam sangramento gengival. Quanto ? maloclus?o, observou-se que 60,33% das crian?as n?o apresentavam problema, 30,17% apresentavam problemas leves e 9,5% problemas severos de maloclus?o. A incid?ncia m?dia de c?rie foi de 1,86 dentes por adolescente. Entre as vari?veis estudadas, dor de dente nos ?ltimos seis meses, renda da m?e e merenda escolar, ajustadas pela percep??o sobre necessidade de tratamento, escolaridade da m?e e consulta ao dentista pelo menos uma vez na vida, foram as vari?veis que apresentaram rela??o positiva com a alta incid?ncia de c?rie dent?ria desta popula??o, a partir da regress?o log?stica. Vari?veis de natureza s?cio-econ?mica, relativas ao acesso aos servi?os de sa?de, comportamentais e biol?gicas apresentaram rela??o com a alta incid?ncia de c?rie. O estudo aponta para a necessidade de implanta??o de servi?os odontol?gicos vinculados ao desenvolvimento de a??es de sa?de de forma humanizada, desenvolvidas por equipes de sa?de bucal efetivamente vinculadas aos interesses da popula??o, que tenham como grande objetivo proporcionar, junto com os gestores dos servi?os p?blicos de sa?de, condi??es adequadas para melhoria da sa?de bucal

Made available in DSpace on 2014-12-17T14:13:21Z (GMT). No. of bitstreams: 1 MaisaPR.pdf: 2067639 bytes, checksum: 1a2a3fa9e8d9a7a58ce31eb1fae8d975 (MD5) Previous issue date: 2007-12-18 / The aim of this study was to learn about the social representations of the care provided by the Family Health Program (FHP) in the city of Natal, Brazil and determine how these representations guide the daily actions of doctors, dentists, nurses, nurse s assistants and oral health assistants during the work process. In this sense, we used the theoreticalmethodological approach to the Theory of Social Representations. For data collection, we used the following instruments: a two-part questionnaire, where the first part recorded sociodemographic data and the second part was adapted to the free word association technique (FWAT), which was applied to 90 professionals belonging to 18 FHP units. Interviews were also used as collection instruments. These were based on inductive stimuli and on direct observations of 30 of these professionals. After a superficial reading of the material, we constructed a corpus from which ten categories emerged. To analyze FWAT we used lexicographic analysis, combining frequency and the mean order of responses. The interviews and sociodemographic variables were analyzed using content analysis and descriptive statistical analysis, respectively. The study showed that the central nucleus of the social representation in question is composed of the elements attention, receptivity and love, revealing that the subjects have different understandings of the FHP care process and that the knowledge accumulated in this respect is supported by an approximate vision of the meaning of care. However, traditional elements with trivializing connotations about care predominate, which compromises the development of strategies to overcome traditional practices. In the set of analyses, we were able to capture the invariance of a contradiction: on one hand, professionals know and affirm the importance of providing care for FHP patients; on the other, the experience of daily practice translates into the negation of this concept. In this contradictory context, professionals build gradual and successive syntheses that allow them to act and affirm themselves by associating information from their academic formation, structured knowledge acquired in other experiences, values and symbols of their daily routine. Thus, they shape and reshape themselves, according to what is concretely and specifically required, at the same time both plural and multiple. The composition of the central nucleus indicates that any measure that intends to modify attitudes that is, the daily actions of FHP professionals with respect to care must take into account and give priority to the debate about the redefining of the semantic fields of the central nucleus (love/attention/receptivity and humanization), especially those of love and attention / Este estudo teve por objetivo apeender as Representa??es Sociais do cuidado das equipes do Programa