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O processo regulatório do acesso à oncologia clínica no Distrito Federal de 2022 a 2024: uma análise à luz do modelo dos múltiplos fluxos de Kingdon

2026-07-07T14:58:23Z

Título: O processo regulatório do acesso à oncologia clínica no Distrito Federal de 2022 a 2024: uma análise à luz do modelo dos múltiplos fluxos de Kingdon Autor(es): Oliveira, Viviane Rezende de Primeiro Orientador: Gottems, Leila Bernarda Donato Abstract: Introduction: In Brazil, healthcare regulation is a governance technology aimed at mitigating failures in access to the Unified Health System (SUS), executed within the Regulatory Complex through the National Regulation System. In the Federal District, clinical oncology is classified as a scarce and strategic service, requiring management by the Regulatory Complex. The relevance of this study lies in the need to investigate operational bottlenecks and compliance with legal frameworks in face of the care pressure resulting from the rising incidence and prevalence of cancer. Objectives: to analyze the regulatory process of access to clinical oncology in the Federal District from 2022 to 2024, from the theoretical perspective of Kingdon's Multiple Streams Model (MSM) and the National Regulation Policy. Specific objectives: to analyze the profile of operational outcomes, technical and structural non-conformities, response times, technological arrangements, the participation of actors in regulation policy, and the normative context to understand prevailing political forces. Method: A retrospective cohort of requests for first appointments in clinical oncology, in SISREG III, from January 1, 2022 to December 31, 2024, and a documentary analysis interpreted through Kingdon's Multiple Streams Model. The theoretical-methodological distinction resided in applying Kingdon’s MSM to interpret flow dysfunctions. Data were processed using Jamovi, software, with descriptive and inferential statistics, including binomial logistic regression to predict compliance and outcomes. Results: A total of 14,883 consultation requests were analyzed. Although the median regulator evaluation time decreased to 1 day in 2024 (95% CI 2.26 – 2.52), the users’ final access deteriorated, reaching a median of 80 days (95% CI 77.09 – 78.90). A critical “instructional blackout” was identified, where technical compliance varied drastically by entry point: the general hospital with clinical oncology showed a predicted probability of compliance ten times higher than that observed in emergency care units (UPAs)—0.1039 (95% CI 0.086 – 0.123) vs. 0.0105 (95% CI 0.003 – 0.032). Logistic regression demonstrated that requests originating from UPAs were 91% less likely to be compliant (OR=0.091, p<0.001). In Kingdon’s problem stream, the deficit of 5,176 vacancies and duplication rates (27%) reveal failures in traceability and network capacity. Conclusions: The findings suggest that the regulatory process in oncology in the Federal District shows a mismatch between the efficiency of technical analysis and real access to treatment. The convergence of Kingdon’s streams indicates that the “instructional blackout” and the shortage of vacancies serve as critical barriers that may compromise equity and comprehensiveness of care. It is concluded that the window of opportunity for improving oncology policy seems to depend on the qualification of primary care and the expansion of installed capacity, aiming for compliance with legal deadlines and reduction of vulnerabilities in the patient care pathway. Editor: Escola Superior de Ciências da Saúde; Universidade do Distrito Federal Tipo: Dissertação

Aprimoramento de modelo de inteligência artificial para estimativa de peso corporal de pacientes acamados por fotos de smartphones

