TEDE Communidade:

Análise espaço-temporal da distribuição de fisioterapeutas e de atendimentos fisioterapêuticos ambulatoriais no sistema único de saúde, Brasil

2026-07-20T17:36:43Z

Título: Análise espaço-temporal da distribuição de fisioterapeutas e de atendimentos fisioterapêuticos ambulatoriais no sistema único de saúde, Brasil Autor: MARQUES, Maria Jhany da Silva Primeiro orientador: ALVES, Cláudia Maria Coelho Abstract: The provision of physical therapy services in the SUS is marked by inequalities. This thesis analyzed the spatiotemporal distribution of physical therapists and outpatient care in the SUS in Brazil and Maranhão (MA). Two ecological studies were conducted using official public data. The first investigated the evolution in the number of physical therapists and visits in Brazil from 2008 to 2019, in relation to per capita Gross Domestic Product (GDP) and per capita SUS budget. The second analyzed the distribution of these professionals and outpatient production in MA from 2022 to 2024, considering socioeconomic, demographic, structural, mobility, and accessibility factors. Analyses included covariance, Pearson correlations, and Tukey’s test in the national study, and association tests, Moran’s indices, and spatial regression in the Maranhão study. In Brazil, GDP per capita showed a positive correlation with physical therapists in all federative units (FUs) and with visits in seven FUs, especially Paraíba (r=0.96), Acre (r=0.88), and Amazonas (r=0.84). Visits correlated with per capita SUS budget in Acre (r=0.84), Amazonas (r=0.76), Tocantins (r=0.73), Paraíba (r=0.65), and Rondônia (r=0.64). In Maranhão, municipalities with coverage <1 physical therapist/10,000 inhabitants decreased from 53 to 19, those with rates ≥6.67/10,000 increased from 1 to 9, and more than 120 municipalities had no recorded visits. High-High clusters of coverage and production were concentrated in the eastern, central-eastern, and western areas. Physical therapist coverage was associated with specialty centers (β=0.115) and per capita SUS budget (β=0.001) in health regions, and with GDP per capita (β=6.839) and polyclinics (β=0.298) in municipalities. Visits were associated with trauma hospitals (β=188.252) in health regions, and with primary health care units (β=2.190), trauma hospitals (β=4.559), and hospitalizations for musculoskeletal surgeries (β=589.786) in municipalities. It is concluded that, in Brazil, GDP per capita and SUS budget per capita were positively associated with the availability of physical therapists and outpatient production, especially in the Northern FUs. In Maranhão, territorial inequalities and care gaps persisted in the provision of physical therapy in the SUS, associated with socioeconomic and structural factors.. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

Assistência oncológica mamária pública e privada em São Luís Maranhão: vivências médicas durante a pandemia de covid-19

2026-07-15T12:31:00Z

Título: Assistência oncológica mamária pública e privada em São Luís Maranhão: vivências médicas durante a pandemia de covid-19 Autor: SANTOS, Jéssica Mendes Costa de Freitas Primeiro orientador: ALVES, Maria Teresa Seabra Soares de Britto e Abstract: The COVID-19 pandemic produced profound repercussions on breast cancer care in Brazil, affecting both the public and private health sectors. This thesis aimed to analyze, from the perspective of specialist physicians, the impacts of the pandemic on the organization of care and on clinical practices related to breast cancer in São Luís, Maranhão, with emphasis on inequalities between sectors and on changes generated by technological mediation. The study is based on the hypothesis that health crises can aggravate pre-existing disparities and reconfigure routines and meanings of health care, especially in contexts marked by the historical segmentation of the health system. This is a qualitative study based on 18 semi-structured interviews with physicians specializing in breast cancer care who worked in both public and private sectors during and after the pandemic. Data analysis followed the procedures of content analysis (Bardin), guided by thematic categories related to the chronological trajectory of the pandemic and to transformations resulting from the virtualization of care. The thesis is composed of two scientific articles. The first analyzes the experiences of professionals across different phases of the pandemic, revealing organizational, emotional, and structural impacts on the health system. The second discusses the effects of digital mediation—such as telehealth, social media, and digital platforms—on oncological practice, highlighting both innovations and ethical, technical, and communicational tensions. The findings indicate that, although important institutional adaptations occurred, historical inequalities deepened, and technological mediation, far from being neutral, produced new forms of exclusion and professional overload. It is concluded that the pandemic acted as a catalyst for changes in ways of caring, communicating, and organizing health work, whose effects still demand critical analysis and the development of equity-oriented public policies. This thesis contributes to the field of Collective Health by integrating structural analysis, attentive listening to professional experiences, and ethical reflection on cancer care in times of crisis. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

Predição de risco de atraso no desenvolvimento neuropsicomotor nos primeiros mil dias de vida utilizando aprendizado de máquina: coorte brisa

