ABSTRACT
A partir das Diretrizes Curriculares Nacionais (DCN), em 2002, o currículo dos cursos de graduação em Odontologia tornou-se mais sensível às necessidades do Sistema Único de Saúde (SUS). O objetivo deste estudo é analisar as percepções dos egressos de um curso de Odontologia de uma universidade pública sobre suas experiências de gestão do cuidado em saúde durante os estágios curriculares no SUS. É um estudo de natureza descritiva com dados qualitativos e quantitativos, produzidos por meio de um questionário com 32 questões, dos relatórios dos estudantes no estágio na Atenção Primária à Saúde e entrevistas. O questionário foi enviado para 491 egressos de 2012/1 a 2017/2, sendo que destes, 172 egressos aceitaram participare responderam ao questionário. Convidou-se uma amostra intencional de 14 egressos para realização de entrevistas. O material quantitativo foi submetido à estatística descritiva e os dados qualitativos foram sistematizados e submetidos a análise de conteúdo temática. A categoria temática dimensões da gestão do cuidado em saúde foi analisada considerando o referencial teórico de Cecílio (2011).Os egressos apresentavam médiade 26 anos de idade, sendo a maioria (70,1%)do sexo feminino e30,4% estão empregados na rede pública de saúde. A inserção na comunidade, o entendimento do SUS, o trabalho em equipe interprofissional e a compreensão da cultura e das diferentes realidades dos usuários fizeram parte do itinerário formativo dos egressos, de modo a prepará-los para a atenção integral ao usuário. Conclui-se queos cenários de práticas dos estágios curricularespossibilitaramaos estudantesinteragir com as várias dimensões da gestão do cuidado em saúde (AU).
After the National Curriculum Guidelines (DCN), in 2002, the curriculum of undergraduate courses in Dentistry became more sensitive to the needs of the Unified Health System (SUS). This study aimed to analyze the perceptions of graduates of a Dentistry course at a public university about their experiences in health care management during theircurricular internships at SUS. This was a descriptive study with qualitative and quantitative data, conducted by a questionnaire containing 32 questions, student reports in the internship in Primary Health Care and interviews. The questionnaire was sent to 491 graduates from 2012/1 to 2017/2, of which 172 graduates agreed to participate and responded to the questionnaire. An intentional sample of 14 graduates was invited to perform the interviews. The quantitative material was analyzed by descriptive statistics, and qualitative data were systematized and submitted to thematic content analysis. The thematic category dimensions of health care management were analyzed considering the theoretical framework of Cecílio (2011). The graduates had mean age 26 years,most (70.1%) were females and 30.4% were employed in the public health network. Insertion in the community, understanding of SUS, work in an interprofessional team and understanding of the culture and different realities of users were part of the trainingitinerary of graduates, to prepare them for the comprehensive attention to the user. It is concluded that the practice scenarios of curricular internships allowed students to interact with the various dimensions of health care management (AU).
Subject(s)
Humans , Male , Female , Adult , Primary Health Care , Social Perception , Students, Dental/psychology , Health Management , Unified Health System , Epidemiology, Descriptive , Surveys and Questionnaires , Data Interpretation, Statistical , Clinical Clerkship , Curriculum , Qualitative ResearchABSTRACT
BACKGROUND: Data estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. Previously we had shown that the incidence and mortality have been decreasing over the last 18 years in Joinville, Southern Brazil. In this study, we aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting. METHODS: From the Joinville Stroke Registry, we identified all the cases of first-ever stroke that occurred from October 2009 to September 2010. Multiple overlapping sources of information were used to ensure the completeness of case identification. Patients were followed up prospectively at regular intervals from 30-days to 3 years after the index event. Kaplan-Meir and Cox proportional hazards were used to assess the cumulative risk of death and recurrence. RESULTS: We registered 407 first-ever stroke patients. After 3 years, 136 (33%) had died. In the first year of stroke the risk of death was 28% (95% CI, 25 to 32). Beyond the first year, approximately 3 to 5% of survivors died each year. The cumulative risk of death in ischemic stroke (IS) subtypes was 3.6 higher for cardioembolic (CE) IS (hazard ratio 3.6, 95% CI, 2.1 to 6.4; p = 0.001) and 3.3 times higher for undetermined IS (HR 3.3, 95% CI 1.9 to 5.8; p = 0.001) compared to small artery occlusion IS. Over 3 years, the overall stroke recurrence risk was 9% (35/407). We found no difference in stroke recurrence risk between IS subtypes. Cardiovascular disease was the main cause of death all follow up time. CONCLUSIONS: Compared to other cohort studies conducted between 10 and 20 years ago in high-income countries, our recurrence rates and 3-year risk of death were similar. Among IS subtypes, we confirmed that CE has highest risk of death. The most common cause of death after a first-ever stroke is cardiovascular disease. This has implications for the uptake of current secondary preventive strategies and the development of new strategies.