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Item O impacto do planejamento estratégico na elaboração e implementação do plano de gerenciamento de resíduos de serviços de saúde na atenção básica(Universidade Federal de Goiás, 2015-03-13) Alves, Sergiane Bisinoto; Tipple, Anaclara Ferreira Veiga; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Takayanagui, Angela Maria Magosso; Pereira, Milca Severino; Rosso, Claci Fátima Weirich; Prado, Marinésia Aparecida doThe waste management is still deficient in many healthcare services. Those healthcare services smaller, as the primary healthcare offices, this problem becomes greater. Also important the destination for healthcare waste management generated by professionals and users in households. Faced with the expansion of the number and specificities of units in primary healthcare of occupational, environmental and social risks represent by healthcare waste generated in these environments, if not correctly managed, interventions in these realities are necessary and urgent. The objective was to evaluate the impact of the implementation of a healthcare waste management plan in primary healthcare unit and to check the approaches adopted by healthcare workers on the management of piercing and cutting waste generated by insulin users at households. This is a comparative and intervention study, pre and post, in a non-hospital unit to emergency care and also in a family healthcare unit, in the period from 2011 to 2014. The intervention performed consisted of: design and implementation of healthcare waste management plan using the situational strategic planning, educational and illustrative activities for users and multimodal permanent education, collective and individualized, for professionals for both healthcare units. A year after the intervention, all waste generated during a week in each healthcare unit were weighed and analyzed about the segregation. The values obtained were compared to those in the pre-intervention phase (Alves, 2010) that made the diagnosis in the same units and used the same methodology for the quantification and segregation analysis of the healthcare waste. The results show that the development and implementation of the waste management plan, using the situational strategic planning reduced healthcare waste generation and the inadequacies found about segregation in both units studied. It was also observed that there isn´t a management plan about management of piercing and cutting waste generated by users in households and that management is not assimilated in professional practice or in institutional procedures. The proposed intervention proved to be easy to apply and to involve all professionals and managers in prepare and implementation of a healthcare waste management plan in primary healthcare unit. The professionals and managers actively participated since the diagnosis of the healthcare waste management situation, discussion of alternatives to solve the problems listed until the decision making, resulting in a collective commitment to implement the healthcare waste management plan of healthcare services.Item Regulação da saúde no estado do Pará: um estudo na região metropolitana de Belém(Universidade Federal de Goiás, 2019-03-11) Bastos, Luzia Beatriz Rodrigues; Barbosa, Maria Alves; http://lattes.cnpq.br/5025797873585225; Barbosa, Maria Alves; Duarte, Célia Scapin; Nogueira, Douglas José; Ferreira, Ilma Pastana; Vila, Vanessa da Silva CarvalhoINTRODUCTION. Regulatory structures can become determinants in the organizational process of health management, since it has the possibility of giving more effective responses to the requesting units and, above all, to the user. It would be up to the establishment of flows for the intended service not only implying optimization of expenses. Objective. To analyze the regulation of health services, in the Metropolitan Region I of the state of Pará, in view of complex and regulatory centers, recommended by the Brazilian Unified Health System (SUS). METHODOLOGY. An exploratory descriptive study with a mixed focus developed in the complexes and central regulators of the municipalities of Belém, Ananindeua, Marituba and Benevides, whose sample was composed of eighteen managers and seventy regulators, from September / 2017 to January 2018. It was applied the questionnaire in the first phase of the research and after that 40 semi-structured interviews were carried out. RESULTS. In the process of calculating the quantitative data it was found that the officials of the regulation, are female, with average age of 39 years; salary range of 2 minimum wages; majority of administrative assistants with effective ties. As limiting factors were found: great demand; lack of indication of priority cases and failure to refer to regulatory criteria; unavailability of beds, systemic difficulties in relation to the agreed services and the SISREG; difficult scheduling and execution procedures; increased demand for repressed elective procedures; problems in the flow of information between primary care and regulation, among others. As main potentialities in health regulation, the following stand out: increase of financial resources to health; reorganization of internal regulatory procedures; meeting the needs of users; health training for regulatory professionals, and strengthening of primary health care. CONCLUSION. The study showed that it is difficult to concentrate higher level professionals to perform the tasks of regulators of medium and high complexity procedures of SUS; there are obstacles in operationalizing the regulatory process, because the regulatory structures created coexist with insufficient resources, unconditional agreements with the reality of the municipalities of the north of the country; there is recognition of the need for a strong regulatory component by the State in guaranteeing qualified health access to the population, one of the greatest challenges being to understand the multiplicity of scenarios, subjects and interests, and to implement strategies focused on the user that needs health services.Item Estratégias de atenção aos cuidadores informais de idosos: pesquisa participante baseada na comunidade(Universidade Federal de Goiás, 2017-03-27) Borges, Cristiane José; Munari, Denize Bouttelet; http://lattes.cnpq.br/8409035360598716; Munari, Denize Bouttelet; Stacciarini, Jeanne Marie Rodrigues; Medeiros, Marcelo; Santana, Rosimere Ferreira; Pagotto, ValériaINTRODUCTION: The process of population aging is a worldwide phenomenon and, simultaneously, a new social role emerges - the informal caregiver-, seen as an essential component to promote elderly’s quality of life in some dependency situation at home. OBJECTIVE: To describe the construction and implementation of care and support strategies for elderlies’ informal caregivers through the Community Based Participatory Research. METHOD: A descriptive study guided by Community Based Participatory Research (CBPR) principles and carried out through the organization of a Community Advisory Committee (CAC), which involved academic and community participants. The study was attended by 384 people, nine community partners, 255 professionals working in family health strategies and 120 elderlies’ informal caregivers. The research was divided into the following phases: 1 - establishment of the community partnership; 2 - identification of problems related to elderly’s informal caregiver; 3 - prioritization of problems related to elderly’s informal caregiver; 4 - capacity survey of community strengths, dynamics and resources; 5 – arrangement of strategies, method, support and care interventions to elderly’s informal caregiver; 6 - implementation of strategies, method, support and care interventions to elderly’s informal caregiver; 7 - data analysis by CAC members; 8- dissemination of results obtained with CAC partnership; 9 - maintenance, CAC sustainability and partnerships evaluation. For the results’ analytical process, the content analysis