https://repositoriobce.fepecs.edu.br/handle/prefix/16 2026-08-25T23:57:47Z https://repositoriobce.fepecs.edu.br/handle/123456789/1713 Título: Riscos psicossociais nas residências em medicina de família e comunidade do Distrito Federal Autor(es): Souza Júnior, David Barbosa de Primeiro Orientador: Salomon, Ana Lúcia Ribeiro Abstract: Introduction: Medical residency, recognized as the gold standard for specialized training in Brazil, is a setting for work-based learning, but also one marked by intense clinical, pedagogical, and subjective demands. In the field of Family and Community Medicine, the expansion of Network Residency Programs, especially within the Federal District State Health Secretariat, increased the number of positions and training settings while also revealing challenges related to working conditions, institutional organization, and the mental health of residents and preceptors. Exposure to psychosocial risk factors, such as overload, harassment, violence, imbalance between personal and professional life, emotional distress, and use of psychoactive substances, may affect training, professional performance, and the quality of health care. Objective: To analyze the psychosocial risks and work context of residents and preceptors in the Family and Community Medicine Residency Program who use training settings linked to the Federal District State Health Secretariat. Method: This was a descriptive, field-based, quantitative, exploratory cross-sectional study conducted with 109 participants, including 37 preceptors, 36 first-year residents, and 36 second-year residents. Data were collected using a structured, validated, and adapted electronic questionnaire administered through the REDCap® platform. Sociodemographic variables, working conditions, satisfaction with the specialty, work environment, exposure to harassment and violence, anxiety and depressive symptoms, psychosomatic complaints, suicidal ideation, professional activities outside residency, and use of psychoactive substances were investigated. The analysis included descriptive and inferential statistical procedures, with a 5% significance level. Results: A total of 109 participants took part in the study, with a predominance of women and heterosexual individuals. Differences were observed between groups regarding marital status and living arrangements, with a higher proportion of single residents and married or cohabiting preceptors. Compared with preceptors, residents reported greater dissatisfaction with the specialty, higher daily emotional exhaustion, anxiety symptoms, difficulty controlling worries, depressive feelings, and greater imbalance between professional and personal life. Physical aggression was more frequent among second-year residents, particularly when perpetrated by patients or accompanying persons. Consumption of energy drinks was higher among residents. Although no statistically significant differences were observed regarding suicidal ideation, its presence was identified in all groups. Psychosomatic complaints were high and similarly distributed among residents and preceptors. Conclusion: Residency in Family and Community Medicine in training settings linked to SES-DF is associated with important psychosocial risk factors, with greater vulnerability among residents, especially regarding emotional distress, dissatisfaction with the specialty, imbalance between work and personal life, and exposure to situations of violence. The findings indicate the need for ongoing institutional strategies to promote mental health, prevent violence, strengthen supervision, and expand psychosocial support, in order to improve the training and work environment, protect residents and preceptors, and contribute to safer, more ethical, and more humanized care within the Brazilian Unified Health System. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação 2026-06-09T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1712 Título: O uso de antipsicóticos no manejo de transtornos mentais crônicos graves e persistentes: uma revisão de escopo Autor(es): Silva, Ana Paula Alves da Primeiro Orientador: Novaes, Maria Rita Carvalho Garbi Abstract: Chronic severe and persistent mental disorders represent a significant public health challenge due to their high prevalence, prolonged course, substantial functional impairment, and the need for continuous follow-up within health care systems. In this context, antipsychotic medications constitute the main pharmacological class used in the clinical management of these conditions and are widely prescribed in the treatment of schizophrenia, schizoaffective disorder, and severe forms of bipolar disorder, both in psychiatric inpatient settings and in community mental health services. Despite their therapeutic relevance, the long-term use of these medications is marked by challenges related to drug selection, therapeutic regimens, safety, treatment adherence, metabolic and neurological adverse effects, as well as the frequent practice of antipsychotic polypharmacy. The general objective of this scoping review was to map and synthesize the scientific evidence published over the last ten years regarding the use of antipsychotics in the management of chronic severe and persistent mental disorders, with emphasis on psychiatric hospitalization and community-based mental health care settings. This is a qualitative, exploratory, and descriptive scoping review conducted in accordance with the methodological framework proposed by Arksey and O’Malley and the recommendations of the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The literature search was carried out in the PubMed/MEDLINE, Virtual Health Library, Scopus, PsycINFO, Web of Science, and CAPES Journals Portal databases, in addition to grey literature sources, considering studies published between January 2015 and December 2024. Original articles, reviews, clinical guidelines, dissertations, and theses addressing the use of first- and/or second-generation antipsychotics in populations with chronic severe and persistent mental disorders were included. The results revealed substantial heterogeneity in antipsychotic use, both regarding pharmacological classes and therapeutic regimens. A predominance of second-generation antipsychotics was observed, mainly justified by their more favorable tolerability profile, although concerns regarding metabolic adverse effects remain prominent. Antipsychotic polypharmacy emerged as a recurrent practice in contexts of greater clinical severity, despite ongoing controversies surrounding its effectiveness and safety. In community mental health services, antipsychotics were identified as a central component of treatment, frequently associated with challenges related to treatment adherence, insufficient monitoring of adverse effects, and weaknesses in the integration of pharmacological management with psychosocial interventions. It is concluded that, although antipsychotics are essential in the management of chronic severe and persistent mental disorders, the scientific literature highlights relevant gaps concerning rational use, long-term treatment safety, and the integration of pharmacological care with psychosocial approaches. This scoping review allowed for the identification of trends, convergences, and challenges in the field, contributing to the improvement of clinical practice, the organization of mental health services, and the direction of future research. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação 2026-05-11T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1698 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 2026-06-03T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1697 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 2026-05-25T00:00:00Z