The aim of my thesis is to design the project documentation of an energy-efficient house for doctors and nurses, located near the hospital in Kroměříž. The work is divided into three parts. The first part focuses on the architectural and construction design of the building. The second part deals with the design of the technical equipment of the building and its layout. The third part deals with the design and comparison of different cooling sources. The building is a two-storey building with a flat, vegetated roof and its design is in the building permit stage. On the ground floor there is a bistro, a dining room with food preparation, technical rooms and 3 apartments. On the second floor there are 9 apartments and a lounge. In the middle of the building there is a circulation area with a staircase, a glass elevator and a large skylight that illuminates the whole area. Heating is provided by a gas condensing boiler. Ventilation is provided by three air handling units. A hybrid cooling system with heat recuperation from the refrigerant is designed. For partial electricity demand, 62 photovoltaic panels are installed on the roof of the building. The third part deals with the design of alternative cooling solutions for the building. Multi split, VRV and water cooling system with roof top chiller are proposed in addition to the already designed hybrid system. These four alternatives are compared with each other and the most suitable option is then designed.

El presente proyecto consiste en la creación de una app que nace en medio de una coyuntura mundial llamada COVID-19, la cual ha puesto a muchas empresas y a personas naturales bajo distintas condiciones incómodas, y para muchos, poco viables. Muchas organizaciones han tenido que adaptarse a estos cambios mayormente referidos a saneamiento y protocolos de inocuidad y otras han aprovechado estos tiempos de crisis para implementar nuevos proyectos que faciliten la vida de las personas en estos momentos difíciles y puedan llegar a encontrar una solución dentro de tanta incertidumbre. Por ello, se crea Doctor Wasi, una aplicación que se encarga de buscar médicos cercanos a tu domicilio, por medio del GPS del Smartphone. El mercado objetivo que se eligió fueron niños hasta los doce años y personas de la tercera edad, pues son el segmento más golpeado por el covid 19 actualmente y se quiso apoyar a esa clase de personas, no obstante, cualquier persona puede descargar la app y disfrutar de la experiencia de Doctor Wasi. Esta aplicación, tendrá tres tipos de especialistas, que son los médicos certificados, las enfermeras y los especialistas en terapia física, los cuales el paciente podrá escoger y contactar por medio de su teléfono celular. Asimismo, se estará en constante innovación de la app y de todas nuestras plataformas online con la ayuda de un experto en el rubro para que el cliente pueda llevarse la mejor experiencia cada vez que solicite el servicio de Doctor Wasi. / This project consists of the creation of an app that was born in the middle of a global situation called COVID-19, which has put many companies and individuals under different uncomfortable conditions, and for many, not very viable. Many organizations have had to adapt to these changes, mainly related to sanitation and safety protocols, and others have taken advantage of these times of crisis to implement new projects that make life easier for people in these difficult times and can find a solution within so much uncertainty. For this reason, Doctor Wasi was created, an application that is responsible for searching for doctors near your home, through the Smartphone's GPS. The target market that was chosen was children up to twelve years of age and the elderly, as they are the segment most affected by covid 19 today and they wanted to support that class of people, however, anyone can download the app and enjoy the Doctor Wasi experience. This application will have three types of specialists, which are certified doctors, nurses and specialists in physical therapy, which the patient can choose and contact through their cell phone. Likewise, we will be constantly innovating the app and all our online platforms with the help of an expert in the field so that the client can get the best experience every time they request the Doctor Wasi service. / Trabajo de investigación

