DSpace Coleção: Trabalhos finais de conclusão de curso

Método Ponseti no tratamento do pé torto congênito idiopático em um serviço de assistência pública à saúde

2025-09-25T00:00:00Z

Título: Método Ponseti no tratamento do pé torto congênito idiopático em um serviço de assistência pública à saúde Autor(es): Brito, André Thiago Scandiuzzi de Primeiro Orientador: Reis, Carmélia Matos Santiago Abstract: Introduction: Congenital Clubfoot (CF) is the most common congenital musculoskeletal deformity in humans. Inadequate treatment can lead to severe functional limitations in adulthood and reduced quality of life. The Ponseti Method, a minimally invasive approach, has demonstrated global success, but data on its effectiveness in public healthcare services in Brazil are still sparse. Objective: To evaluate the effectiveness of the Ponseti method in the treatment of idiopathic CF in a public medical assistance healthcare service. Method: A retrospective longitudinal cohort study was conducted with individuals admitted up to 2 years of age at the Brasília hospital of the Sarah Rehabilitation Hospitals Network between January 6, 1997, and November 22, 2023. Epidemiological data were collected, and the application of the Ponseti method was evaluated in two periods: 2009-2017, with the use of ankle-foot orthosis (AFO), and 2017-2023, with the use of abduction orthosis. Results were assessed using recurrence rates, residual deformities, and the modified Laaveg-Ponseti scale. Results: From 1997-2009, 1,386 individuals were treated with the traditional method, with 93.5% undergoing posteromedial surgery. From 2009-2023, 552 individuals underwent the Ponseti method, comprising 72.7% male, 27.3% female, and 52.5% with bilateral involvement, totaling 842 treated feet. The Pirani classification was used from 2017-2023, with an average score of 5.5 at admission. 92.5% of cases underwent Achilles tenotomy after cast changes. The mean follow-up time was 10.3 years in the first period and 5.3 years in the latter, with an average number of cast changes of 7.4 and 6.2, respectively. Comparing the AFO and abduction orthosis groups, a p-value< 0.05 was found for recurrence (71.9% vs. 31.2%), a p-value< 0.05 for modified Laaveg (good/excellent 69.3% vs. 81.8%), and a p-value < 0.05 for residual deformity (67.7% vs. 43%). Conclusion: The Ponseti method is effective in correcting CF, consistent with existing literature. The use of AFO results in more recurrence, residual deformity, and worse functionality, thus advocating for the routine use of abduction orthosis. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação

Acesso à atenção ambulatorial especializada no Brasil: uma análise comparada dos modelos de regulação em cenários brasileiros selecionados

2025-09-19T00:00:00Z

Título: Acesso à atenção ambulatorial especializada no Brasil: uma análise comparada dos modelos de regulação em cenários brasileiros selecionados Autor(es): Silva, Thais Barros Zanette da Primeiro Orientador: Gottems, Leila Bernarda Donato Abstract: Introduction: In Brazil, the Unified Health System promotes the expansion of population access to health services that are appropriate to their needs and delivered in a timely manner through the national regulatory policy. This policy encourages the development of interventions at state and municipal levels through a body known as Regulatory Complexes, which serve as mediators between user demand and the actual provision of care by health services. These interventions influence service delivery processes by modifying or (re)directing their execution by means of inductive, standardizing, regulatory, or restrictive mechanisms. Objectives: To analyze how different subnational governments, based on common national guidelines, develop their own models for regulating access to specialized outpatient care, with varying degrees of innovation, institutionalization, and sustainability; and to examine how telehealth tools have generated incremental innovations in selected contexts and contributed to addressing local challenges related to access, care coordination, and healthcare network organization. Method: This is a comparative study on the implementation of public policies. Data collection was carried out through interviews with key stakeholders, document analysis, and literature review, consolidated into detailed descriptions of each context, which together composed the researchcorpus. The analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). The selected case studies included the states of Ceará, Santa Catarina, the Federal District, and Rio Grande do Sul, as well as the municipalities of Curitiba-PR, Belo Horizonte-MG, Porto Alegre-RS, and São Paulo-SP. Results: The eight Brazilian experiences with outpatient regulation are marked by diversity in organizational models, levels of institutionalization of teleconsultation, and integration across levels of care. The adoption of technologies, clinical protocols, and digital systems varied across locations and was influenced by structural, normative, and contextual factors. When integrated, teleconsultation improved referral quality and increased problem-solving capacity in primary care; however, its implementation remains uneven across the country. Conclusion: Technological advances have significantly contributed to the development of standardized and reproducible processes that facilitate access to health services for the population. Teleconsultation has proven to be an effective strategy for reducing waitlists and organizing demand for specialized care within thepublic health system. Nonetheless, its use is not yet evenly distributed across different regions of the country. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação

Ações afirmativas na graduação em medicina: avaliação do perfil e do desempenho cognitivo, prático e profissional de estudantes admitidos pelo sistema de cotas e de ampla concorrência no primeiro ano do internato

