Dissertações em Enfermagem (Mestrado) - PPGENF/ICS

URI Permanente para esta coleçãohttps://repositorio.ufpa.br/handle/2011/4815

O Mestrado Acadêmico iniciou-se 01/01/2011 pertence ao Programa de Pós-Graduação em Enfermagem (PPGENF) do Instituto de Ciências da Saúde (ICS) da Universidade Federal do Pará (UFPA).

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Características epidemiológicas e análise temporal de sífilis congênita na região norte do Brasil de 2010 a 2019
(Universidade Federal do Pará, 2022-07-29) SANTOS, Fabio Conceição dos; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460
Introduction: Sexually transmitted infections (STIs) are considered a public health problem, with a direct impact on reproductive and child health, causing infertility and complications in pregnancy and childbirth, in addition to causing fetal death and health problems for children permanent. Among the STIs, syphilis is one of the most frequent, being exclusive to humans, and when vertical transmission occurs, it is called congenital syphilis. Worldwide efforts are used to eliminate Congenital Syphilis, however, its incidence is still high in several countries around the world, including Brazil. Objective: To evaluate the epidemiology and temporal trend of Congenital Syphilis in the North region of Brazil from 2010 to 2019. Materials and Method: This is an epidemiologicaldescriptive, retrospective research with a quantitative approach, which analyzed the epidemiological and temporal profile of cases of Congenital Syphilis in the Northern Region of Brazil from 2010 to 2019, through data recorded in SINAN AND SINASC. A descriptive analysis of the sociodemographic data was carried out, followed by a temporal analysis, through the calculation of the incidence of the regression model by inflection points (Joinpoint Regression Analysis), which allows knowing the annual percentage change (APV) and that of the entire period, called average annual percentage change (VPAM). For each trend detected, the 95% confidence interval was considered. The significance level adopted was 5%. Results: 14,434 cases of congenital syphilis were registered in the North Region, with the state of Pará being the most notified, followed by Amazonas and Tocantins. The data signaled the maternal characteristics, showing that most were of reproductive age, followed by those with a migratory period to adulthood. Most did not complete elementary and high school, with a phenotypic predominance of brown, followed by white. Still, most of the diagnosis of gestational syphilis happened in prenatal care, with them performing followup in 79.54% of cases, and partners in treatment in only 34.68%, with recent congenital syphilis as the most diagnosed in 99, 73% from birth to incomplete 23 months. There was significance for the average annual increasing incidence rates in several states and capitals in the region. All capitals showed a yeartoyear growth trend, with fluctuating periods, as seen in the capitals Macapá and Boa Vista between 2014 and 2015. The capital Belém showed a peak incidence of congenital syphilis cases between 2015 and 2016 (highest incidence rate between years). Other capitals such as Manaus and Palmas had an explosion of cases in 2018, with 19.8 and 17.6 for every thousand live births. Conclusion: In this study there was a limitation in terms of time for an investigation with greater accuracy, which should include other epidemiological and local data, and in regions with a higher incidence of this pathology. Therefore, it is necessary to carry out other studies on SC that work with spatial analysis in its various regions, contributing to the improvement of maternal and child health indicators in the region under study.
Acesso aberto (Open Access)
Covid-19 em parturiente e seus neonatos: estudo de caso controle em uma maternidade de referência na Amazônia brasileira
(Universidade Federal do Pará, 2022-10-25) BARROS, Sirley Costa de; PARENTE, Andressa Tavares; http://lattes.cnpq.br/2584253687792237; https://orcid.org/0000-0001-9364-4574; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460
The Covid-19 pandemic and its rapid global spread had major health repercussions due to its high potential for transmissibility. Pregnant women at any gestational age and women in the puerperal period belong to the risk group. Objective: To know the clinical evolution of Covid-19 in the parturient and her neonates. Methodology: An observational, retrospective, case-control epidemiological study was carried out, comparing 48 parturients with Covid-19 and their respective neonates (case group) and 98 healthy parturients and their respective neonates (control), hospitalized at Santa Casa de Misericórdia do For. The medical records of parturients diagnosed with Covid-19, during the study period, and parturients without Covid-19, both of any age, of all types of delivery, with or without alterations to the physical examination, admitted to the hospital in April were included. from 2020 to June 2021, in a total of 292 participants (parturients and neonates). Data were collected from medical records, from August 2021 to May 2022, and analyzed using the Bioestat 5.3 program. P<0.05 was considered statistically significant. Results: the mean age among parturients in the case group (n=48) and in the control group (n=98) was 27.7 and 28.5 years, respectively. Analytical statistics and Odds Ration (OR) calculations were statistically significant and higher in pregnant women with Covid-19 for the following variables, respectively: cesarean delivery (p < 0.0001/OR= 6.1), preterm labor (p < 0.0001/ OR=20.2), length of stay longer than 48 hours (p<0.0001/OR=3.6), altered body temperature (p=0.0038/OR=7.5) and altered respiratory rate (p<0.0001/OR=9.6) were statistically significant and greater parturients with Covid19 compared to parturients in the control group. The statistically significant repercussions on newborns of mothers with Covid-19 were: lower percentage of breastfeeding (p < 0.0001/OR= 33.7), length of stay longer than 48 hours (p < 0.0015/ OR= 3.9) and referral the neonatal unit (p < 0.0015/OR= 24.3). The death outcome (fetal+neonatal) had 5 (10.4%) occurrences in the case group. Conclusion: the clinical evolution and outcomes are different between parturients positive for Covid-19 and healthy parturients, with important repercussions on newborns.
