https://repositoriobce.fepecs.edu.br/handle/prefix/5 2026-04-12T08:45:56Z https://repositoriobce.fepecs.edu.br/handle/123456789/1676 Título: Saúde da pessoa com lesão medular traumática: um guia interativo para refletir, cuidar e ressignificar o futuro Autor(es): Silva, Pedro Henrique Mourão Primeiro Orientador: Salomon, Ana Lúcia Ribeiro Abstract: Introduction: Traumatic spinal cord injury (TSCI) and aging are interrelated phenomena that result in functional declines arising from the progressive loss of motor, sensory, and autonomic capacities, representing an increasing challenge to global health. The expansion of healthcare services has contributed to increased life expectancy among persons with disabilities, enabling them to reach old age even in the presence of conditions once considered disabling. However, although individuals with TSCI benefit from advances in care practices and therapeutic strategies, their life expectancy remains lower than that of the general population. The limitations resulting from TSCI affect the performance of identity-related activities that confer social and personal meaning—such as work, education, and family or community support— potentially leading to significant emotional and psychosocial consequences. Studies show that the presence of mental disorders is associated with decreased life satisfaction and more pronounced impairments in the performance of daily activities, particularly those related to compromised physical and mental health conditions. Manifestations of emotional distress and challenges in the mental health domain significantly affect individuals’ coping capacity when facing TSCI, increasing their vulnerability to illness processes. In this context, a central question arises: what is the meaning of aging for individuals with TSCI, considering that they have already undergone complex processes of physical, psychological, and social redefinition and adaptation? This question invites reflection on how these individuals, who have experienced profound transformations throughout their life trajectories, perceive the possibility of new functional losses, particularly in light of studies indicating that aging among people with TSCI presents additional challenges compared to typical physiological aging, characterized by the emergence of secondary impairments at a higher rate than in the general population. The research problem originates from the researcher’s professional practice within the Rehabilitation and Long-Term Care Unit of the Hospital de Apoio de Brasília. Objective: To understand the meaning of aging for individuals affected by the sequelae of TSCI. To this end, the study sought to investigate how TSCI sequelae influence the construction of these individuals’ perceptions of aging; to explore the emotional consequences related to the aging experience among people with TSCI; to discuss the influence of socio-environmental factors on the understanding of the meaning of aging among individuals with TSCI sequelae; to analyze how the rehabilitation process affects the perception of aging among people with TSCI; to foster discussions aimed at improving care practices for individuals affected by TSCI sequelae; and to propose the development of educational materials (an e-book and a printed book) to assist people affected by TSCI in understanding the process of re-signification and in promoting a better quality of life. Methods: This study is exploratory and analytical in nature, employing a qualitative approach. Ten participants aged between 33 and 59 years were interviewed, selected through convenience sampling while adhering to inclusion and exclusion criteria. The interview guide included a brief history of the TSCI, the resulting sequelae, the participant’s level of functionality, and other aspects related to the study theme, aligned with the general and specific objectives of the research. Participant selection was carried out through direct contact with hospitalized patients, phone contact with former inpatients, and dissemination of the study in WhatsApp groups composed of beneficiaries from the Special Physical Education Training Center (CETEFE). In all approaches, potential participants were fully informed about the study and its objectives; upon expressing interest, they scheduled an orientation session, signed the Informed Consent Form (ICF), and subsequently underwent the interview. The interviews were conducted in person, respecting the ethical principles of confidentiality and participant protection. Initially, a questionnaire was applied to identify participants’ sociodemographic profiles (Appendix A), followed by a semi-structured interview for further exploration of the information (Appendix B). The in-depth interviews were conducted individually, in a single session, with an average duration of 1 hour and 7 minutes. After data collection, the material was subjected to Content Analysis, using the thematic categorical approach, enabling the identification of eight analytical categories and the mapping of recurring themes in participants’ discourses. All interviews were conducted in full compliance with the ethical standards governing research involving human beings, following approval by the Research Ethics Committee (CEP), under Certificate of Ethical Appreciation (CAAE) No. 760924.1.0000.5553, and substantiated opinion No. 6.863.105. The development of the educational material *HEALTH OF PERSONS WITH TRAUMATIC SPINAL CORD INJURY: An Interactive Guide to Reflect, Care, and Re-signify the Future* was guided by the principles of health education, humanized care, and communicational accessibility, integrating scientific knowledge with the sensitive listening of people living with TSCI. The development process was structured in two main stages: 1. **Conceptual planning** – definition of target audience, pedagogical objectives, and thematic axes, based on the results of the qualitative study *A Study on the Meaning of Aging for People Affected by Sequelae of Traumatic Spinal Cord Injury*. This stage aimed to align the contente with the specific needs of individuals undergoing rehabilitation and receiving