Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-03-21T12:37:29Z No. of bitstreams: 1 JaimeRodriguezCoariti_TESE.pdf: 6941864 bytes, checksum: bb24f2eaaa294eeef0cc4c951d8fb000 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-03-23T14:03:15Z (GMT) No. of bitstreams: 1 JaimeRodriguezCoariti_TESE.pdf: 6941864 bytes, checksum: bb24f2eaaa294eeef0cc4c951d8fb000 (MD5) / Made available in DSpace on 2018-03-23T14:03:15Z (GMT). No. of bitstreams: 1 JaimeRodriguezCoariti_TESE.pdf: 6941864 bytes, checksum: bb24f2eaaa294eeef0cc4c951d8fb000 (MD5) Previous issue date: 2017-12-15 / O Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Nos ?ltimos anos diversos estudos mostraram que a Radia??o Ultravioleta Solar (R-UV) provoca impactos em diversas ?reas, entre elas, destacam-se a sa?de humana e a climatologia. As cidades de La Paz ? Bol?via e Natal ? Brasil caracterizam-se por apresentar fluxos de RUV elevados ao longo de todo o ano. Tais cidades possuem caracter?sticas t?picas e pr?prias: Natal ? uma cidade litor?nea, com clima tropical, enquanto La Paz est? localizada a uma altitude acima de 3.600 m, nos Andes. Este trabalho teve como principais objetivos: 1) avaliar o comportamento dos n?veis de R-UV em solo, por meio do ?ndice ultravioleta (IUV); as Doses M?nimas Eritematosas (DEM) e a Dose Erit?mica Acumulada (DEA), nas cidades de La Paz e Natal, no per?odo compreendido entre 1997 a 2012; 2) realizar uma descri??o das principais caracter?sticas clim?ticas destas cidades que possam detectar potenciais fatores que justifiquem patamares t?o elevados de radia??o e 3) avaliar a incid?ncia de fotodermatoses (FTD) observadas em La Paz, buscando sua poss?vel associa??o com fatores clim?ticos. As informa??es de casos de FTD na cidade de La Paz foram coletadas na Policl?nica Central do Hospital ?Caja Nacional de Salud? (CNS). As informa??es de R-UV foram obtidas por espectrofot?metros Brewer, instalados em ambas as localidades. Referente ? ?rea de sa?de, utilizou-se as equa??es de estima??o generalizada para a determina??o do risco relativo de FTD por sexo e faixa et?ria e as taxas de incid?ncia de FTD foram assim avaliadas. Com rela??o ? intensidade da R-UV, realizou-se uma valida??o da informa??o coletada pelos espectrofot?metros por meio de modelagem. Observou-se que, independente da ?poca do ano, no hor?rio pr?ximo ao meio dia, os registros de IUV corresponderam ?s escalas ?Muito Alto e Extremo? nas duas cidades. A DEM para fototipos IV (450 Jm-2) foi atingida j? nas duas primeiras horas do dia. Nos ver?es, a DEA atingiu um m?ximo de 12.950 Jm-2 em La Paz e 7.546 Jm-2 em Natal. Em La Paz, registraram-se 12.153 casos de FTD dos quais 63,7% correspondem ao sexo feminino. A Taxa m?dia de Incid?ncia (TI) foi de 31 casos por 100.000 habitantes, evidenciando um risco 4,7 vezes maior nos idosos comparado ?quele da faixa de 0 a 4 anos. Uma das principais dificuldades no desenvolvimento desta pesquisa foi referente ao acesso ? informa??o de sa?de em Natal em um hospital de refer?ncia (Hospital Universit?rio Onofre Lopes - HUOL-UFRN). Dado que a pesquisa teria que ser submetida a um comit? de ?tica para avalia??o e/ou aprova??o. Por?m, n?o havia garantia de ser aprovada. No intuito de n?o adiar o estudo decidiu-se por restringir a an?lise dos casos cl?nicos apenas ? cidade de La Paz. Referente ? sa?de da popula??o em La Paz destaca-se que a incid?ncia de FTD no sexo feminino ? maior em rela??o ao masculino, com especial destaque na faixa et?ria de 15 a 59 anos. Conclui-se que h? necessidade de ado??o de novas pol?ticas e estrat?gias educativas de prote??o individual, tanto em La Paz quanto em Natal, devido ? exposi??o das popula??es dessas cidades aos altos fluxos de R-UV observados em solo. / In recent years several studies have shown that ultraviolet radiation (R-UV) causes impacts in several areas, among them, human health and climatology. The cities of La Paz - Bolivia and Natal - Brazil, are characterized by high R-UV fluxes throughout