Doutorado em Enfermagem e Saúde (FEN)

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    Qualidade da assistência especializada a pessoas com diabetes mellitus e hipertensão arterial segundo o Chronic Care Model
    (Universidade Federal de Goiás, 2022-04-27) Borges, Dalma Alves Pereira; Brasil, Virginia Visconde;; Brasil, Virginia Visconde; Vila, Vanessa da Silva Carvalho; Vitorino, Priscila Valverde de Oliveira; Zanini, Claudia Regina de Oliveira; Rezende, Marina Aleixo Diniz
    INTRODUCTION: Support for self-management of chronic conditions and health literacy are essential elements in the development of person-centered services. The use of integrated care models that focus on the person, and not just on the specific disease, represent a viable solution for effective care. The Chronic Care Model is a model that is based on the relationship between motivated and informed users and the proactive and prepared health team. However, there is evidence of gaps in the attention and care that should be provided in the care of chronic conditions, especially in hypertension and diabetes. OBJECTIVE: To characterize the quality of care provided and the health literacy conditions reported by people with arterial hypertension and diabetes mellitus in a secondary care service. METHODS: Crosssectional study, carried out in an outpatient clinic that is a reference in the care of arterial hypertension, in a large Brazilian center, where diabetes is prevalent morbidity. Eighty-two people with diabetes mellitus and arterial hypertension were evaluated, with a follow-up of at least five years and ten consultations. Sociodemographic and clinical data were obtained through a nursing consultation. The Patient Assessment of Care for Chronic Conditions - PACIC questionnaire was applied, with 20 questions and five scales. Higher scores (> 3.0) indicate a perception of greater involvement in self-management and support. Three scales from the Brazilian version of the Health Literacy Questionnaire - HLQ-Br were also used. The score of each scale indicates the person's strengths and weaknesses in relation to their health literacy. Internal consistency was evaluated; Mann-Whitney test, Spearman test and significance of 5% were applied. RESULTS: The mean age of the participants was 68.98±8.79 years, female (82.93%), with a median of 4 years of study (IQR 3 - 8). Most parents (70.73%) did not study. Less than half of the users had controlled values of glycated hemoglobin - HbA1c (34.15%) and blood pressure (36.59%). The Cronbach alpha of PACIC was 0.85 and that of HLQ-Br was 0.75. There was a positive correlation between the time of diagnosis of diabetes and HbA1c. The overall PACIC score was 3.4 (IQR 2.8-3.8) out of a high of 5.0. The highest score was evidenced on the scale of care/decision-making model (4.3) and the lowest on the scale of coordination of care/follow-up (2.8). Support for selfmanagement is assessed by the treatment adherence scores (3.0), problem-solving / follow-up contextualization (3.0), and goal setting (3.8). Those with ≥ 4 years of schooling had higher scores for Attention Coordination / Follow-up (p=0.039). Participants whose parents had some schooling had higher scores for Adherence to treatment (p=0.038), Coordination of care / Follow-up (p=0.042) and general PACIC (p=0.026). Lower scores were identified among participants who did not have HbA1c control, on the Goal Setting scale (p=0.003). Health literacy showed mean scores of 4.07 ± 0.87 on the Ability to interact with the team scale; 3.02±1.31 in Understanding the information and 2.84±1.25 in Finding good information. Male users had higher scores for interacting with professionals, finding information and understanding information (p=0.039, p=0.00 and p=0.003). Those with ≥ to 4 years of schooling had higher scores for Finding and Understanding information (p=0.002 and p< 0.001), as well as those whose parents had some schooling (p=0.036 and p=0.037). Those who were overweight had a higher score for Understanding the information (p= 0.040). There was a positive correlation between the time of diagnosis of diabetes and HbA1c and no correlation was identified between the general value of PACIC and the HLQ-Br scales. CONCLUSIONS: The quality of care was considered high according to the general PACIC, and moderate in terms of the person's participation in decision-making and the contextualization of the treatment plan. Weakness was identified in the dependence on other people to be able to access and understand written information, but the ease of involvement with professionals can favor the use of communication strategies to improve health self-management.