proposed by Bardin was used for qualitative data and the descriptive statistical analysis was used for quantitative data. The Bioecological Theory of Human Development was adopted as a complementary basis for data analysis. RESULTS: Through the CAC constitution, there were identified, in a collective way, 17 problems faced in the elderly’s informal caregiver daily life. The use of the Severity, Urgency and Trend matrix allowed these problems prioritization for decision making. This process mobilized the construction of an action plan composed by five strategies: 1 - teaching of CAC members about the concepts recommended to define the caregiver role; 2 -raising the knowledge of Family Health Strategy professionals about the importance of including the informal caregiver as a care focus; 3 - performance of the 1st Multiprofessional Care Meeting for Elderly and Informal Caregiver; 4 - recording of the city’s informal caregivers of elderly people; 5 - qualification of the elderlies’ informal caregivers. CONCLUSION: The use of Community Based Participatory Research enabled the community partners’ empowerment, that mobilized themselves in support of elderlies’ informal caregivers, developing actions that included the mapping of the city’s informal caregivers of elderly people, mobilization and qualification of the Family Health Strategy professionals, and the organization of care spaces. In this process, it was verified that this research approach strengthens health democratization by promoting greater involvement and social protagonism of community partners, creating ideas and concrete actions for the establishment of care strategies for the elderlies’ informal caregivers.Item Fatores associados à qualidade de vida relacionada à saúde do portador de doença renal crônica em tratamento pré-dialítico(Universidade Federal de Goiás, 2014-12-19) Cordeiro, Jacqueline Andréia Bernardes Leão; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Canhestro, Mônica Ribeiro; Barbosa, Maria Alves; Vila, Vanessa da Silva Carvalho; Freitas, Ana Tereza Vaz de SouzaChronic kidney disease is considered a worldwide public health problem because of the high mortality rates and the physical, social and emotional limitations that interfere significantly in quality of life. The evaluation of the quality of life of chronic kidney disease carrier has demonstrated commitment to many aspects of life of these individuals and it was directed mainly to patients on dialysis. The number of referrals for pre - dialysis monitoring, resulting from complications due to comorbidities such as hypertension and diabetes mellitus is growing, and it requires that the focus of assistance is not only early diagnosis and treatment of disease, but also, aspects related to subjectivity, the perceptions of individuals in relation to their well - being and quality of life (QOL). At present there is no specific instrument to assess QOL of individuals in pre- dialysis treatment. This study aimed to analyze the factors associated with QOL related to the health of the chronic kidney disease carrier in pre- dialysis treatment. An analytical cross-sectional study was developed in three nephrology clinics of large hospitals in the city of Goiânia/Goiás, with 130 patients in stage IV and V of chronic kidney disease. Data collection was done through the application of socio - demographic - clinical - laboratory questionnaire and the specific QOL instrument for kidney disease, KDQOL -SF. A total of 57.7% of patients were male and the group average age was approximately 64 years old. Most patients were classified as stage 4 (69.2%) and some had no schooling (54.6 %). Among the comorbidities detected hypertension was more prevalent, followed by diabetes mellitus and 28.5% of patients had hemoglobin levels lower than expected. The dimensions of quality of life "the professional role" (25.38) and "the physical function" (28.08) showed lower values while "the stimulus by the clinic staff" (88.37) and "the cognitive function" (86.00) had the highest average. QOL is more compromised in women and in patients with five or more children who do not work and have no income, who are obese, hypertensive and show alterations especially in urea and creatinine. It was shown that QOL is influenced by chronic kidney disease, especially when there is change in laboratory parameters which control may extend the start of dialysis therapy or even minimize possible organic misfits. The KDQOL -SF was adequate to evaluate the QOL of individuals in pre- dialysis treatment. The gaps shown by the assessment of QOL in this study showed the importance of care to the kidney patient in the pre- dialysis phase, requiring more effective attention to the subjective demands. This could be achieved if the individual is taught to manage his condition, and it is essential a multidisciplinary monitoring to consider the level of patient understanding, so he can transform the information provided in benefits for his own health.Item Reanimador manual: quando trocar no mesmo paciente(Universidade Federal de Goiás, 2016-03-31) Gomes, Giselle Pinheiro Lima Aires; Pereira, Milca Severino; http://lattes.cnpq.br/9304767101674108; Souza, Adenícia Custódia Silva; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva; http://lattes.cnpq.br/5966034868102264; Oliveira, Adriana Cristina; Tipple, Anaclara Ferreira Veiga; Leão, Lara Stefânia Netto de Oliveira; Brasil, Virginia ViscondeINTRODUCTION: The manual resuscitator is a widely used respiratory assist device that has been reported to be a reservoir and a source of contamination from various microorganisms. At present, there is no criteria to replacement of manual resuscitator when it is in successive use in the same patient. AIM: To evaluate the safest amount of time the manual resuscitator can be successively used in the same patient. METHODS: An open, prospective cohort study was conducted from October to November, 2014 using 30 patient connector valves from manual resuscitator devices obtained from Intensive Care Units of a general hospital located in a region north of Brazil. The samples were collected through swab friction on the manual resuscitator that was used by the same patient, at zero (ready use), 24 and 48 hours. Bacterial identification and antibiotic susceptibility were performed automatically (Vitek 2 Compact®). RESULTS: Of the 30 resuscitators evaluated, 20 (66.6%) were found to be contaminated. There was a significant difference between the microbial load on the manual resuscitators in use at zero and 24 hours (p = 0.03). Associated risk factors for the contamination of manual resuscitators identified were frequency and time of use. The presence of visible soil was not detected on 19 manual resuscitators in use, however, 95.0% were contaminated. The number of microorganisms isolated at zero, 24 and 48 hours were five, 11 and 24, respectively. Thirteen devices were contaminated with two or more bacterial species. Of the Gram-positive cocci, 38.9% (n = 18) were methicillin-resistant Staphylococcus aureus and 11.1% were methicillin-resistant coagulase-negative Staphylococcus, all were constitutive MLSB resistant. Of the Gram-negative rods (n = 36), Acinetobacter baumannii (36.1%), Pseudomonas aeruginosa (19.4%), Serratia marcescens (22.2%) and Proteus spp. (8.3%) dominated. Over 50% of these were resistant to carbapenems, second, third and fourth cephalosporins generations, and ampicillin/sulbactam. CONCLUSION: Manual resuscitators in successive use in the same patient were contaminated even in the absence of visible dirt. Multi- and extensively-resistant bacteria of clinical importance were also detected. Frequency and time of use were identified as risk factors in the contamination of manual resuscitators. The longer the time of use, the greater the number of contaminated resuscitators and bacterial species isolated. These results point to failures in reprocessing, and therefore highlights the importance of having thorough discussions among