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- ItemAnálise epidemiológica da Covid-19 em indígenas aldeados do Espírito Santo(Universidade Federal do Espírito Santo, 2025-09-24) Siqueira, Priscila Carminati; Sales, Carolina Maia Martins ; https://orcid.org/0000-0002-2879-5621; http://lattes.cnpq.br/3613476296412930; Maciel, Ethel Leonor Noia ; https://orcid.org/0000-0003-4826-3355; http://lattes.cnpq.br/3761398932271892; https://orcid.org/; https://lattes.cnpq.br/; 1º membro da banca; https://orcid.org/; https://lattes.cnpq.br/; 2º membro da banca; https://orcid.org/; https://lattes.cnpq.br/; 3º membro da banca; https://orcid.org/; https://lattes.cnpq.br/; 4º membro da banca; https://orcid.org/; https://lattes.cnpq.br/Introduction: Indigenous peoples are more vulnerable to illness and death from COVID 19, since infectious and parasitic diseases rank among the main causes of mortality in these populations, especially when compared to other ethnic and racial groups. This vulnerability is intensified by their collective way of life, cultural traditions that favor the spread of SARS-CoV-2 within communities, as well as social inequalities, difficulties in accessing health services, and the geographic locations of the villages. General objective: To analyze the epidemiology of COVID-19 among the Indigenous population living in villages in the state of Espírito Santo, from 2020 to 2024. Methods: This thesis is structured in the form of four scientific manuscripts, each with a specific objective. Accordingly, each manuscript adopts its own methodological procedures, which together comprise the overall research results and are presented in detail in the individual description of each product. Results: The scoping review initially identified 2,224 studies, resulting in a final sample of 47 publications. The countries with the largest number of studies were the United States, Brazil, and Mexico, with a concentration in 2021 (42.6%). A higher number of deaths was observed among Indigenous males over 60 years of age. The most prevalent comorbidities were cardiovascular diseases, diabetes, hypertension, and obesity. Incidence and mortality rates were higher among Indigenous peoples compared to other racial groups. The completeness analysis of COVID-19 notification forms for Indigenous villagers in Espírito Santo in 2020 showed “excellent” completeness (65.3%), although “very poor” completeness was found in 19.2% of the evaluated items, indicating that some variables in the forms had low data recording quality. The epidemiological profile analysis of the Indigenous population in Espírito Santo from 2020 to 2024 showed a cumulative incidence rate of 30,860.07 per 100,000 inhabitants, mortality rate of 118.09 per 100,000 inhabitants, and a case fatality rate of 0.38%. The highest concentration of COVID-19 cases in this population occurred in 2022, with a downward trend in the following years. Women (55.74%) and Tupiniquim individuals (92.28%) predominated, with the age group of 18–59 years (65.05%) and a mean age of 31.5 years. Deaths occurred in individuals aged ≥18 years, being more frequent among those aged ≥80 years (13.64%, p<0.001), with a mean age at death of 74 years. The highest incidences were recorded in the villages of Pau Brasil, Boa Esperança, and Caieiras Velha. The villages of Guaxindiba, Novo Brasil, and Olho d’Água reported no cases of the disease. The highest mortality and case fatality rates occurred in the village of Areal (395.25 per 100,000 inhabitants; 3.84%). Conclusion: Indigenous peoples present a complex and dynamic health profile, directly related to historical processes of social, economic, and environmental change, linked to the expansion and consolidation of demographic and economic frontiers of society across different regions of Brazil. Over the centuries, these frontiers have exerted significant influence on the determinants of Indigenous health, whether through the introduction of new pathogens causing severe epidemics, the usurpation of territories hindering or preventing subsistence, or the persecution and killing of individuals and even entire communities. Currently, other challenges to Indigenous health have emerged, such as chronic non-communicable diseases, environmental contamination, and food sustainability difficulties. Therefore, it is essential to implement public policies aimed at controlling risk factors within communities, expanding access to health services, and strengthening vaccination campaigns, in order to prevent new outbreaks of COVID-19 and other vaccine-preventable diseases in the villages