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    Gestão autônoma da medicação para promoção do cuidado seguro em atenção psicossocial
    (Universidade Federal de Goiás, 2023-06-06) Pinho, Eurides Santos; Silva, Nathália dos Santos;; Bezerra, Ana Lúcia Queiroz Bezerra;; Bezerra, Ana Lúcia Queiroz; Caixeta, Camila Cardoso; Sousa, Girliani Silva de; Cardozo, Elizabeth Esperidião; Nunes, Fernanda Costa
    INTRODUCTION: Autonomous Medication Management (GAM) enables the co-management of drug treatment by users of mental health services and influences quality and safe care. In Psychosocial Care, the prescription of psychotropic drugs is a care action that focuses on the biological, on the biochemical alterations of psychiatric illnesses without considering the biopsychosocial context of the users. The consumption of psychotropic drugs sometimes disregards the user's participation in conducting the treatment itself. There is evidence of improvements in the context of psychosocial care through investment in the co-management of drug therapy with user involvement in decision-making processes. OBJECTIVE: To analyze, from the perspective of mental health team professionals, the practices of Autonomous Medication Management to promote user involvement in safe care, in psychosocial care. METHOD: This is an intervention-research with a qualitative approach, conducted in four Psychosocial Care Centers in a municipality in the central west region of Brazil, which had the participation of 56 professionals from the teams and health. Data were collected in two stages, the first between May and June 2021 through a questionnaire and semi-structured interview, and the second in August 2022 from the offer of a training process on the autonomous management of medication associated with the perspective of promoting user involvement in safe care. The emerging data were organized using the ATLAS.ti.6.0 software and submitted to content analysis, thematic modality. RESULTS: The GAM is an educational process that encompasses users and professionals. The results of this research were summarized in three categories: Perceptions of professionals about the co-management of drug therapy; Harmless medication in the context of mental health care; Autonomous Medication Management: perspectives for safe care. It was evidenced that the professionals' perception of the demand to involve the user in the decision of drug therapy transits between views based on the hegemony of the biomedical model, which reinforces adherence to the use of psychotropic drugs, between the challenges and existing actions for user involvement and the reformist ideals based on the model of psychosocial care. As actions and challenges to promote co-management, the indiscriminate and inappropriate use of psychotropic drugs and access to information about medications were perceived as intervening in harmless medication and safe care. Autonomous Medication Management was pointed out by professionals with the potential to provide safe care, given the possibilities of carrying out psychoeducational approaches on psychotropic drugs, valuing the participation of family members/caregivers and overcoming obstacles to the involvement of users in medication co-management. FINAL CONSIDERATIONS: The GAM is based on the psychosocial care model, encourages the development of actions that promote co-management through the user's involvement in their treatment and, consequently, provides reflection on their autonomy and protagonism in the face of drug therapy to achieve safe care , in the context of psychosocial care and, more broadly, in mental health.
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    Cobertura vacinal em crianças assentadas, quilombolas e ribeirinhas do estado de Goiás, nascidas entre 2010 e 2017
    (Universidade Federal de Goiás, 2021-08-05) Lima, Juliana de Oliveira Roque e; Rosso, Claci Fátima Weirich;; Caetano, Karlla Antonieta Amorim;; Caetano, Karlla Antonieta Amorim; Pagotto, Valéria; Minamisava, Ruth; Pessoni, Grécia Carolina; Junqueira, Ana Luiza Neto
    Vaccination is considered one of the most cost-effective and most effective measures in healthcare services. On the other hand, some population groups that live in geographic and cultural isolation have been showing low rates of vaccination. In Brazil, there are no data evaluating adherence to vaccines recommended by the National Program for the Immunization of Unified Health System, better known by the acronym SUS considering children from rural and traditional communities. Therefore, this study aimed to evaluate vaccination coverage according to the national calendar of vaccination of children for the first year of life, and their distributions in space and trends in time in children living in rural settlements, communities of quilombolas, and riverside dwellers in the state of Goiás, born from 2010 to 2017. This is an epidemiological, retrospective cohort study, carried out in 40 municipalities of Goiás, followed by an ecological study. The sample consisted of 616 children born between 2010 and 2017, residents of a settled, quilombolas or riverside dwellers community in Goiás. To calculate the vaccination coverage, the percentage of children with a complete general vaccination schedule or by the vaccine was considered, with a 95% confidence interval. In the time-series, trend analysis was estimated for communities according to mesoregions of Goiás, and for this purpose, the Prais-Winsten linear regression was used, with robust variance. Trends were classified as increasing, decreasing, or stationary, according to the p-value and regression coefficient. The spatial distribution of vaccination coverage, according to the mesoregions of Goiás, was carried out along the time-series. In total, 616 children had their vaccine data evaluated, most were male (53.7%) and belonging to the quilombolas community (54.7%). The overall vaccination coverage for the recommended vaccines during the first year of life at 12 months and at 18 months was 52.4% (CI95%: 48.5% - 56.3%) and 57.8% (CI95%: 53.9% - 61.6%), respectively. For children born in 2017, just the yellow fever vaccine and measles/mumps/rubella vaccine had vaccination coverage > 90%. According to the birth cohort from 2010 to 2017, in Goiás, of the ten vaccines evaluated, six showed an increasing trend in vaccination coverage (POLIO, 10-valent pneumococcal, human rotavirus, meningococcal, yellow fever, and measles/mumps/rubella). Considering the spatial and temporal distribution, according to the mesoregions where the communities are located, a decreasing trend for vaccination coverage was only observed in the Center Goiano mesoregion for the hepatitis B vaccine. In the North Goiano mesoregion, increasing temporal trends were observed for most vaccine coverage, the exception was for BCG and measles/mumps/rubella vaccines. Despite this, the North Goiano mesoregion was the only one in which no vaccine achieved 90% coverage in the period of birth cohort 2016/2017. The results present an unequal scenario in the access to vaccination services for rural populations and traditional Brazilians and point to the need for urgent strategies to achieve and ensure equity in health for a group with distinct traditions and characteristics of the urban population of Brazil.