regulators about the recommendations for the reprocessing of semi-critical medical devices, especially, those for ventilatory assistance. Furthermore, the results highlight the need to replace manual resuscitators every 24 hours after use as a strategy for infection control and to minimize the risk of re-colonization or -infection of the respiratory tract.Item Diagnósticos, intervenções e resultados de enfermagem à pessoas em tratamento hemodialítico: validação de consenso por especialistas(Universidade Federal de Goiás, 2015-10-20) Lemes, Maria Madalena Del Duqui; Bachion, Maria Márcia; http://lattes.cnpq.br/8503907944360635; Lemes, Maria Madalena Del Duqui; http://lattes.cnpq.br/8503907944360635; Barbosa, Dulce Aparecida; Brasil, Virgínia Visconde; Munari, Denize Bouttelet; Almeida, Miriam de AbreuINTRODUCTION: Among the health problems experienced by adult and elderly people, who have a strong impact on the quality of life, stands out chronic kidney disease (CKD). The nursing process improves the clinical practice of care in hemodialysis, however, is still in its infancy and the scope of the phenomenas described in the taxonomies of diagnoses, interventions and nursing results, as the focus on hemodialysis scenario has not yet been described. OBJECTIVES: To validate nursing diagnoses as priorities by expert nurses; Validate interventions for diagnosis identified as priority by expert nurses; Validate relevant nursing results for diagnoses identified as priority by expert nurses. METHODOLOGY: A descriptive, cross-sectional study, validation of nursing diagnoses, interventions and priority outcomes for patients with chronic kidney disease on hemodialysis people, from the NANDA-I Terminology / NIC / NOC. Participated 12 hemodialysis units that served 1788 patients and 55 nurses working. From the occupational profile of these nurses was identified 21 experts. Of these, nine validated diagnoses, interventions and nursing outcomes, through a focus group, for people with chronic kidney disease. RESULTS: There were 36 validated diagnostic, 124 interventions and 119 nursing results. Of validated nursing diagnoses, 13 are recognized more often in literature and 23, little mentioned or not mentioned. CONCLUSION: The diagnoses, interventions and nursing outcomes validated by experts in hemodialysis give visibility to a qualified clinical practice proposal for systematization of nursing care in accordance with the reality of unity.Item Análise dos registros de curativos em prontuários de um hospital de ensino do Estado de Goiás(Universidade Federal de Goiás, 2016-06-21) Lemos, Lucimeire Fermino; Barbosa, Maria Alves; http://lattes.cnpq.br/5025797873585225; Almeida, Alessandra Rodrigues de; Barbosa, Nelson Bezerra; Bezerra, Ana Lúcia Queiroz; Prado, Marinésia Aparecida do; Barreto, Regiane Aparecida dos Santos SoaresHealth records are important for keeping effective communication among all professionals involved in the process of taking care as well as for legitimating the team actions in the face of patients and families. The records must be clear and objective because they are sources of information for judicial, research, teaching, billing and auditing issues. This study has an objective to analyze the records of procedures of Level II Curative in medical records of hospitalized patients, from the nurses’ perspective, before and after the pedagogical intervention, in a Brazilian teaching hospital in the Midwest region. It was a descriptive study with both qualitative and quantitative research and was developed in many stages. The first stage included the nurses’ profiles and the identification of the main reasons why the nursing actions were not recorded. The second stage was the analysis of the records before and after the pedagogical action, which was the third stage. At last, the nurses were interviewed about their perception of the importance of the records for billing. It was observed among the sample of nurses the predominance of women (87,2%), post-graduated (82,1%) and statuary civil servants (80,4%). Even though 53,6% of the nurses said that they do not have double employment relationships, 46,4% said they do. The nurses said that it was not possible to record the procedures due to lack of time (50%), work overload (20%), lack of human resources and access to the records (12,5%), interruptions and lack of guidance (2,5%). The objective of the intervention was to discuss the importance of health records, and specially, in relation to the level II curative. 45,2% of the nurses of this institution took part in this event. In the analysis of the records, before and after the intervention, it was possible to observe the increase of the records of the curatives (82,3%), the detailing of the quantity of curatives per patient (69,9%), the classification of the wounds (63,5%), the description of the materials used in the procedures (67,3%), and also the scheduling (74%) and the checking (71,4%). The data shows that the quantity of material used maintained still. However, there was a rise of curative prescription by the nurses (79,4%) and a fall of curative prescription by the doctors (18,3%). It was also possible to observe that the performed and not prescribed procedures or prescribed and not verified procedures, in both cases, were not billed. Nevertheless, the hospital overturn related to this procedure has an increase, from July 2015. The interviews with the nurses showed that they take the responsibility in the treatment of wounds for themselves. However, it is necessary to standardize the prescriptions and the evolutions of the procedure. The complete record of this intervention is important to safeguard the institution in case of auditing. In conclusion, nurses have an important role in recording the wound treatment. The obligation of recording should be reinforced due to the quality of the service and the profession´s visibility as well as for a better material and input control and billing.Item Instrumental ortopédico de conformação complexa: avaliação do processamento, formação de biofilme e suas implicações(Universidade Federal de Goiás, 2016-12-20) Lopes, Lillian Kelly de Oliveira; Watanabe, Evandro; http://lattes.cnpq.br/6142675059689994; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Hunt, Alessandra Marçal Agostinho; Lima, Ana Beatriz Mori; Melo, Dulcelene de Sousa; Caetano, Karlla Antonieta AmorimINTRODUCTION: Depth gauge and flexible drill bite cutter are orthopedic surgical instruments of complex conformation and they are into loanered instrumentation box to different healthcare facilites. The challenge is to ensure that appropriatly cleaning was done to prevent the formation of biofilm in these instruments´models. There are no experimental or clinical studies analyzing the impact of different cleaning protocols on formation of biofilm on surfaces those two surgical instruments. OBJECTIVES: To validate and to evaluate laboratory method to formation of biofilms in stainless steel. To evaluate microbial load and to determine formation of biofilms after laboratory contamination and processing for several cycles in surgical instruments of complex conformation used in surgeries of orthopedic implants. METHOD: Experimental study was developed from November/2014 to March/2016, at the Laboratory of Macquarie University, Sydney (AU). Method´s validation: new forceps halsted hemostatic mosquito were contaminated within contaminant solution containing S. aureus (ATCC 25923) and sterilized in saturated steam. Forceps were divided into three groups according to cleaning: 1) rinsing, 2) manual cleaning and 3) manual cleaning followed by automated cleaning. After 6th, 13th and 20th three forceps from each protocol were analised for microbial load and protein amount (Bicinchoninic Acid Assay) and visual analysis by scanning electronic microscopy. The same method was used on new flexible drill bite cutters and depth gauges, and analised after 10th and 20th reprocessing. RESULTS: Method´s validation: