Doutorado em Saúde Coletiva

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A responsabilidade ética da nutrição frente à questão ambiental
(Universidade Federal do Espírito Santo, 2023-09-13) Sipioni, Marcelo Eliseu; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; https://orcid.org/; http://lattes.cnpq.br/; Salaroli, Luciane Bresciani; https://orcid.org/0000000218810306; http://lattes.cnpq.br/3503255904138561; Priore, Silvia Eloiza; Oliveira, Jelson Roberto de; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969
This study is based on the premise that we live in a context of environmental emergency in which human action represents the main geological force on the planet, which configures the theory of the Anthropocene. The prediction that this context puts future generations at risk has mobilized different actors to break this predatory advance of the human being based on new and necessary conceptions about the relationship between humanity and Nature, so that we no longer subject it to the typical instrumental valuation of utilitarian anthropocentrism, defending a conception of belonging to Her, not of superiority. In this sense, the hegemonic food system represents one of the spheres in which this predatory advance takes place, since it uses technologies and production methods that are extremely aggressive towards Nature. This analysis allows us to identify the implication of Nutrition in this topic, since it is a field of knowledge and practices intrinsically related to the logic of food systems, as can be seen from the analysis of what has been called the Global Syndemic. Thus, this study aimed to identify the perception of national leaders in the field of Nutrition in Brazil about the responsibility of Nutrition and nutritionists in relation to the environmental issue. In this way, a descriptive research with a qualitative approach was carried out with the main nutritionist leaders, at the national level, who, during the period of the study, held some management position in professional, academic or public policy entities or agencies in the food and nutrition´s field in Brazil. The leaders were contacted and interviewed by video call during the first half of year 2022. The questions sought to identify perceptions and opinions they had on the environmental issue, in general, and the general challenges in the Nutrition´s field, in addition to requesting that they express their perspectives and analyzes on the real and ideal implication of the Nutrition´s field in Brazil with the current environmental issue. Data were subjected to thematic analysis. Our findings allow us to state that leaders in the field of Nutrition in Brazil recognize the emergence of the environmental issue and the inevitable implication of Nutrition in this context, especially through the logic of food systems. However, they understand as incipient the debate and the actions carried out in this field so that it is inserted, in a qualified way, with the set of actors that seek to reverse the consequences of the destruction of Nature on several fronts. Among the main challenges presented, there is the need for an educational and informative process that allows the defense of an expanded conception of Nutrition, which stimulates reflections beyond the nutritional reductionist logic. In this sense, based on the findings of this research, and based on ethical proposals that move away from utilitarian anthropocentrism, such as Hans Jonas' Principle of Responsibility, we identified the need for Nutrition to reflect on the expansion of the ethical-political assumptions that underlie its field of practices and knowledge, assuming the task of directing the promotion of healthy and adequate food for everyone involved and implicated in the food system, not just for the individual who eats.
AS AUDIÊNCIAS DE CUSTÓDIA E AS PESSOAS COM TRANSTORNO MENTAL EM CONFLITO COM A LEI
(Universidade Federal do Espírito Santo, 2022-10-31) Campos, Bruno da Silva; Sodre, Francis; https://orcid.org/0000000340379388; http://lattes.cnpq.br/7744765390568573; https://orcid.org/0000000217567201; http://lattes.cnpq.br/; Lima, Rita de Cassia Duarte; https://orcid.org/0000-0002-5931-398X; http://lattes.cnpq.br/2384472795664270; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Silva, Marcos Aurelio da; https://orcid.org/0000-0002-4978-1990; http://lattes.cnpq.br/7366724666644867; Nicolau, Karine Wlasenko; https://orcid.org/0000-0003-4209-6656; http://lattes.cnpq.br/7180650547115138
This study aims to analyze the effects of the medicalization of madness on decisions handed down in custody hearings before people with mental disorders in conflict with the law. For this, we describe the itinerary of these people who enter the criminal justice system through the custody hearing and how the interlocution health and justice in Espírito Santo has been approached, having Collective Health as a theoretical basis. Under methodological aspects, it is a work of qualitative design, consisting of the following steps for data production: documental analysis, and in-depth interviews. The results are presented in the form of articles and, based on them, we aim to contribute to the discussion, referrals and procedures concerning people with mental disorders who commit crimes. As well as providing subsidies for the implementation and strengthening of public policies that concern this portion of the population and that enhance the mental health network and, consequently, living in the city, leaving behind the asylum, institutional and prison model.
