https://tedebc.ufma.br/jspui/handle/tede/882 2026-04-20T07:35:08Z https://tedebc.ufma.br/jspui/handle/tede/6914 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. 2026-02-26T00:00:00Z https://tedebc.ufma.br/jspui/handle/tede/6911 Título: ASSOCIAÇÃO ENTRE CONSUMO DE ALIMENTOS SEGUNDO O GRAU DE PROCESSAMENTO E CÁRIE DENTÁRIA EM ADOLESCENTES DA COORTE BRISA Autor: NASCIMENTO, Sheila Almeida do Primeiro orientador: VIOLA, Poliana Cristina de Almeida Fonseca Abstract: Introduction: Dental caries is the most prevalent oral disease worldwide and presents a high burden already in early adolescence, accounting for more than 2 billion cases in permanent teeth, according to data from the Global Burden of Disease. Although it is multifactorial, contemporary dietary patterns have been identified as a potential risk factor in the etiology of dental caries. Objective: To investigate the association between food consumption according to the level of processing and dental caries among adolescents from the BRISA cohort. Methods: This is a cross-sectional study using data from the BRISA birth cohort in São Luís, Maranhão, Brazil. Participants (n = 1,665) were evaluated in the second follow-up (11–13 years of age), during which sociodemographic information, lifestyle habits, dietary intake, and oral examinations were collected. Theoretical models were tested to assess the association between food consumption according to processing level (percentage in grams) and dental caries. In the first model, the exposure variable was the consumption of unprocessed or minimally processed foods (UMPF); in the second, the consumption of ultra-processed foods (UPF); and in the third, the combined consumption of processed foods + UPF (sensitivity analysis). The outcome (dental caries) was treated as a dichotomous variable. Adjustment variables included a latent socioeconomic status (SES); sex; adolescent age; mother’s skin color; sleep duration (insufficient: < 8 hours/night; sufficient: ≥ 8 hours/night); and screen time (adequate: ≤ 2 hours/day; high: > 2 hours/day). In the theoretical models, SES was considered a more distal determinant linked to both the exposure (dietary consumption) and the outcome (dental caries). The exposure factor was directly associated with the outcome and acted as a mediator between SES and caries, while adjustment variables were linked to both exposure and outcome. Data analysis was performed using R version 4.5.0 and RStudio. Descriptive analysis included absolute and relative frequencies, as well as measures of central tendency and dispersion. Structural equation modeling was used to analyze associations between exposure variables and the outcome, adopting a 95% significance level. The study complied with the recommendations of Resolution 340/2004 of the Brazilian National Health Council. Results: Among the 1,665 adolescents, 53.3% were male and 61.6% were 12 years old; most had mothers with brown or Black skin color (86.3%). The prevalence of dental caries was 34%, and it was higher among females (p = 0.008). Analysis of individual dietary intake showed a mean total energy intake of 1,702 kcal/day (SD: 261.639), with 30.8% coming from UPF. A positive and significant association was observed between UPF consumption and dental caries (β = 0.009; p = 0.033), while a negative and significant association was found between UMPF consumption and caries (β = −0.095; p = 0.045). The latent SES variable showed a significant direct effect on both dietary consumption and dental caries in all models, whereas adjustment variables did not show significant associations. Conclusion: The study found a high contribution of UPF to adolescents’ diets and a direct association with dental caries, as well as a protective effect of UMPF consumption. Additionally, socioeconomic status was associated with dental caries in all models. These findings reinforce the role of dietary patterns and socioeconomic conditions in the occurrence of dental caries in adolescents, highlighting the need for strategies aimed at promoting healthy eating as a central axis for caries prevention in this age group, as well as investments to improve population socioeconomic conditions. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação 2026-02-23T00:00:00Z https://tedebc.ufma.br/jspui/handle/tede/6892 Título: Programa bolsa família e associação com alterações emocionais em crianças de uma coorte em São Luís - MA. Autor: CARVALHO, Eliane Maria Nascimento de Primeiro orientador: SILVA, Antônio Augusto Moura da Abstract: Childhood is a period sensitive to the impact of socioeconomic factors, especially poverty, which negatively affects emotional, behavioral, and cognitive development. In Brazil in 2022, 62.5 million individuals were living in poverty, of whom 17.9 million were living in extreme poverty. The instability of family income to meet basic needs exposes children to social vulnerability, raising the risk of mental disorders. Income Transfer Programs, such as Bolsa Família, have