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Estudo dos óbitos maternos na região metropolitana de Belém
(Universidade Federal do Pará, 2017-02-07) CAMACHO, Elyade Nelly Pires Rocha; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460; https://orcid.org/0000-0002-1312-4753
Data on maternal mortality, whether in developed or developing countries, are more disparate than any other indicator of public health in Brazil. During the United Nations Millennium Development Pact, eight Development Goals were adopted, among them, to reduce maternal mortality by 75% by 2015. The aim of the study was to conduct a study on the occurrence of maternal deaths in the region Metropolitan area of Belém that were notified through the Mortality Information System (MIS) from January 2013 to December 2015, in addition to describing the main causes of maternal mortality. The study is an epidemiological, descriptive, quantitative, analytical, retrospective and documentary approach. It is performed with secondary data stored at the Maternal Mortality Committee consisting of results reported as maternal deaths. From January 2013 to December 2015, 53 deaths were reported in 2013, 45 maternal deaths in 2014 and 40 deaths in 2015. The data identified a maternal mortality ratio (MMR) of 160.3 deaths per 100 A thousand live births in 2013, 136.0 deaths per 100,000 live births in 2014 and 121.9 deaths per 100,000 live births in 2015. We can say that the epidemiological profile is not well defined, diverging with several Literatures. The main causes of maternal mortality are in the world, in Brazil and especially in the metropolitan region I of the state of Pará, the four apocalyptic horsemen, who kill women, Hypertensive Syndrome, Hemorrhage, Sepsis and Abortion remain. That is, despite all the discussions on the subject, the RMM does not diminish over the years, reinforcing the need for improvements in the state's public health.
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Investigação das internações por sífilis congênita: distribuição espaço-temporal, fluxos e gastos
(Universidade Federal do Pará, 2020-03-16) NERI, Débora Talitha; FERREIRA, Glenda Roberta Oliveira Naiff; http://lattes.cnpq.br/7459094802051187; https://orcid.org/0000-0002-8206-4950; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460
In the state of Pará, the high incidence of diagnosis of gestational syphilis in the third trimester of pregnancy and at the time of delivery may be predictors of greater use of hospital services, however, the lack of availability of information on the magnitude and pattern of distribution of hospitalizations in the state do not make it possible to fully estimate the impact of congenital syphilis on the public health system, mainly in the financial aspects, access and sufficiency of quality services. Objective: To investigate hospital admissions for congenital syphilis in Pará, in children under one year old from 2009 to 2018. Methodology: This is an ecological, cross-sectional study with a quantitative approach. Data were collected in the Hospital Information System and Live Birth Information System. Descriptive analyzes of hospitalization rates, lethality, mortality and proportion of expenses were performed. Temporal, spatial analysis and mapping of hospitalization flows for congenital syphilis. Minitab 18®, Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5 and ArcGis 10.3.1 were used in the analysis of the study. Results: 6,487 hospitalizations for SC were recorded in the 10 years studied, most frequently in the early neonatal period, 94% (6,096) of cases. A gross hospitalization rate for SC in Pará shows an increasing increase with an annual percentage variation of 11.9%. Despite the growth without number of cases and the gross rate of hospitalization, there was a reduction in the lethality rate. As hospitalizations for registered SC resulted in an expense to SUS of R $ 6,014,782.17, with R $ 927.20 being the average expenditure of hospitalizations. A spatial analysis indicates direct spatial autocorrelation in the high-high pattern in the two periods. As for the flow, one Metropolitana I was the only one that received all hospitalizations from its residents in the region itself. Thus, there was a greater absorption of interactions from other regions and a positive balance. Conclusion: The results presented here showed a significant increase in the rate of hospitalization for SC in Pará, in several regions and in all health macro-regions, with a proportional increase in expenses. Despite failures in primary health care, there was an improvement in the quality of tertiary care. The mapping of care networks and flows pointed to the predominance of HI that occurred in the same place of residence as the inpatient. However, it demonstrated differences in the organization and compliance with the foundations of the Cegonha Network, within the health regions and macro-regions, with Macroregion I being the one that most managed to guarantee the resolution of hospital health care.
