Doutorado em Saúde Coletiva

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    Fatores 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 Pessoa
    Background: 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.
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    Dar 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/
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    Análise 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.
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    Saúde, 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
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    Mudanças no estilo de vida em adultos e idosos brasileiros durante a pandemia de Covid-19 (SARS-CoV-2)
    (Universidade Federal do Espírito Santo, 2024-07-10) Urquía, Yazareni José Mercadante; Pereira, Taísa Sabrina Silva ; 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; Molina, Maria del Carmen Bisi ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Martins, Marcia Cristina Teixeira; https://orcid.org/; http://lattes.cnpq.br/; Pereira, Marlus Henrique Queiroz; https://orcid.org/; http://lattes.cnpq.br/; Mill, José Geraldo; https://orcid.org/; http://lattes.cnpq.br/; Lopes Júnior, Luís Carlos; 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/
    The COVID-19 pandemic brought numerous challenges to health systems and governments worldwide. Containment measures were adopted to reduce infection rates, affecting various daily activities such as eating habits, beverage consumption, physical activity, screen time, and mental health. These factors may have long-term effects on vulnerable groups, such as individuals with chronic diseases. This study aims to evaluate the relationship between social distancing and lifestyle factors in adults from southeastern Brazil during the first wave of the COVID-19 pandemic; analyze the association between loneliness and alcohol consumption during the pandemic among ELSA-Brasil participants; and assess the relationship between physical activity, screen time behavior, and non-alcoholic beverage consumption among ELSA-Brasil participants. Specific methodologies and two databases (the Ibero-American Study on lifestyle and eating habits during the pandemic and the Longitudinal Study of Adult Health - ELSA-Brasil [COVID wave]) were used. The results of this thesis are presented in three manuscripts. The first manuscript shows a decrease in breakfast consumption (12.5%) and an increase in snack consumption (24.5% in the morning and 12.5% in the afternoon) and eating between meals (20.4%). Individuals in social distancing increased their consumption of vegetables and legumes, while those not in distancing increased their consumption of fish and fast food. Most participants reported weight gain during the pandemic, and those in confinement reported more hours of sleep and higher anxiety related to COVID-19 statistics. The second manuscript highlights a high perception of loneliness and adherence to social distancing among ELSA-Brasil participants, especially women. Moderate and excessive alcohol consumption patterns predominated among men. In both sexes, total alcohol and beer consumption, both moderate and excessive, were higher among those experiencing loneliness. Among women, loneliness increased the likelihood of excessive total alcohol consumption (OR: 1.68; 95% CI 1.09-2.59) and moderate (OR: 1.35; 95% CI 1.07-1.69) and excessive beer consumption (OR: 1.72; 95% CI 1.04-2.82). Among men, loneliness had a similar effect on excessive total alcohol consumption (OR: 1.49; 95% CI 1.05-2.11) and excessive beer consumption (OR: 1.52; 95% CI 1.03-2.25). The third manuscript shows the influence of sociodemographic and lifestyle variables on the consumption of sugary beverages. Excessive screen time and physical inactivity increased the chances of consuming artificially sweetened beverages among men (OR: 2.44; 95% CI 1.54-3.84) and women (OR: 1.72; 95% CI 1.02- 2.91). This behavior was also associated with higher consumption of industrialized juices among men (OR: 2.02; 95% CI 1.15-3.53) and soft drinks among women (OR: 2.28; 95% CI 1.10-4.72). Men with adequate screen time but physically inactive had similar results (OR: 1.93; 95% CI 1.22-3.06) in the consumption of artificially sweetened beverages. In conclusion, the pandemic affected eating habits, alcohol consumption, and physical activity among Brazilian adults, highlighting the need for policies to promote healthy lifestyles, especially among vulnerable groups