The world is changing and humanitarian organisations need to be equipped to change with it. This case study has examined the internal democracy within the association of Medécins Sans Frontières (MSF), the creation of social capital and how it can be used to create bottom-up medical organisational change though motions. The selection of 6 motions was made to investigate if they have created the change they intended to create. The aim of this study is to test the hypothesis that members have the power to create organisational change and that such changes depend on a high degree of internal membership democracy. Internal democracy is in turn a precondition for the formation of social capital. In total were 12 in depth interviews conducted with members, former and current board members as well as the executive. In addition to this has an analysis of video recoded motion debates and feedback session been analysed along with other relevant internal documentation. The study has found that the association of MSF is founded on democratic principles as a mean to guide and hold the executive responsible and fulfils formal criterion for a democracy. The internal democracy has a series of weaknesses in it, like lack of participation from members and unequal weight of influences of different members and national associations. It is also facing threats of executive manipulation due to weak boards. Despite this the association has created a strong social capital that unfortunately is unevenly distributed among the members and its social capital is at risk of declining. Regarding motions there is a lot of potential in this formal tool of influence, but often it is not the motion itself but what the motion writers and audience do with the information as well as if the executive agrees with the motions that create the intended change. It can be interpreted as if down-top approaches to operational medical organisational change only will be achieved if the “top” agrees to the change. In conclusion, the assumption of this thesis has thus been proven to a certain extent. Members have the power to create organisational change through motions but their ability to do that depends on a high degree of internal democracy but also on informal contacts. Social capital is built in the process in the social networks that each association form individually as well as together with all MSF associations. However it is not necessarily a precondition to organisational change even though it is a product of the existing internal democracy. MSF has the opportunity to strengthen the democratic process and to be better equipped to create organisational change in the future.

Thesis (M. Nursing) -- University of Limpopo, 2022 / Background: Emergency departments (EDs) as the hospitals' front door have a critical role in ensuring access to and efficient care of acute illness and injuries in the healthcare system. The environment in EDs is physically and emotionally demanding and burdened by complex patient loads, long shifts, and administrative challenges resulting in high pressure and high volume workloads amongst the staff members. Purpose: The study aimed to develop support strategies for the resuscitation team in EDs of Mankweng and Pietersburg public hospitals in Limpopo Province, South Africa. Study method: A descriptive, phenomenological, and explorative research design was used to explore the resuscitation team's experiences and the available strategies to support them. Purposive and convenience sampling methods were used to select five Medical doctors and twelve Professional nurses to participate in the study. The sample size was determined by the depth of the information obtained from the participants.Data was collected through semi-structured individual interviews. Interview guide was developed to guide with organised line of questioning and thinking. Qualitative data analysis using Tesch's approach was then followed. The quality of data was ensured by applying four elements; credibility, transferability, dependability, and confirmability. Turfloop Research Ethics Committee, the Limpopo Department of Health, and the Mankweng/Pietersburg Ethics Committee permitted the study. The study's details were explained to potential participants, who then agreed to be part of the study and signed consent forms. Results: The following themes emerged: Challenges related to the shortage of resources in the ED, challenges related to lack of standardized procedures and policies for handling the resuscitation process, psychological challenges of resuscitation failure, leadership, and managerial support challenges, and challenges related to education and training of the resuscitation team. Conclusion: This study's results indicated that the resuscitation teams of EDs from Mankweng and Pietersburg Public Hospitals face challenges that cause them stress and burnout. The challenges result from an increased overload of work with no personnel and material resources. They become demoralized by being engaged in failed resuscitation with no psychological support from the management. They don't receive any debriefing or counseling post failed resuscitation and no educational backing of the management. The study's findings guided the researcher in developing strategies to support the resuscitation teams in the EDs of Mankweng and Pietersburg Public Hospitals.

No description available.