Acesso aberto (Open Access)
Letramento funcional em saúde dos idosos acerca de acidentes por queda e sua prevenção
(Universidade Federal do Pará, 2017-12) NEVES, Aline Bento; GONÇALVES, Lucia Hisako Takase; http://lattes.cnpq.br/6191152585879205; https://orcid.org/0000-0001-5172-7814; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460; https://orcid.org/0000-0002-1312-4753
Background: Fall accidents, especially amongst the elderly, are considered to be events of external cause of deaths that are responsible for about five million deaths each year, which represents about 9% of the worldwide mortality. In Brazil, this event is the third cause of death. Health literacy relates to knowledge, motivation, and one’s competence in searching, comprehending and analyzing health related information so they can eventually make decisions over health promotion, disease prevention and improvement in quality of life. Aim: Finding out the level of health literacy amongst an elderly group on the topic of fall accidents and its prevention. Methods: This is an exploratory-descriptive study using a qualitative approach. The participants are 80 elderly that were also public square goers, from these, 40 elderly were interviewed in the Public Square A (located in a middle class neighborhood) and the other forty were interviewed in Public Square B (located in a low-income neighborhood). The interviews used the instrument “Health Literacy”, translated and adapted by Lisiane Paskulin et al. for use within the Brazilian scenario. The sociodemographic data was analyzed using descriptive statistics. The qualitative analysis over the content of the responses to the open questions were categorized according to its different dimensions, considering its nature and frequency. The research project was approved by UFPA - Hospital Barros Barreto’s Research Ethics Committee, under the protocol number 2.095.048. Results: In between both groups there was a predominance of the female gender. A higher formal education rate was found amongst the elderly interviewed in the Public Square A, with the years of formal education varying from 5 to 9 (62,5%), against 1 to 4 years of formal education amongst the elderly found in Public Square B (42,5%). The majority of the elderly in both public squares were house owners. The analysis of the health literacy data was distributed in five dimensions: finding fall accidents information, comprehending fall accidents information, sharing fall accidents information, repercussion of the fall accidents information to the elder, and participation in health education groups. Health literacy in both the middle class neighborhood group and in the low income neighborhood group reached a low level. Conclusion: The low level of health literacy over fall accidents and its prevention was found to be a very important lack in health education. The low percentage of responses from the elderly when questioned over the different dimensions of health literacy revealed an apparent conformity and passivity over general health information.
Acesso aberto (Open Access)
Perfil epidemiológico de gestantes soropositivas ao HIV e seus recém nascidos
(Universidade Federal do Pará, 2019-05-07) ALMEIDA, Amanda Cantanhede Bezerra de Campos; LIMA, Vera Lúcia de Azevedo; http://lattes.cnpq.br/5247917929280755; https://orcid.org/0000-0003-0094-4530; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460; https://orcid.org/0000-0002-1312-4753
Introduction: The Human Immunodeficiency Virus epidemic during motherhood brings out many challenges to the mother, such as facing a chronic and stigmatized disease and the risk of vertical transmission. The amount of women infected with HIV has been increasing and the majority were women in their reproductive years. Concomitantly many women were diagnosed in the gestational period. The lack of quality in the prenatal increases the chances of vertical transmission. Objective: To characterize the epidemiological and sociodemographic profile of seropositive pregnant women for HIV and their newborns in Belém / Pará from 2007 to 2016. Case study and method: A retrospective quantitative study covering a sample composed of 802 pregnant women seropositive for HIV and 210 of their newborns in Belém (Pará), from 2007 to 2016. The data source is the Information System for Notification Diseases provided by the Pará State Secretary of Health and the analysis performed through descriptive and analytical statistics. Results: In ten years, there have been 802 pregnant women and 210 newborns. The number of HIVpositive pregnant women increased 52.2% during the 10year study. Most of the pregnant women studied (73%) were in the 20 to 34 age group. Twentyone percent of the pregnant women were teenagers and 37% of them had incomplete elementary education. Prenatal care was performed by 83% of the patients. The diagnosis of HIV was known in 79% of them. Cesarean section was performed in 69% of pregnant women. Antiretroviral therapy was performed in 76% of the patients during gestational period and 69% during delivery. Antiretroviral therapy was performed in 83% of the new born in the first 24 hours of life. Conclusions: The challenge of preventing vertical transmission persists, despite the hard work developed and several measures implemented by the Ministry of Health. Many obstacles, such as low education level, low quality of prenatal care, and the nonuse of antiretroviral therapy during pregnancy, at delivery and after delivery in exposed infants, increase vertical transmission chances. However, these challenges can be overcome through a herculean and joint effort of health professionals, managers and government officials. Failures in the monitoring of gestation, delivery and the newborn, point to the need for improvements in care. Therefore, greater efforts and investments are needed to ensure the birth of healthy babies from HIVpositive mothers.