2026-07-07T14:55:58Z

Título: Aprimoramento de modelo de inteligência artificial para estimativa de peso corporal de pacientes acamados por fotos de smartphones Autor(es): Faria, Michel Ramos Primeiro Orientador: Salomon, Ana Lúcia Ribeiro Abstract: Reference: Enhancement of an artificial intelligence model for body weight estimation in bedridden patients using smartphone images Introduction: Estimating body weight in bedridden patients remains a frequent challenge in hospital practice when direct measurement is not feasible. Conventional indirect methods present operational limitations and substantial variability in accuracy, whereas artificial intelligence–based approaches have emerged as promising alternatives. Objectives: To develop and improve an artificial intelligence model for body weight estimation from smartphone-acquired images obtained in a real-world hospital environment, aiming to achieve a proportion of estimates within 10% of measured body weight (P10) greater than 70%. Methods: This cross-sectional analytical study was conducted in five public hospitals in the Federal District of Brazil and included 300 hospitalized adults and approximately 1,300 body images. After direct measurement of body weight and height, participants were photographed in a hospital bed to simulate the intended application scenario of the technology. The model employed body segmentation, three-dimensional reconstruction, extraction of anthropometric attributes, and regression techniques to estimate body weight. Performance was evaluated using the proportion of estimates within 10% of measured body weight (P10), Mean Absolute Error (MAE), coefficient of determination (R²), and Intraclass Correlation Coefficient (ICC). Results were compared with those of a previously developed pilot model. Results: The model achieved a P10 of 78.7%, indicating that 78.7% of weight estimates were within 10% of the measured body weight. Compared with the pilot model, the Mean Absolute Error decreased from 13.16 kg to 5.24 kg, corresponding to a mean paired improvement of 7.93 kg. The coefficient of determination increased from 0.388 to 0.873, and agreement between estimated and measured values was high (ICC = 0.93). Conclusions: The artificial intelligence model demonstrated potential for body weight estimation in a real-world hospital setting using smartphone images. The findings indicate substantial improvement compared with the pilot model and performance consistent with contemporary criteria for clinical acceptability, supporting its potential use as a tool to assist multidisciplinary clinical practice when direct body weight measurement is unavailable. Editor: Escola Superior de Ciências da Saúde; Universidade do Distrito Federal Tipo: Dissertação

Associação entre mídias sociais com autolesão não suicida e pensamentos e comportamentos suicidas: uma umbrella review

2026-07-07T14:53:32Z

Título: Associação entre mídias sociais com autolesão não suicida e pensamentos e comportamentos suicidas: uma umbrella review Autor(es): De Toni, Giovanni Gonçalves Primeiro Orientador: Imoto, Aline Mizusaki Abstract: Suicidal behavior (STB) and non-suicidal self-injury (NSSI), usually aggregated under the term self-injurious thoughts and behaviors (SITB), are related conditions that constitute a serious global public health problem, disproportionately affecting young populations, with epidemiological trends of worsening over the last decade. This period coincides temporally with the massive incorporation of social media (SM). The simultaneity of these phenomena established an epidemiological alert, driving investigations into SM exposure as a potential factor associated with NSSI and STB. Objectives To map, synthesize, and critically assess the strength and quality of evidence regarding the association between different patterns and contexts of social media use with STB and NSSI. Methods An umbrella review was conducted following the Joanna Briggs Institute guidelines, with a broad and unrestricted search across seven databases. Systematic reviews (SR) evaluating any profile of participant or user exposed to social media in which the assessed outcome corresponded to the spectrum of NSSI or STB were included. Selection and data extraction were performed by independent pairs of reviewers. The adapted AMSTAR-2 was used for methodological quality analysis and the corrected covered area (CCA) for Data were presented according to thematic synthesis and implications for future practice, research, and policy. Results Sixteen SR met eligibility criteria; 15 comprised the final synthesis, aggregating 256 independent primary studies, predominantly including young people. Methodological quality was critically low for 81.25% and low for 18.75% of the reviews, with predominance of cross-sectional designs. Absence of prior protocol (10/16), non-comprehensive search strategy (14/16), lack of specification of the excluded studies list (10/16), and absence of 11 assessment of funding sources of primary studies were the main items that decreased evidence quality. Overall overlap was low (CCA = 1.79%). For specific exposures, overlap was low for cyberbullying (0%), but high to very high for social media usage time (13.5%); sexting (50%); problematic social media use (28%), and exposure to self-harm and suicide content (11%). Most reviews (75%) included studies with young people aged 12 to 25 years. Meta-analytic evidence from cross-sectional studies demonstrated associations between some variables and different outcomes across the NSSI and STB spectrum. Problematic ) was associated with suicidal ideation (OR = 2.81, 95% CI [1.72, 4.59]; k = 4). Cybervictimization was associated with all constructs of the SITB spectrum, with a smaller effect size for suicidal ideation (OR = 2.93; 95% CI [2.43–3.54]; k = 45) and larger for non-suicidal self-injury (OR = 4.36; 95% CI [2.32–8.20]; k = 3). Sexting was associated with non-suicidal self-injury (OR = 3.07; 95% CI [2.53–3.74]; k = 2) and suicide attempt (OR = 4.24; 95% CI [3.13–5.44]; k = 1), but not with suicidal ideation (OR = 2.37; 95% CI [0.98–5.73]; k = 1). Exposure to SITB content on social media was asociated with all constructs of the SITB spectrum, with a smaller effect size for suicidal ideation (OR = 2.12; 95% CI [1.31–3.43]; k = 3) and larger for non-suicidal self-injury (OR = 3.13; 95% CI [1.41–6.96]; k = 1). Social media usage time showed no significant association with NSSI, suicidal ideation, or suicide plans. Meta-analyzed longitudinal data are available only for cybervictimization, with associations with self-injury (OR = 2.23, 95% CI [1.43–3.47]; k = 3) and suicidal behavior (OR = 1.31, 95% CI [1.11–1.55]; k = 6). Participation in online forums to discuss SITB content showed a coexistence of associated benefits and risks. Greater sense of social connection, use for emotional regulation, and perceived reduction in behavior were benefits cited by users. On the other hand, behavioral activation, presence of behavioral triggers, social comparison, competitiveness for more extreme behaviors, normalization of behavior, formation of a symptom-based identity, social learning and contagion effect, subversion of support, caregiver burden, and vicarious trauma were described as associated harms. Analysis of primary studies points to factors that possibly increase the association, particularly female sex, previous depressive symptoms, interpersonal conflicts or low offline support, younger age, sleep impairment, and increased usage time throughout adolescence. Studies were predominantly cross-sectional. Several methodological factors appear to modify the association, particularly self-report, which may attenuate the effects of usage time but underestimate the association among individuals experiencing psychological distress. Additionally, online recruitment appears to overestimate the effect in quantitative data, but not when assessing the subjective experiences of users of online forums and social networks. The association tends to increase when studies do not control for confounding variables such as baseline psychopathology, depression, or offline bullying. Conclusions The association found for specific exposure variables, to the detriment of usage time, evidences the need to move beyond the use of broad constructs in clinical practice, regulation, and research, prioritizing patterns, contexts, and content accessed. Critical analysis of the evidence points to limits for its extrapolation, but the convergence of findings justifies contextualized preventive strategies, such as protection against cyberbullying and sexting practices, against mechanisms that reduce control over use, and in favor of sensitive content moderation. The data support important considerations for new research in the field. Regarding new reviews, the use of specific exposure and outcome variables and attention to methodological quality may allow better extrapolation of results. For primary studies, particular attention is recommended regarding control for baseline comorbidities, recruitment biases, and measurement validity, as well as the adoption of longitudinal designs capable of supporting causal inference about the relationship between SM and SITB. Despite the low methodological quality, the possible risks of bias noted, and the predominance of cross-sectional studies that do not allow causal inferences, some online phenomena were consistently related to one of the outcomes with greatest lethality within psychiatry. Therefore, given the impact of this condition, it may be unfeasible to await better available evidence for regulatory decisions, at the risk of penalizing an entire generation of young people exposed to a variable never before studied in science. Editor: Escola Superior de Ciências da Saúde; Universidade do Distrito Federal Tipo: Dissertação