Aujourd’hui, le droit français permet aux professions libérales et notamment aux médecins de créer des sociétés et d’exercer en société la médecine. Le recours au droit des sociétés constitue une véritable révolution dans la pratique de la médecine libérale. L’exercice en société apporte d’ailleurs aux médecins de nombreux avantages. Mais lorsqu’ils envisagent de constituer une société, ils se posent légitimement la question de savoir quelles seront les conséquences de ce nouveau mode d’exercice sur leur propre clientèle. L’exercice en société semble constituer un instrument qui permet aux médecins d’exercer une certaine influence et emprise sur leur clientèle. Cet instrument s’avère donc très utile pour le professionnel libéral et notamment le médecin puisque la clientèle constitue leur unique source de revenus et de richesse. En effet, ce mode d’exercice leur permet, tout d’abord, de transmettre leur clientèle dans le cadre de la société et leur permet ensuite de la fidéliser à long terme dans la mesure où il conduit à améliorer la pratique de la médecine libérale. Cette influence sur la clientèle constitue probablement l’une des raisons du succès de l’exercice en société des médecins / Today, the French law permits liberal professions and especially doctors to create different types of companies. It means a real revolution in the way of practising medicine. Corporate law brings a lot of advantages to doctors. But, when they decide to create a company, they need to know what the repercussions will be for their own patients. Companies seem to be an instrument for doctors to exercise their influence on their patients. Working within a company is useful for them because having a regular practice warrants them a safer income. As a matter of fact, being structured into companies permits them to bring their patients and gain their loyalty as both the quality and the functioning of medicine are improved. It’s one of the reasons why such company creation is successful

Les traitements du cancer de la prostate permettent d’analyser les savoirs tels qu’ils sont élaborés actuellement en cancérologie. Les propositions de traitement découlent des savoirs scientifiques. La participation du patient au choix du soin s’en trouve questionnée. Le patient est une figure socialement construite et médicalement produite qui n’a de sens qu’au regard du rôle professionnel du médecin. La relation entre ces deux acteurs s’inscrit dans une structure de soin. Cette situation sociale est instituée autour de la nécessité du soin, entendue comme réponse à la souffrance de l’autre. Notre analyse montre les tensions qui traversent le groupe professionnel des médecins sur la question des recommandations thérapeutiques. Les questions de légitimité et d’expertise permettent de mettre à jour la concurrence entre les urologues et les oncologues-radiothérapeutes. Cette concurrence se joue à travers les traitements proposés. Les savoirs mobilisés pour justifier de la légitimité ne sont pas les mêmes et ne sont pas uniquement scientifiques. Ils s’organisent selon une priorité accordée à la sur-vie. En outre, ces savoirs médicaux retentissent de façon différente chez les patients, eux aussi détenteurs d’un savoir sur le soin. En somme, les savoirs sur le soin apparaissent comme une recherche de sens, une mise en cohérence de la pathologie, inhérente à des mondes sociaux différents, mais qui se nourrissent les uns des autres. / Treatments for prostate cancer have led us to analyze how knowledge can be produced in cancer research. The different treatment options offered to the patient directly originate from scientific knowledge. At that point already, one can question the patient’s participation to the choice of his treatment. The patient is a figure who is socially constructed and medically produced. This figure only becomes significant in regard to the doctor’s professional role. The relation between those two actors – doctor and patient – has to be replaced in its context of a social structure of care. Social situation instituted from the necessary of care, as an answer to human suffering, the analysis shows the tensions that arise within the professional group of doctors. Issues of legitimacy and expertise have revealed the rivalry between urologists and oncologists. That rivalry shows mostly through the treatments which are offered. The knowledge used to legitimate one option or the other varies and is not exclusively scientific. Different bodies of knowledge take priority according to the survival (goal). Moreover those medical bodies of knowledge are not understood in the same way for each patient, as they themselves hold particular knowledge about care/cure. In the end, it appears the pieces of knowledge about cure/care inherently belong to different social worlds that feed from each other, and those different bodies of knowledge seek to make sense of illness.

