PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE COLETIVA - PPGSC

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A morte na Unidade de Terapia Intensiva: o agir e o sentir do profissional de saúde
(Universidade Federal do Maranhão, 2013-06-22) NINA, Rachel Vilela de Abreu Haickel; GARCIA, João Batista Santos; 135570488-02; http://lattes.cnpq.br/0424234103760462; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; GARCIA, João Batista Santos; http://lattes.cnpq.br/0424234103760462; MARINHO, Suely Oliveira; http://lattes.cnpq.br/9819749776052051; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677; THOMAZ, Érika Bárbara Abreu Fonseca; http://lattes.cnpq.br/3644251156905353
Death is a natural process intrinsically linked to life that brings different emotions and meanings, and in recent decades has moved from the familiar environment for the hospital environment, adding a burden of loneliness and negativity that caused her to be transformed into a subject rarely discussed among health professionals. In the training of nurses and doctors death and dying has been shalowed treated and the students have contact with them at specific times and increasingly rare during their training. At the end of their graduation, when faced with the finitude of their patients feelings of failure, anxiety and helplessness may arise, and even cause illness in these professionals. In ICU death is part of their daily lives, it is the place of occurrence of the majority of hospital deaths. The ICU is the space for specialized treatment where technology and training unite to address clinical situations where the threat to life is always present, and thus prolong the dying indefinitely many times. The treatment of these conditions requires the professional to a need to focus on the disease, making him forget and even deny that the human body threatened by the imminence of death. Transformed into an enemy, death is fought at all costs, and during this battle the relationship between professional and patient/family is lost. Aiming to analyze factors associated with the perception of the meaning and attitudes toward death held a study with quantitative and qualitative methods of research. With the quantitative methodology performed a crosssectional study, analytical professional with the four ICUs of a university hospital between August 2010 and August 2012 in which we considered five different outcomes: meaning of death ";" meaning of the patient's death terminal ";" attitude at the news of the death "; "resuscitation of the patient without therapeutic possibility "," discussion of non-resuscitation order ", we used Poisson regression and multinomial logistic (alpha = 5%) to estimate associations. Through questionnaires and semi-structured interviews with professionals from pediatric intensive care, we used qualitative methodology with analysis of the thematic content. Results: there were 118 professionals working in the ICU during the study, 97 were included in this research , and of these 14 were the sample of qualitative methodology. had 52 doctors and 45 nurses whose age ranged from 24 to 62 years (M = 38 ± 7.6), 77.32% were female, aged 27-53 years, the time in the ICU ranged from 1 to 32 years and who worked on average 43 hours weekly. meaning of death varied according to the professional category, type of ICU and weekly workload. Regarding attitude to death news and nurses and those who had weekly workload greater than 60 h share the communication, who said to have their behavior at the news of death to be influenced by education and nurses agreed with the resuscitation of the patient terminal; professionals with over 38 years working in ICU children agreed that the DNR should be discussed. Among those who worked with children a sense of ambivalence about the situation of death was related to the clinical condition and the context in which it took that child. Anxiety, emotion very present among these professionals can arouse guilt and helplessness demonstrating the complexity involved in the perception of death. They use religion as a coping mechanism and recognize the lack of preparation during undergraduate and postgraduate. In conclusion we sought that the feeling was associated with workload weekly professional category and type of ICU in which they work, while the act was associated with vocational training and category, in relation to the death of children, this arouses mixed feelings in health professionals, who use the religion and involvement Family to face it and resent the lack of contact with the subject during their training.
Consumo de alimentos processados e ultraprocessados por crianças de 13 a 35 meses e fatores associados
(Universidade Federal do Maranhão, 2016-02-29) Batalha, Mônica Araujo; FRANÇA, Ana Karina Teixeira da Cunha; CPF:88099512472; FRANÇA, A.K
INTRODUCTION: Healthy eating habits started from the earliest years of life are critical to growth and development of children. However, the ultra-processed products are being introduced early on children's diets and little is known about the determinants of this consumption. OBJECTIVES: To evaluate the consumption of processed and ultra-processed foods (PUP) among children of 13-35 months and associated factors. METHODS: We studied 1185 children, participants following the BRISA cohort in São Luís, Maranhão. Food consumption was investigated using the Food Survey Recall 24h and the percentage of daily caloric intake and nutrients were estimated by groups of food, classify according with the type of processing used in their fabrication. We used Poisson regression model with robust variance estimation and hierarchical approach to estimate the prevalence ratios (PR) of variables associated with high consumption of processed and ultra-processed foods. RESULTS: Mean energy consumption were 1226 kcal/day. After the adjusted analysis, there was a higher proportion of high consumption of PUP among children whose mothers had less than or equal to 8 years of study (PR 1.32; 95% CI: 1.05-1.67), 9 to 11 years of study (PR 1.24; 95% CI: 1.02-1.51) and among those who had more than 18 months of life (PR 1.29; 95% CI: 1.09-1.52). CONCLUSIONS: The knowledge of the factors related to high consumption of PUP in childhood is critical to the direction of intervention and prevention actions, targeting both mothers and children, in order to strengthen the acquisition of healthy habits early.
Fatores perinatais e níveis pressóricos de escolares em duas cidades brasileiras
(Universidade Federal do Maranhão, 2017-07-06) SANTOS, Graciete Helena Nascimento dos; SIMÕES, Vanda Maria Ferreira; 094651893-91; http://lattes.cnpq.br/4024829764707677; SIMÕES, Vanda Maria Ferreira; 094651893-91; http://lattes.cnpq.br/4024829764707677; CARDOSO, Viviane Cunha; http://lattes.cnpq.br/9472547924584965; MARTINS, Marilia da Glória; http://lattes.cnpq.br/1876365333157244; ALMEIDA, Cecília Cláudia Costa Ribeiro de; http://lattes.cnpq.br/1783658679814263; BATISTA, Rosângela Fernandes Lucena; http://lattes.cnpq.br/3936205532436748
Introduction: Changes in the gestational period and at the time of delivery can exert influence on blood pressure in adulthood, however it is still unknown if there is this effect in childhood and adolescence. Objective: The aim of this work was to assess the association of perinatal factors in the blood pressure levels of schoolchildren. Methods: Data from two birth cohorts in two Brazilian cities were evaluated. In the perinatal baseline, 2,858 mothers-babies binomials participated in Ribeirão Preto (RP) in 1994 and in São Luiz (SL) there was a participation of 2,443 mothers-babies in 1997/98. The follow-up in children during their school lives was done in the year of 2005; when 869 children (by the age of 10/11 years) were followed in RP and 805 (by the age of 7/9 years) in SL. The variables had gathered in the perinatal questionnaire were the following: sex, birthplace, mode of delivery, gestational age and birth weight. At the follow-up, further variables had collected: family income, maternal schooling, anthropometric measurements of the child and two measures of the child's blood pressure. An exploratory model using the perinatal period variables was analyzed in association with the outcome, systolic blood pressure (SBP). Multiple linear regression analysis of perinatal factors on the SBP levels was performed, adjusted to sociodemographic variables and anthropometric measurements of children. In the second article, the data from Ribeirão Preto cohort only were analyzed and the response variables, mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP), were standardized in a specific blood pressure z-score by age, sex and height. Multivariate analysis were performed by linear regression analysis to verify the association between the z-score of systolic and diastolic blood pressures and perinatal factors. Thus for analysis of the association between cesarean delivery and the z-scores of SBP e DBP, it was identified the minimum set of variables indicated by a Directed Acyclic Graph (DAG) for adjustment, which were maternal schooling at birth, maternal age, family income at birth and maternal smoking. For this adjusted analysis, two models were used: a multiple linear regression model (MLR) and a causal estimation model by the inverse of the probability weight (CEM). Results: In the first article, it was observed in RP an increase in mean SBP of 2.69 mmHg (95% CI = 0.86; 4.53) in those born by cesarean delivery and in SL, among preterm infants, an increase of 2.51 mmHg (95% CI = 0.81, 4.23). In the second article, in the analyzes adjusted in the two proposed models, there was statistical significance in the two methods between cesarean delivery and the SBP of students with a coefficient of 0.22 (p-value=0.01) in the MLR based on the DAG and coefficient of 0.25 (p-value=0.004) in CEM and the same was not observed with PAD. Conclusion: In the first article, it was drawn an association between cesarean delivery and blood pressure of schoolchildren from the city with the highest socioeconomic status, but not in those one from the poorest city. In the second article, this finding was reinforced and established a possible causality relationship between cesarean delivery and the future levels of SBP.
