Mestrado em Saúde Coletiva
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- ItemTrajetórias de clusters de sintomas oncológicos ao longo de três ciclos de quimioterapia ambulatorial: estudo longitudinal(Universidade Federal do Espírito Santo, 2025-04-24) Minarini, Etreo Junior Carneiro Da Silva; Lopes Júnior, Luís Carlos; https://orcid.org/0000-0002-2424-6510; https://buscatextual.cnpq.br/buscatextual/busca.do; http://lattes.cnpq.br/5919501773501977; https://orcid.org/0000-0003-4883-2968; http://lattes.cnpq.br/3671717404900258; Vasconcelos, Karla Anacleto; https://orcid.org/0000-0002-6462-6390; http://lattes.cnpq.br/8734476211935275; Lopes, Andressa Bolsoni; https://orcid.org/0000-0003-1244-5667; http://lattes.cnpq.br/0097480808041638; Bolina, Alisson Fernandes; https://orcid.org/0000-0002-1364-0176; http://lattes.cnpq.br/6993371391051944; Enriquez-Martinez, Oscar Geovanny; https://orcid.org/0000-0003-4561-122X; http://lattes.cnpq.br/0493747317645178Introduction: Cancer patients undergoing chemotherapy often experience multiple simultaneous symptoms, which tend to cluster into interrelated patterns known as symptom clusters. Understanding these groupings throughout treatment may support more effective care strategies, especially in outpatient settings where continuous monitoring is essential. Objective: To analyze the trajectory and composition of symptom clusters in patients with malignant neoplasms over the first three cycles of outpatient chemotherapy, and to identify the clinical factors associated with their manifestation and evolution. Methods: This prospective cohort study was conducted with 84 adult patients diagnosed with stage I, II, or III cancer who were eligible for outpatient chemotherapy at a public hospital in the Southeastern region of Brazil. Data collection was performed using the Memorial Symptom Assessment Scale (MSAS™), applied during the first three chemotherapy cycles (QT1, QT2, and QT3). Symptom clusters were identified through hierarchical cluster analysis, using Euclidean distance and Ward’s method. To compare the medians of symptom frequency, intensity, and distress across cycles, the Kruskal-Wallis test was applied, followed by Conover-Iman post-hoc tests with Bonferroni correction. Symptom prevalence between QT1 and QT3 was compared using Wilcoxon signed-rank and sign tests. Associations between clusters and sociodemographic, clinical, and therapeutic variables were assessed using the chi-square test and Fisher’s exact test, adopting a significance level of 5% (p < 0.05). Results: The mean age of participants was 57.61 years, with a predominance of female patients diagnosed with ductal carcinoma in situ of the breast. Three clusters were identified in QT1 (emotional, chemotherapy-related, and neuropsychological), and four clusters were observed in both QT2 (autonomic, gastrointestinal, systemic physical, and psychosensory) and QT3 (sensory perceptual, physiological, psychosomatic, and emotional-physical). Statistically significant differences were found among clusters regarding symptom frequency, intensity, and distress across the three cycles (p < 0.05). Clusters 3 and 4 in QT2 and QT3 showed higher median values in all three dimensions, reflecting a greater symptom burden. An increase in symptom complexity was observed throughout the treatment, with an initial predominance of emotional symptoms followed by a diversification into sensory, functional, and psychosocial domains. Three primary clusters remained consistent from QT1 to QT3: emotional, chemotherapy-related, and neuropsychological. Although no statistically significant differences were found in the overall prevalence of symptoms between QT1 and QT3, clinical trends of increased prevalence were identified in 11 of the 15 symptoms assessed. In QT1, a significant association was observed between Cluster 2 (chemotherapy-related) and age ≥65 years (p = 0.048), as well as with the presence of comorbidities (p = 0.004). In QT3, Cluster 2 was more prevalent among female patients (p = 0.005), and Cluster 4 (emotional-physical) was also associated with the female sex (p = 0.010). Cluster 3 (neuropsychological) was associated with the presence of comorbidities (p = 0.033), chemotherapy drug class 4 (p = 0.007), and low platelet-to-lymphocyte ratio (PLR) (p = 0.004), suggesting potential links between clinical-immunological status and psychocognitive distress. Conclusions: The identification and comparison of symptom clusters highlighted the complexity of the symptom experience among patients undergoing chemotherapy, reinforcing the importance of clinical interventions guided by patterns of symptom co-occurrence. While the clusters showed relative stability between the first and third cycles, internal variations in symptom composition were noted. Associations with clinical and therapeutic variables emphasize the importance of continuous monitoring and personalized care based on the predominant symptom profiles throughout treatment.
