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- ItemImunogenicidade natural e induzida pelas vacinas contra a Covid-19 em uma coorte de trabalhadores da saúde(Universidade Federal do Espírito Santo, 2024-11-18) Gouvea, Maria da Penha Gomes; Valim, Valéria; https://orcid.org/0000-0002-0625-1308; Mill, Jose Geraldo; Pinto, Lauro Ferreira; Machado, Ketty Lysie Libardi Lira; Duarte, Djane BrazThe clinical profile of COVID-19 has been linked to age, pre-existing comorbidities, viral load, immunological profile, and individual vaccination status. This study resulted from two consecutive projects. Objectives: In the first phase, monitoring of symptoms and antibody production in a cohort of unvaccinated healthcare professionals over six months. The aim of the second phase was to evaluate the immunogenicity and duration of humoral response of the CoronaVac and AstraZeneca (ChAdOx1) vaccines in a cohort of workers for 180 days after the primary schedule and 180 days after booster dose with ChAdOx1 or Pfizer/BioNTech (BNT 162b2), in homologous and heterologous schemes. Method: Observational longitudinal study. The first phase included healthcare workers diagnosed with COVID-19 confirmed by RT-PCR. The presence of anti-nucleocapsid IgG and IgM antibodies against SARS-CoV-2 was detected by chemiluminescent microparticle immunoassay (ARCHITECT i1000SR, Abbott Laboratories, IL, USA). IgG results > 1.4 AU/mL and IgM > 1.0 AU/mL were considered seroconverted (group A), and those with values below were non-seroconverted (group B). Serologic tests were conducted at 15, 30, 45, 60, 90, and 180 days after COVID-19 symptoms onset. The second phase included healthcare workers which were immunized with two doses of CoronaVac or ChAdOx1 followed by a booster dose with ChAdOx1 or BNT 162b2 (BNT). Subjects underwent 8-9 blood collections for IgG anti-spike antibody levels (IgG-S) measurement, immediately before the first dose, 28 days after the first dose, immediately before the second dose, 28 days and 180 days after the second dose (*), immediately before the third dose, 28, 90, and 180 after the booster dose (#). IgG antibody titers to the SARS-CoV-2 spike receptor binding domain (IgG-S) were determined using a chemiluminescent microparticle immunoassay (CMIA) (ARCHITECT i1000SR, SARS-CoV-2 IgG II Quant assay, Abbott Laboratories, Abbott Park, IL, USA). Results were expressed in arbitrary units per mL (AU/mL) and converted to Binding Antibody Units per mL (BAU/mL), as standardized by the World Health Organization (WHO). Results: The first phase included 73 healthcare workers with COVID-19. 4 subjects were separately evaluated due to reinfection. COVID-19 evolved mildly to moderately in all 69 subjects. Mean age was 40 (±10) years, 74% female, 78.3% with previous comorbidities, and 21.7% used at least one medication for chronic disease. Common initial symptoms were muscle pain (76.9%), headache (75.5%), anosmia (59.6%), ageusia (63.8%), rhinorrhea (58.4%), fever (52.2%), and cough (52.2%). After 30 days, persistent symptoms included anosmia (18.9%), asthenia (18.9%), adynamia (14.5%), muscle pain and ageusia (7.3%). IgG serology curve peaked on the 30th day with an average value of 3.25 AU/mL, and IgM peaked on the 15th day with an average value of 7.2 AU/mL, both showing progressive decline in subsequent serologies. Non-seroconversion for IgG or IgM was observed in 26% of participants (n=18). Among IgG seropositive individuals, 28.3% (n=15) maintained IgG reactivity for 180 days. The symptom Diarrhea had a 4-fold higher likelihood of IgM seropositivity, while sore throat and shortness of breath increased the likelihood by 6-fold for reactive IgG after 180 days. The 4 patients with recurrent infection belonged to the non-seropositive group. The mean period between infection and reinfection was 112 (± 65) days. The recurrence rate was 5.47%. Symptomatic period duration ranged from 3 to 22 days for the first infection and 5 to 19 days for the second infection. RT-PCR cycle threshold (Ct) data showed lower Ct values during COVID-19 recurrence in the four cases. All four participants