Sa?de da Fam?lia (PSF) da cidade do Natal-RN e como essas representa??es orientam as a??es cotidianas desses sujeitos (m?dicos, dentistas, enfermeiros, auxiliares de enfermagem e auxiliares de sa?de bucal) durante o processo de trabalho. Nesse sentido, utilizamos como abordagem te?rica-metodol?gica a Teoria das Representa??es Sociais. Para a coleta de dados, lan?amos m?o dos seguintes instrumentos: um question?rio que na sua primeira parte destinava-se ? coleta dos dados sociodemogr?ficos e na segunda parte adaptado ? t?cnica de associa??o livre de palavras (TALP) que foi aplicado junto a 90 profissionais que comp?em as equipes em 18 unidades do PSF. Ainda como instrumentos de coleta foram realizadas entrevistas, a partir de est?mulos indutores, e tamb?m as observa??es diretas junto a 30 destes profissionais. Ap?s uma leitura flutuante do material, foi constitu?do um corpus para a an?lise do qual emergiram dez categorias. Para analisar a TALP utilizamos a an?lise lexicogr?fica combinando a freq??ncia e a ordem m?dia de evoca??es. As entrevistas e as vari?veis s?ciodemogr?ficas foram analisadas respectivamente a partir da an?lise de conte?do e da an?lise estat?stica descritiva. O estudo mostrou que o n?cleo central da representa??o social em quest?o est? composto pelos elementos aten??o, acolhimento e amor, revelando que os sujeitos apresentam diferentes entendimentos sobre o processo do cuidado no PSF e que o conhecimento constru?do a esse respeito est? amparado numa vis?o aproximada do sentido do cuidar. Entretanto, predominam elementos tradicionais e com conota??es banalizadas sobre o cuidado, o que dificulta o desenvolvimento de estrat?gias de supera??o das pr?ticas tradicionais. No conjunto das an?lises, foi-nos poss?vel captar a invari?ncia de uma contradi??o: de um lado, os profissionais sabem e afirmam a import?ncia da produ??o do cuidado junto aos usu?rios do PSF; de outro, a viv?ncia, na pr?tica cotidiana, traduz a nega??o desse fazer-cuidado. Nesse contexto contradit?rio, o profissional passa a construir s?nteses gradativas e sucessivas que lhe permitem agir e afirmar-se associando informa??es advindas da forma??o, de conhecimentos estruturados em outras experi?ncias, valores e s?mbolos demarcadores de seu cotidiano. Assim, ele se configura e xvi reconfigura na pr?tica, segundo o que ? exigido no seu fazer concreto e espec?fico, ao mesmo tempo em que plural e m?ltiplo. A composi??o do n?cleo central indica que qualquer curso ou capacita??o que pretenda modificar atitudes - portanto a a??o cotidiana dos profissionais do PSF relativas ao cuidado - deve levar em conta e priorizar o debate sobre a ressignifica??o dos campos sem?nticos do n?cleo central (amor/aten??o/acolhimento e humaniza??o), especialmente dos elementos aten??o e amor

Made available in DSpace on 2014-12-17T14:13:32Z (GMT). No. of bitstreams: 1 NilbaLS_Tese.pdf: 636235 bytes, checksum: 871e98d076a82a24e17c822a9ea7198e (MD5) Previous issue date: 2009-12-18 / Hypertensive syndromes in pregnancy (HSP) are configured as one of the major complications in the pregnancy and postpartum period and can lead premature newborn and subsequent hospitalization of the newborn to the Neonatal Intensive Care Unit (NICU). This study aimed to analyze the perceptions, meanings and feelings of mothers on the hypertensive syndromes in pregnancy and premature obstetric labor. The research was qualitative and has a theoretical methodological the Social Representations Theory(SRT) in the approach to the Central Nucleus Theory. The study included 70 women, mean age 29 years, predominantly school to high school, most of them married or in consensual union, primiparous and prevalence of cesarean delivery occurred between 32 and 37 weeks of pregnancy.The data were collected from may to december 2008 in the Maternity School Janu?rio Cicco in Natal , and obtained through the following instruments for data collection: questionnaire including questions about socio-demographic status; the Free Words Association Test (FWAT) and and verbalized mental image construction used three stimuli: such as pregnancy with high blood pressure, preterm birth and NICU, and interview with the following guiding question: what it