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    Violência contra o docente na prática pedagógica em saúde: uma abordagem intercultural
    (Universidade Federal de Goiás, 2021-09-17) Alves, Angela Gilda; Rodriguéz Martín, Dolores Dolores;; Barbosa, Maria Alves;; Barbosa, Maria Alves; Guix Comelles, Eva Maria; Pereira, Edna Regina Silva; Santos, José Luis Guedes dos; Martins, Cleusa Alves
    Introduction. Operationalizing the concept of violence, especially against higher education teachers, is difficult. In addition to the various concepts, the violence is presented in expressions of hatred, anger, revenge, acts contrary to social norms of coexistence, prejudice against those that are different, and mistreatment directed toward the teachers, which can lead to consequences and cause harm even in the pedagogical sphere. Intercultural differences enable different spaces, which represent hermeneutical, epistemological and methodological resources. All of this contributes to a dialogic process with other contexts and thoughts that range from the acquisition of information to the emergence of new theories capable of rethinking and transforming learning. Objective. To analyze violence against teachers in the Health pedagogical practice through an intercultural approach. Methodology. This was a multimethod study developed at a University in the Central Region of Brazil, in which the phenomenon of violence was analyzed from different angles, supported by literature reviews (integrative and scoping), the Delphi method, and a qualitative study with the analysis partially using the Constructivist Grounded Theory (CGT). The target population consisted of all teachers at the Faculty of Nursing of the Federal University of Goiás. Data collection took place through recorded and transcribed interviews and, with the use of the NVivo software, analysis categories were created. The analysis used a step of the Grounded Theory. Results. The theoretical contributions of the study were presented, including the concepts of violence and its relationship with the teaching practice in health education. The discussion of knowledge in Higher Education in Health considering Vygotskian theory evidenced convergent terminologies. Violence against teachers can be defined as a set of actions and situations provoked by students in an insidious or chronic way in the workplace and/or through digital media, mediated by the perception of violence, the teacher's coping mechanism and the organizational management of violence. Indicators of violence against the teacher were defined as any threat, attempt, or actual aggressive act, as well as ignoring or disrespecting the teacher through speech, engaging in sexual harassment, homophobia, receiving coercion from the student's family, as well as using information and communication technologies to perform such acts. The factors that lead teachers to suffer violence in Higher Education in Brazil are characterized by the institutional culture, gender, the perception of violence by the teacher and the triggers that lead students to practice violence. Conclusion. Violence by students against teachers deserves pedagogically important reflections. Social origin converted into inequalities triggers positions of domination and, consequently, creates a fertile ground for violence. Teachers will be able to develop actions that blossom into the construction of skills and attitudes for coping with violence, recognize it and intervening in order to prevent aggressive behavior from spreading, causing mutual illness and weakening interpersonal relationships.
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    Adaptação transcultural e validação do instrumento Patient Engagement in Patient Safety within Canadian Healthcare Organizations para uso no Brasil
    (Universidade Federal de Goiás, 2022-05-25) Sousa, Maiana Regina Gomes de; Pomey, Marie-Pascale; Silva, Ana Elisa Bauer de Camargo;; Silva, Ana Elisa Bauer de Camargo; Bezerra, Ana Lúcia Queiroz; Sousa, Fernanda Raphael Escobar Gimenes de; Vila, Vanessa da Silva Carvalho; Freitas, Juliana Santana de
    INTRODUCTION: for more than two decades, patient safety has been highlighted as a global health challenge, requiring changes and implementation of initiatives to minimize risks, prevent care failures and prevent harm to patients. Patient engagement in patient safety has been one of the strategies used in the main international recommendations to improve the quality and safety of care, making relevant the existence of instruments to evaluate this practice. OBJECTIVE: to produce the Brazilian version of the instrument Patient Engagement in Patient Safety within Canadian Healthcare Organizations. METHOD: methodological study involving cross-cultural adaptation and validation of the instrument Patient Engagement in Patient Safety within Canadian Healthcare Organizations for use in Brazil, developed in two phases. The first phase, held between January 2020 and June 2021, consisted of the cross-cultural adaptation of the instrument for the Portuguese Brazilian and followed six steps: preparation, translation, back translation, pretest with nine health organizations, review, and documentation. The second phase, held between August and November 2021, was to validate of the content of the instrument using the Delphi technique, through the evaluation of a committee of experts in two sequential rounds. The semantic, conceptual, and normative equivalence of the items of the instrument were analyzed using the Coefficient of Agreement between evaluators, being considered satisfactory values greater than or equal to 90.0%. To analyze the content validity was used the Content Validity Index (CVI) and Inter-Rater Agreement (IRA), being considered approved values greater than 0.8, for both CVI and IRA. The analyses were performed using the Software R version 4.1.2. RESULTS: in cross-cultural adaptation, 97.9% of the items of the instrument were considered equivalent by 100% of the evaluators. For the items that presented agreement less than 90%, the best solutions were discussed, until a consensus was reached. The modifications made were approved by the authors of the original instrument. In content validation, most items had CVI approved in all three aspects, with 99.3% for coverage, 95.8% for clarity and 96.1% for relevance. About the IRA, 99.0% of the items presented satisfactory values for coverage, clarity, and relevance. Items with unsatisfactory values were changed and evaluated again by the expert committee and after approval by all the instrument was concluded, available for use in Brazil with the title “Engajamento do Pacientes na Segurança do Paciente em Organizações de Saúde”. CONCLUSION: the instrument is a reliable and valid tool to investigate patient engagement strategies in patient safety implemented in Brazilian health organizations, at different levels of governance.
