Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered. / Science, Faculty of / Statistics, Department of / Graduate

The present study examined stimulus control in autistic children. A matching-to-sample procedure was employed in all experiments. In the first part of Experiment I, autistic and control subjects were trained to discriminate between a vertical line and a line tilted at an angle of 33 degrees from vertical. Following training, subjects were given a generalization test to determine the degree of dimensional control by line tilt. In the second part of Experiment I, subjects were trained to discriminate between a vertical line and lines tilted progressively closer to vertical. Experiment II was also a test for the degree of dimensional control by the line tilt. In Experiment I, the autistic subjects took a greater number of trials than the controls to reach the criterion of 24 consecutive correct trials. However, the difference in the number of trials taken by the two groups was not large. There was also little difference between the autistic and control subjects in part two of Experiment I. All of the autistic subjects successfully discriminated between a vertical line and a 2 degree line tilt to a criterion of eight consecutive correct trials. In the generalization tests in Experiments I and II, there was little difference between the autistic and control subjects in dimensional stimulus control. In Experiment III, the autistic subjects were examined for acquisition of a multidimensional discrimination. Both autistic and control subjects were trained to match a standard stimulus with one of four comparison stimuli that were varied in shape and in the presence and absence of a star within the shape. The autistic subjects took a greater number of trials than the controls to reach the criterion of eight consecutive correct trials. However, the difference between the autistic and control subjects in the number of trials taken to reach criterion was not large. In summary, the study found little difference between autistic and control subjects in the acquisition of simple or multidimensional discrimination. As well, there was little difference between the autistics and the controls in dimensional stimulus control. The results of the study suggest that the autistic child's problem is not one of stimulus selectivity. / Arts, Faculty of / Psychology, Department of / Graduate

Three experiments examined auditory-visual integration of temporal relations by infants. In the first experiment infants of 3, 6 and 10 months of age were placed midway between two flashing visual displays. Tones, temporally synchronized to one of the visual displays, emanated from concealed speakers placed midway between the visual displays directly in front of the infants. The visual displays, and corresponding tones differed in temporal rate by a factor of four. No evidence was found for differential looking to the sound-specified visual pattern in any of the three age levels tested. The 3-month-olds showed a strong right-looking bias regardless of visual pattern or temporal rate of the tone, while the 10-month-olds preferred to look at the fast visual pattern regardless of position or tone rate. Both of these biases impaired the effectiveness of the simultaneous presentation paradigm to detect differential looking related to auditory-visual synchrony. Experiments II and III used an habituation methodology which eliminated any effects of position and rate bias. Only 4-month-old infants were tested. In each experiment, one group of infants was first presented with temporally synchronous auditory and visual signals during habituation trials and then nonsynchronous signals during recovery trials. Two other groups of infants, one in each experiment, received the opposite sequence. In Experiment II the auditory and visual signals were spatially congruous, but they were separated by 90° in Experiment III. Since the pulse rate of the visual stimuli was changed for the nonsynchronous trials, a control group was tested which received only the light during habituation and recovery trials. Both groups initially presented with synchronous signals showed habituation and recovery. Neither group presented with nonsynchronous stimuli during habituation trials demonstrated recovery and only the group with the spatially separated sources habituated. The results suggest that 4-month-old infants are able to coordinate the temporal relations between auditory and visual signals. / Arts, Faculty of / Psychology, Department of / Graduate