- ItemMapeamento e qualificação dos processos na fase pré-estudo de pesquisas clínicas de iniciativa do patrocinador em um hospital universitário(Universidade Federal do Espírito Santo, 2025-05-21) Silva, Vanezia Gonçalves da; Primo, Cândida Caniçali; https://orcid.org/0000-0001-5141-2898; http://lattes.cnpq.br/4739920753105018; https://orcid.org/0000-0001-6667-580X; http://lattes.cnpq.br/7952708165492137; Silva, Dayde Lane Mendonça da; https://orcid.org/0000-0001-5653-7411; http://lattes.cnpq.br/0510866008516545 ; Barcelos, Mara Rejane Barroso; https://orcid.org/0000-0001-7288-9468; http://lattes.cnpq.br/0607193448491008; Comarela, Carolina Fiorin Anhoque; https://orcid.org/0000-0003-0855-596X; http://lattes.cnpq.br/6438307084587108Introduction: Federal university hospitals are characterized by the complexity of their organizational structure, which encompasses multiple interdependent processes focused on care, teaching, and research. In the context of clinical research, this complexity is accentuated due to the multiplicity of responsibilities and stakeholders, institutional interfaces, and operational flows involved in conducting studies. When such processes are not properly defined and articulated, they can lead to rework, inefficiency, and compromise scientific and administrative results. Objective: To analyse the institutional processes that comprise the pre-study phase of sponsor initiated clinical research at a university hospital. Method: This is an action research study based on the need for collective knowledge construction. Professionals from different areas who worked on clinical research protocols at the university hospital participated in the study. The theoretical framework was supported by a scoping review on clinical research management, which guided the development of process mappings and a guidance manual for the pre-study activities. The development and validation of these products took place through six seminars, recorded in audio and video, transcribed, and submitted to Bardin’s categorial and lexical analysis using IRaMuTeQ software to identify challenges in conducting research. Results: The technical products – process mapping and manual – represent practical contributions, as they offer a structured basis for organization, clarity of responsibilities, optimization of flows, and ethical and legal compliance. Academic productions such as the scope review and articles, one focused on analyzing the process mapping development and the other on lexical analysis exploring the challenges, can inspire other institutions that encounter similar difficulties in structuring and managing clinical research in public university environments.
- ItemOrientação da mulher e a duração da amamentação: um estudo de métodos mistos(Universidade Federal do Espírito Santo, 2025-06-30) Minarini, Greyce Pollyne Santos Silva; Figueiredo, Karla Crozeta; https://orcid.org/0000-0003-0917-5301; http://lattes.cnpq.br/8027027232828519; Primo, Cândida Caniçali; https://orcid.org/0000-0001-5141-2898; http://lattes.cnpq.br/4739920753105018; https://orcid.org/0000-0003-0935-9098; http://lattes.cnpq.br/9489012336287358; Almeida, Marcia Valeria de Souza; https://orcid.org/0000-0002-1318-7084; http://lattes.cnpq.br/9372951429429767; Lima, Eliane de Fátima Almeida; https://orcid.org/0000-0001-5128-3715; http://lattes.cnpq.br/4640538188376728; Bueno, Mariana; https://orcid.org/0000-0002-1470-1321; http://lattes.cnpq.br/6764890606065359; Carmona, Ana Paula ReisIntroduction: Breastfeeding guidance provided in both primary and specialized health services can influence maternal decisions to initiate, maintain, and prolong breastfeeding. The use of mixed methods is recommended to investigate this subjective practice, influenced by individual and social factors, and to allow for comparisons between