Doutorado em Saúde Coletiva
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- 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.
- ItemGestão de risco na segurança do paciente na atenção primária à saúde em um município da região central do Espírito Santo(Universidade Federal do Espírito Santo, 2024-11-18) Sirtoli, Fernanda Cordeiro; Lima, Eliane de Fátima Almeida; https://orcid.org/0000-0001-5128-3715; http://lattes.cnpq.br/4640538188376728; Primo, Cândida Caniçali; https://orcid.org/0000-0001-5141-2898; http://lattes.cnpq.br/4739920753105018; https://orcid.org/0000-0002-3601-3394; Sarti, Thiago Dias; Barcelos, Mara Rejane Barroso; Nunes, Elisabete Maria Garcia Teles; Figueiredo, Karla CrozetaIntrodução: A segurança do paciente é um eixo essencial da qualidade do serviço de assistência à saúde e o desenvolvimento de estratégias e práticas seguras na atenção primária à saúde deve ser entendida como uma prioridade na gestão dos riscos. A gestão de riscos trata-se de um um processo para conhecer os riscos aos quais há exposição e, então, avançar para a tomada de decisão sobre o que fazer com relação a eles. Objetivo geral: Desenvolver ferramentas para a gestão de riscos na Atenção Primária à Saúde de um município da Região Central do Espírito Santo. Objetivos específicos: Conhecer a situação de gestão de riscos; definir as prioridades e ferramentas para a gestão de riscos; construir as ferramentas para a gestão de riscos; elaborar uma página eletrônica sobre Segurança do Paciente vinculada ao site institucional do município para divulgação das ferramentas construídas para a gestão de riscos na segurança do paciente. Método: Foi realizada uma Pesquisa-Ação, de abordagem qualitativa. A pesquisa foi desenvolvida no município de Aracruz. A população do estudo foi constituída por um Grupo de Planejamento, com profissionais que atuam na Vigilância Sanitária e Atenção Primária à Saúde, que foram indicados pela Secretaria Municipal de Saúde. O grupo era formado por 46 participantes. Houve uma perda de 10 participantes no segmento da pesquisa, o que equivale a 21,73% dos participantes. Para a análise dos dados foi utilizada a técnica de análise de conteúdo de Bardin (2011). Resultados: Foi realizado o diagnóstico situacional sobre a gestão de riscos na Atenção Primária à Saúde, que apontou que o município não possuia a gestão de riscos implantada de maneira sistemática e efetiva. O grupo definiu as prioridades para a gestão de risco na segurança do paciente no contexto das Unidades Básicas de Saúde, e após isso se seu o processo de construção de tecnologias gerenciais como ferramentas para gestão de riscos: conjunto de protocolos de segurança do paciente na Atenção Primária à Saúde; material instrucional sobre segurança do paciente para profissionais de saúde; formulário eletrônico para gestão interna de notificações de incidentes relacionadas a segurança do paciente e página eletrônica sobre a gestão de riscos assistenciais vinculada ao site institucional do município para fortalecer e consolidar a gestão de riscos assistenciais na Atenção Primária à Saúde. Considerações Finais: Além do alcance dos objetivos desta pesquisa, ressalta-se que ocorreram algumas mudanças no município, como a criação e nomeação oficial do Núcleo de Segurança do Paciente. Estima-se que a pesquisa iniciou um processo de mudança de cultura no município em estudo referente à Segurança do Paciente. Para a assistência multiprofissional na Atenção Primária à Saúde, os resultados deste estudo oferecem uma linha direcional para que o cuidado seguro seja oferecido aos usuários do serviço, além de fortalecer a prática dos profissionais com padronização das ações baseadas nos princípios de segurança do paciente. Para o campo da Saúde Coletiva, essa pesquisa apresenta contribuição para os movimentos de promoção da saúde e políticas públicas saudáveis.
- 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.
