https://tede.unisantos.br/handle/tede/232 2026-10-08T11:24:00Z https://tede.unisantos.br/handle/tede/8135 Title: Entre números e histórias: uma análise sobre a Sífilis gestacional e congênita na Baixada Santista Abstract: Gestational and congenital syphilis remain a public health challenge, despite the availability of effective diagnostic methods and treatment, reflecting social inequalities and weaknesses in prenatal care that sustain vertical transmission. This study aimed to analyze the temporal variation of gestational and congenital syphilis in the Metropolitan Region of Baixada Santista and the perceptions of women who experienced syphilis during pregnancy and whose children were diagnosed with congenital syphilis. This is a mixed-methods study with a convergent-parallel design, descriptive and exploratory in nature, including analysis of secondary data from DATASUS/SINAN (2009–2023) and a qualitative stage based on semi-structured interviews conducted at Hospital Guilherme Álvaro, in Santos. All reported cases were included and analyzed using descriptive statistics, rate calculations, and Joinpoint regression, in addition to thematic analysis with five women. The study was approved by a Research Ethics Committee. The results showed an increase in cases over the historical series, followed by stabilization, with predominance among young women, especially those identified as mixed-race, with a relevant presence of adolescents and a high proportion of missing data. Congenital syphilis remained at high levels, indicating persistent vertical transmission and failures in prenatal care. The narratives revealed lack of knowledge about the infection, feelings of fear and guilt, difficulties in care, and significant emotional impact associated with the child’s illness. The integration of findings demonstrates that the persistence of the condition results from the interplay between social vulnerabilities and weaknesses in the quality of care, particularly in communication, continuity of care, and organization of health services. The findings highlight the need to strengthen prenatal care, with emphasis on timely diagnosis, effective treatment, and health communication, as well as improving the integration between care and surveillance to reduce vertical transmission and promote more comprehensive, equitable, and effective care. Type: Dissertação 2026-04-23T00:00:00Z https://tede.unisantos.br/handle/tede/8134 Title: Associação entre internações por síndrome respiratória aguda grave (SRAG) e variáveis ambientais na Baixada Santista, 2015-2024 Abstract: Acute respiratory infections, particularly when they progress to Severe Acute Respiratory Infection (SARI), represent an important public health problem because of their impact on morbidity, mortality, and the demand for hospital care. In the Baixada Santista region, characteristics such as high population density, a humid tropical climate, intense vehicular traffic, and port and industrial activities may influence the occurrence and worsening of respiratory conditions. This study aimed to analyze the association between SARI cases and concentrations of inhalable particulate matter (PM10), fine particulate matter (PM2.5), air temperature, and relative humidity in the nine municipalities of the Baixada Santista region from 2015 to 2024. This was a longitudinal ecological study with a quantitative approach, based on secondary epidemiological data and environmental information obtained from the QUALAR system of the São Paulo State Environmental Company. A total of 33,616 SARI records were analyzed according to municipality of residence, age group, sex, race/skin color, and temporal distribution. The analyses included descriptive statistics, time-series analysis, and regression models for count data, with assessment of cumulative and lagged effects from zero to seven days. Santos accounted for the largest number of records, followed by São Vicente, Guarujá, and Praia Grande. Individuals aged 60 years or older represented 26.6% of the cases, followed by those aged 36 to 60 years, with 20.5%, and children aged 1 to 4 years, with 18.7%. The environmental analysis showed a nonlinear association between the exposures and the occurrence of SARI. For PM10, a concentration of 100 μg/m³ was associated with a cumulative relative risk of 1.044, with a 95% confidence interval of 1.011 to 1.079, indicating a 4.4% increase in risk compared with the reference value. For PM2.5, the association became statistically significant from 15 μg/m³ onward, with a relative risk of 1.025 and a 95% confidence interval of 1.002 to 1.049. Higher concentrations of both pollutants were associated with a progressive increase in relative risk. Air temperatures above 30 °C were also associated with an increased occurrence of SARI, particularly at temperatures of 35 °C or higher. Relative humidity showed a nonlinear pattern, with