https://repositorio.ufpb.br/jspui/handle/tede/5442 PPGMDS 2026-08-09T16:40:49Z https://repositorio.ufpb.br/jspui/handle/123456789/38541 Título: Escala de avaliação da fadiga: evidências de validade e análise de correlatos Autor(es): Oliveira, Edjaclécio da Silva Orientador: Gouveia, Valdiney Veloso Abstract: Introduction: Fatigue is a multidimensional phenomenon that negatively affects occupational performance, mental health, and quality of life, and is particularly relevant among healthcare professionals. Valid and reliable instruments are essential for screening and for guiding occupational health interventions. Objective: To examine validity evidence for the Fatigue Assessment Scale (EAF) and to investigate the main correlates of fatigue in a national sample of physicians. Method: We conducted a correlational, ex post facto study with a national sample of 7,170 physicians recruited from the Federal Council of Medicine registry. Participants completed the EAF, the 12-item General Health Questionnaire (GHQ-12), and a questionnaire assessing sociodemographic, occupational, and clinical variables. Exploratory and confirmatory factor analyses, measurement invariance testing, Spearman’s correlations, Mann–Whitney U tests, and hierarchical linear regression were performed. Results and Discussion: Results supported the EAF’s unidimensional structure, with excellent internal consistency (α = 0.91; ω = 0.84). Confirmatory factor analysis supported the model, with fit indices varying across regions; multigroup analyses provided evidence of configural, metric, scalar, and residual invariance across Brazil’s five regions, indicating measurement stability. Fatigue was associated with sociodemographic, occupational, clinical, and psychosocial variables. Psychological distress showed the strongest association (ρ = 0.61–0.68) and was the main predictor in the hierarchical regression model, explaining the largest share of variance. Final Considerations: The EAF showed robust psychometric properties for assessing fatigue among physicians in Brazil. Fatigue was multifactorial, with psychosocial determinants, particularly psychological distress, playing a central role, underscoring the need to integrate mental health promotion into workplace management and occupational health surveillance. Editor: Universidade Federal da Paraíba Tipo: Dissertação 2026-02-10T00:00:00Z https://repositorio.ufpb.br/jspui/handle/123456789/38535 Título: Escala de Sintomas Vocais (ESV-TRI) : avaliação das evidências de validade e predição de desfechos vocais por meio de modelos de aprendizado de máquina Autor(es): Alencar, Sauana Alves Leite de Orientador: Almeida, Anna Alice Figueirêdo de Abstract: Introduction: Vocal assessment requires a multidimensional approach that includes the patient’s perception of their own voice. Self-assessment instruments, such as the Vocal Symptoms Scale (VSS), allow measuring the impact of vocal changes on daily life and monitoring therapeutic progress. The Brazilian version validated through Item Response Theory (VSS-IRT) represents a methodological advancement but lacked additional validity evidence based on relationships with other variables and responsiveness. Thus, the present study aimed to (1) investigate validity evidence based on relationships with other variables and (2) analyze the responsiveness of the VSS-IRT. Methods: The research was structured into two complementary studies. The cross-sectional study included 293 dysphonic participants treated at the Speech-Language Pathology teaching clinic of the Federal University of Paraíba (UFPB). Sociodemographic data, selfassessment measures (VSS-IRT, Voice Handicap Index—VHI-IRT, Voice-Related Quality of Life—V-RQOL-IRT, and Vocal Tract Discomfort Scale—VTDS-IRT), auditory-perceptual judgment (APJ), acoustic analysis, and laryngeal examination were collected. Pearson, polychoric, and tetrachoric correlations, logistic regression with recursive feature elimination (RFE), and machine learning models (Random Forest, Logistic Regression, and Gradient Boosting) with stratified cross-validation were performed. The longitudinal study involved 72 participants divided into an intervention group (IG) and a control group (CG). The IG completed six sessions of voice therapy, and both groups were evaluated using the VSS-IRT, APJ, and acoustic measures at preand post–six weeks. Analyses were conducted using Wilcoxon, Mann–Whitney, and mixed ANOVA tests. Results: The VSS-IRT showed strong positive correlations with VHI-IRT (r = 0.636; p < 0.001), V-RQOL-IRT (r = 0.602; p < 0.001), and