biological, psychological, cultural, socioeconomic, and demographic aspects that affect its duration. This approach broadens the understanding of breastfeeding as a lived and relational experience, involving multiple determinants that interact over time. General Objective: To examine the correlation between the guidance received by postpartum women during prenatal, delivery, and postpartum care and the duration of total breastfeeding in the first three months of life. Specific Objectives: To describe postpartum women's perceptions of the breastfeeding guidance received during prenatal, delivery, and postpartum care. To analyze the association of sociodemographic and clinical variables with the type and duration of breastfeeding. Method: The study adopted a convergent mixed-methods approach. In the qualitative phase, a descriptive and exploratory study was designed, with individual interviews guided by a semi-structured script aimed at understanding perceptions and experiences related to breastfeeding. In the quantitative phase, a longitudinal study was conducted, administering a sociodemographic and clinical questionnaire, in addition to using the Interactive Breastfeeding Scale to measure objective aspects of the practice. The study was conducted at the Women's Health Unit of the Espírito Santo University Hospital, Brazil. The population consisted of postpartum women admitted to rooming-in care and discharged after May 2024. The R Interface for Multidimensional Analysis of Texts and Questionnaires (Iramuteq) software, version 7.2, was used for the qualitative analysis, guided by the theoretical framework of the Interactive Theory of Breastfeeding. For the quantitative data analysis, descriptive statistics were applied, including measures of central tendency (mean) and measures of dispersion (standard deviation) for continuous variables, as well as relative and absolute frequencies for categorical variables. After analyzing the data from the quantitative and qualitative stages individually, the data were integrated using the concomitant incorporation strategy. Results: A total of 296 postpartum women were interviewed. Most of the postpartum women included in the study were between 15 and 35 years old (82%), lived with a partner (70%), and had 12 years of education or more (70%). Approximately 63% were primiparous, and 26% were multiparous. Most had more than six prenatal care appointments (85%), and the most common mode of birth was cesarean section (72%), with a predominance of late preterm infants (57%). Regarding the type of feeding, 57% practiced exclusive breastfeeding (EBF), 34% mixed breastfeeding, and 9% exclusive formula. Higher rates of exclusive breastfeeding (EBF) were associated with several factors, such as: a greater number of prenatal care visits (p = 0.010), greater milk production (p = 0.015), vaginal delivery (p = 0.058), absence of formula use in the first 48 hours of life (p < 0.001), absence of breastfeeding difficulties (p = 0.030), and non-use of pacifiers (p < 0.001). The practice of skin-to-skin contact and professional support during childbirth also favored EBF. There was a progressive reduction in breastfeeding difficulties and in the use of formula and pacifiers over time. Although social support was not statistically significant, it was more frequent among mothers who maintained exclusive breastfeeding. The integration of quantitative and qualitative data revealed that, despite statistical associations, the lack of breastfeeding guidance during prenatal care and the mode of delivery limited breastfeeding practices, highlighting the importance of considering maternal experience when evaluating breastfeeding care. Final Considerations: The results demonstrate that multiple factors influence the practice of exclusive breastfeeding, including clinical, care-related, and contextual aspects. Although most women had access to prenatal care and institutionalized birth, the lack of adequate breastfeeding guidance and limitations in immediate support after birth reveal gaps in care. The integration of quantitative and qualitative data demonstrates that considering maternal experience is essential to improving care practices and promoting breastfeeding equitably and effectively.
