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Análise dos conhecimentos e percepções sobre cuidados paliativos entre estudantes de medicina de uma Universidade na Baixada Santista

Tue, 26 Aug 2025 00:00:00 GMT

Title: Análise dos conhecimentos e percepções sobre cuidados paliativos entre estudantes de medicina de uma Universidade na Baixada Santista Abstract: Population aging and the increase in chronic non-communicable diseases impose growing challenges on the training of professionals qualified to manage suffering, highlighting the importance of Palliative Care (PC) as an essential component of health care. Despite normative advances, such as the inclusion of PC in the National Curriculum Guidelines and the enactment of the National Policy for Palliative Care in Brazil, gaps remain in the academic training of future physicians, justifying the need to investigate how this subject has been addressed in educational institutions. This study aimed to analyze the perception of medical students regarding palliative care and to assess their level of knowledge on the subject during the last two years of the course, at a university in the Baixada Santista region. This is a mixed-methods, cross-sectional study conducted in 2024 and 2025. The quantitative stage was carried out with 108 students from the ninth to the twelfth semester, through the application of the Bonn Palliative Care Knowledge Test. Data were analyzed statistically in a descriptive and analytical way, covering participants’ knowledge and self-confidence. In the qualitative stage, semi-structured interviews were conducted with eight students, selected for convenience, including two representatives from each class. Thematic analysis was used for the interpretation of the interviews, followed by data triangulation. The results showed that, in the quantitative stage, the domain related to pain obtained the best scores, while attention to the dying process presented greater fragility. Self-confidence improved in the final semesters, although it remained limited in aspects related to breaking bad news, especially in the face of clinical deterioration or patient death. The qualitative analysis revealed that students recognize the relevance of PC, but pointed out the need for an earlier and more longitudinal approach throughout medical training. However, a progressive gain in knowledge and self-confidence was observed in the more advanced semesters, indicating that, even in a fragmented way, there was observable evolution during the course. It is concluded that PC education, although still limited, provides important advances in students’ perception and preparedness. The findings reinforce the need for more structured pedagogical strategies that integrate PC in a continuous, qualified, and humanized manner throughout medical education. Type: Dissertação

Análise espacial da cobertura vacinal da primeira e segunda dose da vacina contra o HPV em meninas de 9 a 14 anos no Estado de São Paulo (2016-2022)

Thu, 26 Jun 2025 00:00:00 GMT

Title: Análise espacial da cobertura vacinal da primeira e segunda dose da vacina contra o HPV em meninas de 9 a 14 anos no Estado de São Paulo (2016-2022) Abstract: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and is strongly associated with cervical cancer. To reduce its incidence, the World Health Organization (WHO) established a global elimination strategy by 2030, based on three pillars: vaccination of 90% of girls aged 9 to 15, screening of 70% of women, and treatment of 90% of those diagnosed. However, vaccination coverage remains below the targets, hindering the achievement of this goal. In the state of São Paulo, despite its pioneering history, studies indicate significant variations between municipalities, highlighting regional inequalities. This study aimed to analyze the spatial dynamics of HPV vaccine coverage for the first and second doses in girls aged 9 to 14 in the state of São Paulo between 2016 and 2022. This is an ecological study with a mixed-methods approach using secondary data. Information on applied doses (D1 and D2) was obtained from SI-PNI and systematized by DATASUS. Population estimates were extracted from the TabNet database. Vaccination coverage rates were calculated by municipality and year. Statistical analysis included Kruskal-Wallis, Dunn, and Wilcoxon tests. The influence of the COVID-19 pandemic was assessed by comparing three periods (pre-pandemic, pandemic, and post-pandemic). Spatial analysis employed thematic maps and Moran and LISA autocorrelation tests with a 5% significance level. Statistically significant differences were found between the years studied for both doses (p<0.001). The years 2016 and 2018 showed the lowest coverage rates; 2017 recorded the highest rate for the first dose, and 2020 for the second dose. There was a significant decline in second-dose coverage over the years (Wilcoxon test, p<0.001). The pandemic period differed significantly from the others (p<0.001), with a sharp reduction in the second dose. Spatial analysis revealed heterogeneity in vaccination coverage among municipalities and spatial autocorrelation in all years, with a predominance of high-high clusters for the first dose. Only in 2017 was a municipality classified as having adequate vaccination coverage. Finally, the COVID-19 pandemic was not the main factor responsible for the low vaccination coverage, which was already critical, especially for the second dose. The observed spatial heterogeneity highlights significant challenges for health management, reinforcing the need for more effective actions to achieve the WHO target of 90% vaccination coverage to eliminate cervical cancer by 2030. Type: Dissertação

Potencialidade e desafios para a operacionalização da política nacional de educação permanente em saúde

Mon, 14 Apr 2025 00:00:00 GMT

Title: Potencialidade e desafios para a operacionalização da política nacional de educação permanente em saúde Abstract: The National Policy on Permanent Health Education (PHE) constitutes the institutional framework of Brazil's Unified Health System (SUS) to guide the training of health professionals. Grounded in the principles of Permanent Health Education (EPS), it views work as a continuous space for collective learning, with educational practices anchored in service reality, the appreciation of workers’ prior knowledge, and the problematization of daily routines. The implementation of PNEPS across states and municipalities faces numerous challenges. This study aimed to analyze EPS as a training strategy in the municipality of Santos/SP, identifying both obstacles and potentialities. A qualitative approach was adopted, with an exploratory and descriptive design, based on semi-structured interviews with eight professionals working in primary, secondary, and tertiary care, as well as in the management of EPS within the Santos Municipal Health Department. The findings reveal a lack of knowledge or limited understanding of EPS in its operational dimension, conceptual confusion with continuing education, and several difficulties, such as workforce shortages, work overload, inadequate physical infrastructure, lack of planning, undervaluation of EPS, funding barriers, and weak participation of social control. On the other hand, strengths identified include the establishment of the School of Health, the presence of EPS Units in some facilities, and the promotion of meaningful learning. Weak coordination between the municipal EPS and the Regional Health Department of the 4th region emerged as a challenge to be addressed, considering that inter-institutional alignment is essential for developing training projects suited to local needs. Data systematization underscores the relevance of EPS in consolidating the SUS, while also highlighting the need for investments in strategic planning, improvement of facilities and staff, strengthening of social control, and implementation of effective monitoring and evaluation mechanisms. Interprofessionality and matrix support provided by multiprofessional teams are strategic elements for advancing the policy. Coordinated actions and technical support from the Ministry are required to ensure efficient use of financial resources. The study’s limitations include the lack of differentiation of contexts within the municipality, which may lead to generalizations. Future research could deepen this analysis, taking into account the specificities and objectives of each service. Type: Dissertação

Potencialidade e desafios para a operacionalização da política nacional de educação permanente em saúde

Mon, 14 Apr 2025 00:00:00 GMT