https://tede.unisantos.br/handle/tede/232 Fri, 25 Sep 2026 08:05:24 GMT 2026-09-25T08:05:24Z 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 Thu, 20 Aug 2026 00:00:00 GMT https://tede.unisantos.br/handle/tede/8130 2026-08-20T00:00:00Z https://tede.unisantos.br/handle/tede/8129 Title: Sífilis na gestação em pessoas negras e pardas, Santos, SP, Brasil: uma revisão crítica narrativa Abstract: Gestational and congenital syphilis remain significant public health problems in Brazil, partic-ularly among socially vulnerable populations. In the municipality of Santos, in the state of São Paulo, there has been a substantial increase in disease detection rates in recent years, with a pronounced impact on Black and Brown pregnant individuals, highlighting the relationship be-tween illness, social and racial inequalities, and limitations in access to healthcare services. This study aimed to critically analyze the scientific literature and epidemiological data related to syphilis among Black and Brown pregnant women in Santos, São Paulo, Brazil, articulating the social determinants of health, structural racism, and gender inequalities within the context of maternal and child health. This study consisted of a critical narrative literature review with a qualitative approach, grounded in the theoretical frameworks of Collective Health, intersection-ality, and racial studies. Scientific articles published between 2015 and 2025 were analyzed, identified through the SciELO, MEDLINE/PubMed, LILACS, and Virtual Health Library da-tabases, in addition to epidemiological bulletins, institutional documents, and other national and international academic publications addressing gestational syphilis, congenital syphilis, struc-tural racism, and social vulnerabilities. The data were organized into thematic categories that enabled a critical analysis of the social and racial inequalities influencing access to and quality of healthcare provided to Black and Brown pregnant women. The findings demonstrated that Black and Brown populations experience greater vulnerability to gestational syphilis due to the combined effects of low educational attainment, unfavorable socioeconomic conditions, de-layed access to prenatal care, difficulties in continuity of care, and the persistence of institu-tional racism within healthcare services. Epidemiological data from Santos revealed rates of acquired syphilis, gestational syphilis, and congenital syphilis above state and national aver-ages, as well as a substantial increase in reported cases between 2016 and 2023. Despite the existence of a structured healthcare network and local epidemiological surveillance strategies, important limitations remain in the effectiveness of prevention, diagnosis, and treatment, par-ticularly for the most vulnerable populations. Although the studies included in this review were not conducted specifically in the municipality of Santos, their findings provide important in-sights into and a critical examination of the local reality considering the municipality’s epide-miological indicators and its social and territorial characteristics. It is concluded that gestational and congenital syphilis constitute important markers of social and racial health inequalities, demonstrating how factors related to race, education, income, and living conditions influence illness, access to healthcare services, and maternal and neonatal outcomes. Addressing these conditions requires integrated strategies that include epidemiological surveillance, improve-ments in prenatal care, strengthening of Primary Health Care, and enhancement of healthcare practices by incorporating anti-racist perspectives into maternal and childcare. Furthermore, strengthening public policies aimed at racial equity and implementing intersectoral actions to reduce social inequalities and confront structural racism are essential, as these factors are key social determinants of health and fundamental to promoting health equity. Type: Dissertação Mon, 29 Jun 2026 00:00:00 GMT https://tede.unisantos.br/handle/tede/8129 2026-06-29T00:00:00Z 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 Mon, 26 Jan 2026 00:00:00 GMT https://tede.unisantos.br/handle/tede/8122 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 Mon, 23 Feb 2026 00:00:00 GMT https://tede.unisantos.br/handle/tede/8107 2026-02-23T00:00:00Z