Doutorado em Saúde Coletiva

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Efeitos subjetivos do processo de trabalho vivenciados por profissionais em um Centro de Atenção Psicossocial Álcool e Drogas
(Universidade Federal do Espírito Santo, 2015-01-01) Wandekoken, Kallen Dettmann; Dalbello-Araujo, Maristela; Sodré, Francis; Figueiredo, Túlio Alberto Martins de; Borges, Luiz Henrique; Rasch, Scheila Silva
This thesis presents the results of a research that aimed to analyze how workers experience the subjective effects produced by the work process in a Psychosocial Care Center Alcohol and Drugs (CAPSad in Portuguese). The research was conducted under a qualitative approach, in a service of Vila Velha, Espírito Santo State, Brazil . The data was collected through five steps: 1. Desk review of existing policies about drug use; 2. Analysis of medical records; 3. group interview with ten employees; 4. Eighty hours of observation of daily work; 5. In-depth interview with thirteen workers. For data analysis, we used the thematic analysis technique.We conclude that in the analyzed policies, has prevailed ideas related to the users repression, despite the attempt of the Ministry of Health (MS in Portuguese), which considers the harm reduction as a strategy that values the person and their uniqueness.The analysis also pointed out the difficulties faced by workers from that city to act in accordance to the MS guidelines, since the municipal actions has emphasized repression, religious approach and intimidation as a prevention strategy, with the agreement of justice and police. We emphasize that the ambiguities have repercussions at work and for the worker. We also point out other aspects that generate effects on workers: poor working conditions (due to the service structure, low wages and non-existent care network), lack of recognition (due to management failure and the lack of standards) and work overload (due the lack of professionals and conflicts in the activities division).These situations lead to subjective effects such as exhaustion, illness, fear, inability to act, apathy, devaluation, lack of motivation and worker's imprisonment.These effects are all negative and workers has experienced them through emotional detachment in work process, which negatively affects the possibility of producing an effective care.We suggest investments in employee training, with a focus on permanent education, since it causes learning encouragement and creative positioning in face of experienced effects in daily life.There is the needfor dialogue, between workers and management, between the workers themselves and between workers and users.
Epidemiologia da tuberculose resistente e multidroga resistente no estado do Espírito Santo
(Universidade Federal do Espírito Santo, 2016-08-12) Carlesso, Geisa Fregona; Zandonade, Eliana; Maciel, Ethel Leonor Nóia; Dalcolmo, Maria Pretti; Falqueto, Aloísio; Miranda, Angélica Espinosa Barbosa; Prado, Thiago Nascimento
The emergence of resistant strains of Mycobacterium tuberculosis (Mtb) has been a major challenge for the control and elimination of the disease worldwide. In Brazil, the number of reported cases is still small if compared to other countries with high incidence; in Espirito Santo the information about this disease are insufficient. Objectives: To describe and to analyze the sociodemographic, clinical and epidemiological characteristics and factors associated with tuberculosis (TB) resistant to first-line drugs in the ES (a cross-sectional study); to describe the sociodemographic, clinical and epidemiological characteristics of cases of MDRTB (retrospective study described); to analyze factors associated with the occurrence of MDRTB (case-control nested within a cohort); and to analyze the causes of death between TBMDR cases (retrospective study described). Results: In a descriptive and comparative cross-sectional study of resistant TB cases and not resistant, we found a rate of 10.6% resistance to any antituberculosis drugs, among the cases tested. The multidrug-resistant tuberculosis rate (MDRTB) was 5%. After multivariate analysis, were identified the following independent factors associated with resistant TB: history of previous treatment for TB (relapse [OR = 7.72, 95% CI 4.24 to 14.05] and return after default [OR = 3.91; CI 95% = 1.81 to 8.43]), smoking (OR = 3.93; CI 95% = 1.98 to 7.79) and positive culture for Mtb at the time of the event notification (OR = 3.22; CI 95% = 1.15 to 8.99). Descriptive study of cases of MDRTB found respectively 1.1% of primary cases, 18.5% of acquired cases and 5.4% of combined cases. In the characterization of the population, we found an average age of 39 years (SD = 13.8), 79% male, 55% nonwhite and 75% with less education than 8 years of study. The co-infection rate of TB / HIV was 9%; 45% of the cases reported alcohol use, and 43% smoke. Other comorbidities were less frequent, such as diabetes, illicit drug use and mental illness, respectively 12%, 16% and 4%. About clinical and epidemiological history, 99% had the pulmonary form; 67%, bilateral pulmonary involvement, and 88% had evidence of cavitation damage. Sputum smear microscopy was positive in 87% of the cases, and the history of contact with TB case, in 45%. Most of these cases were treated under directly observed treatment (DOT), and the cure rate, default and failure were, respectively, 81%, 5% and 4%. The conversion rate of sputum culture to the 2nd month of treatment was 85%, with 38 days of time mean (SD = 16.0). In study of risk factors for MDRTB, we found that, independently, white and more educated individuals have more risk to be affected by MDRTB in ES, respectively OR 1.87 (CI 95% = 1.08-3.26; p = 0.026) and OR 2.75 (CI 95% = 1.21-6.25; p = 0.000). Variables such as alcoholism, diabetes, mental illness, to be institutionalized, and HIV infection have not been associated with cases of MDRTB (p > 0.005). When TB was the underlying cause of death, the greater mumber of mentions among individuals diagnosed with MDRTB it was respiratory disease. Conclusions: The characteristics of resistant TB cases and MDRTB reproduce the general profile of TB, in ES and Brazil. The factors associated with these cases should serve as a warning to health professionals so that appropriate action can be taken. About higher education and white among the cases of MDRTB, these characteristics should be taken into consideration by the clinical suspicion disease investigation and further investigation in the future. The diagnosis and early treatment should prevent the movement of Mtb strains, thereby providing a reduction in the number of primary cases, besides they may have a greater impact on mortality.