The child's understanding of open systems, as exemplified by an ecosystem and a socio-economic system, was assessed in a Piagetian type interview with 8 males and 8 females in each of grades 3, 5, 7, 9, 11 and first year post-secondary (n=96). Since Piagetian theory has been based on tasks using mainly inanimate, physical content, the generalizability of Piagetian stages and sequences to the two open systems content domains was tested. Tasks assessing the four concrete operations examined were repeated in each of the physical, the bio-ecological and the societal domains. Typical stage and sequence patterns were observed in all three domains. Post-concrete operations were represented by three formal operations in the physical domain and four systemic operations in each of the open systems domains. Logical and philosophical arguments for the qualitative difference between formal and systemic logic were presented. Three blind judges reached spontaneous agreement on 84.6% of the scores assigned for the systemic task protocols. A scalogram analysis and comparisons of the differences between pass/fail proportions indicated that the systemic operations of systems synthesis and transitive recycling were more difficult than the formal operational tasks by a Guttman step of the same size as that between the formal and concrete stages. A cluster analysis showed those most difficult systemic tasks to be grouped as if they were a part of a separate structure d'ensemble. Further analyses indicated that the greater difficulty of these two systemic operations could not be attributed to the greater un-familiarity of the task contents. Systemic task success rates were zero for respondents below grade 9 (14 years) and consistently fell far below formal task success rates for same aged peers'. The most difficult systemic operations satisfied the criteria for membership in a fifth stage as well as any other Piagetian operations do for their imputed stage membership. Nevertheless, an alternative interpretation construing systemic operations as post-concrete developments parallel and complementary to formal operations could not be ruled out. The implications of the findings for the areas of cognitive development, social development and social psychology were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

This study describes ways that parents attempt to help their preschool children with asthma meet their basic human needs. Information about such parental guidance is lacking in the literature and yet parents need assistance from health professionals about how to accomplish the task of rearing their chronically ill children. Ten couples with asthmatic preschool children from the Lower Mainland region of British Columbia were identified and interviewed in their homes. The couples were asked about the actions they took to help their preschool children with asthma meet their basic human needs and the ways they perceived asthma and its treatment affecting their efforts to help these children. An Interview Guide was developed based on the University of British Columbia's Model for Nursing. It is a model with a basic human needs and systems theory framework. All interviews with the couples were audiotaped and later analyzed for content of their communications. The analysis revealed 17 specific helpful actions common to all of the couples, and additional emotions, decisions, and physical efforts to normalize their asthmatic children's and family's daily lives. It was concluded that the couples in this study assumed the responsibilities of helping their preschool children, sick or well, meet their needs to grow and develop according to parental tasks. The intensity of the helping behaviours tended to increase during the children's asthmatic attacks. There are implications for health professionals for developing programs to assist parents to acquire the knowledge, skills and attitudes: to facilitate the growth and development of their children with a chronic disease such as asthma. / Applied Science, Faculty of / Nursing, School of / Graduate