Cartas às Marias: escrevivências da atividade de agentes comunitárias de saúde em tempos de pandemia
(Universidade Federal do Espírito Santo, 2022-12-08) Santos, Gabriela de Brito Martins; Lima, Rita de Cassia Duarte; https://orcid.org/0000-0002-5931-398X; http://lattes.cnpq.br/2384472795664270; Garcia, Ana Claudia Pinheiro; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Ceccim, Ricardo Burg
This thesis is a call to awakening, to freshen up research and approaches to health work processes. It is presented in letters, chronicles, writings of the activity, evidencing a work that incites to perforate textures, displace forms, plots and daily trails, leaving bare multiple looks and expressions of experiencing the textures of the lives of women who, as community health agents, in their doing, compose strengths, desires and aspirations. The study was based on Yves Clot's clinic of activity and Michel Foucault's ethics of self-care for the analysis of health work, especially focusing on the work of community health agents. The methodological contribution, in turn, proposes the approximation of the Activity Clinic, by Yves Clot, and Escrivências (writing the life), by Conceição Evaristo, in the construction of narratives and writings of the agents' daily work, in a self-confrontation of the activity as a living triad. The writings of oneself, of the work and of the collective constitute directions for the analysis and construction of a policy of resistance and (re)existence in a context of the COVID-19 pandemic. The study focused on the pandemic as an analyzer of relationships, public policies, the intensification and precariousness of health work. The results show impediments to the activity, limitations in acting, overloads and uncertainties, differences in women's work and their intersections, but record, as a priority, the lines of flight, deviations, resistances and (re)existences of making history and caring for women, community health agents, who, in experimenting with the production of activity writings, in a pandemic context, self-confront and stylize the work genre as community health agents, in a commitment to reinvent work and health production, led by (re)flourishing of those who do.
Custeio de mensalidades nos cursos de saúde no ensino superior privado em tempos de pandemia de Covid-19
(Universidade Federal do Espírito Santo, 2023-03-08) Castro, Caroline Feitosa Dibai de; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; https://orcid.org/0000-0001-6055-4804; http://lattes.cnpq.br/1658530107144331; Lima, Rita de Cassia Duarte; http://lattes.cnpq.br/2384472795664270; Garcia, Ana Claudia Pinheiro; https://orcid.org/0000-0001-5559-7463; http://lattes.cnpq.br/6391903151079745; Almeida, Ana Paula Santana Coelho; https://orcid.org/0000-0001-5808-5818; http://lattes.cnpq.br/2570855705420190; Rocha, Erika Maria Sampaio
Higher education in a Country is relevant when it comes to the development of its human intellectual capital and its socioeconomic aspects, besides playing an important role in the solution of several social problems. In this context, one must consider the difficulties related to both entry and permanence in undergraduate courses in Brazil, since we have a hybrid publicprivate higher education system. On the one hand, there is the dilemma of a public system, which is not universal, and which reveals institutions that are increasingly scrapped, dismantled, with a gradual insufficiency of financial and material resources, and more directed to the vulnerable population through a system of social and racial quotas. On the other hand, there is a privatized scenario with a significant number of private higher education institutions distributed throughout the country (84%), used on a large scale by the Brazilian middle class. In this sense, government and institutional scholarships, student financing and the direct payment of tuition fees by students to these institutions of higher education should be evaluated together as to the obstacles and difficulties both in access and in staying in higher education under a view of all the socioeconomic dynamics of the Brazilian family, in order to better understand the configuration of the reality of these different types of funding in the formation of human resources in society, especially when considering the current scenario of instability in all productive sectors of the nation generated by the pandemic of COVID-19. The objective of this thesis was to identify the repercussions caused by the pandemic of the COVID-19 on the health area students regarding the costing and financing of higher education as to the access and permanence in a Private Higher Education Institution in Espírito Santo that, together with the specific objectives gave fruit to scientific articles, book chapters and presentation in relevant congresses. The thesis was based on the Brazilian legislation that, in the light of the constitutional texts, approached the theme in question. The search was carried out in public organs and entities available on the electronic sites of the Ministry of Education and Culture, of the National Institute for Teaching and Research, and of secondary data from other researches that approached the theme and subsidized and contextualized the research object of this study. The research methodology was quantitative, according to the approach each article developed. At first, an online questionnaire was applied to the students of all periods and courses in the health area: nursing, physiotherapy, social work and medicine of a private higher education institution in the Metropolitan Region of Vitória, Espírito Santo, through a questionnaire with sociodemographic variables, costing profile and aspects related to the pandemic of COVID-19 that, together with the data from the documentary research with the institution, subsidized the foundation of this thesis. This thesis will be an instrument for the management of higher education in the country, both for public policies and for the ordering of the private sector, in order to generate a different look at the reformulation of social educational policies, generating debates and reflections regarding the management, regulation, and democratization of Brazilian Higher Education, as well as to add greater knowledge to the academic community in the production of scientific knowledge in the area of health, especially when considering the training of professionals in this area in order to meet the needs of the Brazilian population.
