https://tedebc.ufma.br/jspui/handle/tede/672 2026-06-05T06:27:00Z 2026-06-05T06:27:00Z SANTANA, Marta Silva de https://tedebc.ufma.br/jspui/handle/tede/7031 2026-06-03T11:54:44Z 2026-04-10T00:00:00Z

Título: Tendência da mortalidade neonatal no nordeste brasileiro de 2014-2023 Autor: SANTANA, Marta Silva de Primeiro orientador: BATISTA, Rosângela Fernandes Lucena Abstract: INTRODUCTION: Neonatal mortality corresponds to death between zero and 27 days of life, constituting a significant public health problem, especially in developing countries. In Brazil, the highest rates are concentrated in the North and Northeast regions, highlighting marked inequalities compared to the South and Southeast. OBJECTIVES: To analyze the trend of neonatal mortality and its elements, as well as its distribution in the Brazilian Northeast region from 2014-2023. METHODOLOGY: This ecological time-series study analyzed the behavior and trends of neonatal deaths in Northeast Brazil from 2014 to 2023, using secondary data obtained from the Mortality Information System. The data were categorized and organized for descriptive and regression statistical analysis using Rstudio® software with a Prais-Winsten regression model. Causes were analyzed according to the groups in Chapter 10 of the International Classification of Diseases. RESULTS: A total of 62,600 neonatal deaths were recorded, of which 76.8% occurred in the early period and 23.2% in the late period, peaking in 2017 and 2018 with the highest concentration in Bahia and Pernambuco. Deaths were mainly concentrated among male newborns (55.3%), mixed-race infants (70.7%), and those with extremely low birth weight (34.1%), predominantly among children of young mothers (20-29 years old), mixed-race infants (70.7%), and those with intermediate education levels (47.9%). Deaths due to perinatal conditions and congenital malformations were prominent. Early neonatal deaths were the majority, with rates remaining unchanged throughout the decade, while late neonatal deaths increased after 2020, and total rates remained similar throughout the period, even slightly increasing. Bahia and Sergipe showed the highest rates, while Ceará and Alagoas recorded the lowest. In the later period, Sergipe and Piauí led the indicators, contrasting with Rio Grande do Norte and Alagoas, which showed the lowest marks. The overall trend in total neonatal mortality for the Northeast region is one of stability (p=0.633). Among the states, Paraíba showed an increasing trend (APC=1.49%; p=0.021), Rio Grande do Norte a decreasing trend (APC=-1.18%; p=0.008), and the remaining states remained stable. For the early neonatal period, there was a decline in Rio Grande do Norte (APC=-1.85%; p=0.015) and Piauí (APC=- 1.21%; p=0.045) and an increase in Sergipe (APC=1.54%; p=0.020). In the regional panorama, the rates stabilized (p=0.187). For the late neonatal period, there is systemic progression in the region (APC=1.70%; p=0.001); among the states, progression is observed in Bahia (APC=3.24%; p=0.002). Peak growth was observed in Paraíba (APC=3.17%; p=0.010) and Alagoas (APC=1.42%; p=0.049), while mortality remained stable in the other states. CONCLUSION: Neonatal mortality remained stable in the Northeast, with variations between states: a reduction in Rio Grande do Norte and Piauí, and an increase in Paraíba and Sergipe. A notable increase occurred in the late neonatal period in Alagoas, Bahia, and Paraíba, and regionally as a whole. Early deaths due to preventable perinatal causes predominated, indicating persistent challenges and shortcomings in care, requiring improved care. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

2026-04-10T00:00:00Z RODRIGUES, Evandicleude Ferreira de Carvalho https://tedebc.ufma.br/jspui/handle/tede/6937 2026-05-04T14:09:31Z 2026-03-27T00:00:00Z

