Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-03-12T20:18:44Z No. of bitstreams: 1 LayanneCristiniMartinSousa_DISSERT.pdf: 1742028 bytes, checksum: 9edd9252e78cba594579c04e160087da (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-03-16T19:49:44Z (GMT) No. of bitstreams: 1 LayanneCristiniMartinSousa_DISSERT.pdf: 1742028 bytes, checksum: 9edd9252e78cba594579c04e160087da (MD5) / Made available in DSpace on 2018-03-16T19:49:44Z (GMT). No. of bitstreams: 1 LayanneCristiniMartinSousa_DISSERT.pdf: 1742028 bytes, checksum: 9edd9252e78cba594579c04e160087da (MD5) Previous issue date: 2017-12-20 / A Vigil?ncia em Sa?de ? caracterizada como um conjunto articulado de a??es com foco na promo??o da sa?de e preven??o de doen?as, sob a ?tica da integralidade do cuidado. O objetivo deste estudo foi analisar a Vigil?ncia em Sa?de sob a perspectiva de seus trabalhadores, utilizando uma abordagem qualitativa. Foram entrevistados 28 profissionais lotados no n?vel central da Vigil?ncia em Sa?de, dos quais 12 da secretaria de sa?de de Natal e 16 da secretaria de sa?de do Rio Grande do Norte. As entrevistas semi-estruturadas foram realizadas entre novembro e dezembro de 2016. O material produzido foi analisado a luz do referencial te?rico de Bardin, utilizando a t?cnica de An?lise de Conte?do. Emergiram da an?lise quatro categorias tem?ticas: concep??o sobre Vigil?ncia em Sa?de; articula??o intr?nseca e extr?nseca ? Vigil?ncia em Sa?de; potencialidades e desafios. Os resultados mostraram que os trabalhadores t?m uma concep??o ampliada sobre a Vigil?ncia em Sa?de, entretanto a vis?o tecnicista ainda se encontra presente. As a??es desenvolvidas por eles apresentam-se fragmentadas, tanto entre as vigil?ncias como entre estas e os servi?os de sa?de, deixando evidente a desarticula??o entre os processos cotidianos. Os trabalhadores demonstraram satisfa??o e comprometimento no exerc?cio de suas fun??es, configurando-se como potencialidades, no entanto se traduzem em caracter?sticas conflitantes diante do cen?rio de dificuldades e limita??es relatado por eles. Apontaram como desafios a serem superados: maiores investimentos no setor; valoriza??o dos profissionais e maior suporte e apoio por parte da gest?o. Observa-se, portanto, a necessidade de se imprimir novos avan?os na Vigil?ncia em Sa?de, que perpasse, necessariamente, pela redefini??o do modelo de aten??o, e que adote o planejamento coletivo de forma genu?na, a ressignifica??o de processos de trabalho e de forma??o profissional al?m de uma gest?o participativa com controle social, objetivando a efetividade de suas a??es e a integralidade do cuidado. / Health Surveillance is characterized as an articulated set of actions focused on health promotion and disease prevention, from the point of view of integral care. The objective of this study is to analyze the Health Surveillance from the perspective of its workers using a qualitative approach. A total of 28 central-level Health Surveillance professionals were interviewed, of which 12 of the Secretariat of health of Natal and 16 of the Department of health of Rio Grande do Norte. The semi-structured interviews were carried out between November and December 2016. The material produced was analyzed using the Content Analysis technique in light of the theoretical reference of Bardin. Four thematic categories emerged: conception of Surveillance in Health; intrinsic and extrinsic articulation of Health Surveillance; Health Surveillance?s potential; and, conversely, it?s challenges. The results showed that the workers have an expanded concept of Health Surveillance, although the technician?s view is still present. Consequently, their actions developed a fragmented result, both between surveillance and health services, leaving clear the disarticulation between the everyday processes. The workers demonstrated satisfaction and commitment in the performance of their duties, configuring itself as potential, however result in conflicting characteristics before the backdrop of difficulties and limitations reported by them. Pointed as challenges to be overcome: greater investment in the sector; recovery of professionals and greater support on the part of management. There is therefore the need to print new advances in health surveillance, which circulates, necessarily, by redefining the model of attention, and to adopt the collective planning of genuine form, the ressignification of work processes and training Professional plus a participatory management with social control, aiming at the effectiveness of its actions and the completeness of the care.