https://repositoriobce.fepecs.edu.br/handle/prefix/16 2026-10-11T07:59:20Z https://repositoriobce.fepecs.edu.br/handle/123456789/1722 Título: Avaliação do conhecimento sobre câncer de pele em profissionais da saúde e pacientes na atenção primária de saúde do Distrito Federal Autor(es): Machado, Daniela Silva Primeiro Orientador: Reis, Carmélia Matos Santiago Abstract: Introduction: Skin cancer is one of the main contemporary public health challenges, presenting high incidence and significant socioeconomic impact. In the Brazilian context, non-melanoma skin cancer (NMSC) is the most frequent malignant neoplasm, representing approximately 33% of all cancer records in the country. Given the severity of the disease and its curative potential when detected early, Primary Health Care (PHC) plays a strategic role as the coordinating pillar of the network and the gateway for screening and health education. However, the effectiveness of this control may be limited by gaps in the technical knowledge of teams and in the population's perception of risk. Objectives: To evaluate the knowledge of physicians and nurses working in the PHC of the Federal District, Brazil, regarding skin cancer diagnosis, prevention, and risk factors, as well as to investigate the level of information and preventive practices of the population assisted in these units. Method: An observational, analytical, quantitative, and cross-sectional study conducted in 14 Basic Health Units (UBS) covering the seven health regions of the Federal District. The sample consisted of 122 professionals (G1) – physicians and nurses - and 150 patients (G2). Data were collected via in-person questionnaires addressing sociodemographic variables, theoretical knowledge, clinical practices, screening tools (such as the ABCDE mnemonic), and risk factors. Statistical analysis used Pearson's Chi-square test and Student's t-test, with a significance level of 5%, classifying as "satisfactory" a score of 50% or more on the objective questionnaire items. Results: Among health professionals, 67.21% presented unsatisfactory knowledge on the subject. Only 7.38% reported routinely performing skin physical examinations, and 54.10% were unfamiliar with the ABCDE method. It was found that physicians have significantly higher chances of identifying suspicious lesions (O.R.=5.610) and knowing the ABCDE method (O.R.=4.800) compared to nurses. In the patient group, 80% demonstrated unsatisfactory knowledge. The main sources of information were television (49.62%) and the internet (45.11%), while only 16.54% received guidance during consultations. Alarmingly, 74.67% of users stated their skin had never been examined at the UBS, and 86% were never guided on how to perform a skin self-examination. Obstacles such as lack of time (53.28%) and lack of specific training (54.10%) were the most cited difficulties by professionals. Conclusions: The study highlights a critical deficit in technical proficiency and preventive care practices related to skin cancer in the Federal District. Academic background and length of service proved to be determinants of the level of knowledge, revealing asymmetries between professional categories. Regarding patients, the lack of knowledge about the subject—as well as prevention methods—is even more pronounced, underscoring the inadequacy of health education within Primary Health Care (PHC). The implementation of Continuing Health Education (CHE) programs, standardization of active visual screening protocols, and the strengthening of the UBS as a primary source of scientific education are urgently needed to optimize early diagnosis and increase survival rates for SUS users. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação 2026-07-27T00:00:00Z 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