Doutorado em Saúde Coletiva

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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
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.
ACESSO À LINHA DE CUIDADOS, CAPITAL SOCIAL E MULTIMORBIDADE COMPLEXA: Um estudo com usuários de serviços de hemodiálise em região metropolitana de uma capital no sudeste brasileiro
(Universidade Federal do Espírito Santo, 2022-12-02) Soares, Ana Cristina de Oliveira; Salaroli, Luciane Bresciani; https://orcid.org/0000000218810306; http://lattes.cnpq.br/3503255904138561; https://orcid.org/; http://lattes.cnpq.br/; Franca, Ana Karina Teixeira da Cunha; https://orcid.org/0000-0002-4460-2631; http://lattes.cnpq.br/8389486900285691; Esposti, Carolina Dutra Degli; https://orcid.org/0000000181027771; http://lattes.cnpq.br/7465412734380334; Neto, Edson Theodoro dos Santos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; Bezerra, Olivia Maria de Paula Alves; https://orcid.org/0000-0002-5596-657X; http://lattes.cnpq.br/2106229540277568
Introduction: End-stage renal disease is a public health problem, demanding highcomplexity care such as hemodialysis, however, few studies assess access, social capital and complex multimorbidity of users of hemodialysis services. Objectives: To analyze factors associated with access to hemodialysis services, social capital and complex multimorbidity among individuals undergoing hemodialysis treatment in the Greater Vitória Metropolitan Region - RMGV. Method: Analytical cross-sectional epidemiological census with 1024 individuals. Data collection took place from February to September 2019. For access, dimensions were analyzed: accessibility, availability and acceptability. Social capital was categorized into: cognitive, structuring and underlying with data collected using the Integrated Questionnaire to Measure Social Capital. Complex multimorbidity was characterized by the occurrence of three or more chronic diseases affecting three or more organ systems. Data were analyzed by descriptive statistics and multinomial (access and social capital) and binary (complex multimorbidity) logistic regression. Results: Mean age was 54.7+0.59 years, predominant age group between 30 and 59 years (n=528, 51.6%). Most men (n=581, 56.7%), up to 8 years of schooling (n=523, 51.1%), self-declared brown/black (n=737, 72%), income less than or equal to two minimum wages (n=555, 56.2%), retired or away from work, receiving social benefits (n =547, 54.2%) and residing in the same city where hemodialysis was performed (n =642, 62.8%). 25.1% (n=209) were at the highest level of access and the factors that increased the chances of the lowest level of access were: age group between 30 and 59 years (OR 2.16, 95% CI 1.377 –3.383), women (OR 1.74, 95% CI 1.11–2.72) and income less than or equal to two minimum wages (OR 1.80, 95% CI 1.17–2.76). Mean ESF coverage factors (OR 0.54, 95% CI 0.29–0.99), no previous conservative treatment (OR 0.59, 95% CI 0.38–0.91), lack of paid work ( OR 0.35, 95% CI 0.15–0.85), retirement/sick leave (OR 0.27, 95% CI 0.12– 0.64) and poor or very poor self-rated health (OR 0, 62, 95% CI 0.40–0.96) reduced the odds of the lowest access. For social capital, low income was associated with greater chances of lower total social capital (OR 1.62; 95%CI 1.03–2.54) and cognitive (OR 1.71; 95%CI 1.14–2.56) ), while a low level of access was associated with greater chances of lower social capital in all dimensions: total (OR 2.30, 95%CI 1.32–4.01), cognitive (OR 1.78; 95%CI 1 .04-3.04), structuring (OR 1.86; 95%CI 1.08-3.21) and underlying (OR 2.17; 95%CI 1.25-3.76). 81% (n=815) had complex multimorbidity. Low General Mortality Index in the municipality (OR 0.395; 95%CI 0.179–0.870), age between 19 and 29 years (OR 0.402; 95%CI 0.196-0.825), more than eight years of schooling (OR 0.536; 95%CI 0.29– 0.966) and positive self-rated health (OR 0.446; 95%CI 0.301–0.661) reduced the chances of Complex Multimorbidity. Hemodialysis for less than two years increased the chance of Complex Multimorbidity (OR 1.779; 95%CI 1.057- 2.997). Conclusion: Contextual, individual characteristics and health behaviors influence access to services, social capital and complex multimorbidity among hemodialysis users in the RMGV. Keywords: Access to health services; share capital; complex multimorbidity; hemodialysis.
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.