VTDS-IRT (r = 0.720; p < 0.001), confirming convergent validity. There was a significant association between the VSS-IRT and the presence of vocal deviation according to the APJ (p = 0.011), and a moderate positive correlation with the overall severity grade (p = 0.025). Weak correlations were found between the VSS-IRT score and acoustic measures (F0sd, F0cv, shimmer, HNR, and CPPS). A moderate positive correlation was observed between the VSS-IRT and the presence of laryngeal structural alterations (p = 0.048). These findings reinforce the concurrent criterion validity of the VSS-IRT in relation to vocal deviation (APJ), acoustic measures, and laryngeal alterations. Clinical groups categorized by vocal deviation severity (p < 0.0001), laryngeal diagnoses (p < 0.001), and type of dysphonia (p = 0.005) showed significant differences in VSS-IRT scores, demonstrating the instrument’s discriminant validity. No differences were observed regarding gender, education level, or being a voice professional. Machine learning models were developed to test the prediction of VSS-IRT scores based on multidimensional voice assessment outcomes. The Random Forest model identified ten acoustic variables as the most predictive of the VSS-IRT score—F0 deviation, HNR, CPPSmax, HNRD, Shimmer.APQ3, LNPSD, F0 quartile 1, GNE3000, F0min, and GNE2000—with 82% accuracy and AUC > 0.80, indicating predictive capability. In the longitudinal study, the IG showed significant reductions in VSS-IRT scores and improvements in seven acoustic measures and in the APJ overall severity grade, whereas the CG remained stable. Mixed ANOVA confirmed a significant interaction between group and time, indicating vocal improvement only in the IG. The VSS-IRT showed 90.91% specificity, 80.70% overall accuracy, and an 85.11% negative predictive value relative to APJ, demonstrating excellent diagnostic performance for ruling out dysphonia and detecting clinically relevant changes. Conclusion: The VSS-IRT demonstrates full validity evidence in its Brazilian Portuguese version. The study provides validity evidence based on external variables and responsiveness. The VSS-IRT shows (1) convergent validity with VHI-IRT, V-RQOL-IRT, and VTDS-IRT; (2) concurrent criterion validity with laryngeal structural alterations, APJ vocal deviation, and acoustic measures; (3) discriminant validity regarding APJ deviation severity, laryngeal diagnostic categories, and dysphonia types; (4) predictive criterion validity between the VSS-IRT, acoustic measures, and APJ vocal deviation; and (5) responsiveness, demonstrated by its ability to detect significant changes in vocal symptoms throughout therapy. This characteristic reinforces its clinical utility by enabling sensitive and accurate monitoring of patient progress and identifying improvements or persistence of vocal symptoms during intervention. Editor: Universidade Federal da Paraíba Tipo: Tese 2025-11-03T00:00:00Z https://repositorio.ufpb.br/jspui/handle/123456789/38090 Título: Análise da sobrevivência em mulheres com câncer de colo do útero Autor(es): Nóbrega, Maria Clara Paiva Orientador: Figueiredo, Alexandre Medeiros de Abstract: Cervical cancer is one of the leading causes of death from neoplasms among women in Brazil, especially in regions with lower socioeconomic development. Although it is preventable and treatable when detected early, it still presents high incidence and mortality rates, particularly in the Northeast region and in the state of Paraíba. Prevention involves HPV vaccination, Pap smear screening, and educational actions; however, challenges such as low adherence, lack of information, and limited access to health services compromise the effectiveness of these strategies. Treatment varies according to the stage of the disease and tends to be more complex and less effective in advanced stages. Given this context, this study aims to evaluate survival and prognostic factors associated with mortality among women with cervical cancer in the state of Paraíba. This is an observational, retrospective study with a quantitative approach, focusing on the survival analysis of women diagnosed with cervical cancer using data from patients treated at a reference hospital for oncological care in Paraíba, which is part of the network of institutions with data available on the TriNetX platform. The final sample size depended on the availability and completeness of records in the platform, respecting the ethical and technical principles of the study, resulting in data from 570 patients. The results showed that the median age of