Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-05-04T19:10:28Z No. of bitstreams: 1 B?RBARA_FREIBERGER_SCHAEFER.pdf: 1176504 bytes, checksum: 78558bd375bc4c7f9afcb46a36c0d9a9 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-05-14T12:54:32Z (GMT) No. of bitstreams: 1 B?RBARA_FREIBERGER_SCHAEFER.pdf: 1176504 bytes, checksum: 78558bd375bc4c7f9afcb46a36c0d9a9 (MD5) / Made available in DSpace on 2018-05-14T12:59:21Z (GMT). No. of bitstreams: 1 B?RBARA_FREIBERGER_SCHAEFER.pdf: 1176504 bytes, checksum: 78558bd375bc4c7f9afcb46a36c0d9a9 (MD5) Previous issue date: 2018-02-26 / Introduction: The medical interview is fundamental for the approximation and recognition of the patient, and the physical examination usually increases the diagnostic possibility in the investigation. Technological development and immense diagnostic possibilities through complementary examinations have led to the idea of lesser importance of anamnesis and physical examination. Objective: To evaluate the undergraduate medical student's ability to perform a correct clinical diagnosis, from the presentation of clinical cases with information only from anamnesis or anamnesis and clinical examination together, without complementary exams. Methodology: A cross-sectional, exploratory study with quantitative data analysis of four clinical cases (two with isolated anamnesis and two with anamnesis and physical examination) answered by the students as a teaching task of the Medical Clinic discipline, with 97 academics from the School of Medicine of PUCRS from 2016 to 2017. Results: The findings showed that the majority of the students who participated in the study were female (54 subjects - 55.7%), predominantly white (94 - 96.9%), on average of 24.1 (+ 2.3) years old, having correctly determined 177 diagnoses (45.62%) in the first hypothesis. There was a significant difference (p <0.001) when compared the number of correct diagnosis in clinical cases with isolated anamnesis 108 (55.6%) to those with anamnesis and physical examination 69 (35.6%). Conclusion: It was verified that, for the undergraduate medical students of the fourth year from the School of Medicine, the correct answers in the first diagnosis were more frequent and with statistical significance, when clinical cases with isolated anamnesis were offered than when it was offered anamnesis and physical examination. / Introdu??o: A entrevista m?dica ? fundamental para a aproxima??o e reconhecimento do paciente, e o exame f?sico, habitualmente, aumenta a possibilidade diagn?stica na investiga??o. O desenvolvimento tecnol?gico e as imensas possibilidades diagn?sticas atrav?s dos exames complementares t?m levado ? ideia de menor import?ncia da anamnese e exame f?sico. Objetivo: Avaliar o n?mero de ocorr?ncias de diagn?sticos etiol?gicos adequados a partir da Anamnese e Exame F?sico, sem exames complementares, realizados por acad?micos do curso de gradua??o em Medicina. Metodologia: Estudo explorat?rio, transversal, com an?lise quantitativa dos dados, a partir de quatro casos cl?nicos (dois com anamnese isolada e dois com anamnese mais exame f?sico) preenchidos pelos alunos como tarefa de ensino aprendizagem da disciplina de Cl?nica M?dica, com 97 acad?micos de medicina da Escola de Medicina da PUCRS, no ano de 2016 e 2017. Resultados: Os achados evidenciaram que a maior parte dos acad?micos participantes do estudo eram do sexo feminino 54 (55,7%), predominantemente da ra?a branca 94 (96,9%), tinham em m?dia 24,1 (+ 2,3) anos, e que acertaram 177 diagn?sticos (45,62%) na primeira hip?tese. Houve diferen?a significativa (p<0,001) quando comparado o n?mero de acertos no diagn?stico em casos cl?nicos com anamnese isolada 108 (55,6%) comparado com aqueles com anamnese mais o exame f?sico 69 (35,6%). Conclus?o: Verificou-se que, para alunos de medicina do quarto ano de gradua??o da escola m?dica, os acertos com o primeiro diagn?stico foram mais frequentes e com signific?ncia estat?stica quando eram oferecidos casos cl?nicos com anamnese isoladamente do que quando se oferecia anamnese mais o exame f?sico.