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-08-01T14:46:43Z No. of bitstreams: 1 EvaEmanuelaLopesCavalcanteFeitosa_DISSERT.pdf: 1416642 bytes, checksum: 07ed51ca5827795a2f98e99bb5ed0bd6 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-08-08T14:46:47Z (GMT) No. of bitstreams: 1 EvaEmanuelaLopesCavalcanteFeitosa_DISSERT.pdf: 1416642 bytes, checksum: 07ed51ca5827795a2f98e99bb5ed0bd6 (MD5) / Made available in DSpace on 2017-08-08T14:46:47Z (GMT). No. of bitstreams: 1 EvaEmanuelaLopesCavalcanteFeitosa_DISSERT.pdf: 1416642 bytes, checksum: 07ed51ca5827795a2f98e99bb5ed0bd6 (MD5) Previous issue date: 2017-06-26 / A Vigil?ncia em Sa?de faz parte do arcabou?o das propostas do Sistema ?nico de Sa?de (SUS), contemplando as a??es da Vigil?ncia Epidemiol?gica, Vigil?ncia Sanit?ria, Vigil?ncia Ambiental e Vigil?ncia em Sa?de do Trabalhador, com foco na preven??o de doen?as e na promo??o da sa?de. Nesse sentido, esta pesquisa teve como objetivo analisar as concep??es e as pr?ticas da Vigil?ncia em Sa?de, sob a ?tica dos gestores. Trata-se de um estudo com abordagem qualitativa, realizado junto a 11 gestores, por meio de entrevistas com roteiro semiestruturado, no per?odo de outubro a dezembro de 2016. A partir do material coletado, foram constitu?dos dois corpus para an?lise. O primeiro foi submetido ao programa Iramuteq e gerou tr?s classes. O segundo corpus foi submetido ? an?lise de conte?do de Laurence Bardin e originou duas categorias tem?ticas: ?Concep??es sobre Vigil?ncia em Sa?de? e ?Pr?ticas da Vigil?ncia em Sa?de?, discutidas ? luz do referencial te?rico adotado. Os resultados demonstram que os gestores compreendem Vigil?ncia em Sa?de como um modelo indispens?vel para o SUS, al?m de apontar para a realiza??o de planejamento coletivo. Contudo, verificam-se contradi??es ao mencionarem que as a??es desenvolvidas s?o desarticuladas entre os setores e, portanto, necessitam da implanta??o de estrat?gias capazes de impactar sobre a efetividade da articula??o. H?, tamb?m, relatos de precariedade das condi??es de trabalho, de n?mero insuficiente de recursos humanos e de fragilidade no setor da sa?de do trabalhador. Com vistas a superar tais limita??es, sugere-se o engajamento de apoiadores, gestores, profissionais e controle social em torno de um amplo debate, na perspectiva de promover novos saberes e fazeres capazes de transformar o atual modelo de aten??o no tocante ? Vigil?ncia em Sa?de. / The Health Surveillance is part of the proposals framework of the Health Unique System (Sistema ?nico de Sa?de, SUS), contemplating the actions of the Epidemiological Surveillance, Sanitary Surveillance, Environmental Surveillance, Occupational Health Surveillance, focusing in disease prevention and the health promotion. This research aims to analyze conceptions and practices of the Health Surveillance, from the conceptions of the managers. For the study, we used a qualitative approach, carried out with 11 managers, from the interviews with semi-structured script, carried out during October and December 2016. From the material collected, two corpus were constituted to analysis. The first was submitted to the program Iramuteq and was generated three categories. The second corpus was submitted the analysis of the Laurence Bardin's content and was originated two thematic categories: ?Conceptions about the Health Surveillance? and ?Practices of the health in Surveillance?, discussed from the theoretical framework. The results demonstrate that the managers understand Health Surveillance as an indispensable model to SUS, in addition pointing to the realization of the collective planning. However, there are contradictions when the managers mentioning that the developed actions are disarticulated between the sectors and, thus, they need the implementation of strategies capable of the impacts about the effectiveness of the articulation. There are also, reports of precarious working conditions, insufficient human resources and fragility in the worker health sector. From this reality, it?s necessary the support of the supporters, managers, professionals and social control around a broad debate, with the perspective of promoting new knowledge and actions capable of transforming the current model of care in relation to Health Surveillance.