meant for you to have a pregnancy with high blood pressure and consequently the birth of a premature baby? Data analysis was performed using multi-method obtained from the data processing by EVOC (Ensemble Programmes Permettant L 'Analyze des ?vocations) and ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segment de Texte) and thematic analysis in categories. The results will be presented in four thematic units under the following representative universes: HSP, prematurity as a result of HSP, NICU and the social representations of mothers on the hypertensive disorder of pregnancy sequenced premature birth and hospitalization of the child in the NICU. The results obtained by multimethod analyses showed similar constructions and point to death as the central nucleus and negative aspects, coping strategies, need of care, knowledge about the disease, fragility and meanings of the NICU as peripheral elements. It is considered that the perceptions, meanings and feelings of puerperal women in relation to HSPs and to premature delivery are a negative social representation, with representational elements that may have influenced the adverse effects on the disease and its consequences. We suggest action on the peripheral elements of this representation, with adequate orientation, early diagnosis, effective conduct, receptive attitude on the part of the team, health promotion measures and effective public policies, in order to improve the care provided to puerperal women, making them feel welcome and minimizing their suffering / As s?ndromes hipertensivas da gravidez (SHG) s?o complica??es do per?odo grav?dico puerperal e podem levar ? prematuridade neonatal e consequente hospitaliza??o do rec?m-nascido em Unidade de Terapia Intensiva Neonatal (UTIN). O estudo objetivou compreender percep??es, significados e sentimentos de pu?rperas relativos ?s SHGs que tiveram como consequ?ncia o parto prematuro e a hospitaliza??o do filho na UTIN. ? um estudo qualitativo que teve como referencial te?rico metodol?gico a Teoria das Representa??es Sociais (TRS), na abordagem complementar da Teoria do N?cleo Central. Participaram do estudo 70 mulheres ; com idade m?dia de 29 anos; a maioria com n?vel m?dio de escolaridade; em uni?o consensual; prim?paras e com parto ces?rio ocorrido entre 32 e 37 semanas de gesta??o. Os dados foram coletados de maio a dezembro de 2008, na Maternidade Escola Janu?rio Cicco, em Natal/RN, por meio de: question?rio para caracteriza??o sociodemogr?fica das participantes; t?cnica de associa??o livre de palavras (TALP); constru??o verbalizada de imagens mentais; e entrevista, com a seguinte quest?o norteadora: O que significou para voc? ter uma gravidez com press?o alta e, como consequ?ncia, o nascimento de um filho prematuro? A an?lise de dados foi realizada por meio de multim?todos, a partir do processamento de dados pelos software EVOC (Ensemble de programmes permettant L analyse des evocations) e ALCESTE (An?lise lexical por contexto em um conjunto de segmentos de texto), e an?lise tem?tica categorial. Os resultados foram apresentados em quatro unidades tem?ticas, no ?mbito dos seguintes universos representativos: SHG; prematuridade como consequ?ncia das SHGs; UTIN; e as representa??es sociais de pu?rperas sobre as SHGs seguidas do nascimento prematuro e hospitaliza??o do filho na UTIN. Os resultados obtidos por meio dos multim?todos de an?lise apresentaram constru??es semelhantes entre si e apontam a morte como n?cleo perif?rico, aspectos negativos, estrat?gias de enfrentamento, necessidades de cuidados, conhecimento sobre a doen?a, fragilidade e significados da UTIN. Considera-se que as percep??es, significados e sentimentos de pu?rperas relativas ?s SHGs e ao parto prematuro constituem uma representa??o social negativa, com elementos representacionais que podem ter influenciado os efeitos adversos sobre a doen?a e suas consequ?ncias. Sugere-se atua??o sobre os elementos perif?ricos dessa representa??o, com orienta??es adequadas, diagn?stico precoce, condutas efetivas, postura acolhedora da equipe, atitudes de promo??o ? sa?de e pol?ticas p?blicas eficazes, de forma a melhorar a assist?ncia ?s mulheres/pu?rperas, acolhendo-as adequadamente e minimizando seus sofrimentos

