SALVIANO, Ana Laura Góes , SANTANA, Giovanna Rocha , DIAS, Claudio Alberto Gellis de Mattos , ARAÚJO, Maria Helena Mendonça de , OLIVEIRA, Euzébio de , DENDASCK, Carla Viana , SANTOS, Bruno Rodrigues dos , FECURY, Amanda Alves 
SALVIANO, Ana Laura Góes. Et al. Knowledge about ways to prevent and spread STIs among students enrolled in State Schools in the City of Macapá, Amazônia, Brazil. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 12, Vol. 10, pp. 05-16. December 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/prevent-and-spread, DOI: 10.32749/nucleodoconhecimento.com.br/health/prevent-and-spread
Sexuality began to be seen as a positive scope of human action, in this context, it began to value sexual education, raising discussions about its importance. The aim of this article was to analyze knowledge about forms of contagion and prevention of STIs. This study was conducted in 03 state schools of elementary and secondary level. The sample consisted of 287 students regularly enrolled in these schools covering the 8th grade/ 7th grade of elementary school until the 3rd year of high school. Data on gender, age, marital status, education and others were collected in this study. Most participants have already had contact with the term STI; however, it still has beliefs about its forms of transmission. There is a need to approach sexuality with a more natural and positive aspect of human life, providing the free discussion of norms and patterns of behavior and the debate of attitudes.
Keywords: STIs, AIDS, adolescence, sexuality.
There is no universal standard that defines the age group of adolescence and young adults and, with regard to adolescence for the Statute of children and adolescents, this goes from 12 to 18 years. For the Ministry of Health and WHO, it goes from 10 to 19 years of age, in addition to adopting the 15-24 age group as youth (BRASIL, 2012; WHO, 2016) The World Health Organization (WHO) defines young adolescents who are between 15 and 19 years old and young adults as 20 to 24 years old, that is, these age groups together comprise youth (UNFPA, 2010).
According to the census, adolescents and young people aged 15 to 29 years correspond to 51.3 million, that is, 1/4 of the total population, which makes Brazil a relatively young population country (IBGE, 2014).
Sexuality has passed through various senses throughout history, from a wide freedom experienced in Greece and Rome (where only pleasure was sought, without rules or limits, both in search of reproduction and love) to the rise of Christianity, when there was enormous pressure/coerção of the Catholic Church on pleasure being something extremely sinful and sex practiced only with reproductive scopes (MAROLA et al., 2011).
Sexuality came to be seen as a positive scope of human action, with sex, gender identity and role, sexual orientation, eroticism, pleasure, intimacy and reproduction. In this context, sexual education began to be valued and not seen as a problem, raising discussions and arguments about its importance in the midst of the historical and cultural aspect of certain societies (MAROLA et al., 2011).
WHO provides for sexual rights in accordance with human rights recognized by international laws and documents. They prohibit any form of coerção, violence or discrimination; as well as rights for all. This also applies to adolescents because, during this age group, the onset of sexual life usually occurs and these young people are exposed to all positive and negative factors of this process (MAROLA et al., 2011).
Adolescence is a very troubled period, because it is in it that the individual seeks his identity, freedom and autonomy, so that he can assert himself in the environment in which he lives as a subject. This process primarily involves biological changes (hormonal and body) that influence and mix with psychological and behavioral changes, all of which are influenced by living with family, friends, educators and other individuals inserted in close relationships (BESERRA et al., 2008).
During this process of self-affirmation the adolescent also seeks to impose himself in society and a way to do this is sex. Thus, it is at this stage of life that the onset of sexual life usually occurs (BESERRA et al., 2008) and is when sexuality becomes more evident, because due to the biopsychosocial transformations that the adolescent’s life permeates, this is a moment of great curiosity and discoveries. In this way, young people seek new experiences, especially sexual experiences (CARLETO et al., 2010).