Avaliação do desenvolvimento de crianças no segundo ano de vida através do Bayley Screening Test III em uma cidade do nordeste brasileiro: Coorte Brisa
(Universidade Federal do Maranhão, 2017-11-09) LOPES, Monique Kelly Duarte; SIMÕES, Vanda Maria; http://lattes.cnpq.br/4024829764707677; SILVA, Mabile Francine Ferreira; http://lattes.cnpq.br/3416840498163553; RAFAEL, Eremita Val; http://lattes.cnpq.br/1422358646120220; BATISTA, Rosângela Fernandes Lucena; http://lattes.cnpq.br/3936205532436748; SANTOS, Alcione Miranda dos; http://lattes.cnpq.br/2709550775435326
The early years of the child's life become of great importance to lay the foundation for their future acquisitions. Early diagnosis becomes increasingly important, and a challenge for the health professional in the assessment and accurate understanding of the meaning of any delay and the limits of normality. This study aimed to evaluate the development of children in the second year of life in a city in northeastern Brazil. Two articles were carried out: the first one described the use of the Bayley III Screening Test in children of two cohorts conducted in the city of São Luís referring to the BRISA Study. A total of 2062 children were evaluated using the Bayley-III instrument, prenatal and birth cohort from January 2010 to June 2011. They were submitted to evaluation of neuromotor development through the Bayley-III instrument in the period from April 2011 to March 2013, in the second year of life. It was observed that the mean age of the children was 16 months, with a minimum of 8 months and a maximum of 24. In the sample, 80.3% were aged less than or equal to 18 months and 15 days. Among the domains selected for competent, emerging and risk classification, expressive communication presented a higher risk for development (5.87%), as well as a higher frequency of children in the emerging classification (36.37%); in the second article, we evaluated the risk factors for neuromotor development in children in the second year of life, using data from the birth cohort of the BRISA study. Poisson regression with robust variance was used for the data analysis and only the information referring to the "competent" and "emergent" classifications was considered. We obtained mothers with schooling up to high school (RR = 1.85, 95% CI = 0.99-3.46, p = 0.054), or until elementary school (IRR: 1.93, 95% CI = 0 , 98-3,82, p = 0,058) as a risk factor for the development of receptive communication, consensual union (RR = 0.70, 95% CI = 0.49-1.01, p = 0.057), influenced (RR = 1.55, 95% CI = 1.04-2.30, p = 0.031) and be preterm (RR = 1.38, 95% CI = 1.04-1.81; p = 0.024) impaired fine motor development. One of the protection factors found was not having other children (RR = 0.64, 95% CI = 0.47- 0.88, p = 0.005) for cognitive development; (RR = 0.88, 95% CI = 0.59-0.55, p = 0.003) or in the mother's bed (RR = 0.48, 95% CI = 0.26-0.86, p = = 0.014) benefited receptive communication; belonging to socioeconomic class A (RR: 0.64, 95% CI = 0.43-0.94, p = 0.025) protected expressive communication; being primiparous (RR: 0.62, 95% CI = 0.42- 0.92, p = 0.019) favored the coarse motor; and being in the cradle next to the mother (RR: 0.64, 95% CI = 0.42-0.98, p = 0.042) benefited the fine motor. It was concluded that the Bayley-III instrument allowed the description by age group and area of development, pointing out the greater number of children at risk and emerging for expressive communication. In addition to showing that preterm birth increased by 38% the chances of children presenting with impairment in fine motor development.
FATORES DOS PRIMEIROS 1000 DIAS DE VIDA ASSOCIADOS À SINTOMAS ASMA NA INFÂNCIA NA COORTE BRISA EM SÃO LUÍS E RIBEIRÃO PRETO, BRASIL.
(Universidade Federal do Maranhão, 2018-02-05) NASCIMENTO, Joelma Ximenes Prado Teixeira; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; ALMEIDA, Cecília Cláudia Costa Ribeiro de; 507.669.963-87; BATISTA, Rosângela Fernandes Lucena; 363.734.943-49; http://lattes.cnpq.br/3936205532436748; VIANNA, Elcio dos Santos Oliveira; http://lattes.cnpq.br/8733105749892750; BARBIERI, Marco Antonio; http://lattes.cnpq.br/0765555733544821; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430
Asthma is a complex syndrome, of difficult diagnosis in children. The mechanisms involved in the etiopathogeny of the disease have not been completely elucidated. Environmental exposures during the first 1000 days of life (270 days of gestation plus the 365 days of the first year of life and 365 days of the second of life) appear to have a strong influence on epigenetic regulation, increasing predisposition to childhood asthma. The association between early exposures of the prenatal period, birth and the first years of life with asthma symptoms in children involves multicausality and temporality relationships between these variables that can be better studied by structural equation modeling (SEM). Chapter I of this thesis was the original article: The First 1000 Days of Life Factors Associated with “Childhood Asthma Symptoms”: Brisa Cohort, São Luís, Brazil, which aimed to analyze the associations between the environmental factors up to the first 1000 days of life and “Childhood Asthma Symptoms”. It is a prospective study involving three moments of the BRISA cohort in Sao Luis (n = 1140), where the outcome was the latent variable “Childhood Asthma Symptoms”, formed by four indicators with convergent loads: medical diagnosis of asthma, number of wheezing episodes, emergency care visit due to wheezing and medical diagnosis of rhinitis. A theoretical model that included prenatal factors, birth factors and of the second year of life, were analyzed in association with “Childhood Asthma Symptoms” using SEM. It was observed that the higher the pre-gestational BMI, high soft drink consumption in gestation, cesarean section without labor, chill in the first three months of life, carpeted floor and child´s exposure to tobacco were associated with higher values of “Childhood Asthma Symptoms”. In contrast, high birth weight, the age of the child and children exclusively breastfed for six months were associated with lower values of “Childhood Asthma Symptoms”. Chapter II of this thesis was the original article: Environmental factors linked microbiota hypothesis and “Childhood Asthma Symptoms”: BRISA cohort, Ribeirão Preto, Brazil, which aimed to analyze environmental factors linked to the microbiota hypothesis and “Childhood Asthma Symptoms”. It is a prospective study involving population-based sample of the BRISA birth cohort in Ribeirão Preto (n = 3694). Birth and second year life factors linked to the microbiota hypothesis were analyzed on a theoretical model having as outcome the latent variable “Childhood Asthma Symptoms” was formed by three indicators (medical diagnosis of asthma, number of wheezing episodes and emergency care visit due to wheezing) using SEM. It was observed that children with higher BMI values, belonging to the black race, with diarrhea and older presented higher values for “Childhood Asthma Symptoms”; while better economic situation, female gender and longer breastfeeding presented lower values for “Childhood Asthma Symptoms”. In the present thesis, the analyzes of the variable “Childhood Asthma Symptoms” as a continuous latent formed by clinical indicators of convergent loads reduced the error of measurement of this outcome difficult to diagnose in children. Our findings suggest that environmental exposures during the first 1000 days of life, such as: maternal and child overweight, consumption of soft drinks in gestation, cesarean delivery, would be involved in the early programming of asthma children, while breastfeeding would protect from this condition.
