https://repositoriobce.fepecs.edu.br/handle/123456789/1392 2026-10-11T08:03:16Z 2026-10-11T08:03:16Z Luz, Beatriz Maciel https://repositoriobce.fepecs.edu.br/handle/123456789/1721 2026-09-29T20:23:28Z 2025-02-27T00:00:00Z

Título: Transmissão vertical do vírus linfotrópico de célula T humana (HTLV) no Distrito Federal: uma realidade? Autor(es): Luz, Beatriz Maciel Primeiro Orientador: Imoto, Aline Mizusaki Abstract: Introduction: Human T-cell lymphotropic virus (HTLV) is a retrovirus associated with severe diseases, including adult T-cell leukaemia/lymphoma and HTLV-1-associated yelopathy/tropical spastic paraparesis, as well as other inflammatory, neurological, dermatological, ophthalmological and infectious conditions. Infection may remain asymptomatic for many years, contributing to silent transmission and to the maintenance of family and community transmission chains. HTLV can be transmitted sexually, through blood exposure and vertically from mother to child. Vertical transmission is one of the main routes of viral spread in endemic areas, especially when breastfeeding is prolonged. The absence of a vaccine or curative treatment reinforces the importance of preventive strategies, particularly antenatal screening, adequate counselling, avoidance of breastfeeding, use of lactation inhibitors and provision of infant formula. In Brazil, antenatal screening for HTLV was incorporated into the Unified Health System in 2024. However, the Federal District has offered HTLV testing to pregnant women attending the public health system since 2013. This pioneering experience includes screening using dried blood spot samples, confirmatory testing in serum samples and recommendations to prevent vertical transmission, such as contraindication of breastfeeding, use of cabergoline and provision of infant formula for exposed infants up to 12 months of age. Despite these advances, professional practice revealed important gaps in the organization of care, particularly regarding counselling for pregnant women, timely access to infant formula, follow-up of exposed children and the availability of specific educational materials to support communication between health professionals and women living with HTLV. The research problem originated directly from the author’s professional practice at the Sexually Transmitted Infections Surveillance Management Unit of the Health Department of the Federal District, the technical area responsible for surveillance, monitoring and coordination of prevention actions related to HTLV and other sexually transmitted infections. In the daily practice of public health management and epidemiological surveillance, it was observed that, although the Federal District had been testing pregnant women for more than a decade, there were no systematized data on the occurrence of vertical transmission among children born to women diagnosed during antenatal care. There was also a need to produce educational materials to support health professionals and pregnant women in understanding the infection, its modes of transmission, preventive measures and care pathways. Therefore, this dissertation was structured in a multipaper format, combining scientific production and a Technical-Technological Product, with a focus on generating evidence and applying results to the Brazilian Unified Health System. Objective: To analyse HTLV vertical transmission in the Federal District, Brazil, based on the epidemiological characterization of pregnant women diagnosed during antenatal care and their exposed children, and to develop scientific and technical-educational products aimed at improving care, preventing vertical transmission, and strengthening surveillance and maternal and child health actions. Method: This is a Professional Master’s Final Paper organized in a multipaper format, comprising one scientific production and one Technical-Technological Product. The scientific production was developed from three integrated methodological components: a retrospective analysis of operational data from the antenatal HTLV-1/2 testing strategy in the Federal District; a cross-sectional component with a questionnaire administered to women living with HTLV-1/2 diagnosed during antenatal care; and a cross-sectional study with children of women living with HTLV-1/2 to assess the occurrence of vertical transmission. The retrospective analysis considered data from the antenatal screening programme in the Federal District, focusing on operational aspects of testing, such as when the test was offered, turnaround time for screening results, time to confirmatory testing and completion of the testing strategy. The cross-sectional component with women aimed to characterize sociodemographic, clinical, healthcare and access-related aspects of vertical transmission prevention measures. The study with exposed children assessed HTLV infection and allowed evaluation of vertical transmission in the local context. Women diagnosed with HTLV-1/2 during antenatal care in the Federal District between 