ADOLESCENTES QUE VIVEM COM HIV/AIDS NO ESTADO DO ESPÍRITO SANTO: CARACTERÍSTICAS EPIDEMIOLÓGICAS E REPRESENTAÇÕES SOCIAIS
(Universidade Federal do Espírito Santo, 2022-10-18) Fialho, Camila Bruno; Miranda, Angelica Espinosa Barbosa; https://orcid.org/0000-0002-5556-8379; http://lattes.cnpq.br/5842271060162462; https://orcid.org/0000-0002-8857-3342; http://lattes.cnpq.br/4720944482078483; Esposti, Carolina Dutra Degli; https://orcid.org/0000000181027771; http://lattes.cnpq.br/7465412734380334; Bonomo, Mariana; https://orcid.org/0000-0002-3919-3976; http://lattes.cnpq.br/4087691008379051; Neto, Edson Theodoro dos Santos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; Queiroz, Maria Alix Leite Araujo; https://orcid.org/0000-0002-4156-5783; http://lattes.cnpq.br/6300811398792069; Ferreira, Ana Cristina Garcia; http://lattes.cnpq.br/7126831545165079
In recent years, there has been an increase in cases of Human Immunodeficiency Virus (HIV) infection among adolescents and young people. Thus, it is essential to know this population to scientifically support health actions and policies. Objectives: To identify the epidemiological characteristics and social representations of aids among adolescents living with HIV/aids in the state of Espírito Santo. Methodology: Quantitative-qualitative study. 1) Quantitative part. Ecological study, in which HIV/AIDS notifications were analyzed among adolescents, aged 13 to 19 years, who lived in the state of Espírito Santo, between 2010 and 2020. 2) Qualitative part. Interviews of those adolescents, infected via vertical transmission, who were treated at the state's referral hospital. Content Analysis and Descending Hierarchical Classification were used to analyze qualitative data, and Descriptive and Spatial Analysis were used to process quantitative data. Results and discussion: We found 523 adolescents living with HIV/AIDS in the analyzed period (average of 47 cases/year). A higher frequency of HIV/AIDS cases was observed in male adolescents, over 16 years old, of mixed race/color, who attended high school and lived in the metropolitan region, close to the capital. The most frequent route of infection was sexual, in homosexual relationships. The HIV viral load was detectable in almost all cases and 11 (6,8%) of these adolescents died. Among the adolescents currently undergoing treatment, 13 were interviewed, aged between 13 and 17 years old, of both sexes. In this group, 8 adolescents had a detectable viral load. The analysis of the narratives showed that although Antiretroviral Therapy (ART) does not have a great impact on the adolescents' routine (since they have been undergoing treatment since childhood, already adapted to the routine of consultations/exams/medication), non- adherence practices were mentioned. These adolescents face the difficulty of dealing with the death of their parents and revealing to their friends and boyfriend that they are living with HIV, reducing their social support network. The social representations of AIDS, therefore, for this group, are more associated with the psychosocial context than with biomedical issues. Conclusion: The high frequency of detectable viral load signals serious public health problems, such as late diagnosis and lack of adherence to ART. Adherence, among adolescents living with HIV since birth, appeared intrinsically linked to social representations, as the adolescents interviewed live in a sociocultural context where common sense continues to share representations with negative elements about AIDS, a fact that restricts the network of support, so important for treatment adherence.
Agregação de fatores de risco para diabetes mellitus gestacional e a macrossomia fetal em participantes do Projeto Viver
(Universidade Federal do Espírito Santo, 2023-07-27) Oliveira, Gabriela; Oliveira, Elizabete Regina Araujo de; http://lattes.cnpq.br/4671078095444887; https://orcid.org/0000-0002-2403-5094; http://lattes.cnpq.br/5786768878261180; Calmon, Marcela Vieira; Almeida, Marcia Valeria de Souza; http://lattes.cnpq.br/9372951429429767; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; Pereira, Taisa Sabrina Silva
The existence of risk factors, modifiable or not, in the lives of pregnant women favors the development of diseases and the presence of more than one risk factor tends to potentiate its effects. This study aimed to analyze the aggregation of risk factors for the development of gestational diabetes mellitus and fetal macrosomia in the participants of Projeto Viver. This is an observational, cross-sectional study, conducted from data collected by Projeto Viver, which was a multicenter, longitudinal and state study with puerperal women and their newborns selected from three maternity hospitals located in the Metropolitan region and North of Espírito Santo. Data collection was carried out between August 2019 and March 2020. First, the need to carry out a systematic review was identified to understand more about the population of interest. The sample for article 2 consisted of 2,488 women who had filled in information about the variables of interest for each study and aimed to analyze the aggregation of risk factors (advanced maternal age, family history of diabetes mellitus, overweight and multiparity). for gestational diabetes mellitus. The prevalence of risk factors, their confidence intervals and distributions according to sociodemographic aspects were calculated, such as: race (white or non-white), years of education (≤8 years or >8 years), currently working (Yes or No) , hospital assistance (Philanthropic ME, Philanthropic NO and Private) and index of goods according to the classification of the Brazilian Association of Population Studies (ABEP) (A and B; C; D and E). Aggregation was evaluated based on the ratio of the prevalence of observed factors to the expected prevalence. The aggregation of the four analyzed factors was verified (O/E=2). In the aggregation of the three risk factors, the most frequent was a family history of diabetes, advanced maternal age and multiparity (O/E=2.8). In the third article, in addition to the aggregation analysis, the Odds Ratio of prevalence was also calculated (ORP) to identify the aggregation of two factors, regardless of the exposure of the other two factors, and aimed to analyze the aggregation of risk factors (gestational diabetes, advanced maternal age, overweight and multiparity) for fetal macrosomia. The sample consisted of 2,488 women and the aggregation of the four risk factors (O/E=3.9) was identified. As for the Odds Ratio of prevalence, there was a greater association between gestational diabetes and advanced maternal age (ORP = 2.76), especially in those who do not work. Although the synergistic effect of risk factors is already known, few studies have explored these relationships, especially in this population. Strategies focused on the health and lifestyle pattern of the female population can contribute to controlling the incidence of gestational diabetes and fetal macrosomia. Understanding the real situation of puerperal women regarding the aggregation of risk factors is an important step to encourage prevention actions and strategies.