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-03-21T13:17:45Z No. of bitstreams: 1 WilmaMariaDaCostaMedeiros_TESE.pdf: 1291691 bytes, checksum: 21ca1efae5ecd551cf1c7041795af6af (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-03-26T18:11:28Z (GMT) No. of bitstreams: 1 WilmaMariaDaCostaMedeiros_TESE.pdf: 1291691 bytes, checksum: 21ca1efae5ecd551cf1c7041795af6af (MD5) / Made available in DSpace on 2018-03-26T18:11:28Z (GMT). No. of bitstreams: 1 WilmaMariaDaCostaMedeiros_TESE.pdf: 1291691 bytes, checksum: 21ca1efae5ecd551cf1c7041795af6af (MD5) Previous issue date: 2017-12-22 / Introdu??o: Os acidentes de transporte terrestre se constituem em relevante problema de sa?de p?blica mundial dada a sua magnitude e transcend?ncia, bem como ao alto custo humano e material que acarreta a sociedade. Em fun??o do aumento dos sobreviventes de acidentes de transporte terrestre com les?es leves e graves, nos ?ltimos anos, conhecer as v?timas sob o ponto de vista de caracter?sticas epidemiol?gicas e a percep??o do estado de sa?de, torna-se ?til para melhor monitorar as v?timas pelos sistemas de sa?de. Objetivo: Estimar a preval?ncia e identificar os fatores associados aos acidentes de transporte terrestre, bem como seus efeitos sobre a sa?de autorreferida da popula??o brasileira, segundo a Pesquisa Nacional de Sa?de, 2013. M?todo: Estudo de associa??o de fatores que utilizou dados da Pesquisa Nacional de Sa?de, realizada em 2013, atrav?s do inqu?rito populacional de base domiciliar, pelo Minist?rio da Sa?de e Funda??o Oswaldo Cruz, em parceria com Instituto Brasileiro de Geografia e Estat?stica, realizada no per?odo de agosto de 2013 a fevereiro de 2014. Para a an?lise dos dados foram calculadas as frequ?ncias relativas dos aspectos relacionados aos acidentes de transporte terrestre e da sa?de autorreferida, para fins de caracteriza??o da popula??o de estudo. As associa??es foram verificadas pelo teste Qui-Quadrado, considerando-se um n?vel de signific?ncia de 5%. Na sequ?ncia foram estimadas as raz?es de preval?ncia bruta e ajustadas, utilizando regress?o de Poisson com vari?ncia robusta, n?veis de signific?ncia de 0,05. Para estimar as raz?es de preval?ncia ajustadas, inicialmente foi realizada an?lise bivariada, que verificou associa??o dos acidentes de transporte terrestre com as vari?veis sociodemogr?ficas e as relacionadas aos aspectos da ocorr?ncia; da sa?de autorreferida com as vari?veis sociodemogr?ficas, socioecon?mica e aspecto inerente ? consequ?ncia do evento. As associa??es que apresentaram valor de p<0,05 foram inclu?das no modelo multivariado. Resultados: Do total de entrevistados na Pesquisa Nacional de Sa?de, 3,2% dos indiv?duos relataram ter sofrido acidentes de transporte terrestre no Brasil. Na an?lise de acidentes de transporte terrestre, vari?veis sociodemogr?ficas e aspectos envolvidos no evento, os indiv?duos do sexo masculino (RP=1,46 e IC95%: 1,22?1,75), que relataram n?o serem casados (RP=1,30 e IC95%: 1,12?1,52), dirigirem motocicleta (RP=2,41 e IC95%: 1,84?3,15) apresentaram maior probabilidade de referir envolvimento em acidente de transporte terrestre. As vari?veis idade e frequ?ncia com que anda de moto mostraram associa??o inversa com o desfecho. Na an?lise da sa?de autorreferida, vari?veis sociodemogr?ficas e socioecon?mica, os indiv?duos v?timas de acidentes de transporte terrestre que sofreram sequelas e/ou incapacidades (RP=1,51 e IC95%: 1,17?1,96), com mais de 40 anos (RP=1,75 e IC95%: 1,35?2,27), pertencentes tanto ? classe social D e E (RP=2,82 e IC95%: 1,58?5,00) quanto a C (RP=2,60 e IC95%: 1,49?4,54) apresentaram maior probabilidade de autoavaliar o estado de sa?de como prec?rio. Faz-se necess?rio destacar ainda, que sequela e/ou incapacidade ? a vari?vel independente principal e as demais s?o de ajuste. Conclus?es: Os acidentes de transporte terrestre no Brasil s?o mais prevalentes em motociclistas, do sexo masculino e n?o