Emergências psiquiátricas infantojuvenis: lacunas na linha de cuidadi em políticas públicas de saúde mental no SUS-DF

2026-07-07T14:48:28Z

Título: Emergências psiquiátricas infantojuvenis: lacunas na linha de cuidadi em políticas públicas de saúde mental no SUS-DF Autor(es): Azevedo, Ana paula Bilac Primeiro Orientador: Romão, Bernardo Abstract: This dissertation analyzes the care pathway for child and adolescent psychiatric emergencies within the Unified Health System of the Federal District (SUS-DF), based on SES-DF Ordinance No. 185/2012, SES-DF Ordinance No. 536/2018, and the Federal District Mental Health Master Plan (PDSM-DF). It is a qualitative, exploratory, and documentary study grounded in thematic Content Analysis, as proposed by Bardin, complemented by lexical analysis using MAXQDA software. The findings indicate advances in the formal structuring of the care network and in the description of its service components; however, they also reveal persistent normative gaps regarding the definition of child and adolescent psychiatric crisis, the organization of care flows, the allocation of responsibilities across service points, and the specificities of care for children and adolescents. Lexical recurrence analysis reinforced the centrality of terms associated with a hospital-centered logic and the low discursive density of categories related to development, comprehensive protection, and territorialized care. It is concluded that the analyzed care pathway remains marked by operational ambiguities and insufficient normative density to support comprehensive, intersectoral, and territorial responses to child and adolescent psychiatric crises, indicating the need to strengthen public policies and the Psychosocial Care Network (RAPS). Editor: Escola Superior de Ciências da Saúde; Universidade do Distrito Federal Tipo: Dissertação