statistically significant associations at approximately 70% and 80%, whereas, for most of the lag periods analyzed, the confidence intervals included the null value. It was concluded that higher concentrations of PM10 and PM2.5 and higher air temperatures were associated with an increased risk of SARI, although the magnitude and temporal distribution of the effects varied across exposures. Integrated monitoring of epidemiological indicators, air quality, and meteorological conditions may contribute to the planning of preventive actions, the organization of healthcare services, and the development of environmental health policies in the Baixada Santista region. Type: Dissertação 2026-08-26T00:00:00Z https://tede.unisantos.br/handle/tede/8133 Title: Território e envelhecimento ativo: qualidade de vida relacionada à saúde de idosos em programas de unidades básicas de saúde em Santos/SP Abstract: Population aging in Brazil poses significant challenges for public health policies, requiring strategies aimed at promoting active aging. In this context, Basic Health Units (UBS) play a central role by offering programs that seek to improve the quality of life of the elderly population. This study aimed to evaluate the health-related quality of life of elderly individuals participating in active aging programs at Basic Health Units in Santos, São Paulo. It was a quantitative, cross-sectional, and descriptive study involving 51 elderly participants from active aging programs at three UBS facilities in the municipality of Santos. Data collection was carried out using the SF-36 questionnaire, complemented by a sociodemographic instrument. Data was analyzed using descriptive statistics, and the Kruskal-Wallis non-parametric test was used to compare the units, adopting a 5% significance level. The results indicated higher mean scores in the domains of Social Functioning, Role-Physical, and Mental Health, whereas the General Health domain showed the lowest performance. Statistically significant differences were observed between the UBS facilities in the domains of Physical Functioning, Social Functioning, and Role-Emotional. It is concluded that the participants' health-related quality of life varies across the evaluated domains and the analyzed units, suggesting the importance of the territorial context in the aging experience. The findings contribute to the improvement of strategies for promoting active aging within the scope of Primary Health Care. Type: Dissertação 2026-09-09T00:00:00Z https://tede.unisantos.br/handle/tede/8130 Title: Iniquidades raciais no acesso ao diagnóstico da tuberculose na atenção primária à saúde: invisibilidade e desafios enfrentados pela população negra Abstract: This study aims to analyze access to tuberculosis diagnosis among the Black population within Primary Health Care services, considering the social, institutional, and territorial factors that shape the care process. This is a qualitative, exploratory, and descriptive study conducted through semi-structured interviews with individuals undergoing treatment for tuberculosis. Data analysis was carried out using thematic analysis, grounded in the theoretical framework of justice as fairness proposedby John Rawls (2008) and its extension to health by Daniels (2008). The results indicate that diagnosis occurs predominantlyat a late stage, mediated by fragmented and non-linear therapeutic itineraries, marked by the centrality of urgency and Emergency care services. Limited involvement of Primary Health Care in early case detection was observed, revealing weaknesses in territorial surveillance, care coordination, and integration between primary care and epidemiological surveillance. Participants' narratives highlight the invisibility of early symptoms, discontinuity of follow-up, and limitations in active case-finding strategies. Despite these shortcomings, users expressed a positive evaluation of the services, particularly regarding relational dimensions of care, such as welcoming practices and the establishment of bonds, revealing a tension between recognition and critique. The analysis demonstrates that access to diagnosis is shaped by social determinants and racial inequalities, with structural racism emerging as a central factor in the production of inequities. In light of the theory of justice as fairness, it is concluded that such inequalities compromise the guarantee of fair equality of opportunity in access to healthcare. Diagnostic delay is therefore understood as an expression of structural limitations of Primary Health Care rather than the result of individual choices. The study highlights the need to strengthen Primary Health Care, with emphasis on active surveillance, longitudinal follow-up, and the addressing of social and racial inequalities, in alignment with the principles of equity and social justice. Type: Dissertação 2026-08-20T00:00:00Z