Entering sexual life in many cases can occur early, between 11 and 15 years (BESERRA et al., 2008). In a study with newly-ticketed university students (ARAUJO et al., 2012) most of the first sexual relations occurred between 14 and 17 years (72.1%), and the lowest age detected was 10 years and the highest was 20 years. However, this precocity is not accompanied by social responsibility, which is occurring in the lives of young people more and more later and for this reason we can find behaviors and attitudes, typical of adolescents in age groups older than 19 years recommended by the WHO (BRÊTAS et al., 2009). For this reason there is an increase in the occurrence of teenage pregnancy and contagion from sexually transmitted infections (STIs) or both (BESERRA et al., 2008).
The early onset of sex life is particularly interesting especially for boys, as this can be considered a sign of masculinity. The male adolescent is also more imposed within a couple relationship, for example, which makes him use of the condom or one or another type of sexual practice is performed (CAMARGO and FERRARI, 2009). This can be evidenced by the increasing incidence of the HIV virus among adolescent women (OLIVEIRA et al., 2009; ALVES et al., 2019).
The magnitude of the problem among these young women is greater than one thinks, because although many of them train the knowledge necessary for condom use they have difficulties in negotiating this practice with their partner. In a study conducted in 104 adolescents who used the contraceptive pill, only 40% of them used condoms in all sexual relations (OLIVEIRA et al., 2009).
The occurrence of STIs in 13-year-old boys demonstrates how early they are entering sexual practice and for this reason adolescents should be instructed early on about forms of contagion and prevention of STIs. This should be done through frank and open dialogue, where the young person is allowed to express himself and ask his questions (BESERRA et al., 2008).
This information should be primarily granted by the family through conversations where parents could clarify their children’s doubts and guide them in the best possible way. However, when parents avoid the subject these young people seek information in other places, such as school. And often teachers and other professionals involved in the educational process are not prepared to deal with it. This causes the adolescent not to obtain the proper information and ends up remaining unprotected (BESERRA et al., 2008).
In addition, a study conducted in Rio Branco, Acre with high school students, found that the greatest source of information for these young people was their own friends. These are probably equally devoid of maturity and sufficient knowledge to be able to express themselves about something so serious and important (CARLETO et al., 2010).
In 2010, Carleto et al. they did work with 499 adolescents in Cuiabá in the State of Mato Grosso, where they inquired about the forms of stis contagion. It was considered that he had adequate knowledge who selected: sex without condom, oral sex, anal and / or vaginal without protection, sharing syringe and needle to inject drug. Of this total, only 4.62% were able to get them all right.
A reflection of this is the high incidence of HIV/AIDS worldwide among adolescents – about 430,000 (UNAIDS, 2019). In Brazil, in 2007, 10,337 cases of the disease were reported among young people aged 13 to 19 years (CARLETO et al., 2010). In a survey of 74 adolescents (high school students) from a state school in Cruz Alta, Rio Grande do Sul, only 3 of them did not have any STi (BUENO et al., 2012).
The aim of this article was to analyze knowledge about forms of contagion and prevention of STIs of students from state elementary and high schools in the State of Amapá, regularly enrolled in the urban area of the capital, Macapá.
MATERIALS AND METHODS
This study was conducted in 03 state schools of elementary and secondary level. The sample consisted of 287 students regularly enrolled in these schools covering the 8th grade/ 7th grade of elementary school until the 3rd year of high school.
The 8th ratio was used year/ 7th grade and 9th grade / 8th grade because some schools have not yet implemented Bill No. 144/2005 approved by the Senate in January 2006 and sanctioned in February 2006 by the President of the Republic from law no. 11,274 (BRASIL, 2006) that regulates elementary school for 9 years with mandatory enrollment from 6 (six) years of age. The legislation provides that its measure should be implemented by 2010 by the Municipalities, States and the Distrito Federal.