Análise da completude do tratamento preventivo da tuberculose no Brasil
(Universidade Federal do Espírito Santo, 2023-08-18) Cola, João Paulo; Maciel, Ethel Leonor Noia; https://orcid.org/0000000348263355; http://lattes.cnpq.br/3761398932271892; https://orcid.org/0000-0003-4972-4686; http://lattes.cnpq.br/4129413362195000; Carlesso, Geisa Fregona; https://orcid.org/0000-0001-5835-8222; http://lattes.cnpq.br/6009637045326708; Leite, Franciele Marabotti Costa; https://orcid.org/0000000261716972; http://lattes.cnpq.br/7170760158919766; Arcêncio, Ricardo Alexandre; https://orcid.org/0000-0003-4792-8714; http://lattes.cnpq.br/9149546439669346; Tavares, Noemia Urruth Leao
The completeness of the preventive treatment for tuberculosis (PTT) is still a challenge to be faced, due to the social, economic and clinical factors of the affected population and the long therapeutic regimens or those with high doses of medication. It was intended to discuss in this thesis the challenges involved in completing the TPT and to bring new opportunities to the TPT in Brazil with the incorporation of Isoniazid in the 300mg presentation. Objective: To analyze the preventive treatment of tuberculosis in Brazil. Methods: To carry out this study, 2 execution stages were adopted. The first step was a retrospective cohort study based on secondary TPT data reported to the Brazilian IL-TB information system. Individuals who started TPT between January 2018 and December 2020 were included. The outcome was non-completion of the TPT. A robust variance Poisson regression model was used to estimate the relative risk of non-completion of the TPT. The second stage is a pragmatic, randomized, non-blinded clinical trial to determine the completeness of the TPT with the drug Isoniazid in the presentation of a 300mg tablet. The study intervention was the treatment of ITB with Isoniazid 300mg. The primary outcome was TPT completeness. A robust variance Poisson regression model was used to estimate the relative risk of TPT completion with Isoniazid 300mg. Results: Of the 39,973 TPT reported during the study period, 8,534 (21.5%) did not complete the TPT. Age 15–60 years (RR 1.27, 95% CI 1.20–1.35), TPT with isoniazid (RR 1.40, 95% CI 1.19–1.64), and black race/skin color (RR 1.17, 95% CI 1.09–1.25) were associated with a higher risk of non-completion of the TPT. The risk of completing the TPT was 31 times greater in the group that used the INH 300mg treatment (RR 1.31, 95% CI 1.01 to 1.70). The mean effect of TPT with INH 300mg, based on propensity score weighting, describes that TPT with INH 300mg improved 16% (Coefficient 0.16, 95%CI 0.01 to 0.30) treatment completion rate. Conclusion: Individuals of black race/skin color, younger and on a longer TPT regimen, were more likely to be associated with non-completion of the TPT. The therapeutic regimen with isoniazid 300mg presented greater TPT completeness. This study supports theoretical and operational strategies that respond to the demand for the incorporation of a new drug formulation for the treatment of ITB in the Unified Health System network.
