Doutorado em Saúde Coletiva
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- ItemAnálise das infecções sexualmente transmissíveis por HIV e sífilis em migrantes venezuelanas(Universidade Federal do Espírito Santo, 2025-06-30) Mocelin, Helaine Jacinta Salvador; Jezus, Sonia Vivian de; https://orcid.org/0000-0002-0423-8927; http://lattes.cnpq.br/0820815379109713; Maciel, Ethel Leonor Noia; https://orcid.org/0000-0003-4826-3355; http://lattes.cnpq.br/3761398932271892; https://orcid.org/0000-0001-9789-9670; http://lattes.cnpq.br/7637268526665579; Arcêncio, Ricardo Alexandre; https://orcid.org/0000-0003-4792-8714; http://lattes.cnpq.br/9149546439669346; Mascarello, Keila Cristina; https://orcid.org/0000-0003-4567-487X; http://lattes.cnpq.br/8417184843741770; Lopes Júnior, Luís Carlos; https://orcid.org/0000-0002-2424-6510; http://lattes.cnpq.br/5919501773501977; Calicchio, Maria das Graças de Mendonça Silva; http://lattes.cnpq.br/5516652842952996 ; Vincenzi, Brunela Vieira de; http://lattes.cnpq.br/2875969853934385Introduction: Brazil still lacks a consolidated national policy for the migrant, refugee, and stateless populations. In most cases, sexually transmitted infections are not considered a health priority, and sexual and reproductive health rights are not guaranteed. Objectives: To analyze the response to sexually transmitted infections (HIV/AIDS) and syphilis among Venezuelan migrants; to synthesize and critically evaluate the evidence from cross-sectional studies that estimated the prevalence of HIV and syphilis among migrant women worldwide; to understand Venezuelan women's perceptions of access to health services, diagnosis, and treatment of HIV/AIDS and syphilis in Brazil; and to contrast the perceptions of healthcare managers with those of Venezuelan women regarding access to health services, diagnosis, and treatment of HIV/AIDS and syphilis in Brazil. Methods: The thesis follows a structure composed of three articles and one book chapter. To meet the objectives outlined in each manuscript, specific methodological choices were necessary. Thus, the common methodological approach used in the articles is described, while particularities will be detailed later in each article that comprises the research findings. Results: The findings from this thesis reveal a high prevalence of AIDS/STIs and syphilis among migrant women, particularly among pregnant women and sex workers. They also expose the protectionist perspective of healthcare managers regarding the role of the State, which contrasts with the barriers migrant women face in accessing health services. Conclusion: There is an urgent need to develop sexual and reproductive health interventions that are culturally and contextually sensitive to this group of migrant women. Structural barriers to accessing health services—such as lack of legal documentation, language obstacles, fear of deportation, institutional discrimination, and healthcare-related costs—remain significant obstacles to securing essential care for migrant women. Overcoming these challenges requires community outreach strategies grounded in social engagement and the building of trust through culturally competent and gender-sensitive services. Integrating STI prevention into maternal, sexual, and reproductive healthcare services presents a strategic opportunity to optimize early detection and treatment, reduce the risk of vertical transmission, and ensure continuity of care throughout the migration process. It is essential that governments and international organizations acknowledge the impact of restrictive migration laws and exclusionary health policies in exacerbating migrant women’s vulnerability to STIs. Recognizing migrant women as a key population in global STI control efforts transcends public health efficiency and constitutes a matter of human rights and social justice. By aligning health interventions, inclusive policies, and solid scientific evidence, countries can move toward the consolidation of more equitable, responsive, and effective public health systems committed to the principle of leaving no one behind.
- 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.
- 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.