PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA - PPGSC

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    Cuidados oferecidos a crianças elegiveis para cuidados paliativos em ambiente hospitalar
    (Universidade Federal do Maranhão, 2018-12-19) LIMA, Sara Fiterman; SOUZA, Tadeu de Paula; 055221367-00; http://lattes.cnpq.br/9097512115715636; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; ALVES, Rosana; http://lattes.cnpq.br/5958737240424992; GARCIA, João Batista; http://lattes.cnpq.br/0424234103760462; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677
    The study sought to analyze the care offered to eligible children for palliative care in a hospital environment. This is an exploratory study, with a quantitative and qualitative approach, carried out in 04 hospitals of the network of public institutions with hospitalization care for children in the municipality of São Luís - Maranhão. The universe of the study was composed of children hospitalized in the hospitals during the period of data collection. Using the inclusion criteria to be between 0 and 9 years old, potential indication for palliative care according to service professionals and to fall into one of the 04 groups of conditions eligible for pediatric palliatives of the Association for Children Palliative Care, emerged 133 children, that went through an expert evaluation for the application of non-inclusion criteria - not being eligible and being in final moments of life - according to the opinion of this professional. Thus, study participants were 131 children eligible for palliative care, their primary caregivers, and the professionals who provided care. The techniques for collection were interviews, participant observation and documentary analysis. From this sample, the case study of 09 children was carried out. The results are as follows: The profile of the public network for pediatric palliative care in the municipality; The socio-demographic profile of children and caregivers; The characterization of the clinical conditions of these children; The evaluation of the dynamics that involves the provision of palliative care in one of the hospitals. The process of indicating palliative care in pediatrics allows different understandings. Eligible children also had other diagnoses that helped the palliative indication. Social issues were present and fragmented care. Spirituality can help or serve as a barrier to care. Mourning care still comes down to the moment of death, with guidelines for funeral procedures. Several misunderstandings interfere in practice. We conclude that findings point to the need for investments in the training and preparation of professionals, for the sharing of decisions among the members of the team, for the rapprochement with the relatives and the reception of their symptoms of suffering, for the inclusion of this family and child in the decision-making, and to broaden the focus of care, understanding family and death as an integral part of the care process.
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    EXPERIÊNCIAS VIVIDAS POR PROFISSIONAIS NO PROCESSO DE TRABALHO COM CRIANÇAS EM CUIDADOS PALIATIVOS.
    (Universidade Federal do Maranhão, 2019-02-26) MOREIRA, Jacqueline Dutra Nascimento; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; LEMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; ALVES, Rosana; http://lattes.cnpq.br/5958737240424992; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; CARVALHO, Ruth Helena de Souza Britto Ferreira de; http://lattes.cnpq.br/6914279050780248
    Pediatric Palliative Care (CPP) includes total pediatric care in the body, mind and soul, and family support. Tending its onset when a serious illness is diagnosed and continues to be a curatorial cure process. They are based on multiprofessionality and interdisciplinarity focused on evaluating and alleviating the physical, psychological, social and spiritual exercise of the child and his / her family. The objective was to understand the experiences experienced by professionals in the process of working with children in palliative care. This is an exploratory study of a qualitative approach of the phenomenological type, carried out in a university hospital from March to May 2018. The sample was chosen with the intention of involving 32 professionals from the research sector. The analysis of the ideas was carried out in search of the work process in health, contemplating like Van Manen visions. The themes that emerged were: Fragilities, disagreements and contradictions in the presentation and offer of palliative care and facilitating initiatives in palliative practice. The understanding of the lived experiences made possible the understanding of a knowledge about the association of concepts and contradictions in palliative care. Palliative Care was introduced in a terminality, to abandonment and euthanasia. Where an denial of the natural process of death prosers, it may result in the adoption of a futile treatment. The occurrence of the biomedical model and the fragmentation of care that led, in some situations, to the work process, was adopted for decision making and for the child and his family. However, as experiences have already been promoted by the integration of knowledge, and the incorporation of new tools in daily care, which promote a user-centered approach with respect to their subjectivity. It is necessary, changes in the logic of the work processes in health, in search of a collaborative work, with emphasis on the protagonism of the user, valorization of the worker and extension of the clinic.
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    FATORES DOS PRIMEIROS 1000 DIAS DE VIDA ASSOCIADOS À SINTOMAS ASMA NA INFÂNCIA NA COORTE BRISA EM SÃO LUÍS E RIBEIRÃO PRETO, BRASIL.
