TEDE Communidade:

Associação entre consumo de alimentos segundo o grau de processamento e dificuldades comportamentais em adolescentes de 10 a 13 anos da coorte brisa

2026-02-25T00:00:00Z

Título: Associação entre consumo de alimentos segundo o grau de processamento e dificuldades comportamentais em adolescentes de 10 a 13 anos da coorte brisa Autor: OLIVEIRA, Lucia Regina Moreira de Primeiro orientador: VIOLA, Poliana Cristina de Almeida Fonseca Abstract: Introduction: Adolescence is a critical period for the consolidation of dietary habits and mental health development. Growing evidence suggests that diet quality, particularly the high consumption of Ultra-Processed Foods (UPF), can negatively influence behavior and mental health, given their low nutrient density and pro-inflammatory potential. Studying this relationship, while controlling for socioeconomic and behavioral factors, is essential for formulating specific interventions. Objective: To investigate the association between the degree of food processing and behavioral difficulties in adolescents (10 to 13 years old) participating in the BRISA cohort. Methods: This was a cross-sectional cohort study conducted with adolescents aged 10-12 years from the BRISA Cohort, São Luís, Maranhão (N=2293). The exposure variable was food consumption, categorized according to the NOVA classification and measured in energy percentage (%Kcal) using a 24-Hour Dietary Recall (24hDR). The primary outcome was the Total Difficulties Score, assessed by the Strengths and Difficulties Questionnaire (SDQ). Sociodemographic, socioeconomic, and behavioral variables (Sex, Age, Brazilian Economic Class, Physical Activity, Screen Time, Sleep Duration) were used as confounding factors, as directed by a Directed Acyclic Graph (DAG). The association was tested through bivariate analyses and adjusted Multiple Linear Regression. A significance level of 5% was adopted. Results: The average consumption of UPF corresponded to 30.3% of the Total Energy Value of the diet. The SDQ analysis revealed that 26% of adolescents were classified as at risk (borderline + clinical) in the total score. Bivariate analysis indicated a significant association between UPF consumption and sex, with female adolescents being more prevalent in the higher consumption tertiles (p=0.002). Multiple Linear Regression demonstrated that, even after adjustment for all confounders, a higher consumption of UPF was independently associated with higher behavioral difficulties scores (β=0.300; 95% CI: 0.05; 0.55). Complementarily, an increase in the consumption of Unprocessed or Minimally Processed Foods (UMPF) was associated with a reduction in the Total Difficulties Score (β = - 0.410; 95% CI: -0.70; -0.12). Other risk factors included sedentary behavior/inactivity and high screen time. Conclusion: The consumption of ultra-processed foods acts as a fundamental determinant of increased behavioral difficulties in adolescence. The findings reinforce the urgent need for comprehensive public policies that promote the substitution of ultra-processed foods with diets based on unprocessed and minimally processed foods, aiming to protect the mental health of Brazilian adolescents. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

Relações da atividade física e do comportamento sedentário com um fenótipo da saúde musculoesquelética em adolescentes: consórcio RPS, São Luís

