https://tede.unisantos.br/handle/tede/232 2026-05-17T02:13:16Z https://tede.unisantos.br/handle/tede/8122 Title: Análise das taxas de internação por desnutrição, nos anos de 2010 a 2023, no estado de São Paulo Abstract: Introduction: Malnutrition remains one of the main public health challenges, influenced by social, economic, environmental, and cultural determinants. Environmental contamination, mainly of soil and water, is a health risk factor and can indirectly contribute to the worsening of nutritional status. Objective: To analyze the relationship between hospitalization rates due to malnutrition and the presence of contaminated areas in the state of São Paulo, between 2010 and 2023. Methods: This is an ecological epidemiological study with a quantitative approach, using publicly available secondary data. Hospitalizations due to malnutrition, registered in the SUS Hospital Information System (SIH/DATASUS), between 2010 and 2023, were analyzed, considering residents of the state of São Paulo. Information on contaminated areas was obtained from the database of the Environmental Company of the State of São Paulo (CETESB). Standardized rates per 10,000 inhabitants were calculated for each Regional Health Department (DRS), using data from the IBGE Demographic Census (2022). Statistical analysis included descriptive and spatial statistics, and univariate and multiple logistic regression models, with a significance level of 5%. Results: During the analyzed period, 34,884,937 hospitalizations were recorded in the state of São Paulo, of which 606,954 were due to malnutrition (1.7%). It was observed that, although the largest number of hospitalizations is concentrated in adults and the elderly between 36 and 99 years of age (74.7%), the greatest relative risk was identified at the extremes of age and in vulnerable groups. Long-lived individuals (>100 years) had a significantly higher chance of hospitalization due to malnutrition (OR 3.929), followed by indigenous peoples (OR 1.200) and females, who, in addition to representing 54% of cases, had an OR of 1.099. Conclusion: Understanding the malnutrition scenario is important to support the planning of intersectoral public policies that consider environmental factors as determinants of health, promoting equity and well-being of the population. Type: Dissertação 2026-01-26T00:00:00Z https://tede.unisantos.br/handle/tede/8107 Title: Avaliação da contaminação por metais tóxicos na água potável fornecida à população de cidades da Baixada Santista Abstract: The contamination of drinking water by toxic metals constitutes a significant public health issue, especially in the Metropolitan Region of Baixada Santista (RMBS), characterized by intense industrialization, unplanned urbanization, and a history of environmental degradation, which raises concerns about the population's exposure to toxic metals such as aluminum, chromium, manganese, lead, and other chemical elements. This study aimed to evaluate the presence of these toxic metals in the water supplied by the recently privatized utility to the populations of the municipalities of Cubatão, Santos, and São Vicente, through quantitative determination of drinking water distributed by the Cubatão Integrated System. The study contributes data for independent environmental monitoring for the Exposure and Environmental Risk Assessment Group at the Universidade Católica de Santos, as well as aims to protect public health in the region. Water samples were collected at 30 georeferenced points, strategically distributed in consumption areas, during two distinct periods (summer and winter). The samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS), a highly sensitive technique recognized as the gold standard by the World Health Organization, using certified reference materials and automated accessories to minimize potential contamination during sample handling. The results indicated the presence of some metals above the limits established by legislation, such as aluminum, in the neighborhoods of Santa Maria, Vila Nova, Japuí, and Parque das Bandeiras in the summer collection, and Jockey Club and Jardim Rio Branco in the winter collection. The remaining metals investigated were found below quantification limits or within legal parameters, highlighting the need for continuous monitoring to ensure the safety of the water consumed by the population of Baixada Santista, especially considering seasonal variations and changes in water management. Type: Dissertação 2026-02-23T00:00:00Z https://tede.unisantos.br/handle/tede/8102 Title: Análise dos conhecimentos e percepções sobre cuidados paliativos entre estudantes de medicina de uma Universidade na Baixada Santista Abstract: Population aging and the increase in chronic non-communicable diseases impose growing challenges on the training of professionals qualified to manage suffering, highlighting the importance of Palliative Care (PC) as an essential component of health care. Despite