- ItemHemorragia pós-parto : determinantes e conhecimentos dos profissionais na assistência ao parto(Universidade Federal do Espírito Santo, 2025-02-25) Santos, Alendiana da Silva; Santos Neto, Edson Theodoro dos; https://orcid.org/0000-0002-7351-7719; http://lattes.cnpq.br/5430137427291413; https://orcid.org/0000-0002-1612-277X; http://lattes.cnpq.br/3359813795531314; Barcelos, Mara Rejane Barroso ; Dias, Bárbara Almeida SoaresThis dissertation aims to analyze the magnitude of postpartum hemorrhage (PPH) in Brazil from different perspectives. To achieve this, two studies with distinct methodologies were conducted. The first sought to develop a theoretical-conceptual model of PPH and describe the characteristics of women affected by this condition in the “Born in Brazil” survey, a descriptive analysis based on 47 identified cases of PPH. The results indicate that the majority of women affected by PPH self-identified as non white (72,3% or 34) and were aged between 20 and 34 years (61,7% or 29). In educational terms, 76,6% (36) had not completed high school, and 59,6% (28) reported having received lasting emotional support. Among clinical conditions, 6,4% (3) presented anemia, and 27,6% (13) were overweight. Regarding obstetric factors, 8,5% (4) of the women had hypertensive complications, and despite all births being normal, in accordance with World Health Organization (WHO) recommendations, 51,1% (24) of the women experienced some genital trauma during delivery. Additionally, 19,1% (9) of the newborns presented macrosomia, a factor that may increase maternal and neonatal risks. The study's conclusion suggests that socioeconomic vulnerability, limited access to obstetric care, and unfavorable clinical conditions elevate the risk of PPH, and the occurrence of genital traumas underscores the need to review obstetric practices. The second study aimed to evaluate the profile and practices of health professionals regarding the management of PPH in maternity hospitals in Espírito Santo (ES) according to their professional experience. A cross-sectional study was conducted with 254 professionals (doctors, nurses, and nursing technicians), using a questionnaire that addressed critical practices such as administration of uterotonics, pulse checking, and assessment of atonic uterus. The results show that a significant percentage of professionals do not perform these essential practices, which may negatively impact the management of PPH. Only 44,9% (114) of the professionals conducted examinations to identify the cause of PPH, only 9,1% (23) administered uterotonics, and 16,1% (41) checked the pulse. Although uterine massage did not show significant differences between the groups, only 28,7% (73) performed the intervention, and only 9,4% (24) reported having performed bimanual uterine compression. Finally, only 30,7% (78) evaluated uterine atony. The performance of essential practices was more frequent among professionals with greater experience, suggesting that training and practice time influence the effectiveness of interventions. These findings highlight the importance of continuing education programs that integrate theoretical and practical education for all healthcare professionals, regardless of experience level, to ensure the consistent implementation of critical practices, improving maternal safety and the quality of care in obstetric emergency situations. Further studies are needed to inform public policies aimed at maternal health, deepening the understanding of the predisposing factors of PPH, investigating barriers to implementing critical practices, and assessing the effectiveness of educational interventions in various work contexts
- ItemGestação, parto e puerpério nas transmasculinidades : uma socioanálise(Universidade Federal do Espírito Santo, 2025-07-04) Duque, Brida Luísa Torres; Coqueiro, Jandesson Mendes; https://orcid.org/0000-0002-5321-5174; http://lattes.cnpq.br/0584858296936896; https://orcid.org/0000-0002-2153-9334; Santos, Marcia Cristina Brasil; Márcia Valéria de Souza AlmeidaPregnancy, labor, and the postpartum period, contrary to what is established by social norms, are not experienced exclusively by cisgender women. This is because, in the absence of gender-affirming surgical procedures, transmasculine individuals are physiologically capable of becoming pregnant. However, when in this position, they must access spaces historically considered feminine, which exposes them to violence and inequities. This dissertation aimed to analyze the discourse of transmasculine individuals regarding the healthcare process during pregnancy, labor, and the