became IgM and IgG seropositive during reinfection, with symptoms considered more severe in one participant requiring medical care and non-invasive respiratory support for 24 hours. In the second phase of this study, serological results from the first blood collection showed 42.8% IgG-S reactivity in the VAC group and 29.7% in the AZV group. In both groups, IgG-S levels increased [Geometric Mean Titers (95% CI)], with CoronaVac or ChAdOx1 [D28 = 12(10–15) vs. 71(57–88) and D28* = 115(96–137) vs. 488(407–586)]. Seroconversion rate at D28* was 100% in both groups. At D180, 88% of VAC participants remained reactive, and 100% in the AZV group. Sharp decline in titers averaged 3.73 times and 2.61 times in seronegative groups, and averaged 2.16 times and 1.66 times in seropositive, VAC and AZV groups, respectively. Six months after primary vaccination (D180), the geometric mean titer significantly decreased in VAC [30(24–39)] and AZV [186(155–226)]. Confirming this, PRNT neutralizing antibody test demonstrated higher geometric mean titers in the AZV group compared to VAC, regardless of serological status [237 (181–311) vs. 43 (34–55) seronegative and 748 (534–1,048) vs. 145 (111–189) seropositive], with high correlation (r = 0.93, p < 0.001). In the VAC seronegative group, soluble plasma mediators were increased at D28* compared to D28 and compared to AZV. The AZV seropositive group showed high levels of soluble plasma mediators at D28 and D28* compared to the VAC group. Levels of soluble immune mediators were reduced at D28 compared to D0 in both seronegative groups. At D28*, the CCL3, CCL2, IL-1B, IL-6, IFN-y, IL-5, VEGF, and PDGF set was increased, while the IL-12, IL-15, IL-17, IL-10, IL-13, FGF-basic, G-CSF, GM-CSF, and IL-2 set remained unchanged. Soluble mediators that differed between vaccine schemes were CCL11, CXCL8, CCL4, CCL5, CXCL10, TNF-a, IL-1Ra, IL-4, and IL-9, with the VAC seronegative group showing higher levels than AZV at D28*. On the booster day (D0#), all AZV group participants remained seropositive, while in the VAC group, seropositivity rate was 16% lower. Heterologous groups were formed: VAC/BNT, VAC/AZV, AZV/BNT, and 1 homologous group AZV/AZV. At D28#, heterologous groups showed stronger titers with VAC/AZV and VAC/BNT (45 times and 118 times, respectively) compared to AZV/BNT (29 times), while the homologous AZV/AZV scheme showed a slight increase (3.9 times). Heterologous schemes induced higher neutralizing antibody titers against the Wuhan ancestral lineage, Delta, and Omicron variants. Seropositivity rate for the Omicron variant was significantly lower in the homologous scheme (VAC/AZV = 93%; VAC/BNT = 100%; AZV/BNT = 100% vs. AZV/AZV = 64%). Following booster dose, antibody response in VAC or AZV groups showed exponential growth. VAC/BNT scheme induced titers as high as AZV/BNT and maintained them up to 180 days after the booster dose. Conclusion: IgM and IgG peak approximately 15/30 days after symptom onset. Natural infection with SARS CoV-2 does not provide similar protection in all individuals, and absence of specific antibodies may increase reinfection risk. Exacerbated symptoms in second infection may be associated with higher viral load. 28 days after the second dose, CoronaVac and AstraZeneca vaccines induced seroconversion in 100% of patients. CoronaVac induced lower titers and shorter duration of immunity compared to AstraZeneca. Higher activation of inflammatory response biomarkers was observed in the VAC group compared to the AZV group, possibly due to the multiplicity of antigens present in the inactivated virus vaccine. Heterologous booster with AstraZeneca or BNT 162b2 provided protection against the ancestral strain and Delta and Omicron variants, regardless of primary immunization scheme. Overall, kinetic analysis of IgGS reactivity reinforces the efficacy of the heterologous scheme in inducing antibody response to SARS-CoV-2. Additionally, the heterologous scheme produced higher geometric mean titers than the homologous regimen. Lower titers and faster decline of specific antibody levels suggest the need for a booster dose.