The study population consisted of male and female adolescents and young adults (15 to 24 years old), regularly enrolled in schools in the municipality of Macapá- AP, who attend elementary or high school in state public schools. The sample used was defined by sample calculation.
From tables made available by the Department of Education of the State of Amapá, according to the number of elementary school students enrolled regularly in 2017 and high school students enrolled in 2018. The sampling error used was 5%, confidence level of 95%. For the calculation of students from state public elementary schools 8th year/ 7th grade and 9th year/ 8th grade and regular high school were used the values of the total number of students of public schools in the State of Amapá in urban areas related to the values of macapá schools that belong to the urban area and that include the grades described above.
Male and female individuals residing in the State of Amapá and who are in elementary or high school were included in the study. They authorized voluntary participation in the research by signing the Free and Informed Consent Term (TCLE) and, for those under 18, signing their legal guardian (TALE – Termo de Assentimento Livre e Esclarecido). Individuals who do not meet the established criteria, who do not authorize participation and who are not enrolled in the regular school system will be excluded from the study.
For each participant, a main questionnaire containing two blocks was submitted: A and B. The questions in block A were related to the sociodemographic information of each student. There are 12 questions in which the following themes were addressed: gender, age, marital status, educational level, higher course than the head of his family completed, race, religion, current work situation and possible items that exist in their homes.
For data collection, an adaptation of the questionnaire used by the Ministry of Health for the research of Knowledge, Attitudes and Practices in the Brazilian Population was performed in 2008 (BRASIL, 2011).
The schools that were contacted and initially agreed to participate in the study had a term of consent. It was explained to all the participating students, in clear and direct language, the objectives, benefits and possible harm stemming from the research, besides that there was absolute secrecy and the privacy of each one was guaranteed. After that, when agreeing, the individual signed the Free and Informed Consent Form (TCLE), authorizing his voluntary participation. If the participant was a minor, his legal guardian also signed a Free and Enlightened Consent Term (TALE). The study met the ethical considerations set out in resolution 466 of December 12, 2012 of the National Health Council and was submitted to evaluation and approved by the Research Ethics Committee (CAAE 66761617.1.0000.0003), after registration in plataforma Brasil.
A study participated in 287 students, 140 (48.8%) females and 147 (51.2%) to the male.
Regarding age, most students were between 16 and 18 years old. Of these, 75 (26.1%) were 16 years old; 85 (29.6%), 17 years; and 60 (20.9%), 18 years.
In the question of what marital status they were currently in, 224 (78.1%) were never married, 35 (12.2%) are living (married or living with a partner) and 9 (3.1%) are separated, 3 (1.0%) widowed, and 16 (5.6%) people did not respond to this item.
Regarding the level of education of these students, 141 (49.1%) are in the 1st or 2nd grade of high school, 79 (27.5 %) have completed elementary school, 44 (15.3%) have completed high school, 5 (1.7%) are in the 1st to 3rd grade of elementary school, 2 (0.7%) are in the 4th to 7th grade of elementary school and 16 (5.7%) students did not respond to this item.
In the question “What is the highest course that the head of his family completed?”, 86 (30.0%) stated that it was the Complete Superior, 75 (26.1%) Complete High School, 34 (11.8%) 4th to 7th grade of elementary school, 25 (8.8%) Complete Elementary School, 23 (8%) Superior Incomplete, 20 (6.9%) 1st or 2nd grade of high school, 14 (5%) 1st to 3rd grade of Elementary School, 3 (1%) are illiterate and 7 (2.4%) people did not respond to this item.
When asked “How do they rank in relation to their color?”, 140 (48.8%) declared to be brown, 49 (17%) whites, 46 (16%) blacks, 14 (4.9%) yellow, 12 (4.1%) indigenous peoples, 14 (4.9%) did not know how to answer their color/race and 12 (4.3%) students left this item blank.
