http://repositorio.ufc.br/handle/riufc/57322 2026-04-13T12:40:58Z http://repositorio.ufc.br/handle/riufc/85578 Título: Morbimortalidade por doenças tropicais negligenciadas no Brasil, 2000-2024: padrões espaço-temporais, iniquidades e prioridades para a resposta no SUS Autor(es): Ferreira, Anderson Fuentes Abstract: Introduction: Neglected Tropical Diseases (NTDs) are sensitive markers of structural inequalities and serve as proxies for equitable human and social development: where NTDs persist, long-standing barriers to sanitation, adequate housing, education, social protection, and timely, effective health services also persist. In Brazil, their persistence reflects the territorial reproduction of poverty, segmented access to care and surveillance, and insufficient political prioritization of diseases that disproportionately affect Black, Indigenous, rural, and urbanperipheral populations. Despite their relevance, integrated evidence on the country’s NTDrelated morbidity and mortality burden remains limited. Objective: Analyse the magnitude, spatiotemporal patterns, and factors associated with NTD-related morbidity and mortality in Brazil from 2000 to 2024. Methods: Mixed-methods study combining ecological, crosssectional and longitudinal components to analyze epidemiological and operational indicators of NTD-related morbidity and mortality. We used hospitalization data (AIH/SIH-SUS), mortality data (SIM), and case data (SINAN and/or surveys). Selection included underlying and associated causes in SIM and primary and secondary diagnoses in SIH-SUS. Analyses were integratively organized into eight analytical strands: (1) national magnitude and trends in cases and deaths; (2) intersectional inequalities by sex and race/skin color; (3) burden in children (0– 11 and 0–14 years); (4) spatiotemporal persistence of leprosy clusters; (5) rurality and factors associated with risk of death; (6) mortality and in-hospital mortality due to neglected mycoses; (7) mortality, hospitalisations and in-hospital mortality due to paracoccidioidomycosis; and (8) mortality and in-hospital mortality due to ectoparasitoses. We estimated crude and age- and sex-standardized rates (direct method), trends using segmented regression (Joinpoint, Poisson model), and spatial/spatiotemporal patterns (including cluster detection using SaTScan). Associated factors were examined using multivariable modelling. As this study used secondary, de-identified data, submission to a Research Ethics Committee was not required. Results: NTDs showed a high burden in Brazil, with 583,960 cases in 2016–2020 (annual mean 116,792) and 152,894 cases in 2015; in the same periods, high cause-specific rates were observed for conditions such as snakebite envenoming (2016–2020) and Schistosoma mansoni infection (2015). Regarding mortality, 7,978 NTD deaths were recorded in 2015 and 40,857 deaths in 2016–2020 (annual mean 8,171), with Chagas disease as the primary contributor to mortality rates. Inequalities were striking: incidence rates were higher among men and Indigenous peoples, whereas mortality rates were higher among Black men. Among children (2010–2023), the burden was substantial and sensitive to the inclusion of arboviruses: with arboviruses, there were an estimated 1,644,521 cases (0–11 years) and 2,315,516 (0–14 years), with 1,890 and 2,177 deaths, respectively; without arboviruses, there were 222,048 cases (0– 11 years) and 299,024 (0–14 years), with 1,086 and 1,182 deaths, respectively. Spatiotemporal analyses identified persistent leprosy clusters (2001–2023) concentrated in the North and Northeast regions, with 795,802 new cases (adjusted rate: 17.58/100,000). Over 2000–2024, an estimated 253,774 NTD deaths occurred (0.8% of all deaths in Brazil), of which 42,463 were recorded in municipalities classified as rural, with higher risk of death among men, Indigenous peoples, and individuals with no schooling. In addition, conditions often underrepresented in NTD agendas showed relevant burden: neglected mycoses accounted for 22,320 deaths (adjusted rate 0.45/100,000) and 4,471 in-hospital deaths (0.09/100,000); for paracoccidioidomycosis, 4,904 deaths, 18,239 hospitalizations, and 1,136 in-hospital deaths were recorded; for ectoparasitoses, 2,894 deaths and 736 in-hospital deaths were recorded, with rates per 1,000,000 inhabitants. Conclusion: NTD-related morbidity and mortality in Brazil exhibit persistent spatiotemporal patterns and structural inequalities by territory, race/skin color, sex, age, and rurality, with significant variation in the context of COVID-19. These findings support territorial prioritization, strengthened surveillance–care integration, and intersectoral strategies within the Unified Health System (SUS), including a focus on childhood and increased visibility of endemic mycoses and ectoparasitoses as relevant causes of mortality and in-hospital mortality, compounded by the difficulty of accessing medium and high complexity services. This body of evidence provides epidemiological foundations for equityoriented action and the elimination of NTDs, converging with goals for human development and reduced vulnerabilities. Tipo: Tese 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/85576 