Made available in DSpace on 2014-12-17T14:13:33Z (GMT). No. of bitstreams: 1 RichardsonRSA_Tese.pdf: 1809117 bytes, checksum: 464fe0f4ad6e16db7d25aa3443366d02 (MD5) Previous issue date: 2009-12-18 / Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS / Objetivo: O prop?sito dessa investiga??o foi o de avaliar a aten??o ? sa?de de portadores de HIV/Aids no Centro de Refer?ncia para o tratamento da Aids em Natal/RN por profissionais e usu?rios do servi?o. M?todos: Trata-se de um estudo avaliativo, com abordagem quantitativa, realizada no servi?o ambulatorial do Hospital Giselda Trigueiro, em Natal (RN). A popula??o-alvo foi composta por 313 portadores de HIV e os 34 profissionais do referido centro. A coleta de dados ocorreu de agosto de 2007 a julho de 2008, com um formul?rio estruturado de entrevista, validado por meio de um estudo piloto. Os dados foram analisados pela estat?stica descritiva e inferencial. Resultados: A avalia??o do servi?o foi considerada insatisfat?ria por 85,6% usu?rios. No entanto, 58,8% dos profissionais consideraram-a satisfat?ria. Verificou-se diferen?a na avalia??o dos seguintes indicadores: relacionamento profissionais usu?rios, apoio oferecido, pontualidade dos profissionais, orienta??es sobre o tratamento. Observou-se semelhan?a nos seguintes indicadores: estrutura f?sica, respeito ? privacidade, oportunidade de fazer reclama??es, acolhimento, conveni?ncia dos hor?rios, disponibilidade de ARV e exames laboratoriais, e facilidade de acesso. Conclus?o: Os resultados apontaram para insatisfa??o dos usu?rios e a satisfa??o dos profissionais com a aten??o a sa?de de portadores de HIV/Aids no servi?o pesquisado. Constatou-se que os indicadores utilizados nesse estudo podem ser considerados pertinentes para avaliar o servi?o em quest?o, bem como, constituir par?metros de monitoramento aceit?veis da qualidade da aten??o ? sa?de pelo Programa Nacional de DST/Aids

Made available in DSpace on 2014-12-17T15:31:00Z (GMT). No. of bitstreams: 1 RicardoDC.pdf: 826837 bytes, checksum: a7ad11918ea2c5f5b732ad0bfee98c9e (MD5) Previous issue date: 2007-02-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Due to the fact of oral health sector reestructuration within Brazilian public health politics, this work had the object of evaluating, under users point of view, the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect. To achieve this, questionnaires were given to users in their homes, considering the censitary sector. Nine sectors of the urban zone were evaluated, selected by chance, and one from the rural zone, selected by convenience. The sample was composed by 194 users, calculated considering the estimated prevalence of event represented by the indicator I ve never been to the dentist + I ve been to the dentist more than three years ago from the Projeto SB Brasil Report . To complement the results, interviews were made with others actors involved in the process of oral health care: professionals (dentists) and manager (Health Municipal Secretary). From the data obtained it was possible to identify that 12,9% of the population had never visited the dentist, and that the search for the service was not influenced by the users individual and socioeconomics characteristics, excepting the gender. It was verified that 36,1% of the users went to the dentist in less than one year, with the youngests (p<0,05) being among those who went to the dentist more frequently. 63,3% of the interviewed related that they found some kind of difficulty when they search for dentistry services, with the difficulties for schedule, the queues and the long wait among the most cited. It was identified that 43,2% of the users wait three weeks or more for the appointment. It is still pointed out that 71,4% of the interviewed find difficulties to get urgency appointment, the long wait to be attended by the dentist was the most found. 