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-09-19T21:49:20Z No. of bitstreams: 1 AngelicaTeresaNascimentoDeMedeiros_TESE.pdf: 1856140 bytes, checksum: 15ad94c9cef9e309c09e63e79f262837 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-09-22T19:32:34Z (GMT) No. of bitstreams: 1 AngelicaTeresaNascimentoDeMedeiros_TESE.pdf: 1856140 bytes, checksum: 15ad94c9cef9e309c09e63e79f262837 (MD5) / Made available in DSpace on 2017-09-22T19:32:34Z (GMT). No. of bitstreams: 1 AngelicaTeresaNascimentoDeMedeiros_TESE.pdf: 1856140 bytes, checksum: 15ad94c9cef9e309c09e63e79f262837 (MD5) Previous issue date: 2017-03-17 / A coqueluche, doen?a infectocontagiosa, atualmente vem apresentando um perfil reemergente. Fatores como diminui??o da imunidade, anos ap?s a vacina??o, mudan?as no gen?tipo da bact?ria e maior susceptibilidade entre jovens e adultos s?o considerados como contribuintes para o aumento da taxa da incid?ncia da doen?a. Assim, esse estudo teve como objetivos verificar a distribui??o espacial dos casos confirmados de coqueluche entre o per?odo de 2007 a 2015; identificar o comportamento da s?rie hist?rica da taxa de incid?ncia da coqueluche durante o per?odo de 2001 a 2015 no Brasil e verificar a associa??o da vacina contra coqueluche e a ocorr?ncia da doen?a no estado do Rio Grande do Norte. Dessa forma, o caminho metodol?gico da pesquisa foi dividido em tr?s partes. A an?lise da distribui??o espacial considerou como unidade de an?lise as 482 Regi?es Imediatas de Articula??o Urbana e utilizou o software Terraview para constru??o dos mapas tem?ticos. Para se verificar a tend?ncia da s?rie optamos por utilizar o ajuste de uma fun??o polinomial no tempo, utilizando-se assim modelos de regress?o polinomial. Em rela??o a associa??o foi estabelecido como crit?rio de inclus?o a confirma??o do caso de acordo com os crit?rios estabelecidos pelo Minist?rio da Sa?de, sendo exclu?dos aqueles cujas fichas n?o encontravam-se devidamente preenchidas ou que estivessem com algum tipo de d?vida que comprometesse a coleta dos dados. Os resultados demonstraram que a doen?a apresentou uma distribui??o espacial democr?tica em todo territ?rio nacional, formando pequenos clusters com altas taxas de incid?ncia nas regi?es de articula??o urbana presentes nas regi?es sul e sudeste. Identificamos tamb?m que houve, na s?rie hist?rica, uma tend?ncia crescente da doen?a ao longo de 15 anos. E por fim, os resultados apontam que independentemente do estado vacinal os indiv?duos est?o adoecendo por coqueluche, o que n?o gerou evid?ncia cient?fica suficiente para medir a efetividade da vacina. Os achados sugerem que aspectos relacionados a vacina??o precisam ser melhor investigados para que se possa garantir o controle da doen?a. ? necess?rio tamb?m que ocorram melhorias nas a??es de vigil?ncia, o que pode garantir uma representa??o epidemiol?gica fidedigna da doen?a. / Pertussis, an infectious-contagious disease, is currently presenting a reemerging profile. Factors such as decreased immunity years after vaccination, changes in the genotype of the bacteria and increased susceptibility among young and adults are considered to have contributed to increase the disease incidence rate. Therefore, this study aimed to verify the spatial distribution of confirmed pertussis cases between 2007 and 2015; to identify the patterns in the time-series of pertussis incidence rates during the period 2001 to 2015 in Brazil and to verify the association of pertussis vaccine with the occurrence of the disease in the state of Rio Grande do Norte. Thus, the methodological path of the research was divided into three parts. The analysis of the spatial distribution considered the 482 Regions Immediate Urban Articulation as unit of analysis and used the Terraview software to construct the thematic maps. In order to verify the trend in the series we chose to use the adjustment of a polynomial function in time, using polynomial regression models. Regarding the association, the confirmation of the case was established as inclusion criteria in accordance with the criteria established by the Ministry of Health, being excluded those files that were not properly filled or had any uncertainties that could compromise the data collection. The results suggests that the disease has a democratic spatial distribution throughout the country, forming small clusters with high incidence rates in the urban articulation present in the South and Southeast regions. It was also identified in the time-series an increasing tendency of the disease over a period of 15 years. Finally, the results indicate that regardless of vaccination status individuals are being infected with pertussis, which did not generate enough scientific evidence to measure the effectiveness of the vaccine. The findings suggest that aspects related to vaccination need further investigation in order to guarantee disease control. There is also a need for improvements in surveillance actions, which can ensure a reliable epidemiological representation of the disease.