http://repositorio.ufc.br/handle/riufc/57322 Wed, 12 Aug 2026 22:50:18 GMT 2026-08-12T22:50:18Z http://repositorio.ufc.br/handle/riufc/87049 Título: Reações hansênicas em pós alta de poliquimioterapia: fatores associados e visão dos usuários numa área endêmica do Brasil Autor(es): Alencar, Maria de Jesus Freitas de Abstract: Introduction: Leprosy reactions are classified as type 1 (reversal reaction - RR), type 2 (Erythema Nodosum Leprosum - ENL) and pure neuritis. These lead to a potential risk of developing disabilities and deformities before and during anti-leprosy treatment as well as after release from treatment (RFT). Reactions must be diagnosed early and treated effectively. This research is justified by the scarcity of studies on the occurrence of reactions, monitoring practices of patients and factors associated with reaction episodes after RFT. We know little about existing diagnostic problems, about case management from the perspective of the affected persons with reactions.Methods: Transversal study design, consisting of a simplifíed neurological examination, a dermato-neurological examination and interviews of the defined target group. Five municipalities were included in the cluster areas: Araguaina (Tocantins), Floriano (Piauí), Bacabal and Caxias (Maranhão) and Marabá (Pará). The target population consisted of all resident individuais with leprosy reactions after being released from multidrug therapy, who presented themselves to the health Services in the period 2007 to 2009, regardless of the date of start of treatment. We compared the EHF (eye- hand-foot) scores at diagnosis and during the respondents’ examinations. In another analysis we compared the presence of disability scores (0-1) to the current EHF scores. In the analysis we used the Chi square test and for those associations where the expected value was less than 5 we used Fischer’s exact test. Results: A total of 280 patients were included in the study. Of those, 190 (67.9%) were male. The ages ranged from 8 to 85 years, with a mean of 46.5 years. Six patients were under 15 years and five aged between 15 and 17 years. The average monthly income of the respondents was R$ 1,077.00 (around €400) with values between R$ 60 (€22) and R$ 6,000 (€2200). More than ninety per cent lived in urban areas. As for education, 53 persons (18.9%) were illiterate and 53.6% had an incomplete primary education. In total 45 patients (16.1%) were classified as PB and 232 (83.7%) were classified as MB. The predominant clinicai form (Madrid classification) was dimorphous in 115 (41.1%) cases, followed by 82 lepromatous forms (29.6%). Type 1 reaction was present in 104 patients (37.1%), type 2 reactions in 18.6% of cases and pure neuritis in 13.9%. An associated neuritis was found in 51.9% of patients with type 2 reactions. The frequency of reaction episodes ranged from one to six. One episode only was developed by 215 patients (77.3%). The first episode occurred during anti-leprosy treatment for 121 patients (43.2%), followed in frequency of occurrence by patients after RFT. The EHF score at the time of diagnosis ranged from 0 to 11. At the time of the examination the EHF score range was 0-10, with a predominance of scores between 1 and 4. In 88 out of 198 patients (44.4%) their scores worsened. The risk of worsening was associated with the following socio-demographic variables: being illiterate (PR = 1.64, 95% Cl: 1.21 - 2.21, p = 0.003), being widower (PR = 1.98, 95% Cl: 1.20 - 3.96, p = 0.013). A protective factor was found: having completed secondary school education (PR = 0.4, 95% Cl: 0.23 - 0.71 p = 0.000). Worsening of the EHF scores was associated with borderline leprosy (PR = 3.71, 95% Cl: 1.00 - 13.70, p = 0.009), having had a reaction during MDT (PR = 1, 70; 95% Cl 1.13 to 2.54 P = 0.004), and the presence of a thickened nerve (PR = 1, 78, 95% Cl: 1.30 - 3.08 p = 0.024). In the patients’ health seeking behaviour towards diagnosis, self-perception of symptoms was reported by 240 respondents (85.8%). Dermatological symptoms were the main complaint, in 176 (62.9%) cases. Primary health care Services were the First point of entry for 95 patients (34%). The main reaction symptoms mentioned were of dermatological nature, in 115 (42%) cases Neurological complaints were mentioned by 97 (35.4%) respondents. In total, 206 out of the 280 patients (73, 5%) responded that leprosy brought about changes, problems and troubles in their lives. Among the intrapersonal changes, physical changes played an important role for 129 (62.6%) participants. These changes led to limitations in work performance and income, as well as causing restrictions in activities of daily living. Conclusions: Episodes of reactions worsen physical and psycho-social impairments, reduce social participation, cause problems at work and hamper activities of daily living. It is necessary to focus on the quality of life of individuais after RFT, especially among those with already