92,9% and 94,1% of the interviewed had never been headed to especialized appointments and complementary exams, respectively. Due to the data founded, it was possible to verify that the accessibility to oral health services in Santa Cruz (RN) is damaged by factors related to the organization of public polices developed, mainly in relation to the working process / Diante do fato de reestrutura??o do setor sa?de bucal dentro das pol?ticas p?blicas de sa?de brasileiras, este trabalho se prop?s avaliar, sob o ponto de vista dos usu?rios, a acessibilidade aos servi?os de sa?de bucal no munic?pio de Santa Cruz (RN), enfocando o aspecto organizacional. Para tanto, question?rios foram dirigidos aos usu?rios em seus domic?lios, considerando o setor censit?rio. Foram avaliados 9 setores da zona urbana, escolhidos atrav?s de sorteio, e 1 da zona rural, selecionado por conveni?ncia. A amostra foi composta por 194 usu?rios, calculada considerando a preval?ncia estimada do evento representada pelo indicador nunca foi ao dentista + foi ao dentista h? mais de tr?s anos do Relat?rio do Projeto SB Brasil. Para complementa??o dos resultados, ainda foram realizadas entrevistas com outros atores envolvidos no processo de produ??o de sa?de bucal: profissionais (Cirurgi?es-Dentistas) e Gestor (Secret?rio Municipal de Sa?de). A partir dos dados obtidos foi poss?vel identificar que 12,9% da popula??o nunca visitaram o dentista, e que a procura pelo servi?o n?o foi influenciada pelas caracter?sticas individuais e socioecon?micas dos usu?rios, com exce??o do g?nero. Verificou-se que 36,1% dos usu?rios buscaram o dentista em menos de ano, estando os mais jovens (p<0,05) entre aqueles que buscam o dentista com mais freq??ncia. 63,3% dos entrevistados relataram encontrar algum tipo de dificuldade quando da busca pelo atendimento odontol?gico, estando as dificuldades para agendamento, a exist?ncia de filas e longa espera entre os mais citados. Foi identificado que 43,2% dos usu?rios esperam 3 semanas ou mais pelo atendimento. Destaca-se ainda que 71,4% dos entrevistados encontram dificuldades para conseguir atendimento de urg?ncia, sendo a longa espera pela consulta a mais citada. 92,9% e 94,1% dos entrevistos nunca foram encaminhados para realiza??o de consultas mais especializas e exames complementares, respectivamente, evidenciando que os usu?rios n?o est?o recebendo atendimentos integrais. Diante dos dados encontrados p?de-se verificar que a acessibilidade aos servi?os de sa?de bucal do munic?pio de Santa Cruz (RN) encontra-se prejudicada por fatores relacionados ? organiza??o das pol?ticas p?blicas desenvolvidas, principalmente no que se refere ao processo de trabalho

Made available in DSpace on 2014-12-17T15:31:01Z (GMT). No. of bitstreams: 1 SamaraCMS.pdf: 573528 bytes, checksum: 311fd624f3dee6677140c8c52aaee17b (MD5) Previous issue date: 2007-04-30 / Nowadays, the basic attention in health works according to the Health Family Program (HFP), which is responsible for the organization of the health services with view to provide an appropriate attendance to the needs of the population. Its expansion is expressive in whole country and, the oral health, included in this process, has been seen as a possibility of change the health practices centered in the disease. In face of this perspective, the proposal of study is to discover possible changes in the health care model of oral health in a district, made possible through the perception, evaluation and degree of satisfaction of the user s health service. To reach such objectives, the district of Maca?ba in the State of Rio Grande do Norte, was chosen for operational subjects, such as time of implantation of HFP and great covering of this program. The current research used interviews structured with objectives and subjectives questions and questionnaires of socioeconomic characterization addressed to two hundred and seventy (270) individuals (ninety users of an Urban PSF, ninety of a Rural PSF and ninety of an unit non PSF). The analysis of the data was accomplished through the software SPSS/99, that made possible a statistical and analytic appreciation. The HFP units and non HFP units has shown to sort the common odontology problems of the community, and this didn't establish a direct relationship with the general satisfaction. On the other hands, the programmed consultation is related with lager satisfaction of the users. The access form to the odontology treatment of the Units, the satisfaction with the attendance rendered by