Título: Fatores sociodemográficos e comportamentais associados à prevalência de infecção por HIV em adolescentes HSH em duas metrópoles do Brasil Autor(es): Sanzana, Carlos Erasmo Sanhueza Abstract: Introduction: The HIV/aids epidemic among adolescent men who have sex with men (AMSM) continues to increase globally. In Brazil, between 2007 and 2024, 29,187 new HIV infections were reported among adolescents aged 15 to 19 years, of which 65% occurred in males. Despite this, the prevalence of HIV and its associated risk factors remain poorly understood in this population. Objective: To estimate the prevalence of HIV among AMSM aged 15 to 19 years in the cities of Fortaleza and São Paulo and to identify sociodemographic and sociobehavioral factors associated with HIV infection. Methods: This is a mixed-methods study. In the qualitative phase, formative research was conducted to understand adolescents’ perceptions of their vulnerability to HIV/aids and to guide the implementation of the Respondent Driven Sampling (RDS) study between December 2021 and August 2022. In the quantitative phase, 275 AMSM participated. Serological samples were collected for HIV testing. The variables analyzed included: gender identity; sexual orientation; risk behaviors; social network characteristics, socioeconomic and sociodemographic characteristics, care and access to health services, knowledge and use of combined prevention strategies such as Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), alcohol and drug use; stigma and discrimination; and mental health. The Pearson chi-square test was used to evaluate differences in the proportions of categorical variables associated with HIV infection. Weighted Poisson regression according to social network size was performed. A systematic review and meta- analysis were also conducted to compare the prevalence found in RDS studies conducted in Brazil and other countries. Results: Discrepancies were identified across categories of gender identity and sexual orientation among AMSM, as well as the presence of intersectional stigma and discrimination in family, schools, and healthcare services. AMSM living with HIV described strategies to conceal their serostatus, as well as difficulties adhering to routine testing, and abandonment of antiretroviral therapy (ART). In addition, frequent use of geosocial networks and dating apps to seek partners was observed, associated with inconsistent condom use and limited knowledge of combined prevention methods. The overall HIV prevalence was 2.6% (95%CI: 1.1-6.1) across both cities, 6.3% (95%CI: 2.3-15.9) in Fortaleza, and 2.3% (95%CI: 0.8-6.4) in São Paulo. Among risk factors associated with HIV infection, AMSM aged 18 to 19 years had a 13.8-fold higher likelihood of infection compared to those aged 15-17 years. In addition, having had unprotected anal intercourse in the past 12 months (PR=10.6); self-identifying as bisexual (PR=9.4); and presenting moderate or severe depressive symptoms (PR=7.7) were factors strongly associated with higher likelihood of HIV infection. Conclusion: The high HIV prevalence among AMSM in both cities suggests a resurgence of the epidemic in this population and indicates the urgent need for community-based HIV testing programs, as well as for addressing factors that accelerate HIV transmission among AMSM in urban areas, and expanding the response of combined prevention strategies. Tipo: Tese 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/85386 Título: Desenvolvimento de modelo preditivo das repercussões da pandemia da Covid-19 na saúde mental das crianças acompanhadas no CAPSi e suas famílias com base em inteligência artificial Autor(es): Tavares, Diego Rodrigues Abstract: The COVID-19 pandemic significantly impacted children's mental health, increasing psychosocial challenges and affecting the overall well-being of children and their families. This study aims to develop, based on Artificial Intelligence, a descriptive model (unsupervised learning) and a predictive model (supervised learning) of the repercussions of the COVID-19 pandemic on the mental health of children monitored at the Child and Adolescent Psychosocial Care Center (CAPSi) and their families. The study employed an exploratory quantitative method for generating both descriptive and predictive models. Secondary data from a previous study conducted at CAPSi in Fortaleza, Ceará, involving 150 participants aged 6 to 12 years, were utilized. The study was developed in four phases:Phase 1- Selection of variables from the secondary database; Phase 2 - Descriptive statistical analysis of the selected variables;Phase 3- Machine Learning (unsupervised learning);Phase 4 - Machine Learning (supervised learning).In Phase 1, the original database, consisting of 183 variables, was analyzed, and 48 variables were selected for evaluation in subsequent phases. Additionally, the responses of the selected variables were recategorized. In Phase 2, the selected variables were analyzed descriptively, using graphs and tables for visualization. In Phase 3, the K-means algorithm was applied in Python to create three clusters of patients. This clustering allowed for an in-depth analysis of