forceps submitted to protocols 1 (positive control of cleaning) and 2 showed coccus in biofilms and forceps sumitted to protocol 3 showed organics residues after 20 reprocessing. No microbial load or residual protein was found. Complex instruments: flexible drill bite cutters submitted to rinsing presented high amount of protein with increase of 1699μg of protein from 10th to 20th reprocessing (P = 0.03). Depth gauge submitted protocol 1 presented high amount of protein, however there was no statistically significant difference from 10th to 20th processing (P = 0.60). All instruments submitted to manual and/or automated cleaning did not present residual protein. It was possible to identify residue and biofilm into lumen of surgical instruments after 20 reprocessing. CONCLUSION: Experimental techniques to formation and evaluation of biofilm in surgical instruments manufactures in stainless steel were validated and 20 inappropriated cleaning processing were enough to buildup biofilm. Biofilm was formed within lumens of flexible drill bite cutter and depth gauge, after 20 processing despite the instruments were submitted to “gold standard” cleaning, also accumulation of protein on flexible drill bite cutters. Depth gauge lumen allowed accumulation of waste using manual cleaning followed by automation cleaning and manual cleaning allowed buildup residue on its external surface. Manual cleaning allowed accumulation residue on deep gauge. It was not possible to recover viable S. aureus in biofilm on instrumental surface, but it indicates that design of instruments evaluated is not safe to processing. It is presumed have risk ratio for aseptic loss of prostheses and infection related to healthcare, since they are instruments of difficult cleaning control and circulate in numerous healthcare facilites using different cleaning protocols.Item Ação de detergentes e desinfetantes em biofilme tradicional e buildup no modelo MBEC(Universidade Federal de Goiás, 2016-12-20) Luciano, Cristiana da Costa; Alfa, Michelle J.; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Hunt, Alessandra Marçal Agostinho; Watanabe, Evandro; Melo, Dulcelene de Souza; Teles, Sheila Araújo; Tipple, Anaclara Ferreira VeigaINTRODUCTION: Flexible Gastrointestinal Endoscopes (FGE) are used for diagnostic and therapeutic procedures, classified as semicritical health products (HP), requiring High-Level Disinfection (HLD) processing among users. The FGE designs are complex, making it difficult to process and favor the occurrence of faults that contribute to the accumulation of organic matter on the surface of the internal channels of the endoscopes, contributing to the formation of the biofilm. OBJECTIVE: To develop a Biofilm Buildup (BBF) accumulation model, based on repeated exposure of test soil containing Entercoccus faecalis and Pseudomonas aeruginosa by means of repeated cycles of fixation and to evaluate the ability of detergents and disinfectants to destroy and remove bacteria in the Traditional Biofilm (TBF) and Buildup. MATERIALS AND METHODS: TBF was developed in MBEC ™ peg, without hydroxyapatite, and BBF, with hydroxyapatite, over a period of eight days. For the development of both biofilms, E. faecalis and P. aeruginosa, containing 8 log10, colony forming units per cubic centimeters (CFU/cm2) were used. Prolystica Enzymatic (D1), Prolystica Neutral (D2), Neodisher (D3) and Endozime (D4) were tested alone and in combination with Glutaraldehyde (GLUT), Orthophthaldehyde (OPA) and Hydrogen Peroxide Accelerator (APH) to determine if both biofilms could be removed. The removal of the traditional biofilm and buidulp, using viable bacteria count, quantification of protein and carbohydrates and by means of scanning electron microscopy (SEM) was evaluated. RESULTS: After eight days of BBF development, 6.14 log10 CFU/cm2 of E. faecalis and 7.71 log10 CFU/cm2 of P. aeruginosa were reached. None of the detergents and disinfectants have been able to remove the traditional biofilms and buildup or reduce the level of bacteria. The combination of detergents and disinfectants tested in BBF provided a reduction of 3 to 5 log10 in viable bacteria, but no combination could provide the expected reduction of l log10. Only enzyme Prolystica and Endozime removed both E. faecalis (3.90 log10 colony forming units per milliliter (CFU/mL)) and P. aeruginosa (3.96 log10 CFU/mL) in suspension bacteria. None of the detergents tested removed > 1 log10 CFU/cm2 from the bacteria within the traditional biofilm. No combination of high-level disinfectant and detergent reduced the level of both E. faecalis and P. aeruginosa from the traditional biofilm interior (3 to 5 log10 CFU/cm2). Although the combination of Endozyme and Glutaraldehyde reduced 6 log10, it did not eliminate both bacteria in the traditional biofilm. CONCLUSION: Data indicate that if TBF and BBF accumulate in the EGF channels during repeated processing cycles, neither detergents nor high level disinfectants will provide the expected level of bacterial removal or destruction. Future research using the buildup model can help develop new cleaning and disinfection methods that can prevent or eliminate the BBF within the endoscope channels.Item Implicações pessoais e profissionais do acidente com material biológico para o trabalhador da saúde(Universidade Federal de Goiás, 2014-01-31) Melo, Dulcelene de Sousa; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Tipple, Anaclara Ferreira Veiga; Lemes, Lila Maria Spadoni; Pereira, Milca Severino; Vila, Vanessa da Silva CarvalhoINTRODUCTION: The health of workers, in their everyday work, are exposed to various risks, among which, biological. This represents a danger important to public health, which may, in addition to physical injury, have broader implications, and impact various aspects of their lives. OBJECTIVE: To analyze the personal and professional implications of exposure to biological material for healthcare workers. METHODOLOGY: A qualitative study conducted with ten workers in the healthcare field who experienced accidents with biological material and who were treated by a reference healthcare service in Goiania, Brazil. Data were collected between October and November 2012, through interviews using the critical incident technique. Data processing used the content analysis methods proposed by Bardin, with the additional aid of Atlas ti 6.0 software. The discussion of findings was presented using theoretical frameworks of complex thinking from the perspective of Edgar Morin, as well as cultural theory of risk by Douglas. RESULTS: From the narratives of those experiences, for ten healthcare workers treated by three units of reference specializing in situations of exposure to biological material, four categories of analysis emerged: personal implications; professional implications, the workplace and risk management, and reference service and risk management. The results showed great psychological distress expressed through feelings of fear of contamination of self and family, worry, despair, lack of protection, guilt, anger, insecurity, introspection, helplessness, uncertainty, and awkwardness, among others. This suffering was reflected in the three spheres of interaction, as well as relationships between exposed workers. On the other hand, some might experience the solidarity from co-workers, patients, and professionals during service, through gestures and relationships that help in coping with tensions when such a situation arises. The structures in place at work and in referral services showed contradictions in such situations: support / helplessness; commitment / disengagement; climate of security / insecurity; careful / careless; organization / disorganization, respect / disrespect; acceptance / leaving at the mercy of fate. The accident was established as the driving force for workers to pay attention to their own safety and change their routines in this context, extending this reflection not only to themselves, but for those who they