A gestão do trabalho na Estratégia Saúde da Família : o governo de si e do outro sob a ótica do gestor
(Universidade Federal do Espírito Santo, 2016-09-02) Galavote, Heletícia Scabelo; Lima, Rita de Cássia Duarte; 1º membro da banca
The process of healthcare work management in the scenario of the Family Health Strategy is highlighted as an analytical intention founded on the concepts proposed by Foucault about the apparatuses of power and the techniques for the care of self and others as the foundtion of a political power exercise. The analysis unity transits between the space of macro-politics and that of the micro-politics of the management of work in healthcare, which permeated the teritory of imanence between what is taken as the norm and re-normalization. The objective it to analize the management of work in the Family Health Strategy in the state of Espirito Santo, starting from the discourse of the managers, as well as identifying the pratices involved by the managers in the constitution of the government of self and others. This is a descriptive and exploratory study, with a qualitative approach. To achieve this objectives, managers from 36 municipalities of the state of Espirito Santo were invited to participate: the Municipal Health Secretary; the Municipal Coordinator for the Family Health Strategy; and the Municipal Coordinator for Primary Health Care. A semi-structured interview and participant observation were used for the collection of data. The discourse analysis was the basis for data analysis, and the cartography was used as a complementary method of research. There are elements in the discourse that are highlighted for signaling to a practice of management through discipline and control over the workers, through the attainement of results, founded in mandatory acts and in the normalization of the work, which is called prescribed, dead, amputating the autonomy and creativity of the worker. For the managers, to innovate means to mobilize the workers based on a political centralization that warrants for the manager the final decision and the definition of the directions, once the teams have little governability relating to the definition of goals and indicators. The managers produce self practices, but are inprisoned by the normalizations of the healthcare organiztion itself through the marks that are inscribed on their bodies and that determine a healthcare manager with serialized discourses and actions. They are stultus managers, since they don't exercize the self care as freedom, and bare a subordinate will, which is not free
Internações por condições sensíveis à Atenção Primária no Estado do Espírito Santo 2000 a 2014
(Universidade Federal do Espírito Santo, 2017-09-26) Rosalva Grobério Pazó; CADE, N. V.; 1º membro da banca
abstract
Metodologia de gestão do trabalho em saúde e a qualidade da assistência pré-natal e seus desfechos perinatais no município de Vitória, Espírito Santo
(Universidade Federal do Espírito Santo, 2018-02-27) Ruschi, Gustavo Enrico Cabral; Zandonade, Eliana; Miranda, Angélica Espinosa Barbosa; Chambô Filho, Antônio; Sarti, Thiago Dias; Santos Neto, Theodoro Dos; Cade, Nágela Valadão
The computerization of health and the implementation of Matrix Support (AM) in Women's Health are normative work processes adopted in the city of Vitória, Espírito Santo (ES), aiming to qualify and increase the resolubility of professionals inserted in the context of Primary Health Care (APS). Objectives: To evaluate the quality dimensions of data from patients' electronic patient records (PEP) followed in the APS of Vitória-ES, the influence of MA in determining the quality of prenatal care and to understand its effect on the determination of adverse perinatal outcomes. Material and Methods: Two cross sectional studies were carried out, with a quantitative approach, from a representative sample, previously calculated and randomly selected from the records of pregnant women enrolled in the basic health care units of Vitória, Espírito Santo, between January 2013 and December (coverage, non-duplicity, accessibility, timeliness, methodological clarity, completeness, consistency and reliability); the second analyzed the quality of prenatal care based on the number of visits, prenatal start, clinicalobstetric procedures and laboratory tests performed. The third study is a cohort with multilevel hierarchical analysis of records of newborns from mothers followed-up in the APS of Vitória-ES, during the same period from 2013 to 2014, evaluating adverse perinatal outcomes (prematurity, low birth weight and early neonatal death). Results: In the evaluation of the data quality dimensions of the PEP, prenatal coverage, considering the onset of prenatal care, was 80%. Despite the restriction of access, opportunity and lack of methodological clarity, the clinical record showed excellent consistency and completeness in the fields of obstetric procedures and laboratory tests. Reliability showed disagreements with the Live Birth Information System. When analyzing the quality of prenatal care, there is a decrease in the adequacy of care provided as the level of analysis becomes more complex. The variables that showed an association with the non-adequacy of care quality were: greater number of children (OR=0.63; IC=0.44-0.92), gestational risk (OR=1.86; IC95%=1.02-3.38) and absence of matrix support (OR=1.50; IC95%=1.10-2.06). The hierarchical analysis model inferred that the chance of a pregnancy to progress to an adverse perinatal outcome increases the higher the number of previous pregnancies (OR=4.39; IC95%=1,93-10,0) and the lower number of prenatal consultations performed (OR=4,99; IC95%=2,18-11,42). No effect of MA on outcomes was observed. Conclusions: There is potential of the electronic medical record as a source of epidemiological information on prenatal care. However, the data suggest that the presence of the Matrix Support does not significantly influence the completeness of the medical record. Greater emphasis on completing medical records and integrating with other levels of care is necessary. The implantation and valorization of strategies of reorganization of services and practices, such as AM, are determinants of quality improvement in prenatal care, and it is necessary to increase the degree of support. Although the proposed hierarchical model demonstrates direct determination of sociodemographic and obstetric characteristics on adverse outcomes, the particular characteristics of PHC in the city of Vitoria-ES reduce the positive effects of AM.