the data and an understanding of each group. The distribution of patients across the three clusters was 29.3% for the first group (group 0), 37.3% for the second group (group 1), and 33.3% for the third group (group 2). In group 0, the quality of sleep variable emerged as a significant factor influencing the outcome, indicating a deterioration in children's mental health during the COVID-19 pandemic. In group 1, evidence suggested that some children intentionally hurt themselves, indicating worsened mental health within this group during the pandemic. In group 2, the quality of sleep variable had less impact on the outcome. When comparing groups 0 and 2, it was noted that the educational level of children in group 2 was primarily between the 4th and 6th grades, which was higher than the educational level of children in group 0. In Phase 4, predictive models based on artificial intelligence were developed using logistic regression and CatBoost. These are robust approaches for data analysis, with different capabilities for interpreting complex and categorical variables. For both models, four primary evaluation metrics were used: accuracy, precision, recall (sensitivity), and AUC (Area Under the Curve). Logistic regression achieved an accuracy of 76.6% in tests, which was considered good for the available data volume. Meanwhile, CatBoost achieved an accuracy of 80% in tests, outperforming logistic regression and demonstrating even greater robustness, particularly given the size of the dataset. This study explores the impacts of the pandemic on children's mental health using quantitative methods and artificial intelligence, providing a solid foundation for future research. Tipo: Tese 2024-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/84703 Título: Caracterização da Tungíase e Escabiose no estado do Ceará através de um novo método de avaliação rápida Autor(es): Silva, Nathiel de Sousa Abstract: Tungiasis and scabies are neglected tropical skin diseases caused by the flea Tunga penetrans and the mite Sarcoptes scabiei, respectively. There are no systematic data on their occurrence in Ceará State, nor in Brazil. In this sense, both diseases require further studies to describe their epidemiology and to develop effective control measures. The objective was to develop and apply a Rapid Assessment Method (RAM) to collect data on the occurrence of both diseases in an agile and low-cost manner, in addition to identifying unicipalities with occurrence of cases in humans and animals, and municipalities with evere cases, as well as associated socio-environmental determinants. Through the RAM in the form of an online questionnaire on the Googleforms platform, a total of 1,329 responses were collected, indicating, for each disease, its occurrence in 181 of the 184 municipalities. In the bivariate analysis, associations were found between climatic and socioeconomic variables and the occurrence of severe cases of tungiasis at present: altitude of the municipality (tungiasis – median = 88.8 m and no tungiasis – median = 201 m; p < 0.001), air humidity (medians = 66.5% and 63%; p = 0.018), minimum temperature (medians = 23.4°C and 22.7°C; p = 0.002), aridity index (medians = 50.6 and 45.1; p = 0.019), expected precipitation (medians = 950 mm and 821 mm; p = 0.002), observed precipitation (medians = 883 mm and 741 mm; p = 0.037), Municipal Human Development Index (MHDI) (medians = 0.616 and 0.611; p=0.048), Municipal Development Index (MDI) (medians = 27.5 and 21.8; p<.001), and MHDI ongevity (means = 0.769 and 0.759; p=0.007). Municipalities with a predominance of uvisols had a lower occurrence of severe cases (RR = 0.46; 95% CI = 0.27–0.79; p = 0.003), while those with predominantly gleysols had a higher occurrence (RR = 2.44; 95% CI = 1.43–4.15; p = 0.010). The occurrence of severe cases of scabies was associated with altitude (medians = 153 m and 246 m; p = 0.003), air humidity (medians = 65.9% and 61%; p = 0.001), minimum temperature (medians = 23.1°C and 22.3°C; p < 0.001), aridity index (medians = 48.2 and 41.9; p = 0.014), expected precipitation (medians = 900 mm and 782 mm; p = 0.006), observed precipitation (medians = 804 mm and 708 mm; p<0.001), MHDI (medians = 0.616 and 0.608; p=0.012), MDI (medians = 24.3 and 21.1; p=0.005), and MHDI Education (means = 0.559 and 0.541; p=0.014). In the multivariate analysis, only MDI maintained a statistically significant association with the occurrence of severe cases of tungiasis in the final model (RR = 1.04; 95% CI = 1.02 – 1.05; p < 0.001) while scabies showed a significant association with minimum temperature (RR = 1.13; 95% CI = 1.04–1.24; p = 0.003) and the aridity index (RR = 1.01; 95% CI = 1.00–1.01; p = 0.004). The RAM proved successful in collecting data from municipalities in Ceará, establishing itself as a useful tool that can be replicated in other areas and for other diseases. The endemicity and occurrence of severe cases of tungiasis and scabies throughout the state, both in humans and animals, highlights these ectoparasitic diseases as a public health problem. It is essential to develop evidence-based control measures focused on the identified high-risk areas. Tipo: Tese 2025-01-01T00:00:00Z