interact with professionally interaction. CONCLUSION: The experiences of these workers shows antagonistic, contradictory, and complementary aspects of complex systems for the health services worker. It suggests the need for a greater appreciation and consideration of the psycho-emotional consequences experienced by workers, along with review of treatment procedures as to their effectiveness and problem solving that improve quality of life to the healthcare worker.Item Risco biológico nas etapas finais do sistema de medicação em serviços de urgência e emergência e a implementação de uma estratégica educativa pautada no Arco de Maguerez(Universidade Federal de Goiás, 2013-11-04) Mendonça, Katiane Martins; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Tipple, Anaclara Ferreira Veiga; Pereira, Milca Severino; Vila, Vanessa da Silva Carvalho; Queiroz, Maria Goretti; Souza, Adenícia Custódia Silva eINTRODUCTION: the prepare and the administration medications´s are activities performed by nursing staff and involve the biological risk to users and to professionals. This risk may be exacerbated when work activities are developed in areas such as emergency care that require immediate decisions. For intervention in this reality is necessary be based on situational analysis and involve all staff in the change process. OBJECTIVES: the general was to analyze the biological risk in the final stages of the medication system in the context of emergency services. And the specifics were to identify the recognition by nursing staff on the occurrence of behaviors that are characterized as biological risk in the final stages of the medication system, in the context of emergency services; characterize cases of accidents with biological material during the administration of medication in emergency services; describe ways to reduce the occurrence of accidents, indicated by the victims during the administration of medications in emergency services and describe the process of implementing an educational intervention on the biological risk in the prepare and the administration medications´s based on Problematization Methodology with Maguerez´s Arch. METHOD: The study was divided into two stages. The first presented an analytical design. Data collection occurred from October/2011 to April/2012, using a questionnaire, with demographic data and related accidents with biological material and Likert scale, with 44 items about risk behaviors previously observed among the study participants. The instruments were subjected to pilot testing. The data were processed by SPSS / IBM 20.0. In the second stage there was a descriptive exploratory study with a qualitative approach. The sources of information were recordings of the group discussions, field notes and record the speeches in the posters. The data´s collection, analysis and presentation were guided by the stages of the Arch and the guidelines of Bogdan and Biklen (2010). The educational intervention was performed in 44 meetings 34 professionals, in small groups, from August to December 2012. All went through by the stages of Maguerez´s Arch (reality observation, problem definition, key points, theorizing, possible solutions and application to reality). The project was approved by the Ethics Committee number 065/08 and 118/08 and all participants signed the informed consent. RESULTS: The scale showed the recognition by professionals of the existence of conduct that characterized the biological risk. The scale showed satisfactory reliability (Cronbach's alpha of 0.75 overall) and showed the recognition by professionals of the existence of conduct that characterized the biological risk. The conducts were related to the practice of hand washing, protective equipment, maintenance of aseptic chain, waste of health services and occupational accidents. The accident rate was 41.7% and most of the victims worked at night and said it had not received training to work in the emergency department. The protection items were neglected. Individual and organizational issues were identified as ways to reduce accidents. The educational intervention in these departments required adaptations. Were held 44 meetings with the participation of 34 professionals (87.2% of the population), six nurses and 28 nursing technicians, divided into small groups, from August to December/2012. All went through the steps of the Maguerez´s Arch (observation of reality, problem definition, key points, theorizing, possible solutions and application to reality). From the proposal for discussion of the problem related to the practice of preparation and administration of medications in emergency care unit, the key points prioritized contemplated infrastructure, human and material resources and staff qualification. Theorizing complemented the stage of the search for possible solutions, among which could be implemented in the short, medium and long term. The evaluation of the implementation of this strategy showed the commitment of professionals with field experience and successful methodology. CONCLUSION: all accidents reflected the configuration of risk behaviors recognized. The essence of this study was to understand the practice where it gives, with our own eyes, the eyes of the other and together seek a path to transformation. We found that the route chosen for the study provided us subsidies to analyze and reflect on the process of intervening in questions about the biological risk units with the wealth of specifics, such as emergency departments and direct strategies for use in units with characteristics like.Item Uso e manuseio do jaleco: uma análise das condutas dos trabalhadores da saúde na prática clínica(Universidade Federal de Goiás, 2015-09-15) Neves, Heliny Carneiro Cunha; Santos, Silvana de Lima Vieira dos; http://lattes.cnpq.br/2461784381351166; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Pereira, Milca Severino; Souza, Sandra Brunini de; Silva, Ana Elisa Bauer de Camargo; Melo, Dulcelene de SousaInappropriate behaviors of healthcare workers about the use and the handling lab coat represent a risk to the patient and the professional, family and community. The recommendations in this area are guided on limited evidences and the specific norms for the standardization of practices for use and handling is fragile. OBJECTIVE: To analyze the use and handling of lab coats by healthcare workers. METHODS: Cross-sectional, observational and analytical study conducted with 103 healthcare workers in a public teaching hospital, located in the Center-West of Brazil. The characteristics of the lab coats, the data regarding the transport and the handwashing practice before wearing and after removing the lab coat were observed at the arrival timing and exit of the unit and registered in check list. The use of clothes and larger contact areas with surfaces and patients were observed at the time of procedures execution. Sociodemographic and occupational data and the worker's conduct about lab coat handling were collected through interview after the observation period of each professional. To estimate the factors associated with misconduct of healthcare workers as hand hygiene, transportation and exchange frequency of lab coat the univariate analysis was performed. Then variables with p <0.10 were included in the Poisson regression model. The chi-square test was used to verify the differences between the ratios and p values <0.05 were considered statistically significant. RESULTS: The workers used the lab coat and the gown to the different clinical situations observed, without clarity when to use each clothes. Fists and abdominal region of lab coats and gown were areas that had higher patient contact and higher environmental surfaces contact. Workers had inappropriate handling about the lab coats transport, exchange frequency, washing process and hand hygiene. Were predictors for misconduct about the exchange frequency of lab coat, to be physicians and other healthcare workers male, with shorter professional practice