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-03-20T22:51:47Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) cassio_almeida_lima.pdf: 1180731 bytes, checksum: 95f86fdaad149f5f97c975753999285b (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-03-29T14:07:32Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) cassio_almeida_lima.pdf: 1180731 bytes, checksum: 95f86fdaad149f5f97c975753999285b (MD5) / Made available in DSpace on 2018-03-29T14:07:32Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) cassio_almeida_lima.pdf: 1180731 bytes, checksum: 95f86fdaad149f5f97c975753999285b (MD5) Previous issue date: 2017 / Este estudo teve como objetivo analisar a ocorr?ncia de acidentes e ?bitos provocados por animais pe?onhentos na regi?o Sudeste, Brasil. Trata-se de pesquisa epidemiol?gica, com delineamento ecol?gico e anal?tico. Efetuou-se uma busca no Sistema de Informa??o de Agravos de Notifica??o-NET, sobre a ocorr?ncia de acidentes e ?bitos por todos os tipos de animais pe?onhentos e aqueles causados por serpentes, escorpi?es e aranhas, ocorridos nas unidades federativas da regi?o Sudeste, no per?odo de 2005 a 2015. A organiza??o dos dados e an?lise estat?stica foram processadas por meio do Software IBM SPSS vers?o 22.0 para Windows?. A descri??o dos resultados foi apresentada em valores absolutos, percentuais, m?dias, desvio padr?o, m?nimo e m?ximo, al?m de s?rie hist?rica. Efetuaram-se an?lises bivariadas (teste Kolmogorov Smirnov) para comparar as m?dias entre as unidades federativas do Sudeste (p<0,05), bem como correla??es com indicadores sociais e de sa?de por meio da correla??o Spearman's. Considerou-se o n?vel de signific?ncia de 5% (p<0,05). Entre 2005 e 2015, observou-se um total de 47.1403 acidentes e de 684 ?bitos causados por animais pe?onhentos, com a maior parte dos acidentes registrada em 2014 (58.544), enquanto o maior n?mero de ?bitos ocorreu em 2015 (99). Na s?rie hist?rica, constatou-se uma ascens?o acentuada a partir de 2010. No Sudeste, o escorpi?o representou maior m?dia de acidentes e ?bitos: 5.694,14 e 7,45 respectivamente. Em todos os anos, Minas Gerais concentrou a maior quantidade de acidentes e ?bitos no geral; e em espec?fico pelos animais estudados, exceto quanto aos acidentes por aranhas. As correla??es, embora n?o tenham sido estatisticamente significantes (p>0,05), demonstraram rela??o entre maior quantidade de acidentes e ?bitos e menor ?ndice de Desenvolvimento Humano, menor n?mero de m?dicos e gastos em sa?de p?blica. O estudo evidenciou uma elevada frequ?ncia de acidentes e ?bitos provocados por animais pe?onhentos e a sua ascens?o ao longo da s?ria hist?rica analisada, principalmente em anos mais recentes. Delineou-se uma realidade preocupante que deve ser analisada com prud?ncia, considerando que diversos fatores podem estar envolvidos. Assim, ? imperativo que o problema estudado seja efetivamente gerenciado e n?o seja negligenciado. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / This study aimed to analyze the occurrence of accidents and deaths caused by venomous animals in the Southeast region of Brazil. This is an epidemiological research with ecological and analytical design. A search in the Notification System Review of Information-NET on the frequency of accidents and dearth by all kinds of poisonous animals and those caused by snakes, scorpions and spiders on the period of 2005 to 2015 in the federation units of the southeast region was done. The organization and analysis of statistical data were processed through the IBM SPSS Software version 22.0 for Windows?. The description of the results was presented in absolute, percentage, average, standard deviation, minimum and maximum, besides historical values. Bivariated analysis were made (Kolmogorov Smirnov test) to compare the average among the federation units of the southeast (p<0.05), as well as to correlate the social and