established physical disabilities. The EHF score is an important tool to detect the progression of physical disability. The tool should be used in the diagnostic procedure, at the time of RFT and during reactions for all patients. Primary health care Services and reference centres in the municipalities involved need to improve monitoring persons after RFT. Improved monitoring is needed not just in those patients with existing disabilities (DG1 and DG2), but also for those without disability present at discharge. Evidence indicates the need for empowerment of people affected by leprosy to deal effectively with the signs and symptoms of reaction after MDT. It is suggested to establish a system for monitoring and surveillance of reactions for a period of minimally six months up to five years after RFT. This surveillance is especially important considering that patients may develop neurological impairment gradually and without presenting symptoms, with the subsequent possibility of physical and psycho-social harm. Tipo: Tese Sun, 01 Jan 2012 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/87049 2012-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86854 Título: Pessoas com deficiência no estado do Ceará: uma análise situacional Autor(es): Almondes, Jardel Gonçalves de Sousa Abstract: INTRODUCTION: In the context of developing the State Policy for Persons with Disabilities in the state of Ceará, the need for the production of qualified information to support health planning becomes evident. OBJECTIVE: To carry out a situational analysis of the population with disabilities in Ceará, considering their sociodemographic profile, access to assistive technologies, and the territorial distribution of health services. METHOD: This is a descriptive, exploratory study with a quantitative approach, developed using secondary data from the State Registry of Persons with Disabilities and public databases from the Ministry of Health. Demographic, socioeconomic, and clinical variables were analyzed, as well as information on the use of assistive devices and access to rehabilitation services. Additionally, a spatial analysis was conducted, integrating the distribution of the population with disabilities and the specialized outpatient care network in the state. RESULTS: The findings revealed inequalities in access to assistive technologies, with greater unmet needs among individuals with visual and hearing disabilities, as well as among women, lower-income individuals, and residents of less advantaged regions. A concentration of specialized services in more urbanized areas was also observed, contrasting with the territorial dispersion of the population with disabilities, indicating a possible underestimation of service provision in certain health regions. CONCLUSION: The population with disabilities in Ceará faces structural inequalities in access to assistive resources and health services, associated with socioeconomic and territorial factors. The findings reinforce the need to reorganize the care network based on principles of equity, regionalization, and the strengthening of public policies aimed at inclusion and the guarantee of rights. Tipo: Tese Thu, 01 Jan 2026 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/86854 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86196 Título: Prevalência de fadiga por compaixão e sua associação com a exposição ocupacional à violência e o risco de adoecimento psíquico entre policiais da perícia forense do Ceará Autor(es): Oliveira, Marizangela Lissandra de Abstract: Occupational exposure to violence represents a risk factor for mental illness among public safety professionals, especially in the context of forensic science. Continuous work with trauma victims can cause mental disorders, notably compassion fatigue (CF), a phenomenon composed of Burnout (BO) and Secondary Traumatic Stress (STS). This condition can be mitigated by Compassion Satisfaction (CS), which arises when the professional feels fulfilled by helping others, and is associated with self-compassion and emotional regulation. This study analyzed the prevalence of CF and its association with exposure to violence and the risk of mental illness among police officers of the Forensic Science Department of Ceará (PEFOCE). This is a cross-sectional, analytical study, a subset of the research project "Experienced Violence, Health Conditions and Illness among Civil and Military Police Officers in the State of Ceará," conducted with police officers from PEFOCE. A structured online questionnaire was used, encompassing the FC (outcome) and sociodemographic variables, work characteristics, lifestyle habits, exposure to violence, common mental disorders (CMD), suicidal ideation, and substance use disorder (SUD). Absolute and relative frequencies were obtained; the prevalence ratio (PR) was calculated to analyze the association between exposures and the outcome; multivariate analysis of factors associated with FC was