and reporting inadequate practice to transport lab coats. Were associated with inadequate practices of lab coats transport, have misconduct about the exchange frequency and the physicians workers. CONCLUSIONS: The conduct of workers using their own lab coat like a protective equipment and transports to process at home are inadequate and can endanger the health and safety of workers, their families and patients. These findings show that the lab coat worker must not be used as personal protective equipment in clinical practice.Item Acidentes com material biológico entre trabalhadores da área da saúde da região metropolitana de Goiânia-GO: uma análise de 25 anos de registros(Universidade Federal de Goiás, 2016-03-30) Neves, Zilah Cândida Pereira das; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Oliveira, Adriana Cristina de; Souza, Adenícia Custódia Silva e; Pereira, Milca Severino; Mendonça, Katiane Martins; Tipple, Anaclara Ferreira VeigaAccidents with biological material are reportable events, health care workers (TAS), victims of these accidents may be exposed to the hepatitis B and C and HIV, among others. The aims of this study were: to analyze the epidemiology of occupational accidents with biological material among health care workers of the metropolitan area of Goiania-GO (general); describe the socio-demographic and occupational profile of health care workers, victims of occupational accidents with biological material; describe the profile of accidents with biological material among health care workers; characterize the adoption of pre-exposure behaviours related to the latest accident; identify the serological status related to hepatitis B, C and HIV in victims of occupational accidents involving biological material and source patients, and establish the demographic and employment factors associated with the occurrence of multiple accidents among health care workers of the metropolitan area of Goiania-GO. Epidemiological Cross and analytical study which included all registration records of accidents involving biological material of HCW from two sources: A - records of injured HCW in a reference hospital for notification in Goiania, from the first record in 1989 to 2010, and B - records of Sinan, including the first record in 2006 until those available at 31/12/2014. Linkage of databases was performed and data analyzed using the Statistical Package for Social Sciences (SPSS). Socio-demographic and employment variables were the predictor variables and have suffered more than one accident, the outcome. Univariate analysis was performed and variables with P<0.10 were included in a logistic regression model. Ethical precepts were followed (Approval Ethics Committees: 033/2010 and 414.258/2013). A total of 11,536 accidents were recorded from 1989 to December 2014. Of these, 9,575 (83.0%) occurred among HCW and the majority was female. It was found that 665 (7.5%) of the HCW experienced more than one accident, while 70 (0.8%) experienced three or more accidents, totaling 8,825 victims. Nursing staff, auxiliary cleaning, physician, and dental and laboratory teams were the ones who were more frequently hurted, respectively. Most of the victims had completed high school (3,719 (48.0%). Blood/serum/plasma were the biological materials found to be the most involved (6,480/67.7%), at the time of administering medications/vascular access puncture occurring in 2.759 (28.9%), and involving needles with and without lumen in 6,097 (63.7%). A total of 6,653 (75.4%) HCW were vaccinated for hepatitis B. Incomplete information on Sinan records such as, use of PPE (gloves, masks, boots and safety glasses) and serological markers (HBsAg; Anti-HBs, Anti-HCV and Anti-HIV) was found to be the major factor that hampered data analysis. Age, type of material, and organic fluid were predictors risk factor for multiple accidents involving biological material among health care workers.Item Planejamento de sucessão: uma ferramenta para potencializar a liderança em enfermagem(Universidade Federal de Goiás, 2018-04-26) Nogueira, Alyne Leite Gomes; Ribeiro, Luana Cássia Miranda; http://lattes.cnpq.br/1727326201446926; Munari, Denize Bouttelet; http://lattes.cnpq.br/8409035360598716; Bezerra, Ana Lucia Queiroz; Munari, Denize Bouttelet; Siqueira, Karina Machado; Coelho, Maria Alice; Haddad, Maria do Carmo Fernandez LourencoSuccession planning (SP) for nursing leadership allows leaders to prepare new professionals to carry on or improve care quality in institutions. It is an innovative tool in the management of people. The objective of this study was to create a succession planning model for nursing leaderships at a hospital institution, based on an appreciative reflection of nurses. A descriptive exploratory study, using a qualitative approach and grounded on appreciative inquiry (AI), was developed at a public federal hospital in the Center-West region of Brazil. The study took place in two stages. In the first stage, the participants were 36 nurses with different hierarchical positions, from managers to care staff. The authors investigated the experience of the participants on leadership and their perspectives as regards leadership succession in nursing by means of individual interviews with application of the snowball technique. The second stage consisted of a group intervention with 22 nurses who participated in the first stage, using the AI methodology. The collected data were submitted to thematic content analysis and organized using the WebQDA 2016 software. Two categories emerged from the first stage: Current leadership: foundation for a succession planning; and Succession planning: a necessary tool for leadership in the institution. The second category included the creation of the Leadership Succession Planning, according to the 4D cycle methodological structure, which comprises four phases (Discovery, Dream, Design, and Destiny). At Discovery, positive points of the institution regarding leadership succession were presented and, at the Dream phase, nine desirable dreams for an ideal future in terms of leadership succession, the institution’s internal policy, and shared management and leadership development. At the Design phase, five goals were defined, along with their respective deadlines, whereas at the Destiny, there was the creation of one or more plans for each of the goals, including what had to be done in order to achieve them, with the definition of actions and those responsible for carrying them out. At the end of the 4D cycle, the group developed the Succession Planning for Nursing Leadership for the institution, which contributed to organize and strengthen this process. The use of the AI was a powerful tool in the development of collective work with the group of nurses and an important ally in the generation of changes. Considering that the subject of nursing leadership is not addressed systematically in Brazilian healthcare institutions, this study proposes a new way of thinking over the subject in the different institutional settings and, therefore, presents an innovative character for the field of management in health and nursing. Hence, this study can inspire nurses and researchers who are committed to offering quality care to their patients.Item Subconjunto terminológico da CIPE® para atendimento de pessoas com hanseníase(Universidade Federal de Goiás, 2017-02-10) Oliveira, Michele Dias da Silva; Garcia, Telma Ribeiro; http://lattes.cnpq.br/5849780347831135; Bachion, Maria Márcia; http://lattes.cnpq.br/8503907944360635; Nóbrega, Maria Miriam Lima da; Lima, Jacqueline Rodrigues de; Medeiros, Marcelo; Pereira, Lilian Varanda; Bachion, Maria MárciaIntroduction: To take care of people with leprosy, nurses make diagnostic and therapeutic judgments, which must be expressed through special terminology of the profession of theoretical nursing models. Therefore, the International Classification for Nursing Practice usage - CIPE® for the construction of a terminological subset aimed at people with