Nascimento por cesariana e adiposidade central em adolescentes de uma coorte de nascimentos (RPS) de uma capital do nordeste brasileiro
(Universidade Federal do Maranhão, 2018-02-26) ABREU, Joana D’Arc Matos França de; LAMY FILHO, Fernando; 725.080.007-87; http://lattes.cnpq.br/3977956820339735; ALMEIDA, Cecília Claudia Costa Ribeiro de; http://lattes.cnpq.br/1783658679814263; BETTIOL, Heloisa; http://lattes.cnpq.br/1783658679814263; FRANÇA, Ana Karina Teixeira da Cunha; http://lattes.cnpq.br/8389486900285691
INTRODUCTION: Caesarean section has been associated with the development of obesity and metabolic changes throughout life, but studies on the association with central fat, more associated with cardiovascular risk, are not consensual. OBJECTIVE: To evaluate the causal effect between cesarean birth and central adiposity of the body in adolescents. METHODS: A cohort study was carried out, including 601 participants, evaluated at birth and in adolescence aged 17 to 18 years. The following ratios were evaluated by DEXA as the definition of central fat: android / gynoid fat mass (A/G); trunk / total fat mass (T/T); fat mass of the trunk / limbs (T/LB) and fat mass of the trunk / legs (T/LG). A Directed Acyclic Graph (DAG) was constructed to select the variables for minimum adjustment for confounding, being selected: intrauterine growth retardation, gestational age at birth, maternal schooling, maternal smoking, mother's BMI, family income at birth and the mother's marital status. In the analysis, a marginal structural model was used, which allows a better adjustment of the confounders. We also used inverse-weighted estimators of the likelihood of exposure selection. The presence of interchangeability between the exposure groups was verified by the teballance command of the software StataTM v. 14. RESULTS: There was no statistical difference in the central fat mass of adolescents born by cesarean section or vaginal route, for the four indicators used: A/G ratios (CI 95% = -0.015, 0.018, P = 0.875); T/T ratio (CI 95% = -0.013; 0.007, P = 0.541); T/LB ratio (CI 95% = -0.048; 0.016; P = .333); T/LG ratio (CI 95% = -0.06; 0.03, P = 0.532). CONCLUSION: In the present study, no causal effect was observed between cesarean births and the higher presence of central fat in the adolescents studied.
AVALIAÇÃO DO PROGRAMA BOLSA FAMÍLIA: foco, cobertura e impacto na vacinação de crianças das coortes de nascimento BRISA, Ribeirão Preto/SP e São Luís/MA, Brasil.
(Universidade Federal do Maranhão, 2018-11-28) SILVA, Francelena de Sousa; SILVA, Antônio Augusto Moura da; 176.754.643-20; http://lattes.cnpq.br/8652081312944025; QUEIROZ, Rejane Christine de Sousa; 698.466.933-20; http://lattes.cnpq.br/0222566094063579; QUEIROZ, Rejane Christine de Sousa; 698.466.933-20; http://lattes.cnpq.br/0222566094063579; SILVA, Antônio Augusto Moura da; 176.754.643-20; http://lattes.cnpq.br/8652081312944025; PACHECO, Marcos Antonio Barbosa; http://lattes.cnpq.br/2293822271258933; LIMA, Valéria Ferreira Santos de Almada; http://lattes.cnpq.br/7758192020816194; LAMY FILHO, Fernando; http://lattes.cnpq.br/3977956820339735
INTRODUCTION: Childish vaccination has important impact on children health. Although, vaccine coverage are heterogeneous. The Bolsa Familia Program that has vaccination as one of its conditionalities is highlighted It aimed to estimate the percentages of focus and coverage of BFP and analyze the effect of to be a beneficiary of BFP on incomplete vaccine for low-income children, 13 to 35 months, born in 2010, from BRISA birth cohorts, Ribeirão Preto (RP)/SP and São Luís (SL)/MA. METHOD: Starting from RP, of all residents births and from probabilistic sampling of 1/3 of the resident births in SLZ. 3.805 children in RP and 3.308 in SLZ returned at the time of the follow-up (2011 to 2013). Only low-income children eligible to BFP were selected, with final sample of 532 in RP and 1.229 in SLZ. Were used to categorize the variable of exposure receiving benefit of BFP (yes or no), the data from the Single Cadaster for Social Programs and from the cohorts. The variable outcome was Children Vaccine Scheme (CVS), built with the vaccines BCG, DTP, MMR, Hepatitis B, polio, rotavirus and yellow fever. The adjustment variables were economic class , mother’s education, mother’s skin color. We considered as eligible to BFP, children with monthly family income per capta from 140,00 to 280,00 and economic class (EC) D/E. Percentage of focus and coverage of the BFP were estimated. To estimate the effect of being a beneficiary of BFP on incomplete vaccine for low-income children, a theoretical model was done by Directed Acyclic Graph (DAG). A pairing by propensity score and weighting by the inverse of the probability of selection was used in statistical analyzes. RESULTS: Focus of BFP for monthly family income per capta was 33,8% in SLZ and 15,9% in RB; and to EC was 33,7% in SLZ and 15,3% in RP. Coverage of BFP according to monthly family income per capta was 82,1% in SLZ and 71,6% in RP; and to EC was 68,9% in SLZ and 46,8% and RP. The percentage of incompleteness of CVS was 37,4% in SLZ and 15,2% in RP. Considering monthly family income per capta up to R$280,00, being beneficiary of BFP had no effect on CVS, according to: weighting by the inverse of the probability of selection (SLZ – coefficient: -0,01; CI 95%: - 0,07 to 0,04; p: 0,725 and RP –coefficient: 0,04; CI 95%: - 0,02 to 0,10; p: 0,244). CONCLUSION: Coverage percentages were higher than those of focus that were low. The receipt of the benefit of BFP had no influence on children vaccination incompleteness, which may indicate that this conditionality is not being properly monitored.
Cuidados oferecidos a crianças elegiveis para cuidados paliativos em ambiente hospitalar
(Universidade Federal do Maranhão, 2018-12-19) LIMA, Sara Fiterman; SOUZA, Tadeu de Paula; 055221367-00; http://lattes.cnpq.br/9097512115715636; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; 128326933-34; http://lattes.cnpq.br/9896819318523369; ALVES, Rosana; http://lattes.cnpq.br/5958737240424992; GARCIA, João Batista; http://lattes.cnpq.br/0424234103760462; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677
The study sought to analyze the care offered to eligible children for palliative care in a hospital environment. This is an exploratory study, with a quantitative and qualitative approach, carried out in 04 hospitals of the network of public institutions with hospitalization care for children in the municipality of São Luís - Maranhão. The universe of the study was composed of children hospitalized in the hospitals during the period of data collection. Using the inclusion criteria to be between 0 and 9 years old, potential indication for palliative care according to service professionals and to fall into one of the 04 groups of conditions eligible for pediatric palliatives of the Association for Children Palliative Care, emerged 133 children, that went through an expert evaluation for the application of non-inclusion criteria - not being eligible and being in final moments of life - according to the opinion of this professional. Thus, study participants were 131 children eligible for palliative care, their primary caregivers, and the professionals who provided care. The techniques for collection were interviews, participant observation and documentary analysis. From this sample, the case study of 09 children was carried out. The results are as follows: The profile of the public network for pediatric palliative care in the municipality; The socio-demographic profile of children and caregivers; The characterization of the clinical conditions of these children; The evaluation of the dynamics that involves the provision of palliative care in one of the hospitals. The process of indicating palliative care in pediatrics allows different understandings. Eligible children also had other diagnoses that helped the palliative indication. Social issues were present and fragmented care. Spirituality can help or serve as a barrier to care. Mourning care still comes down to the moment of death, with guidelines for funeral procedures. Several misunderstandings interfere in practice. We conclude that findings point to the need for investments in the training and preparation of professionals, for the sharing of decisions among the members of the team, for the rapprochement with the relatives and the reception of their symptoms of suffering, for the inclusion of this family and child in the decision-making, and to broaden the focus of care, understanding family and death as an integral part of the care process.
