http://repositorio.ufc.br/handle/riufc/179 2026-06-20T00:29:33Z http://repositorio.ufc.br/handle/riufc/86821 Título: Determinantes sociais de saúde e a qualidade de vida na intenção de amamentar Autor(es): Rodrigues, Icleia Parente Abstract: Social Determinants of Health (SDH) indicate the living and health conditions of a community, promoting comprehensiveness, equity, and highlighting pathways to reduce social inequities. Related to SDH, Quality of Life (QoL) is considered a predictor of health and well-being. The relationship between SDH and QoL regarding breastfeeding intention has been explored separately in the literature, making it difficult to understand the interrelationship between these constructs. Furthermore, the originality of this study lies in its focus on investigating breastfeeding intention rather than breastfeeding management. This study aimed to investigate the relationship between SDH and QoL in the breastfeeding intention of adolescent and young puerperal women. This was a cross-sectional, analytical, and correlational study conducted at a high-complexity maternity hospital within the Brazilian Unified Health System in Fortaleza, Ceará, Brazil. A total of 323 adolescents and young women aged 10 to 24 years admitted to a rooming-in care unit were included. The following instruments were applied: 1) sociodemographic, clinical, and obstetric questionnaire; 2) Social Determinants of Health in Schoolchildren Questionnaire (Q-DSSE); 3) Health-Related Quality of Life Scale for Children and Adolescents (KIDSCREEN-52); and 4) Infant Feeding Intentions Scale (IFI). The Chisquare test was used to analyze associations between variables, and the strength of association was calculated using prevalence ratios (PR). Variables with p<0.20 in bivariate analyses were included in logistic regression. Simple linear regression was performed with transformed scale scores. A significance level of 5% was adopted for all analyses. The research project was approved by the Research Ethics Committee under opinion no. 6,800,591. The results showed a statistically significant reduction in the intention to exclusively breastfeed over time, with a progressive decline in mean scores between the 1st, 3rd, and 6th postpartum months (p<0.001). Correlation analysis revealed statistically significant positive associations, although of weak magnitude, between breastfeeding intention and maternal age (p=0.020), as well as neonatal clinical indicators. Higher Apgar scores at the 1st minute (p=0.002) and 5th minute of life (p<0.001) were associated with higher levels of maternal intention to exclusively breastfeed. Regarding QoL, puerperal women with more than one childbirth showed a higher proportion of low or regular QoL (39.3%) and (27.7%) (PR=1.69; p=0.031; 95%CI:1.05–2.74). Similarly, those with a previous childbirth presented worse scores (40.4%) (PR=0.55; p=0.017; 95%CI:0.34–0.90). Equivalent findings were observed among women with previous breastfeeding experience, who also showed a higher frequency of low or regular QoL (40.5%) (PR=0.55; p=0.017; 95%CI:0.34–0.90). It is concluded that, for adolescent and young puerperal women, breastfeeding intention appears to be less determined by structural social conditions and more sensitive to clinical and obstetric experiences, highlighting the importance of early interventions focused on perinatal care and individualized support in the immediate postpartum period. This study contributes to broadening the understanding of factors influencing breastfeeding and points to the need for comprehensive, longitudinal, and socially sensitive care strategies. Tipo: Tese 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86816 Título: Análise da expressão de genes envolvidos na síntese de translesão e na integridade do DNA em pacientes com leucemia mieloide crônica em uso de inibidores de tirosina-quinase Autor(es): Gadelha, Anna Thawanny Gadelha Abstract: Introduction: Chronic Myeloid Leukemia (CML) is a hematologic neoplasm characterized by the presence of the Philadelphia chromosome (Ph), resulting from the t(9;22)(q34;q11) translocation, which generates the BCR-ABL fusion gene. This gene encodes an oncoprotein with constitutive tyrosine kinase activity that drives CML pathogenesis by promoting DNA damage and compromising genomic integrity. Tyrosine kinase inhibitors (TKIs), such as imatinib, dasatinib, and nilotinib, are fundamental in the treatment of CML; however, concerns remain regarding their genotoxic effects and the role of DNA damage repair and damage tolerance mechanisms under therapeutic pressure. Objective: This study aimed to investigate the expression of genes involved in translesion synthesis and maintenance of genomic integrity (REV1, SETD2, APEX1, and POLB) in patients with CML receiving first- or second-generation TKIs, and to explore their implications for genomic stability and treatment response. Methods: A cross-sectional study was conducted involving 71 patients with chronic-phase CML and 25 healthy individuals as the control group. Clinical and laboratory data were collected from medical records. Peripheral blood samples were obtained, and gene expression was quantified by RT-qPCR. Differences in gene expression between groups and prognostic variables were evaluated using Mann-Whitney and Kruskal-Wallis tests with Dunn/Bonferroni post hoc analysis. Multivariate logistic regression (stepwise method) and ROC curve analyses were employed to assess the predictive value of genes for the absence of complete cytogenetic response (CCyR) and molecular response (MR). Additionally, a MANOVA was performed, adjusted for therapeutic response (CCyR, MR) and type of TKI, to identify joint effects on gene expression. Results: In the initial comparison, a significant reduction in POLB and APEX1 expression was observed in CML patients compared to controls (p < 0.0001), indicating impairment of the base excision repair (BER) pathway. Patients with an altered karyotype showed higher expression of APEX1 (p < 0.0001), and those classified as low-risk according to the EUTOS score exhibited higher POLB levels (p = 0.049). Stratification by type of TKI demonstrated that dasatinib or nilotinib use was associated with increased expression of REV1 and SETD2 (p < 0.005) compared to imatinib. MANOVA indicated a statistically significant effect on REV1 (p = 0.001) and SETD2 (p = 0.045) expression, reflecting the influence of treatment type and clinical response. In ROC curve analyses, REV1 showed an AUC of 0.733 for absence of CCyR (95% CI: 0.564–0.909) and 0.721 for absence of MR (95% CI: 0.564–0.877). In multivariate logistic regression, REV1 overexpression increased the odds of absence of CCyR by approximately 16-fold (OR = 15.9; p = 0.039), while high SETD2 expression exerted a protective effect (OR = 0.358; p = 0.022). Additionally, low APEX1 expression was more pronounced in patients refractory to achieving CCyR, underscoring the essential role of BER in maintaining genomic stability. Conclusion: The results indicate that deficiency of POLB and APEX1, combined with activation of REV1 and SETD2, is strongly associated with genomic instability and therapeutic resistance in CML. The use of second-generation TKIs further reinforced the reliance on damage tolerance mechanisms, highlighting the importance of the REV1-mediated TLS pathway. REV1 overexpression emerged as an independent predictor of poor prognosis, whereas SETD2 exerted a protective effect, suggesting their potential as molecular biomarkers for risk stratification and optimization of therapeutic strategies. In this context, an integrated understanding of DNA repair and damage tolerance pathways provides critical insights for preventing clonal evolution and improving the clinical management of CML patients. Tipo: Tese 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86804 Título: O que você sabe sobre o uso de métodos não farmacológicos para alívio da dor no parto? Vamos conhecer! Autor(es): Balsells, Marianne Maia Dutra; Aquino, Priscila de Souza Tipo: Folheto 2022-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86721 Título: Reações adversas a medicamento sem pacientes hospitalizados por insuficiência hepática crônica moderada ou grave em hospitais do Nordeste do Brasil Autor(es): Araújo, Breno Queiroz de Abstract: Chronic liver failure (CLF) is characterized by progressive and irreversible loss of liver function, which may lead to alterations in the pharmacokinetics of various medications and increased susceptibility to adverse drug reactions (ADRs). In this context, the clinical pharmacist plays a fundamental role in the prevention, identification, and management of these reactions. This study aimed to characterize the incidence, determinants, and clinical relevance of ADRs in patients hospitalized with moderate to severe CLF in hospitals in the Northeast region of Brazil. This is an observational, analytical, multicenter prospective cohort study that included patients with moderate to severe CLF (Child-Pugh B or C) hospitalized in seven hospitals in Northeast Brazil between September 2023 and January 2026. Daily collection of clinical, laboratory, and pharmacotherapeutic data was performed, with active surveillance of ADRs through medical record review, trigger tools, and reports from the healthcare team and patients. ADRs were coded according to the Medical Dictionary for Regulatory Activities (MedDRA®) and classified regarding causality, severity, and preventability using validated tools. Data analysis was performed using Stata 15®, adopting a significance level of p < 0.05. A total of 252 patients were included, with a predominance of males (59.1%) and a mean age of 59.2 years. Overall, 38.9% of patients experienced at least one ADR, totaling 207 events. The most frequent ADRs involved gastrointestinal, nervous system, and metabolic disorders, with furosemide, lactulose, and carvedilol identified as the main suspected drugs. Most ADRs were classified as probable or possible, of mild severity, and largely preventable. ADRs were associated with longer follow-up time, previous upper gastrointestinal bleeding, and laboratory abnormalities suggestive of hepatic and renal dysfunction, such as elevated urea, bilirubin, and aspartate aminotransferase (AST), as well as hyponatremia. ADRs were also associated with relevant clinical outcomes, including hepatorenal syndrome, prophylactic variceal ligation, acute-on-chronic liver failure, jaundice, and hepatic coma. In conclusion, ADRs are frequent in patients with CLF, many of which are preventable, and are associated with worse clinical outcomes, highlighting the need for rigorous pharmacotherapeutic monitoring and strategies to ensure safe medication use in this population. Tipo: Dissertação 2026-01-01T00:00:00Z