been implemented as strategies to combat poverty, with positive effects on health, education and nutrition indicators. There is increasing evidence suggesting that PTR may indirectly influence children's mental health, but the results are heterogeneous and not well established. In the Maranhense context, marked by socioeconomic inequalities, investigating this relationship is crucial to understand the associations between income transfer and emotional alterations of children. Objective: Analyze the association between income transfer in early childhood and the presence of emotional problems in adolescents participating in the Brazilian Birth Cohort Studies, Ribeirão Preto and São Luís, Maranhão. Method: Cross-sectional study carried out in São Luís (MA), including 488 children from families with income ≤ R$ 140.00 valued at 1-3 years and 11-13 years of age. The exposition was to be a beneficiary of the Bolsa Família Program (PBF) and the loss was alterations in emotions and behavior, measured by the SDQ score. Negative binomial regression was used to estimate taxa ratios, considering significance of p < 0.05. The theoretical model, represented by directed acyclic graph (DAG), oriented to the selection of adjustment variables. Results: It was observed that 48.2% were beneficiaries of the Bolsa Família Program and the average SDQ score was 10.36 (±6.53). No association was observed between PBF and the presence of emotional and behavioral alterations in adolescents in raw (p = 0.707) or adjusted (p = 0.829) models. As a secondary symptom, the presence of symptoms of psychological distress in most women is associated with higher SDQ scores among children and adolescents (IRR: 1.20; 95% CI: 1.06-1.37). Conclusion: A direct effect of PBF on psychic alterations in children aged 11-13 was not observed. The results suggest that public policies aimed exclusively at poverty reduction, however, may be insufficient to promote consistent improvements in children's mental health. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação 2026-02-24T00:00:00Z https://tedebc.ufma.br/jspui/handle/tede/6891 Título: 11° Conferência Estadual de Saúde do Maranhão: análise a partir da teoria da desdemocratização Autor: MUNIZ, Ingrid Feitoza Primeiro orientador: PINHO, Judith Rafaelle Oliveira Abstract: Introduction: the Health Conferences are deliberative instances of Social Control of the Unified Health System institutionalized by Law n° 8142/1990. Every four years, civil society brings together to analyze public health and propose guidelines to compose health plans and policies. Despite their democratic potential, they face organizational and structural weaknesses both at the national and local levels, in a context of de-democratization of democratic institutions. In Maranhão, the 11th State Health Conference of Maranhão took place amid political polarization and budgetary dependence. The study analyzes its organization and challenges, contributing to the understanding of Social Control in the state of Maranhão. Objective: to analyze the organizational and structural context of the 11th State Health Conference of Maranhão. Methods: this is a qualitative research on the organization of the 11th State Health Conference of Maranhão. The study took place in São Luís – MA, from May 2023 to October 2025. The study population consists of the Organizing Committee and the Executive Committee of the conference, which totals 26 members, nine of whom participated in this study. As a research instrument, a semi-structured interview was prepared and data collection took place between June 2023 and August 2024. Content analysis of the interviews was carried out, according to the method of Bardin (2011), through the NVivo platform, resulting in three categories of analysis. The theoretical framework to support the analysis and discussion was Brown's Theory of Dedemocratization (2015). Results and Discussion: the interviews showed that the organization of the conference had weaknesses such as financial dependence, delays in resources, management failures and low leadership renewal, which limited autonomy and participatory effectiveness, reflecting the process of Dedemocratization described by Brown (2015). On the other hand, social mobilization, institutional partnerships, learning, integration and democratic exercise were highlighted as potentialities that strengthened the event. Finally, even in the face of structural and organizational challenges, the resistance of Social Control in the face of institutional dismantling and the advance of neoliberalism was evident. Final Considerations: despite the weaknesses and limitations of the conference in the midst of thecontext of Dedemocratization, the 11th State Health Conference of Maranhão reaffirmed the right to social participation in the management of health policies and evidenced the resistance of democratic institutions. Instituição: Universidade Federal do Maranhão Tipo do documento: Dissertação 2026-03-22T00:00:00Z