2025-09-29T00:00:00Z

Título: Ações afirmativas na graduação em medicina: avaliação do perfil e do desempenho cognitivo, prático e profissional de estudantes admitidos pelo sistema de cotas e de ampla concorrência no primeiro ano do internato Autor(es): Zaramella, Claudia Regina Primeiro Orientador: Amorim, Fábio Ferreira Abstract: Introduction: The expansion of access to higher education through affirmative action policies has been a strategy adopted to reduce educational opportunity inequalities in Brazil. These policies aim to increase the representation of historically underrepresented groups; however, they continue to generate debate, particularly in highly competitive programs such as Medicine, regarding their impact on student profiles and academic performance. Objective: This study aimed to compare the sociodemographic and socioeconomic profiles of students admitted through regular path and those admitted through affirmative action system. Additionally, it sought to evaluate the academic performance of these groups in the fifth year of the Medical Program at the School of Health Sciences, taking into account factors associated with academic achievement. Methods: This prospective cohort study included 236 students enrolled in the Medical Program at the School of Health Sciences (ESCS) who completed the fifth year of the program between 2022 and 2024. Data were obtained from the ESCS academic system and government databases. Academic performance was assessed based on cognitive evaluations, practical assessments, professionalism evaluations, and the final year grade point average. Statistical analyses included univariate tests and multiple linear regression models. Results: Of 236 students, 102 (43.2%) were admitted through the social quota system and 134 (56.8%) through open competition. Quota students had a higher median age at admission (median [MD] = 21 years; interquartile range [IQR] = 19–24) compared to non-quota students (MD = 20; IQR = 19–21; p < 0.001), a lower proportion of selfdeclared white students (46.1% vs. 78.4%; p < 0.001), a lower frequency of parentes with higher education (44.1% vs. 94.8%; p < 0.001), lower household Human Development Index (MD = 0.813; IQR = 0.731–0.883 vs. 0.941; IQR = 0.866–0.955; p < 0.001), and lower per capita income (MD = 2.17; IQR = 1.37–3.99 vs. 7.93; IQR = 3.99–10.63; p < 0.001). Although open competition students performed better in three of the four assessments in the univariate analysis, the type of admission was not significantly associated with academic performance in the multivariate analysis. In the cognitive assessment, only age at admission showed a statistically significant association, with a negative effect on performance (β = –0.039; 95% CI: –0.065 to – 0.014; p < 0.001). In the practical assessment, none of the variables analyzed showed a significant association with performance. In the professionalism assessment, significant associations were observed with female sex (β = 0.165; 95% CI: 0.013 to 0.316; p = 0.033), being married (β = 0.589; 95% CI: 0.151 to 1.027; p = 0.009), having at least one parent with higher education (β = 0.242; 95% CI: 0.036 to 0.448; p = 0.021), and age at admission, which again showed a negative association (β = –0.033; 95% CI: –0.055 to –0.011; p = 0.003). Finally, regarding the final fifth-year grade point average, factors significantly associated with better performance included female sex (β = 0.146; 95% CI: 0.032 to 0.261; p = 0.013), being married (β = 0.376; 95% CI: 0.044 to 0.708; p = 0.0271), and younger age at admission (β = –0.032; 95% CI: – 0.048 to –0.015; p < 0.001). Conclusion: Despite the sociodemographic and socioeconomic differences identified between the groups, quota students demonstrated academic performance equivalent to that of non-quota students when contextual variables were controlled. These findings reinforce the effectiveness of affirmative action as a strategy for social inclusion and equity in higher education, without compromising the quality of medical graduation. Editor: Escola Superior de Ciências da Saúde, Universidade do Distrito Federal Tipo: Dissertação

Avaliação das demências: uma revisão de escopo sobre instrumetnos utilizados no Brasil

2025-07-30T00:00:00Z

Título: Avaliação das demências: uma revisão de escopo sobre instrumetnos utilizados no Brasil Autor(es): Andrade, Camila Emerenciano Berrondo Primeiro Orientador: Salomon, Ana Lúcia Ribeiro Abstract: Introduction: The assessment of dementia in elderly individuals requires the use of validated psychometric instruments that are culturally adapted to the Brazilian population. However, there is still a lack of studies that explore the quality of these tools in the national context. Considering the aging population and the increasing prevalence of dementia, it is essential to understand the methodological robustness of the available instruments. Objective: To map the instruments used in Brazil to assess dementia and provide a comprehensive view of the applicability of these tools in the clinical context and in the Unified Health System (SUS). Method: A scoping review was conducted, and the review followed the PRISMA-ScR guidelines. The study protocol was registered with the Open Science Framework. The research question was developed based on the Population, Context and Concept framework. Four databases were used (Psycinfo, PubMed, Scielo, LILACS). In addition, eligibility criteria were defined. Digital Artificial Intelligence tools, such as Rayyan and ChatGPT, were used to assist in the operationalization of some specific parts of this study. Results: A total of 273 studies were identified, and after all the steps for analysis and selection of articles, 28 studies were included in this scoping review. To better understand the data extracted from these articles, the results were categorized into five sections: (i) Tests covered in the literature; (ii) Cognitive functions with greater recurrence in neuropsychological tests; (iii) Locations with greater prevalence of the identified studies; (iv) Psychometric data of the identified instruments; (v) Instruments aimed at the assessment of specific subtypes of dementia. Conclusions: The analysis of the included studies revealed that, despite the existence of a significant number of instruments adapted and/or developed for the Brazilian context, there is still significant heterogeneity regarding the methods used to verify their validity, reliability, sensitivity, and specificity. However, even with this variability, the instruments mapped in this review can qualify the early dentification of dementia conditions and clinical monitoring in the SUS, contributing to more effective diagnoses and interventions focused on the elderly. Editor: Escola Superior de Ciências da Saúde Tipo: Dissertação