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; https://orcid.org/; http://lattes.cnpq.br/; Lima, Rita de Cassia Duarte; https://orcid.org/; http://lattes.cnpq.br/2384472795664270; Prado, Thiago Nascimento do; https://orcid.org/0000000181326288; http://lattes.cnpq.br/6388559394015871; Junior, Luis Carlos Lopes; https://orcid.org/; http://lattes.cnpq.br/5919501773501977; Rodrigues, Rodrigo Ribeiro; https://orcid.org/000000020675110X; http://lattes.cnpq.br/3822046497362615; Souza, Camila Brandao de
abstract
Análise das hospitalizações por Covid-19 no Estado do Espírito Santo
(Universidade Federal do Espírito Santo, 2023-08-17) Garbin, Juliana Rodrigues Tovar; Leite, Franciele Marabotti Costa; https://orcid.org/0000000261716972; http://lattes.cnpq.br/7170760158919766; https://orcid.org/0000-0002-8184-7822; http://lattes.cnpq.br/2189705200630988; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Portugal, Flavia Batista; https://orcid.org/0000000244252627; http://lattes.cnpq.br/1876697154549534; Ferreira, Glenda Roberta Oliveira Naiff; Santos, Carolina Rocio Oliveira
Introduction: For about three years, the world experienced the pandemic of a disease caused by the new coronavirus (SARS-CoV-2): COVID-19, which has become one of the greatest health challenges on a global scale in this century. Aim: To analyze hospitalizations due to COVID-19 in the State of Espírito Santo from 2020 to 2021. Methodology: for the three articles, we chose to use the analytical, retrospective type of study. In article 1, survival analysis was used, where the dependent variable of interest was the time elapsed from the first day of hospitalization until the onset of death from COVID-19. The second article analyzed the mean length of hospitalization for COVID-19 in different waves and the third analyzed the risk factors associated with long-term hospitalization in patients with COVID-19. The analysis began by organizing the databases in the Microsoft Excel version 10 program, and later IBM SPSS Statistics version 24 and STATA version 14 were used. For article 1, multiple logistic regression was performed with the selection method of forward variables, Log-rank test and Cox regression. In article 2, to analyze the distribution of hospitalizations according to waves, the non-parametric Kruskal-Wallis test was used. In article 3, bivariate analyzes were performed using the chi-square test for heterogeneity. Subsequently, the crude and adjusted Odds / Odds Ratio (RO/OR) and their respective 95% confidence intervals were calculated using the logistic regression model. The alpha level of significance used in all analyzes was 5%. The present study was submitted for approval by the Secretary of State for Health of Espírito Santo and the research ethics committee, through the brasil platform under the consubstantiated opinion number 5.180.941 of December 20, 2021. Results: In article 1, the mean age of the group was 58 years (SD ± 18.3) and the mean length of hospital stay was 10.5 days (SD ± 11.8).p < 0.001, age group of 60 to 79 years (HR: 1.62; p < 0.001) and 80 years or older (HR = 2.56; p < 0.001), presence of chronic cardiovascular disease (HR = 1.18; p = 0.028), chronic chronic kidney disease (HR = 1.5; p = 0.004), smoking (HR = 1.41; p < 0.001), obesity (HR = 2.28; p < 0.001), neoplasms (HR = 1.81; p < 0.001) and chronic neurological disease (HR = 1.68; p< 0.001). In article 2, the average length of stay in the hospital was associated with the following characteristics of the patients: age groups up to 59 years old and from 60 to 79 years old, high school and higher education, white and non-white race, female and male gender and resident from the urban area (p<0.05). With regard to the presence of comorbidities, there was a statistically significant difference for the mean days of hospitalization among patients with chronic cardiovascular disease, diabetes mellitus and obesity (p<0.05). In article 03, regarding the associated factors, in the first wave, the chance of having a long hospitalization was greater in elderly patients (OR = 1.67; 95%CI 1.35-2.06, p<0.001), in individuals with 10 or more symptoms (OR=2.03; 95%CI 1.04-3.94, p<0.05), obese (OR=2.0; 95%CI 1.53- 2.74) and with two or more more comorbidities (OR= 2.22; 95%CI 1.71-2.89, p<0.05). In the second wave, in individuals aged 60 years or more (OR=2.04; 95% CI 1.58-2.62, p<0.001) and with two or more comorbidities (OR= 1.77; 95% CI 1.29-2.41, p<0.001). Individuals with 8 to 11 years of education were 36% less likely (OR= 0.64; 95% CI 0.46 to 0.90) than individuals with 12 years or more. As for the third wave, in individuals aged 60 years or more (OR= 1.89; 95%CI 1.65- 2.17, p<0.001), with five to nine symptoms (OR= 1.52; 95%CI 1, 20-1.92, p<0.001), obese (OR= 2.2; 95% CI 1.78-2.73, p<0.001) and with one/two or more comorbidities (OR= 1.45; CI 95 %: 1.22-1.72 and OR= 2.0, 95%CI: 1.69-2.45, p<0.001). Conclusion: Taking into account that diseases do not occur by chance, as they are guided by social and health determinants, and that the pandemic caused by the new coronavirus reached different groups of society, the present study is of great relevance for Collective Health , as it allowed the identification of priority groups, being able to direct the implementation of more specific prevention and control strategies, such as those that protect the elderly, pregnant women, people with low education, with comorbidities and prioritize testing for early detection of positive cases.