Prevalência de hipotensão ortostática e fatores associados no estudo longitudinal de saúde do adulto (ELSA-Brasil)
(Universidade Federal do Espírito Santo, 2018-04-18) Velten, Ana Paula Costa; Benseñor, Isabela Judith Martins; Mill, José Geraldo; Chor, Dora; Oliveira, Elizabete Regina Araújo de; Zandonade, Eliana
Orthostatic hypotension (OH) is a sustained reduction in blood pressure when the individual stands up from lying down. OH occurs as consequence of failure in compensatory mechanisms of reduced venous return. In population studies, OH has been associated with cardiovascular comorbidities such as coronary artery disease, atrial fibrillation, hypertension, heart failure, stroke, arterial stiffness and chronic kidney disease. Besides the risk factors for OH have been neglected in clinical practice, few epidemiological studies have dedicated to this subject. Moreover, studies in the Brazilian population are a missing. This thesis sought to estimate the prevalence of OH and its associated factors among participants of the Brazilian cohort "Longitudinal Study of Adult Health" (ELSA-Brazil). Data collected at baseline were used for 14,833 participants (both sexes, 35-74 years) who had complete data of postural maneuver. The postural maneuver was performed after 20 minutes rest in the supine position by active adoption of stand up posture. Blood pressure (BP) was measured at both supine and at 2, 3 and 5 minutes of orthostasis. OH was defined as a fall ≥20 mmHg in systolic BP and / or a fall ≥10 mmHg in diastolic BP at 3 minutes of orthostasis. The distribution of BP variation after the postural maneuver was determined in a subsample (N = 8,011) after exclusion of participants with cardiovascular morbidity and diabetes. Associated factors were determined by a cross sectional study. The covariates analyzed were gender, age range, race/skin color, schooling, nutritional status, waist circumference, changes in brachial ankle index, pulse wave velocity, heart disease, acute myocardial infarction (AMI)/revascularization, stroke, diabetes, hypertension, antihypertensive medication use, systolic and diastolic pressure, cholesterol, triglycerides, Chagas serology, presence of symptoms and variation of heart rate. The total prevalence of OH was 2.0% (95% CI: 1.8-2.3) and similar between sexes, with increasing frequency with age (1.2% at age <45 years and 3.4% at age > 65 years). When pressure drop in any time measured was used as criterion, the prevalence of OH increased to 4.3% (95% CI: 4.0-4.7). Symptoms as dizziness, visual changes and nausea were self-reported in 19.7% (95% CI: 15.6-24.6) of the participants with OH and only in 1.4% (95% CI: 1.2 -1.6) of the participants without HO. The -2 Z-scores of the pressure variations before and after the postural maneuver in the sub-sample were -14.1 mmHg in the systolic BP and -5.4 mmHg in the diastolic BP. OH was significantly associated with largest age group, OR: 1.83 (95% CI: 1.14-2.95); changes in brachial ankle index, OR: 2.8 (95% CI: 1.13-6.88), AMI/ revascularization, OR: 1.70 (95% CI: 1.01-2.87); self-reported heart disease, OR: 3.03 (95% CI: 1.71-5.36); increased systolic BP, OR: 1.012 (95% CI: 1.006-1.019); positive Chagas disease serology, OR: 2.29 (95% IC: 1.23-4.27) and self-reported symptoms in postural change, OR: 20.81 (95% CI: 14.81-29.24). The prevalence of OH varied substantially depending on the moment of pressure measurement. The current cutoff points adopted may underestimate the actual occurrence of OH in the population. The presence of OH could be very useful as an alert for potential cardiovascular impairment, and therefore a tool for screening and prevention.
Comunicando o risco: um olhar sobre a epidemia de zika
(Universidade Federal do Espírito Santo, 2018-07-17) Antunes, Michele Nacif; Oliveira, Adauto Emmerich; Pimenta, Denise Nacif; Goveia, Fábio Gomes; Maciel, Ethel Leonor Noia; Figueiredo, Túlio Alberto Martins de
Risk communication is defined as a process of planning communication of public institutions to face situations of crises or risks, which almost always become media events. Nowadays, more and more, they can also become social media events. And, therefore, social media must be considered when planning communication in the face of emergencies. The purpose of this thesis is to understand the aspects that involve the relationships between a public health emergency, the media and society, and public institutions responsible for risk management, taking as its central axis the role of social media in contemporary society. To take a look at the zika epidemic, some aspects and elements help us. We start from the issued warnings and the declaration of the public health emergency, from the epidemic of meanings in which zika is surrounded, mainly by the context of uncertainty in which it arose. And before society that experiences uncertainty daily, we make brief considerations about the risk. From risk, we move to risk communication and the emergency in public health and the influences that social media operate on this equation. Four studies were developed. In the first one, metassynthesis was performed, in which topics such as the post-truth and the challenges faced by public institutions in this context were also discussed. In the second, a survey of the main communication actions was carried out, based on the official documents that deal with risk communication and the survey of the high resources spent on advertising during the zika epidemic. We concluded that advertising, among other actions, was considered a priority and occupied a prominent place in communication strategies. In the third one, we discuss the use of Facebook as a risk communication tool of public institutions in the response to the zika epidemic. A survey of the postings of the pages of the Ministry of Health and the Government of the State of Espírito Santo related to the topic was carried out, and soon after that, they were categorized according to the subject addressed. It was observed that during the emergence of the zika epidemic, the strategies used in social media do not differ from practices in other media: an invitation to combat mosquitoes. In the fourth study images that aroused more interest and more number of shares on the part of the Internet users from the device in the social network Instagram were analyzed. In the study, we used ImageCloud, an application developed by the Laboratory of Image and Cyberculture Studies (Labic). In summary, we conclude that the current model adopted by risk communication and public health emergencies points to the need for changes that incorporate new strategies and practices that take into account the diverse spaces, scenarios, contexts and existing social processes. In this way, the following question arises: is it possible another form of risk communication and public health emergencies in Brazil? A kind of communication that is anchored in the integration and articulation of several actors in facing the risk?
