http://repositorio.ufc.br/handle/riufc/397 Sun, 05 Apr 2026 02:45:27 GMT 2026-04-05T02:45:27Z http://repositorio.ufc.br/handle/riufc/84813 Título: Modelagem integrada de redes Multilayer, Análises Espaciais e Aprendizado de Máquina na investigação da disseminação de COVID-19 e de arboviroses (Dengue, Zika e Chikungunya) em Fortaleza Autor(es): Silva, Rôney Reis de Castro e Abstract: The rise of arboviral diseases—and, in particular, COVID-19—calls for approaches that integrate multiple territorial dimensions. This thesis adopts an integrated approach combining multilayer networks, statistical and spatial analyses, and interpretable machine learning to understand diffusion patterns of COVID-19, dengue, zika, and chikungunya in Fortaleza (CE), 2020–2024. Layers comprise epidemiological, socioeconomic/demographic, infrastructure, and political/HDI variables; intralayer relations are defined by neighborhood similarity, and interlayer relations by associations between variables. The COVID-19 dataset was built from weekly epidemiological bulletins, aggregated by month and neighborhood, prioritizing territorial patterns comparable across diseases. Spatially, we use global and local autocorrelation (Moran’s I, LISA) to identify clusters and local patterns; in the network domain, we compute centralities and apply community detection. Predictive models (Random Forest, XGBoost) and SHAP-based explanations assess the variables’ predictive power and contributions. K-means clustering synthesizes territorial profiles by combining structural and epidemiological characteristics. Findings reveal spatial heterogeneity and cross-layer differences, with territorial convergences and divergences that inform vulnerability assessment and prioritization. As a practical contribution, the thesis includes an Appendix: Methodological Enhancement Proposal (“Integrated Framework”) to guide future standardization and support municipal decision-making. Tipo: Tese Wed, 01 Jan 2025 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/84813 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/84194 Título: Impacto da volemia sobre a barreira funcional do epitélio intestinal em pacientes críticos com insuficiência cardíaca aguda Autor(es): Monte Neto, Vicente Lopes Abstract: The regulation of blood volume (volemic homeostasis) depends on the interaction between the cardiovascular, renal, and intestinal systems, whose dynamics are not yet fully understood. In cases of Acute Heart Failure (AHF), these systems may be affected, particularly the intestinal barrier, which undergoes increased permeability. This phenomenon, poorly studied and with limited diagnostic tools, may compromise intestinal epithelial cells. The objective of this study was to investigate how acute changes in blood volume influence the integrity and function of the intestinal barrier in patients with AHF. This was a cross-sectional study, approved by the Research Ethics Committee of the Vale do Acaraú State University (CEP/CONEP), which evaluated intestinal barrier integrity in 80 individuals between March 2022 and January 2024. The sample consisted of 40 patients with AHF (clinical and echocardiographic diagnosis), 14 controls with Coronary Artery Disease (CAD), and 26 healthy controls. Intestinal permeability was measured using the lactulose/mannitol (L:M) urinary excretion ratio by HPLC-PAD. Patients with AHF presented a median L:M ratio of 0.1094 (IQR 25–75%: 0.0411–0.2732), representing an increase of 277.2% compared to healthy volunteers and 466.8% compared to the CAD group, with a statistically significant difference according to the Kruskal-Wallis test (P = 0.001). Kendall’s correlation was used to assess the association between the L:M ratio and Pro-BNP levels, as well as hemodynamic parameters obtained by echocardiography. Multiple regression was performed considering the L:M ratio as the dependent variable and clinical, therapeutic, and in-hospital prognostic characteristics as independent variables. Kendall’s correlation indicated a negative association between the Left Ventricular Outflow Tract (LVOT) Velocity-Time Integral (VTI) and L:M ratio, without statistical significance. Multiple regression did not show significant associations between L:M ratio and clinical, therapeutic, or prognostic variables. Conclusion: Patients with AHF presented increased intestinal permeability, reflected by elevated L:M ratio, suggesting epithelial barrier dysfunction and reduced effective absorptive area. These findings indicate a relevant interaction between cardiovascular dysfunction and intestinal integrity. Tipo: Tese Wed, 01 Jan 2025 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/84194 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/84059 Título: Síndrome Respiratória Aguda Grave por COVID-19 em crianças e adolescentes no Brasil (2020 a 2024) : análise das características clínicas, epidemiológicas e vacinais Autor(es): Viana, Vânia Angélica Feitosa Abstract: The COVID-19 pandemic underscored the critical importance of epidemiological surveillance of Severe Acute Respiratory Syndrome (SARS) in children and adolescents. Although this demographic is less susceptible to severe forms of the disease, it was not exempt from complications, hospitalizations, and fatalities. Brazil recorded one of the highest rates of pediatric mortality from COVID-19 globally. Within this context, this study aims to elucidate the determinants of morbidity and mortality in children and adolescents (0-19 years) between 2020 and 2024 through a comprehensive and detailed analysis of SARS cases due to COVID- 19. This is a retrospective cohort study conducted using publicly available secondary data. Among the 34,369 cases analyzed, disparities in case fatality rates (CFR) were observed. Higher CFRs were identified in the North (13.02%) and Northeast (11.6%) regions, among Indigenous populations (22.54%), rural residents (14.34%), municipalities with a low Human Development Index (HDI) (9.41%), and the 15-19 age group. The circulation of the Gamma and Delta variants (2021) was associated with peaks in incidence and mortality, whereas during the Omicron variant period (2022–2024), mortality decreased despite periods of high incidence. Nosocomial cases had a significantly higher CFR (14.6%) than community- acquired cases (5.3%), particularly among adolescents (15-19 years) and in the North and Northeast regions. Sustained pediatric intensive care unit (ICU) occupancy rates (25–32%) after 2022, coupled with a sharp increase in ICU admissions among children aged 0-4 years (from approximately 52% in 2020–2021 to over 78% in 2024), highlight the critical demand for targeted strategies focused on the pediatric population. Comorbidities such as immunosuppression (OR: 4.44) and Down syndrome (OR: 3.13) were critical predictors of severe outcomes. Vaccination demonstrated a significant protective effect; however, a marked disparity in vaccination coverage was observed, with children under 5 years (95.9% unvaccinated) and the North/Northeast regions showing the lowest rates. This study demonstrated that SARS due to COVID-19 in children and adolescents in Brazil was characterized by significant sociodemographic, regional, clinical, and vaccination disparities. Consequently, the findings emphasize the necessity for integrated public health policies to reduce pediatric morbidity and mortality in future health emergencies. These should include regionalized strategies for vulnerable populations, the strengthening of pediatric ICU capacity, enhanced hospital infection control, and the equitable expansion of vaccination programs. Tipo: Tese Wed, 01 Jan 2025 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/84059 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/83777 Título: Prevalência da síndrome de Burnout em profissionais de saúde de Unidades de Terapia Intensiva de Fortaleza-CE no início e final da pandemia da Covid-19 Autor(es): Medeiros, Ana Irene Carlos de Abstract: Introduction: Health professionals who work in the Intensive Care Unit (ICU) are exposed to a high load of stress due to excessive work demand, patient severity and criticality of the environment, being the area most affected by Burnout Syndrome (BS). BS is characterized by a feeling of exhaustion, leading to depersonalization and reduced professional fulfillment, which can affect both the individual's well-being and the quality of care offered to their patients. Therefore, it is important to enable measures that can minimize the prevalence of BS in ICUs, and identifying the presence of this disorder and its associated factors is the first step towards this reduction. Objective: To evaluate the prevalence of Burnout syndrome in healthcare professionals in Intensive Care Units in Fortaleza/CE in the first year (2020) and last year (2023) of the COVID-19 pandemic. Methods: A cross-sectional study was carried out with health professionals (Doctors, Physiotherapists, Nurses and Nursing Technicians) working in public Adult ICUs in Fortaleza-CE during 2 different periods. Between June and July 2020, burnout was assessed online, after access to the ICUs was granted, face-to-face interviews were carried out between January and August 2023, with burnout, anxiety, depression and resilience being assessed. Results: 265 professionals were included in the 2020 study and 194 professionals in the 2023 study. At the beginning of the pandemic, emotional exhaustion was present in almost half of health professionals (48.6%) and depersonalization in a third of professionals (29 .4%), and Burnout levels remained high at the end of the pandemic, with 54.1% of professionals showing emotional exhaustion and 37.6% depersonalization. At the end of the pandemic, the prevalence of anxiety was 27.3% and depression was 6.2%. In the 2020 study, depersonalization was lower in women (OR 0.33 CI95% 0.18-0.62, p=0.01) and higher among professionals under 33 years old (OR 2.03 CI95% 1.15 -3.56, p=0.01). Increased workload was associated with depersonalization and emotional exhaustion [(OR 2.37 95% CI 2.02-5.50, p=0.04) and (OR 1.89 95% CI 1.04-3 .58; p = 0.030, respectively)]. In the 2023 study, age under 35 years old [OR 3.32(1.12-4.82)] and working in more than 2 hospitals [OR 3.03 (1.40-6.75)] were factors of risk for Burnout, while resilience was a protective factor for depersonalization [OR 0.97 (0.96-0.99)], exhaustion [OR 0.97 (0.96-0.99)], and global burnout. Conclusion: Burnout Syndrome was present in around half of the healthcare professionals in this research, both at the beginning and at the end of the COVID-19 pandemic. BS was more common in younger individuals and those with an increased workload. Emotional exhaustion was related to anxiety and depression, while resilience was a protective factor for depersonalization, emotional exhaustion, and global burnout. Tipo: Tese Mon, 01 Jan 2024 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/83777 2024-01-01T00:00:00Z