O que acontece no encontro do médico com a morte do seu paciente diz de algo estruturante da condição humana que transcende a formação acadêmica e mobiliza por este estar na presença de outro ser humano. Trata-se de uma pesquisa qualitativa que teve como objetivo principal descrever e conhecer o que existe de estruturante no encontro do médico com a morte do seu paciente. Este estudo utiliza o método fenomenológico de pesquisa, entendido como um convite para o exercício reflexivo visando à construção de novos paradigmas na produção de conhecimento. O autor de base que fundamenta a análise teórica foi Maurice Merleau-Ponty (2006). Foram realizadas quatro entrevistas com médicos oncologistas clínicos, embasadas na pergunta norteadora: O que significa para você cuidar do paciente oncológico, sem possibilidade de cura, que vivencia o seu processo de morrer e posteriormente perdê-lo?. Após a realização das entrevistas, os relatos (ingênuos) foram literalizados, dos quais foram levantadas as unidades de análise e transformadas em categorias analisadas fenomenologicamente, que possibilitaram o diálogo intersubjetivo e objetivo com os pressupostos teóricos sobre o tema em pauta. Categorias estas denominadas de: 1. Relação médico e paciente: o desvelar das emoções e sentimentos; 2. Relação médico e paciente: um distanciamento da morte do paciente; 3. O encontro do médico com a morte: a morte imprevisível; 4. Construção da identidade do sujeito: a dimensão ética do ser médico. A partir da análise das categorias, observou-se que tal encontro ocorre de diversas formas, principalmente pelo distanciamento como os médicos em questão lidam com a morte de seus pacientes, vista como um acidente, com falta de diálogo que, necessariamente, esbarra nas questões éticas e de formação acadêmica. A estrutura do fenômeno reside na ausência de diálogo pela dificuldade de lidar com os próprios sentimentos e emoções emergidas do processo de perda por morte de seus pacientes / What happens in the doctors encounter with the death of his patient says about human condition structuring which transcends academic formation and mobilizes in the presence of another human being.This is a qualitative research which had as its principal aim to describe and know what exists of structuring in the doctors encounter with the death of his patient. This study uses the phenomenological method of research, understood as an invitation to the reflexive exercise which aims the construction of new paradigms in the knowledge production.The fundamental author who substantiates the theorical analysis is Maurice Merleau-Ponty (2006). Four interviews with clinical oncologist doctors were made, based on the guiding question: What means to you to take care of the cancer patient, without the possibility of healing, who experiences his dying process and eventually lose him?After the interviews were made, the narratives (literal) were literalized, from which the analysis units were raised and transformed into phenomenologically analyzed categories, which enabled the intersubjective and objective dialog with the theoretical presuppositions about the subject under discussion.These categories are named: 1. Relation between doctor and patient: the unveiling of emotions and feelings; 2. Relation between doctor and patient: a detachment from the patients death; 3. The doctors encounter with death: the unpredictable death; 4. Construction of the subjects identity: the ethical dimension of being a doctor. From the analysis of the categories it was possible to observe that such encounter occurs in several ways, mainly by the detachment which the doctors from this study deal with the death of their patients, seen as an accident, with lack of dialog that necessarily touches the ethical and academic formation questions. The structure of the phenomenon dwells in the lack of dialog due to the difficulty to deal with ones own feelings and emotions emerged from the process of losing ones patients by death