Diabetes mellitus, mídia impressa e gestão do trabalho em saúde: uma socioanálise
(Universidade Federal do Espírito Santo, 2018-08-03) Coqueiro, Jandesson Mendes; Figueiredo, Túlio Alberto Martins de; 1º membro da banca
abstract
Consumo de produtos lácteos e sua relação com fatores de Risco cardiovascular em participantes do estudo longitudinal de saúde do adulto (ELSA-Brasil)
(Universidade Federal do Espírito Santo, 2019-03-14) Ribeiro, Amanda Gomes; MOLINA, M. C. B.; 1º membro da banca
abstract
Bullying, características psicossociais e sociorrelacionais entre adolescentes
(Universidade Federal do Espírito Santo, 2019-04-11) Sarlo, Andressa Reisen; Santos Neto, Edson Theodoro dos; 1º membro da banca
abstract
Desigualdades sociais em experiências de adoecimento por Diabetes mellitus tipo 2
(Universidade Federal do Espírito Santo, 2019-11-25) Ruiz, Nicolás Ortiz; Lima, Rita de Cassia Duarte; https://orcid.org/0000-0002-5931-398X; http://lattes.cnpq.br/2384472795664270; https://orcid.org/0000-0001-8730-3773; http://lattes.cnpq.br/4440961635540250; Maciel, Ethel Leonor Noia; https://orcid.org/0000000348263355; http://lattes.cnpq.br/3761398932271892; Bicudo, Sheilla Diniz Silveira; https://orcid.org/0000-0002-0634-2015; http://lattes.cnpq.br/8241230955222443; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; López, Pilar Montero
Diseases are manifestations in the bodies of individuals, related to the social, political, economic and cultural conditions they experience. Consequently, their intensity and frequency, their effects, vary according to social structure at different times in history. Type 2 diabetes mellitus is a disease whose development and evolution are directly influenced by social situations. Its epidemic behavior involves a complex group of genetic and epigenetic systems that interact within an equally complex social structure capable of determining individual and collective behaviors and practices. It is a typical example of a disease that appears to be concentrated in areas of greater poverty and in individuals with low incomes and low levels of education. The objective of this research was to analyze and understand how the social inequalities experienced by individuals diagnosed with type 2 diabetes mellitus affect their illness experiences. This study corresponds to a qualitative research, based on biographical reports of people with this diagnosis for over a year and with different socioeconomic and sociocultural characteristics. The cases were selected in different health centers in the city of Santiago de Cali-Colombia, seeking representation from different social classes, gender and racial ethnicity. The main findings show a close relationship between context, life trajectories and illness experiences. It is observed that, in life trajectories, the main axes around which social inequalities are configured are the territory, gender and the link between education and work. From these axes, the relationships between social structures, social interactions and the actions of individuals establish distributions and differential access to various capitals. This configures a ranking of social positions that enables greater advantages, benefits, opportunities for some individuals over others. In illness experiences, these inequalities are articulated in the access and use of services, in relationships with health personnel, in social support and networks and in self-care practices. Similarly, the disease has the potential to articulate according to levels of social vulnerability, producing a vicious circle between vulnerability-disease-vulnerability. This paper offers alternative to quantitative methods for analyzing health inequalities. In this sense, the importance of quantifying the magnitude and distribution of social asymmetry and disadvantage phenomena in large population groups is highlighted, but, on the other hand, understanding experiences in specific contexts provides inputs to generate equal opportunities, access and capabilities, recognizing territorial, socioeconomic and socio-cultural differences and inequalities. It is essential to continue to deepen intersectionalities in order to identify the specific ways in which different experiences articulate in certain forms of social organization to produce social inequalities. In this sense, it is important to insist on the situated and particular character of these intersectionalities so as not to fall into the determinisms of class, gender or race, to name a few, which eventually make certain populations vulnerable, or prevent other forms of inequality from being recognized.economic and cultural conditions they experience. Consequently, their intensity and frequency, their effects, vary according to social structure at different times in history. Type 2 diabetes mellitus is a disease whose development and evolution are directly influenced by social situations. Its epidemic behavior involves a complex group of genetic and epigenetic systems that interact within an equally complex social structure capable of determining individual and collective behaviors and practices. It is a typical example of a disease that appears to be concentrated in areas of greater poverty and in individuals with low incomes and low levels of education. The objective of this research was to analyze and understand how the social inequalities experienced by individuals diagnosed with type 2 diabetes mellitus affect their illness experiences. This study corresponds to a qualitative research, based on biographical reports of people with this diagnosis for over a year and with different socioeconomic and sociocultural characteristics. The cases were selected in different health centers in the city of Santiago de Cali-Colombia, seeking representation from different social classes, gender and racial ethnicity. The main findings show a close relationship between context, life trajectories and illness experiences. It is observed that, in life trajectories, the main axes around which social inequalities are configured are the territory, gender and the link between education and work. From these axes, the relationships between social structures, social interactions and the actions of individuals establish distributions and differential access to various capitals. This configures a ranking of social positions that enables greater advantages, benefits, opportunities for some individuals over others. In illness experiences, these inequalities are articulated in the access and use of services, in relationships with health personnel, in social support and networks and in self-care practices. Similarly, the disease has the potential to articulate according to levels of social vulnerability, producing a vicious circle between vulnerability-disease-vulnerability. This paper offers alternative to quantitative methods for analyzing health inequalities. In this sense, the importance of quantifying the magnitude and distribution of social asymmetry and disadvantage phenomena in large population groups is highlighted, but, on the other hand, understanding experiences in specific contexts provides inputs to generate equal opportunities, access and capabilities, recognizing territorial, socioeconomic and socio-cultural differences and inequalities. It is essential to continue to deepen intersectionalities in order to identify the specific ways in which different experiences articulate in certain forms of social organization to produce social inequalities. In this sense, it is important to insist on the situated and particular character of these intersectionalities so as not to fall into the determinisms of class, gender or race, to name a few, which eventually make certain populations vulnerable, or prevent other forms of inequality from being recognized.
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
Dependência de internet, ansiedade, depressão e uso de substâncias psicoativas na adolescência tardia
(Universidade Federal do Espírito Santo, 2020-07-27) Bueno, George Nunes; Santos Neto, Edson Theodoro dos ; https://orcid.org/0000-0002-7351-7719; http://lattes.cnpq.br/5430137427291413; https://orcid.org/0000-0002-2682-4214; http://lattes.cnpq.br/9461730986418352; Portugal, Flavia Batista; https://orcid.org/0000000244252627; http://lattes.cnpq.br/1876697154549534; Tavares, Hermano; https://orcid.org/0000-0002-6632-2745; http://lattes.cnpq.br/6074429593047006; Viana, Maria Carmen Moldes; https://orcid.org/0000-0002-0464-4845; http://lattes.cnpq.br/4338126917250074; Sarlo, Andressa Reisen; https://orcid.org/0000-0003-3916-462X; http://lattes.cnpq.br/7553715313970938