Análise de riscos competitivos da sobrevida-específica de pacientes diagnosticados com câncer de próstata no Espírito Santo : estudo de coorte retrospectivo
(Universidade Federal do Espírito Santo, 2024-03-27) Grippa, Wesley Rocha; Salaroli, Luciane Bresciani; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Lopes-Júnior, Luís Carlos ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Dell'Antonio, Larissa Soares ; https://orcid.org/; http://lattes.cnpq.br/; Araújo, Jeferson Santos ; https://orcid.org/; http://lattes.cnpq.br/; Leite, Franciéle Marabotti Costa ; https://orcid.org/; http://lattes.cnpq.br/; Sarti, Thiago Dias ; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/
Background: Prostate cancer is one of the most common cancers in the world, being one of the main causes of premature death in men. Advances in survival analysis techniques have played an important role in recent years, especially after the development and improvement of statistical methods, with direct applications in Public Health and Oncology. Objective: To analyze the specific survival probability of patients with prostate cancer and the factors associated with the risk of death from cancer or other causes in patients diagnosed with prostate cancer who started treatment at the Oncological Care Network (OCN) in the state of Espírito Santo (ES), Brazil. Methods: This is a retrospective observational cohort study. Retrospective observational cohort study. Secondary data were collected via the Tumor Registration Form (TRF) from the Hospital-based Cancer Records (HCR) of patients who received care in a hospital in the OCN of ES, and from the Mortality Information System (SIM/ES), in the period between 2000 and 2020. All occurrences of prostate cancer proven by anatomopathological examinations (ICD-10) were included and analyzed. For data analysis, a descriptive analysis of the epidemiological profile of patients diagnosed with prostate cancer was carried out, in addition to an analysis of completeness of the epidemiological variables from HCR of the ES, which data incompleteness was classified as excellent (< 5%), good (between 5% and 10%), regular (between 10% and 20%), bad (between 20% and 50%) and very bad (> 50%), according to the percentage of missing information. For survival analysis, the deterministic linkage method was done, using the TRF records from the Integrator of the Brazilian Cancer Hospital Registry (SIS-RHC) with the records from the Mortality Information System (SIM/ES). To estimate overall specific survival, the Kaplan-Meier method and multivariate analyzes were used, based on the Cox proportional hazards model and the Fine and Gray competing risks model, in order to investigate the probability of specific death from prostate cancer. In the analysis of the adjusted models, a 5% significance level was adopted to evaluate the significant effect of each of the variables studied. All statistical analyzes were performed using the free software R and RStudio. Approved was obtained by the CCS-UFES Research Ethics Committee (Opinion Number: 5,533,541). Results: The initial dataset included 13,519 cases of prostate cancer in the HCR, recorded with diagnoses between 2000 and 2020. Conclusions: Most variables in the HCR exhibited excellent completeness, but important variables had high percentages of incompleteness, such as TNM and clinical staging, as well as alcoholism and smoking. There was a growing trend in prostate cancer incidence over the years in the ES, with a predilection for older, married men with low educational levels. Furthermore, survival analysis revealed an overall specific survival of 87.7%, and age, educational level, distant metastasis, surgery, radiotherapy, and hormone therapy were associated with the risk of specific mortality among prostate cancer patients. Taken together, these data can assist in decision-making by managers and stakeholders, to support screening and treatment programs, in addition to guiding the improvement of public policies in the area of Oncology, with a view to planning effective actions for cancer surveillance in the various assistance levels of the Health Care Network, in order to improve men’s health care.
Ansiedade, qualidade de vida e práticas de lazer em tempos de pandemia da COVID-19 na população idosa de centros de convivência do município de Vitória - ES
(Universidade Federal do Espírito Santo, 2023-11-17) Aguiar, Adriana Drummond de; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; https://orcid.org/0000-0002-2305-4218; http://lattes.cnpq.br/7650563657500203; Barcellos, Ludmilla Awad; Biazevic, Maria Gabriela Haye; Oliveira, Elizabete Regina Araujo de; http://lattes.cnpq.br/4671078095444887
Introduction: The elderly constitute a prominent population group in the COVID-19 pandemic, mainly due to the risk potential of this population, especially those with chronic diseases. Therefore, the diversity of aging, anxiety, quality of life and leisure practices are important aspects to be investigated. Objective: To evaluate the factors associated with anxiety, quality of life, and leisure practices in times of the COVID-19 pandemic in the elderly population of Community Centers in the municipality of Vitória, Espírito Santo. Material and Method: This is an analytical observational study with a cross-sectional design, carried out in the capital of the state of Espírito Santo, in the four Senior Living Centers, in a sample of 345 elderly people. For the collection of sociodemographic data, a script adapted from the IBGE and the Brazilian Economic Classification Criterion were used. With regard to the dependent variables, Anxiety was verified by means of the Geriatric Anxiety Inventory, Leisure Practices was categorized by the Leisure Practices Scale, while Quality of Life was analyzed by the 36-Item Short-Form Health Survey, through the physical and mental dimensions that were dichotomized into below mean and above average. Data collection took place from June to December 2022. The characterization of the data was presented in the form of tables. The normality of the probability distribution was verified using the Kolmogorov-Smirnov test. The level of significance was set at 5% and the 95% confidence interval was set. Results: In the Anxiety outcome, it was identified that older adults who practice less leisure are 3.9 times (p<0.001) more likely to have characteristics of Generalized Anxiety Disorder, and that older adults with a mental component of quality of life below average are 6.5 times more likely (p<0.001). With regard to the outcome quality of life, multivariate logistic regression showed that beingof "white" race/color increases by 2.51 times the odds (p=0.032) of having an above- average mental component of quality of life, that not having characteristics of Generalized Anxiety Disorder increases by 16.43 times the odds (p<0.001) of having an above-average mental component of quality of life and practicing more leisure timeincreases by 4.82 times the odds (p<0.001) of having an above-average physical component of quality of life. Regarding the leisure outcome, being female increases the chances of having more leisure practice by 2.8 times (p=0.016). Elderly people without characteristics of Generalized Anxiety Disorder are 5.0 times (p<0.001) more likely to have more leisure, and those with a physical component of quality of life above-average have these chances increased by 2.6 times (p=0.009). Conclusions: The factors associated with anxiety in the elderly population are lower leisure practicesand a mental component of quality of life below average. The quality of life of the elderly is associated with white race/color, not having characteristics of Generalized Anxiety Disorder and practicing more leisure. Leisure practices, on the other hand, areassociated with female gender, not having characteristics of Generalized Anxiety Disorder and the physical component of above-average quality of life.