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    A efetividade de escovas descartáveis e submetidas à desinfecção para a higiene bucal em pacientes ventilados mecanicamente: ensaio clínico
    (Universidade Federal de Goiás, 2019-04-30) Gonçalves, Fernanda Alves Ferreira; Torres, Ieda Maria Sapateiro;; Campos, Cerise de Castro;; Brasil, Virginia Visconde;; Brasil, Virginia Visconde; Souza, Adenícia Custódia Silva e; Roriz, Virgílio Moreira; Melo, Dulcelene de Sousa; Tipple, Anaclara Ferreira Veiga
    INTRODUCTION: Invasive ventilatory and intubated patients are dependent on the nursing team. The mechanical removal of the biofilm with toothbrush is the first option, but after single use it can be contaminated by microorganisms from the oral cavity, as well as from the external environment. The use of the brush should be associated with chemical control of chlorhexidine digluconate, which is semi-critical and requires high level disinfection or be discarded. Peracetic acid is a high-level disinfectant, but has not been tested for use on toothbrushes. AIM: To compare the effectiveness of the use of disposable toothbrushes and disinfection with peracetic acid used for oral hygiene (OH) of patients under mechanical ventilation. MATERIALS AND METHODS: Randomized-controlled clinical trial performed at an intensive care unit of a public hospital in Goiânia / GO. Data were collected from 31 patients, intubated and under mechanical ventilation, between June 2017 and August 2018. The patients were divided into Control Group (OH with disinfected brushes) and Intervention Group (HB with brushes discarded). A dental evaluation was performed on day 1. Saliva collection was performed on day 1, day 3 and day 5 for counting of colony forming units (CFU). HB was performed twice a day, for up to five days, with 0.12% CHX gel and disinfected or discarded brushes. RESULTS: At admission, patients presented poor oral hygiene, periodontal disease, periodontitis and gingivitis. Most of the participants were male, with a mean age of 59.0 ± 14.4 years and mean of 19 teeth. Throughout the days of HB there was a decreasing tendency of buccal and lingual biofilms, however, there was no significant reduction of UFC, with no difference between the groups that used disposable brushes and disinfected brushes. In relation to the bacteria isolated on the fifth day, there was homogeneity in both groups, with predominance of Pseudomonas aeruginosa, Enterococcus faecium, Klebsiella pneumoniae and Staphylococcus haemolyticus. CONCLUSIONS: There was no difference in tooth and tongue brushing, performed with single use brushes, discarded or disinfected at each use. The important thing is to brush properly, following established protocols.
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    Gravidez na adolescência e sua prevenção: sentidos atribuídos por um grupo de adolescentes escolares de Porto Velho – Rondônia
    (Universidade Federal de Goiás, 2019-12-11) Fernandes, Daiana Evangelista Rodrigues; Medeiros, Marcelo;; Medeiros, Marcelo; Silva, Joana Aparecida Fernandes da; Reis, Mary Lopes; Santos, Walterlânia Silva; Barbosa, Maria Alves
    Recent World Health Organization data show that approximately 16 million girls aged 15-19 each year and 1 million girls under 15 annually become mothers worldwide. Teenage pregnancy is an important public health problem that can affect the mother-child binomial in social, biological and psychological aspects. The aim of this study is to identify and analyze the meanings attributed by school adolescents to teenage pregnancy and its prevention. Qualitative study, approaching the principles of ethnography, conducted in a public school in the city of Porto Velho - RO, from October 2017 to November 2018. Participants were 20 adolescents of both sexes, aged 16 or 17 years. who had sexually active lives or not and were in the first or second year of high school. Data were obtained during the fieldwork, through participant observation and individual interviews, following a semi-structured script. The interviews were analyzed by the meanings interpretation method. From the process of analysis of the qualitative material obtained two themes emerged. The first, “Information for the prevention of teenage pregnancy”, shows that mothers are the people who talk and report the most about aspects related to their children's sexual health. Participants also reported as sources of information, leaflets, lectures, classes at school, advertisements and television programs. Regarding contraceptive methods, they reported mainly condom use and oral contraception. The theme “Repercussions of teenage pregnancy” shows that, in general, adolescents consider pregnancy at this stage of life something wrong, which undermines their studies and imposes the need to work. In addition, they evidenced the desire to complete their studies and develop in various professions in order to obtain financial stability and material goods so that only then can they have children. The study showed that participants referred more about their plans and dreams for development as people and future professionals than the desire for a teenage pregnancy. In contrast, the process of sexual and reproductive health education for these adolescents was weakened. Information is fragmented and there is no necessary dialogue between family, school and health service, and others who could participate in this continuum of actions for health promotion. Similarly, the use of contraceptive methods was not stable. However, participants demonstrated the use of the information to which they had access and adopted contraceptive measures motivated by future desires and dreams.