A tese analisa mudanças que estão ocorrendo nos cursos de medicina no Brasil, a partir do Programa Mais Médicos e dos Novos Parâmetros Curriculares, e na Espanha, a partir da criação do Espaço Europeu de Educação Superior (EEES), visando desenvolver um novo perfil médico. No Brasil, visa-se uma formação geral, humanista, que qualifique médicos para atuar principalmente na Atenção Básica do Sistema Único de Saúde (SUS). Na Espanha, investe-se na formação de um médico que associe a pesquisa à sua prática, criando um profissional mais competitivo. Do currículo de dois cursos foram selecionadas as disciplinas de Saúde Coletiva e Seminário Integrador, na Universidade Federal da Fronteira Sul, e Inovação Biomédica e Novas Tecnologias, na Universidade de Valladolid. Foram realizadas observações em aula, entrevistas com professores e aplicados questionários com alunos dos dois cursos. Utilizou-se a metodologia de Estudo de Caso (YIN, 2005; STAKE, 2010), com apoio no estudo comparado (BADIE; HERMET, 1993). A concepção de inovação nesta tese se sustenta em autores como Santos, Lucarelli, Leite, Cunha, dentre outros. Considera-se inovação em educação: um movimento de ruptura com o modelo de conhecimento hegemônico da ciência; que seja promotora de participação e protagonismo dos sujeitos; de relações sustentadas na cooperação e solidariedade; de partilha de saberes e de poderes; integração de teoria e prática e de ensino e trabalho; que pode ocorrer em diferentes cenários de aprendizagem. A inovação pedagógica também foi considerada em relação ao grau de distanciamento com o padrão tradicional de formação médica. Acredita-se que o que está em jogo, em especial no cenário brasileiro, é a disputa entre dois modelos de atenção e formação médica. Foi possível identificar a coexistência de dois modelos de formação nos casos estudados: o biomédico, tradicional, presente na racionalidade médica e nas práticas pedagógicas, bem como na resistência de alguns alunos e professores, que não aceitam a proposta voltada para Atenção Básica, integralidade e humanização, no caso brasileiro; e, no caso espanhol, a tensão aparece igualmente na resistência e descrença à inovações de práticas pedagógicas e propostas fora do modelo hegemônico da ciência. Para análise do campo médico e de certas resistências encontradas na formação no Brasil e Espanha foram utilizados conceitos de Bourdieu. / The thesis analyzes the changes taking place in Medicine courses in Brazil through the “More Doctors” Program and the New Curricular Parameters; and in Spain, through the creation of the European Higher Education Area (EHEA), aiming to develop a new medical profile. In Brazil, it aims a general, humanist education that qualifies doctors to act mainly in Basic Health Care from Brazilian Unified Health System (SUS). In Spain, they invest in the education of a physician who associates research to his or her practice, creating a more competitive professional. From the curriculum of two courses, the subjects of Collective Health and Integrator Seminar, at the Federal University of Fronteira Sul, and Biomedical Innovation and New Technologies, at the University of Valladolid, were selected. Class observations, interview with professors were made and questionnaires with students from the two courses were applied. Case Study Method was used (YIN, 2005; STAKE, 2010), through a comparative approach (BADIE; HERMET, 1993). The conception of innovation in this thesis is supported by authors such as Lucarelli, Leite, Cunha, among others. It is considered innovation in education: a rupture movement with the hegemonic Science knowledge model; that promotes participation; of relations based on cooperation and solidarity; of knowledge and power sharing; integration of theory and practice and of teaching and working. It may occur in different learning scenarios. The pedagogical innovation was also considered in relation to the degree of detachment with the traditional pattern of medical education. It is believed that what is at stake, especially in Brazilian scenario, is the dispute between two models of care and medical education. It was possible to identify the coexistence of two education models in the two cases studied: the biomedical, traditional, present in medical rationality and in pedagogical practices, as well as in the resistance of some students and professor, who do not accept the proposal focused on Basic Health Care, integrality and humanization, in Brazilian case; in the Spanish case, the tension also appears in the resistance and disbelief to the innovation of pedagogical practices and in the proposals out of the hegemonic Science model. For analysis of medical field and of certain resistances found in education in Brazil and Spain, Bourdieu’s concepts were used. / Esta tesis analiza los cambios que están ocurriendo en los cursos de medicina en Brasil, a partir del Programa Más