Aplicativo móvel sara no tratamento da tuberculose
(Universidade Federal do Espírito Santo, 2023-03-17) Araújo, Mariana Pereira da Silva; Prado, Thiago Nascimento Do; https://orcid.org/0000000181326288; http://lattes.cnpq.br/6388559394015871; https://orcid.org/; http://lattes.cnpq.br/; Monteiro, Maxwell Eduardo; https://orcid.org/; http://lattes.cnpq.br/8831352516689445; Silva, Adriana Ilha da; https://orcid.org/; http://lattes.cnpq.br/4088542085942883; Possuelo, Lia Goncalves; https://orcid.org/; http://lattes.cnpq.br/; Garcia, Anilton Salles; http://lattes.cnpq.br/1029501009628001
Introduction: Tuberculosis (TB) is a chronic transmissible disease that mainly affects emerging countries due to the lack of minimal infrastructure and difficulties in accessing quality health services. It is a transmissible infectious disease caused by the microorganism Mycobacterium tuberculosis or Koch's Bacillus (BK). Objective: to evaluate a mobile application in the treatment of people with tuberculosis. Methodology: this research is the result of a partnership between the Federal University of Espírito Santo and the Federal Institute of Espírito Santo with the project entitled Innovative Technologies applied to Tuberculosis and HIV surveillance, which proposes the development and validation of innovative technologies for the disease surveillance and evaluation of the incorporation of new technologies in the Unified Health System (SUS). This is a quantitative research carried out in 03 stages. Step 1 consists of building and validating the SARA application, Step 2 a usability study of the application. The randomized clinical trial resulted in article 3. Results: in article 1, the application was built in its final version after three steps of the Delphi Technique. In the Delphi 3 stage, the global Content Validity Index was 0.92, being evaluated by seven expert judges in the North, Northeast, Midwest, South and Southeast regions and validated by six people with tuberculosis attended, reaching an Index of Global Content Validity of 0.98. In article 2, based on the scores obtained in the SURE Questionnaire, the participants agreed that the help given by the application was useful. And, finally, in article 3, it was possible to establish a clinical protocol for a randomized pragmatic trial. Conclusion: The application was validated for its content and semantics by expert judges, from a multidisciplinary perspective, and active in the field of tuberculosis in more than one region of Brazil and by the target audience for which it is intended, being considered an important tool to add to the control strategies for the end of tuberculosis. This study characterizes an important indication that the SARA application can be widely tested.
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.