With the increased use of the Internet and new technologies, mainly (or among) younger individuals, it can be seen that adolescents demonstrate a pattern of intense use, spending more and more time daily connected and also using social networks. The Internet can provide benefits, but its overuse can lead to addiction and harm both the social and personal fields of individuals. In adolescence, individuals are prone to various types of mental disorders, such as Anxiety and Depression It is also at this stage that the adolescent seems to be more resistant to the instructions of their parents, with a greater susceptibility to experimentation and possible drug abuse. This thesis aim to verify the association between Internet addiction, sociodemographic characteristics and the pattern of use of Internet and social media. As well as, to verify the association of Internet dependence with Anxiety, Depression, Self-esteem and the use of psychoactive substances in adolescents aged 15 to 19 years, high school students in public and private schools in the Metropolitan Region of Grande Vitória - ES (RMGV- ES). This study is part of a school-based sectional epidemiological survey, carried out between the years 2016 and 2017 from a representative sample of students aged 15 to 19 years enrolled in high school at (RMGV-ES). Interviews were conducted with 2,293 adolescents and the association between Internet addiction test (IAT) with sociodemographic factors, use of psychoactive substances (Area 1 of the Drug Use Screening Inventory - DUSI-R), symptoms of Anxiety and Depression (Hospital Scale for Anxiety and Depression - HAD) and Self-Esteem (Rosenberg's Self-Esteem Scale - EAR). Statistical analysis involved Pearson's chi-square test and binary and multinomial logistic regression. Associations of Internet addiction were found in adolescents who were in the early grades of high school (p = 0.001), with those who had a head of the family with a low level of education (p = 0.018), who spent four or more hours day browsing (p <0.001) and those who used the Internet every day of the week (p = 0.004). Internet addiction was also associated with the use of Twitter (p-value = 0.040), the subjective reasons for use (p = 0.001) and those who stopped using it for social reasons (p = 0.001). In addition, females were associated with greater chances of presenting anxious symptoms (ORaj = 1.36; 95% CI = 1.11-1.65) and low selfesteem (ORaj = 1.92; 95% CI = 1.00- 3.68), depressive symptoms were more frequent in first-year high school students (ORaj = 1.92; 95% CI = 1.22-3.00) and in public school students (ORaj = 1.43; 95% CI = 1.06-1.93). Internet addiction was also associated with the presence of anxious symptoms (ORaj = 0.22; 95% CI = 0.22- 0.36), depressive symptoms (ORaj = 0.60; 95% CI = 0.42-0.87) and low self-esteem (ORaj = 0.66; 95% CI = 0.50-0.87). The association with the experimental use of alcohol and other drugs was perceived in adolescents of black race / color (ORaj = 1.39; 95% CI = 1.00-1.94) and with probable anxiety (ORaj = 1.39; 95% CI % = 1.09- 1.78). Associations were also found in the abusive users of alcohol and other drugs with the male gender (ORaj = 1.4; 95% CI = 1.00-1.94), the social class AB (ORaj = 1.56; 95% CI = 1 , 05-2.33), work in a paid way (ORaj = 1.55; 95% CI = 1.19-2.04), have probable anxiety (ORaj = 2.57; 95% CI = 1.84-3, 60) and be dependent on the Internet (ORaj = 1.95; 95% CI = 1.49-2.56). In addition, the results showed that the chance of being dependent on psychoactive substances increases when the adolescent is dependent on the Internet (ORaj = 2.16; 95% CI = 1.46-3.20), with probable anxiety (ORaj = 3, 45; 95% CI = 2.08-5.71) and possible depression (ORaj = 1.60; 95% CI = 1.05-2.43). The results demonstrate that there is a need to build public policies that focus on the education of adolescents and family members and on protection with a focus on the most susceptible. Internet addiction is associated with younger teenagers, who spent four or more hours a day browsing and those who used the Internet every day of the week, as well as those who use Twitter, and the subjective reasons for use (leisure and socialization). In addition, there was an association with symptoms of anxiety, depression and low self-esteem, as well as with the use of psychoactive substances
Organizações sociais de saúde como forma de privatização do Sistema Único de Saúde
(Universidade Federal do Espírito Santo, 2020-10-30) Turino, Fabiana; Siqueira, Carlos Eduardo Gomes; https://orcid.org/0000-0001-8993-3031; http://lattes.cnpq.br/5416960178072112; Sodré, Francis; https://orcid.org/0000-0003-4037-9388; http://lattes.cnpq.br/7744765390568573; https://orcid.org/0000-0002-5291-1346; http://lattes.cnpq.br/6476006704270634; Filippon, Jonathan Gonçalves ; https://orcid.org/0000-0003-3907-1992; http://lattes.cnpq.br/1655529281503303; Andrade, Maria Angélica Carvalho; https://orcid.org/0000-0002-3690-6416; http://lattes.cnpq.br/5427520110626795; Oliveira, Adauto Emmerich; https://orcid.org/0000-0002-9679-8592; http://lattes.cnpq.br/1534956621971641; Bahia, Ligia; https://orcid.org/0000-0001-8730-2244; http://lattes.cnpq.br/1810292003452931
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. The main objective was to investigate how the transfer of public resources to private non-profit entities creates new characteristics for the Brazilian public health system. To achieve this goal, management contracts and additive terms of the agreements signed between the OSS and the health departments of the states of Rio de Janeiro and São Paulo, as well as with their capitals, between 1998 and 2018 were analyzed. The results of this investigation are arranged in the thesis in four articles. The first was a theoretical analysis and a systematic review that pointed to New Public Management as a central argument for administrative reforms that resulted in actions to reduce bureaucracy and make public management more flexible. In the second article, the use of the management contract as a legal instrument to enable the SUS privatization process was analyzed. The third article, on the other hand, confirmed that the use of additive terms from management contracts results in the instrumentalization of the privatization process. Finally, the fourth article presented the double certification of non-profit organizations as a problem, as they add entitlements - OSS and philanthropy - that enable tax advantages. This evidence supports the conclusion that the transfer of the management of public health services to OSS is a process of functional and fluctuating privatization
Acesso à saúde da mulher na atenção primária: marcadores e interseccionalidades
(Universidade Federal do Espírito Santo, 2021-05-17) Barbosa, Bruna Ligia Ferreira de Almeida; Lima, Rita de Cássia Duarte; https://orcid.org/0000-0002-5931-398X; http://lattes.cnpq.br/2384472795664270; https://orcid.org/000000020085049X; http://lattes.cnpq.br/7266254969244866; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; Dias, Jerusa Araújo; https://orcid.org/0000-0002-0490-2488; http://lattes.cnpq.br/4947139217720033; Leite, Franciele Marabotti Costa; https://orcid.org/0000000261716972; http://lattes.cnpq.br/7170760158919766; Lima, Eliane de Fatima Almeida; https://orcid.org/0000-0001-5128-3715; http://lattes.cnpq.br/4640538188376728; Dawson, Angela; https://orcid.org/0000-0003-0926-2202
Introduction: The reality about the health problems that women have been experiencing in Brazil, evidences the denial of comprehensiveness, insofar as it requires embracement, sensitive listening, access, continuity, and resolution. The existence of social markers, whether of race, economic, social, and educational status, places women in a situation of vulnerability, reflecting on access to Primary Health Care services. In this perspective, considering that women are the majority among the Primary Health Care users, their experiences must be contextualized, respecting the singularities and recognizing their conditions of vulnerability, in order to alleviate the inequalities that interfere in the access and use of health services. Objective: Analyse the access to and utilization of services aimed to women’s health into the Primary Health Care system in the state of Espírito Santo. Methodology: Descriptive study, with a qualitative approach, carried out in women users of Primary Health Care, from October 2020 to January 2021, in five municipalities that represent the health regions of Espírito Santo, plus the capital Vitória. A questionnaire with sociodemographic information of the users and a script guided by the theoretical framework of access and use of health services by McIntyre and Mooney (2007) was used. For data analysis, the Thematic Analysis technique by Bardin (2011) was used, which consists of three stages: data pre-analysis, resource exploration, and data interpretation. Results: Barriers were identified with regard to availability, acceptability and ability to pay for access to services offered in Primary Health Care. These barries are present mainly in relation to referral to specialized services, reception, health promotion actions and diagnostic tests. In addition, the different levels of information between the service teams and the users, were related to a greater or lesser extent to the access and use of health services, especially regarding mammography. Final considerations: There are factors that interfere with access to primary care services, reflecting the inequalities among women. The race/color, gender and social class cuts reflect and reveal the structural/institutional racism that shapes our society, highlighting the inequalities faced by women when accessing, among others, health services.Propositional strategies for reorganizing women's health policies are necessary in order to overcome barriers and enable greater access and use of women to primary care services.