- ItemFatores associados à sobrevida global de crianças e adolescentes com câncer no Espírito Santo e sua relação com o índice brasileiro de privação(Universidade Federal do Espírito Santo, 2024-06-19) Rodrigues, Jonathan Grassi; Lopes-Júnior, Luís Carlos; https://orcid.org/0000-0002-2424-6510; Lima, Regina Aparecida Garcia de; Dell'Antonio, Larissa Soares; Sarti, Thiago Dias; Almeida, Aline Neves PessoaBackground: Childhood cancer (between 0 and 19 years of age) accounts for 1 to 4% of all malignant tumors in most populations. Over the past four decades, there have been substantial advances in the treatment of childhood cancer and, in line with these advances, survival analysis techniques have assumed a pivotal role in recent years, mainly after the development and improvement of statistical methods technology, with several applications, especially into Public Health. Objective: To investigate the occurrence of pediatric malignant neoplasms in the state of Espírito Santo; to assess the quality and completeness of data, overall survival and to identify associated factors as well as their relationship with the Brazilian Deprivation Index (DPI). Methods: This is an analytical observational study. The cohort was comprised by new cases diagnosed with primary malignant neoplasm of any morphology in children and adolescents between 0 and 19 y.o., in a 10-year period (between 2007 and 2015) in Espírito Santo (ES), Brazil. Secondary data were obtained from the Hospital-based Cancer Registry (HCR) of the Nossa Senhora da Glória State Children's Hospital (HEINSG) as well as from the Mortality Information System - SIM/ES. For data analysis the Kaplan-Meier method was used and the Cox proportional hazards model was performed in multivariate analysis. In the final model, variables that presented significance levels below 5% have remained. Statistical analyses were held using the free software RStudio (version 2022.07.2) and R (version 4.1.0). Results: It was found that the variables with the highest incompleteness included race/color (17.24%), level of education (51.40%), TNM (56.88%), disease status at the end of the first treatment (12.09%), family history of cancer (79.12%), history of alcohol consumption (39.25%), history of tobacco consumption (38.32%) and type of admission clinic (10.28%). A significant trend of decreasing completeness was observed for race/color, TNM and history of tobacco consumption. The mean age was 7.85 years; the majority were mixed-race (53.32%), in the age range of 1-4 years (29.47%) (p=0.008). Leukemias, followed by central nervous system tumors and lymphomas were the most frequent in males (p=0.006) with a significant difference between age groups, with a higher occurrence between 5 and 9 years (p=0.007). This historical series have shown a decreasing trend in the number of new cases (p<0.001). At the end of treatment, complete remission of the disease was observed in 30.57% of cases. Five-year overall survival was 76% (95% CI: 0.736−0.790) at 1 year, 69% (95% CI: 0.665−0.724) at 2 years, and 62% (95% CI: 0.587−0.650) at 5 years. Girls had a 28% lower risk of dying from cancer within 5 years compared to boys (HR=0.72; 95% CI: 0.579−0.901; p=0.004). The highest survival rates were found for individuals with Hodgkin lymphoma, neuroblastoma, and ganglioneuroblastoma. The lowest 5-year survival rates were observed for patients with acute myeloid leukemia. The estimated 5-year overall survival was 61% (95% CI: 0.585−0.651; p=0.1) for children from the least disadvantaged city in the state according to the DPI. We observed a significantly increased risk of death among children and adolescents in the most disadvantaged cities (Q5) (HR=2.12; 95% CI: 1.06−4.23; p=0.034). Conclusion: In summary, although most variables maintained excellent completeness, the increasing trend of incompleteness in race/color and the decreasing trend in TNM highlight the importance of reliable and complete HCR for personalized cancer care, public policy planning, and conducting cancer control research. Our findings indicated a gradual decline in the incidence of cancer in children and adolescents over the time series evaluated, with a higher prevalence of leukemia in male children and a higher occurrence of malignant bone tumors and carcinomas in adolescents aged 10 to 14. In this historical series, we found an overall five-year survival rate of 62% for patients diagnosed between 2007 and 2015, which was associated with sex and diagnostic groups and is closely related to the socioeconomic context. Furthermore, the socioeconomic level estimated through the DPI was associated with worse survival among children and adolescents with cancer. Socioeconomically vulnerable children and adolescents may constitute a group of high-risk patients, who should be identified at the time of diagnosis for personalized and timely management. Some approaches can result in better survival rates, such as investing in public education, improved training of health professionals, investing in the detection of childhood cancer, strengthening and access to oncology services, clinical research and international cooperation.
- ItemDar o rumo nem sempre a prumo : atuação das secretárias e secretários municipais de saúde nas rotas do Brasil(Universidade Federal do Espírito Santo, 2024-06-07) Riquieri, Manuella Ribeiro Lira; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Sarti, Thiago Dias ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Carvalho, André Luís Bonifácio de ; https://orcid.org/0000-0003-0328-6588; http://lattes.cnpq.br/; Ouverney, Assis Luiz Mafort ; https://orcid.org/0000-0002-8581-3777; http://lattes.cnpq.br/; Andrade, Maria Angélica Carvalho ; https://orcid.org/; http://lattes.cnpq.br/; Almeida, Ana Paula Santana Coelho; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Não disponível