EXPERIÊNCIAS VIVIDAS POR PROFISSIONAIS NO PROCESSO DE TRABALHO COM CRIANÇAS EM CUIDADOS PALIATIVOS.
(Universidade Federal do Maranhão, 2019-02-26) MOREIRA, Jacqueline Dutra Nascimento; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; LEMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; ALVES, Rosana; http://lattes.cnpq.br/5958737240424992; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; CARVALHO, Ruth Helena de Souza Britto Ferreira de; http://lattes.cnpq.br/6914279050780248
Pediatric Palliative Care (CPP) includes total pediatric care in the body, mind and soul, and family support. Tending its onset when a serious illness is diagnosed and continues to be a curatorial cure process. They are based on multiprofessionality and interdisciplinarity focused on evaluating and alleviating the physical, psychological, social and spiritual exercise of the child and his / her family. The objective was to understand the experiences experienced by professionals in the process of working with children in palliative care. This is an exploratory study of a qualitative approach of the phenomenological type, carried out in a university hospital from March to May 2018. The sample was chosen with the intention of involving 32 professionals from the research sector. The analysis of the ideas was carried out in search of the work process in health, contemplating like Van Manen visions. The themes that emerged were: Fragilities, disagreements and contradictions in the presentation and offer of palliative care and facilitating initiatives in palliative practice. The understanding of the lived experiences made possible the understanding of a knowledge about the association of concepts and contradictions in palliative care. Palliative Care was introduced in a terminality, to abandonment and euthanasia. Where an denial of the natural process of death prosers, it may result in the adoption of a futile treatment. The occurrence of the biomedical model and the fragmentation of care that led, in some situations, to the work process, was adopted for decision making and for the child and his family. However, as experiences have already been promoted by the integration of knowledge, and the incorporation of new tools in daily care, which promote a user-centered approach with respect to their subjectivity. It is necessary, changes in the logic of the work processes in health, in search of a collaborative work, with emphasis on the protagonism of the user, valorization of the worker and extension of the clinic.
ANÁLISE ESPACIAL DE CASOS PROVÁVEIS DE DENGUE, CHIKUNGUNYA E ZIKA NO MARANHÃO, BRASIL.
(Universidade Federal do Maranhão, 2019-11-01) COSTA, Silmery da Silva Brito; SANTOS, Alcione Miranda dos; 641.261.104-53; http://lattes.cnpq.br/2709550775435326; BRANCO, Maria dos Remédios Freitas Carvalho; 255.487.513-87; http://lattes.cnpq.br/5449951869928014; BRANCO, Maria dos Remédios Freitas Carvalho; 255.487.513-87; http://lattes.cnpq.br/5449951869928014; SANTOS, Alcione Miranda dos; 641.261.104-53; http://lattes.cnpq.br/2709550775435326; MEDEIROS, Maria Nilza Lima; http://lattes.cnpq.br/2755510184384522; GONÇALVES, Eloisa da Graça do Rosário; http://lattes.cnpq.br/2449592677614097; CALDAS, Arlene de Jesus Mendes; http://lattes.cnpq.br/7214761052240294
Dengue, chikungunya and zika are extremely relevant arboviruses for world public health, given the damage they cause to the population and economic and social impacts in the affected countries. This ecological study used spatial analysis of probable cases of dengue, chikungunya and zika reported in the Notified Disease Information System (SINAN) in the State of Maranhão, Brazil, from 2015 to 2016. In the first article, the distribution of probable cases of dengue, chikungunya and zika in Maranhão was spatially analyzed, relating it to sociodemographic and economic factors, Unified Health System Performance Index (IDSUS) and vector infestation. The unit of analysis was the municipalities. Geodaversion 1.10 software was used to calculate Moran Global and Local indexes. In the univariate analysis, the Moran Global Index identified a significant autocorrelation of dengue (I = 0.10; p = 0.009) and Zika (I = 0.07; p = 0.03) incidence rates. In the bivariate analysis, there was a positive spatial correlation between dengue and population density (I = 0.31; p <0.001) and a negative correlation with IDSUS for primary care coverage (I = -0.08; p = 0.01). Regarding chikungunya, there were positive spatial correlations with population density (I = 0.06; p = 0.03) and the Municipal Human Development Index (MHDI) (I = 0.10; p = 0.002) and negative correlation with Gini index (I = -0.01; p <0.001) and IDSUS for primary care coverage (I = - 0.18; p <0.001). Finally, positive spatial correlations were identified between zika and population density (I = 0.13; p = 0.005) and MHDI (I = 0.12; p <0.001), as well as negative correlation with Gini index. (I = -0.11; p <0.001) and IDSUS by primary care coverage (I = - 0.05; p = 0.03). In the second article, we analyzed the spatial distribution of the cases of the three georeferenced diseases in the municipality of São Luís, Maranhão, from 2015 to 2016, relating it to socioenvironmental factors, economic and strategic points. The unit of analysis was the census sector. Arcgis version 10.4.1 software was used for georeferencing of disease cases, QGIS version 3.6.0 to aggregate cases by census sector, GeoDa 1.10 for the Global and Local Moran Index and spatial models, and for the classical model, the Stata software. ® 14.0. From the Moran Global Index, significant spatial autocorrelation of the incidence of the three arboviruses was identified (I = 0.55; p = 0.001). The model with the best performance was the SpatialLag, with the highest likelihood log value, the explanatory power (R2 = 0.508) and the Akaike information criterion (2059.28) and the Bayesian Schwarz criterion (2099; 46). In this model only the percentage variable of accumulated garbage in the surroundings remained with a statistically significant positive correlation (p = 0.03). The findings suggest that sociodemographic factors influenced the occurrence of dengue, chikungunya and zika in the state of Maranhão. In São Luís the improper disposal of solid waste had an impact on the occurrence of the three arboviruses.