- ItemQualidade da alimentação, potencial inflamatório da dieta e resistência à insulina e diabetes mellitus no ELSA-Brasil(Universidade Federal do Espírito Santo, 2025-03-14) Aprelini, Carla Moronari de Oliveira; Molina, Maria del Carmen Bisi; https://orcid.org/0000-0002-8614-988X; http://lattes.cnpq.br/9238370951122705; Guandalini, Valdete Regina; Faria, Carolina Perim de; Luft, Vivian Cristine; Pereira, Marlus Henrique QueirozInsulin resistance (IR) is considered an independent predictor of diabetes mellitus (DM), which is currently a global emergency. Its determinants are complex and include, among other factors, behavioral ones. Chronic subclinical inflammation participates in the pathogenesis of IR and DM through different mechanisms, and there is evidence that diet interferes with these processes. Therefore, this thesis aims to propose a new diet quality index and analyze the association between the inflammatory potential of the diet and the occurrence of IR and DM. The analyses were conducted using data from three waves of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): baseline (2008-2010), second follow-up (2017-2019), and the Covid wave (2020-2021), and are presented in three articles. Socioeconomic information and lifestyle habits were collected through structured questionnaires, and standardized clinical and physical examinations. The first article developed and validated Food Quality Score (FQS) using a qualitative Food Frequency Questionnaire. Pearson correlation, Principal Component Analysis, and Cronbach's alpha were used to test validity and reliability. Women and older individuals who engaged in more physical activity and had higher income levels exhibited higher FQS, in contrast to those who reported higher alcohol consumption and smoking. Cronbach's alpha coefficient was 0.47. The DQS demonstrated satisfactory validity and reliability and was associated with socioeconomic and lifestyle variables. The second article examined the relationship between the Inflammatory Food Index (IFI) and socioeconomic conditions and lifestyle habits. Multiple Correspondence Analysis and Multinomial Logistic Regression were used, with p < 0.05 considered statistically significant. Groups with more anti- or proinflammatory dietary patterns were expressed in a bidimensional graph. Low-income individuals, smokers, males, sedentary individuals, those diagnosed with obesity and those under 60 years of age were more likely to have a pro-inflammatory diet. The third article evaluated the prospective association between the inflammatory potential of the diet, estimated by the IFI, and the risk of IR and DM. Adjusted Cox regression models were used, considering a bilateral p-value of < 0.05. Incident cases of IR and DM were identified in 19.6% and 10.1% of participants, respectively. Being in the highest quintiles (greater dietary inflammatory potential) at the beginning of the study increased the risk of IR and DM in both sexes. Individuals who maintained a high score across the analyzed periods had a 1.5-fold increased risk for IR (95% CI 1.2-1.9; and 1.2-1.8, for men and women, respectively). These results contribute to a better understanding of the life and health aspects that impact dietary patterns and, consequently, the development of chronic diseases, enabling the improvement of dietary prescriptions focused on the prevention and treatment of IR and DM. Furthermore, the developed IFI allows for the analysis and comparison of the diet across other waves of ELSA-Brasil, contributing to the investigation of associations between eating habits, social determinants, and health outcomes within the context of nutritional epidemiology
- ItemConsumo de sal e sua relação com a pressão arterial em populações indígenas(Universidade Federal do Espírito Santo, 2025-03-10) Porto, Aline Silva; Mill, José Geraldo ; https://orcid.org/0000-0002-0987-368X; http://lattes.cnpq.br/2497419234600362; https://orcid.org/0000-0002-4780-3228; http://lattes.cnpq.br/0733677667808693; Alvim, Rafael de Oliveira; https://orcid.org/0000-0003-3150-4239; http://lattes.cnpq.br/3204117077254917; Zaniqueli, Divanei dos Anjos ; https://orcid.org/0000-0002-6146-1658; http://lattes.cnpq.br/1478607888567973; Miotto, Maria Helena Monteiro de Barros ; https://orcid.org/0000-0002-3227-7608; http://lattes.cnpq.br/4289442514763843Introduction: Diets high in sodium/salt can increase blood pressure. However, the pressure increase per gram of dietary salt shows significant differences among populations. Objective: To determine the consumption of salt, sodium, and potassium and their relationship with blood pressure in the indigenous population living in the villages of Aracruz, Espírito Santo. Methods: The doctoral project was structured in the format of three original papers and a literature review. Data collection in the indigenous population was conducted in two phases: the first in 2003 and the most recent in 2020-2022. Data from the general population of Vitória, studied in the MONICA-OMS/Vitória Project in 1999-2000, served as a comparison parameter. The studies were approved by the Ethics Research Committee of the Health Sciences Center at UFES. Results: The first manuscript is an integrative literature review on salt consumption in different populations. The second manuscript compares the impact of salt consumption in the urban population of Vitória and the indigenous people of Aracruz, with salt consumption estimated from the sodium excretion in 12-hour urine samples collected at night in both surveys. Only individuals not using antihypertensive medications were included in the analysis. The estimated salt consumption was high in both populations, higher among the indigenous (12.8 ± 5.7 g/day vs. 11.8 ± 5.9 g/day; p<0.01). Data from two collected databases (between 1999-2004) were used to compare salt consumption (12-hour urinary excretion) and its relationship with blood pressure in two populations, one with a representative sample from Vitória (ES) (n = 1,279) and the indigenous population of Aracruz (ES) (n = 526). High salt consumption was found in both populations (12.8 ± 5.7 g/day vs. 11.8 ± 5.9 g/day; even higher in the indigenous population, P<0.01). The slope of systolic blood pressure in indigenous people in the multivariate analysis showed that the salt consumption, age, and BMI explained 27% and 21% of the systolic and diastolic BP variability in the indigenous group. However the strongest predictor of both systolic and diastolic BP was the body adiposity. The third manuscript used data from indigenous populations collected in 2022, which sought to reassess salt consumption (casual urine) and its relationship with blood pressure (n = 800). The average salt consumption was 10 g/day. The variability of systolic pressure after adjustment for age, BMI, and salt was 24%. The fourth manuscript aimed to identify the sodium and potassium consumption profile, totaling 1,048 indigenous participants, and found very high values for salt consumption (10 g/day) and very low values for potassium consumption (1.8 g/day). Additionally, unsatisfactory diet quality was found for the indigenous community (Na+/K+=3.8).Conclusion: Salt consumption is high in both populations and appears to be associated with blood pressure, particularly systolic pressure. The diet quality of the indigenous populations is poor and requires government public health policies focused on food and nutrition to reduce the development of cardiovascular diseases in this population