    (Universidade Federal do Maranhão, 2018-02-05) NASCIMENTO, Joelma Ximenes Prado Teixeira; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; VIANNA, Elcio dos Santos Oliveira; http://lattes.cnpq.br/8733105749892750; BARBIERI, Marco Antonio; http://lattes.cnpq.br/0765555733544821; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430
    Asthma is a complex syndrome, of difficult diagnosis in children. The mechanisms involved in the etiopathogeny of the disease have not been completely elucidated. Environmental exposures during the first 1000 days of life (270 days of gestation plus the 365 days of the first year of life and 365 days of the second of life) appear to have a strong influence on epigenetic regulation, increasing predisposition to childhood asthma. The association between early exposures of the prenatal period, birth and the first years of life with asthma symptoms in children involves multicausality and temporality relationships between these variables that can be better studied by structural equation modeling (SEM). Chapter I of this thesis was the original article: The First 1000 Days of Life Factors Associated with “Childhood Asthma Symptoms”: Brisa Cohort, São Luís, Brazil, which aimed to analyze the associations between the environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. It is a prospective study involving three moments of the BRISA cohort in Sao Luis (n = 1140), where the outcome was the latent variable “Childhood Asthma Symptoms”, formed by four indicators with convergent loads: medical diagnosis of asthma, number of wheezing episodes, emergency care visit due to wheezing and medical diagnosis of rhinitis. A theoretical model that included prenatal factors, birth factors and of the second year of life, were analyzed in association with “Childhood Asthma Symptoms” using SEM. It was observed that the higher the pre-gestational BMI, high soft drink consumption in gestation, cesarean section without labor, chill in the first three months of life, carpeted floor and child´s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, the age of the child and children exclusively breastfed for six months were associated with lower values of “Childhood Asthma Symptoms”. Chapter II of this thesis was the original article: Environmental factors linked microbiota hypothesis and “Childhood Asthma Symptoms”: BRISA cohort, Ribeirão Preto, Brazil, which aimed to analyze environmental factors linked to the microbiota hypothesis and “Childhood Asthma Symptoms”. It is a prospective study involving population-based sample of the BRISA birth cohort in Ribeirão Preto (n = 3694). Birth and second year life factors linked to the microbiota hypothesis were analyzed on a theoretical model having as outcome the latent variable “Childhood Asthma Symptoms” was formed by three indicators (medical diagnosis of asthma, number of wheezing episodes and emergency care visit due to wheezing) using SEM. It was observed that children with higher BMI values, belonging to the black race, with diarrhea and older presented higher values for “Childhood Asthma Symptoms”; while better economic situation, female gender and longer breastfeeding presented lower values for “Childhood Asthma Symptoms”. In the present thesis, the analyzes of the variable “Childhood Asthma Symptoms” as a continuous latent formed by clinical indicators of convergent loads reduced the error of measurement of this outcome difficult to diagnose in children. Our findings suggest that environmental exposures during the first 1000 days of life, such as: maternal and child overweight, consumption of soft drinks in gestation, cesarean delivery, would be involved in the early programming of asthma children, while breastfeeding would protect from this condition.
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    VIVÊNCIAS DE PROFISSIONAIS EM UNIDADE DE TERAPIA INTENSIVA E NÚCLEO INTERNO DE REGULAÇÃO DE LEITOS NA PANDEMIA DA COVID-19
    (Universidade Federal do Maranhão, 2022-10-27) PEREIRA, Joelmara Furtado dos Santos; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; CORREA, Maria Elizabeth da Silva Hernandes; http://lattes.cnpq.br/5935428566690008; CARVALHO, Alexandre Guilherme Ribeiro de; http://lattes.cnpq.br/7062148392179283; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; CARVALHO, Ruth Helena de Souza Britto Ferreira de; http://lattes.cnpq.br/6914279050780248
    INTRODUCTION: In 2020, Brazil experienced an unprecedented health crisis, the so-called first wave of the COVID-19 Pandemic. The unexpected increase in patients with severe illness who demanded mechanical ventilators, beds and intensive care threatened the high complexity response capacity. From this perspective, this research sought to analyze the experiences of health professionals who worked in the Intensive Care Unit and in the Internal Bed Regulation Nuclei, in the context of the COVID-19 pandemic. METHODS: This is a descriptive exploratory study with a qualitative approach developed in the Intensive Care Units and Internal Bed Regulation Centers of two public hospitals, from November 2020 to January 2021, in the state of Maranhão. 22 professionals were selected, this sample was defined by the criterion of saturation of the senses. The data collection technique was the semi-structured interview. For analysis of the interviews, the technique of content analysis was used, in the thematic modality and the software NVIVO® 12 was used to aid in the organization and treatment of the data. RESULTS: Professionals reported that in the face of high demand, critically ill patients and insufficient beds, there was a need to reorganize the hospital environment and expand existing beds. Of the situations mentioned, the following stand out: the work overload and the shortage of professionals that affected the quality of care, leading to new forms of care production and the transitory rupture of the overvaluation of professional categories; the challenge of offering the expected high-standard care, which began to be built under the rhythm of uncertainty and ignorance of the disease; the feeling of professional collaboration and the perception of security in the team signaled as necessary presuppositions for the continuity of care. The experience with death and dying on a larger scale interfered in the way of facing the end of life in that context. In parallel with this overwhelming context, deciding who would occupy the intensive bed was a difficult and conflicting task, given the uncertainties of the “new disease”. Thus, a combination of clinical and non-clinical criteria was considered, evaluated on a case-by-case basis, such as severity, chance of survival, distance to be covered and transport conditions. It was identified that the context of an unknown disease, family and institutional pressures were points of tension and interfered in the decision-making process.FINAL CONSIDERATIONS: The changes that occurred in the work environment of the ICU and NIR influenced the way of dealing with that exceptional situation. Their experiences with the (re)organization of space, the meaning attributed to care and interprofessional relationships, showed that these agents were affected in a way and intensity peculiar to each one. Decision making was marked by practices and challenges arising from the context of exacerbation of the lack of beds and the knowledge that was structured about the disease, from the perspective of an arduous phenomenon and related to aspects extrinsic to the technical-assistance sphere.