DISSERTAÇÃO DE MESTRADO - PROGRAMA DE PÓS-GRADUAÇÃO EM ENFERMAGEM

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    Análise espacial dos casos e óbitos da covid-19 e sua relação com indicadores socioeconômicos e de saúde no estado do Maranhão.
    (Universidade Federal do Maranhão, 2023-04-12) ALENCAR, Larissa Karla Barros de; SOEIRO, Vanessa Moreira da Silva; http://lattes.cnpq.br/2013273011748287; CALDAS, Arlene de Jesus Mendes; http://lattes.cnpq.br/7214761052240294; CALDAS, Arlene de Jesus Mendes; http://lattes.cnpq.br/7214761052240294; SOEIRO, Vanessa Moreira da Silva; http://lattes.cnpq.br/2013273011748287; FERREIRA, Thaís Furtado; http://lattes.cnpq.br/1542923855954206; COUTINHO, Nair Portela Silva; http://lattes.cnpq.br/0041085284657642
    Introduction: COVID-19 is an infectious disease, caused by the SARS-CoV-2 virus, with high transmissibility and global distribution. Since it was first reported in the city of Wuhan, China, in December 2019, the world has been following the exponential growth of cases of the disease. Objective: To analyze the spatial distribution of COVID-19 cases and deaths in Maranhão and its relationship with socioeconomic and health indicators. Methodology: Ecological study of all cases and deaths of COVID-19 in the state of Maranhão notified until August 2022 at the Secretary of State for Health. Socioeconomic and health indicators were collected from the online sites of the Brazilian Institute of Geography and Statistics (IBGE), Institute of Applied Economic Research (IPEA) and e-Gestor Assistência Básica. The dependent variables used were: incidence, mortality and lethality of COVID-19, and the independent ones were: resident population of the municipalities of Maranhão, Gini Index, Municipal Human Development Index (MHDI), Social Vulnerability Index (SVI), income per capita, proportion of poor people, household crowding, illiteracy rate of people aged 15 years or over, proportion of households with a general water network, unemployment rate of the population aged 18 years or over and coverage of Primary Care (AB). The incidence, mortality and lethality rates of the 217 municipalities in Maranhão were estimated. The Global Moran Index (I) was used to assess the existence of spatial autocorrelation with the dependent variables, and the Local Moran Index to identify high and low risk areas (clusters). The maps were made using the QGIS software version 3.12.0. To calculate the global spatial autocorrelation indices, as well as the regression models, the GeoDa software, version 1.14, was used. Result: Until August 31, 2022, 468,943 cases and 11,524 deaths from COVID-19 were reported in Maranhão. The municipality of São Luís registered the highest number of cases and deaths, with 73,218 (15.61%) and 2,873 (24.93%), respectively, and the municipality of Boa Vista do Gurupi registered the lowest number, 16 cases (0.003 %). The municipality of São Francisco do Brejão did not record a death from COVID-19. The highest incidence rate was recorded in the municipality of Lagoa do Mato (25,957.44/100,000 inhab.) and the lowest rate was in Boa Vista do Gurupi (188.36/100,000 inhab.). The highest mortality rate was recorded in Imperatriz (374.25/100,000 inhab.) and the highest lethality rate was in Boa Vista do Gurupi (31.25%). The Moran I Index showed positive spatial autocorrelation for incidence, mortality and lethality in the studied period, making it possible to identify clusters of high and low risk for the dependent variables. The Ordinary Least Squares Estimation (OLS) regression model confirmed spatial autocorrelation with the dependent variables. Incidence showed a positive association with the Gini Index and AB coverage, and a negative association with IVS, MHDI and proportion of poor people. Mortality was positively associated with the Gini Index and illiteracy rate and negatively associated with the proportion of poor people and IVS. Regarding lethality, there was a positive correlation with household crowding and a negative correlation with primary care coverage and illiteracy rate. Conclusion: The spread of COVID-19 occurred heterogeneously, with wide variation between the municipalities of Maranhão, making it possible to identify areas of greater and lesser risk for the disease. Socioeconomic and health indicators influenced the evolution of the pandemic, and that such characteristics should be considered in the formulation of public policies to control the disease, as well as to reduce existing inequalities in the State.
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    Distribuição espacial e temporal da tuberculose em povos indígenas no estado do Maranhão.