performed; and Spearman's correlation test was used between the BO, ETS, and SC scales. The analysis was performed taking into account the sampling design, using SPSS 21.0 software, considering a 95% confidence interval. The results indicated a predominance of men (67.1%), Black/mixed-race individuals (56.0%), an average age of 39.4 years, religious beliefs (84.1%), and postgraduate education (66.8%). The majority worked in Fortaleza (53.5%), on shift work (88.1%), with more than six years of service (55.3%). Almost half had another job and intended to change jobs (45.3%). Despite a relatively healthy lifestyle (fruit consumption: 82%; physical activity: 79.5%), 39.8% engaged in excessive screen time during their free time. The work environment was marked by high exposure to violence (93.1%), mainly in assisting victims and their families (75.3%). The prevalence of chronic violence was 58.9%, predominantly influenced by police reports (moderate level in 55.2%). Social security showed a favorable profile (only 3% with a low level), acting as a moderating factor. There was a moderate negative correlation between BO and SC (-0.38), and a moderate positive correlation between BO and ETS (0.36). In the bivariate analysis, factors such as living with up to two people and the absence of chemical dependency were protective; while poor financial health, intention to rotate jobs, harmful use of screens, lack of mental health activities, police victimization, risk of injury/death, victim care, mental distress, and suicide risk were risk factors. In the multivariate analysis, the risk factors for CF were: attending to victims of violence (PR=1.407), harmful use of screens (PR=1.326), activities with high cognitive and psychosocial demands (PR=1.504), mental distress (PR=1.672), and intention to rotate jobs (PR=1.280). It is concluded that compassion fatigue is an important health problem among forensic experts, directly associated with occupational exposure to violence and the risk of other mental disorders. The findings reinforce the urgent need to implement institutional strategies focused on prevention, monitoring, and mental health care for this vulnerable population. Tipo: Tese Thu, 01 Jan 2026 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/86196 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86066 Título: Prevalência e fatores associados ao autorrelato de violência interpessoal física no contexto comunitário entre escolares do 6° ao 9° ano do Ensino Fundamental no Estado do Ceará: análise da PeNSE 2019 Autor(es): Vale, Cecília Regina Sousa do Abstract: Interpersonal violence in the community context represents a significant public health concern during adolescence, with important implications for physical and mental health as well as social development. This study aimed to analyze the prevalence and factors associated with self-reported interpersonal physical aggression in the community context among students enrolled in the 6th to 9th grades of elementary school in the state of Ceará, Brazil, in 2019. This is a cross-sectional, population-based study using data from the 2019 National School Health Survey (PeNSE). The outcome was defined as self-reported physical aggression experienced in the 30 days prior to the survey, occurring in community settings (such as streets or schools) and perpetrated by individuals outside the family context. Independent variables were organized into analytical blocks grounded in a multidimensional theoretical framework, including sociodemographic characteristics, mental health indicators, lifestyle-related behaviors, social bonding variables, and access to health services. All analyses accounted for the complex sampling design of PeNSE. Prevalence estimates and bivariate analyses were initially conducted, followed by multivariable logistic regression to estimate adjusted odds ratios, adopting a 5% significance level. The prevalence of self-reported interpersonal physical aggression in the community context was 14.7%. After multivariable adjustment, the factors that remained independently associated with the outcome were male sex, frequent feelings of loneliness and hopelessness, alcohol consumption, use of other psychoactive substances, and indicators of weak social bonds. The findings highlight the coexistence of individual and contextual vulnerabilities, supporting the proposed theoretical model by demonstrating that mental health conditions, social bonds, and risk behaviors interact in explaining adolescents’ exposure to community-based violence. Interpersonal physical aggression in the community context shows substantial prevalence among schoolchildren in Ceará and is associated with multifactorial determinants, reinforcing the need for intersectoral strategies focused on health promotion, strengthening social bonds, and violence prevention in adolescence. Tipo: Tese Thu, 01 Jan 2026 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/86066 2026-01-01T00:00:00Z