Título: O ensino de epidemiologia nos cursos de graduação em Enfermagem do Brasil Autor: RODRIGUES, Evandicleude Ferreira de Carvalho Primeiro orientador: OLIVEIRA, Bruno Luciano Carneiro Alves de Abstract: Introduction: Epidemiology constitutes an essential foundational component in the education of nurses. However, significant gaps remain in the knowledge regarding the provision of this discipline within undergraduate Nursing programs at Brazilian higher education institutions. Objective: To analyze the teaching of Epidemiology in the pedagogical projects of undergraduate Nursing programs at public higher education institutions in Brazil. Methods: This was a cross-sectional, document-based study employing a qualitative-quantitative approach. Data was collected from the Pedagogical Projects of Undergraduate Nursing Programs at public higher education institutions in Brazil. A total of 124 programs from 87 higher education institutions were included. Eligible institutions were officially accredited and registered in the e-MEC system, had a score equal to or higher than 3 in the 2023 National Student Performance Examination (ENADE), and had their pedagogical project publicly available. Quantitative data were analyzed using descriptive statistics with support from Microsoft Excel and RStudio software. Qualitative analysis was conducted using Bardin’s content analysis framework, supported by IRaMuTeQ software for data coding, categorization, and thematic class generation. Results: Epidemiology was identified in all programs analyzed. However, substantial variability was observed in its curriculares organization. In most institutions (72.2%), epidemiology was offered as a standalone discipline, whereas in others (27.8%), it was integrated into thematic axes related to Public Health, Biostatistics, and Health Surveillance. Additional variations were identified in course workload, year of offering, and types of bibliographic references adopted. Content analysis revealed three thematic classes. Terms related to epidemiological indicators, measures, and analytical methods predominated (49%), followed by content addressing the application of Epidemiology to health planning, management, and practice (38.6%). Expressions associated with health conditions and determinants of the health–disease process in Public Health appeared less frequently (12.4%). Statistically significant regional differences were observed among thematic classes (p-value = 0.012). The theoretical-descriptive dimension of the discipline was the most prevalent nationwide (73.0%), particularly in programs located in the North and Northeast regions. Approaches emphasizing health planning and management, either independently or integrated with the quantitative applicability of the discipline, were more predominant in the Midwest, Southeast, and South regions. Only five programs nationwide included all thematic classes within their course syllabi. Conclusion: The study demonstrates heterogeneity in the teaching of Epidemiology in public undergraduate Nursing programs in Brazil. Although the discipline is present in all analyzed programs, there is variability in curricular organization and a predominance of a conceptual and technical-operational approach in course syllabi, to the detriment of discussions addressing public health conditions and determinants. This scenario may pose challenges to the comprehensive education of nurses. The incorporation and integration of thematic classes, longitudinal distribution of the discipline throughout the curriculum, and strengthening of its critical-analytical depth across different stages of training emerge as strategies to reinforce a comprehensive perspective of Epidemiology and to reduce fragmentation in undergraduate Nursing education in Brazil. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

2026-03-27T00:00:00Z CRUZ, Pablo Nascimento https://tedebc.ufma.br/jspui/handle/tede/6924 2026-04-23T13:41:23Z 2026-03-06T00:00:00Z