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    Adaptação transcultural e validação para uso no Brasil do instrumento Quality and Safety Education for Nurses Student Evaluation Survey
    (Universidade Federal de Goiás, 2019-05-22) Freitas, Juliana Santana de; Dolansky, Mary; Silva, Ana Elisa Bauer de Camargo;; Silva, Ana Elisa Bauer de Camargo; Bezerra, Ana Lucia Queiroz; Brasil, Virginia Visconde; Vila, Vanessa da Silva Carvalho; Alves, Sergiane Bisinoto
    INTRODUCTION: The development of quality and patient safety competencies in health education has been the object of study and focus of recommendations built and published in recent decades in several countries. The evaluation of the achievement of these competencies by the students is necessary, however, in Brazil there are no tools published for this purpose. The Quality and Safety Education for Nurses Student Evaluation Survey (QSEN SES) evaluates, through three scales, the knowledge, skills and attitudes of Nursing students related to the following competencies: Patient-centered care; Evidence-based practice; Teamwork and collaboration; Quality Improvement; Safety and Informatics. OBJECTIVES: To perform the cross-cultural adaptation of the QSEN SES for use in Brazil and to evaluate its initial psychometric properties. METHOD: Methodological study, developed in two phases. The first consisted of the cross-cultural adaptation of the QSEN SES instrument into Brazilian Portuguese and followed six stages: translation, synthesis, back translation, expert committee review, pre-test with 30 undergraduate Nursing students from a public university and validation by the author of the original instrument. In the second phase, the Brazilian version of the QSEN SES was applied to 130 undergraduate Nursing students from three public universities, who had already completed at least 50% of the total course workload. The construct validity and reliability of the instrument were analyzed through confirmatory factor analysis and internal consistency. The Mann-Whitney and Kruskall-Wallis tests were used to verify the possible relationship between the sociodemographic variables and the quality and safety skills and attitudes. RESULTS: The QSEN SES was cross-culturally adapted for use in Brazil, presenting good reliability (Skills scale: 0,70≥ α ≤0,94; Attitudes sale: 0,86≥ α ≤0,97). The confirmatory analysis had insufficient adjustment indices for the skills model (χ2 = 352.46, SRMR = 0.075, RMSEA = 0.084, CFI = 0.868) and for the attitudes model (χ2 = 981.02, SRMR = 0.112, RMSEA = 0.193, CFI = 0.608). There was evidence of association between skills and university and sex variables. The results of the application of the QSEN SES Br in Nursing undergraduate courses in Brazil pointed out that, in a general way, the students reported the exposure to the contents related to the quality and safety in their formation, they recognize the actions as very important, however, feel unprepared to execute them. CONCLUSION: The Brazilian version of the QSEN SES is equivalent to the original version, it is reliable, however, it is suggested new studies with a larger population sample, to confirm the validity of the construct. The application of QSEN SES in Nursing schools will allow a situational analysis of education, producing information that is fundamental for educators and managers to plan curricular reforms, innovations and changes, aligned with identified needs, sustainable, with greater potential for success and longevity.
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    Adesão e imunogenicidade aos esquemas ultra-acelerado e acelerado de vacinação contra hepatite B entre homens em situação de rua
    (Universidade Federal de Goiás, 2019-08-29) Souza, Christiane Moreira; Souza, Sandra Maria Brunini de;; Souza, Sandra Maria Brunini de; Souza, Márcia Maria de; Teles, Sheila Araújo; Oliveira, Adriana Cristina de; Minamisava, Ruth
    Considering the long duration of the classic hepatitis B virus (HBV) vaccination schedule, with the common loss of vaccine follow-up, alternative schemes have been proposed for vulnerable populations. The aim of this study was to evaluate the adhesion and immunogenicity of HBV vaccine in homeless men (HSR) under the accelerated (E-UA) and accelerated (E-A) vaccination regimens. Randomized, two-arm, controlled, non-inferiority trial was performed by identifying HBV-susceptible HSR, which were allocated at a 1:1 ratio for E-UA (doses at 0, 7, and 21 days) and E-A (doses at 0, 1 and 2 months). For those who completed the proposed regimen, immunogenicity assessment was performed at 30, 60 and 90 days after the last dose of each regimen. Study approved by the Research Ethics Committee and registered in the Brazilian Clinical Trials Registry (ReBEC) platform. Of the 156 screened HSR, 67 were excluded; 35 (22.4%; 95% CI: 16.6-29.6%) for having some marker of HBV exposure (2 HBsAg/positive total anti-HBc; 15 positive isolated total anti-HBc and 18 anti-HBc/anti-HBs positive) and 32 (20.5%; 95% CI: 14.9-27.5%) for isolated immunity. Of the 89 susceptible identified, 18 (20.2%) were absent at the start of the intervention and the 71 eligible were randomized and allocated to E-UA (n= 35) and E-A (n= 36). The E-UA adherence rate was 94.3% (95% CI: 81.4 -98.4%) and the E-A rate was 63.9% (95% CI: 47.6-77.5%), and E-UA was associated with higher vaccine adherence rate (RR: 1.3; 95% CI: 1.1-1.7). In the analysis of the geometric mean titre (MGT) of anti-HBs, 30 days after the last dose of the vaccine, the group submitted to E-UA had a MGT of 147.6 mIU/mL versus 224.8 mIU/mL of those submitted to the vaccine. E-A (p-value= 0.985). After 60 days, the MGT for E-UA patients was 231.7 mIU/mL versus 211.2 mIU/mL for E-A (p-value= 0.572). After 90 days, the MGT between E-UA and E-A was 259.6 mIU/mL versus 233.1 mIU/mL (p-value= 0.548). In the analysis of adequate immune response (anti-HBs titers ≥10 mIU/mL), after 30 days, 88.0% of E-UA individuals and 94.7% of E-A individuals responded to the vaccine (p-value = 0.622). After 60 days, the response to the vaccine was similar between the E-UA and E-A groups (95.5% versus 92.9%; p-value = 1,000). After 90 days, this rate was 94.7% for the E-UA group and 100.0% for the E-A group (p-value = 1,000). The use of E-UA and E-A was effective with regard to early immunogenicity. Regarding adherence, E-UA was statistically identified as the best vaccination schedule option in this study.