participants was 55 years (SD ± 13.58), ranging from 21 to 87 years, including diagnoses that occurred between 2020 and 2025. Of the total number of patients registered in the database, 73 (12.81%) progressed to death due to cervical cancer, while 497 (87.19%) had no record of the analyzed outcome in the database and were therefore considered censored. The overall survival analysis using the Kaplan–Meier method showed a higher concentration of deaths in the first months after diagnosis, followed by stabilization of the survival curve. The Weibull Mixture Model (WMM) with a cure fraction showed good agreement with the empirical curve, indicating adequate modeling of the temporal survival pattern. Stratified analyses demonstrated that clinical staging is the main prognostic determinant, exhibiting a clear prognostic gradient: patients in stages I–II presented the highest survival probabilities, those in stage III showed intermediate behavior, and patients in stage IV experienced a marked decline in survival with stabilization at a substantially lower level. Additionally, radiotherapy was associated with better survival probabilities throughout the follow-up period. Editor: Universidade Federal da Paraíba Tipo: Dissertação 2026-02-26T00:00:00Z https://repositorio.ufpb.br/jspui/handle/123456789/37855 Título: A oferta de cuidados à saúde das pessoas com deficiência em municipios brasileiros de pequeno e medio porte Autor(es): Nogueira, Rafaela Raulino Orientador: Ribeiro, Kátia Suely Queiroz Silva Abstract: This thesis aimed to analyze the provision of health care for persons with disabilities in smalland medium-sized Brazilian municipalities, addressing the following guiding question: how have these municipalities organized care for persons with disabilities to meet their health needs? It is a mixed-method study with a descriptive, exploratory, and cross-sectional design, developed using data from the national project “Evaluation of the Comprehensive Care Network for Persons with Disabilities in the SUS – Redecin Brasil”, which covered 50 municipalities distributed across the five geographic regions of the country. In the quantitative stage, 1,555 Primary Health Care (PHC) professionals participated through stratified sampling, responding to a structured questionnaire on health actions aimed at persons with disabilities. The internal consistency of the questions related to specific actions was assessed using Cronbach’s Alpha (α = 0.809), resulting in the Primary Health Care Action Score for Persons with Disabilities (EAS/PHC-PwD). Statistical analysis included comparative tests and multiple linear regressions, stratified according to the population size of the municipalities. The results revealed that knowledge about the Care Network for Persons with Disabilities (RCPD), perception of the adequacy of care provided to persons with disabilities, team composition, and the number of available services showed statistically significant evidence of being associated with an increase in the EAS/PHC-PwD. Additionally, small and medium-sized municipalities demonstrated better performance in implementing actions compared to large municipalities, highlighting the importance of differentiated approaches according to local specificities. The qualitative stage, conducted with 16 managers (PHC coordinators and municipal health secretaries) from municipalities with lower densities of health services, analyzed perceptions and experiences related to the organization of the RCPD and care for persons with disabilities through interviews and content analysis, systematized using the SWOT Matrix. Identified Strengths included physical accessibility, management strategies, and specific PHC actions; Weaknesses involved the absence of clinical protocols, inadequate infrastructure, and limited professional training; Opportunities were represented by state-level support and strengthened communication in small municipalities; while Threats referred to underfunding, political instability, pandemic impacts, and limited access to specialized services. The findings demonstrate that team qualification, knowledge of the RCPD, and the strengthening of PHC structure and actions are central elements for ensuring comprehensive care for persons with disabilities. The final proposal of the thesis included decision-support models sensitive to territorial particularities, with the potential to guide managers and professionals in developing more effective and equitable practices within the PHC context. Editor: Universidade Federal da Paraíba Tipo: Tese 2025-08-28T00:00:00Z