ongoing care. 2. **Content development** – textual production supported by recent scientific evidence on rehabilitation, mental health, quality of life, and aging among persons with physical disabilities, published in high-impact journals in the last five years. The content was designed to be inclusive, clear, and dialogic, promoting accessible and meaningful understanding for the target audience. Developed Products: Product 1 – Technical and Technological Product (TTP) – Book: HEALTH OF PERSONS WITH TRAUMATIC SPINAL CORD INJURY: An Interactive Guide to Reflect, Care, and Re-signify the Future. Final Considerations: The investigation revealed that the aging process in individuals with TSCI is shaped by multiple interwoven dimensions—physical, psychological, social, and spiritual—that converge to construct layers of meaning throughout life. Eight central categories emerged, expressing the daily challenges faced by individuals with TSCI: losses; invisibility and accessibility; dependence and independence; aging; faith and hope; the need to improve health services; and overcoming and re-signification. These dimensions form a mosaic of experiences permeated by feelings of fear, loneliness, shame, and loss of autonomy, but also by the desire for survival, hope, and the search for meaning. The narratives revealed that aging is initially perceived as an amplification of the vulnerabilities associated with TSCI, evoking the fear of becoming a burden to family members. However, as the dialogues deepened, new ways of understanding aging emerged—linked to the maintenance of autonomy, family relationships, sports practice, and the pursuit of personal projects. The tension between dependence and independence proved to be the structuring axis of these experiences, highlighting the decisive role of public policies, accessibility, technological resources, and the quality of health services in shaping the meaning of aging. The results show that aging with TSCI transcends the biological dimension, constituting a process of re-signification supported by faith, social support, and active participation in community life. The study also demonstrated that leisure, sports, work, and family interaction function as key elements that foster hope and belonging, strengthening life projects and reducing fears related to old age. This research culminated in the development of the educational material *HEALTH OF PERSONS WITH TRAUMATIC SPINAL CORD INJURY: An Interactive Guide to Reflect, Care, and Re-signify the Future*, conceived as an instrument for health education and comprehensive care support. The product organizes the thematic axes that emerged from the participants’ narratives and proposes a welcoming and participatory approach aimed at reflection on the body, emotions, and life projects—serving as an applicable resource in rehabilitation programs and within Brazil’s Unified Health System (SUS). The research objectives were successfully achieved, contributing to the advancement of knowledge about aging with TSCI and to the improvement of healthcare delivery for persons with disabilities in the Brazilian context. Future studies are recommended to include greater female representation and to expand national investigations on this subject. Finally, it is emphasized that aging with TSCI can be understood not merely as na accumulation of losses, but as an opportunity for reinvention and empowerment—when supported by inclusive public policies, humanized practices, and networks of solidarity and care. Editor: Escola de Saúde Pública do Distrito Federal Tipo: Dissertação 2025-12-05T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1675 Título: Identificação precoce dos sinais de risco para transtorno do espetro autista no ambulatório de puericultura de um serviço de referência do Distrito Federal: trainamento no uso da Grade Preaut Autor(es): Campos, Indira Souza Costa Primeiro Orientador: Figueiredo, Ana Cláudia Novais Godoy Abstract: Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as restricted and repetitive behaviors and interests. Early diagnosis is associated with timely intervention and attenuation of the severity of phenotypic and genetic expression. ASD originates in the early years of life; however, its clinical presentation is heterogeneous, and early signs may be evident shortly after birth, making its identification, treatment, and the formulation of public health policies a major challenge. Objective: To identify the prevalence of positive signs of psychic risk for the development of ASD in infants aged four to fifteen months followed at a reference service in the Federal District using the PREAUT Grid—a screening tool validated in Brazil, originally developed in France and grounded in psychoanalytic principles—while also training healthcare professionals responsible for child health care to incorporate the PREAUT Grid into routine clinical practice. Methods: This was an observational, cross-sectional, and descriptive study conducted between March and July 2025, including infants aged four to fifteen months. Risk signs and associated factors for ASD were assessed using the PREAUT Grid and a structured questionnaire containing sociodemographic and perinatal variables considered relevant in the literature, including chronological age (months), gestational age (weeks and days), sex (female or male), type of delivery (vaginal or cesarean), Apgar scores at 1 and 5 minutes, birth weight (grams), and parental age (years), need for neonatal ICU admission, need for oxygen therapy, prenatal care received by the mother, gestational period at which prenatal care began and number of visits, maternal illnesses during pregnancy, use of neuropsychiatric medications by the mother, and other clinical conditions.. The study was carried out at the Pediatric Outpatient Clinic – Growth and Development, located in the Child and Adolescent Unit of a university hospital in the Federal District. The research comprised four stages: participant selection, data collection, training of the healthcare team in the use of the PREAUT Grid, and statistical analysis of the association between the