Asked about “Do you consider yourself religious?”, 211 (73.5%) answered with ‘Yes’ while 66 (23.0%) answered with “No.” Only 10 (3.5%) people did not respond to this item. Regarding the question “What is your religion?”, 107 (37.3%) claimed to be Catholic, 105 (36.6%) Evangelicals, 2 (0.7%) Ubanda/Candombé and 1 (0.4%) spiritist. 72 (25%) people did not respond to this item.
In the question “What is your current employment situation?”, 226 (78.8%) reported not currently working, 13 (4.5 %) are employed with a signed license, 12 (4.3%) work without a signed license, 10 (3.5%) self-employed, 7 (2.4%) are employers, 6 (2 %) are public servants and 13 (4.5%) students did not respond to this item.
When asked “What is the main reason you are not currently working?”, 142 (49.5%) confirmed that they were not working due to studies/training, 56 (19.6%) searched, but could not find work, 3 (1%) are housewives/care for the family, 1 (0.3%) is retired, 1 (0.3%) is sick, 1 (0.3%) (has unpaid work), 83 (29%) students did not respond to this item.
Sociodemographic information about the items that the interviewees have in their homes. Most students have a TV (275/287), have no radio (138/287), have a bathroom (272/287), car (164/287), no monthly employees (2 05/287), has washing machine (258/287), DVD or vcr (180/287), refrigerator (264/287) and freezer (162/287).
Block B refers to the forms of transmission of some diseases. Regarding the question “Which or which of the diseases described in the card can a person be infected by being bitten by an insect, such as a mosquito or mosquito?”, 42 (14.6%) students reported that STIs (AIDS, syphilis, hepatitis and gonorrhea) can be transmitted by insect bite; 250 (87,1%) students marked “Dengue”; 168 (58.5%), the “Malaria” option; 9 (3.1%), the option “None of these”; 10 (3.4%) students left the questioning empty.
As for the question “Which or which of the diseases described in the chart can a person be infected when using public restrooms?” 50 (17,4%) students marked the option “AIDS”, 68 (23.7%), the option “syphilis”, 50 (17.4%) the option “hepatitis”, 8 (2.7%), the option “dengue”, 10 (3.8%) the option “malaria”, 134 (46.6%), the option “gonorrhea”, 38 (13.2%), the option “none of these” and 27 (9.4%) students did not score.
Regarding the question “Which or which of the diseases described in the chart can a person be infected by sharing a syringe or needle with others?” 230 (80,13%) students marked the item “aids”, 57 (19.86%), the item “syphilis”, 65 (22.64%), the item “hepatitis”, 8 (2.78%), the item “dengue”, 1 5 (5.22%), the item “malaria”, 27 (9.40%), the item “gonorrhea”, 8 (2.78%), the item “none of these” and 18 (6.27%) did not point to the questioning.
In the question “What diseases described in the card can a person be infected by not using condoms in sexual intercourse?” 256 (89,19%) students marked the item “Aids”, 138 (48.08%), the item “Syphilis”, 16 (5.57%), the item “Hepatitis”, 5 (1.74%), the item “Dengue”, 2 (0.69%), the item “Malaria”, 117 (40.76%), the item “Gonorrhea”, 4 (1.39%), the item “None of these” and 13 (4.52%) didn’t score.
With regard to the question “For which or which of the diseases described in the chart is there a cure?” 14 (4,87%) students indicated the option “AIDS”, 51 (17.77%), the option “Syphilis”, 124 (43.20%), the option “Hepatitis”, 219 (76.30%), the option “Dengue”, 19 6 (58.88%), the option “Malaria”, 112 (39.02%), the option “Gonorrhea”, 10 (3.48%), the option “None of these” and 15 (5.22%) left the questioning empty.
From the questioning, the students should mark whether they agreed or disagreed with the proposed assertion. In the statement 18 “The risk of transmission of the AIDS virus can be reduced if a person has sex only with a faithful and uninfected partner”, 155 (54.0%) students marked the option “Agree”; 93 (32.4%), the option “Disagrees”; 28 (9.8%), the option “does not know” and 11 (3.8%) left the assertion empty.