ASSOCIAÇÃO DA DEPRESSÃO COM INGESTÃO DE MICRONUTRIENTES E SÍNDROME METABÓLICA EM PARTICIPANTES DO ELSA-BRASIL
(Universidade Federal do Espírito Santo, 2022-10-21) Ferriani, Lara Onofre; Viana, Maria Carmen Moldes; https://orcid.org/; http://lattes.cnpq.br/4338126917250074; https://orcid.org/; http://lattes.cnpq.br/; Mill, Jose Geraldo; https://orcid.org/000000020987368X; http://lattes.cnpq.br/2497419234600362; Barreto, Sandhi Maria; https://orcid.org/; http://lattes.cnpq.br/; Coutinho, Evandro da Silva Freire; https://orcid.org/; http://lattes.cnpq.br/; Molina, Maria Del Carmen Bisi; http://lattes.cnpq.br/9238370951122705
abstract
Associação entre Propósito de Vida, Cognição e Funcionalidade em Idosos da Região Rural da Amazônia
(Universidade Federal do Espírito Santo, 2024-02-06) Campos, Hércules Lázaro Morais; Oliveira, Elizabete Regina Araujo; https://orcid.org/0000-0002-6616-4273; http://lattes.cnpq.br/4671078095444887; https://orcid.org/0000-0002-6919-8161; http://lattes.cnpq.br/3543724672096710; Miotto, Maria Helena Monteiro de Barros; https://orcid.org/0000-0002-3227-7608; http://lattes.cnpq.br/4289442514763843; Lima, Rita de Cássia Duarte; https://orcid.org/0000-0002-5931-398X; http://lattes.cnpq.br/2384472795664270; Silva, Cristina Cristóvão Ribeiro da; https://orcid.org/0000-0001-6222-3232; http://lattes.cnpq.br/1322953486284487; Silva, Anna Quialheiro Abreu da; https://orcid.org/0000-0002-4168-6585; http://lattes.cnpq.br/4874881297354282
Growing old in a developing country is a major challenge and becoming old in the rural Amazonian context enhances, instigates and makes these elderly men and women develop resilience. It is known that in developing countries rural ageing is a male phenomenon, but studies on this population have female characteristics; it is the elderly women who take part in the research and it is from them that we have the most information. OBJECTIVES: To characterize and describe the presence of cognition, functionality and life purpose in elderly people aging in rural Amazonas. METHODOLOGY: A sociodemographic questionnaire was used to assess and characterize elderly women and men aging in rural Amazonas in 2020. To assess health, cognition, functionality and purpose in life, the elderly were visited in their rural communities and/or at home. To assess cognition, the Mini-Mental State Examination (MMSE) was applied, with cut-off scores according to schooling; functionality and physical performance were assessed using the Short Physical Performance Battery (SPPB); and to assess purpose in life (PiL), the scale validated in Brazil was applied. The database analyzed in this study has n=215 observations, with no missing data.Categorical variables were presented as absolute and relative frequencies, while numerical variables were described using measures of central tendency and dispersion. Pearson's chi-square test of independence and Fisher's exact test were used to test the association between the independent variables and the Life Purpose Scale. A binomial logistic regression model was adjusted for the variables that showed statistical significance in the association test, with the OR (odds ratio) being presented for the analyses; significance was used at the 5% level. All procedures were carried out using R Studio (2023.03.1+446 "Cherry Blossom") and R (4.2.2) software. RESULTS AND DISCUSSION: Rural ageing in Amazonas, as described in this study, is also female, surrounded by women farmers, with low levels of schooling, cognitive changes that deserve attention, are partially functional and, surprisingly, have a purpose in life. The first article recorded and produced a systematic review protocol on how to grow old from a cognitive, functional and life purpose point of view in a rural context around the world; the second article produced a systematic review on how to grow old in a rural context around the world, evaluating these crosssectional studies methodologically through methodological quality and risk of bias (OSQE), and found that until April 2023 there had been no publications on life purpose in the rural elderly population around the world. Finally, the last article found the presence of life purpose in rural elderly people in the Amazon and that working even after retirement and having moderate physical function are protective for future life goals. The way we age in a rural context from a cognitive, functional and physical function perspective is still very homogeneous, diverse and depends very much on the rural region in the world where this ageing takes place. CONCLUSION: The data on how people age in rural areas is still very homogeneous, sometimes confusing and contradictory, and more elderly men need to be included in this context. Life purpose, together with age, schooling and functionality were protective factors for the health of elderly people aging in rural Amazonas. This study is the first to verify the presence of life purpose in elderly people aging in a rural context. Presenting PiL is an important and protective factor for cognition, functionality, physical function and rural ageing in the barrancas of Amazonas.
Atenção à saúde na assistência estudantil em universidades federais da região nordeste do Brasil
(Universidade Federal do Espírito Santo, 2023-03-31) Trindade, Samara Nagla Chaves; Almeida, Ana Paula Santana Coelho; https://orcid.org/0000-0001-5808-5818; http://lattes.cnpq.br/2570855705420190; http://lattes.cnpq.br/6087229569556815; Salaroli, Luciane Bresciani; https://orcid.org/0000000218810306; http://lattes.cnpq.br/3503255904138561; Almeida, Mônica Rafaela de; https://orcid.org/0000-0002-6199-0138; http://lattes.cnpq.br/9790804214512842; Sarti, Thiago Dias; https://orcid.org/0000000215456276; http://lattes.cnpq.br/7489127535403969; Portugal, Flavia Batista; https://orcid.org/0000000244252627; http://lattes.cnpq.br/1876697154549534; Oliveira, Anatalia Dejane Silva de
The emergence of public universities in Brazil was strongly marked by an elitist character, which led, from the end of the 20th century to the search for democratization of access. The expansion of institutions, which took place across the country between 2007 and 2014, made it possible for the most vulnerable to access undergraduate courses, which encouraged the implementation of assistance actions aimed at permanence. In this context, the National Student Assistance Program emerges, which provides for ten areas to be attended to, including health care. However, the Program lacks guidance that establishes the procedures for its execution in institutional practice, and each university is responsible for defining norms, areas to be attended and allocation of resources. This study proposed to map the existing student health care actions in federal universities in the Northeast region of Brazil, as well as their operationalization; describe the health conditions of undergraduate students at the Federal University of West Bahia (UFOB), verify the pattern of access and use of health services offered by student assistance and identify their respective associated factors and analyze health actions in the context of the university and its integration with the local health system. This is a qualitative and quantitative research, which included federal universities in the Northeast region of Brazil, undergraduate students, student assistance professionals and a municipal health manager. Data were collected through electronic questionnaires and individual interviews. For analysis, in the qualitative stages, content and thematic analyzes were carried out and, in the quantitative stage, descriptive, crude and adjusted analyses. The results of the study were presented in the format of a scientific article, producing three articles. The findings found from the mapping of health actions in federal universities in the Northeast region, demonstrated that there is no uniformity in the provision of health services in the institutions; universities partner with internal and external bodies to improve service delivery; the professionals available in the teams are unaware of the operation of the municipality's health network and are insufficient to meet the entire demand. When studying the health conditions of the students, it was evidenced that, despite the majority reporting good health, a significant part mentioned having multimorbidity and weight change after entering the university and it was verified that, attending the last periods of the course , being a beneficiary of student aid and having gained weight is associated with greater use of health services offered by the university. Regarding the integration between the university's student health care services and the municipal health care network, it was verified that there was no intersectoral relationship between the two and that there were impasses for students to access the network, especially in relation to those who come from other municipalities to attend graduation. The results reveal the importance of offering health services to undergraduates, however, they point to the need to implement a national health policy capable of filling existing gaps and promoting integration between the university and the health care network.
