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MORTALIDADE MATERNA E DETERMINANTES DOS MUNICÍPIOS NORDESTINOS: ANÁLISE ESPACIAL ANTES E DURANTE A PANDEMIA DE COVID-19

2026-07-14T12:34:58Z

Título: MORTALIDADE MATERNA E DETERMINANTES DOS MUNICÍPIOS NORDESTINOS: ANÁLISE ESPACIAL ANTES E DURANTE A PANDEMIA DE COVID-19 Autor: FILGUEIRAS, Ellen Rose Santos Primeiro orientador: QUEIROZ, Rejane Christine de Sousa Abstract: Objective: To analyze the spatial distribution of maternal mortality in Northeast Brazil before and during the COVID-19 pandemic, correlating the Maternal Mortality Ratio (MMR) with social vulnerability and maternal healthcare indicators. Methods: This is an ecological and analytical study based on secondary data from 2017 to 2022. Global and Local Moran spatial autocorrelation indices were applied to identify territorial patterns and risk clusters. Correlation analyses were also conducted between the Maternal Mortality Ratio (MMR), social vulnerability indicators, Primary Health Care coverage, and adequacy of prenatal care. Analyses were performed for all municipalities in Northeast Brazil. Results: At the regional level, positive spatial autocorrelation of MMR was observed in all analyzed periods. Before the pandemic, the Global Moran’s I was 0.140, increasing to 0.234 during the pandemic period (2020–2022), indicating that maternal mortality is not randomly distributed across the territory. Low–Low clusters predominated, representing municipalities with lower mortality rates. However, during the COVID-19 pandemic, changes in the spatial configuration of these clusters were observed, with increased inequalities and greater territorial heterogeneity. In Maranhão, spatial patterns showed greater instability during the pandemic, with more pronounced changes in cluster distribution and stronger associations between maternal mortality, social vulnerability, lower Primary Health Care coverage, and inadequate prenatal care. Conclusion: Despite the challenges imposed by the COVID-19 pandemic, some municipalities in Northeast Brazil maintained more favorable maternal mortality patterns, possibly related to better healthcare infrastructure and more organized Primary Health Care systems. In Maranhão, however, territorial inequalities were more pronounced, reinforcing the need to strengthen maternal health policies, improve maternal death surveillance, and enhance healthcare networks with a territorial and equity-focused approach. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

Qualidade de vida e laboral dos agentes comunitários de saúde em um município do Maranhão

2026-07-09T19:26:43Z

Título: Qualidade de vida e laboral dos agentes comunitários de saúde em um município do Maranhão Autor: ABREU, Lillia Michely Nunes Primeiro orientador: MONTEIRO, Sally Cristina Moutinho Abstract: Community Health Workers (CHWs) play a central role in the Family Health Strategy. However, they are often exposed to adverse working conditions and occupational stressors, which may compromise their quality of life and the effectiveness of Primary Health Care. This study aimed to analyze the quality of life and quality of work life of Community Health Workers in São José de Ribamar, Maranhão, as well as their associated factors. This is a cross-sectional, quantitative study with 155 participants, whose data were collected through a semi-structured questionnaire covering sociodemographic characteristics, lifestyle habits, and health conditions, as well as validated instruments to assess quality of life and quality of work life. Data were analyzed using descriptive and inferential statistics. Qualitative variables were expressed as absolute and relative frequencies, while quantitative variables, after the Shapiro–Wilk normality test, were presented as medians and percentiles. A predominance of females was observed, with a higher proportion aged over 50 years (56.1%) and a long professional trajectory (median of 25 years). Regarding lifestyle habits, most participants were non-smokers (95.5%) and did not consume alcoholic beverages (78.6%), while 45.2% reported engaging in regular physical activity. A high prevalence of overweight (83.3%) and chronic conditions such as hypertension (32.9%), diabetes (17.4%), and dyslipidemia (24.0%) was identified. Quality of life scores were higher in the psychological and social relationships domains (median of 75.0), intermediate in the physical domain (67.9), and lower in the environment domain (60.7). Quality of work life showed a median of 76.0, indicating an overall satisfactory perception. A negative association was observed between the physical domain and age, number of children, and number of families followed, while a positive association was found between the psychological domain and years of professional experience. The environment domain was negatively correlated with the number of children, with no significant associations identified for the social relationships domain or quality of work life. In multivariate analysis, the number of families followed and family burden showed a negative impact on the physical and environmental domains. It is concluded that, although CHWs perceive their work-related quality of life as satisfactory, factors such as age, family burden, and the number of families followed may negatively impact the physical and environmental domains of their quality of life. These findings highlight the need for policies focused on workload management, occupational health promotion, and family and psychosocial support strategies for this professional group. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

Adesão ao tratamento da hipertensão arterial na população negra do maior quilombo urbano da América Latina

