TEDE Coleção:https://tedebc.ufma.br/jspui/handle/tede/tede/8832023-12-12T10:22:23Z2023-12-12T10:22:23ZPandemia de covid-19: mudanças e desafios na gestão da atenção hospitalarMANTESSO, Jhennyfer Barbosa de Oliveirahttps://tedebc.ufma.br/jspui/handle/tede/tede/48172023-07-12T13:58:06Z2023-05-25T00:00:00ZTítulo: Pandemia de covid-19: mudanças e desafios na gestão da atenção hospitalar
Autor: MANTESSO, Jhennyfer Barbosa de Oliveira
Primeiro orientador: LAMY, Zeni Carvalho
Abstract: INTRODUCTION: In early 2020 covid-19 was classified as a public health emergency of
international importance becoming the latest global health crisis. In March of the same year, it
was classified as a pandemic, causing changes in health services and work processes.
OBJECTIVE: To analyze the challenges in hospital care management during the covid-19
pandemic. METHOD: This study with a qualitative, exploratory approach of the case study
type. It was developed in a university hospital in a capital of northeastern Brazil, from March
to September 2022. The participants were 22 professionals assigned to management, care or
support service in the first and second waves of covid-19. Face-to-face or online interviews
were conducted, recorded, and later transcribed, of the individual semi-structured type with the
application of a structured questionnaire and interview script. Content analysis was used in the
thematic modality. RESULTS: They are presented from two categories: Changes, challenges,
and decisions: new emergencies and Conflicts, negotiations and cooperation. The pandemic
scenario has required rapid decision-making, often surrounded by uncertainty and insecurity.
Structural and organizational changes were identified, related to physical reforms, human
resources and related to the work process. Thus, sectors had to be closed and professionals
relocated to provide care to patients with covid-19, in most cases, with great initial resistance,
requiring the management a posture of imposition, on the one hand, and of negotiation. There
was also a barrier in the creation of protocols that were in fact effective, given in part to the
denial existing in the federal government that impacted the accreditation of these professionals
to include ministerial recommendations in their plans and the lack of effective treatment. Faced
with the increase in the demand for care, the departure of some professionals and the licenses
due to contamination of the teams, some managers also assumed functions in care. The reports
of strengthening cooperation relations between professionals in this scenario of uncertainties
were highlighted, facilitating interdisciplinary actions and strategies, and producing a tendency
to horizontalization of labor relations. CONCLUSION: The various challenges that arose for
management during the pandemic required rapid responses and actions by managers for the
organization of services, and the lack of clear national policy guidelines caused anxiety. The
daily work, with mistakes and successes, enabled the construction and agreement of strategies
to cope with the pandemic, seeking to minimize conflicts, promote integration and ensure the
safety of workers, patients and families.
Instituição: Universidade Federal do Maranhão
Tipo do documento: Dissertação2023-05-25T00:00:00ZFatores associados à capacidade antioxidante total da dieta de gestantes brasileirasCARVALHO, Roberta Rejane Santos dehttps://tedebc.ufma.br/jspui/handle/tede/tede/47452023-06-05T12:43:43Z2023-04-04T00:00:00ZTítulo: Fatores associados à capacidade antioxidante total da dieta de gestantes brasileiras
Autor: CARVALHO, Roberta Rejane Santos de
Primeiro orientador: CARVALHO, Carolina Abreu de
Abstract: Introduction: Pregnancy is considered a phase of oxidative stress, in which the demands for
nutrients with antioxidant properties are increased. The total antioxidant capacity of the diet
(TACd) is an instrument that evaluates the consumption of antioxidants present in the diet.
Objective: The present study aimed to analyze the association of socioeconomic, regional,
trimester and nutritional status factors with the CATd of Brazilian pregnant women
participating in the “Multicentric Study on Iodine Deficiency (EMDI-BRASIL)”, carried out in
eleven centers and distributed in nine states and the Federal District. Methods: This is a cross-
sectional study with 2232 pregnant women, aged 18 years or older, in the first, second or third
trimester of pregnancy, assisted by teams from Basic Health Units in eleven cities in Brazil,
namely Aracaju, Belo Horizonte, Brasília, Macaé, Palmas, Pinhais, Ribeirão Preto,
Rondonópolis, São Luís, Viçosa and Vitória, who reported not having thyroid disease
(hypothyroidism, hyperthyroidism, Hashimoto's disease and neoplasms) or surgery on the
thyroid gland. A semi-structured questionnaire was used to assess socioeconomic, demographic
and health data and a 24-hour recall (R24h) was used to assess dietary intake. The total
antioxidant capacity of the diet was obtained through the consumption of foods and beverages
reported in the R24h and with the aid of tables that used the “ferric reducing-antioxidant power”
(FRAP) method to calculate the amount of antioxidants in each food. Associations between
sociodemographic factors and total dietary antioxidant capacity were analyzed using logistic
regression. Results: The median CATd of pregnant women was 5.32 mmol/day. Pregnant
women aged 20 to 34 years (OR:1.86; CI 95%; 1.26-2.76), 35 years or older (OR:3.68; CI 95%;
2.21-6.14) and who were in the second trimester of pregnancy (OR:1.50; CI 95%; 1.11-2.01)
were more likely to be in the highest CATd tertile. While pregnant women with higher
education (OR: 0.67; CI 95%; 0.48-0.92) were 67% less likely to be in the highest CATd tertile.