- ItemTrabalho remoto, atividades de bem-estar e mudanças nos hábitos de vida durante a pandemia da Covid-19: resultados do ELSA-Brasil(Universidade Federal do Espírito Santo, 2025-05-19) Martins, Haysla Xavier; Pereira, Taísa Sabrina Silva; https://orcid.org/0000-0002-5922-7424; http://lattes.cnpq.br/6842932234822212; Molina, Maria del Carmen Bisi; https://orcid.org/0000-0002-8614-988X; http://lattes.cnpq.br/9238370951122705; https://orcid.org/0000-0001-8827-1793; Griep, Rosane Härter; Pereira, Marlus Henrique Queiroz; Faria, Carolina Perim de; Mill, José GeraldoAs a result of the COVID-19 pandemic and the consequent recommendation of social distancing, there have been changes in the lifestyle habits of several populations around the world. Among these, the adoption of remote work as an alternative to maintaining work activities stands out. Despite its advantages, there is evidence that remote work implies longer working hours and greater pressure on professional performance, interfering with other aspects of workers' lives and health. It is therefore important to identify the conditions of this remote work and its relationship with lifestyle habits. In addition, it is proposed to evaluate other changes resulting from social distancing, as in the practice of physical activity and its association with the perception of weight gain. Therefore, this doctoral thesis addresses the theme of changes in lifestyle habits and remote work during the COVID-19 pandemic. The results are structured in three original manuscripts. Data from the Longitudinal Study of Adult Health – ELSA-Brasil, from the second follow-up visit – Wave 3 (2017-2019) and from Wave-COVID (July/2020 to February/2021) were used. Data collection for Wave 3 was carried out in person, where clinical examinations and interviews were conducted at the Research Centers participating in the study. In Wave-COVID, data collection was conducted through a digital platform in which participants were encouraged to answer four questionnaire modules that covered questions about adherence to social distancing, exposure, signs and symptoms of COVID-19, lifestyle habits, diet, occupational history, among other topics. Data were analyzed using the Statistical Package for the Social Sciences – SPSS 21.0, adopting a significance level of p < 0.05. The first manuscript aimed to identify the eating habits associated with remote work during the COVID-19 pandemic, through a cross-sectional study with 2,463 active workers in the Wave-COVID. It was identified that 78% were in the remote modality. In the adjusted model, there was a greater chance of cooking among individuals who were working remotely, both for men (OR = 2.45 95% CI: 1.75-3.42) and for women (OR = 2.93 95% CI 2.19-3.92), compared to those working in person. No difference was observed between the food quality score and work modality. However, when evaluating the score by fast food delivery utilization, those who used it weekly had worse food quality. The second manuscript aimed to describe the practices of well being activities during COVID-19 and to verify the association between the occurrence of these activities and Work-time control (WTC) in remote modality based on the cross sectional analysis of data from Wave-COVID. Information from 1,987 active workers who worked remotely was evaluated. The most mentioned activity was “Watching TV/Movies/Series” (91.2%) by men and “Cooking” (93.7%) by women. Adjusted regression models indicated that the prevalence of “praying or participating in prayer groups”, “physical activity/stretching indoors” and “reading books/magazines” were higher in men with strong WTC compared to those with weak WTC (PR = 1.30 [95%CI 1.11–1.53]; PR = 1.15 [95%CI 1.02–1.31]; PR = 1.08 [95%CI 1.01–1.15], respectively). Among women, the prevalence of “deep breathing techniques” and “physical activity/stretching indoors” were significantly higher among those with strong WTC (PR = 1.17 [95%CI 1.005–1.37] and PR = 1.16 [95%CI 1.03–1.32], respectively). The third manuscript aimed to identify the association between changes in leisure-time physical activity (LTPA) and perceived weight gain during the COVID-19 pandemic. A longitudinal analysis was conducted with data from 4,402 individuals between Wave 3 and Wave-COVID. Individuals who reduced their LTPA levels to the point of changing their classification were more likely to present perceived weight gain. Specifically, those who were moderately active in Wave 3 and became sedentary (OR = 1.5 [95% CI 1.2-1.9]) or had low LTPA levels in Wave-COVID (OR = 1.6 [95% CI 1.2-2.1]); those who were highly active in Wave 3 and had low LTPA levels in Wave-COVID (OR = 2.3 [95% CI 1.05-5.4]). The results of this thesis elucidate some of the changes in the lifestyle habits of Brazilian public servants during the COVID-19 health crisis, especially regarding diet and physical activity. Furthermore, the role of the mandatory transition to remote work in the occurrence of certain changes in individuals' lifestyles is discussed. Finally, the importance of autonomy and flexibility in the remote work environment, as reflected in the WTC assessment, and the impact on the performance of self-care activities are also addressed. It is expected that these findings will foster knowledge about an unprecedented scenario, such as the COVID-19 pandemic, and contribute to future discussions around the consequences of the changes examined here.