    (Universidade Federal do Maranhão, 2016-08-04) Sá, Karina Vanessa Chagas da Silva; CALDAS, Arlene de Jesus Mendes; 067.220.913-68
    Tuberculosis (TB) presents as a serious public health problem in the world, constituting a relevant infectious disease with high morbidity and mortality, particularly in indigenous people, considered a population at risk for having an incidence rate ten times higher if compared to the general population. Maranhão, from the point of view of the ethnic constitution of its population, has 38,831 indigenous people, distributed in 19 regional units of health. It's the objective of this study to analyze the spatial and temporal distribution of new cases of tuberculosis in indigenous in the state of Maranhão. We conducted an ecological study of historical series of new cases of TB in indigenous from 2010 to 2014 reported in the System for Notifiable Diseases Information System (SINAN). The population consisted of all new cases of tuberculosis in indigenous in the State of Maranhão , reported in the System for Notifiable Diseases Information System (SINAN), from January 2010 to December 2014. For mapping TB in indigenous was held the organization of addresses as to type of the public place,street name, house number, neighborhood, zip code, longitude, latitude, city of residence, health regional, state of residence. The results, after georeferencing of cases during the study period, were presented in thematic maps elaborated in the Geographical Information System (GIS), ArcGIS Program, version 10.1. As to the sociodemographic characteristics of the indigenous population, the highest frequency was observed in the age group of 20-39 years (38.8%), males (68.3%), with ≤8 years of study (50.0%) and residents in rural areas (74.2%); and clinical and laboratory aspects, the pulmonary form was the most frequent (94.4%) and the non-performance of the tuberculin skin test (78.7%), the positive Gram stain in the first sample (50.0%), the negativity second sample (32.0%), the non-performance of the culture (90.4%), and the negative result of HIV testing (53.4%). When evaluating TB cases per year of occurrence it was observed that 2012 (58,1 / 100.000 hab.) And 2014 (77,0 / 100,000 hab.) had the lowest incidence rates, and in 2010 (95,2 / 100,000 hab .) the highest. The areas of Regional Units of Health - RUH with the highest incidences were: Bacabal, Codó, Rosário, Pinheiro, São Luís, Itapecuru-Mirim, Balsas, Chapadinha e Presidente Dutra. It is concluded that the number of cases of TB in indigenous in Maranhao is still quite high and is distributed in RUH, especially in those presenting the highest concentration of indigenous areas, requiring the adoption of more effective measures to prevent and control the disease the indigenous population of the state.
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    A experiência de trabalho das enfermeiras nas ações de atenção primária à saúde no Maranhão na década de 1980: o resgate da memória
    (Universidade Federal do Maranhão, 2018-02-28) RODRIGUES, Kardene Pereira; COIMBRA, Liberata Campos; 271325363-20; http://lattes.cnpq.br/9128715784318958; COIMBRA, Liberata Campos; 271352363-20; http://lattes.cnpq.br/9128715784318958; CABRERA, Isabel Ibarra; http://lattes.cnpq.br/0765622564575420; SILVA, Elza Lima; http://lattes.cnpq.br/6524486747562167; SILVA, Tatiana Raquel Reis; http://lattes.cnpq.br/1154566878083509
    In the 1980s, the sedimentation of the private hospital model of health was being studied, and at the same time the aim was to redesign the function of the state, municipal and outpatient health units of INAMPS, as well as discussions on the participation of health professionals in Integrated Health Actions (AIS), which emphasized Primary Health Care. Nursing work in Primary Care is seen as the effective promotion and protection of the health of the population, making use of knowledge of the nursing sciences as well as the social sciences and public health, this statement was made by the Scope and Standards of Public Health Nursing Practice. The recognition that memory is, above all, a continuous and updated reconstruction of the past is a consensus among scholars. The fact is that memory is more a conjuncture than a content, an always attainable purpose, a composite of strategies. It is a descriptive study, with a qualitative approach, using as methodological instrument Oral History and analyzed by the thematic-categorial content of Bardin. According to DataSus, in the Maranhão of the 1980s the resident population was 3,996,445 distributed among 129 municipalities and in São Luís the resident population was 449,433 inhabitants. In the early 1980s the State of Maranhão had high rates of maternal and infant mortality, with diarrheal diseases, low vaccination coverage, low adherence to breastfeeding, malnutrition and low rates of prenatal follow- factors that generated the high rates. The infant mortality rate was approximately 130 / 1,000NV, the second highest rate in the Northeast. in APS the nurse is a valuable leadership in territories of extreme poverty, they act in the management and assistance with interference in the processes of reflection, actions of health promotion and integrality of care next to this reality. The 1980s are considered as one of the decades that have occurred most changes in the nursing profession, challenging the hegemony of positivism that dominated the health area. In the experiment studied, the nurses involved independently exercised the care mainly to pregnant women and children through the nursing consultation. They performed prenatal and child care in Health Centers and this action may be considered a pioneer in Maranhão.