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Preditores da sífilis gestacional em um estado da Amazônia brasileira: um estudo de caso e controle
(Universidade Federal do Pará, 2021-12-03) UCHÔA, Thais Lopes do Amaral; FERREIRA, Glenda Roberta Oliveira Naiff; http://lattes.cnpq.br/7459094802051187; https://orcid.org/0000-0002-8206-4950; ARAÚJO, Eliete da Cunha; http://lattes.cnpq.br/5906453187927460
Introduction: Advances in public policies aimed at maternal and child care implemented in Brazil in recent decades have not yet had an impact on reducing gestational syphilis and, especially, congenital syphilis. In Pará, there is still a high number of cases of gestational syphilis detected in childbirth and puerperium. The factors that relate to the maintenance of this context are unknown. Objective: To determine the predictors of gestational syphilis in a state in the Brazilian Amazon region. Methods: Unpaired case-control study, carried out in a public reference maternity hospital in Pará. Data were collected from November 2020 to July 2021, from the application of the form, analysis of the pregnant woman's card and medical records. Women diagnosed with syphilis during pregnancy, childbirth or puerperium were considered as cases. Controls were women without a diagnosis of syphilis in the pregnancy puerperal cycle. The response variable was the diagnosis or not of gestational syphilis, the event being considered the diagnosis of gestational syphilis in the prenatal, delivery or postpartum period. Independent variables were grouped into: a) sociodemographic; b) gynecological and obstetric by two (02) categorical variables and five (05) discrete variables; c) sexual and obstetric practices by eight (08) categorical variables; d) knowledge is composed of fifteen (15) categorical variables and e) Attitudes is composed of six (06) categorical variables. The sample size, calculated using the Kelsey method, was 204 participants, 68 cases and 136 controls. To test the main hypothesis of the study, multiple logistic regression analysis was performed. In the Bioestat 5.3® program, the chi-square test of independence, tendency and G test were applied. In the Minitab 20® program, descriptive analyzes and logistic regression were performed. Odds ratio, 95% confidence interval was calculated. P values <0.05 were considered statistically significant. Results: Among the 68 cases and 137 controls, age ranged from 15 to 41 years, mean age was 26.1 years (SD: 6.2). In the multiple logistic regression, the cases are independently associated with the lowest number of prenatal consultations (OR: 0.82; p = 0.02), history of previous STI (OR: 24.8; p = 0.00 ), spontaneous abortion (OR: 2.86; p = 0.025) and difficulty in talking with the partner about the use of sexual condoms in relationships (OR: 4.43; p = 0.00). Among the factors of knowledge and attitudes, cases were associated with knowledge about vertical transmission (OD: 0.24; p= 0.019), treatment with penicillin (OD: 0.47; p= 0.023) and on the availability of treatment in basic health units (OD: 0.14; p= 0.014). However, they are associated with the lack of knowledge about the lack of vaccine (OD: 1.94; p= 0.04). The analysis of variables related to attitudes showed an association of cases (OD: 2.40; p= 0.016) with inadequate attitude about the beginning of prenatal care. There is an increase in reactive cases from the 1st trimester to the puerperium with p < 0.0001, with the highest significant proportions of reactive cases during delivery and postpartum. Conclusion: gynecological-obstetric factors, sexual and reproductive practices and knowledge are associated with gestational syphilis. In a population with precarious socioeconomic conditions, no association of these factors was demonstrated. Actions for monitoring and evaluating prenatal care are urgent.

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