casado. J? os que sofreram sequelas nos acidentes, com idade mais avan?ada e das classes menos favorecidas economicamente possuem um estado de sa?de mais prec?rio. Tais resultados devem subsidiar pol?ticas p?blicas e programas de preven??o, de promo??o da sa?de e seguran?a no tr?nsito, com atua??o intersetorial, que vai muito al?m de medidas educativas e campanhas de m?dia. / Introduction: Land transport accidents constitute a significant global public health problem due to its magnitude and transcendence, as well as to the high human and material costs that society entails. Due to the increase in the number of land transport accidents survivors with mild and severe injuries in recent years, to know the victims from the point of view of their epidemiological characteristics and their perception of the state of health, it becomes useful to better monitor the health of the victims provided health systems. Objective: To estimate the prevalence and identify the factors associated with land transportation accidents, as well as the self-rated health of the Brazilian population affected by this event, according to the National Health Survey, 2013. Method: Association study of factors that used data of the National Health Survey, conducted in 2013, through a population-based household survey, by the Ministry of Health and the Oswaldo Cruz Foundation, in partnership with the Brazilian Institute of Geography and Statistics, conducted in August 2013 to February 2014. For the analysis of the data, the relative frequencies of the aspects related to land transportation accidents and self-rated health were calculated for the purposes of characterization of the study population. The associations were verified by the chi-square test, considering a level of significance of 5%. The crude and adjusted prevalence ratios were estimated using Poisson regression with robust variance, significance levels of 0.05. To estimate the adjusted prevalence ratios, we initially performed a bivariate analysis, which verified the association of land transport accidents with sociodemographic variables and those related to aspects of the occurrence; of precarious self-reported health with the sociodemographic, socioeconomic and inherent aspects of the consequence of the event. Associations that presented p value <0.05 were included in the multivariate model. Results: Of the total number of interviewees in the National Health Survey, 3.2% of the individuals reported having suffered land transportation accidents in Brazil. In the analysis of ground transportation accidents, sociodemographic variables and aspects involved in the event, male subjects (PR = 1.46 and 95% CI: 1.22-1.75), who reported not being married (PR = 1.30 and 95% CI: 1.12-1.52), motorcycle driving (PR = 2.41 and 95% CI: 1.84-3.15) were more likely to report involvement in ground transportation accidents. The variables age and frequency of motorcycle riding showed an inverse association with the outcome. In the analysis of self-rated health, socio-demographic variables and socioeconomic variables, individuals who were victims of road transport accidents that suffered sequels and/or disabilities (RP = 1.51 and 95% CI: 1.17-1.96), older than 40 (RP = 1.75 and 95% CI: 1.35-2.27), belonging to both social class D and E (RP = 2.82 and 95% CI: 1.58-5.00) and C (RP = 2.60 and 95% CI: 1.49-4.54) were more likely to self-assess health status as precarious. It is also necessary to highlight that sequela and/or incapacity is the main independent variable and the others are of adjustment. Conclusions: Land transportation accidents in Brazil are more prevalent in motorcyclists, male and unmarried. Those who have suffered sequels in accidents, with more advanced age and the economically disadvantaged classes, have a poorer health condition. Such results should support public policies and prevention programs, health promotion and traffic safety, with intersectoral action, which goes far beyond educational measures and media campaigns.