outcome variable and predefined covariates. The PREAUT Grid consists of four questions assessing mother–infant interaction, with a maximum score of 15 points. When the initial score is below three, two additional questions are applied. Based on the observed behaviors, infants are classified as “positive” or “non-positive” for psychic risk potentially leading to ASD, with “positive infant” defined as the study outcome. The minimum estimated sample size was 123 infants, considering 80% power, a 95% confidence level, a 5% alpha error, and an estimated prevalence of 50%. Data analysis included descriptive statistics, measures of central tendency and dispersion, and estimation of prevalence with corresponding 95% confidence intervals. For the in-service training, the target audience—professionals responsible for child health care—was defined, theoretical topics were selected, and lecturers with expertise in the field were chosen from within the institution. The number of available slots was determined by the auditorium capacity. The course was advertised through the Doity platform with institutional authorization. The total workload was 20 hours, and practical training took place in the pediatric outpatient clinic. Results: The first product, a scientific article entitled “Prevalence of positive signs of psychic risk for autism spectrum disorder in infants attending child health care clinics”, identified a prevalence of 5.7% of positive risk signs for ASD. The sample was predominantly male (60.98%), born by cesarean section (58.20%), with birth weight greater than 2500 g (81.30%), and born at term (≥37 weeks; 80.49%). Most infants had a 5-minute Apgar score greater than 7 (91.87%). Most mothers were aged 20–34 years (69.92%), and most fathers were aged 40 years or younger (83.90%). Maternal diseases during pregnancy were reported in 73.17% of cases, with gestational diabetes (30.77%) and other clinical conditions (30.77%) being the most frequent. Most infants did not experience fetal distress (83.47%), did not require neonatal intensive care (76.23%), or oxygen therapy (66.67%). Almost all mothers attended prenatal care (99.17%), initiated in the first trimester (88.03%), with more than six consultations (91.38%). The in-service training, entitled “I Course on Infant Development: Training in the Early Identification of Autism Risk and Practical Use of the PREAUT Grid.”, yielded satisfactory results, with 55 participants, including professionals from nursing and psychology, highlighting its multiprofessional nature. High participant engagement was observed. These findings support the feasibility of implementing the PREAUT Grid in public child health services in the Federal District to promote early identification of ASD risk and reduce delayed diagnoses. The project aligns with the research line Quality of Care for Women’s, Children’s, and Adolescents’ Health. Discussion: The 5.7% prevalence of ASD risk signs identified using the PREAUT Grid supports the feasibility of early detection of developmental vulnerabilities within the first year of life. The predominance of male infants aligns with epidemiological evidence, while the fact that most infants were born at term with adequate birth weight highlights the multifactorial nature of ASD. Communication- and interaction-related behavioral signs become increasingly discriminative toward the end of the first year of life, supporting the use of screening tools during this period. Although early markers show limited stability, attentional, motor, and relational changes may precede formal diagnosis. Systematic use of tools such as the PREAUT Grid—especially when combined with other instruments—can enhance developmental surveillance and timely referral. The professional training demonstrated the feasibility of qualifying healthcare teams for early risk identification within child health care settings. Incorporating standardized tools and continuing education can improve care quality and reduce reliance on late referrals. As a screening tool rather than a diagnostic instrument, the PREAUT Grid enables early parental guidance and longitudinal follow-up, aligning with preventive and health promotion models. Its integration into routine care may also improve service organization and reduce tertiary care overload. Conclusion: The findings highlight the importance of expanding research and professional training initiatives aimed at early identification of ASD risk. Qualified healthcare professionals play a critical role in establishing timely diagnoses and initiating appropriate interventions, thereby improving quality of life for affected individuals and their families. The study demonstrated the prevalence of psychic risk signs for ASD in infants and reinforces the need for complementary diagnostic approaches in children under two years of age. The proposed method is innovative and has the potential to inform child health policies, professional training, and clinical practice, particularly in nursing, given the role of nurses in primary child health care. The training course developed represents a technical product with potential local, regional, and national impact. Further large-scale, longitudinal studies are recommended to better characterize the sociodemographic and psychosocial profile of ASD cases and strengthen early detection strategies. Editor: Escola de Saúde Pública do Distrito Federal Tipo: Dissertação 2026-01-19T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1674 Título: O impacto da avaliação pré-anestésica na ansiedade dos pacientes ortopédicos: um ensaio clpinico randomizado Autor(es): Lopes, Iuri Ferreira Primeiro Orientador: Fagundes Júnior, Antônio Aurélio Abstract: Reference: The Impact of Pre-anesthetic Evaluation on Anxiety in Orthopedic Patients: A Randomized Clinical Trial. Background: Pre-anesthetic evaluation (PAE) is an essential process that prepares patients for surgery and may reduce anxiety and associated risks. It is a patient right and a medical duty, according to the resolutions of the Federal Council of Medicine (CFM). The relationship between PAE and anxiety reduction still requires