Qualidade de vida e felicidade relacionadas a saúde bucal em adolescentes
(Universidade Federal do Espírito Santo, 2021-08-13) Calmon, Marcela Vieira; Miotto, Maria Helena Monteiro de Barros; https://orcid.org/0000-0002-3227-7608; http://lattes.cnpq.br/4289442514763843; https://orcid.org/0000-0001-5936-7534; http://lattes.cnpq.br/8715667294079962; Salaroli, Luciane Bresciani; https://orcid.org/0000000218810306; http://lattes.cnpq.br/3503255904138561; Laignier, Daniela Feu Rosa Kroeff de Souza; https://orcid.org/0000-0003-1734-4793; http://lattes.cnpq.br/6358913651043240; Almeida, Ana Paula Santana Coelho; https://orcid.org/0000-0001-5808-5818; http://lattes.cnpq.br/2570855705420190; Barcellos, Ludmilla Awad; https://orcid.org/0000-0003-3732-9515; http://lattes.cnpq.br/7262427405068645
Introduction: Adolescence for Dentistry represents a period considered at risk in relation to oral health problems due to a greater risk for numerous oral problems, due to the limited control of dental biofilm and the reduction in oral hygiene care. Objective: To assess the impact of oral disorders on quality of life; the relationship between oral health and happiness; and the associations between quality of life and happiness and sociodemographic variables, oral clinics and use of dental services in adolescents. Methods: The sample consisted of 387 adolescents from 05 public schools in urban and rural areas. Four structured scripts were applied and visual tactile clinical examination was performed. Quality of life associated with oral health was verified by the OHIP-14. Happiness has been verified by SHS. The association between the variables was verified by statistical tests: Test T; Chi-Square Test; Fischer's exact test; Mantel-Haenzsel Test; Cross Products Ratio Test (OR). Logistic regression models were adjusted for each dimension of the OHIP and t-test for the association between quality of life related to oral health and happiness. Results: The frequency of impact of oral condition on quality of life was 26.4%. Living in rural areas was associated with a lower impact of oral health on quality of life (p=0,017). Caries and tooth loss were statistically significant, however, when logistic regression was performed, the greatest prediction of the impact of oral health on adolescents' lives was associated with sex [OR 1,760 (1,078-2,875)], halitosis [OR 2,383 (1,405-4,041)] and crowding [OR 2,072 (1,262-3,401)]. An average of 4.84 happiness was found among adolescents. Being male (p=0,011), being between 17 and 19 years old (p=0,019), living and studying in the rural area (p=0,000) were associated with better levels of happiness. Furthermore, a positive relationship was found between happiness and quality of life related to oral health in adolescents (p=0,001). Final considerations: These results are important to redirect oral health care to this specific group. Based on the impact of oral conditions on adolescents, health promotion efforts should be at the center of public health policies for this population, as oral health problems are mostly cumulative and will worsen over time.
Uso de recursos em saúde e custos em pacientes com artrite reumatoide em tratamento com terapia biológica no SUS
(Universidade Federal do Espírito Santo, 2021-08-31) Buffon, Poliane Barbosa Sampaio; Valim, Valéria; https://orcid.org/0000-0002-0625-1308; http://lattes.cnpq.br/3210373469770019; https://orcid.org/0000-0001-7681-296X; http://lattes.cnpq.br/5161812604975395; Mill, José Geraldo; https://orcid.org/000000020987368X; http://lattes.cnpq.br/2497419234600362; Abreu, Mirhelen Mendes de; https://orcid.org/0000-0002-2264-0442; http://lattes.cnpq.br/7242246597159087; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Zandonade, Eliana; https://orcid.org/0000-0001-5160-3280; http://lattes.cnpq.br/0983533134908583; Cade, Nagela Valadão; https://orcid.org/000000016073504X; http://lattes.cnpq.br/9239824143586213
Introduction: This research was motivated by the need to analyze the trajectory of patients facing the introduction of new effective therapies for the treatment of Rheumatoid Arthritis (RA). Treatment with conventional synthetic disease-modifying drugs (csDMARD) and biological DMARD (bDMARD) for RA are provided by the Unified Health System (SUS). Available biological medicines are said to be expensive. Assessing the economic costs associated with AR is an action of great importance for decision making. The thesis was divided into three parts, the first part being a pharmacoepidemiological analysis, through secondary data, with a temporal trend, the profile of patients diagnosed with RA undergoing treatment with biological therapy treated at the Citizens' Pharmacies in Espírito Santo; the second part presents the results of a qualitative study that shows the paths taken through an individual experience of patients diagnosed with RA undergoing treatment with biological therapy and; the third part covers an analysis that portrays the use of resources and the valuation of these resources by patients diagnosed with RA from the perspective of the SUS. Objective: To assess the epidemiological characteristics of the use of health resources and costs under the broad perspective of the SUS by mapping the trajectory of all patients with rheumatoid arthritis treated with biological therapies in the state of Espírito Santo. Methodology: Retrospective cohort of secondary data in historical series, in order to analyze the profile, time series and estimate the use of health resources and costs by mapping the trajectory of all RA patients treated with biological therapies in ten public pharmacies, called Citizen Pharmacies, distributed in the municipalities of the state of Espírito Santo, served between 2009 and 2017. The record linkage technique was adopted in the joint use of the database of citizen pharmacies in ES between the Outpatient Production Bulletin (BPAB) and the System of Hospital Information (SIH) and High Complexity Procedure Authorization (APAC). A sensitivity analysis was carried out on the PMVG and PF prices of each drug used for RA provided by the SUS, through the change of key variables within the model, in order to understand different scenarios of expenses and trading values. A study with a qualitative approach was also carried out, carried out with ten subjects with RA using biological therapy, registered in a Citizen's