published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / abstract / Medicine / Master / Master of Philosophy

published_or_final_version / Community Medicine / Master / Master of Public Health

The purpose of this research was to describe the relationships among patient characteristics, care processes, and care outcomes for patients in a coronary care unit (CCU). The sample consisted of 179 CCU patients. Data collectors reviewed charts and retrieved the chart information needed to measure the operational variables of APACHE II score (Acute Physiology and Chronic Health Evaluation II), years of age, CCU length of stay, nurse to patient ratio, and mortality. Descriptive statistics were used to analyze the demographic data of the patient characteristics. Correlational statistics were used to analyze the five operational variables in the "CCU Patient Outcomes Model." Pearson correlations revealed significant positive relationships between APACHE II score and age and nurse to patient ratio. Point Biserial correlations revealed significant positive relationships between mortality and APACHE II score and nurse to patient ratio. Patient characteristics were related to care processes. Patient characteristics and care processes were related to patient outcomes.

Induction of vertebrate heart development requires inhibition of canonical/<i>β</i>-catenin dependent Wnt signalling, activation of non-canonical/<i>β</i>-catenin independent Wnt signalling and transcription factor activation. Wnt/<i>β</i>-catenin signalling may also have a later regulatory role in cardiogenesis. The recent discovery of Wnt6 expression next to and within the developing heart during the relevant stages of cardiomyogenesis, combined with knockdown and over-expression data suggests that Wnt6 may have a role in the regulation of this process. Inhibition of canonical signalling leads to increased expression of cardiac associated transcription factors such as members of the Nkx2 and GATA family. These families are expressed in overlapping regions which specify the early heart field prior to the expression of the later cardiomyocyte-specific genes. This study demonstrates the ability of <i>β</i>-catenin to inhibit cardiogenesis during later developmental stages, before the cardiac mesoderm begins to differentiate into myocardium (heart muscle) and that the newly discovered Wnt6 exerts inhibition of cardiogenesis in a <i>β-</i>catenin<i> </i>dependent manner. This inhibition of cardiogenesis by <i>β-</i>catenin can occur in a cell-autonomous manner and is a result of direct inhibition of cardiac transcription factors of the GATA family. Over-expression of these pro-cardiogenic transcription factors GATA4 and GATA6 can restore the cardiomyogenic differentiation programme in embryos where it has previously been inhibited by <i>β</i>-catenin. In conclusion GATA factors are the relevant targets of Wnt/<i>β-</i>catenin signalling in the inhibition of normal cardiac development. The subsequent loss of cardiac gene expression observed is therefore a result of insufficient GATA expression and function.

This report examines differences in risk of myocardial infarction and stroke (cardiovascular events) between the cyclooxygenase-2 (COX-2) inhibitors Rofecoxib, Celecoxib, and Valdecoxib, and the traditional nonsteroidal anti-inflammatory agents (NSAIDs) Naproxen and Ibuprofen, as well as Meloxicam, a preferential COX-2 inhibitor. The population studied was the DoD TRICARE beneficiary population greater than age 40 during the study period. In September of 2004, Rofecoxib was removed from the market due to an increased risk of cardiovascular events. In February of 2005, the Food and Drug Administration (FDA) examined the entire class of COX-2 inhibitors and recommended that Valdecoxib also be withdrawn from the market. According to Department of Defense TRICARE prescription records, COX-2 inhibitor prescription numbers were increasing rapidly and more than $7 million was spent on these agents alone in July of 2004. Logistic regression was used to analyze TRICARE prescription and diagnosis data from calendar years 2002, 2003, and 2004 for cardiovascular event risk comparisons among various NSAIDs. Rofecoxib was found to have a significantly increased risk of cardiovascular events when compared with all other medications in the study, including Valdecoxib. Odds ratios for comparison with Valdecoxib, Celecoxib, Meloxicam, Ibuprofen, and Naproxen were 1.09, 1.14, 1.15, 1.28, and 1.23. Valdecoxib showed a significant increase compared to Ibuprofen, Naproxen, and Celecoxib (odds ratios 1.21, 1.16, and 1.06). Ibuprofen showed a significantly decreased risk relative to all medications except Naproxen. When considering only cardiovascular risk, this study suggests prescribers should consider Ibuprofen or Naproxen as the primary agent of choice, with Meloxicam, and Celecoxib as reasonable second choices. Ultimately, the decision must also weigh the patient's risk of gastrointestinal side effects and cost of therapy.

Gender microaggressions are normative messages that communicate harmful stereotypes or attitudes towards women. Research suggests that being the target of microaggresions may contribute to negative mental and physical health outcomes. The current study examined how gender microaggressions affect emotional and physiological reactivity as well as performance on a working memory task. Results indicated condition (i.e., control vs. sexual objectification microaggression vs. denial of sexism microaggression) did not have a significant affect on reactivity or performance. Issues of population bias and essentialism may have played an important role in study findings. Future directions are discussed.