Telessaúde: uma ferramenta de educação permanente em saúde para os profissionais da atenção básica do Estado do Maranhão
(Universidade Federal do Maranhão, 2019-12-18) NEVES, Ariane Cristina Ferreira Bernardes; COIMBRA, Liberata Campos; 271325363-20; http://lattes.cnpq.br/9128715784318958; COIMBRA, Liberata Campos; 271325363-20; http://lattes.cnpq.br/9128715784318958; HADDAD, Ana Estela; http://lattes.cnpq.br/5132173662388670; PACHECO , Marcos Antonio Barbosa; http://lattes.cnpq.br/2293822271258933; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/402482976470767; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369
The study aimed to evaluate Telehealth as a tool for Permanent Health Education (EPS) for Primary Care (AB) workers from the State of Maranhão. This is an evaluative research with quantitative and qualitative approach. In article 1 the indicators of utilization of the services offered by the State Program of Telehealth of HUUFMA, in its relation with EPS, were evaluated through secondary data from the Brazilian National Telehealth Platform for the years 2015 and 2016. The monthly system usage rate and the mean monthly request rate per municipality and primary health care unit were calculated. Teleconsultations were described regarding the requester’s profession, most frequent topics, satisfaction with the response provided, and resolvability of responses. During the study period, 13 976 teleconsultations from 47 municipalities were small and had low Municipal Human Development Index. The mean overall usage rate and the monthly usage rate by municipality and unit were higher than those reported in the literature. Nurses and Community Health Workers were the most active professionals and reported having their question was answered. In article 2, the analysis of the health professionals' perception of PHC in the State of Maranhão on the use of telehealth as an EPS tool was performed. The collection was held in the city of Caxias-MA, in June 2018. The sample was intentional, being composed of 21 health professionals from the AB teams. Data were collected through individual open interviews and analyzed through Content Analysis, which revealed three thematic categories: renewing knowledge responsibly, safely and based on scientific evidence; sharing knowledge and reducing professional isolation in AB and; barriers to the use of telehealth services and the implementation of EPS. The results portrayed the contribution of Telehealth in improving care, with changes in working practices, clinical case guidance working with a second opinion, and avoiding referrals to other specialists. As well as support in the teams' EPS process, however, there are barriers to its use. It was concluded with the use indicators of the HUUFMA Telehealth Program that the service is sustainable, with the potential to support AB and to be used as an EPS tool. Sensitization and training of professionals and, in particular, municipal managers is recommended, in order to make Telehealth multi-professional, daily and continuous in its entirety.
Fatores de risco comportamentais modificáveis para doenças crônicas não transmissíveis e padrão de sono em adolescentes.
(Universidade Federal do Maranhão, 2021-02-24) LIMA, Raina Jansen Cutrim Propp; BATISTA, Rosângela Fernandes Lucena; http://lattes.cnpq.br/3936205532436748; BATISTA, Rosângela Fernandes Lucena; http://lattes.cnpq.br/3936205532436748; ECKELI, Alan Luiz; http://lattes.cnpq.br/8031377932900248; NASCIMENTO, Joelma Ximenes Prado Teixeira; RIBEIRO, Cecília Claudia Costa; http://lattes.cnpq.br/1783658679814263; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677
Sleep is essential for the healthy development of adolescents. Changes in sleep patterns can have their effects accumulated throughout life, associated with harmful consequences to health. The main modifiable behavioral risk factors for noncommunicable diseases (NCDs) – harmful use of alcohol, smoking, unhealthy diet and physical inactivity, according to the World Health Organization (WHO) – would be associated with poor sleep quality and excessive daytime sleepiness in adolescents. Objective: to analyze the associations between modifiable behavioral risk factors for NCDs and sleep in adolescents. Methods: crosssectional study nested in a cohort study developed in São Luís, Maranhão. 2,515 adolescents participating in the second cohort follow-up were evaluated. In the proposed theoretical model, estimated by structural equation modeling, socioeconomic status and behavioral risk factors for NCDs, including use of legal (alcohol and cigarette) and illicit drugs, consumption of an unhealthy diet (caffeine and sugar-sweetened beverages), screen time and physical inactivity were tested as predictors of worsening sleep in adolescents, assessed by sleep quality (Pittsburgh Sleep Quality Index - PSQI) and excessive daytime sleepiness (Epworth Sleepiness Scale - ESS). Excess weight was considered a mediator in the analysis, with all variables having an effect on him to reach the outcome, which may influence the effects of these on adolescents' sleep. Results: physical inactivity (Standardized coefficient, SC=0.112; p=0.001), higher consumption of alcohol (SC=0.168; p=0.019) and sugar-sweetened beverages (SC=0.128; p<0.001), in addition to better socioeconomic status (SC=0.128; p<0.001), were associated with excessive daytime sleepiness in adolescents. Physical inactivity (SC=0.147; p<0.001) and higher consumption of sugar-sweetened beverages (SC=0.089; p=0.003) were also associated with poor sleep quality. However, in this sample of adolescents, excess weight was not a mediator, nor was it associated with sleep quality and excessive daytime sleepiness. Conclusion: the main modifiable behavioral risk factors for NCDs are associated, at the same time, with poor sleep quality and excessive daytime sleepiness in adolescents, being independent of overweight.
ANÁLISE ESPACIAL DO ABANDONO DO TRATAMENTO DA TUBERCULOSE E DA DUPLA CARGA TUBERCULOSE-DIABETES.
(Universidade Federal do Maranhão, 2021-03-23) SOEIRO, Vanessa Moreira da Silva; CALDAS, Arlene de Jesus Mendes; http://lattes.cnpq.br/7214761052240294; CALDAS, Arlene de Jesus Mendes; http://lattes.cnpq.br/7214761052240294; GALVÃO, Marli Teresinha Gimeniz; http://lattes.cnpq.br/8090769371296465; VASCONCELOS, Vitor Vieira; http://lattes.cnpq.br/8151243279050980; SANTOS, Alcione Miranda dos; http://lattes.cnpq.br/2709550775435326; BRANCO, Maria dos Remédios Freitas Carvalho
The abandonment of tuberculosis (TB) treatment and the tuberculosis-diabetes mellitus comorbidity (TB-DM) are part of the set of challenges to TB control as a public health problem. We aimed to analyze the spatio-temporal distribution of TB treatment abandonment and the tuberculosis-diabetes double burden in Brazil. An ecological study was conducted on the abandonment of treatment of new cases of TB and cases of tuberculosis-diabetes comorbidity in Brazil, in the period from 2012 to 2018, notified in the Sistema de Informação de Agravos de Notificação - Sinan, with municipalities as units of analysis. The study population consisted of all new cases of TB, of all clinical forms, whose outcome was the abandonment of TB treatment, and also all cases of tuberculosis, in all clinical forms, with the comorbidity Diabetes Mellitus. The Prais-Winsten model was used for the trend analysis and the Moran's Global and Local indices for the spatial analysis. It was found that the mean proportion of TB treatment abandonment in the country was 10.44% (SD:±1.36) with a trend considered stable. The highest averages were observed in the Southeast (10.80±1.50), South (10.67±3.17), and Midwest (10.12±0.86). The states with the highest rates were Rondônia (13.94±1.65), Rio Grande do Sul (13.73±4.56), and Rio de Janeiro (12.36±1.68). There was stability in the proportion of TB treatment abandonment in the country, and the North and South regions showed a decreasing trend, with variation rates of -5.45% and -16.62%, respectively. There was heterogeneous and non-random distribution, with the existence of high-risk areas concentrated, above all, in the Southeast region. As for the prevalence of TB DM comorbidity, in the period under study this indicator was 7.02%. In the annual and period distribution, the municipalities with prevalences above 6% are concentrated in the Southeast, Northeast, and South regions. The proportion of comorbidity TB-DM was heterogeneously distributed in Brazilian municipalities and did not occur randomly, with statistically significant positive spatial autocorrelation in the analysis of the period aggregate (Moran I= 0.193; p<0.0001). Spatial autocorrelation was verified by means of the Moran indices, with prevalence in high-risk areas equal to 28.04% and in low-risk areas equal to 5.86%. The high risk cluster was composed of municipalities belonging mainly to the Northeast, Southeast, and South regions. In the classic multivariate regression model, the coverage of Primary Care, percentage of the population living in households with a density greater than two people per room, percentage of unemployment of people over 18 years of age, per capita GDP, and per capita income fitted better. A negative association was observed between the dependent variable and the variables 'Primary Care coverage' and 'GDP per capita', which expresses in numerical terms that, for each increase in these markers, there is a decrease in the log of the number of MD-TB cases. The other variables were positively associated with the outcome. These variables were entered into the Spatial Lag and Spatial Error models and the results compared, with the latter showing the best parameters: R2=0.421, Log of the Likelihood=- 4661.03, AIC=9334.07 and SBC=9371.00. The Spatial Error residuals showed normal distribution and the overall Moran's index was -0.022 (p<0.001), indicating that the inclusion of the spatial component eliminated spatial autocorrelation from the residuals (value closer to zero), especially when compared to the residuals from the classical regression (OLS). The findings of this paper suggest that both treatment abandonment and TB-DM double burden are influenced by space for their occurrence and that socioeconomic and health factors explained the occurrence of TB-DM comorbidity in Brazil. The study of the spatial analysis of TB treatment abandonment and TB-DM comorbidity allowed us to highlight the heterogeneity and the pattern of geographical distribution of these two challenges to TB control as a public health problem in Brazil. The results presented here reinforce the need to recognize the abandonment of TB treatment and the TB-DM comorbidity as barriers to combating the disease in Brazil. This recognition is indispensable to the construction and implementation of public policies. It is hoped that the results of this study can contribute to the improvement of health actions, providing elements for the development of strategies aimed at reducing cases of treatment abandonment and for confronting the synergy of TB and DM, through the targeting of interventions in areas of greater risk, thus supporting the actions of public health management.