- ItemUso de aprendizado de máquina em análise preditiva na interrupção do tratamento da tuberculose em pessoas que vivem com HIV(Universidade Federal do Espírito Santo, 2025-01-30) Soares, Karllian Kerlen Simonelli; Hisatugu, Wilian Hiroshi; https://orcid.org/0000-0001-8333-0539; http://lattes.cnpq.br/6597878238749014; Prado, Thiago Nascimento do; https://orcid.org/0000-0001-8132-6288; http://lattes.cnpq.br/6388559394015871; https://orcid.org/0000-0002-2296-1190; Sanabria, Gladys Mercedes Estigarribia; Negri, Leticya dos Santos Almeida; Rissino, Silvia das Dores; Possuelo, Lia GonçalvesObjective: To build a prediction model for interruption of tuberculosis treatment in people living with HIV. Methods: This is a cross-sectional study developed in three stages: first, the analysis of the quality of SINAN data using the Centers for Disease Control and Prevention (CDC) Guide, from 2016 to 2018, with five methodological stages that included quality analysis, standardization of records, duplication analysis, data completeness through linkage with the SINAN-HIV database, and data anonymization. In the second stage, in addition to the methodological process of preparing the database and descriptive data analysis, the STATA statistical package, version 16 (StataCorp LP, College Station, TX, USA) was used to perform descriptive analyses with identification of relative and absolute values, and tables were generated for data analysis. The third stage consists of building the predictive model through machine learning using Multilayer Perceptron (MLP) and Restricted Boltzmann Machines (RBM) artificial neural network algorithms and Random Forest and CatBoost decision trees of TB-HIV co-infection, from 2016 to 2021, in Brazil, implemented in Python version 3.10.3; with validation through accuracy, sensitivity, specificity, true positive values and true negative values. The study obtained ethical approval under opinion no. 4022892 on 05/12/2020. Results: In the first stage, the study showed that 89% of the mandatory variables and 91% of the essential variables presented satisfactory completeness. In the case of TB-HIV co-infection, 73% of the variables were completed, but essential variables related to monitoring of TB treatment presented unsatisfactory completeness. In the second stage, of a total of 4,428 cases, 325 cases were of TB-HIV co-infection, 322 cases were located in the SINAN-TB database and three cases were located after linkage with the SINAN-HIV database that presented a record of a negative result for the HIV diagnostic test in the SINAN-TB database. The vulnerability profile of coinfection was observed in men (71%), young (20 to 39 years) (52%), mixed race (59%), with up to 8 years of education (25%), alcoholics (29%) and smokers (37%) and who used drugs (26%), with 65% adherence to antiretroviral therapy and only 44% with a cure outcome and 20% interrupted treatment; approximately 61% did not undergo directly observed treatment and only 6.9% of cases reported receiving assistance from the government's income transfer program. In the third stage, a total of 12,556 cases of TB-HIV coinfection in Brazil were analyzed, and the Multilayer Perceptron neural network algorithms were sensitive in identifying potential cases of treatment interruption, and were validated by an accuracy of 0.73, sensitivity of 0.75, and specificity of 0.62; Positive Predictive Value (PPV) of 0.91 and Negative Predictive Value (NPV) of 0.31. Conclusion: Training and capacity building to improve data collection, integration and analysis are essential to promote data quality. As well as social support, in order to enable access to health services and timely treatment for the most vulnerable. And finally, the implementation of new technologies, which optimize the breaking of the chain of TB transmission in people living with HIV, favoring actions aimed at screening, treatment and monitoring of cases. To strengthen care networks and promote equity in access to health services.