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    Efeito da lanolina anidra comparado ao leite materno combinado à concha de proteção para tratamento da dor e do trauma mamilar em lactantes: ensaio clínico randomizado
    (Universidade Federal de Goiás, 2013-04-30) Vieira, Flaviana Vely Mendonça; Mota, Dálete Delalibera Correa de Faria;; Bachion, Maria Márcia;; Bachion, Maria Márcia; Abrão, Ana Cristina Freitas Vilhena; Almeida, Ana Maria de; Costa, Paulo Sérgio Sucasas da; Guimarães, Janaína Valadares
    INTRODUCTION: Women often experience nipple trauma when they start breastfeeding, and this is one of the predictive factors of early weaning. There is no sufficient evidence to date supporting one best treatment for nipple trauma. OBJECTIVE: Assess the effect of lanolin anhydrous in the treatment of nipple pain, compared to mother’s breast milk combined with nipple protection shells during breastfeeding. METHOD: Randomized clinical trial, controlled with 100 puerperal women with nipple trauma, who had delivered at a public maternity hospital of Goiânia, Goiás, Brazil. Fifty women were randomized to group 1 and 50 to group 2. In group 1, a total of 97 breasts with nipple trauma were treated with lanolin anhydrous, and in group 2, 95 breasts with nipple trauma were treated with breast milk combined with nipple protection shells, and followed for up to 10 days. Both groups received educational instructions regarding breastfeeding. The outcome variables were: nipple trauma healing – determined by the Nipple Trauma Score (NTS) and pain in the nipple-areolar region – determined by a numerical pain scale. The research proposal was approved by the Research Ethics Committee of the University Hospital at Federal University of Goiás, and was recorded on the Brazilian Record System of Clinical Trials. Data analysis was performed using chi-square test, Fisher’s Exact Test and ANOVA MR, with significance at p<0.05. RESULTS: In the baseline assessment, the groups were homogenous in terms of sociodemographic, obstetrical and neonatal characteristics. The onset of nipple trauma was on the 2nd day postpartum, in average. Intervention was initiated on the 2nd day of nipple trauma. There was a variation of traumas, with the crust being the most frequent. Nipple depigmentation improved with time, with a difference between the groups on day 7 (p=0.013) and 10 (p=0.001). There was no difference between groups for the NTS before the intervention (p=0.642). The analysis of variance over time (ANOVA MR) indicated lower NTS in group 2 with a difference between the groups on days 3 (p=0.026), 5 (p=0.004), 7 (p<0.001) and 10 (p<0.001) of follow-up. Regarding the intensity of pain in the nipple-areolar region, a 5.5 mean was found for group 1 and 5.8 for group 2, on day 1, with no difference between the groups. The intensity of pain was smaller in group 2 compared to group 1 on days 5 (p=0.001), 7 (p<0.001) and 10 (p<0.001). CONCLUSION: Compared to lanolin anhydrous, breast milk combined with nipple protection shells proved more effective in reducing pain and healing nipple trauma in breastfeeding puerperal women.
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    Incidentes com pacientes atendidos nos centros de atenção psicossociais: vivências da equipe de saúde
    (Universidade Federal de Goiás, 2019-04-29) Souza, Adrielle Cristina Silva; Caixeta, Camila Cardoso;; Bezerra, Ana Lúcia Queiroz;; Bezerra, Ana Lúcia Queiroz; Lucchese, Roselma; Alves, Sergiane Bisinoto; Cardoso, Elizabeth Esperidião; Medeiros, Marcelo
    OBJECTIVE: To analyze the security context of the users served at the Psychosocial Care Centers, based on the experiences of the multiprofessional team. METHODOLOGY: Qualitative study, intervention, mediated by the Cycle of Experiential Learning. 31 professionals from two service units - Psychosocial Care Center - Adult CAPS III from the metropolitan region of Goiânia participated. The data collection took place through group meetings, in which the professionals developed activities proposed by the researcher that led to reflection and learning about patient safety. The data were submitted to content analysis, using qualitative analysis software. RESULTS: The thematic content analysis was performed with the data obtained through participants' experiential techniques. The thematic categories that emerged from the content analysis were: 1 - Knowledge of professionals about patient safety; 2 - Incidents and situations of risks experienced by professionals of the multiprofessional team 3 - Strategies and evaluation of the educational process to promote safety in care. The data revealed low knowledge in the area of ​​patient safety, which further heightened the interest of the team's professionals in understanding the issue. Understanding that the theory is currently more focused on the hospital environment, its focus on psychosocial care is something innovative. Incidents and situations of risks to the patient's safety were revealed in the physical aspects of the unit; in the work process in the services and low communication of the service network; in the lack and professional qualification; inadequate care; low family involvement; deficiency of records and mechanism from prescription to drug administration. The Permanent Health Education strategy in a problematic and participatory manner developed the team's understanding of safe care, which enabled professionals to outline strategies for incident prevention and promotion of safe care in CAPS. The process was evaluated as positive because it allows rethinking and instigating better attitudes in the work, in a dynamic and involving way, being possible to align theory and practice, besides being able to demystify that the clinic does not fit in the unit of mental health respecting the psychosocial attention. FINAL CONSIDERATIONS: Continuous efforts are required in practice, from senior management to direct assistance professionals, with the aim of promoting physical, human and organizational structure that guarantees the promotion of the safety culture in the CAPS. The experiential method favored the reflection of the service dynamics revealing the risk situations in the assistance to the users. The legitimacy of EPS as spaces for the exchange of practices and knowledge in the reflexion-action-reflection process, for the production of knowledge that improves patient safety in mental health is perceived, which will help both the improvement of the quality of services and in the training of professionals.