Conclusion: The present study demonstrated that there are differences in the consumption of
antioxidants in different cities in Brazil and that associated factors such as age, education and
the gestational trimester can impact the intake of foods rich in antioxidants. We encourage the
creation of public policies focused on these more vulnerable groups and alert health professionals about the need to reinforce the importance of a diet rich in antioxidants during
prenatal care.
Instituição: Universidade Federal do Maranhão
Tipo do documento: Dissertação2023-04-04T00:00:00ZÍndice inflamatório da dieta ajustado por energia e dismenorreia em adolescentes de São Luís - MAARCOVERDE, Fernanda Vieira Linshttps://tedebc.ufma.br/jspui/handle/tede/tede/47442023-06-05T12:29:50Z2023-04-11T00:00:00ZTítulo: Índice inflamatório da dieta ajustado por energia e dismenorreia em adolescentes de São Luís - MA
Autor: ARCOVERDE, Fernanda Vieira Lins
Primeiro orientador: LAMY FILHO, Fernando
Abstract: Objective: To evaluate the association between the energy-adjusted dietary inflammatory
index (IIDE) and the presence of dysmenorrhea requiring use of medication in adolescents from
São Luís - MA.
Methods: This is a cross-sectional study with 1263 female adolescents, aged between 18 and
19 years old. The presence of dysmenorrhea was assessed by report of the use of drugs for
analgesia by the participant. Food consumption was assessed using the food frequency
questionnaire (FFQ), allowing the calculation of the IIDE. The associations between the
prevalence of dysmenorrhea and the IIDE, skin color, socioeconomic level, years of schooling,
body fat percentage, number of pregnancies, use of hormonal contraceptives, smoking and
physical activity were analyzed using a binary logistic regression model. The hierarchical
approach was used to define the variables included in the fitted model.
Results: Dysmenorrhea had a prevalence of 10.7% in the studied population. The IIDE ranged
from -3.08 to 5.77, with a mean of 1.62 (SD +/-1.52) and first and second tertiles of 0.97 and
2.25, respectively. In the final model, the IIDE did not prove to be a statistically significant
predictor for the presence of dysmenorrhea in the studied population (p= 0.849; R2Nagelkerke
= 0.036). Two other variables had a statistically significant association with the outcome
variable, which were the socioeconomic level (C1, C2 D/E) (OR = 0.655; 95% CI: 0.43 – 0.97)
and the number of pregnancies (greater or equal to one) (OR=0.136; 95%CI: 0.01-0.99).
Conclusion: Dysmenorrhea had a lower prevalence than that reported in the literature, and there
was no association between IIDE and this condition in this population. Considering the weight
of this association in nutritional recommendations for adolescents, the present study contributes
to this important debate.
Instituição: Universidade Federal do Maranhão
Tipo do documento: Dissertação2023-04-11T00:00:00ZAnálise da distribuição espacial de óbitos por doença renal crônica/COVID- 19, Brasil, 2020-2021CARVALHO, Ariane Luzhttps://tedebc.ufma.br/jspui/handle/tede/tede/46372023-05-19T12:42:39Z2023-03-27T00:00:00ZTítulo: Análise da distribuição espacial de óbitos por doença renal crônica/COVID- 19, Brasil, 2020-2021
Autor: CARVALHO, Ariane Luz
Primeiro orientador: BRANCO, Maria dos Remédios Freitas Carvalho
Abstract: Chronic kidney disease (CKD) is considered a comorbidity that represents a risk factor for
complications from COVID-19, associated with high mortality rates worldwide. The objective
of this study was to analyze the spatial distribution of deaths from CKD/COVID-19 in the adult
population in Brazil in the years 2020-2021. This dissertation presents a theoretical discussion
around the epidemiology of COVID-19 and its relationship with CKD, points out characteristics
of the information system on mortality (SIM) and the fundamentals of spatial analysis, together
with a bibliographic survey on mortality from COVID-19 in this methodology. This is an
ecological study of deaths from CKD/COVID-19 in Brazil that occurred in 2020 and 2021,
recorded in the SIM. The study describes deaths from CKD/COVID-19 reported in the country,
presenting a descriptive analysis of the data, including predictive imputation due to
incompleteness of the database used, calculations of proportional mortality by cause and also
by total deaths, and spatial visualization of the findings distributed across Brazilian federative
units, in all their context using R software tools. In 2020 there were 36.604 deaths from CKD
in adults, and of these, 9.6% with COVID-19. In 2021, deaths from CKD reached 39,391, of
which 5.614 (14.2%) had a record of COVID-19. Deaths from CKD/COVID-19 were more
frequent in men, people aged 60 to 79 years, elementary schooling level, race/brown color, and
married marital status, in both years of study. The proportional mortality rates by cause and the
proportional mortality rates by deaths were heterogeneous among the states, with emphasis on
the states in the North region, which had the highest proportions during the two years studied,
while there was a decrease in the states in the Northeast region in 2021 . It is worth noting the
proportional increase in deaths from CKD/COVID-19 in the country in 2021 compared to 2020.
Instituição: Universidade Federal do Maranhão
Tipo do documento: Dissertação; Documento sob sigilo. Prazo provável para disponibilização total: 03/10/2023. Motivo do sigilo: publicação de artigo.2023-03-27T00:00:00Z