Determinantes do aleitamento materno exclusivo em uma coorte de nascimento no Espírito Santo
(Universidade Federal do Espírito Santo, 2023-11-09) Silva, Ananda Larisse Bezerra da; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; https://orcid.org/0000-0003-0061-1103; http://lattes.cnpq.br/3353628933154111; Lima, Rita de Cassia Duarte; http://lattes.cnpq.br/2384472795664270; Barcellos, Ludmilla Awad; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Pena, Francineide Pereira da Silva
Introduction: Exclusive breastfeeding (EBF) is recommended until six months of age and complemented until two years or more, with a healthy diet. There are several benefits of EBF, both for mothers and newborns, however, exclusive breastfeeding rates are below those recommended by the World Health Organization (WHO). Furthermore, there are numerous determinants and factors that can influence adequate breastfeeding practices. Objective: Analyze the determinants associated with exclusive breastfeeding. Methods: The construction of this thesis consisted of three scientific articles, being a scope-type literature review study, which followed the methodology Joanna Briggs Institute (JBI), concomitantly with the recommendations of the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Checklist”, across-sectional, multicenter and quantitative study and another longitudinal, multicenter and quantitative study. For these studies, data from a larger study was used, collected in three maternity hospitals in the State of Espírito Santo. Results: In article 1, 3,998 titles were found and, after all selection steps, 145 studies were included. The health determinants associated with exclusive breastfeeding were mapped: maternal education, family income, attendance and number of prenatal consultations, breastfeeding guidance and practices, time until the first breastfeed, sex of the newborn, maternal work and maternity leave, use of pacifiers and guidance on exclusive breastfeeding in health services. In article 2, exclusive breastfeeding before hospital discharge was 85.2%. Using logistic regression, women under 19 years of age and babies born with normal weight and full-term were more likely to practice exclusive breastfeeding while still in the maternity ward. In article 3, 80.7% remained on EBF on the 7th day and 79.2%onthe27thday after birth. The determinants of EBF on the 7th day after birth were having a partner, consumption of alcohol and/or tobacco, non-use of illicit drugs and normal birth weight. On the 27th day after birth, being up to 19 years of age and being born at term were considered determining factors. Not having difficulties breastfeeding was present in both moments. Final considerations: This thesis proposed to present three articles referring to the theme of determinants associated with exclusive breastfeeding. These studies can contribute to the planning and updating of public policies in favor of breastfeeding, as well as contributing to better results in breastfeeding rates and exclusive breastfeeding.
Eixo formação do programa Mais Médicos e os preditores de fixação em áreas desassistidas no estado da Bahia: análise sob a ótica do ciclo de políticas de Stephen Ball
(Universidade Federal do Espírito Santo, 2020-02-14) Rocha, Erika Maria Sampaio; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; https://orcid.org/; http://lattes.cnpq.br/; Lima, Rita de Cassia Duarte; https://orcid.org/; http://lattes.cnpq.br/2384472795664270; Santana, Luciana Alaide Alves; https://orcid.org/; http://lattes.cnpq.br/; Azevedo, George Dantas de; https://orcid.org/; http://lattes.cnpq.br/; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Siqueira, Carlos Eduardo Gomes
This thesis consists in an analysis of the axis Education of the Mais Medicos Program, specifically around the changes in the education in Medicine, as a strategy for facing the issue of the lack of physicians in Brazil. A mixed qualitative and transversa
Impactos da gestão das organizações sociais de saúde nos trabalhadores de um hospital público estadual no Espírito Santo
(Universidade Federal do Espírito Santo, 2023-03-14) Fernandes, Lorena Estevam Martins; Sodre, Francis; https://orcid.org/0000000340379388; http://lattes.cnpq.br/7744765390568573; https://orcid.org/0000000261134817; http://lattes.cnpq.br/0157702476664805; Bittencourt, Roberto José; https://orcid.org/0000-0002-6482-5840; http://lattes.cnpq.br/0259061999419918; Bussinguer, Elda Coelho de Azevedo; https://orcid.org/0000-0003-4303-4211; http://lattes.cnpq.br/8933361259561564; Filippon, Jonathan Goncalves; https://orcid.org/0000-0003-3907-1992; http://lattes.cnpq.br/1655529281503303; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; Soares, Magda Ribeiro de Castro; http://lattes.cnpq.br/6810603722774269
The Social Organizations (OS) emerged in Brazil in the State managerial counterreform, in 1995, to differentiate exclusive activities from non-exclusive ones. This “new” management advocated the implementation of a results-oriented management model. The inclusion of SUS in the counter-reform was justified to improve the performance of public health services, through the transfer of hospital management to Social Health Organizations (OSS) through the signing of management contracts with the Executive Branch. This research discussed the outsourcing of management through OSS as an alternative to public management considered inefficient and without quality, and aimed to analyze the impacts of management through OSS on workers at a state hospital in Espírito Santo. It consisted of an unprecedented work in Brazil and proposed a single case study in a hospital with mixed labor, public servants assigned and employees hired by the OSS. Forty interviews with medical, nursing, administrative and multidisciplinary professionals were analyzed. These were submitted to document analysis and thematic analysis, based on the Grounded Theory of Data or Grounded Theory. The findings showed that OSS management was self-centered and hierarchical. It did not have, or were not granted, indicators or significant consolidated HR information demonstrating the non-priority given to the management of health work. There were impacts of OSS management on people management, health and quality of life of workers. The main losses were in the mental health of workers, generated by precariousness, suffering, violence, work overload and mental illness of employees. The conclusions showed that the OSS did not add quality to the hiring and management processes of professionals, because despite providing manpower, they did not do it in sufficient numbers, did not invest in training or in improving working conditions. OSS management did not prove to be an adequate choice for the management of this hospital service in the Unified Health System.
O diálogo como resposta à judicialização da saúde no município de Barreiras – BA
(Universidade Federal do Espírito Santo, 2022-12-19) Calixto, Fabiana de Carvalho; Almeida, Ana Paula Santana Coelho; https://orcid.org/; http://lattes.cnpq.br/2570855705420190; https://orcid.org/0000-0003-0819-0120; http://lattes.cnpq.br/5550900366118690; Rafagnin, Thiago Ribeiro; https://orcid.org/0000-0002-2015-4811; http://lattes.cnpq.br/3377502960363268; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Souza, Andrea Santana Leone de; https://orcid.org/0000-0001-7304-9639; http://lattes.cnpq.br/5544509014780655
This research approaches the issue of Philosophical Education in prison. The central aim is to raise reflections within the prisoners about the founding causes for their own incarcerations. Furthermore, about the necessity to search for knowledge to illustrate one’s actions in order to avoid criminal recidivism which causes a new incarceration upon completion of sentence. The course of this investigation and philosophical practice addresses three diachronic periods of time. Firstly, with the assistance of Michel Foucault, this study approaches the basis and definition of the misconceptions in prison while recognizing the disassociation which occurs from the serving of the sentences to their learning purposes. Secondly, assisted by Plato, through his dialectic and The Allegory of the Cave, the discernment and identification together with the incarcerated population of the true shadows present inside the regulations of the crime world. From there, the perspective of one’s ability to avoid attitudes based on opinions, pre-judgement and prejudice, such as, chauvinist attitudes towards women, the practical target of this intervention, which caused the incarceration and may cause recidivism. Thirdly, the construction of a philosophical practice, based on the platonic maieutic and contemplated by traumatisms and groping, that lead the prisoners to the affection of their own existence. Accordingly, this aims to provide for the possibility to remission and transcendency of one’s crimes from the humane movement of one’s interiorities. This is the significant result to be achieved by this investigation and practice of Philosophy Education as means towards comprehension of the liberty within imprisonment, from The Allegory of the Cave – Prison Nevermore.