A community health unit in a British Columbia suburb established a screening clinic for 3-year-olds modelled on similar programs already operating in nearby localities. The purpose of the study was to describe this new screening clinic: to report on the procedures employed, the personnel involved, the characteristics of the clientele, and the types, incidence, and disposition of problems detected amongst the children brought to the clinic. The study population consisted of the 47 children and their parents who were the clients of the clinic during its first three months. The research instruments were original questionnaires and forms devised to obtain sociological and health history information. The forms were completed during a home visit and by a telephone interview with each family. The data are arranged in frequency tables and percentages calculated where appropriate. A few variables are cross-tabulated to add descriptive depth to the study. The families in the study were from the middle and upper-middle class segment of society. They had frequently used other health resources in the community. The mothers' main concerns were about speech and language development and behavior problems of their children. Twenty-four children were referred by the clinic staff for 39 problems requiring retesting, further investigation, or intervention. Twelve of these referrals were for problems of vision, 10 for behavior, 6 for speech and language, 3 each for hearing, nutrition, and dental health, and 2 for physical developmental delay. The children cooperated enthusiastically in the test procedures and their parents found the clinic to be reassuring and a valuable learning experience. The parents were willing to comply with the referrals, but some delays in the follow-up procedures were noted, due to the newness of the clinic. The screening clinic for 3-year-olds appears to be filling a previously unmet need in the community. Community health workers involved in planning and promoting new services should find the detailed descriptions of the procedures and of the clientele of the clinic useful to them. The extensive bibliography provides a background of published material on the rationale and result of a variety of methods of screening. Comparison with similar clinics in other areas will be impossible until terminology used, test procedures employed, and methods of reporting results are standardized. Meanwhile, the clinic staff should continue to maintain statistical evidence of the results obtained and to evaluate the procedures used in its program. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Carmen Silvia Bertuzzo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T12:24:01Z (GMT). No. of bitstreams: 1 Gabetta_CarmenSilvia_M.pdf: 642277 bytes, checksum: 9c3fa4d0b21882840d4d106d571f5952 (MD5) Previous issue date: 2006 / Resumo: As hemoglobinopatias constituem o distúrbio genético de maior prevalência na raça humana, sendo a Doença Falciforme a mais freqüente dentre as hemoglobinopatias chegando a atingir 1 a cada 500 indivíduos da raça negra. No Brasil estima-se a presença de 6.000.000 de portadores para esta doença. Justificativa: Com a triagem neonatal podemos avaliar a freqüência real dessas alterações hemoglobínicas. Objetivos: Verificar a freqüência gênica das hemoglobinopatias na região metropolitana de Campinas diagnosticada pela triagem neonatal. Casuística: Os resultados de 12 anos de trabalho foram obtidos da triagem neonatal para hemoglobinopatias, no período entre 28 de agosto de 1992 a 31 de dezembro de 2004. Materiais e Métodos: A triagem para hemoglobinopatias foi realizada inicialmente pela técnica de eletroforese em acetato de celulose em amostras de sangue obtidas do cordão umbilical no momento do nascimento. Posteriormente, esta técnica foi substituída pela técnica de focalização isoelétrica em gel de agarose, e as amostras de sangue passaram a ser coletadas em papel filtro da punção plantar da criança após 48 horas de vida. Resultados: Foram analisadas 433.306 amostras de recém nascidos no período de 28 de agosto de 1992 a 31 de dezembro de 2004, 128 (0,029%) doentes falciformes foram detectados e inseridos no Programa de Atenção ao Doente Falcêmico do Centro Infantil Boldrini. Em 7.494 neonatos foi identificado o traço falciforme, o que corresponde à freqüência de 1,73% na população estudada. Já o portador de traço C foi encontrado a freqüência de 0,53% / Abstract: The hemoglobinopathies are the genetic pathology of higher prevalence in the human race, and among them the most frequent is the Sickle Cell Disease, reaching frequency of at least 1 in 500 individuals of the black race. In Brazil there are the presence of 6.000.000 carriers for this disease. With the neonatal screening, we can evaluate the real frequency of hemoglobin alterations. We obtain the results of 12 years of work, from the neonatal screening for hemoglobinopathies, in the period between August 28, 1992 and December 31, 2004. Initially, the screening for hemoglobinopathies was carried by the electrophoresis in cellulose acetate in blood samples from the umbilical cord at birth. More recently, this technique was replaced by isoelectric focusing on agarose gel, in blood samples collected in filter paper by hell pick in children after 48 hours of life. We screened the 433,306 newborn samples in the study period and 128 patients with sickle cell disease were identified and refered to Sickle Cell Disease Attention Program. In 7.494 newborn the sickle trait was identified, corresponding to 1,73% incidence. In addition, the C trait carrier was found, corresponding to 0,53% incidences / Mestrado / Mestre em Farmacologia