Avaliação de saúde bucal e seu impacto na qualidade de vida da população indígena do Espírito Santo
(Universidade Federal do Espírito Santo, 2023-07-28) Ramos, Deise Berger Velten; Miotto, Maria Helena Monteiro de Barros; http://lattes.cnpq.br/4289442514763843; https://orcid.org/0000-0002-8750-0782; http://lattes.cnpq.br/2484586060622755; Mill, Jose Geraldo; https://orcid.org/000000020987368X; http://lattes.cnpq.br/2497419234600362; Calmon, Marcela Vieira; Barcellos, Ludmilla Awad; Oliveira, Elizabete Regina Araujo de; http://lattes.cnpq.br/4671078095444887
Introduction: Knowledge of the oral conditions of specific populations is essential, so that adequate planning of policies can be carried out that takes into account the real needs of these people, and studies with indigenous populations are sporadic, almost always restricted to work with small samples. The epidemiological picture of oral health among indigenous peoples in Brazil is little known due to the scarcity of scientific investigations, surveys and comprehensive censuses. Objective: To evaluate the impact caused by oral problems on quality of life, orofacial pain, tooth loss and the association with sociodemographic characteristics, need for prosthesis, use of dental services in indigenous and non-indigenous populations living in Guarani and Tupiniquin villages located in the Municipality of Aracruz, Espírito Santo. Methodology: This study was a cross-sectional observational study, in which 1084 indigenous people had their oral conditions assessed subjectively using the OHIP-14 form, through questionnaires on tooth pain and tooth loss and a visual clinical examination was also carried out to assess the condition of tooth loss. Individuals aged 20 years or older and who were residents of the Tupiniquin and Guarani villages were included. The Chi-square and/or Fisher's exact tests were used to calculate possible associations between OHIP, dental pain, tooth loss, sociodemographic conditions, use of dental services and the need for removable prostheses. Results: The prevalence of impact of oral problems on quality of life in the indigenous population was 45.7%, with individuals aged up to 50 years (OR=1.9), with a declared need for a removable partial denture (OR= 2.5) and without the need for a complete removable denture (OR=2.3) reported a greater perception of the impact of oral problems on quality of life. Tooth loss was associated with age over 51 years (OR=6.3), less education (up to 10 years of study) (OR=2.1), more impact of oral problems on quality of life (OR=2. 3). Dental pain was more common in women, aged up to 50 years, who sought dental care for urgent reasons and in those who did not require a Removable Partial Prosthesis (RPD). Conclusions: The prevalence of impact of oral problems on the quality of life of indigenous people was higher than that normally found in nonindigenous populations, as well as a more precarious situation related to dental pain and tooth loss compared to the general population. , which demonstrates the need for improvements in the planning of public policies for the prevention and promotion of oral health and also expanding access to dental services that are more effective, aiming to improve the quality of life of this vulnerable population.
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, Leticya dos Santos Almeida; Maciel, Ethel Leonor Noia; https://orcid.org/0000000348263355; http://lattes.cnpq.br/3761398932271892; https://orcid.org/; http://lattes.cnpq.br/; Miranda, Angelica Espinosa Barbosa; https://orcid.org/; http://lattes.cnpq.br/5842271060162462; Kritski, Afranio Lineu; https://orcid.org/; http://lattes.cnpq.br/; Silva, Adriana Ilha da; https://orcid.org/; http://lattes.cnpq.br/4088542085942883; Vieira, Anne Caroline Barbosa Cerqueira
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 e
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
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.

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