Título: ESPACIALIZAÇÃO, TENDÊNCIA TEMPORAL E FATORES ASSOCIADOS À MORTALIDADE FEMININA POR CÂNCER DE MAMA NA AMAZÔNIA LEGAL Autor: CRUZ, Pablo Nascimento Primeiro orientador: RABÊLO, Poliana Pereira Costa Abstract: Objective: To analyze the spatial dynamics, temporal trends, and factors associated with female mortality from breast cancer in the Brazilian Legal Amazon. Method: This is an ecological study on breast cancer mortality among women aged 20 years or older. Records of deaths occurring in the Legal Amazon between 2014 and 2023 were included, collected from January to May 2025. The data sources were: TABNET/DATASUS, Brazilian Institute of Geography and Statistics, Atlas of Human Development in Brazil, and IPS Brazil. Mortality rates were standardized using the direct method (SMR), based on the female population from the 2022 demographic census, with correction for ill-defined causes. The ecological units for temporal analysis were the states, and for spatial analysis, the health regions (HR). Temporal trends in sociodemographic characteristics and SMR were assessed using Joinpoint Regression, estimating Annual Percent Change (APC). Spatial analysis was performed using Global Moran’s Index, Local Moran’s Index (LISA Map), and spacetime scan statistics. The association between the dependent variable (SMR) and socioeconomic and healthcare indicators, based on the Social Determinants of Health (SDH) framework, was assessed through multivariate linear regression (OLS), Spatial Error Model (SEM), and Spatial Lag Model (SAR). Results: A total of 12,034 deaths were recorded during the study period. The average SMR for the Legal Amazon was 18.6 per 100,000 women, with the highest rates observed in Mato Grosso (SMR=21.7), Amazonas (SMR=21.4), and Roraima (SMR=20.3). An increasing trend was observed in the Legal Amazon (APC=2.17), Maranhão (APC=1.85), and Roraima (APC=9.97), as well as among the following groups: women aged ≥80 years, with 8 or more years of schooling, separated, and Black women after 2020. Conversely, declining trends were identified among women aged 30–39 years from 2018 onward, and among those aged 40–49 years, with 0–3 years of schooling and married. Significant spatial autocorrelation was found (I=0.218; p=0.002), and local analysis indicated “High-High” clusters in Mato Grosso, “Low-Low” clusters in Maranhão, Pará, and Amazonas, and outliers in areas of epidemiological transition. The space-time scan identified 10 clusters, including 4 protective clusters in Maranhão, Tocantins, Pará, Roraima, Amazonas, and Acre, and 6 risk clusters in Mato Grosso, Roraima, Amazonas, and Pará. Positive associations of SMR were found with aging rate (β=0.899), household per capita income (β=0.022), and number of nurses (β=0.004), while an inverse effect was observed for expected years of schooling (β=-2.101). Conclusion: The geographic and temporal disparities identified in mortality patterns underscore the relevance of SDH and highlight the need for more targeted public policies aimed at improving access to healthcare services. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

2026-03-06T00:00:00Z PEREIRA, Girlane Caroline https://tedebc.ufma.br/jspui/handle/tede/6789 2026-02-24T12:28:56Z 2025-12-22T00:00:00Z

Título: Avaliação do uso tópico da ALOE vera no reparo tecidual de feridas crônicas Autor: PEREIRA, Girlane Caroline Primeiro orientador: DIAS, Rosilda Silva Abstract: Introduction: The management of chronic wounds represents a persistent challenge in healthcare services, requiring therapeutic alternatives that are effective, safe, and accessible. Aloe vera (L.) Burm. f. stands out in phytotherapy due to its anti- inflammatory, antioxidant, and regenerative properties, being considered a promising option in the wound healing process. Objective: To evaluate the clinical and histological effects of the topical application of in natura Aloe vero gel on the tissue repair of chronic wounds of different etiologies. Methods: This is a descriptive, quantitative, longitudinal case series clinical study conducted from August to October 2025 in a specialized outpatient clinic for the care of people with chronic wounds, linked to a public hospital in the municipality of São Luís, Maranhão, Brazil. Follow-up included serial clinical evaluations and comparative histological analysis at baseline (Day 0) and at the end (Day 15), aiming to analyze tissue and cellular evolution. Results: Favorable clinical evolution was observed in all participants, characterized by reduction of exudate, improvement in wound bed appearance, progression of epithelialization, and decreased pain intensity. In three participants, complete formation of granulation tissue was observed at the end of the follow-up period. Histological analysis corroborated the clinical findings, showing reduced inflammatory infiltrate, increased angiogenesis, and proliferation of young fibroblasts, consistent with progression to the proliferative phase of tissue repair. Conclusion: The topical use of in natura Aloe vera gel demonstrated positive effects on tissue repair and pain control in chronic wounds, representing a safe, low-cost, and potentially relevant therapeutic alternative for nursing practice. The findings indicate the feasibility of incorporating this approach as a complementary strategy in the care of chronic wounds within the Unified Health System (SUS). Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

2025-12-22T00:00:00Z