leprosy is necessary to train nurse clinical practice. Objective: To create a terminological subset of nursing diagnoses, results and interventions for the care of people with leprosy, using CIPE® in clinical practice. Method: This is a methodological research study with two phases: one exploratory and the other, a field study. In the exploratory phase, three stages were used to perform terminological research and cross mapping between the terms extracted from Health Ministry publications, related to leprosy and those contained in CIPE® version 2015. In field phase: 1 - Nursing consultation based on Orem's self-care theory with elaboration of nursing diagnosis, results and interventions; 2 - Nursing diagnosis statements validation by three specialists; 3 - Cross mapping of diagnostic statements, results and nursing interventions with CIPE® and the database of terms extracted from the Health Ministry publications; 4 - Creation of the terminology subset of CIPE® to assist people with leprosy. Results: In exploratory phase, 1,041 terms were extracted from the Ministry of Health publications related to leprosy, from which 300 (28.80%) were equal to constant terms in the CIPE® axes; 51 (4.86%) were similar; 49 (4.68%) were larger; 172 (16.45%) were more restricted and 469 (45.00%) were different from the terms of that classification. In field phase, nursing consultations have been carried out on 24 people with leprosy, resulting in 81 nursing diagnoses / results and 303 nursing interventions. In the statements analysis of diagnosis / results and nursing interventions, 564 primitive terms have been evaluated: 342 (61%) were considered constant (equal term, similar, similar more restricted and Similar) in CIPE® and 222 (39.4%) different from CIPE®. From pre-coordinated terms, 384 were evaluated, from which 275 (72%) were considered constant (equal term, similar, more similar, similar and broader) and 109 (28.4%) different from pre-coordinated ICNP terms. Conclusions: The methodology used in this research made it possible to create a terminological subset based on Dorothea Orem self-care theory and CIPE®, and it can be used in clinical practice in nursing care to people with leprosy, in a systematized way, using the steps of nursing process and assisting in the teaching and creation of electronic medical records. In addition, from the results found in this study, it was noticed the need to expand CIPE® in order to better contemplate the phenomena of nursing practice in the care of people with leprosy.Item A prática assistencial na rede de enfrentamento da violência contra as mulheres em Palmas/TO(Universidade Federal de Goiás, 2015-06-30) Pacheco, Leonora Rezende; Medeiros, Marcelo; http://lattes.cnpq.br/3009722217245952; Medeiros, Marcelo; Guilhem, Dirce; Bezerra, Ana Lúcia Queiroz; Caixeta, Camila Cardoso; Brasil, Virginia ViscondeThe combating of violence against women must be done by the work that involves the health, legal, police and psychosocial areas in an intersectoral network, because it is a complex and multifactorial phenomenon. The nurse belongs to the health area and the care practice is essential in the confronting of violence.This study aims to: analyze the meanings of violence against women by professionals of Network of Violence Against Women Combat, Understand the operations of the Network of Violence Against Women Combat according to its professionals, analyze the nurse assistance in Network of Violence Against Women Combat by the professionals and nurses from the network. The theoretical categories for data analysis contemplated the concepts of violence against women, the practice of the nurse, the historic route of the nursing work in Brazil and the operationalization of Network of Violence Against Women Combat; passing by authors like: Lenore Walker, Hannah Arendt and Karl Marx. It is a Social Research in Strategic Mode on a qualitative form. The data were collected through semi-structured interview with 21 professionals from 15 institutions that composed the Network of Violence Against Women Combat of Palmas/TO, and by observation of the field. Data analysis was based on thematic content analysis, emerging three thematic categories: "Meanings of violence against women", treating about the meanings, concepts and forms of violence for the participants; "Understanding the Network of Violence Against Women Combat" describing the operation of the network, its barriers and solutions; "The meanings of nurse's practice assistance in the Network of Violence Against Women Combat", participants showed how nurses were performing their practice assistance in the fighting of violence against women. After analyzing the barriers in the functioning of Network of Violence Against Women Combat and the aspects recommended by the literature and public political, a model/flowchart of network operating was proposed in a integrate and cross-sectoral way. The research concluded that for the implementation of networking is necessary to sensitize professionals and nurses about his role in the fighting of violence against women, making them recognize that the network service depends on the co-responsibility, initiative, communication and partnership of each of them. The network consists of institutions, and these by their professionals that should act effectively. Also offered subsidies for nurses practice, as well for other professionals from several sectors, in the establishment of coherent, solving and transforming actions for the prevention, detection and care of women in situations of violence. The training and inclusion of the issue of violence in the formation of professionals are very important. This research contributed to the Network of Violence Against Women Combat of Palmas, in the sensitize of professionals, recognition of partners and communication between them.Item Segurança do paciente na atenção primária: conhecimento dos profissionais de saúde(Universidade Federal de Goiás, 2015-02-18) Paranaguá, Thatianny Tanferri de Brito; Bezerra, Ana Lúcia Queiroz; http://lattes.cnpq.br/0088227879433410; Bezerra, Ana Lúcia Queiroz; Rosso, Claci Fátima Weirich; Minavisava, Ruth; Vieira, Maria Aparecida Da Silva; Coelho, Maria AliceThe general objective was to analyze the effect of an educational program on patient safety, developed by Tele-education, in the knowledge of professionals working in primary care. Study type intervention before and after, conducted with registered health professionals in Telehealth Network of Goiás. Were used self-report instruments, via web and carried out a descriptive statistical analysis. The results showed weaknesses in the knowledge of health professionals on patient safety, in the context of the practice, which subsidized the construction of an educational program which proved satisfactory to the expansion of knowledge about the studied subject. The reports of the incidents revealed the importance of acquiring knowledge on patient safety, to identify occurrences of the various incidents in primary care and highlighted the need to work conceptual aspects with greater depth in order to increase the accuracy of these professionals for the identification and monitoring of incidents arising from care. The study can be used globally, contributing to the diagnosis of knowledge about patient safety, to identify gaps that need to be worked for the management of health services, and the elaboration of educational policies that support the formation of a safety culture and quality in health services, in order to reduce the occurrence of incidents and prevent harm to patients who weeks care in primary care.Item Rastreamento da infecção pelo vírus da Hepatite B em indivíduos portadores de doenças onco-hematológicas em goiás: subsídios para prevenção e controle(Universidade Federal de Goiás, 2015-05-05) Pessoni, Grécia Carolina; Carneiro, Megmar Aparecida dos Santos; http://lattes.cnpq.br/8398563469665169; Teles, Sheila Araujo; http://lattes.cnpq.br/4975298732179917; Teles, Sheila