- ItemAnálise de riscos competitivos da sobrevida-específica de pacientes diagnosticados com câncer de próstata no Espírito Santo : estudo de coorte retrospectivo(Universidade Federal do Espírito Santo, 2024-03-27) Grippa, Wesley Rocha; Salaroli, Luciane Bresciani; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Lopes-Júnior, Luís Carlos ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Dell'Antonio, Larissa Soares ; https://orcid.org/; http://lattes.cnpq.br/; Araújo, Jeferson Santos ; https://orcid.org/; http://lattes.cnpq.br/; Leite, Franciéle Marabotti Costa ; https://orcid.org/; http://lattes.cnpq.br/; Sarti, Thiago Dias ; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Background: Prostate cancer is one of the most common cancers in the world, being one of the main causes of premature death in men. Advances in survival analysis techniques have played an important role in recent years, especially after the development and improvement of statistical methods, with direct applications in Public Health and Oncology. Objective: To analyze the specific survival probability of patients with prostate cancer and the factors associated with the risk of death from cancer or other causes in patients diagnosed with prostate cancer who started treatment at the Oncological Care Network (OCN) in the state of Espírito Santo (ES), Brazil. Methods: This is a retrospective observational cohort study. Retrospective observational cohort study. Secondary data were collected via the Tumor Registration Form (TRF) from the Hospital-based Cancer Records (HCR) of patients who received care in a hospital in the OCN of ES, and from the Mortality Information System (SIM/ES), in the period between 2000 and 2020. All occurrences of prostate cancer proven by anatomopathological examinations (ICD-10) were included and analyzed. For data analysis, a descriptive analysis of the epidemiological profile of patients diagnosed with prostate cancer was carried out, in addition to an analysis of completeness of the epidemiological variables from HCR of the ES, which data incompleteness was classified as excellent (< 5%), good (between 5% and 10%), regular (between 10% and 20%), bad (between 20% and 50%) and very bad (> 50%), according to the percentage of missing information. For survival analysis, the deterministic linkage method was done, using the TRF records from the Integrator of the Brazilian Cancer Hospital Registry (SIS-RHC) with the records from the Mortality Information System (SIM/ES). To estimate overall specific survival, the Kaplan-Meier method and multivariate analyzes were used, based on the Cox proportional hazards model and the Fine and Gray competing risks model, in order to investigate the probability of specific death from prostate cancer. In the analysis of the adjusted models, a 5% significance level was adopted to evaluate the significant effect of each of the variables studied. All statistical analyzes were performed using the free software R and RStudio. Approved was obtained by the CCS-UFES Research Ethics Committee (Opinion Number: 5,533,541). Results: The initial dataset included 13,519 cases of prostate cancer in the HCR, recorded with diagnoses between 2000 and 2020. Conclusions: Most variables in the HCR exhibited excellent completeness, but important variables had high percentages of incompleteness, such as TNM and clinical staging, as well as alcoholism and smoking. There was a growing trend in prostate cancer incidence over the years in the ES, with a predilection for older, married men with low educational levels. Furthermore, survival analysis revealed an overall specific survival of 87.7%, and age, educational level, distant metastasis, surgery, radiotherapy, and hormone therapy were associated with the risk of specific mortality among prostate cancer patients. Taken together, these data can assist in decision-making by managers and stakeholders, to support screening and treatment programs, in addition to guiding the improvement of public policies in the area of Oncology, with a view to planning effective actions for cancer surveillance in the various assistance levels of the Health Care Network, in order to improve men’s health care.
- ItemSaúde, rizoma e feminismos : cartografia de coletivos de mulheres na universidade federal(Universidade Federal do Espírito Santo, 2024-04-28) Barbosa, Jeanine Pacheco Moreira; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador3; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador4; ID do co-orientador4; Lattes do co-orientador4; Andrade, Maria Angélica Carvalho ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Cambraia, Rosana Passos ; https://orcid.org/; http://lattes.cnpq.br/; Dias, Luciana de Oliveira ; https://orcid.org/; http://lattes.cnpq.br/; Souza, Susane Petinelli ; https://orcid.org/; http://lattes.cnpq.br/; Siqueira, Luziane de Assis Ruela ; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Despite the significant presence of women in universities, it is still possible to identify traces of oppression and inequality, a legacy of modern colonialism. Understanding this phenomenon as a public health problem indicates the relevance of this research, which followed the movements of women's collectives in Brazilian federal universities, problematizing the power of these collectives based on the narratives of these women. The research used a two-stage qualitative approach, identifying the collectives present in the universities and characterizing them; and interviewing twelve women who are/were part of them. The instruments used were narrative interviews conducted via Google Meet and the construction of a field diary, which, once transcribed, gave rise to the unique stories that make up the corpus of the research. Based on the cartographic ethos, the analysis was based on the philosophy of difference and gender studies, emphasizing the approaches of intersectionality and decoloniality. The results showed the need to develop a conceptual tool, Rhizomatic Feminism, to accompany the overflowing of boundaries between feminist movements expressed by women's collectives, giving visibility to new free subjectivities, in other words, to becoming-woman. They also highlighted the leading role of women's collectives at the university in the face of the many challenges they face, emphasizing the importance of a rhizomatic approach to women's health. The work bets on the power of these collectives to produce ruptures with the racist, hetropatriarchal and capitalist heritage that perpetuates structures of exploitation of women at university. From an ethical-aesthetic-political paradigm, it argues that health is only collective when it is assumed to be an invention and a work of art, opening up to feminist listening