Orientador: Jose Luiz Pereira, Valeria Chritina Amstalden Junqueira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-07T20:30:44Z (GMT). No. of bitstreams: 1 Santos_RosanaFranciscoSiqueirados_M.pdf: 1367464 bytes, checksum: 1f8a0a9b0f9ec558cd3f583d15def385 (MD5) Previous issue date: 2006 / Mestrado / Mestre em Ciência de Alimentos

Orientador: Maria Aparecida Marques dos Santos Mezzacappa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T12:18:58Z (GMT). No. of bitstreams: 1 Carvalho_FabianaLima_D.pdf: 2973772 bytes, checksum: e05926e4203b1f74a8eaef36e44c4856 (MD5) Previous issue date: 2015 / Resumo: OBJETIVO: Determinar a incidência e os fatores associados às complicações da assistência ventilatória em recém-nascidos. MÉTODOS: Estudo de coorte prospectivo, para determinar a frequência das complicações da assistência ventilatória (AV), bem como seus fatores de risco, em um em período de 23 meses, em 222 recém-nascidos. Foram estudadas as síndromes de escape de ar (pneumotórax, pneumomediastino, pneumoperitôneo, pneumopericárdio, enfisema pulmonar intersticial, embolia aérea venosa, enfisema subcutâneo); as complicações traumáticas das vias aéreas (estenose de laringe, granuloma, erosão e paralisia de cordas vocais, estridor laríngeo e lesão de columelas); as infecciosas (pneumonias e sepse); a atelectasia pulmonar e a extubação não planejada. Foram estudados como fatores de risco variáveis maternas e neonatais. Os fatores de risco maternos avaliados foram: paridade, pré-natal e o número de consultas, tipo de parto, doença materna, raça da mãe, idade materna, presença de bolsa rota. As variáveis neonatais estudadas foram: gênero do RN, peso de nascimento, idade gestacional, doença que indicou a necessidade da AV, via de intubação, duração total da AV, duração da AV até a constatação da primeira complicação, uso de sedação, maior valor do pico de pressão inspiratória (PIP) utilizado, duração da internação, mau posicionamento da cânula após a intubação e mau posicionamento da cânula durante a intubação. Para a análise estatística foram usados os testes de Qui-quadrado e Mann-Whitney e a análise de regressão de Cox univariada e múltipla. RESULTADOS: Ocorreram 229 complicações associadas à AV em 111 sujeitos (50%), com média de 2,06 eventos por paciente. As complicações mais frequentes foram a extubação não planejada, a atelectasia pulmonar, o estridor e a sepse.As variáveis associadas às complicações da AV foram o peso ao nascer < 1500g (RR=1,610; IC95%=1,099-2,359; p=0,0145), a menor idade gestacional (RR=1,051; IC95%=1,007-1,097; p= 0,0223), duas ou mais ocorrências de mau posicionamento da cânula traqueal na intubação (RR=2,085; IC95%=1,268-3,424, p= 0,0038), mau posicionamento da cânula durante a AV (uma ocorrência) (RR=1,848; IC95%=1,189-2,872,p= 0,0064) e duas ou mais ocorrências de mau posicionamento da cânula durante a AV (RR=2,508; IC95%=1,454-4,327, p= 0,0010). A duração total da AV e a duração da internação foram significativamente maiores no grupo de RN com complicações (p<0,001). Pela regressão múltipla o preditor independente para as complicações da AV foi o mau posicionamento da cânula durante a AV (uma ocorrência) (RR=1,848; IC95%=1,189-2,872; p=0,064), e duas ou mais ocorrências de mau posicionamento da cânula durante a AV (RR=2,508; IC95%=1,454-4,327; p=0,0010). CONCLUSÕES: As complicações da AV acometeram 50% da amostra, sendo o mau posicionamento da cânula durante a AV o único preditor independente para essas complicações, com risco para as complicações de 1,8 vezes (quando ocorreu uma única vez) e 2,5 vezes (quando ocorreram dois ou mais eventos) / Abstract: To determine the incidence and factors associated with complications resulting from mechanical ventilation in newborns.Outcomes: A prospective cohort study to determine the frequency of complications of mechanical ventilation (MV) and their risk factors, in a period of 23 months in 222 newborns. The complications studied were air leak syndrome (pneumothorax, pneumomediastinum, pneumoperitoneum, pneumopericardium, pulmonary interstitial emphysema, venous air