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    Epidemiologia da Sífilis e HIV em cortadores manuais de cana-de-açúcar: bases para ações de promoção da saúde
    (Universidade Federal de Goiás, 2019-04-15) Rocha, Déborah Ferreira Noronha de Castro; Teles, Sheila Araújo;; Teles, Sheila Araújo; Pinheiro, Raquel Silva; Carneiro, Megmar Aparecida dos Santos; Souza, Marcia Maria de; Souza, Sandra Maria Brunini de
    In Brazil, manual cane harvesting is still common in less developed regions and is predominantly carried out by migrant seasonal workers, mainly from the Northeast of Brazil. Migration results in family isolation, remaining far from their sexual partners. This situation may favor unprotected sex and thus make them vulnerable to sexually transmitted infections (STIs), including syphilis and Human Immunodeficiency Virus (HIV). The objective of this study was to investigate the epidemiology of syphilis and HIV in cane cutters in Goiás and Paraíba. It is a cross-sectional and analytical study carried out from February to September 2016, in the states of Goiás and Paraíba, in five sugar-alcohol plants. A total of 937 cane cutters participated in the study. All were interviewed and tested for serological markers of HIV (anti-HIV 1 and 2) and syphilis (anti-T.pallidum) by the rapid test (TR). The samples were positive for anti-T. pallidum (syphilis in life) were retested by VDRL (active syphilis). All of them were male, ranging in age from 18 to 67 years and almost half (47.4%) had up to four years of study. The majority were married or had a stable union (77.5%), had no prison history (90.4%) and reported an occupational accident (53.4%). A state analysis showed a higher proportion of sugarcane cutters in Goiás that reported multiple sexual partners, which consistently used condoms during sexual intercourse, consumed alcoholic beverages and cocaine (p <0.05). On the other hand, the frequency of homosexual relationships was higher in Paraiba cutters (p <0.05). A global prevalence of anti-HIV-1 of 0.3% (95% CI: 0.1-1.0), syphilis in life of 2.4% (95% CI: 1.6-3.6) and active syphilis of 1.2% (95% CI: 0.6-2.1). The variables religion and marijuana consumption were independently associated with syphilis in life. However, the first variable was shown as a protective factor (adjusted OR: 0.3, 95% CI: 0.1-0.8), and the second was risk-adjusted (adjusted OR: 2.94, 95% CI: 1,1-7,7). The results of this study show sociodemographic and behavioral differences between Goiás and Paraíba sugarcane cutters and the circulation of syphilis and HIV-1 in this impoverished population that has the potential for viral dissemination. The agreement of the public health services with sugar and alcohol industries to carry out prevention and health promotion actions in sugarcane cutters' workplaces would be an important strategy directed at this population of male rural workers.
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    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;; Barbosa, Maria Alves; Duarte, Célia Scapin; Nogueira, Douglas José; Ferreira, Ilma Pastana; Vila, Vanessa da Silva Carvalho
    INTRODUCTION. 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.
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    Avaliação da funcionalidade familiar por idosos
    (Universidade Federal de Goiás, 2013-03-11) Vera, Ivana; Lucchese, Roselma;; Nakatani, Adélia Yaeko Kyosen;; Nakatani, Adélia Yaeko Kyosen; Alvarenga, Márcia Regina; Vila, Vanessa da Silva Carvalho; Munari, Denize Bouttelet; Sadoyama, Geraldo
    Demographic and epidemiologic transitions influence the Family arrangements, making the course of life of the families dynamic and leading to intergenerationality. These factors influence several aspects of the life of the elderly, especially their family relations. To assess the family dynamic of the elderly is associated to the lack of studies on the family function in this context. Thus, the objective was to assess the family relationship of the elderly using the family APGAR and the associated factors in a capital city in the Brazilian Mid-West region. This is a cross-sectional, populationbased, epidemiological study which is part of the matrix study carried out by the Rede de Vigilância a Saúde do Idoso (REVISI -Network for Elderly Health Surveillance). The probability sample was formed by 934 elderly living in the urban area of Goiânia, Goiás, Brazil. Data were collected from November 2009 to April 2010. A standardized questionnaire was applied including socioeconomic and demographic variables, self-referred health conditions, pain, falls, and access to health services. Scales to measure functional and cognitive capacities were applied. Family APGAR index assessed the family dynamics. Scores 7 refer to Good Family Function (GFF) and scores <7 refer to Family Dysfunction (FD). The outcome variables considered were the family relations and all the other relations considered as predictor variables in the instrument. For univariate association analysis, Chisquare (c)2, or Fischer’s Exact test was used at a 5% significance level. The association magnitude was expressed by Prevalence Ratio (PR) and their respective confidence intervals (CI95%). Multiple logistic regressions were used to identify factors associated to the outcome by building the model with the predictor variables whose p values were 0.20 in the univariate analysis. When we inquired the total sample that answered the index, GFF was associated to age, education, having an income, self-refer health as bad /terrible, pain complaint osteoporosis and cancer. As for the elderly who referred family dysfunction, high dysfunction was associated to falls, and a previous episode of AMI. When the population aged 80 was assessed, GFF was associated to variables of referring bad /terrible health, osteoporosis and falls. These results characterize the family dynamics of non-institutionalized elderly regarding GFF prevalence and they point to the need to adjust the current State policies to focus on the real needs of this population stratum so that professionals understand and can help balance the family dynamics and that it can strengthen the health team that works on strategies for Family health.