the dentist and the equip, enough dentists for the community and the social class of the user were decisive for the general satisfaction with the service of oral health. On the other hand, variables as age and education, resolution of the problem and physical conditions of the unit didn't influence the general satisfaction. In spite of the progresses in the implantation of the oral health in ESF, preventive activities, visits at home, access and social participation still reproduce the traditional model of attendance, showing a primary change process / A aten??o b?sica em sa?de ? atualmente operacionalizada atrav?s da Estrat?gia de Sa?de da Fam?lia (ESF). Esta ? respons?vel pela reorganiza??o e ordenamento dos servi?os de sa?de com vista a proporcionar um atendimento apropriado ?s necessidades da popula??o. Sua expans?o ? expressiva em todo pa?s e, a sa?de bucal ao incorporar-se neste processo tem sido vista como uma possibilidade de mudan?a das pr?ticas de sa?de centrada na doen?a. Diante desta perspectiva, este trabalho tem por objetivo caracterizar o modelo assistencial de sa?de bucal em n?vel local ou municipal, viabilizada atrav?s da percep??o, avalia??o e do grau de satisfa??o do principal interessado com o servi?o prestado pelo setor p?blico de sa?de: o usu?rio. Para atingir tais objetivos escolheu-se, intencionalmente, o Munic?pio de Maca?ba no Estado do Rio Grande do Norte, por quest?es operacionais, pelo tempo de implanta??o do ESF e sua alta cobertura. Para isto, utilizaram-se como instrumentos de coleta de informa??es, entrevistas estruturadas com quest?es fechadas e abertas e question?rios de caracteriza??o s?cio-econ?mica direcionados a duzentos e setenta (270) indiv?duos, sendo, esses, usu?rios do servi?o de sa?de bucal de Unidades B?sicas de Sa?de do Munic?pio (noventa usu?rios de um PSF Urbano, noventa de um PSF Rural e noventa de uma unidade n?o PSF). A an?lise dos dados foi realizada atrav?s do software SPSS/99, que possibilitou uma aprecia??o estat?stica e anal?tica. As unidades mostraram-se resolutivas n?o apresentando diferen?a estatisticamente significativa entre unidade n?o PSF e unidades PSF, e n?o estabeleceu uma rela??o direta com a satisfa??o geral. O sistema de refer?ncia e contra-refer?ncia n?o se encontra totalmente organizado e a forma de acesso na ESF n?o se apresenta definida, ocorrendo concomit?ncia entre livre demanda e agendamento, estando esta ?ltima relacionada com maior satisfa??o. A forma de acesso ao tratamento odontol?gico das Unidades, a satisfa??o com o atendimento prestado pelo dentista e sua equipe, o n?mero de dentistas suficientes para a comunidade e a classe social do usu?rio foi determinante para a satisfa??o geral destes com o servi?o de sa?de bucal. Por outro lado, vari?veis como idade e escolaridade, resolu??o do problema e condi??es f?sicas da unidade n?o influenciaram a satisfa??o geral. Apesar dos avan?os na implanta??o da sa?de bucal na ESF pode-se verificar que, em certos pontos, atividades preventivas, visitas domiciliares, acesso e participa??o social reproduzem, ainda, o tradicional modelo de assist?ncia, sinalizando um incipiente processo de mudan?a

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-22T19:29:09Z No. of bitstreams: 1 MarcelaFernandesDeAraujoBatistaDeMorais_DISSERT.pdf: 1437009 bytes, checksum: 82683a52ce54fddf852e05ff414bc844 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-07T20:05:55Z (GMT) No. of bitstreams: 1 MarcelaFernandesDeAraujoBatistaDeMorais_DISSERT.pdf: 1437009 bytes, checksum: 82683a52ce54fddf852e05ff414bc844 (MD5) / Made available in DSpace on 2017-03-07T20:05:55Z (GMT). No. of bitstreams: 1 MarcelaFernandesDeAraujoBatistaDeMorais_DISSERT.pdf: 1437009 bytes, checksum: 82683a52ce54fddf852e05ff414bc844 (MD5) Previous issue date: 2016-08-11 / No processo de constru??o do Sistema ?nico de Sa?de se fortalece e se evidencia a import?ncia da Aten??o Prim?ria ? Sa?de. Dentro desta h? a??es priorit?rias, dentre as quais se encontra o acompanhamento pr?