2026-03-10T00:00:00Z

Título: Relações da atividade física e do comportamento sedentário com um fenótipo da saúde musculoesquelética em adolescentes: consórcio RPS, São Luís Autor: TOCANTINS, Patrícia Viana Primeiro orientador: ALMEIDA, Cecília Cláudia Costa Ribeiro de Abstract: Adolescence is an essential stage for musculoskeletal development, characterized by the consolidation of bone mass, muscle mass, and muscle strength, which are fundamental components for functional capacity and the prevention of musculoskeletal diseases in adulthood. These processes are strongly influenced by human movement–related behaviors, such as physical activity at different levels, as well as sedentary behavior. Insufficient levels of physical activity and excessive sedentary time during adolescence may compromise the development of the musculoskeletal system, resulting in less favorable health profiles, with an increased risk of chronic non-communicable diseases (NCDS) and functional frailty throughout life. In this context, this dissertation aims to analyze the association between physical activity, sedentary behavior, and the Musculoskeletal Health Phenotype in adolescents at the end of the second decade of life. This is a cross-sectional analytical study nested within a birth cohort, using data from the 18–19-year follow-up of the 1997/98 birth cohort from São Luís, Brazil, with a sample of 2,515 participants. Physical activity was assessed using a validated questionnaire, the Self-Administered Physical Activity Checklist (SAPAC), and actigraphy. Sedentary behavior was measured by the daily time spent in low-energy-expenditure activities. The outcome corresponded to the Musculoskeletal Health Phenotype, a latent variable constructed from the shared variance among bone mineral density, handgrip strength (HGS), and muscle mass. Associations were estimated using Structural Equation Modeling, adjusted for socioeconomic status, sex, and nutritional status. The results indicated that physical activity showed a direct positive association, increasing the values of the Musculoskeletal Health Phenotype (standardized coefficient = 0.143; p < 0.001), whereas sedentary behavior exerted a direct negative effect (standardized coefficient = −0.040; p < 0.001). Lower socioeconomic status increased the values of the Musculoskeletal Health Phenotype (standardized coefficient = 0.291; p < 0.001) and reduced sedentary behavior (standardized coefficient = −0.041; p < 0.001). Female sex was associated with lower levels of physical activity and greater sedentary behavior, while overweight increased the values of the Musculoskeletal Health Phenotype (standardized coefficient = 0.263; p < 0.001). The findings highlight the importance of interventions to promote physical activity among adolescents, preventing future risks to musculoskeletal health and associated chronic non-communicable diseases. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

SISTEMA DE SAÚDE NO MARANHÃO: O PÚBLICO E O PRIVADO SOB A PERSPECTIVA DE GESTORES, GERENTES, EMPRESÁRIOS E PROFISSIONAIS DE SAÚDE

2026-03-30T00:00:00Z

Título: SISTEMA DE SAÚDE NO MARANHÃO: O PÚBLICO E O PRIVADO SOB A PERSPECTIVA DE GESTORES, GERENTES, EMPRESÁRIOS E PROFISSIONAIS DE SAÚDE Autor: CAMPOS, Douglas Moraes Primeiro orientador: PINHO, Judith Rafaelle Oliveira Abstract: This thesis investigates the interactions between the public and private healthcare systems in Maranhão, based on the perspectives of managers, administrators, healthcare professionals, and business owners. The perspective situated from different positions “within the system” and these agents’ reflections on their daily work practices contributed to an understanding of tensions in the public-private relationship, particularly regarding the coordination of federal entities, human resource management, the role of Social Health Organizations (SHO), and the expansion of Low-Cost Clinics in the state capital. The analysis of these issues through the intertwining of the pathways traversed by these agents allowed for the contextualization of issues raised at the local-regional level. Grounded in the Social and Human Sciences in Health, the research employed mixed methods, combining semi-structured interviews and georeferencing in the capital, São Luís. The results highlight tensions between the Unified Health System (UHS) and the private sector, driven by the selective expansion of the market and the overload of the public network. In the study, SHO and Low-Cost Clinics, which are dependent on the public sector, are presented by their representatives as alternatives for unmet demands within the SUS. The participants emphasized that Primary Health Care (PHC) has been severely affected by hospital-centric policies, leading to the fragmentation of Health Care Networks (HCNs), the precariousness of employment relationships, and hospital overcrowding, even as hospital care expands in rural areas. This scenario unfolds in a context in which the state of Maranhão has progressively opened space, within the UHS framework, for private entities to operate in the provision of healthcare services and hospital management. Through georeferencing, it was demonstrated that the expansion of Low-Cost Clinics is not random; these entities occupy areas of high population density in the center and in some outlying areas of São Luís, located near Basic Health Units (UBS). In this sense, actions coexist within the territory in which the value of health differs: as a universal right and as an economic asset, access to which is mediated by payment. The analysis identifies the expansion of the private sector’s presence in healthcare provision and management within the UHS, reconfiguring care and creating tension around health as a right in the face of its commodification. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese; Trabalho sob sigilo. Motivo: O sigilo se dá pois há artigos não publicados e que estão em processo de submissão em revistas científicas que exigem exclusividade na disponibilização dos dados. Data Provável de Liberação: 24 meses.