2013 and 2022 were eligible, identified through epidemiological surveillance records and the laboratory responsible for antenatal testing. Their children were also considered eligible, regardless of age, provided that consent for participation was obtained. Potential participants were contacted by a previously trained team using a standardized telephone script. Interviews and sample collection were scheduled at primary healthcare units according to the participants’ health region of residence. Before interviews and biological sample collection, applicable ethical procedures were carried out, including the reading and signing of informed consent and assent forms, when appropriate. The study was approved by a Research Ethics Committee. The variables analysed included characteristics of women, such as age, self-reported race/skin colour, education, family income, number of pregnancies, number of live-born children, timing of diagnosis, counselling received about HTLV, guidance on avoiding breastfeeding, use of lactation inhibitors, access to infant formula, partner serology and presence of HTLV cases in the family. Among children, variables included sex, age, race/skin colour, breastfeeding history, duration of breastfeeding, receipt of infant formula, previous HTLV testing and test result obtained during the study. Data analysis included descriptive statistics and evaluation of outcomes related to the occurrence of vertical transmission. The Technical-Technological Product was developed based on the epidemiological findings and the gaps identified in healthcare and surveillance practice. It consisted of a methodological study for the development and validation of educational health materials, conducted within the Health Department of the Federal District. Three materials were developed: an insert for the Pregnant Woman’s Handbook, an informational poster for healthcare facilities and a quick-reference desk prism guide for health professionals. The materials addressed information on HTLV, modes of transmission, prevention of vertical transmission, diagnosis, counselling, avoidance of breastfeeding, use of infant formula, follow-up of exposed children and organization of care within the health network. Validation was conducted with experts and women living with HTLV, using the Health Education Content Validation Instrument and the Suitability Assessment of Materials. The former assesses the domains of objectives, structure/presentation and relevance, while the latter evaluates the suitability of materials for the target audience, considering aspects such as clarity, organization, language, presentation and visual appeal. Products developed: The first product developed was the scientific manuscript entitled HTLV-1/2 Antenatal Screening in Distrito Federal, Brazil: Evaluation of Programme Implementation and Public Health Impact. The manuscript analyses the experience of the Federal District in implementing antenatal HTLV-1/2 screening and its effects on the prevention of vertical transmission. The analysis showed that programme implementation reduced vertical transmission from 10.2% to 0% among children born after maternal diagnosis and adoption of preventive measures. Most diagnosed women completed the diagnostic strategy by the second trimester of pregnancy, with a median turnaround time of seven days for screening test results and 12 days for confirmatory test results. Only 3.7% were diagnosed after delivery. Most diagnosed women formula-fed their children and received information on how to access free infant formula; however, only about half received formula before discharge from maternity care. Low coverage of HTLV testing among exposed children prior to the study was observed, indicating weaknesses in infant follow-up. The results demonstrate that the experience of the Federal District is relevant to guide the implementation of programmes aimed at eliminating HTLV vertical transmission in Brazil and in other contexts in the Americas, especially because it shows that timely diagnosis, combined with avoidance of breastfeeding, use of lactation inhibitors and provision of infant formula, can interrupt vertical transmission. In the updated document, the manuscript is presented in English and highlights the Federal District as a pioneering region with potential contributions to the national and regional response to HTLV. The second product was the Technical-Technological Product entitled Educational materials for the prevention of HTLV vertical transmission: strengthening care for pregnant women and health professionals. Three complementary educational materials were developed: an HTLV insert for the Pregnant Woman’s Handbook, containing information on the infection, modes of transmission and preventive measures; an informational poster for healthcare facilities, aiming to increase visibility of the topic and raise awareness among pregnant women, families and professionals; and a quick-reference desk prism guide for health professionals, containing flows