Médicos y los Nuevos Parámetros Curriculares; y en España, a partir de la creación del Espacio Europeo de la Educación Superior (EEES), con el objetivo de desarrollar un nuevo perfil médico. En Brasil, se objetiva una formación general, humanista, que cualifique médicos para actuar principalmente en la Atención Básica del Sistema Único de Salud (SUS). En España, se objetiva la formación de un médico que asocie la investigación a su práctica, creando un profesional más competitivo. Del currículo de los dos cursos, fueron seleccionadas las asignaturas de Salud Colectiva y Seminario Integrador en la Universidad Federal da Fronteira Sul, e Innovación Biomédica y Nuevas Tecnologías en la Universidad de Valladolid. Fueron realizadas observaciones en clase, entrevistas con profesores y se aplicaron cuestionarios con alumnos de los dos cursos. Fue utilizada la metodología Estudio de Caso (YIN, 2005; STAKE, 2010), con apoyo en el estudio comparado (BADIE; HERMET, 1993). La concepción de innovación en esta tesis, está sustentada en autores como Santos, Lucarelli, Leite, Cunha, entre otros. Se considera innovación en educación: un movimiento de ruptura con el modelo de conocimiento hegemónico de la ciencia; que promueva la participación y la protagonización de los sujetos; de relaciones sustentadas en la cooperación y la solidaridad; de compartir saberes y poderes; integración de teoría y práctica, y de enseñanza y trabajo; y, pudiendo ocurrir en diferentes escenarios del aprendizaje. La innovación pedagógica también fue considerada en relación al grado de distanciamiento con el modelo tradicional de la formación médica. Se cree que lo que está en juego, en especial en el escenario brasileño, es la disputa entre dos modelos de atención y formación médica. Fue posible identificar la existencia de dos modelos de formación en los casos estudiados: el biomédico, tradicional, presente en la racionalidad médica y en las prácticas pedagógicas, así como, la resistencia de algunos alumnos y profesores, que no aceptan la propuesta enfocada en la Atención Básica, integralidad y humanización, en el caso brasileño; y, en el caso español, la tensión aparece de igual forma en la resistencia y descreimiento con respecto a las innovaciones de prácticas y propuestas fuera del modelo hegemónico de la ciencia. Para el análisis del campo médico y de ciertas resistencias encontradas en la formación, en Brasil y España, fueron utilizados los conceptos de Bourdieu.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-19T19:02:41Z No. of bitstreams: 1 SilviaMariaCostaAmorim.pdf: 957239 bytes, checksum: b98502fdc52522d7a931ae44f18b1454 (MD5) / Made available in DSpace on 2017-05-19T19:02:41Z (GMT). No. of bitstreams: 1 SilviaMariaCostaAmorim.pdf: 957239 bytes, checksum: b98502fdc52522d7a931ae44f18b1454 (MD5) Previous issue date: 2016-12-01 / Introduction: The More Health Program (Programa Mais Médicos – PMM) for Brazil was created in order to reduce professional shortage in the regions with the greatest need and vulnerability and invest in training and qualification of all the professionals involved. In Maranhão, the program included 558 professionals until the 8th cycle in nineteen regions of health. Objective: analyze the evolution of health indicators with the implementation of PMM to Brazil in Maranhão municipalities. Methods: This was an ecological study, temporal, descriptive and analytical series. Secondary data will be analyzed, aggregated to the municipal level, through means (± standard deviations) if the variables have normal distribution, or median (± interquartile deviations) for variables with asymmetric distribution. To assess the normality of the distribution will be considered histograms, box-plots, skewness coefficient, kurtosis and the Kolmogorov-Smirnov test. Correlations between the n° of PMM physicians and the study variables were estimated by Spearman correlation coefficient (R). To test differences in health indicators with the implementation of PMM were estimated regression coefficients (β) in linear regression analysis of mixed effects, with hierarchical modeling (alpha = 5%). Results: 214 municipalities have received at least one doctor from PMM until the eighth cycle. Of these, seven in Special Indigenous Health District. The majority received from 1-4 physicians. Maranhão went from 0.58 to 0.67 physicians / 100 inhabitants. Most benefited municipalities had poverty profile (74.67%) and were