robust evidence in the Brazilian scenario, a gap this study seeks to fill within the context of orthopedic trauma. Objective: To evaluate the impact of PAE timing on perioperative anxiety levels in patients undergoing orthopedic surgery. Secondary objectives included performing a concurrent validation of the Likert scale (self-declaration) against the short-form STAI scale and determining the prevalence of clinically significant anxiety in the sample compared to data available in national and international literature. Method: A randomized clinical trial was conducted with inpatients for orthopedic surgery at a tertiary hospital. Patients with a previous diagnosis of anxiety or depression disorders were excluded. Participants were allocated into two groups: Group 1 Control (PAE a few minutes before surgery) or Group 2 Intervention (PAE up to 12 hours before the surgical procedure). Anxiety was measured upon admission to the preoperative room using the short-form STAI scale and a Likert scale. Results: A total of 99 patients were analyzed, predominantly male (72%), lowincome (58%), and accident victims (75%). The mean short-form STAI score was 20.6 (moderate anxiety). The Likert scale was validated against the short-form STAI, showing a discriminative accuracy of 0.914. An anxiety prevalence of 24.2% was identified, a value lower than global averages, potentially influenced by the sample's resilience profile and the exclusion criteria. There was no statistically significant difference in global scores between groups; however, the variable "I am tense" showed a significant reduction in the intervention group (p=0.023). Discussion: The results indicate that the timing of the evaluation did not alter global anxiety scores, diverging from part of the international literature. However, the specific reduction in tension suggests that early PAE modulates extreme emotional states. The low prevalence found reflects the intrinsic characteristics of the treated trauma population and the impact of excluding patients with a psychiatric history from the sample. Conclusion: PAE does not suppress basal anxiety, a legitimate emotional response, but it modulates its most extreme peaks, such as tension. The validation of the Likert scale as a rapid screening tool demonstrates practical utility for clinical workflow. The equivalence between groups validates the logistic flexibility of the service in public hospitals, allowing for schedule organization according to demand without compromising the measured emotional well-being. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação 2026-03-04T00:00:00Z https://repositoriobce.fepecs.edu.br/handle/123456789/1622 Título: Alimentação escolar no Distrito Federal: uma análise socioambiental das refeições oferecidas nas escolas públicas Autor(es): Mello, Julia Serejo Primeiro Orientador: Hargreaves, Shila Minari Abstract: Introduction: School feeding in Brazil is guided by the National School Feeding Programme (PNAE), which establishes directives for providing healthy, balanced, and culturally appropriate meals that promote beneficial and sustainable eating habits. The Program also aims to foster local economic and social development by supporting family farming and contributing to environmental and social sustainability. In the Federal District, the PNAE is implemented by the State Department of Education (SEEDF), which serves multiple educational modalities and provides approximately 97 million meals per year to more than 400,000 students. In 2024, school menus showed a substantial presence of animal-based foods, raising concerns about the socioenvironmental impacts associated with their production and consumption. Consequently, there is a clear need to promote food offerings in schools that are both healthy and environmentally sustainable, in alignment with national and international recommendations advocating for reduced consumption of animal-derived products to safeguard human and environmental health. Objective: To evaluate the environmental impact and nutritional quality of school meals provided to students in the public education system of the Federal District. Methodology: The research was structured in two stages, beginning with the analysis of a sample comprising 130 daily menus provided by the School Feeding Programme of the Federal District in 2024, considering both nutritional quality and environmental impact through the assessment of water and carbon footprints. Subsequently, a theoretical model of a strict vegetarian menu was developed with the aim of comparing it to the current menu, enabling an analysis of the nutritional and environmental implications of both. Results: The 2024 public school meals demonstrated adequate nutritional composition in most assessed aspects, with a variety of food groups and low levels of ultra-processed products. Nutritional inadequacies identified included excessive levels of saturated fat and protein, both surpassing recommended values. Moreover, animal-based foods were found to have the highest environmental impact, accounting for more than 86% of the water and carbon footprints despite contributing less than 30% of the diet’s total caloric content. To mitigate these impacts, the implementation of the “Meatless Monday” campaign is proposed, consisting of the introduction of a strictly vegetarian menu once per week. This measure has the potential to generate numerous benefits, particularly by increasing dietary fiber, reducing saturated fat intake, and significantly lowering environmental footprints compared with those observed in the analyzed sample. Conclusion: The findings highlight the need to invest in strategies that reduce the environmental impacts of public-school meals while simultaneously improving student health outcomes. The primary recommendation is the adoption of the “Meatless Monday” initiative. Finally, food and nutrition education initiatives are essential for raising awareness within the school community, improving student acceptance of legume-based dishes, and training school food service staff. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação 2026-02-06T00:00:00Z