postpartum period. The specific objectives were: to discuss the challenges and possibilities experienced by transmasculine people throughout pregnancy, labor, and postpartum (Article 1); and to examine their experiences in health services during these stages (Article 2). This is a qualitative study involving five participants. Data collection was carried out through individualized projective interviews, scheduled according to participant availability and conducted via the Google Meet platform, in addition to field diary entries. Data analysis followed the perspective of Socioanalysis, a branch of Institutional Analysis. The participants, aged between 22 and 34 years and all self identified as white, revealed key analyzers such as transphobia, gender dysphoria, and obstetric violence. Other relevant themes included the lack of support networks, the role of healthcare professionals, and the structure and practices of healthcare services. The study highlights the need for action across multiple fields of knowledge to transform the reality of trans people who become pregnant. It recommends further research, the implementation of continuing education with the inclusion of gender related topics, and the adoption of measures to strengthen care and align professional practices with ethical principles
- ItemAtenção primária à saúde & o adolescente em conflito com a lei: uma socioanálise(Universidade Federal do Espírito Santo, 2024-11-01) Oliveira, Lucélia Jaqueline Barbosa dos Santos; Coqueiro, Jandesson Mendes; https://orcid.org/0000-0002-5321-5174; https://buscatextual.cnpq.br/buscatextual/busca.do; http://lattes.cnpq.br/0584858296936896; https://orcid.org/0009-0007-8230-4081; http://lattes.cnpq.br/2956382043304807; Lima, Thiago de Sousa Freitas; http://lattes.cnpq.br/0801808528661526; Lazarini, Welington Serra; https://orcid.org/0000-0003-2798-7223; http://lattes.cnpq.br/5114282145335545This qualitative study aimed to analyse the discourse of Primary Health Care professionals in regard to the health care for adolescents in conflict with the law. The study setting was the municipality of Vila Velha, Espírito Santo. The study participants were 10 health professionals who worked in the Basic Health Units (UBSs) that provide care to adolescents in conflict with the law. The instruments for material production were: projective interview and field diary. The fieldwork took place from May to June 2024.The projective interview was previously scheduled with each participant and performed using analyzers device and voice recorders. Notes were made in the field diary. The interviews were transcribed and read accurately, along with the notes from the field diary. All the produced material was analyzed by the theoretical-methodological framework of Institutional Analysis in its Socioanalytical aspect. It was verified that health professionals have a perception of adolescents associated with biological and psychological changes that they believe to occur in this phase of life, producing a perception that is anchored in stereotypes. At the same time, they perceive that adolescence is not experienced equally by all individuals, thus revealing the valorization of the medical-biological discourse and acreeting a social perspective to the theme. They report that in the field of healthcare there is a stigmatizing and prejudiced view of adolescents in conflict with the law. With regard to the care of adolescents in conflict with the law in the context of Primary Health Care, the study identified obstacles such as drug trafficking, the structural problems existing in the National Health System, stigma and prejudice and the lack of training of health professionals in relation to the theme. It was also possible to identify pontentialities in regard to the care when it comes to learning that results from the contact of health professionals with the adolescents that in compliance with socio-educational measures and the reception that is offered when this adolescents receive health care at the Basic Health Units.
- ItemPráticas integrativas e complementares na atenção primária à saúde : potencialidades e atravessamentos(Universidade Federal do Espírito Santo, 2025-05-22) Cordeiro, Brunella Gomes; Coqueiro, Jandesson Mendes ; https://orcid.org/0000-0002-5321-5174; http://lattes.cnpq.br/0584858296936896; https://orcid.org/0009-0007-7096-8104; http://lattes.cnpq.br/9909010371571387; Simões, Jeremias Campos ; https://orcid.org/0000-0002-3970-0819; http://lattes.cnpq.br/3848925103258680; Lazarini, Welington Serra ; https://orcid.org/0000-0003-2798-7223; http://lattes.cnpq.br/5114282145335545abstract