the year. These cities have typical and proper characteristics: Natal is a coastal city with a tropical climate, while La Paz is located at an altitude above 3,600 m in the Andes. The main objectives of this work were: 1) to evaluate the behavior of R-UV levels by means of the ultraviolet index (UVI); the Minimum Erythemical Dose (DEM) and the Cumulative Erythema Dose (DEA) determination, in the cities of La Paz and Natal, between 1997 and 2012; 2) to perform a description of the main climatic characteristics of these cities that can detect potential factors that could justify such high levels of radiation and 3) to evaluate the incidence of photodermatoses (FTD) observed in La Paz, seeking its possible association with climatic factors. The information on FTD cases in the city of La Paz was collected at the Central Polyclinic of the Hospital "Caja Nacional de Salud" (CNS). The R-UV information was obtained by Brewer spectrophotometers, installed in both locations. Regarding the health area, the generalized estimation equations were used to determine the relative risk of FTD by sex and age group and so the incidence rates of FTD were evaluated. About the intensity of the RUV, it was carried out a validation of the information collected by the spectrophotometers through modeling. It was observed that, regardless of the time of the year, around midday, IUV records corresponded to the "Very High and Extreme" scales in the two cities. The DEM for phototypes IV (450 Jm-2) was reached already in the first two hours of the day. In summers, the DEA reached a maximum of 12,950 Jm-2 in La Paz and 7,546 Jm-2 in Natal. In La Paz, there were 12,153 cases of FTD, of which 63.7% were female. The average Incidence Rate (TI) was 31 cases per 100,000 inhabitants, showing a 4.7 times higher risk in the elderly compared to the 0 to 4 year age range. One of the main difficulties in the development of this research was the access to health information in Natal in a reference hospital (Hospital Universit?rio Onofre Lopes - HUOL-UFRN) due to the research would have to be submitted to an ethics committee for evaluation and / or approval. However, there was no guarantee of approval. In order to not postpone the study, it was decided to restrict the analysis of the clinical cases only to the city of La Paz. Concerning the health of the population in La Paz it is emphasized that the incidence of FTD in the female sex is greater in relation to the male, with special emphasis on the age group of 15 to 59 years. It is concluded that there is a need to adopt educational policies and strategies for individual protection, both in La Paz and Natal, due to the exposure of the populations of these cities to the high fluxes of R-UV observed in soil.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-21T18:57:51Z No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-28T00:43:51Z (GMT) No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) / Made available in DSpace on 2017-03-28T00:43:51Z (GMT). No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) Previous issue date: 2016-11-22 / O risco de s?ndrome metab?lica pode ser influenciado pelo status inadequado de vitamina D, sendo a exposi??o ? luz solar a principal fonte externa desta vitamina. O objetivo do estudo foi avaliar a influ?ncia dos fatores ambientais, biol?gicos e nutricionais em fun??o das esta??es do ano no status de 25OHD em pacientes com s?ndrome metab?lica. Estudo transversal desenvolvido com 180 indiv?duos adultos e idosos com idade entre 18-80 anos, ambos os sexos, com diagn?stico de s?ndrome metab?lica, segundo os crit?rios do National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Foi considerada como vari?vel dependente a concentra??o de 25OHD; e como vari?veis independentes: idade, sexo, cor da pele, uso de filtro solar, fototipo de pele, escore de exposi??o solar, ?ndice de radia??o ultravioleta (IRUV), localiza??o geogr?fica, esta??es do ano, ?ndice de massa corporal (IMC), rela??o cintura-quadril (RCQ), circunfer?ncia da cintura (CC), paratorm?nio (PTH), c?lcio total s?rico, al?m do c?lcio e vitamina D da dieta. Potenciais preditores para a magnitude do status de 25OHD foram investigados por meio de 16 modelos de regress?o linear univariado, e sete modelos de regress?o m?ltipla. Foram estabelecidas medidas de associa??o e correla??o. O n?vel de signific?ncia adotado foi 5%. O status de 25OHD foi significativamente diferente entre inverno e ver?o (P=0,017). A m?dia de 25OHD indicou insufici?ncia no inverno (25,89ng/mL+7,61) e sufici?ncia no ver?o (31,81ng/mL+10,22), com aumento de 5,59ng/mL no ver?o. No modelo de regress?o linear simples, a concentra??o de 25OHD associou-se significativamente com o ver?o (P=0,003), de modo que a vari?vel esta??o do ano explicou 4,2% da variabilidade do status de 25OHD. O escore de exposi??o solar foi significativamente associado com a concentra??o de 25OHD (P=0,008), explicando 3,4% da variabilidade. No modelo de regress?o m?ltipla, sexo (P=0,027), RCQ (P=0,027), escore de exposi??o solar (P=0,006) e inverno vs. ver?o (P=0,004), explicaram 10,4% da varia??o da concentra??o de 25OHD. Os homens tiveram a concentra??o de 25OHD 3,71ng/mL maior do que as mulheres. O aumento de 1,0 unidade no escore de exposi??o solar, resultou no acr?scimo de aproximadamente 0,16ng/mL na concentra??o de 25OHD. A RCQ teve associa??o inversa com a concentra??o de 25OHD. A esta??o do ano ver?o e a exposi??o solar influenciaram no status de 25OHD dos indiv?duos com s?ndrome metab?lica residentes de uma regi?o do Brasil com elevados ?ndices de radia??o ultravioleta. / The risk of metabolic syndrome can be influenced by inadequate vitamin D levels, and exposure to sunlight is the main external source of vitamin D. This study assessed the influence of environmental, biological and nutritional factors as a function of seasons on the 25OHD status among individuals with metabolic syndrome. A cross-sectional study was developed with 180 adult and elderly individuals of both genders, between 18-80 years of age, with metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The 25OHD concentration was considered dependent variable; the independent variables were age, gender, skin color, use of sunscreen, skin type, sun exposure score, ultraviolet index (UVI), geographic location, season, body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), parathyroid hormone (PTH) level, total serum calcium level, and diet levels of calcium and vitamin D. The potential predictors for the 25OHD levels were investigated using 16 univariate linear regression models and seven multiple regression models. Measures of association and correlation were established and statistical significance was assumed for P < 0.05 (5%). The 25OHD status differed significantly between winter and summer (P = 0.017). The average 25OHD level was insufficient during the winter (25.89 ? 7.61 ng/mL) and sufficient during the summer (31.81 ? 10.22 ng/mL), with an increase of 5.59 ng/mL in the summer. In the simple linear regression model, 25OHD concentration was significantly associated with the summer season (P = 0.003); the season variable explained 4.2% of the variability in 25OHD concentration. The sun exposure score was significantly associated with 25OHD concentration (P = 0.008), explaining 3.4% of the variability. In the multiple regression model, gender (P = 0.27), WHR (P = 0.27), sun exposure score (P = 0.006), and winter vs. summer (P = 0.004) explained 10.4% of the variation in 25OHD concentration. Men had a 25OHD concentration 3.71 ng/mL higher than that of women. An increase of 1.0 unit in the sun exposure score resulted in an increase of approximately 0.16 ng/mL on 25OHD concentration. WHR showed an inverse association with the 25OHD concentration. The summer season and sun exposure influenced the 25OHD status in individuals with metabolic syndrome living in a region of Brazil with a high ultraviolet radiation index.