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    Histórico de Enfermagem: Manejo e Percepções de Enfermeiros no Contexto da Terapia Intensiva Pediátrica
    (Universidade Federal do Maranhão, 2016-03-28) Pinheiro, Jaynara Menezes Sousa; SOUSA, Francisca Georgina Macedo de; 088.890.233-68
    The Nursing Care Systematization is the methodology used to plan, execute and The Nursing Care Systematization is the methodology used to plan, execute and assess the care, having as essence the care as a working organization tool, the Nursing Process. That is operationalized by a team work, articulated and complementary, enabling the care continuity. The Nursing Process first stage was inserted at the Pediatric Intensive Care Unit of Maranhão Federal University Teaching Hospital in 2013. In the last two years this service has been through a plenty of work staff alterations due to retirement, resignation and new workers hiring. This fact, associated to matters of operation and work process, made us question: what conceptions are revealed by the nurses about the Nursing Process and how they deal with the assistance history operationalization? The research had as objectives: comprehend the nurses’ conceptions about the children care Nursing Process in intensive care; assess the registers and characterize the Nursing History handling in this Intensive Care Unit. It was used the research mixed method combining quantitative and qualitative research with statistical and textual analysis. For data obtainment, it was used the participant observation and primary data collection with the 12 nurses, supported by a questionnaire with open questions analyzed with the Content Analysis methodological support. The research second stage was documental and retrospective using as documental support 72 hospitalized children Nursing Histories in the period between January and August, 2015. For the Nursing History analysis it was used a tool made specifically for this goal, from the items of each Human Basic Need on the same mode they are presented on the Nursing History of the research service context. For the analysis of the Nursing History filling it was used scores which vary from 1 to 189 points. It was classified as Terrible (1 to 66 points); Bad (67 to 100 points); Regular (101 to 145 points); Good or Great (145 or more points). On the qualitative approach two thematic categories were built (Nursing History Valorization and Difficulties on the Nursing History Handling) and seven subcategories (First Contact and Bond Mobilizing Opportunity and Interactive Process; Care Planning and Management Instrument; Individualized and Enlarged Care Strategy; Risks Security and Minimization Resource; Nursing Valorization Instrument; Relative to Working Process; Relative to Nursing History Structure). The qualitative results revealed the nurses assign bureaucratic characteristics to the Nursing History, despite of considering it contributes for the integral care, ample and resolutive on an ambivalent construct between what they think and do as a substantial number of the analyzed items were incomplete or blank. Regarding the Nursing History filling 47,2% were classified as regular, 23,7% bad, 22,2% great and 6,9% terrible. The results characterized the Nursing History handling by nurses of the pediatric intensive care from a subjective and objective perspective of the data analysis revealing it as ambivalent, ambiguous and disqualified in terms of its filling during the nurse care practices.
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    Ser–pessoa–idosa com sequelas da covid-19: um estudo fenomenológico
    (Universidade Federal do Maranhão, 2023-02-10) CASTRO, Polyanna Freitas Albuquerque; SILVA, Líscia Divana Carvalho; http://lattes.cnpq.br/8574936257819873; DIAS, Rosilda Silva; http://lattes.cnpq.br/6699170604660310; DIAS, Rosilda Silva; http://lattes.cnpq.br/6699170604660310; SILVA , Líscia Divana Carvalho; http://lattes.cnpq.br/8574936257819873; SILVA, Andrea Cristina Oliveira; http://lattes.cnpq.br/6318715436250827; BORBA, Ana Karla de Oliveira Tito
    The Covid-19 pandemic is configured as the biggest public health challenge experienced in recent decades and although it represents an acute disease, most of those infected have experienced persistent symptoms and health consequences due to sequelae and complications. The objective of this research is to understand the meanings of the experience of being an elderly person with a sequel to Covid-19. Methodology: descriptive study with a qualitative approach developed at the Municipal Post-Covid-19 Reference Center in the municipality of São Luís, Maranhão. Elderly people were selected as an eligibility criterion who presented in their medical records a record of care by at least two professionals, among them the nurse, and a Post-Covid-19 Functional Status Scale (PCFS) score with a minimum value of one (1.0). Of the total of twenty-two (22) elderly people with PCFS greater than one (1.0), ten (10) elderly people participated in the phenomenological interview. The interview took place from May to July 2022 . The theoretical-methodological framework used was Martin Heidegger's Phenomenology. There was a predominance of age between 60 and 69 years, female, married/stable union and widows, retired, with income between 0 and 1 minimum wage. The most prevalent comorbidities were Systemic Arterial Hypertension and Diabetes Mellitus. Most were sedentary, few were considered smokers, alcoholics and overweight. The understanding moment made it possible to identify six units of meaning: Being-ill-with Covid-19; The Physical Being with sequel of Covid-19; The Psychological Being with sequel of Covid-19; Being-dependent with Covid-19 sequel; The Being-with with sequel of Covid-19 and The Being-spiritual with sequel of Covid-19. The repercussions on physical and mental health and functionality put the elderly person in front of a new condition, a new Being-there with himself, with the world and with the other. It was understood that the sense of being-elderly-person with a sequel to Covid-19 revealed himself as resigned to the fact of existing, the being-there thrown into a world without choices, led the elderly person to experience the illness of the body by Covid-19, facing existential anguish generated by the pain and suffering of his clinical condition, insecurity and fear in relation to the future and the lives of those he loves. The Being-elderly-person with a sequel to Covid-19 was permeated by transformations in their daily life, awakening disturbing feelings such as insecurity, fear, frustration, sadness, anguish, loneliness. Spirituality and the family and social support network proved to be tools for coping with adversity, enabling resilience, improving well-being and quality of life. The elderly person who experienced, in their own, particular and singular way, the circumstances of the illness, sought in "themselves" possibilities to deal with negative feelings related to the sequelae of their disease, revealing that, even in the face of adverse situations caused by the sequelae of Covid-19, was the bearer of its own care. It is also noted that there are challenges in the complexity of health practices and in the completeness of care, especially in the concrete appreciation of the Being in its entirety .