Regarding the statement “A healthy-looking person may be infected with the AIDS virus”, 220 (76.7%) students marked the item “Agrees”; 26 (9.0%), the item “Disagrees”; 30 (10.5%), the item “Do not know” and 11 (3.8%) have not marked any item.
Regarding the statement “Using condoms is the best way to prevent the AIDS virus from being transmitted during sexual intercourse”, 258 (90.0%) students marked the item “Agree”; 11 (3.8%), the item “Disagrees”; 9 (3.1%), the item “Do not know” and 9 (3.1%) left the assertion empty.
Regarding the statement “A person can be infected with the AIDS virus by sharing cutlery, glasses or meals”, 68 (23.7%) marked the option “Agree”; 160 (55.8%), the option “Disagrees”; 50 (17.4%), the option “Do not know” and 9 (3.1%) left the assertion blank.
About the statement “A pregnant woman who has the AIDS virus and receives specific treatment during pregnancy and at the time of delivery decreases the risk of passing the AIDS virus to her child”, 142 (49.5%) marked the item “Agree”; 60 (20.9%), the item “Disagrees”; 77 (26.8%), the item “Do not know” and 8 (2.8%) have not marked any item.
Of the 287 students who responded to this survey, the majority belonged to the male gender (51.2%). A similar study, conducted Brêtas et al. (2009), also found a predominance of men. This slight predominance of males among adolescent high school students seen in both studies may be related to the also predominance of such gender in the school age group from 13 to 17 years (IBGE, 2015).
Most students reported being 17 years old and the mean age was 16.7 years. According to data from IBGE 2015, students enrolled in public schools are similar to that found in this study, between 15 and 17 years of age. It is observed that the number of young people enrolled in high school in this age group was approximately 80% of the total number of young people (BRASIL, 2013a).
Regarding the marital status of the interviewees, the majority declared themselves single (78.1%), corroborating the findings in another study (ARAGÃO et al., 2011). These data may be related to the age group still young of the interviewees, who tend to have a majority of singles (IBGE, 2016).
Regarding the level of education of the interviewees, those who were attending high school predominated. A counterpoint found in the questionnaire applied is in the question – “What is your level of education? “,because the interviewed students observed the absence of an item that contemplated those who are in the 3rd year of high school, and they were instructed to mark the option that most closely approximated their teaching series. The predominance of students attending high school is due to the fact that the target audience of this research is in the age group of 14 to 21 years of age (IBGE, 2015).
One of the items deals with the level of education of the students’ parents. In the distribution of these levels of education there was a slight predominance of parents with complete higher education (30.7%). A study that assesses the knowledge about sexuality of 1545 students found similar distribution. In view of this information, we should pay to the increase in the number of years of schooling of Brazilian workers, which, according to data released by the Getúlio Vargas Foundation, in 2017, there was an average increase of 68% in years of schooling for the poorest layers of the population and an increase of 10% for the richest classes between 2003 and 2014 (CARVALHO et al. ,2017; PINTO, 2017).
Another item of this research asked about the color/race of the students interviewed. Of these, the majority declared to be brown (48.8%). This finding is compatible with the latest studies published by IBGE where they show that most Brazilians declare themselves brown (46.8%). It is possible to notice in this information that the research data followed a change in race/color predominance evidenced since 2014, where the increase in the number of Brazilians who declared themselves black and brown was observed, promoting a fall in those who declared themselves white (IBGE, 2014; 2017).