Araujo; Soares, Caroline Cordeiro; Arantes, Adriano de Moraes; Minamisava, Ruth; Tipple, Anaclara Ferreira VeigaThis is an observational, cross-sectional, analytical study of 348 individuals with onco-hematological diseases (OD), ie leukemia, Hodgkin's and non-Hodgkin’s lymphoma, conducted in two hospitals in Goiania, Goias. The objective was to track hepatitis B (HBV) infections in the area. Data were obtained through interviews and collecting blood samples from July 2011 to August 2012 and a survey of hospital records from June to October 2014. Initially, all samples were tested for HBsAg, anti-HBs and total anti-HBc. HBsAg and anti-HBc samples with isolated reagents were tested for HBeAg and anti-HBe, subjected to extraction and partial amplification of the pre-S / S region of HBV-DNA by polymerase chain reaction (PCR). Samples positive for viral DNA were also sequenced and genotyped. Most participants were aged between 36 and 65 years (55.4%) and were male (54.3%). The most frequent OD were chronic myeloid leukemia (33.5%), and non-Hodgkin’s lymphoma (32.2%). The overall prevalence of HBV was 14.9% (95% CI, 11.58 to 19.07), being 1.1% (95% CI: 0.45 to 2.92) for HBsAg, 9.5% (95% CI: 6.83 to 13.0) for anti-HBc and anti-HBs, and 4.3% (95% CI: 2.63 to 6.99) for anti-HBc. Of the total participants, 8.6% (95% CI 6.10 to 12.2) tested positive for anti-HBs, suggesting low vaccination coverage. Viral DNA was detected in four samples, three of them non-reactive for HBsAg, showing hidden HBV infection. All samples were identified as genotypes A / A1. The records of eight patients suggested seroconversion for anti-HBc during the treatment period for OD. Only history of acupuncture (RP: 2.07; p = 0.035) was predictive of exposure to HBV. The low frequency of individuals immunized against hepatitis B, detection of HBV DNA in HBsAg negative samples, and the suggestion of exposure to HBV during treatment show the potential to spread this virus in this population, reinforcing the importance of serological monitoring, vaccination against hepatitis B and adoption of precautionary measures in patients with OD.Item Pessoas em situação de rua abrigadas: uma população-chave na epidemiologia da sífilis e infecção pelo HIV em Goiânia-Goiás(Universidade Federal de Goiás, 2017-12-11) Pinheiro, Raquel Silva; Teles, Sheila Araújo; http://lattes.cnpq.br/4975298732179917; Teles, Sheila Araújo; Carneiro, Megmar Aparecida dos Santos; Gir, Elucir; Matos, Marcos André de; Souza, Sandra Maria Brunini deContact with the street exposes the individual to a high risk of physical, sexual exploitation and involvement in illicit activities as means of survival and maintenance of their basic needs. In addition, low levels of education, poor hygiene, low income, unemployment, malnutrition and limited access to health services increase the vulnerability of the homeless to sexually transmitted infections (STI), such as the human immunodeficiency virus (HIV) and syphilis. The objective of the present study was to investigate the epidemiological profile of HIV infection and syphilis in homeless individuals housed in Goiânia, Goiás. This is an observational, analytical, cross-sectional study carried out on individuals housed in the Casa de Acolhida Cidadã I (CAC) in Goiânia-GO. From September 2014 to August 2015, 355 individuals were recruited on the street. All participants were interviewed and tested for HIV serological markers (anti-HIV 1 and 2) and syphilis (anti-T. pallidum) by the rapid test. The samples positive for anti-T. pallidum were submitted to VDRL. Of the total number of recruited individuals, 81.4% were male, young (median: 36 years), unmarried (59.4%) and self-declared brown (60.6%). More than half had five to nine years of study, 35.7% reported having no income and most reported having some religion. The median length of stay in CAC was 10 days and 57.5% had an overnight stay experience. An anti-HIV prevalence of 3.9% (95% CI: 2.3-6.4%) was estimated. Of the 355 samples tested by the rapid test for syphilis, 22.0% (95% CI: 17.9-26.5%) were positive and 8.2% (95% CI: 5.6-11.4%) presented positive results VDRL titles. The prevalence of active HIV/syphilis coinfection was 0.6% (2/355; 95% CI: 0.09 - 1.85). In multivariate logistic regression analysis, daily use of alcoholic beverages (adjusted OR: 4.0, p=0.02), sex with HIV/aids carrier (adjusted OR: 8.1, p=0.00) and sex with people of the same sex (adjusted OR: 4.6, p=0.01) were independently associated with HIV infection. The variables age ≤ 36 years (adjusted OR: 3.3, p=0.02), married/stable union (adjusted OR: 2.9, p = 0.02), previous syphilis testing (adjusted OR: 2.6, p=0.03), previous IST (adjusted OR: 3.4, p=0.00) and crack use in the last six months (adjusted OR: 3.6; p ≤0,001) were predictors for syphilis active The results of the present study show that the prevalence of syphilis and HIV infection in sheltered homeless people is high, with the development of prevention and control strategies, including counseling and testing, as well as the provision of treatment for STI in the setting street and temporary and/or permanent shelters.Item Entre a proteção e a vulnerabilidade: significados atribuídos ao uso de drogas entre adolescentes de escola pública de período integral(Universidade Federal de Goiás, 2018-07-09) Pires, Laurena Moreira; Souza, Márcia Maria de; http://lattes.cnpq.br/6954087338926237; Medeiros, Marcelo; http://lattes.cnpq.br/3009722217245952; Medeiros, Marcelo; Reis, Mary Lopes; Pedrosa, Sheila Mara; Pacheco, Leonora Rezende; Barbosa, Maria AlvesObjectives: To identify and to analyze aspects related to the relational and labor insertion of adolescents attending a full-time school; and to investigate the relationship between adolescents' social vulnerability and the abusive and harmful use of psychoactive drugs. Methodology: This is a social research, with a qualitative approach of a strategic type, developed from January 2016 to December 2017. For data collection, we used the technique of focus groups guided by a predetermined script. A total of 49 adolescents aged 15 to 19 years attending a Full-time Education Center (CEPI), located in the eastern region of Goiânia- Goiás, participated in the study. Focus groups were held in the school environment. Results and discussion: The content analysis of the participants' speeches allowed the construction of four categories of analysis: "Tell us where it came from"; "With whom you walk"; "If you study, how to work?"; "Drugs: non-parallel universe". The family, the school and the group of friends were pointed out as the main groups for the relational insertion of these subjects. The adolescents presented themselves influenced by the context of economic fragility to which their families were exposed, which, in turn, motivated that they were inserted in groups of equals in that context. The meanings attributed to the world of work involved the search for family emancipation and the acquisition of consumer items. The duality faced by the adolescents resided in the impossibility of attending to the immediate desire to enter the labor market given the insertion in a full-time school, becoming an important conflict for these subjects. On the other hand, psychoactive drugs were widely present in the social context of these adolescents, permeating the meanings attributed to their relational insertions. In this sense, even if they did not use them, they felt their effects, even capable of leading them to disaffiliation. Final considerations: Finally, it was concluded that the social vulnerability of the group of participating adolescents, and of many other Brazilians, is related to the effects of poor income distribution, and this is expressed in families because of precariousness and insecurity. insertion in work, fragility of social relations permeated and subsidized by the harmful use of psychoactive substances, as well as inefficiency of social protection institutions and the State, in this case, full-time public school.