Indicadores de saúde materna e infantil em uma capital do nordeste brasileiro: Uma análise de séries temporais

2026-02-26T00:00:00Z

Título: Indicadores de saúde materna e infantil em uma capital do nordeste brasileiro: Uma análise de séries temporais Autor: AZEVEDO, Thalita Lisboa Gonçalves Primeiro orientador: THOMAZ, Erika Barbara Abreu Fonseca Abstract: Introduction: Maternal and child health problems remain significant worldwide, especially in low- and middle-income countries. In Brazil, regional inequalities still hinder the achievement of the Sustainable Development Goals (SDGs), with the Northeast region facing major challenges. In this context, monitoring maternal and child health through indicators available in health information systems enables the continuous evaluation of service performance and implemented actions, particularly within the scope of care during the first 1,000 days. Objective: To analyze the temporal trend of maternal and child health indicators in Primary Health Care (PHC) in the city of São Luís, capital of Maranhão, from 2017 to 2024. Methods: This is an ecological time-series study using secondary data from the Primary Health Care Information System (SISAB). Six indicators related to women’s health were analyzed [number of pregnant women with prenatal care initiated up to 12 weeks of gestational age (GA); number of pregnant women with exams performed up to 20 weeks of GA; number of pregnant women with six or more prenatal visits; number of collective educational activities with pregnant women; number of home visits by community health workers (CHWs) to pregnant women; number of home visits by CHWs to postpartum women], and four indicators related to child health [number of home visits by CHWs to newborns (NB); number of children in exclusive breastfeeding; number of children in complementary breastfeeding; and number of children with up-to-date vaccination]. All indicators were expressed as ratios per 100 live births. Trends were estimated using Joinpoint regression, calculating semiannual percent changes (SPC), considering a 5% significance level. For each indicator, the number of joinpoints was selected based on the lowest Bayesian Information Criterion (BIC). Results: Descriptive analysis showed wide variability across indicators, with high coefficients of variation, reflecting irregularity in the provision of PHC actions. In the temporal trend analysis (Joinpoint model), high variability was also observed, with the highest coefficients of variation found in the indicators “number of collective educational activities with pregnant women” (CV=90%) and “number of pregnant women with six or more prenatal visits” (CV=81%). Significant increasing trends were identified for early initiation of prenatal care (SPC=14.77%; p<0.001), completion of six or more prenatal visits (SPC=20.06%; p<0.001), and exams up to 20 weeks between 2017 and 2023 (SPC=15.20%; p=0.003), with a non-significant inflection in the final period. Educational activities showed a significant decrease between 2019 and 2021, followed by growth thereafter (SPC=36.74%; p=0.002). Exclusive breastfeeding (SPC=16.58%; p<0.001) and complementary breastfeeding from 2020 onward (SPC=21.50%; p=0.024) also showed significant increases. In contrast, oscillatory behavior was observed in home visits and in indicators related to vaccination and child followup. Conclusion: The temporal trend of maternal and child health indicators in Primary Health Care in São Luís showed a heterogeneous pattern from 2017 to 2024. Consistent improvements were observed in indicators related to timely access to prenatal care and breastfeeding practices, whereas indicators related to home visits, vaccination, and child follow-up showed instabilities, suggesting weaknesses in the continuity and regularity of care actions. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação; Trabalho sob sigilo. Motivo: O sigilo parcial se justifica pela intenção de submissão de artigos científicos derivados da dissertação a periódicos acadêmicos, visando preservar a originalidade do conteúdo e atender às exigências editoriais das revistas. Prazo previsto para disponibilização total: 24 meses.