-natal e puerperal. O presente estudo teve como objetivo avaliar a aten??o ? sa?de da mulher no ciclo grav?dico-puerperal na regi?o Nordeste do Brasil atrav?s dos dados do Programa de Melhoria e Acesso da Qualidade da Aten??o B?sica. Trata-se de um estudo avaliativo, com abordagem quantitativa, no qual foram utilizados dados secund?rios obtidos atrav?s do banco da avalia??o externa dos dois ciclos realizados pelo programa. Participaram respondendo o instrumento, 5146 profissionais de sa?de em cada ciclo de avalia??o, e em rela??o aos usu?rios, responderam as quest?es voltadas ao pr?-natal, 1732 mulheres no primeiro ciclo, e 2004 mulheres no segundo ciclo. Para as vari?veis correspondentes ao puerp?rio, participaram 1743 mulheres no primeiro ciclo, e 1952 mulheres no segundo ciclo. Os resultados foram apresentados e discutidos em dimens?es voltadas a estrutura, processo de trabalho no pr?-natal e processo de trabalho no puerp?rio. No tocante ? infraestrutura, observou-se melhoria em quase totalidade das suas vari?veis, tendo apenas a disponibilidade de ?cido f?lico regredido de um ciclo para outro. Apesar desses avan?os, algumas vari?veis, tais como: baixa disponibilidade de testes r?pidos de HIV, s?filis e gravidez, merecem destaque. Em rela??o ao processo de trabalho no pr?-natal, os dados mostram grande defici?ncia em rela??o ? educa??o em sa?de, destaca-se tamb?m a regress?o percentual na maioria das vari?veis voltadas ? orienta??o das mulheres. No processo de trabalho no puerp?rio foi identificado que um grande n?mero de mulheres n?o realizou consulta puerperal. Para tanto, para as que realizaram, foi identificado um avan?o importante no tocante a essa realiza??o no prazo de at? 10 dias. Tamb?m foi observada regress?o quando analisada ? visita do Agente Comunit?rio de Sa?de na primeira semana p?s-parto. No geral, quando comparados o primeiro com o segundo ciclo do programa, percebem-se avan?os, embora ainda haja desafios a serem superados. / In the process of construction of the Single Health System (SUS), it is stronger and more evident the importance of National Primary Care (NPC). There are some high-priority actions, among others, the prenatal and puerperal assistance.The present study aimed to evaluate women?s health care in the pregnant and puerperal cycle in the Northeast of Brazil through the data of the NPCAQIP.It is an evaluation study, with quantitative approach. The data used was obtained through the external evaluation bank of the NPCAQIP. The number of participants who took part in the study was 5146 health care professionals on each cycle of evaluation, and concerning the clients, 1732 women on the first cycle took part in the study answering questions related to prenatal and 2004 women on the second cycle. For the variable concerning the puerperium, 1743 women took part on the first cycle and 1952 women took part on the second one.The results were presented and discussed in different dimensions related to structure, process of work in the prenatal and process of work in the puerperium. Concerning the infrastructure, it could be noticed an almost total improvement of its variables, just with regression of the availability of folic acid from one cycle to another. Despite this progress, some variables deserve attention, such as: low availability of HIV, syphilis and pregnancy rapid tests. In relation to the process of work in the prenatal, data showed great deficiency related to health education, it is also highlighted the percentage regression of women orientation on most variables. In the process of work in the puerperium it was identified that a considerable amount of women did not have puerperal consultation. Therefore, for the ones who had, it was identified a progress related to the importance of having this consultation within 10 days. It was also observed the regression of the visit of the Community Health Agent on the first week post-partum. In general, when we compare the first and second cycles of the program, it can be noticed advances, however there are still some challenges to be overcome.