Regarding the question of “whether they had religion”, 73.5% of the students answered “yes”, while 23.0% of them answered “no”, and the current majority religion (37.3%) was Catholicism, followed by evangelical religion (36.6%). The growing number of those who declare that they do not have religion can be explained by the fact that both the Catholic and evangelical religions persist in criticizing the untying of sexual activity to marriage or fecundity, despite recognizing the profound changes experienced in the spheres of religion and sexuality. It is possible to notice that churches tend to use punitive instruments to ensure that their young people do not start their premarital sex life (such as the loss of prestige or leadership within the church) and can thus remove adolescents from their religions (COUTINHO and RIBEIRO, 2014).
In the items that questioned about the interviewee’s current employment and what the main reason for not currently working, it is possible to perceive a clear difficulty of response on the part of the students, because they marked options incompatible with their age group and educational level. This type of difficulty is justified by the fact that the existence of a predetermined list of options in interviews in the form of questionnaires with “closed” answers can create a tendency to choose one or more categories (options) without the interviewee actually reflecting on the subject (JUNIOR, 2005).
Regarding the second block of questions, of the 287 students interviewed, only 14.63% (Graph 11) reported that STIs (AIDS, syphilis, hepatitis and gonorrhea) can be transmitted by insect bite, which means that the majority (85.36%) distancethe term “STIs” from mosquito-borne diseases. In a strudo, it was found that most students knew how to adequately define STIs as a sexually transmitted disease (GENZ et al., 2017). This result is possible because since the 1990s there have been proposals for innovation in Brazilian basic education, from the introduction of transversal themes, such as sexual orientation. (SILVA, 2008).
However, in the analysis of the questioning about the transmissibility of certain STIs when using the public bathroom, 46.68% marked the option “gonorrhea”, showing that almost half of the students, despite the conceptual knowledge of the term “STIs”, have beliefs about the forms of contagion of certain sexually transmitted infections. Brêtas et al. (2009), found this in his study, in which a large percentage of adolescents did not know any form of transmission of STIs. The presence of some myths can be justified because, according to Beserra et al. (2008), information on sexual relations is most often discussed among young people themselves; and such information is usually brought by the media and misinterpreted.
Still on modes of infection, one should pay to the fact that most students (80.13%) pointed out that AIDS can be transmitted by sharing a syringe or needle with others, showing that many know other ways. Most of the adolescents interviewed knew about this form of transmission (NADER et al., 2009). Based on these data, it can be seen, therefore, that adolescents, despite some knowledge, still have doubts and uncertainties about the theme (AMORIM and MAIA, 2012).
About the possibility of infection from the non-use of condoms, there were discrepancies in the knowledge of the listed STIs, almost 90% of the students answered AIDS, but less than half of the students reported syphilis, gonorrhea and hepatitis, showing that many are unaware of other sexually transmitted infections besides AIDS. In public schools in Rio Claro, SP, less than 10% of the students mentioned hepatitis, just over 20% cited gonorrhea and syphilis (SILVA, 2015). This result can be justified by the fact that since the 1980s AIDS has been seen as an epidemic in Brazil and, in this context, public policies about this STIs are higher (BRASIL, 2015).
When asked about the cure of certain diseases, almost 40% were unaware of the cure of gonorrhea, more than 40% classified hepatitis as curable and only 4.87% reported AIDS, showing that knowledge among STIs varies among students, with predominance of certainties about AIDS. Brêtas et al. (2009), had a different result, its students knew mainly gonorrhea as curable STIs, followed by syphilis and herpes. The difference in knowledge between the study population of Brêtas et al. (2009) and this research can be justified by the fact that in the North region access to information may be scarcer than when compared to the Southeast of the country (BRASIL, 2014).
Two questions are related in the research (graphs 16 and 18), because they assess the risk of transmission of the AIDS virus from a faithful partner and the use of condoms. Slightly more than half of students (54%) agrees that the faithful and uninfected partner reduces the risk of infection and almost 90% (258) of students agree that condoms are the best way to prevent the virus from being transmitted in sexual intercourse. These results are compared in a study in which more than half (66%) of the adolescents interviewed did not use condoms, despite having the knowledge about the forms of transmission, justifying by: “already knowing the partner”, “being married”, “fixed partner”, that is, despite the knowledge, they still submitted to the risk due to factors related to the partner (CANO et al., 2007).