embolism, subcutaneous emphysema); those related to airway trauma ( laryngeal stenosis, granuloma, vocal cord paralysis and erosion, laryngeal stridor and columellar injury); infectious complications ( pneumonias and sepsis); pulmonary atelectasis and accidental extubation. They were studied as risk factors maternal and neonatal variables. The maternal risk factors studied were: parity, prenatal care and number of consultations, type of delivery, maternal disease, maternal race, maternal age, presence of rupture of membranes. The neonatal variables studied were: gender, birthweight, gestational age, disease indicating the need for RS, route of intubation, total duration of respiratory support, length of MV until the first complication, use of sedation, higher peak inspiratory pressure (PIP) used, length of hospital stay, endotracheal tube malpostion immediately after intubation and tube malposition during MV. For statistical analysis we used the Chi-square test and Mann-Whitney and the analysis of univariate and multiple Cox regression. Results: There were 229 complications associated with MV in 111 subjects (50%), with a mean of 2.06 events per paciente. The most frequent complications were accidental extubation, pulmonary atelectasis, stridor and sepsis. The variables associated with complications due to MV were birthweight lower than 1500g (RR=1.610; CI95%=1.099-2.359; p=00145), each gestational week earlier than the due date (RR=1.051;CI95%=1.097-1.007; p=0,0223), a two fold or higher rate of endotracheal tube malposition during intubation (RR=2.085; CI95%=1.268-3.424;p=0,0038), one event of malposition during MV (RR=1.848; CI95%=1.189-2.872; p= 0,0064) and two or more events of tube malposition during MV (RR=2.508; CI95%=1.454-4.327; p=0,0010). The total duration of MV and length of hospital stay were significantly higher in the group with complications (p<0,001). On multiple regression analysis, the independent predictors of MV were: one event of tube malposition during MV (RR=1.848; CI95%=1.189-2.872; p=0,064) and a two fold or higher rate of tube malposition during MV (RR=2.508; CI95%=1.454-4.327; p= 0,0010).Conclusion: Complications of MV affected 50% of the sample, and tube malposition was the only independent predictor for complications, with risk of 1,8 times higher (one event of malposition) and 2,5 times higher (two or more events of tube malposition) / Doutorado / Pediatria / Doutora em Ciências

A infecção primária com o herpesvirus humano tipo 6 (HHV-6) pode resultar no exantema súbito, encefalite e recorrentes complicações. Pesquisas demonstram que crianças obtêm os anticorpos contra o HHV-6 antes dos dois anos de idade. Após a infecção primária, o DNA do HHV-6 permanece latente em linfócitos, saliva ou líquor. A rota de transmissão permanece controversa. A liberação do HHV-6 em saliva parece ser a maior rota de transmissão. A transmissão intra-uterina, integrada no cromossomo é outra sugestão de transmissão. Foram colhidas 172 amostras, 86 de secreção cervical (mãe) e 86 de aspirado de nasofaringe (filho). Utilizamos a técnica de nested PCR para detecção do DNA viral do HHV-6. Das amostras positivas, 64% foram detectadas na secreção cervical. A positividade mãe-recém nascido foi de 14%. Das amostras de nasofaringe positivas, 25% não tiveram pareamento de positividade com as secreções cervicais de suas mães. Com estes resultados sugerimos que está existindo uma passagem viral do HHV-6, da mãe para o seu recém-nascido antes do nascimento. / The primary infection with the human herpesvirus type 6 (HHV-6) can result in sudden exanthema, encephalitis and recurrent complications. Research data show that children obtain antibodies against the HHV-6 before two years old. After the primary infection, the HHV-6 DNA remains latent in lymphocytes, saliva, or spinal fluid. The transmission route remains controverse. The HHV-6 elimination of saliva seems to be the major transmission route. Intrauterine transmission, integrated in the chromosomes, is another suggested route of transmission. A total of 172 samples was collected, including 86 cervical secretion samples (mother) and 86 nasopharyngeal aspirates (newborn). We used the nested PCR technique for HHV-6 DNA detection. Among the positive samples, 64% were detected in cervical secretion. The co-positivity between mother and newborn was 14%. Among the positive nasopharyngeal samples, 25% did not present co-positivity with the cervical secretion samples of the respective mothers. Based on our results, we suggest the existence of HHV-6 transference from the mother to the fetus before birth.