Controle social no estado do Maranhão: perfil dos conselhos de saúde
(Universidade Federal do Maranhão, 2021-07-16) HORA, Ana Carolina Alves da; PINHO, Judith Rafaelle Oliveira; http://lattes.cnpq.br/1541809941431244; PINHO, Judith Rafaelle Oliveira; http://lattes.cnpq.br/1541809941431244; CARNUT, Leonardo; http://lattes.cnpq.br/2575803021196614; ALVES, Maria Teresa Seabra Soares De Britto e; http://lattes.cnpq.br/3910533965773430; QUEIROZ, Rejane Christine de Sousa; http://lattes.cnpq.br/0222566094063579
The Health Councils instituted by Law no. 8,142/90, enables community participation in the management of the Unified Health System (SUS) and allows to recognize strategies for consolidating the Social Control implementation in SUS. It is also perceived gaps that demonstrate what structural and administrative conditions these councils have and whether they allow actions to happen as established by law. This aim of this research was to evaluate the composition of instances for social control in health from the Health Councils of the state of Maranhão. It is an evaluation research, whose unit of analysis was the municipal health councils registered in the Health Councils Monitoring System (SIACS). Of the 218 health councils in the state of Maranhão, only 147 were registered until December 2020, which became the universe of study in this research. The primary data collect was used, by electronic questionnaire prepared in Google Forms® and the secondary, characterized by the survey and extraction of information contained in the SIACS. A score classification composed of five dimensions was elaborated, with information regarding the qualification of these councils based on the current legislation. In all, 67.4% (p = 147) of the councils were eligible for study, showing that 32.6% (p = 71) are non-existent with regard to registration in the system; 53.74% (p = 79) do not have an internal regulation; 80.27% (p = 118) do not have any other standard or resolution; 41.82% (n = 23) of the councils do not have a system for receiving complaints; 64.58% (p = 93) do not have their own headquarters; as for the entities that make up the users' follow-up, 76.24% (p = 106) are made up of religious organizations. Considering the score, 31.97% of the evaluated councils are adequate (n = 47), 42.18% are partially adequate (n = 62) and 25.85% presented results of inadequacy (n = 38). There is a predominance of low representativeness, little renewal of members, domination by more organized groups and weakening of the struggle on other participatory fronts. It is concluded that, there are potential weaknesses in meeting the regulatory standards of health councils in Maranhão, thus impacting directly on the effective practice of Social Control in the State.
Fatores de risco comportamentais e metabólicos associados a depressão, risco de suicídio e fenótipo de risco vascular em adolescentes: Coorte RPS, São Luís
(Universidade Federal do Maranhão, 2021-11-12) BARBOSA, Janaina Maiana Abreu; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677; RIBEIRO, Cecília Cláudia Costa; http://lattes.cnpq.br/1783658679814263; RIBEIRO, Cecília Cláudia Costa; http://lattes.cnpq.br/1783658679814263; SIMÕES, Vanda Maria Ferreira; http://lattes.cnpq.br/4024829764707677; FERRARO, Alexandre Archanjo; http://lattes.cnpq.br/2770300692287670; SALGADO, Bernadete Jorge Leal; RIBEIRO, Maria Jacqueline Silva; http://lattes.cnpq.br/2821422730030116
Adolescence is a sensitive period of human development, and greater exposure to risk behaviors for Non-Communicable Diseases (NCD), such as smoking, physical inactivity, unhealthy diet and harmful use of alcohol, can have repercussions on mental health, insulin sensitivity, diabetes and future cardiovascular risk. This thesis comprises two articles. In the first article, the association of the main risk factors for NCDs with depression and the risk of suicide was evaluated through structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This is a population-based study carried out with 2,515 adolescents aged 18 and 19, belonging to the RPS Cohort, from São Luís – MA. Exposures were the main risk factors for NCDs: Substance use behaviors (latent variable deduced from the use of alcohol, tobacco and drugs), physical inactivity and components of the unhealthy diet (added sugar and saturated fat). The body fat index was evaluated by the fat mass index. Outcomes were depression and suicide risk. Substance use behaviors (standardized coefficient SC = 0.304; p <0.001), higher consumption of added sugar (SC = 0.094; p = 0.005) and female gender (SC = 0.310; p <0.001) were associated with depression. Substance use behaviors (SC = 0.356; p <0.001), higher consumption of added sugar (SC = 0.100; p = 0.012) and female gender (SC = 0.207; p <0.001) were also associated with the risk of suicide. Additive NCD risk behaviors have been associated with depression and suicide risk in adolescents, which may explain clustering of NCDs and mental disorders in adulthood. In the second article, the association between the Insulin Resistance Phenotype and Vascular Risk Phenotype was investigated. This is a cross-sectional study with 2,515 adolescents aged 18 and 19, Cohort RPS, from São Luís – MA. A theoretical model was proposed to assess the direct association between the Insulin Resistance Phenotype and Vascular Risk Phenotype at the end of the second decade of life, and indirect pathways starting from social vulnerability, alcohol consumption and body fat in young people. The latent variable Insulin Resistance Phenotype was formed by the HDL Triglycerides ratio (TG/HDL), Triglycerides-Glycemic Index (TyG) and VLDL levels and the Vascular Risk Phenotype was formed by the Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Wave Velocity. Body fat was measured by the fat mass index, measured by dual-emission X-ray densitometry (DEXA). The Insulin Resistance Phenotype was directly associated with the Vascular Risk Phenotype in males (SC=0.183; p < 0.001) and females (SC=0.152; p < 0.001) at the end of the second decade of life. The Insulin Resistance Phenotype mediated the association between the highest body fat index and the Vascular Risk Phenotype in males (SC=0.054; p < 0.001) and females (SC=0.041; p < 0.001). The association between Insulin Resistance Phenotype and Vascular Risk Phenotype in young people is suggestive of common pathophysiological mechanisms in early events on the diabetes and cardiovascular continuums, effect not mediated by body fat.
AUSÊNCIA DO ACOMPANHANTE EM TEMPO INTEGRAL E SEU EFEITO NA OCORRÊNCIA DE INTERVENÇÕES DESNECESSÁRIAS NO PRÉ-PARTO E PARTO EM MATERNIDADES BRASILEIRAS VINCULADAS À REDE CEGONHA.