Pharmacy. The material was produced through an open interview, in which, after transcription, the data were analyzed using the Content Analysis technique, in the Thematic Analysis modality. Two categories suggest, namely, Limits of Therapeutic Itineraries – which measure financial expenses, absence from work and the trajectory of treatment diagnosis; and Potentialities of Therapeutic Itineraries – knowledge about the treatment itself and access to SUS. Results: There were 9,804 requests for treatment with biological therapies, with dispensing concentrated in Citizen Pharmacies in the Metropolitan Region of the state (69%); with a predominance of women (84%), and mean age of 56 years; the drug with the highest prevalence was Adalimumab (40%), followed by Infliximab (21%), with a total expense of R$ 6,335,100.71. Of the 902 patients treated with RA using DMARDb, 783 were identified, after record linkage between 2009 and 2017. After the integration of the 3 databases BPAB, SIH and APAC, it was possible to match 386 (42.8%) patients. Of these, 83.9% were women, aged 56 12.2 years. During the period, 1147 outpatient and inpatient procedures were performed, 77.41% outpatients and 22.59% inpatients. When evaluating the average costs of these procedures (BPABR$96,556.08; SIH-R$765,644.00), it is observed that despite the SHI having a significantly lower number of procedures, its cost represents 88.80% of the resources used. The average cost per patient per year, with medicines (DMCDb + DMARDcs), considering the maximum, average and minimum scenarios was R$ 3,548,775.00, R$ 2,753,441.00 and R$ 2,090,033.00. The sum of all the average costs of all procedures was R$862,200.22 during the study period. Considering the estimated average scenario value for drugs, this means that biological therapy costs represent 94.27% of drug costs and 91.4% of all costs. In the study of therapeutic itineraries, family income was a significant issue of experiences, marking life stories, and told in their narratives; weaknesses in the early diagnosis were noticed, but the experiences lived during the process for the correct diagnosis and treatment provided the patients with an acquisition of knowledge about their disease. Conclusion: The linkage of SUS banks enabled the (re)construction of the trajectory of patients with RA on a large scale and the estimation of the use of resources and costs with the treatment of RA in Brazil. Spending on biological therapy is progressive and represents 91.4% of all costs. In the itinerary taken by the participants of this research, the delay in the diagnosis is noticeable and, with it, the worsening of the signs/or symptoms of the disease. None of the participants were diagnosed in less than a year of presenting the characteristics of the disease, regardless of being a total SUS patient or having a private health plan, and the difficulties in the itinerary were the same, that is, late diagnosis and impact on family income.
Avaliação dos custos totais das famílias de pessoas com tuberculose por níveis de atenção à saúde no Brasil, 2019 - 2021
(Universidade Federal do Espírito Santo, 2021-10-18) Negri, Letícya dos Santos Almeida; Maciel, Ethel Leonor Noia; https://orcid.org/0000000348263355; http://lattes.cnpq.br/3761398932271892; https://orcid.org/0000-0002-0056-4506; http://lattes.cnpq.br/1856133153859244; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; Kritski, Afranio Lineu; https://orcid.org/0000-0002-5900-6007; http://lattes.cnpq.br/0008770194107817; Silva, Adriana Ilha da; https://orcid.org/0000-0001-8698-5768; http://lattes.cnpq.br/4088542085942883; Vieira, Anne Caroline Barbosa Cerqueira; https://orcid.org/0000-0003-2464-6423; http://lattes.cnpq.br/4055120283760991
Introduction: Tuberculosis is a serious public health problem and, associated with tuberculosis care, are the extra costs that patients and families incur, which can lead to economic hardship, impact on life and the outcome of the disease. Objective: To evaluate the total costs for families of people with tuberculosis in Brazil by level of health care, in the period from 2019 to 2021, to identify the impoverishment resulting from the diagnosis and treatment of tuberculosis. Method: Cross-sectional research, period from September 2019 to March 2021, in 35 municipalities in Brazil, with people diagnosed with tuberculosis. The instrument adapted for Brazil was used, following the World Health Organization protocol, version 2017. For continuous data, median, mean, and 95% confidence interval were used. For categorical data, absolute and relative frequencies were calculated. Multivariate logistic regression was used to determine associated factors. Statistical significance was defined with a p value < 0.05, and statistical analyses and data visualizations were performed using the statistical program R Studio, version14. McNemar's and Pearson's chi-square tests were used to assess the level of significance of the impoverishment variable before and after TB diagnosis and associations. All cost data were reported in international dollars, with a mean 2020 exchange rate change value of 5.16 Brazilian reals. Results: In Brazil, the costs faced by patients are high. Total medical costs were $1,553.00, of which $42 and $85 respectively in the pre-diagnosis and post-diagnosis of tuberculosis. The total cost is equivalent to 7.8 minimum wages on average and the average lost work time was 64.4 hours. The biggest drivers were food supplementation and travel for appointments. Most patients on TB treatment became impoverished after TB diagnosis. Conclusion: Although the service offered to tuberculosis patients in Brazil is free and provided by the public health system, patients incurred high costs, some factors are associated such as low education and not receiving benefits. Receiving emergency aid for Sars-CoV-2 during treatment was a protective factor for patients who impoverished. Identifying these barriers to costs incurred helps to assist in fostering a national policy to reduce costs for TB patients. Since most of the costs are indirect, it is about the effectiveness of the national police of food security, social assistance and employment and income, which already exist, but their action has been limited and insufficient in the face of the framework of social inequalities, poverty and priorities of the public agenda.