and guidance on screening, diagnosis, counselling, prevention of vertical transmission, clinical management and follow-up of exposed children. The rationale for developing these materials was based on research findings that identified important gaps in counselling for pregnant women living with HTLV: some participants did not receive sufficient information about the infection, were not adequately advised about the contraindication of breastfeeding or did not have timely access to infant formula. Validation of the materials involved experts and women living with HTLV, using the Health Education Content Validation Instrument and the Suitability Assessment of Materials. All materials achieved a Content Validity Index of 0.80 or higher, indicating adequacy regarding content, language, presentation and applicability. Implementation of these materials within the Health Department of the Federal District has the potential to support counselling, strengthen continuing health education, standardize guidance, improve work processes and contribute to the prevention of HTLV vertical transmission. This project is aligned with the research line Quality of Adult Health Care. Conclusion: The experience of the Federal District demonstrates that antenatal HTLV screening, when linked to effective preventive measures, has the potential to reduce and interrupt vertical transmission of the virus. Timely diagnosis of pregnant women, recommendation to avoid breastfeeding, use of lactation inhibitors and provision of infant formula are key strategies for prevention. However, the findings also reveal relevant challenges for consolidating this policy, particularly regarding the quality of counselling, timely access to supplies in maternity care and laboratory and healthcare follow-up of exposed children. The method used is appropriate for the objective of a professional master’s degree, as it combines analysis of data from a real programme of the Brazilian Unified Health System, investigation with women and exposed children, and development of an educational product applied to practice. It also presents an innovative character by systematizing the pioneering experience of the Federal District in antenatal HTLV screening and by integrating scientific production with educational technologies aimed at improving care. The work has the potential to influence public policies, healthcare practices, surveillance actions and continuing education processes, especially in the context of national implementation of antenatal HTLV screening and goals for eliminating vertical transmission. The dissertation presents scientific, technological, social and innovation relevance by addressing a neglected infection that remains poorly visible to professionals, managers and the general population, and by producing local evidence capable of supporting public health decision-making. The manuscript contributes to the scientific community by presenting data on effectiveness, timeliness of diagnosis, infant feeding, access to formula and follow-up of exposed children. The Technical-Technological Product, in turn, has the potential to generate direct impact in the health network by providing validated materials to support professionals and users in the care process. Its applicability is local, as it was developed for the reality of the Health Department of the Federal District; regional and national, as it can be adapted to other Brazilian territories implementing HTLV screening; and international, as it is aligned with the agenda of the Americas for the elimination of vertical transmission. Dissemination of results to the scientific community, managers and health authorities may occur through manuscript submission, availability of educational materials and their incorporation into surveillance, care and continuing education strategies. Editor: Escola de Saúde Pública do Distrito Federal Tipo: Dissertação

2025-02-27T00:00:00Z Feitosa, Maria Jacinta Alves https://repositoriobce.fepecs.edu.br/handle/123456789/1715 2026-08-05T17:55:47Z 2026-05-14T00:00:00Z

Título: Convalidação de curso em ambiente Virtual de Aprendizagem (AVA) sobre desenvolvimento de competências gerenciais na atenção primária à saúde Autor(es): Feitosa, Maria Jacinta Alves Primeiro Orientador: Dutra, Adriana Haack de Arruda Abstract: Introduction: Managerial work in healthcare constitutes a central element for the organization of services, the qualification of work processes, and the assurance of public access to actions and services provided within the Brazilian Unified Health System (SUS). In Primary Health Care (PHC), this role becomes even more complex due to its coordinating function within the healthcare network, the need to integrate care, management, and territory, as well as the coordination of multidisciplinary teams in dynamic contexts often marked by structural limitations. In this scenario, managerial practice requires the development of specific competencies related to planning, decision-making, leadership, people