normative advances, such as the inclusion of PC in the National Curriculum Guidelines and the enactment of the National Policy for Palliative Care in Brazil, gaps remain in the academic training of future physicians, justifying the need to investigate how this subject has been addressed in educational institutions. This study aimed to analyze the perception of medical students regarding palliative care and to assess their level of knowledge on the subject during the last two years of the course, at a university in the Baixada Santista region. This is a mixed-methods, cross-sectional study conducted in 2024 and 2025. The quantitative stage was carried out with 108 students from the ninth to the twelfth semester, through the application of the Bonn Palliative Care Knowledge Test. Data were analyzed statistically in a descriptive and analytical way, covering participants’ knowledge and self-confidence. In the qualitative stage, semi-structured interviews were conducted with eight students, selected for convenience, including two representatives from each class. Thematic analysis was used for the interpretation of the interviews, followed by data triangulation. The results showed that, in the quantitative stage, the domain related to pain obtained the best scores, while attention to the dying process presented greater fragility. Self-confidence improved in the final semesters, although it remained limited in aspects related to breaking bad news, especially in the face of clinical deterioration or patient death. The qualitative analysis revealed that students recognize the relevance of PC, but pointed out the need for an earlier and more longitudinal approach throughout medical training. However, a progressive gain in knowledge and self-confidence was observed in the more advanced semesters, indicating that, even in a fragmented way, there was observable evolution during the course. It is concluded that PC education, although still limited, provides important advances in students’ perception and preparedness. The findings reinforce the need for more structured pedagogical strategies that integrate PC in a continuous, qualified, and humanized manner throughout medical education. Type: Dissertação 2025-08-26T00:00:00Z https://tede.unisantos.br/handle/tede/8089 Title: Análise espacial da cobertura vacinal da primeira e segunda dose da vacina contra o HPV em meninas de 9 a 14 anos no Estado de São Paulo (2016-2022) Abstract: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and is strongly associated with cervical cancer. To reduce its incidence, the World Health Organization (WHO) established a global elimination strategy by 2030, based on three pillars: vaccination of 90% of girls aged 9 to 15, screening of 70% of women, and treatment of 90% of those diagnosed. However, vaccination coverage remains below the targets, hindering the achievement of this goal. In the state of São Paulo, despite its pioneering history, studies indicate significant variations between municipalities, highlighting regional inequalities. This study aimed to analyze the spatial dynamics of HPV vaccine coverage for the first and second doses in girls aged 9 to 14 in the state of São Paulo between 2016 and 2022. This is an ecological study with a mixed-methods approach using secondary data. Information on applied doses (D1 and D2) was obtained from SI-PNI and systematized by DATASUS. Population estimates were extracted from the TabNet database. Vaccination coverage rates were calculated by municipality and year. Statistical analysis included Kruskal-Wallis, Dunn, and Wilcoxon tests. The influence of the COVID-19 pandemic was assessed by comparing three periods (pre-pandemic, pandemic, and post-pandemic). Spatial analysis employed thematic maps and Moran and LISA autocorrelation tests with a 5% significance level. Statistically significant differences were found between the years studied for both doses (p<0.001). The years 2016 and 2018 showed the lowest coverage rates; 2017 recorded the highest rate for the first dose, and 2020 for the second dose. There was a significant decline in second-dose coverage over the years (Wilcoxon test, p<0.001). The pandemic period differed significantly from the others (p<0.001), with a sharp reduction in the second dose. Spatial analysis revealed heterogeneity in vaccination coverage among municipalities and spatial autocorrelation in all years, with a predominance of high-high clusters for the first dose. Only in 2017 was a municipality classified as having adequate vaccination coverage. Finally, the COVID-19 pandemic was not the main factor responsible for the low vaccination coverage, which was already critical, especially for the second dose. The observed spatial heterogeneity highlights significant challenges for health management, reinforcing the need for more effective actions to achieve the WHO target of 90% vaccination coverage to eliminate cervical cancer by 2030. Type: Dissertação 2025-06-26T00:00:00Z