ORGANIZAÇÕES SOCIAIS DE SAÚDE COMO FORMA DE PRIVATIZAÇÃO DO SISTEMA ÚNICO DE SAÚDE
(Universidade Federal do Espírito Santo, 2020-10-30) Turino, Fabiana; Sodre, Francis; https://orcid.org/0000000340379388; http://lattes.cnpq.br/7744765390568573; https://orcid.org/0000000252911346; http://lattes.cnpq.br/; Filippon, Jonathan Goncalves; https://orcid.org/; http://lattes.cnpq.br/; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; Oliveira, Adauto Emmerich; https://orcid.org/; http://lattes.cnpq.br/1534956621971641; Bahia, Ligia; Siqueira, Carlos Eduardo Gomes
This PhD thesis focused on the theme of privatization of the Unified Health System (SUS) through the entry of Social Health Organizations (OSS) in the management of these services. The methodology used was a mixed, qualitative and quantitative approach. T
Trabalho em saúde sob o olhar de quem cuida: experiência das profissionais de enfermagem de um hospital universitário sob o contexto da COVID-19
(Universidade Federal do Espírito Santo, 2023-12-05) Demarchi, Stephania Mendes; Andrade, Maria Angelica Carvalho; https://orcid.org/0000000236906416; http://lattes.cnpq.br/5427520110626795; https://orcid.org/0000-0002-2403-8842; http://lattes.cnpq.br/8912778148744941; Lima, Rita de Cassia Duarte; http://lattes.cnpq.br/2384472795664270; Souza, Susane Petinelli; http://lattes.cnpq.br/1918347901202858; Santos, Dherik Fraga; Rocha, Erika Maria Sampaio
In Brazil, there are more than 2.5 million nursing professionals, and the profession is structured into four categories: nurse, nursing technician, nursing assistant and midwife. Nursing is a profession with multiple applicability, as it involves assistance, public health, prevention and health promotion. The Covid-19 pandemic has overwhelmed nursing, a profession that is mostly female. OBJECTIVE: This article aims to identify the experiences of nursing professionals at a university hospital in the context of the Covid-19 pandemic. METHODOLOGY: This research is based on a qualitative and descriptive approach. 40 female nursing professionals were interviewed. We chose to use interviews with a semi-structured script and Bardin's content analysis. This is research with a qualitative and descriptive approach, semi- structured interviews were carried out, questions were applied that involve the intended scope of the interview. The objective of the interview was to obtain individual perceptions from the interviewees on the topic studied. The research location was a large public hospital. To achieve the objective, nursing professionals were interviewed, valuing the subjects' point of view, their experiences and perceptions in relation to their activity. Self-writing was brought as a theoretical-methodological element, and we chose the interview and field diary as instruments. Hannah Arendt was the author used to reflect on the narrative of women and health workers, because, despite women moving from the private to the public sphere, they were able to access the public world, that is, they now had the right to see and be seen, to speak and be heard, and listening to them is still a challenge in current times, especially their experiences as workers, caregivers, women. Given this, it was decided to work with the narrative which, according to Arendt, allows reflection on the paths of experience. RESULTS: In this way, the pandemic unmasked the difficulties that nursing professionals face in their work routine. There were countless challenges caused by the pandemic mentioned by nursing workers, such as: dealing with an unknown disease, problems with the use of personal protective equipment (whether excessive use or lack thereof), deaths, lack of professionals and structure, management ineffective or dehumanized behavior, changes in routine, family or social withdrawal and harassment or prejudice. Furthermore, in relation to working women who had children under their care, four thematic categories were found: 1- domestic work and the difficulty of reconciling this with work in the hospital; 2- motherhood: being a mother and a worker during the pandemic period; 3- the multiple shifts, overload and loneliness of working women; and 4- the naturalization of practices and discourses. CONCLUSION: We must, as a society, rethink the quality of life of this group composed mainly of women, as in the face of inequalities in gender roles, it was concluded that they became even more evident during the period of the Covid-19 pandemic, when women were still more burdened with tasks related to taking care of the home and children, in addition to the increased work demands of the research subjects, nursing workers. Given the challenges faced by nursing workers, in this research, we realized, through reports on their daily lives, that these women face numerous factors that can compromise their physical and mental health.

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