Desenvolvimento de software para avaliação de indicadores da saúde da mulher: um processo colaborativo
(Universidade Federal do Espírito Santo, 2021-12-14) Cruz, Sheila Cristina de Souza; Lima, Eliane de Fatima Almeida; https://orcid.org/0000-0001-5128-3715; http://lattes.cnpq.br/4640538188376728; https://orcid.org/0000-0002-5499-4405; http://lattes.cnpq.br/3066235380099390; Figueiredo, Karla Crozeta; https://orcid.org/0000-0003-3544-5643; http://lattes.cnpq.br/3066235380099390; Primo, Candida Canicali; https://orcid.org/0000000151412898; http://lattes.cnpq.br/4739920753105018; Anna, Hugo Cristo Sant; https://orcid.org/0000000348906728; http://lattes.cnpq.br/5657051115739955
Introduction: Information and Communication Technologies in Health contribute to the management of indicators, enabling the collection, storage, retrieval, and critical analysis of data. This study takes a look at the municipal management system and its functionalities, and the information generated by Primary Health Care, supporting the monitoring of actions through the improvement of the Rede Bem Estar Management System. Objectives: To describe the participatory process of developing software for the evaluation of women's health indicators of the Rede Bem Estar Informatized Management System, as well as to highlight the indicators related to women's health and create dashboards for monitoring. Methodology: This is action research, carried out in twelve phases to develop a managerial technology. The study was carried out in Vitória-ES through eleven seminars. LILACS, MEDLINE, and integrated search (IAHx) databases were used in the Virtual Health Library portal to collect theoretical references. Data production took place from April 27 to December 31, 2020. The participants were a multidisciplinary team with 13 technical experts from the strategic areas of the Health Secretariat and information technology. Data analysis relied on the IRAMUTEQ® software for statistical analysis of the text corpus. Results: This research resulted in the development of software for evaluation and monitoring of women's health care, the creation of the concept map of the women's health management system, as well as the approximation between the areas of public health and information technology, favoring the agreement and description of indicators for the creation of dashboards. The implementation of technological tools built into the local computerized system provides greater interactivity, customizable interface, and improvement in the management of health information produced by primary care teams. Products: Managerial technology in software format for management of indicators; creation of Business Intelligence dashboard tool for visualization of metrics and indicators; organization of digital reports and system functionalities; protocol for mapping indicators and tutorial for the system. Conclusion: Research on information and communication technology in healthcare is a trend. With this, this research aimed to expand initiatives aimed at informatization in health, strengthening e-Health, to adopt technologies in Primary Care to enable teams and managers the monitoring of women's health indicators with the use of software, enabling the optimization of public resources and integration of technological tools for clinical and management decision making.
Análise da mortalidade por Covid-19 no Estado do Espírito Santo
(Universidade Federal do Espírito Santo, 2022-03-25) Dell'Antonio, Larissa Soares ; Leite, Franciele Marabotti Costa; https://orcid.org/0000000261716972; http://lattes.cnpq.br/7170760158919766; Lima, Rita de Cassia Duarte; http://lattes.cnpq.br/2384472795664270; Prado, Thiago Nascimento do; https://orcid.org/0000000181326288; http://lattes.cnpq.br/6388559394015871; Lopes Junior, Luís Carlos; http://lattes.cnpq.br/5919501773501977; Rodrigues, Rodrigo Ribeiro; https://orcid.org/000000020675110X; http://lattes.cnpq.br/3822046497362615; Souza, Camila Brandão de
Introduction: Covid-19 is a disease caused by the SARS-CoV-2 coronavirus that has been impacted the entire world. In addition, this pandemic has become the biggest one in the last hundred years and causing more than 429 million cases and approximately 6 million deaths worldwide. Objective: To analyze the management of the pandemic and the mortality by the Covid-19 in the Espírito Santo state, from 2020 up to 2021, as well as to evaluate the quality of information on deaths in this state. Methodology: A hybrid study was undertaken. Initially two descriptive studies were carried out in order to report the experience of Epidemiological Surveillance facing to the pandemic in Espírito Santo state and the second one aimed to assess the quality of information on deaths by Covid-19 in the Espírito Santo state. The third study was observational, using secondary mortality data from Covid-19 that took place in the Espírito Santo state between April 1, 2020 and August 31, 2021. The data from the third study were stratified by the three waves of the pandemic. The study population consisted of all records with the outcome “death by Covid-19” retrieved from the e-SUS VS database. We have used the IBM SPSS Statistics version 24 and STATA version 15.1 (StataCorp, College Station, TX, USA) for data analysis. The Kolmogorov & Smirnov test was used to assess the probability of distribution and data normality. Pearson's chi-square test was used to verify the relationship between sócio clinical variables and waves of death incidence, otherwise Fisher's Exact test was used when that one did not have its assumptions met. The Friedman test was used for comparing the time between diagnosis and death between waves, and simple quantile regression was employed in order to verify the putative relationships between the time of diagnosis and death in each wave of death incidence. Multiple multinomial regression with the forward variable selection method was used to associate the public employment with socio-clinical variables. For all analysis, the alpha level of significance was set in 5%. The study was approved by the Institutional Review Board (reference: No. 4,166,025 in July 21, 2020). Results: The experience of coping with the pandemic in the Espírito Santo state have shown the potential of the state management can achieve by promoting the articulation of different government entities for a common objective, that is, to mitigate the pandemic across the state. Regarding the quality of information on deaths, the variables of “case identification” and “condition variables” were classified with excellent completeness. Among the evolution variables, only “hospitalization” was classified as regular. For laboratory variables, only “PCR” has showed excellent completeness, while the variables “rapid test” and “serologies for IgG and IgM” were classified with good completeness. The mean time between diagnosis and death was 18.5 days: 20.5 days and 21.4 days respectively in the first, second and third pandemic wave. In the first wave, the deaths that took place into public hospitals, were associated with the following variables: immunodeficiency; obesity; neoplasm and origin place. In the second wave, the deaths were associated with education; O2 saturation < 95%; chronic neurological disease, as well as origin place. While in the third wave, deaths were associated with race/color; schooling, respiratory difficulty; nasal or conjunctival congestion; irritability/confusion; adynamia/weakness; chronic cardiovascular disease; neoplasms, and diabetes mellitus; individuals from the Metropolitan Region, and from the Central/North Region of the state. The origin place was associated with the outcome in the three waves of the pandemic, likewise the vabiable schooling in the second and third waves (p<0.05). Conclusion: We observed that during the pandemic the resilience of the Unified Health System was tested in different ways and that the articulation of different actors was necessary for a positive intervention facinf this difficult scenario. Additionally, the excellent quality of the data from the state as well as the validity of the study were confirmed. Deaths that occurred in public hospitals were associated with socio-clinical characteristics. The analysis of deaths by Covid-19 is extremely relevant to support management and stakeholders in the planning of the Health Care Network.

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