https://rd.uffs.edu.br/handle/prefix/3718 2025-12-01T21:41:56Z https://rd.uffs.edu.br/handle/prefix/3832 Title: Análise espaço-temporal do HIV no Estado de Santa Catarina: 2008-2017 Author: Tombini, Larissa Hermes Thomas First advisor: Kupek, Emil Abstract: The objective of this work was to analyze the spatio-temporal distribution of HIV in the State of Santa Catarina over the 2008-2017 period. To this end, a retrospective longitudinal study was carried out, using the data at both individual and municipal (ecological) levels. Individual data on HIV and AIDS cases were retrieved from the epidemiological surveillance (SINAN), mortality (SIM), and laboratory monitoring (SISCEL). The data were compiled through a probabilistic algorithm whereby the records were linked by a unique personal identifier to identify all cases. As a result, 67.340 records were identified: 29.734 (44.2%) by SINAN, 5.540 (8.2%) by SIM and 32.066 (47.6%) by SISCEL. After merging the data sources, the size of the HIV-infected population was estimated at 45.707 over the period analyzed. This was the first step towards the first specific objective of the study - to estimate the number of HIV-infected individuals aged 15 to 79 years in the state over this period. Capture-recapture estimates were obtained by log-linear modeling with the main effects and interaction between information systems, adjusted for age, sex, and period. Also, an adjustment for underreporting of AIDS-related deaths used published data on ill-defined causes of AIDS death and mortality. In this study, 44 individuals were aggregated by capture-recapture and 1.512 unreported deaths related to AIDS, estimating a total of 47.263 HIV-infected individuals (95% CI 47.245-47.282) and the corresponding incidence of 93 (95% CI 91-96) per 100.000 in Santa Catarina. The coverage of 62.9%, 78.5%, and 67.8% was estimated for SINAN, SIM, and SISCEL, respectively. The second specific objective of this work was to estimate the HIV incidence rate for sex-byage population groups on the municipal level and analyze their spatial and temporal distribution of HIV incidence in the state over the 2008-2017 period. All 47.505 cases registered/identified in the aforementioned analysis were geographically referenced to the municipalities of residence and smoothed by Poisson regression with random effects. Further statistical analysis identified a high incidence of HIV in Santa Catarina, particularly in men between 25 and 54 years of age, in all periods analyzed. There was a significant increase in young men (15-24 years) in the 2013-2017 period in all state regions. The municipal spatial distribution of the HIV incidence by period was heterogeneous, with greater incidence in the coastal municipalities. The third specific objective of this study was to identify the effects of individual, socioeconomic and demographic factors at the municipal level on the HIV incidence - an ecological study with space-time approach. To this end, multivariate multilevel Poisson regression with both fixed and random effects was used. For spatial analysis, the rates were smoothed by the local empirical Bayesian estimator. Global and local Moran indices identified dependence and local spatial autocorrelation. The study reaffirmed the male gender and the age group between 25-54 years old as risk factors for HIV, as well as the degree of urbanization, the demographic density, the Human Development Index, the unemployment rate, and the macro-region of residence. The analysis of the spatial autocorrelation revealed spatial clusters of high incidence located mainly in the coastal region of the state, over the periods analyzed. Overall, the present study results underline the following points: a) given the size of underreporting identified for the health information systems, their linkage should be routine, b) persistence of high HIV incidence in the state and its increase among young men in the coastal regions calls for reinforcement and reorientation of the HIV prevention efforts. Also, the finding that the greatest variation in the incidence of HIV came from random effects (i.e. other relevant effects not available in the database) at the municipal level, points to the need for future research to identify additional factors that influence the incidence at this level. Publisher: Universidade Federal de Santa Catarina Type: Tese 2020-11-08T00:00:00Z https://rd.uffs.edu.br/handle/prefix/3728 Title: Ensaio clínico randomizado de prática regular de exercício físico e yoga/meditação para redução de estresse: implicações sobre o risco cardiovascular e biomarcadores Author: Haag, Fabiana Brum First advisor: Lucchese, Fernanda Abstract: Stress can have harmful implications on several systems, with the cardiovascular and emotional systems being directly affected. Although still under investigation, some interventions have already been proven for its control and reduction, such as regular physical exercise and meditation / yoga. Objective: To evaluate the effectiveness of a regular exercise intervention, as well as a meditation / yoga intervention to reduce stress in university students in the health area. Methodology: Sampling of 58 university students from health courses randomized into three groups: Physical Exercise Group (GEF), Yoga / Meditation Group (GYM) and Control Group (CG). Mental stress was assessed using the Perceived Stress Scale (PSS) and the Lipp Stress Symptoms Inventory (ISSL) and the serum cortisol. The GEF followed an established exercise protocol for 8 weeks. GYM also held a yoga / meditation program for a period of 8 weeks. Before and after the interventions, blood samples were collected for laboratory exams, vital signs were measured and anthropometric measurements were taken, as well as instruments for measuring mental stress were applied. Results: 58 subjects (50 women) participated in the interventions, with an average age of 23 ± (3.60), all nursing and medical students. ANOVA test with repeated measures for quantitative variables was used and the Wilcoxon test for categorical variables. GYM showed a significant reduction in cortisol (; p <0.001), PSS (p˂0.001) and ISSL in the resistance (p˂0.001) and exhaustion (p˂0.001) phases. There was also a reduction in abdominal circumference (WC) (p50.05) and systolic blood pressure (SBP) with (p˂0.05). The GEF demonstrated a significant reduction in ISSL (resistance and exhaustion) with (p˂0.001) and (p˂0.001), respectively, of PSS (p˂0.05) and without significant changes in serum cortisol levels (p = 0.4 ). There was a significant reduction in BP (p˂0.001), HR with (p˂0.001) and AC with (p˂0.001), total cholesterol (p˂0.05) and triglycerides (p˂0.05). No significant changes were observed in the CG. Conclusion: it is concluded that regular physical31 exercise and yoga / meditation produce beneficial effects on mental stress (PSS, ISSL, and serum cortisol), and the risk factors for CVD. Publisher: Instituto de Cardiologia - Fundação Universitária de Cardiologia Type: Tese 2020-08-28T00:00:00Z