management, and the use of health information. However, many professionals who assume managerial roles in PHC lack specific training for such responsibilities, which may compromise service efficiency and the quality of care provided. Despite advances in Permanent Health Education policies, gaps remain in the availability of structured, contextualized, and evidence-based training programs focused on the development of managerial competencies. Therefore, the following guiding question emerged: which competencies and content should compose a distance-learning management training program for managers and supervisors of Basic Health Units in the Federal District, and how can this content be validated regarding its clarity and relevance? Objective: To validate a distance-learning management training program designed for managers and supervisors of Basic Health Units in the Federal District, aiming to develop managerial competencies in Primary Health Care. Method: This is a methodological study aimed at the development and validation of an educational technical product. The research was conducted in three sequential and complementary stages. The first stage consisted of an exploratory literature review and course development. A bibliographic search was carried out in the PubMed, SciELO, LILACS, and VHL databases, including publications in Portuguese, English, and Spanish from the last ten years. Based on the findings, common themes, pedagogical strategies, and evaluation methods used in PHC management training were identified, supporting the pedagogical structure of the course according to Morrison’s instructional design model. The course was organized into four thematic modules, totaling 40 hours, and designed for distance learning through the ESP-DF platform. The second stage involved expert validation. Expert judges were selected using an adapted Fehring model, requiring a minimum score of five points according to academic qualifications, scientific production, and professional experience in PHC management or supervision. Ten experts participated in the validation process. Data collection was conducted using a structured four-point Likert-scale instrument assessing the clarity and relevance of the course content. The study was approved by the FEPECS Research Ethics Committee, and all participants signed an informed consent form. The third stage involved statistical analysis and content refinement. The Content Validity Index (CVI) was calculated, adopting a cutoff point of CVI ≥ 0.78 for item acceptance. Items scoring below the established threshold were reformulated based on qualitative feedback provided by the experts. Results: The panel of experts consisted of 10 judges, including PhD and postdoctoral professionals, all with recent experience in the Health Department of the Federal District (SES-DF) or educational institutions such as FEPECS and ESP-DF. The only item that did not achieve the minimum acceptability index was “Budget Management” (CVI = 0.70). Qualitative analyses supported the revision of this content, considering that Basic Health Unit managers in the Federal District do not directly manage financial resources, as budget execution is centralized. Suggestions provided by the experts led to the adaptation of the content toward resource management through the Progressive Decentralization Program for Health Actions (PDPAS), ensuring greater alignment with local governance practices. Even items with satisfactory CVI scores were refined based on expert recommendations. Adjustments included regionalization and technical refinement of the content, replacing concepts of direct financial management with approaches related to supply and logistics management, in accordance with the organizational structure of Basic Health Units within SES-DF. The final version of the course was structured for implementation on the ESP-DF virtual learning platform: https://ava.espdf.fepecs.edu.br/. Developed Products: Two products were developed as part of the study. Product 1 consisted of a scientific article entitled “Validation of Educational Technology for Managerial Competencies in Primary Health Care”, submitted to the Revista Gaúcha de Enfermagem, describing the process of development and validation of the educational technology. Product 2 corresponded to the Technical-Technological Product (TTP): a Virtual Learning Environment (VLE)-based course focused on the development of managerial competencies in Primary Health Care, structured into four thematic modules and offered through distance education for managers and supervisors of Basic Health Units in the Federal District. The course was adapted to the institutional reality of SES-DF and is suitable for implementation on the School of Public Health of the Federal District (ESP-DF) platform. Conclusion: This study demonstrated the feasibility of validating, with methodological rigor, a distance-learning educational technology aligned with the institutional specificities of Primary Health Care in the Federal District, presenting evidence of content validity obtained through expert evaluation. The educational material was technically validated, demonstrating coherence and practical applicability. The final version of the course is suitable for implementation on the ESP-DF platform, contributing to the continuing education of healthcare managers in the Federal District. This study is aligned with the research line “Quality in Adult and Elderly Health Care” of the Graduate Program in Health Sciences (PPCS/ESPDF-FEPECS). Editor: Escola de Saúde Pública do Distrto Federal Tipo: Dissertação