We report here the development of new and more general synthetic pathways for the preparation of allenyl and alkynyl carbonyls. These highly dense functionalized compounds were utilized as key intermediates for the synthesis of [3.2.1] and [3.3.1] bicyclic framework, the motifs found in many natural products. A convenient method described for the dehydration of ketoesters to generate conjugated and deconjugated alkynyl esters and conjugated allenyl esters. This sequential one-pot method involves the formation of a vinyl triflate monoanion intermediate that leads to the selective formation of alkynes or allenes depending on additives and conditions used. Product outcomes appear to be a function of unique monoand dianion mechanisms which are described. Our design of a Morita-Baylis-Hilman (MBH) reaction to include a fast silyl 1,3- Brook rearrangement has enabled the first ever anion-catalysis. This new reaction makes possible the addition of both aliphatic and aromatic aldehydes to s ilylallenes leading to carbinol allenoates. These new MBH reactions products allow for a fasttracked synthesis of [3.2.1] bisoxa-bicycles which make up the framework of many biologically active natural products including Vitisinol D. The development of cyclic addition of hydrazine nitrogen to unactivated alkynes catalyzed by non-metals is reported. Starting from readily accessible silyl allenyl esters, alkynyl hydrazines are prepared in one step and subsequently undergo unprecedented cyclization reactions in the presence of ammonium and phosphonium catalysts leading to dehydro-azaproline products. These heterocycles were also produced in high enantiomeric excesses using chiral ammonium phase transfer catalysts via a kinetic resolution pathway. / The racemic synthesis of fully functionalized bicyclic core of Vitisinol D was achieved using allenyl ester as a key intermediate. The required electron withdrawing group (EWG) at the position was screened for better addition followed by the compatibility towards successive transformation and, finally, the ease of removal. A reductive aldol method to transform lactone-enol to the desired [3.2.1] bicycle was extensively studied to understand the stereoelectronic requirements for the formation of such bicyclic structures. Due to the necessity of selective protection and deprotection of many phenolic and aliphatic hydroxyls as well as ester groups, orthogonal protecting groups were established accordingly. / by Pradip Maity. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Orientador: Roberto Jorge da S. Franco / Coorientador: Luis Cuadrado Martin / Coorientador: Evelyne Marie Therese Mainbourg / Banca: Pasqual Baretti / Banca: Vanessa dos Santos Silva / Banca: Eduardo Barbosa Coelho / Banca: Marcio Dantas / Resumo: As doenças cardiovasculares representam a primeira causa de morte no Brasil e no mundo. Os poucos estudos biomédicos realizados com grupos indígenas aldeados revelam que obesidade, hipertensão arterial sistêmica e diabetes Mellitus, principais fatores de risco para o desenvolvimento das doenças cardiovasculares, têm sido frequentes. Objetivo: O objetivo deste estudo foi comparar a prevalência dos fatores de risco para as doenças cardiovasculares entre indígenas das etnias do Rio Negro, dos sateré-mawé e de seus vizinhos brancos, pardos/negros que residem na cidade de Manaus. Casuística e Métodos: A amostra foi de 191 sujeitos, sendo 35 (18,3%) indígenas sateré-mawé, 43 (22,5%) indígenas do Rio Negro, 24 (12,6%) brancos e 89 pardos/negros (46,6%). Resultados: Os resultados mostraram que, em todos os grupos, as mulheres foram maioria. A prevalência de HAS foi de 25% entre os pardos/negros, 21% entre os brancos, 11,6% nos indígenas do Rio Negro e 2,3% nos sateré-mawé. A análise de regressão logística mostrou que os indígenas do Rio Negro apresentaram chances semelhantes a dos brancos e pardos/negros para desenvolver HAS, enquanto que os indígenas sateré-mawé apresentaram maior proteção para vir a ter a doença. Por outro lado, os indígenas do Rio Negro apresentaram menor chance de terem triglicerídeos elevados, enquanto que os indígenas sateré-mawé tiveram chances similares aos brancos e pardos/negros. Para todos os grupos, o aumento do IMC, assim como o sedentarismo e atividade física irregular, estiveram associados a níveis de glicemia e triglicerídeos mais elevados. Discussão: Sugere-se que a mudança do estilo de vida e dos hábitos alimentares para os grupos, principalmente os indígenas, tenha influenciado tanto os mecanismos de proteção, como os de maior exposição aos fatores de risco para as DCVs. Conclusão: Entende-se a necessidade de estudos que possibilitem investigar, de forma mais detalhada... / Abstract: Cardiovascular diseases are the leading cause of death in Brazil and worldwide. The few biomedical studies conducted with indigenous groups in villages reveal that obesity, hypertension and diabetes mellitus, major risk factors for the development of cardiovascular diseases, have been frequent. Objective: This study aimed to compare the prevalence of risk factors for cardiovascular diseases among indigenous ethnic groups of the Rio Negro region, the sateré-mawé and their white neighbors, browns / blacks living in the city of Manaus. Methods: The sample consisted of 191 subjects, 35 (18.3%) sateré-mawé natives, 43 (22.5%) natives of the Rio Negro, 24 (12.6%) white and 89 browns / blacks (46.6%). Results: The results showed that in all groups there were mostly women. The prevalence of hypertension was 25% among the browns / blacks, 21% among whites, 11.6% among natives of the Rio Negro and 2.3% in sateré-mawé. The logistic regression analysis showed that the natives of Rio Negro had similar chances to whites and browns / blacks to develop hypertension, whereas the sateré-mawé natives showed greater protection to come to have the disease. On the other hand, the natives of Rio Negro were less likely to have high triglycerides, while the sateré-mawé had similar chances to whites and browns / blacks. For all groups increased BMI, as well as sedentary lifestyles and irregular physical activity, were associated with blood glucose levels and higher triglycerides. Discussion: We suggest that changes in lifestyle and eating habits of these groups, especially indigenous people, have influenced both protection mechanisms, such as increased exposure to risk factors for CVD's. Conclusion: There is need for studies that investigate in more detail, the types and amounts of food consumed by these groups; or there is the hypothesis that saterê-mawé natives have some additional protective factor for hypertension. / Doutor