between 10,000 and 50,000 inhabitants. There was a significant correlation between the number of PMM doctors deployed in municipalities with the following structure variables: Numbers of Basic Health Units (BHU) in construction (R = 0.115), average doctors / staff (R = 0.475), doctors in Primary Health Care (PHC) / 3000 inhabitants (R = 0.194), % BHU opening in minimum time (R = 0.127), % BHU that supply ≥75% of vaccines of the basic calendar (R = 0298), % BHU to offer rapid tests (R = 0.137) and % BHU that has minimal structure for Telehealth (R = 0491). There was no correlation with the working process variables (P> 0.05). There was also correlation with three variables expressing outcome – prenatal exam in pregnant women (R = 0.134). After adjustment of the models, remained associated with the number of implanted in PMM only one structure variable (number of BHU under construction: β = 0.188, P = 0.035) and one indicator of work process (% of family health team with access to telehealth in the city (β = 0.175, P = 0.008). Conclusion. Despite advances harmonized by the program, such as increased physician / inhabitant ratio and distribution of physicians to locations with greater vulnerability, remain the shortage of professionals and care empty. It is noticeable impact on rehabilitation of BHU and improving access to telehealth. / Introdução. O Programa Mais Médicos (PMM) foi criado com objetivo de diminuir a carência profissional nas regiões com maior necessidade e vulnerabilidade com o provimento de médicos e investimento na formação e na qualificação do conjunto dos profissionais envolvidos. No Maranhão, foram incluídos pelo programa 419 profissionais, até o 4º ciclo, nas dezenove regiões de saúde. Objetivo. Analisar a evolução de indicadores de estrutura, processo de trabalho e resultados com a implantação do PMM em municípios maranhenses. Métodos. Trata-se de um estudo ecológico, de série temporal, descritivo e analítico. Foram analisados dados secundários, agregados para o nível do município, por meio de médias (± desvios padrão), caso as variáveis tenham distribuição normal, ou mediana (± desvios interquartílicos), para variáveis com distribuição assimétrica. Para avaliar a normalidade da distribuição foram considerados histogramas, box-plots, coeficiente de assimetria, curtose e o teste de Kolmogorov-Smirnov. Correlações o nº de médicos do PMM e as variáveis do estudo foram estimadas pelo coeficiente de correlação de Spearman (R). Para testar diferenças nos indicadores de saúde com a implantação do PMMB, foram estimados coeficientes de regressão (β) em análises de regressão linear de efeitos mistos, com modelagem hierarquizada (Alpha=5%). Resultados. 214 municípios receberam pelo menos um médico do PMM. Destes, sete em Distritos Especiais de Saúde Indígena. A maior parte recebeu entre 1-4 médicos. O Maranhão passou de 0,58 para 0,67 médicos/1000 habitantes. Municípios mais beneficiados possuíam perfil de pobreza (74,67%) e tinham entre 10.000 e 50.000 habitantes. Houve correlação significativa entre o número de médicos do PMM implantados nos municípios com as seguintes variáveis de estrutura: nº de Unidades Básicas de Saúde (UBS) em reforma (R=0,115), média de médicos/equipe (R=0,475), médicos da Ateção Básica em Saúde (ABS) / 3000 hab. (R=0,194), %UBS que abre em horário mínimo (R=0,127), %UBS que oferta ≥75% das vacinas do calendário básico (R=0,298), %UBS que oferta os testes rápidos (R=0,137) e %UBS que possui estrutura mínima p/Telessaúde (R=0,491). Não houve correlação com as variáveis de processo de trabalho (P>0,05). Houve ainda correlação com três variáveis que expressam resultado/impacto: Exame de pré-natal em gestantes (R=0,134), Nº de óbitos infantis (R=0,209) e Nº de óbitos maternos (R=0,193). Após ajuste dos modelos, permaneceram associadas com o número de médicos implantados no PMM apenas uma variável de estrutura (Nº de UBS em construção: β=0,188; P=0,035); uma de processo de trabalho (% de equipes de saúde da família com acesso ao Telessaúde no município: β=0,175; P=0,008) e uma de resultado (Nº de óbitos infantis: β=0,354; P=0,013). Conclusão. Apesar dos avanços harmonizados pelo Programa, como o aumento da razão médico/habitante e a distribuição dos médicos para localidades com maior vulnerabilidade, permanecem a escassez de profissionais e os vazios assistenciais. É perceptível o impacto na requalificação das UBS e a melhoria do acesso ao Telessaúde.