2026-05-14T00:00:00Z Souza, JéssIca Tolentino https://repositoriobce.fepecs.edu.br/handle/123456789/1714 2026-08-05T17:57:08Z 2026-06-10T00:00:00Z

Título: Tecnologias educativas para qualificação do cuidado farmacêutico na artrite reumatoide: desenvolvimento de materiais para profissionais e usuários do SUS Autor(es): Souza, JéssIca Tolentino Primeiro Orientador: Novaes, Maria Rita Carvalho Garbi Abstract: Medication dispensing within the Specialized Component of Pharmaceutical Assistance (CEAF) represents a strategic step to ensure access and continuity of treatment for individuals with chronic conditions and rare diseases within the Brazilian Unified Health System (SUS). This study aimed to analyze the weaknesses, strengths, opportunities, and threats related to the medication dispensing process at the CEAF of the Federal District (CEAF), based on the perceptions of pharmacists working in the service. This is a descriptive, qualitative study conducted through interviews with fifteen pharmacists, whose analysis was guided by the FOFA matrix (Strengths, Weaknesses, Opportunities, and Threats). The results identified strengths such as individualized pharmaceutical consultation during first dispensing, double-checking processes, and home delivery of medications. Weaknesses included medication shortages, shortage of human resources, inadequate infrastructure, and excessive documentation bureaucracy. Opportunities involved strengthening communication with users, advancing digital strategies, and decentralizing services, whereas threats included management issues, industrial discontinuity, misinformation, and economic barriers faced by users. It is concluded that dispensing in the CEAF shows relevant advances as a clinical practice but remains strongly conditioned by organizational and systemic limitations. Strengthening dispensing requires structural investments, integration of the healthcare network, continuing education, and governance strategies capable of articulating pharmaceutical care in a continuous, safe, and patient-centered manner. Editor: Escola de Saúde Pública do Distrito Federal Tipo: Dissertação

2026-06-10T00:00:00Z Lima, Gabryel Cordeiro de https://repositoriobce.fepecs.edu.br/handle/123456789/1687 2026-05-28T19:32:45Z 2026-04-04T00:00:00Z

Título: Internações por transtornos psiquiátricos em unidades de terapia intensiva: uma coorte multicêntrica em unidades privadas em Brasília - DF (2016-2024) Autor(es): Lima, Gabryel Cordeiro de Primeiro Orientador: Fagundes Junior, Antônio Aurélio de Paiva Abstract: Background: Intensive care unit (ICU) admissions with a primary psychiatric diagnosis represent a distinct care subgroup and may be associated with acute medical complications. Objective: To describe the clinical-epidemiological profile, temporal trends, and outcomes of ICU admissions with a primary psychiatric diagnosis in three tertiary hospitals within the supplementary health sector in the Federal District, Brazil (2015–2024). Methods: Multicenter retrospective cohort including adults (≥18 years), identified using ICD-10 codes and extracted from the Epimed Monitor® registry. Phase-based temporal analyses used pre-pandemic, pandemic, and post-pandemic periods defined by national regulatory milestones. The primary outcome was prolonged ICU length of stay (LOS ≥7 days); ICU mortality was a descriptive secondary outcome. Results: Among 47,400 ICU admissions, 2,159 (4.55%) had a primary psychiatric diagnosis; 1,348 comprised the final cohort. Most patients were women (71.88%), and self-harm/attempted suicide predominated (63.43%), followed by mood disorders (12.54%) and psychotic disorders (9.72%). LOS ≥7 days occurred in 133 admissions (9.87%). ICU mortality was 0.59% (n=8). In the multivariable model for LOS ≥7 days, higher odds were observed for uncomplicated diabetes (OR 3.26; 95% CI 1.62–6.12), prior stroke without sequelae (OR 7.05; 95% CI 1.16–41.38), focal neurological deficit (OR 6.00; 95% CI 1.94–16.84), pneumonia (OR 16.90; 95% CI 4.75–67.01), and parenteral nutrition (OR 45.07; 95% CI 6.59–886.16). Conclusion: Primary psychiatric ICU admissions were infrequent and had low ICU mortality; prolonged LOS was mainly associated with acute medical complications, and intensive support needs rather than the psychiatric diagnostic category itself. Editor: Escola Superior de Ciências da Saúde, Universidade do Distrito Federal Tipo: Dissertação

2026-04-04T00:00:00Z