2026-05-22T13:44:29Z

Título: Adesão ao tratamento da hipertensão arterial na população negra do maior quilombo urbano da América Latina Autor: BOGÉA, Rômulo Luiz Neves Primeiro orientador: SARDINHA, Ana Hélia de Lima Abstract: Hypertension imposes a heavy burden in Brazil and disproportionately affects the black population, especially when social determinants and primary health care arrangements limit therapeutic continuity and blood pressure control. In this context, urban quilombo communities deserve attention because they combine geographical proximity to services with organizational microbarriers that impact the effectiveness of care. This study aimed to evaluate adherence to antihypertensive treatment in black people living in an urban quilombo. This is a cross-sectional, analytical study with a quantitative approach, conducted at a health center in an urban quilombo in São Luís, Maranhão, Brazil; the sample consisted of 288 registered users diagnosed with hypertension who self-identified as black. Two instruments were used for data collection: the first on sociodemographic profile, lifestyle, and health, and the second related to adherence to hypertension treatment. Descriptive analyses and multivariate models were used to estimate associations between adherence scores and blood pressure control. The results of the survey showed that the majority were women (69.4%) and elderly (51%), with low education (46%) and income (87.1%); overweight was frequent (63.3%). A very high proportion of adherence was observed according to the instrument applied (98.6%), but a substantial portion maintained blood pressure above the recommended clinical target (52.4%); in addition, higher adherence scores were associated with lower diastolic blood pressure levels, while the effect on systolic blood pressure was less consistent. These findings suggest that medication use alone are not sufficient to ensure optimal blood pressure control when other conditions that impact blood pressure levels persist. Self-reported adherence may be high and still coexist with suboptimal blood pressure control; continued access and care bonding showed potential to increase adherence; however, social determinants and lifestyle also continue to significantly influence the clinical response, thereby primary care professionals, when considering strategies to improve adherence, need to combine these aspects with care arrangements for the effective control of hypertension. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

PREVALÊNCIA DE SINAIS E SINTOMAS DO CLIMATÉRIO EM MULHERES ATENDIDAS NA ESTRATÉGIA SAÚDE DA FAMÍLIA

2026-05-22T13:26:02Z

Título: PREVALÊNCIA DE SINAIS E SINTOMAS DO CLIMATÉRIO EM MULHERES ATENDIDAS NA ESTRATÉGIA SAÚDE DA FAMÍLIA Autor: SANTOS, Kassia Rejane dos Primeiro orientador: RABELO, Poliana Pereira Costa Abstract: The climacteric, the transition period from the reproductive to the non-reproductive phase, represents a growing public health challenge due to population aging. This study aimed to estimate climacteric signs and symptoms in women attending Primary Health Care, correlating them with sociodemographic, gynecological, obstetric, and psychological aspects. A crosssectional study was conducted with 182 users aged 40 to 64 years from the Family Health Strategy, using the Mini-Mental State Examination, a structured sociodemographic questionnaire, and the Greene Climacteric Scale for data collection. Descriptive and inferential statistical analysis (p<0.05) was employed to process the information, including Shapiro-Wilk and Kruskal-Wallis tests. The results showed climacteric symptomatology in 100% of the studied sample, with a predominance of symptoms of mild (57.1%) to moderate (32.4%) intensity. There was a statistically significant association between climacteric symptoms and a previous diagnosis of depression and anxiety. Regarding asthma or bronchitis, a condition absent in most of the sample, it was found that most participants presented mild symptoms. Among gynecological history, only the number of pregnancies showed a significant association with the intensity of symptoms. Negative self-perception of health was related to a higher frequency of moderate and intense symptoms. Identifying the intensity of climacteric symptoms in Primary Health Care is important because it allows for the early recognition of more vulnerable women and the targeting of individualized interventions. This knowledge supports the planning of educational, preventive, and continuous monitoring actions, strengthening comprehensive women's health care. Furthermore, it contributes to improving the performance of the multidisciplinary team, especially nursing, in promoting quality of life during menopause.; El climaterio, el período de transición de la fase reproductiva a la no reproductiva, representa un creciente desafío de salud pública debido al envejecimiento de la población. Este estudio tuvo como objetivo estimar los signos y síntomas del climaterio en mujeres que acuden a Atención Primaria de Salud, correlacionándolos con aspectos sociodemográficos, ginecológicos, obstétricos y psicológicos. Se realizó un estudio transversal con 182 usuarias de entre 40 y 64 años de edad de la Estrategia de Salud Familiar, utilizando el Mini-Examen del Estado Mental, un cuestionario sociodemográfico estructurado y la Escala Climatérica de Greene para la recolección de datos. Se empleó un análisis estadístico descriptivo e inferencial (p<0,05) para procesar la información, incluyendo las pruebas de Shapiro-Wilk y KruskalWallis. Los resultados mostraron sintomatología climatérica en el 100% de la muestra estudiada, con un predominio de síntomas de intensidad leve (57,1%) a moderada (32,4%). Hubo una asociación estadísticamente significativa entre los síntomas del climaterio y un diagnóstico previo de depresión y ansiedad. En cuanto al asma o la bronquitis, afecciones ausentes en la mayoría de la muestra, se observó que la mayoría de las participantes presentaban síntomas leves. Entre los antecedentes ginecológicos, solo el número de embarazos mostró una asociación significativa con la intensidad de los síntomas. La autopercepción negativa de la salud se relacionó con una mayor frecuencia de síntomas moderados e intensos. Identificar la intensidad de los síntomas climatéricos en la Atención Primaria de Salud es importante porque permite la detección temprana de mujeres más vulnerables y la aplicación de intervenciones individualizadas. Este conocimiento respalda la planificación de acciones educativas, preventivas y de seguimiento continuo, fortaleciendo la atención integral de la salud de la mujer. Además, contribuye a mejorar el desempeño del equipo multidisciplinario, especialmente el de enfermería, en la promoción de la calidad de vida durante la menopausia. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação; Trabalho sob Sigilo. Motivo: Não informado pelo Autor. Data Provável de Liberação: 29/04/2026.