Detalhes bibliográficos
| Ano de defesa: |
2021 |
| Autor(a) principal: |
Viera, Fernanda Dineia |
| Orientador(a): |
Saccol, Ana Lúcia de Freitas |
| Banca de defesa: |
Ginani, Verônica Cortez,
Zanin, Laís Mariano,
Saccol, Ana Lúcia de Freitas |
| Tipo de documento: |
Dissertação
|
| Tipo de acesso: |
Acesso embargado |
| Idioma: |
por |
| Instituição de defesa: |
Universidade Franciscana
|
| Programa de Pós-Graduação: |
Mestrado em Ciências da Saúde e da Vida
|
| Departamento: |
Ciências da Saúde e da Vida
|
| País: |
Brasil
|
| Palavras-chave em Português: |
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| Palavras-chave em Inglês: |
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| Área do conhecimento CNPq: |
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| Link de acesso: |
http://www.tede.universidadefranciscana.edu.br:8080/handle/UFN-BDTD/1047
|
Resumo: |
The World Cup of the International Federation of Association Football in 2014 prompted officers of the National Health Surveillance Agency to implement a Pilot Project for Categorization of Food Services. The strategy proposed to classify the food services by calculating the health risk score, which is globally used to reduce Foodborne Diseases outbreaks. Seven years after the event, this research aimed to investigate how Categorization of food services has been unfolding in the country. An electronic form was sent to all the health authorities who participated in the Categorization, belonging to the different spheres of government, with 29 open and closed questions aiming to evaluate the outcomes in the respective scope. All subjects were contacted via e-mail; after three attempts, phone contact was used. Thematic content analysis was applied to analyze the qualitative data. The need to propose a new method of health risk scoring for the Checklist arose, and three phases were used for that. In phase 1, different methods were identified and simulated; in phase 2, pre-test, two proposals of health risk score were tested to determine the “New Method”; and in phase 3, validation was performed on the basis of a secondary dataset containing 3072 evaluations conducted in food services in two inspection cycles. The risk score and the classifications generated by the “New Method'' were compared with the methodology adopted in the Pilot Project. Correlation was analyzed via the Lin test, and agreement through Kappa. Thirty health authorities (61%) responded the electronic form. They were mostly females over 51 years old, having more than 10 years of experience in the area of health surveillance; the vast majority is still working in the same field. Discontinuation of the Categorization strategy was observed. Regarding the category “Legacies and benefits of the Categorization project”, the most relevant subcategories emerging from the core meaning were "Positive impact of Categorization on the performance of health surveillance" and "Communication of health risk: benefits to consumer". Four subcategories were obtained from the category “Obstacles and difficulties of the Categorization project”: “Limitations of the health surveillance sector”, “Vulnerability in the Categorization process”, “Unfavorable context of the regulated sector” and “Discontinuation of the Categorization at the national level”. With respect to the use of the Checklist and the risk score, a few health authorities claimed to continue applying the checklist by Anvisa. Among the points that were raised, the core meaning “Lack of adequacy of score determination with the reality of the place” in the category “Obstacles and difficulties” must be highlighted. In this context, for the proposal of a new method with a risk score determination which is adaptable to the reality of the local health authorities, Kappa values of 0.756 (p<0.001) and 0.816 (p<0.001) were obtained in the first and second inspection cycle, respectively, in phase 3 of validation. A positive and ascending relationship was verified, with the Lin’s correlation coefficients being 0.7433 (IC95 0.7288; 0.7572) and 0.8251 (IC95 0.8142; 0.8355) in the first and second cycle, respectively. The “New Method” uses the consequence classification (C) as established by the group of experts in the Pilot Project and a proposal for the calculation of probability (P), with the Risk (R) being calculated by multiplying C x P. This new method may be used in the entire Brazilian territory. It was based on the score methodology adopted in the Pilot Project, with the methodological differential that enables the inclusion of new evaluation items and/or exclusion of evaluation items from the List according to the local reality. The findings of the present research disclose explanations and implications of the Pilot Project Categorization, which was extremely successful in Brazil. Nonetheless, there were no advances towards the implementation of a Program at a National level. It is believed that all political, technological and technical barriers may be overcome. The work evidenced that this categorization system reduces the health risk and integrates the public and the private sectors as well as the health surveillance service. Furthermore, it motivates the food services to invest in food safety and promotes risk communication, with the health category being displayed to consumers who are then able to make safer choices. |