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-07-04T14:52:40Z No. of bitstreams: 1 HelidaMariaBezerra_DISSERT.pdf: 9931928 bytes, checksum: 26e1ff7ff2ea69cdafbbf8e0db826dbe (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-07-14T14:22:38Z (GMT) No. of bitstreams: 1 HelidaMariaBezerra_DISSERT.pdf: 9931928 bytes, checksum: 26e1ff7ff2ea69cdafbbf8e0db826dbe (MD5) / Made available in DSpace on 2017-07-14T14:22:38Z (GMT). No. of bitstreams: 1 HelidaMariaBezerra_DISSERT.pdf: 9931928 bytes, checksum: 26e1ff7ff2ea69cdafbbf8e0db826dbe (MD5) Previous issue date: 2016-10-07 / Objetivo: Aumentar a ades?o ?s pr?ticas de preven??o de pneumonias associadas ? ventila??o mec?nica (PAV) em unidades de terapia intensiva (UTI), atrav?s de um ciclo de melhoria interno. Metodologia: Foi aplicado um ciclo de melhoria da qualidade com desenho quase experimental do tipo antes e depois em duas UTI de um hospital p?blico no nordeste do Brasil, com um total de 19 leitos. Foram estabelecidos nove crit?rios de qualidade relacionados com a preven??o de PAV e um indicador composto com os quais se avaliou o n?vel basal de qualidade e posteriormente mais duas avalia??es subsequentes com intervalos de quatro meses buscando medir as poss?veis melhorias adquiridas nesses per?odos. O Gr?fico de Pareto foi utilizado para representar a frequ?ncia de n?o cumprimentos de cada crit?rio avaliado nos tr?s momentos. Utilizou-se o c?lculo de estima??o pontual e o intervalo de confian?a (95%) para a medi??o dos crit?rios. Para quantificar a efetividade da interven??o, calculou-se a melhoria absoluta e relativa, al?m da significa??o estat?stica da melhoria absoluta mediante o teste unilateral do valor de z. Resultados: Ocorreu uma ligeira melhoria em todos os crit?rios quando comparadas as duas primeiras avalia??es, por?m nesta compara??o inicial, apenas um crit?rio apresentou melhora estatisticamente significante (p<0,05). Na segunda compara??o feita entre a 1? e 3? avalia??es, os resultados revelaram melhora no cumprimento de quase todos os crit?rios, onde dos nove crit?rios estabelecidos, oito obtiveram melhora, sendo seis com melhora estatisticamente significante (p < 0,05), dois com melhora sem signific?ncia e em um crit?rio houve piora no percentual de cumprimento. O indicador composto, que resume todos os crit?rios avaliados, obteve uma melhora significativa de quase 40% (p<0,05) na segunda compara??o. Conclus?es: A implanta??o de ciclos internos de melhoria constitui-se em importante ferramenta de gest?o da qualidade para incorpora??o de boas pr?ticas para preven??o de PAV em UTI. / Objective: To increase adherence of the preventive practices concerning Ventilator-associated pneumonia (VAP) in intensive care units (ICU), through an internal improvement cycle. Methodology: A quality improvement cycle, quasi-experimental design before-after was applied in two ICUs of a public hospital in the northeast of Brazil, with a total of 19 beds. Nine quality criteria related to the prevention of VAP were established and a composite indicator with which to assess the baseline level of quality and later two more subsequent assessments at intervals of four months seeking measure possible improvements acquired during these periods. The Pareto chart was used to represent the frequency of non-compliance of each criterion assessed in three moments. It was used the point estimation and the confidence interval (95%) for the measurement of the criteria. To quantify the effectiveness of the intervention, it calculated the absolute and relative improvement, beyond the statistical significance of the absolute improvement through unilateral test value of z. Results: There was a slight improvement on all criteria when comparing the first two assessments, but this initial comparison, only one criteria showed a statistically significant improvement (p <0.05). In the second comparison between the 1st and 3rd evaluations, the results showed improvement in the performance of all the criteria almost, where the nine established criteria, eight showed improvement, and six with a statistically significant improvement (p <0.05), with two improvement without significance and one criteria has worsened in the percentage of compliance. The composite indicator, which summarizes all the criteria evaluated, obtained a significant improvement of almost 40% (p<0.05) in the second comparison. Conclusions: The implementation of an internal improvement cycle was an important tool in quality management for the adoption of best practices for the prevention of VAP in ICU.