This research showed that 23.34% of students are unaware that a healthy-looking person may be infected with the HIV virus. In Brazil, it is estimated that 600,000 people live with the virus or have already developed AIDS (SANTOS et al., 2012). One study obtained a similar result (26.8%), where the interviewees did not know if an infected person had apparent symptoms. Therefore, it is perceived that knowledge on the subject among young people is still scarce when researching in depth about the social stigmas related to AIDS, and it is necessary to invest in quality content on the subject (NADER et al., 2009).
Another question was regarding the transmission from cutlery, glasses and meals. More than 40% agreed with this risk or did not know what to answer (Graph 19). Another study showed that 20% of respondents reported that these are possible sources of contamination (NADER et al., 2009). The fact is that there is no real risk of saliva contact infection, since it contains proteins and low amount of salt capable of neutralizing the virus (FREITAS et al., 2017).
Another important point was about the possibility of a woman undergoing specific treatment during pregnancy and childbirth decrease the chances of transmitting the HIV virus to her child, about 47% disagreed or could not answer (graph 20). Jordan et al. (2016), obtained a similar result in a study conducted with pregnant women, in which 45.8% were unaware of the possibility of taking a medication capable of preventing the transmission of the AIDS virus from an infected pregnant woman to their baby. In this context, it is perceived that there is a decline in knowledge of the young and adult population when it comes to vertical transmission (JORDÃO et al., 2016).
Most participants have already had contact with the term STI; however, it still has beliefs about its forms of transmission. These results show the importance of investing in the sexual education of adolescents, as they are the main age target of vulnerability of STIs. Such teaching should be orchestrated at the level of understanding of these young people, making them aware of the right to choose with the care of their health.
This information can be proven, because since the 1980s many investments in public policies and social media on AIDS have provided increased knowledge in relation to other STIs. Many are still unaware of the same risk for other sexually transmitted infections such as syphilis, hepatitis and gonorrhea. Evidencing the need to approach sexuality with a more natural and positive aspect of human life, providing the free discussion of norms and patterns of behavior and the debate of people’s attitudes towards sex and sexuality itself, emphasizing discussions about forms of transmission and contagion of STIs.
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 Resident in Medical Clinic (HOSPITAL OPHIR LOYLA), Belém, PA.
 Resident in Clinical Medicine (UNIVERSITY HOSPITAL OF SERGIPE), Aracajú, SE.
 PhD in Theory and Behavior Research (UFPA). Professor and Researcher at the Federal Institute of Amapá (IFAP), Macapá campus, AP. Professor and Researcher in the Graduate Program in Professional and Technological Education (ProfEPT), IFAP, Santana campus, AP.
 Master in Teaching and Health Sciences. Professor and researcher at the Federal University of Amapá (UNIFAP), Macapá campus, AP.
 PhD in Theory and Behavior Research (UFPA). Professor and Researcher at the Federal University of Pará (UFPA), Campus Castanhal, PA.
 Theologian, PhD in Clinical Psychoanalysis. She has been working for 15 years with Scientific Methodology (Research Method) in Scientific Production Guidance for Masters and Doctoral Students. Specialist in Market Research and Health Research. Doctoral Student in Communication and Semiotics (PUC SP).
 PhD in Theory and Behavior Research (UFPA). Professor and Researcher at the Federal University of Pará (UFPA), Campus Belém, PA.
 PhD in Tropical Diseases (UFPA). Professor and researcher at the Federal University of Amapá (UNIFAP), Macapá campus. Professor and researcher at the Graduate Program in Health Sciences (UFPA). Pro-Rector of Research and Graduate Studies at the Federal University of Amapá (UNIFAP).
Submitted: December, 2020.
Approved: December, 2020.