(Universidade Federal do Maranhão, 2021-12-28) GOIABEIRA, Yara Nayá Lopes de Andrade; THOMAZ, Erika Bárbara Abreu Fonseca; QUEIROZ, Rejane Christine de Sousa; http://lattes.cnpq.br/0222566094063579; QUEIROZ, Rejane Christine de Sousa; THOMAZ, Erika Bárbara Abreu Fonseca; MARRERO, Lihsieh; NOGUEIRA, Adriana Gomes; LAMY, Zeni Carvalho
Introduction: The presence of a full-time companion is a right guaranteed by law, capable of optimizing the physiology of childbirth, reducing the hospital stay, providing psychological and emotional support to the woman, among other benefits. However, this right has not been fulfilled in its entirety in maternity hospitals linked to Rede Cegonha. Objective: To analyze the absence of a full time companion and its effect on the occurrence of unnecessary interventions in pre-partum and childbirth in Brazilian maternity hospitals linked to Rede Cegonha. Method: A national, cross-sectional study carried out in all Brazilian maternity hospitals linked to the RC of the Unified Health System (SUS – Sistema Único de Saúde), from December/2016 to October/2017. The participants of the study were 5,113 mothers from all regions of the country who had a vaginal birth in one of the 606 maternity hospitals with a regional action plan approved by Rede Cegonha. In the first article, proportions and respective 95% confidence intervals (CI) were estimated, adjusted for the cluster effect, comparing macro-regions by Wald's Chi-square test, and in the second article, a theoretical model was developed using Directed Acyclic Graph, testing the hypotheses by causal inference. The absence of a companion during hospitalization was considered as exposure and the occurrence of unnecessary interventions in pre-partum and delivery as an outcome. Pairing by propensity score and weighting by the inverse probability of exposure were used to balance the groups and estimate the causal effect, through adjusted regression coefficients (RC) and respective 95% CI and (alpha=5%). Results: The presence of a full-time companion occurred in 71.2% of deliveries, being higher among mothers aged 20-35 years, brown, with higher education, married and who gave birth vaginally. Almost 30% of postpartum women did not have a full time companion. Self-declared black women, with less education, single and who were assisted by a medical professional during childbirth had fewer companions. The time of delivery had a greater absence of a companion (70.8%). It was found that 92.1% of women who gave birth vaginally suffered some type of unnecessary interventions in pre-partum and/or delivery. The North, Northeast, and Southeast regions had a higher occurrence of interventions in unaccompanied women. The absence of a companion had an effect on the occurrence of venoclysis (Coef = 0.083; 95% CI 0.037 - 0.129), lithotomy (Coef = 0.144; 95% CI 0.103 - 0.185) and episiotomy (Coef = 0.064; CI 95% 0.022 – 0.105). Conclusion: The presence of a full-time companion in the maternity hospital works as a quality control of professional care, contributing to the reduction of professional behaviors in childbirth care considered harmful and/or ineffective, making them less technical and medicalizing.
Pontos de corte da relação cintura estatura e circunferência do pescoço em adolescentes: predição da obesidade, risco cardiovascular e relação com marcadores inflamatórios
(Universidade Federal do Maranhão, 2022-05-27) CARVALHO, Wyllyane Rayana Chaves; SANTOS, Alcione Miranda dos; http://lattes.cnpq.br/2709550775435326; FRANÇA, Ana Karina Teixeira da Cunha; http://lattes.cnpq.br/8389486900285691; FRANÇA, Ana Karina da Cunha; http://lattes.cnpq.br/8389486900285691; SANTOS, Alcione Miranda dos; http://lattes.cnpq.br/2709550775435326; MAGALHÃES, Elma Izze da Silva; http://lattes.cnpq.br/1834062948913299; GOMES, Taisa Lisboa Montagner; http://lattes.cnpq.br/7453277764664688; CONCEIÇÃO, Sueli Ismael Oliveira da; http://lattes.cnpq.br/3410453664705622
INTRODUCTION: Obesity is an important factor for the increase of inflammatory cells and cardiovascular risk even in young populations. Indicators are being investigated, including the Waist-to-Height Ratio (WHtR) and Neck Circumference (CP) in the prediction of obesity, cardiovascular outcomes and the relationship with inflammatory markers in adolescence. OBJECTIVE: To identify the cut-off points for the waist-to- height ratio (WHtR) to determine obesity and its association with inflammatory markers in adolescents (Article 1) and to determine the cut-off points for CP and WHtR for predicting obesity and cardiovascular risk in adolescents (Article 2). METHODS: Cross- sectional study with 2209 adolescents aged 18 and 19 (Article 1), belonging to the third phase of the birth cohort held in São Luís 1997/1998, called “RPS”, carried out in 2016/2017; and a subsample of 648 adolescents from that cohort (Article 2). The total area under the ROC curve (AUC) was identified to assess the predictive capacity of RCEstand CP in relation to% GC, obtained by ADP and cardiovascular risk by PDAY. The association of CERs with Interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and C- reactive protein (CRP) was evaluated. RESULTS: Article 1: Prevalence of obesity by %BF of 10.3% in males and 40.4% in females. The cutoff points of WHtR = 0.50 and AUC of 0.90 (95%CI 0.88-0.92) were identified for females and WHtR = 0.51 and AUC of 0.93 (95%CI 0.90 -0.97) for males. Elevated WHtR was associated with higher levels of IL-6 and CRP (p<0.05). Article 2: Prevalence of obesity of 7.6% in males and 41.3% in females and high risk by PDAY were from 13.8% and 10.9%, respectively. CP cutoff points identified for males=44.0, AUC was 0.70 (95%CI 0,58-0,83); WHtR=0.50, AUC 0.90 (95%CI 0.80-0.99). In females, PC=39.8, AUC was 0.75 (95%CI 0,69-0,80) and WHtR=0.50, AUC 0.87 (95%CI 0,83-0,90). To predict high cardiovascular risk in males, the AUC of CP was 0.71 (95%CI 0.62-0.80) and WHtR was 0.73 (95%CI 0.63-0.82); in females, the AUC of CP was 0.63 (95%CI 0.53-0.73) and WHtR was 0.55 (95%CI 0.45-0.65). CONCLUSION: The anthropometric indicators evaluated showed a statistically significant predictive capacity to identify obese individuals, in both sexes. Elevated WHtR values were associated with early inflammatory markers. For the prediction of cardiovascular risk, both indicators were classified as moderate, except for WHtR in females, considered to have low predictive capacity for risk. This study contributed to the identification of cutoff points of simple anthropometric indicators that can be used in health services to screen adolescents with obesity and high cardiovascular risk.