health indicators through Spearman?s correlation. The level of significance was considered of 5% (p<0.05). Between 2005 to 2015, a total of 47,1403 accidents and 684 deaths by poisonous animals were registered, with the majority of accidents registered in 2014 (58,544), and the greater number of deaths in 2015 (99). In the historic search, a steep rise was noticed from 2010. On the Southeast, the scorpion presented greater average of accidents and deaths: 5,694 and 7,45 respectively. In all the years, Minas Gerais reported the highest quantity of accidents and deaths in general; and specifically with the studied animals, with the exception of accidents with spiders. The correlations, although not significant to statistics (p>0.05), show relation among the greater quantity of accidents and deaths and the lower Index of Human Development, lower number of doctors and expenses in public health. The study put in evidence a high frequency of accidents and deaths by poisonous animals and the rise during the history that was analyzed, especially in the most recent years. A concerning reality was perceived and must be analyzed with prudence, considering that many factors may be involved. Thus, it is imperative that the studied problem be effectively managed and not be neglected.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-28T20:31:43Z No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-30T00:04:50Z (GMT) No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) / Made available in DSpace on 2017-03-30T00:04:50Z (GMT). No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) Previous issue date: 2016-11-29 / O Acidente Vascular Cerebral (AVC) ? um importante problema de sa?de p?blica, por isso foi realizado um estudo com o objetivo de avaliar os fatores epidemiol?gicos, cl?nicos e funcionais de pacientes com AVC. Participaram do estudo 433 pacientes (229 mulheres e 204 homens). Em Natal/RN, os pacientes foram avaliados atrav?s do Step 1 e Escala de Rankin Modificada. Os dados foram analisados pelo teste Qui-quadrado e an?lise de regress?o log?stica. Resultados: Verificou-se maior frequ?ncia de pacientes na faixa et?ria de 70 a 89 anos (40,9%). A hipertens?o arterial foi o fator de risco mais frequente (85,4%) e o AVC isqu?mico (68,5%). Foi observada maior frequ?ncia de pacientes com incapacidade de andar e realizar higiene pessoal (48,8%) (p= 0,001). Observou-se uma correla??o entre o grau de comprometimento neurol?gico e a funcionalidade (r= 0,53; p= 0,006). Considerando as atividades b?sicas da vida di?ria (ABVDs), 25% dos pacientes n?o podiam levantar da cama e 70,8% n?o conseguiam ir ao banheiro sozinhos (ambos p< 0.05). Os modelos de regress?o apontaram os fatores preditores da depend?ncia funcional para as atividades: "banho", quantidade de fatores de risco (OR=0,4; IC=0,2-0,7; p=0,005) e quantidade de medica??o usada previamente ao AVC (OR=1,7; IC=1,1-27; p=0,013). Para "higiene pessoal", realiza??o de Fisioterapia ap?s a alta (OR=2,5; IC=1,2-5,1; p=0,014) e sexo feminino (OR=1,6; IC=1,06-2,4; p=0,026); para "transfer?ncia", quantidade de fatores de risco (OR=0,4; IC=0,2-0,9; p=0,025); para "contin?ncia", tipo de AVC (OR=2,2; IC=1,1-3,8; p=0,003 ? 10? dia; OR=1,9; IC=1,1-3,3; p=0,013 ? 28? dia) e realiza??o de Fisioterapia ap?s a alta (OR=4,1; IC=1,5-11,3; p=0,005); e para atividade "alimenta??o", quantidade de AVC pr?vio (OR=0,5; IC=0,2-0,9; p=0,036) e realiza??o de Fisioterapia ap?s a alta (OR=4,2; IC=1,6-11,1; p=0,003). Para as seis atividades, a idade acima de 60 anos e a falta de realiza??o da fisioterapia durante a interna??o hospitalar foram os mais fortes fatores preditivos para a depend?ncia funcional. Os resultados indicam fatores importantes que influenciam a depend?ncia funcional dos pacientes com AVC, trazem uma contribui??o cient?fica para que os prestadores de sa?de possam identificar oportunidades de interven??o e apontam a necessidade urgente de implanta??o de Unidades de AVC no Estado Rio Grande do Norte. / Stroke is an important public health problem, thus one study was carried out with the aim to evaluate epidemiological, clinical and functional factors of stroke patients. Materials and Methods: Four hundred thirty-three patients participated in the study (229 women and 204 men). In Natal/RN, the patients were assessed through the Step 1 and the Modified Rankin Scale. The data were analysed through the chi-squared test and logistic regression analysis. Results: It was noticed that the higher frequency of patients were in the age range of 70 to 89 years (40,9%). Arterial hypertension was the most frequent risk factor (85,4%) as well as the ischemic stroke (68,5%). There was a higher frequency of patients with incapacity to walk and do their personal hygiene (48,8%) (p= 0,001). It was also observed a correlation between the degree of neurological impairment and functionality (r= 0,53; p= 0,006). Regarding the basic activities of daily living (BADL), 25% of the patients could not rise from bed and 70,8% could not go to bathroom on their own (both p< 0.05). The regression models pointed out to the predictive factors of functional dependence to the activities: ?bathing?, quantity of risk factors (OR=0,4; IC=0,2-0,7; p=0,005) and quantity of medication used prior to stroke (OR=1,7; IC=1,1-27; p=0,013). To ?personal hygiene?, attendance to physiotherapy after discharge (OR=2,5; IC=1,2-5,1; p=0,014) and female sex (OR=1,6; IC=1,06-2,4; p=0,026); to ?transfer?, quantity of risk factors (OR=0,4; IC=0,2-0,9; p=0,025); to ?continence?, type of stroke (OR=2,2; IC=1,1-3,8; p=0,003 ? day 10; OR=1,9; IC=1,1- 3,3; p=0,013 ? day 28) and attendance to physiotherapy after discharge (OR=4,1; IC=1,5-11,3; p=0,005); and to the activity ?eating?, frequency of stroke (OR=0,5; IC=0,2-0,9; p=0,036) and attendance to physiotherapy after discharge (OR=4,2; IC=1,6- 11,1; p=0,003). To the six activities, age above 60 years and nonattendance to physiotherapy during hospital stay were the strongest predictive factors for functional dependence. Conclusion: The results indicate important factors that affect the functional dependence of stroke patients, thus bringing about a scientific contribution so that the healthcare providers may identify opportunities of intervention; they also point out the urgent need of implanting a Stroke Unit in the state of Rio Grande do Norte.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:22:49Z No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-11T18:05:37Z (GMT) No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Made available in DSpace on 2017-04-11T18:05:37Z (GMT). No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) Previous issue date: 2016-12-15 / A s?filis ? uma doen?a infecciosa que permanece como um dos principais agravos de notifica??o a ser enfrentado em ?mbito global. No contexto materno-infantil relaciona-se a efeitos delet?rios a partir da transmiss?o vertical e exp?e o bin?mio m?e e filho a riscos como o aborto e a morte perinatal. Desse modo, a??es efetivas para o controle da doen?a devem ser realizadas no pr?-natal, em momento oportuno, para garantir a preven??o da forma cong?nita da doen?a. Neste sentido, esta pesquisa objetiva analisar as notifica??es de s?filis gestacional e cong?nita e os fatores relacionados ? transmiss?o vertical. Trata-se de uma pesquisa de abordagem quantitativa epidemiol?gica, tipo seccional, de dados secund?rios, realizado no ano de 2016. A amostra foi composta a partir dos crit?rios de elegibilidade e totalizou 129 notifica??es de s?filis em gestantes e 132 notifica??es para s?filis cong?nita no per?odo entre junho de 2011 e dezembro de 2015, no Munic?pio de Natal/RN. A coleta de dados ocorreu entre os meses de maio a agosto por meio do banco do Sistema de Informa??o de Agravos de Notifica??o. Os dados foram analisados pela estat?stica descritiva e inferencial. Os testes Qui-Quadrado, T-Student e Fisher foram utilizados para verificar as associa??es entre as vari?veis de interesse. A pesquisa recebeu parecer favor?vel pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, sob o n?mero 1.449.134 e Certificado de Apresenta??o para Aprecia??o ?tica 53305315.3.0000.5537. No per?odo investigado foi observado um incremento de casos notificados no ano de 2012. O perfil materno registrado aponta mulheres com idade m?dia de 24,78 anos, pardas (70,5%), residentes na zona urbana (95,3%) do Munic?pio de Natal. A an?lise do pr?