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    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;; Medeiros, Marcelo;; Medeiros, Marcelo; Reis, Mary Lopes; Pedrosa, Sheila Mara; Pacheco, Leonora Rezende; Barbosa, Maria Alves
    Objectives: 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.
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    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;; Munari, Denize Bouttelet;; Bezerra, Ana Lucia Queiroz; Munari, Denize Bouttelet; Siqueira, Karina Machado; Coelho, Maria Alice; Haddad, Maria do Carmo Fernandez Lourenco
    Succession 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.
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    Qualificação dos registros de procedimentos em centros de atenção psicossocial: educação permanente em saúde como estratégia de gestão
    (Universidade Federal de Goiás, 2018-01-25) Silva, Nathália dos Santos; Cardozo, Elizabeth Esperidião;; Bezerra, Ana Lúcia Queiroz;; Bezerra, Ana Lúcia Queiroz;; Lucchese, Roselma; Medeiros, Marcelo; Caixeta, Camila Cardoso; Dallegrave, Daniela
    The Psychosocial Care Centers (CAPS) are strategic services of the Psychosocial Care Network to promote the social reintegration of people with mental disorders and or problems related to the use of alcohol and other drugs. Thus, it is imperative that the actions in the CAPS be monitored and evidenced to support the superiority of this proposal. However, this will only be possible if there are data recorded by the professionals working in the CAPS to enable the evaluation for the management of the quality of the services. This study aimed to analyze the quality of records of procedures using the Permanent Education in Health as a strategy for the management of the work process of the health professionals of the CAPS. This is an intervention research of a qualitative nature, carried out with 58 professionals from seven CAPS from three municipalities of the State of Goiás. Data collection occurred from March to October 2016. The Permanent Health Education was procedural and occurred in three stages: focus groups, seminars and workshops on CAPS procedures and elaboration of a Unique Therapeutic Project (PTS). With the data obtained through the reflection of the subjects, the thematic content analysis was performed. The thematic categories and subcategories that emerged from the content analysis were: Process of registration of the CAPS procedures, the Unique Therapeutic Project in quotation marks and Qualification of the PTS through the understanding of the records and and the opposite also. The results showed that the professionals did not know the instruments of records of CAPS procedures, the meaning of the names of the procedures, the management and purposes of the records and the importance of the data as the driver of information for work and service management. Two situations on the quality of records were evidenced that the data were underreported or reflected the inexistence of psychosocial actions. It was perceived the need of investment in the training of the professionals with focus on the records management and through the systematization of PTS. The Permanent Health Education strategy expanded the repertoire of information about CAPS procedures and was evaluated positively by enabling a better understanding of the records, deconstruction of the idea of association of registration for financial transfer, use of the list of procedures as a care line for elaboration of more robust PTS and revision of Institutional Therapeutic Projects. The incompleteness and underreporting of the data do not depict what the teams in the CAPS are developing and, therefore, the conclusion that the analysis of the data generated through them does not coincide with the reality of the services. It is important to emphasize the importance of the process of permanent education as a way of giving priority to more meaningful learning practices involving the participants in the process of change and thus highlighting the psychosocial practices by recording the actions developed in the CAPS or other devices in the territory. This evidence is fundamental for the technical and political defense of the model of psychosocial care in force in the country.
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    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;; Teles, Sheila Araújo; Carneiro, Megmar Aparecida dos Santos; Gir, Elucir; Matos, Marcos André de; Souza, Sandra Maria Brunini de
    Contact 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.
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    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;; Munari, Denize Bouttelet; Stacciarini, Jeanne Marie Rodrigues; Medeiros, Marcelo; Santana, Rosimere Ferreira; Pagotto, Valéria
    INTRODUCTION: 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.
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    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;; Tipple, Anaclara Ferreira Veiga;; Tipple, Anaclara Ferreira Veiga;; Hunt, Alessandra Marçal Agostinho; Lima, Ana Beatriz Mori; Melo, Dulcelene de Sousa; Caetano, Karlla Antonieta Amorim
    INTRODUCTION: 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.