VIVÊNCIAS DE PROFISSIONAIS EM UNIDADE DE TERAPIA INTENSIVA E NÚCLEO INTERNO DE REGULAÇÃO DE LEITOS NA PANDEMIA DA COVID-19
(Universidade Federal do Maranhão, 2022-10-27) PEREIRA, Joelmara Furtado dos Santos; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; ALVES, Maria Teresa Seabra Soares de Britto e; http://lattes.cnpq.br/3910533965773430; CORREA, Maria Elizabeth da Silva Hernandes; http://lattes.cnpq.br/5935428566690008; CARVALHO, Alexandre Guilherme Ribeiro de; http://lattes.cnpq.br/7062148392179283; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; CARVALHO, Ruth Helena de Souza Britto Ferreira de; http://lattes.cnpq.br/6914279050780248
INTRODUCTION: In 2020, Brazil experienced an unprecedented health crisis, the so-called first wave of the COVID-19 Pandemic. The unexpected increase in patients with severe illness who demanded mechanical ventilators, beds and intensive care threatened the high complexity response capacity. From this perspective, this research sought to analyze the experiences of health professionals who worked in the Intensive Care Unit and in the Internal Bed Regulation Nuclei, in the context of the COVID-19 pandemic. METHODS: This is a descriptive exploratory study with a qualitative approach developed in the Intensive Care Units and Internal Bed Regulation Centers of two public hospitals, from November 2020 to January 2021, in the state of Maranhão. 22 professionals were selected, this sample was defined by the criterion of saturation of the senses. The data collection technique was the semi-structured interview. For analysis of the interviews, the technique of content analysis was used, in the thematic modality and the software NVIVO® 12 was used to aid in the organization and treatment of the data. RESULTS: Professionals reported that in the face of high demand, critically ill patients and insufficient beds, there was a need to reorganize the hospital environment and expand existing beds. Of the situations mentioned, the following stand out: the work overload and the shortage of professionals that affected the quality of care, leading to new forms of care production and the transitory rupture of the overvaluation of professional categories; the challenge of offering the expected high-standard care, which began to be built under the rhythm of uncertainty and ignorance of the disease; the feeling of professional collaboration and the perception of security in the team signaled as necessary presuppositions for the continuity of care. The experience with death and dying on a larger scale interfered in the way of facing the end of life in that context. In parallel with this overwhelming context, deciding who would occupy the intensive bed was a difficult and conflicting task, given the uncertainties of the “new disease”. Thus, a combination of clinical and non-clinical criteria was considered, evaluated on a case-by-case basis, such as severity, chance of survival, distance to be covered and transport conditions. It was identified that the context of an unknown disease, family and institutional pressures were points of tension and interfered in the decision-making process.FINAL CONSIDERATIONS: The changes that occurred in the work environment of the ICU and NIR influenced the way of dealing with that exceptional situation. Their experiences with the (re)organization of space, the meaning attributed to care and interprofessional relationships, showed that these agents were affected in a way and intensity peculiar to each one. Decision making was marked by practices and challenges arising from the context of exacerbation of the lack of beds and the knowledge that was structured about the disease, from the perspective of an arduous phenomenon and related to aspects extrinsic to the technical-assistance sphere.
Vivências de mulheres em relação à gestação, parto e puerpério durante a pandemia de covid-19
(Universidade Federal do Maranhão, 2023-03-30) POTY, Nalma Alexandra Rocha De Carvalho; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; LAMY, Zeni Carvalho; http://lattes.cnpq.br/9896819318523369; NEVES, Ednalva Maciel; http://lattes.cnpq.br/7766410071856075; SERRA, Jacira do Nascimento; http://lattes.cnpq.br/4831631346909667; CHAVEZ, Leidy Janeth Erazo; http://lattes.cnpq.br/6870905026005875
INTRODUCTION: The covid-19 pandemic brought changes in the way of life of women during the puerperal pregnancy cycle. Added to the inherent risk of the disease and the determination of social isolation, mothers who experienced the pandemic were not only affected by issues related to pregnancy and childbirth, but also by external influences that may have impacted their lives during this period. OBJECTIVE: To analyze the experiences of women in relation to pregnancy, childbirth and the puerperium during the covid-19 pandemic. METHOD: Qualitative research, carried out in two reference maternity hospitals for the care of cases of covid-19, in Maranhão, Brazil, with women who had the laboratory diagnosis (RT - PCR for covid-19) confirmed, during the first wave of the pandemic, period from March 2020 to November 2020. The survey of the study population took place from September to November 2020. Data collection took place from November 2020 to May 2021, using a semi-structured interview, based on 2 instruments. The first was followed by sociodemographic and clinical data of the woman and the newborn, and the second was a semi-structured script with open questions. Content analysis was used in the thematic modality. RESULTS: There were 20 interviews that showed that, for the women in the study, receiving the news of the covid-19 pandemic was a devastating experience that caused insecurity, fear and the need to reorganize plans for childbirth. Thus, at the time of delivery and birth, problems of access to services, setbacks in guaranteeing rights and good practices already consolidated, impacted the quality of maternal and child care. Participants noticed changes in care in the hospital environment caused by fear of contamination. Soon after returning home, they reported difficulties in getting puerperal and childcare consultations, which meant interrupting health care in some cases or seeking private services. The fear of their children's exposure to the coronavirus made them restrict visits from relatives and friends, which contributed to the weakening of support networks. Hygiene measures at home were intensified. Breastfeeding was considered a fundamental care strategy, which would not cause harm if public health recommendations were followed during practice. FINAL CONSIDERATIONS: The search for care by women who needed obstetric care during the pandemic period was marked by difficulties, exposing and intensifying weaknesses in the health system, especially access to services and the use of good practices, negatively affecting their experiences in childbirth and in child care. The pandemic also caused changes in support networks and restructuring of traditional models of family care, which had an impact on the lives of women and children.
Análise da distribuição espacial de beribéri e de síndrome respiratória aguda grave por covid-19
(Universidade Federal do Maranhão, 2023-05-09) MAXIMINO, Flávio Donalwan Sá; CASTELO BRANCO, Maria dos Remédios Freitas; http://lattes.cnpq.br/5449951869928014; CASTELO BRANCO, Maria dos Remédios Freitas; http://lattes.cnpq.br/5449951869928014; MEDEIROS, Maria Nilza Lima; http://lattes.cnpq.br/2755510184384522; FROTA, Maria Tereza Borges Araújo; http://lattes.cnpq.br/6922517649206885; FRANÇA, Ana Karina Teixeira Da Cunha; http://lattes.cnpq.br/8389486900285691; SOUZA, Bruno Feres de; http://lattes.cnpq.br/4112635495117258
Introduction: The location and distribution of diseases are fundamental in the epidemiological context of a society. Spatial analysis makes it possible to study geographic and spatial patterns of health and disease, assessing the relationships between spatial data and health. Objective: To discuss the importance of spatial distribution analysis as a health surveillance tool for neglected diseases and severe acute respiratory syndromes (SARIs). Method: This is a descriptive study, which addresses the analysis of the spatial distribution for two diseases: beriberi and SARS due to COVID-19. The first article is an ecological study with spatial distribution analysis, based on three databases: HORUS System (thiamine distribution); Ministry of Health (cases of beriberi) and Mortality Information System (deaths due to beriberi), from 2014 to 2020, in all federative units of Brazil. The second article is a descriptive study of SARS lethality rates by COVID-19 by municipality of notification and residence in Maranhão, based on records in the Information System for Epidemiological Surveillance of Influenza (SIVEP-Gripe), by municipalities of notification and of residence, from March 2020 to December 2022. Results: In the first study, 542 cases and 177 deaths from beriberi were recorded. Roraima and Tocantins registered the majority of cases (518; 95.5%), especially in the indigenous population (269; 49.6%). Cases predominated in men (405; 74.7%), rural areas (335; 61.8%) and with alcohol consumption (359; 66.2%). Deaths were more frequent in the white race/color (85; 48.0%), in São Paulo (36; 20.3%) and Minas Gerais (28; 15.8%). Indigenous establishments received a low quantity of thiamine tablets (1,381,141; 3.8%). In the second study, on SARS lethality due to COVID-19, 3,617 deaths were reported in 2020, 5,288 in 2021 and 588 in 2022. The lethality rate in the period was 39.1%, 45.3% in 2020; 36.4% in 2021; and 33.3% in 2022. The lethality rate by municipality of notification and residence was equal to 100% in 18 (8.2%) and five (2.3%) municipalities, respectively. 106 municipalities (48.8%) did not notify cases, while 129 municipalities (59.4%) did not register deaths. Conclusion: Beriberi is a neglected disease and is present in all regions, especially in poor, vulnerable areas with an indigenous population. Most cases are related to men, in rural areas, with alcohol consumption. Differences were found between lethality rates by municipality of hospitalization and municipality of residence. The data suggest that there are underreporting/underreporting of cases and deaths in SIVEP-Flu, changing SARS lethality rates due to COVID-19.

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