-natal identificou predom?nio do diagn?stico materno no terceiro trimestre gestacional (69%) e presen?a de testes n?o trepon?micos reagentes em 94,6% das mulheres no momento do parto. No tocante ao tratamento materno, apenas 1,6% destas mulheres foram registradas com esquema de tratamento adequado e 16,3% dos parceiros foram tratados concomitantemente ?s gestantes. Nos desfechos relativos ?s crian?as, 78,8% foram registradas como assintom?ticas, contudo, essa vari?vel apresentou signific?ncia estat?stica quando relacionada ? titula??o do teste n?o trepon?mico materno e ? realiza??o de tratamento antes do parto. Na an?lise espacial por georreferenciamento, foi identificado o predom?nio de casos nos bairros Quintas e Felipe Camar?o, ambos assistidos pelo Distrito Sanit?rio Oeste do munic?pio. Os resultados apontam, al?m disso, para lacunas importantes nos processos de vigil?ncia epidemiol?gica quanto ao preenchimento das notifica??es no que versa a informa??es ignoradas e em branco. A an?lise da notifica??o da s?filis gestacional e cong?nita, possibilitou concluir que a transmiss?o vertical esteve relacionada a perdas de oportunidades diagn?sticas e terap?uticas. A elabora??o de estrat?gias para detec??o precoce e ades?o ao tratamento da doen?a devem ser adotadas, tendo em vista o fortalecimento da assist?ncia e a quebra na cadeia da transmiss?o vertical da s?filis. Ressalta-se a necessidade de qualifica??o profissional para notifica??o da doen?a e amplia??o no fornecimento de informa??es ? vigil?ncia epidemiol?gica, a fim de possibilitar a continuidade da an?lise ao agravo. / Syphilis is an infectious disease that remains as one of the major reporting aggravations to be addressed globally. In the maternal-infant context it is related to deleterious effects from the vertical transmission and exposes the mother-child binomial to risks such as abortion and perinatal death. Thus, effective actions to control the disease must be performed in prenatal care, in a timely manner, to ensure the prevention of the congenital form of the disease. In this sense, this research aims to analyze the reports of gestational and congenital syphilis and the factors related to vertical transmission. This is a cross-sectional, epidemiological, epidemiological approach to secondary data, conducted in 2016. The sample was composed of eligibility criteria and totaled 129 reports of syphilis in pregnant women and 132 reports for congenital syphilis in the period Between June 2011 and December 2015, in the Municipality of Natal / RN. Data collection occurred between May and August through the Database of the Notification of Injury Information System. Data were analyzed by descriptive and inferential statistics. The Chi-square, T-Student, and Fisher tests were used to verify the associations between the variables of interest. The research received a favorable opinion by the Ethics Committee of the Federal University of Rio Grande do Norte under number 1,449,134 and Certificate of Presentation for Ethical Appraisal 53305315.3.0000.5537. In the period under investigation, there was an increase in reported cases in the year 2012. The registered maternal profile indicates women with a mean age of 24.78 years, browns (70.5%), living in the urban area (95.3%) of the Municipality from Natal. The prenatal analysis identified a predominance of maternal diagnosis in the third gestational trimester (69%) and presence of non-treponemal reactive tests in 94.6% of the women at the time of delivery. Regarding maternal treatment, only 1.6% of these women were registered with an adequate treatment regimen and 16.3% of the partners were treated concomitantly with the pregnant women. In the outcomes related to the children, 78.8% were registered as asymptomatic, however, this variable presented statistical significance when related to the titration of the non-treponemal maternal test and to the pre-delivery treatment. In the spatial analysis by geo - referencing, the predominance of cases in Quintas and Felipe Camar?o neighborhoods, both assisted by the Sanitary District West of the municipality, was identified. The results point, moreover, to important gaps in the epidemiological surveillance processes regarding the filling of notifications regarding unknown and blank information. The analysis of the notification of gestational and congenital syphilis made it possible to conclude that vertical transmission was related to loss of diagnostic and therapeutic opportunities. The development of strategies for early detection and adherence to treatment of the disease should be adopted, with a view to strengthening care and breaking down the vertical syphilis transmission chain. The need for professional qualification for notification of the disease and extension in the provision of information to epidemiological surveillance is emphasized, in order to allow the continuity of the analysis to the disease.