2026-07-01T18:32:49Z

Título: Predição de risco de atraso no desenvolvimento neuropsicomotor nos primeiros mil dias de vida utilizando aprendizado de máquina: coorte brisa Autor: SILVA, Katia Susana Azevedo Primeiro orientador: SOUZA, Bruno Feres de Abstract: Introduction: The first thousand days of life represent a critical window of brain plasticity, in which neuropsychomotor development (NPMD) is sensitive to biological and psychosocial influences. Early prediction of risks during this period is fundamental for timely interventions, although it constitutes a complex challenge in community-based populations. Objective: To develop and evaluate Machine Learning (ML) models to predict the risk of NPMD delay in children during the first thousand days of life. Methods: Prospective study with data from 972 mother-child pairs from the BRISA cohort (São Luís – MA). The outcome was the risk of delay assessed in the cognitive, communication and motor domains evaluated by the Bayley III scale. The algorithms Penalized Logistic Regression (PLR), Random Forest (RF), Support Vector Machines (SVM) with radial kernel and Artificial Neural Networks (ANN), and the null classifier were tested. Preprocessing included imputation of missing data, encoding of categorical variables by one-shot encoding and standardization of numerical variables. For the evaluation of the generated ML models, K-fold cross-validation (k = 5) with 10 repetitions was used. As performances metrics, the area under the AUC-ROC curve (AUC), sensitivity, specificity, accuracy, precision and F1-score were used. The interpretability of the models was analyzed using the SHapley Additive Explanations (SHAP) technique. Results: The highest prevalence of risk of delay occurred in expressive communication (44.1%). The models showed moderate performance with AUC ranging between 0.533 and 0.603, with PLR being the most stable algorithm, reaching an AUC of 0.603 in the fine motor domain. SHAP analysis identified as main predictors: family history of epilepsy, child's sex, maternal depressive symptoms, psychological violence and social support, maternal education and family income. Conclusion: ML models demonstrated moderate discrimination ability in heterogeneous population samples, showing that increased algorithmic complexity did not surpass logistic regression. The findings reinforce the multifactorial nature of development, highlighting the impact of psychosocial and biological determinants, contributing to the development of screening tools applicable to Primary Health Care. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação

PERCEPÇÕES DE PROFISSIONAIS DA ATENÇÃO PRIMÁRIA SOBRE A SAÚDE DE PESSOAS LGBTQIA+

2026-06-17T11:57:14Z

Título: PERCEPÇÕES DE PROFISSIONAIS DA ATENÇÃO PRIMÁRIA SOBRE A SAÚDE DE PESSOAS LGBTQIA+ Autor: ABREU, Carla Michelle Rodrigues Primeiro orientador: LIMA, Sara Fiterman Abstract: Introduction: Despite advances in the creation of the National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals, Transvestites, and Transsexuals, the health needs of the LGBTQIA+ population are still unknown to a large part of health professionals. Without adequate care, lesbians, gays, bisexuals, and transgender people tend to resist seeking qualified support. In this context, it becomes fundamental that professionals develop skills and competencies to understand and value the real needs of this population. Objective: To analyze the perceptions and attitudes of Primary Care professionals regarding the health of the LGBTQIA+ community. Method: This is a qualitative, descriptive, and analytical study, carried out between October 2025 and January 2026 at the Bezerra de Menezes Primary Health Care Unit, São Francisco Primary Health Care Unit, Centro Primary Health Care Unit, and Liberdade Primary Health Care Unit, located in São Luís – MA, with professionals from the Family Health Strategy. Data collection was carried out through a focus group, using a structured questionnaire for sociodemographic information and professional trajectory, and a semi-structured interview guide. The interviews were transcribed and analyzed according to Thematic Analysis, following the perspective of Braun and Clarke. Results: From the analysis of the statements, three main categories emerged: the first, Conceptual understanding of gender identity and sexual orientation, is composed of three core meanings: Lack of knowledge of the acronym LGBTQIA+ and its meanings, generating misunderstanding about sexual and gender diversity; The first part, "Attitudes and Positions of Professionals Towards the LGBTQIA+ Population," is composed of three core meanings: Perception and Recognition of Prejudice in the Care of the LGBTQIA+ Population; Influence of Personal, Religious, Moral, or Cultural Beliefs; Recognition of Ethical-Professional Duty in Care. The second part, "Experiences in the Care of the LGBTQIA+ Population in Primary Health Care," is composed of four core meanings: Programmed Invisibility: Accounts of Little or No Experience; Clinical Reductionism: Care Centered on Complaint and Pathologization; Conducts Marked by Insecurity, Hesitation, and Exclusionary Attitudes; Primary Health Care as an Entry Point: Potentialities and Limitations in Reception. Final Considerations: The participants' statements reveal conceptual confusion, embarrassment when addressing the topic, and resistance in the correct use of pronouns and social names, revealing weaknesses both in the technical field and in the fulfillment of human rights. legal. The influence of personal moral and religious values proves to be a limiting element for professional practice guided by ethical principles and the universality of the SUS (Brazilian Unified Health System). Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação