This study examined correlations of historical changes in diet and physical inactivity with the rise of noncommunicable diseases (NCDs) in Kenya. Historical data on diet, wage jobs by industry, urbanization, gross domestic product (GDP), and morbidity due to NCDs were extracted from Kenya Statistical Abstracts, Food and Agriculture Organization (FAOSTAT), and the World Bank online database. These data were plotted and correlations between these factors and the incidence of different NCDs over time were evaluated. There was a rapid rise in the incidence of circulatory disease starting in 2001, and of hypertension and diabetes starting in 2008. The rise of these NCDs, especially hypertension and diabetes, was accompanied over the same period by a rise in per capita GDP and physical inactivity (as measured by increased urbanization and declining proportion of agricultural and forestry wage jobs); a rise in per capita supply of rice, wheat and its products, and cooking oils; and a decline in the per capita supply of maize and sugar. In conclusion, the positive correlations between indicators of dietary consumption and physical inactivity and rates of hypertension, circulatory disease, and diabetes suggest that the rapid rise of NCDs in Kenya may be, in part, due to changes in these modifiable factors.

Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2021 / Introduction: Zebediela Hospital in Limpopo Province is running an outreach programme as part of its chronic care initiative. In the programme, pharmacy personnel visit the feeder clinics attached to the hospital to dispense chronic medicines to patients. This study aimed at evaluating how this pharmacy chronic care outreach programme is performing, by looking at pharmacy personnel, nursing personnel and patients’ perceptions. Method: A cross-sectional descriptive study was conducted at the six feeder clinics attached to Zebediela Hospital in the Lepelle-Nkumpi municipality of the Capricorn district in Limpopo Province using a quantitative research method. This quantitative research was administered in the form of a survey. Questionnaires were used to collect data from patients, nursing personnel and pharmacy personnel. A total of 399 participants (n=399) took part in the study. The participants included 337 patients from six different clinics, 18 pharmacy personnel and 44 nursing personnel. Data was analysed using the SPSS version 25.0. Results: The pharmacy personnel showed that an allocation of more than three personnel per duty roster sufficed. Regarding transport used by pharmacy personnel when embarking on the Pharmacy Chronic Care Outreach Programme, 71.4% of pharmacy personnel indicated that they always used hospital transport in 83.3% of the cases. The study findings showed that, 71% of patients agreed they were satisfied with the pharmacy times for collecting medicines apart from the fact that 65.6% of patients travelled for more than two hours from their respective homes to their nearest clinic. Sixty eight percent of pharmacy personnel perceived the PCCOP model to be reducing patient waiting time at the clinics. Both the patients and nursing personnel were however not satisfied with the pharmacy personnel’s arrival time at the clinic. The other negative aspect reported was the space problem at the clinics where, 77.8% of pharmacy personnel and 54.5% of nursing personnel reported this as not user-friendly. The patients’ satisfaction levels regarding the PCCOP model for “very satisfied” stood at 64.2% and 0.6% for “very dissatisfied”. Both pharmacy and nursing personnel recommended that the PCCOP model be continued with recommendations towards improving human resources and infrastructure. Conclusion: In conclusion, both pharmacy personnel and nursing personnel showed that the outreach programme was a good initiative in the health system and it benefitted patients. However, the concerns mentioned by patients included long waiting times at the clinic and medicine stock outs. As the results show, the pharmacy chronic care outreach programme should be continued, as long as patients’ complaints can be attended to. Key words: Evaluation, Pharmacy Chronic care Outreach Programme, Zebediela

Introducción: Las enfermedades crónicas se desarrollan por un conjunto de factores de riesgo que en muchos de los casos se pueden prevenir. Entre estos factores destacan el consumo de tabaco y la baja ingesta de frutas y verduras. Métodos: Estudio transversal analítico realizado en una universidad privada de Lima, 2018. La población estudiada comprendió universitarios de 18 a 26 años. Resultados: Se encuestaron 233 estudiantes, de los cuales solo 215 cumplían con las características de la población de interés, 101 (47%) mujeres y 114 (53%) hombres. La media de edad de los encuestados fue de 21.37 años. En los encuestados el 19 % (n=41) nunca ha consumido tabaco, el 16% (n=35) no consumió en el último mes, el 38 % (n=81) son fumadores ocasionales y 27% (n=58) son fumadores diarios. Los estudiantes encuestados que tienen un consumo adecuado de frutas y verduras representan el 7.44% (n=16). Se encontró una asociación entre fumar y el consumo de frutas y verduras (valor p=0,0001), y, al observar la media de consumo de porciones de frutas y verduras por día para cada categoría de hábito de fumar, se vio que, a mayor consumo de tabaco, menor consumo de frutas y verduras. Conclusión: Se encontró una relación entre el hábito de fumar y el consumo de frutas y verduras, pero es importante evidenciar los altos porcentajes de los factores de riesgo de consumo de tabaco y baja ingesta de frutas y verduras en la población estudiada. / Introduction: Chronic diseases are developed by a set of risk factors that in many cases can be prevented. These factors include tobacco consumption and low intake of fruits and vegetables. Methods: Analytical cross-sectional study carried out at a private university in Lima, during the first academic semester in 2018. The population studied comprised universitity students from 18 to 26 years old. Results: 233 students were surveyed, of whom only 215 met the characteristics of the population of interest, 101 (47%) women and 114 (53%) men. The mean age of the respondents was 21.37 years. In the respondents, 19% (n = 41) had never used tobacco, 16% (n = 35) had not used in the last month, 38% (n = 81) were occasional smokers and 27% (n = 58) they are daily smokers. The surveyed students who have an adequate consumption of fruits and vegetables represent 7.44% (n = 16). An association was found between smoking and the consumption of fruits and vegetables (p value = 0.0001), and, when observing the average consumption of portions of fruits and vegetables per day for each category of smoking, it was evidenced that, the higher the consumption of tobacco, the lower the consumption of fruits and vegetables. Conclusion: In our study, a relationship was found between smoking and the consumption of fruits and vegetables, but it is important to note the high percentages of risk factors for tobacco use and low intake of fruits and vegetables in the study population. / Trabajo de investigación

BACKGROUND: The increasing prevalence of undiagnosed and diagnosed type 2 diabetes (T2D) posed a major challenge for public health and thus screening for T2D becomes essentially important. The social-demographical factors associated with the use of T2D screening have been widely studied, however, little is known about the impact of behavioral factors, mental health and chronic diseases on prevalence of screening, especially by gender and age groups. METHODS: We investigated the impact of behavioral factors, mental health and chronic diseases across gender and age groups on the usage rate of T2D screening. To analyze the likelihood of the use of T2D screening, we performed weighted binomial logistic regression analyses. RESULTS: Obesity, physical activity and smoking increased the use of T2D screening for females more than for males, and alcohol use increased screenings only for females. Serious psychological distress (SPD) was found to have a positive association with the use of T2D screening for females rather than for males; whereas hypertension and diabetes increased the use of T2D screening for males more than for females. Physical activity was an effective predictor of screening for T2D in the groups of 45-64 years and 65 years or older. Former drinking was positively associated with T2D screening for people aged 65 or older, and smoking was found to increase the odds of screening for T2D for people aged less than 65. CONCLUSIONS: Behavioral factors, mental health, and chronic diseases were significantly associated with the use of T2D screening and further demonstrated that gender differences exist in the role of above factors.

With diet being such a huge factor in the development of diseases, emerging research has supported that apple consumption is a promising candidate for disease prevention due to the high phenolic content it possesses. These polyphenols can be found in two forms: extractable polyphenols (EP) and non-extractable polyphenols (NEP). Polyphenols have been shown to have strong anti-inflammatory and anti-oxidant properties, but up until this point, most researchers focus on EP fractions, while NEP are neglected. After the EP extraction using acetone and acetic acid (99:1) from the Apple Boost powder, three additional extraction methods were conducted on the remaining powder residue to extract the NEP. These extractions put the residue in three different environments for hydrolysis to compare their extraction abilities: enzyme, alkaline, and acid. After analyzing the EP and NEP total phenolic content (TPC) levels, oxygen radical absorbance capacity (ORAC) assay was conducted to measure anti-oxidation capacity of each extraction, and in vitro anti-inflammatory assay was performed to evaluate the anti-inflammation capacity of each extraction where inflammation was induced by LPS. The results showed that the NEP obtained from acid hydrolysis had the highest readings in both the TPC and ORAC assay, but did not show any anti-inflammatory effects in vitro. The EP extraction had the second highest readings in the TPC, ORAC and anti-inflammatory assays. The NEP enzyme extraction had the second lowest TPC and ORAC assay performance, but highest performance in the anti-inflammatory assay. The NEP alkaline extraction had the lowest TPC and performed poorly in both the anti-inflammatory assay and ORAC assay.

Introduction : En psychologie de la santé, les études réalisées pour comprendre les perceptions des technologies par les patients sont peu nombreuses et nécessitent d’être développées. Ce travail a eu pour objectif d’identifier et d’évaluer les déterminants qui composent l’acceptabilité des nouvelles technologies en santé, en associant les développements issus de la psychologie sociale et de la psychologie de la santé.Méthodologie : Pour évaluer l’acceptabilité des technologies de santé, auprès des patients et des professionnels de santé, nous avons réalisé trois études. Nous avons choisi d’utiliser une approche par méthodes multiples (Ajzen, 1991 ; Fisher & Tarquinio, 2006) dans le but d’identifier les différents déterminants prédisant l’intention d’usage des technologies.Objectifs et études : Le premier objectif de notre travail a consisté à choisir le modèle le plus approprié parmi les théories intentionnelles classiques et à identifier les déterminants pouvant le compléter. Les résultats obtenus, à l’aide de la méthodologie qualitative par focus group, révèlent que les déterminants proposés dans le modèle de l’UTAUT (Venkatesh, 2003), complété de déterminants affectifs et interpersonnels, semblent les plus appropriés pour évaluer le processus d’acceptabilité en santé. Dans une seconde étude, nous avons proposé d’adapter le modèle de l’UTAUT en y associant une dimension affective, composée de l’anxiété et de la confiance envers la technologie, puis nous avons testé le pouvoir prédictif de ce modèle auprès de patients et de professionnels de santé. Ce modèle admet des résultats tout à fait satisfaisants pour prédire l’intention d’usage. Chez les patients, les technologies sont initialement appréhendées au travers des composantes émotionnelles et générales (anxiété perçue et attitude) alors que chez les professionnels de santé, expérimentés et familiers, les technologies sont appréhendées au travers des composantes cognitives et spécifiques (utilité et contrôle perçus). Pour améliorer notre modèle, nous avons ensuite exploré dans une troisième étude, deux nouvelles variables correspondant au niveau de confiance envers le médecin et aux connaissances sur la technologie issues de la relation médecin-patient (dimension interpersonnelle).Discussion : La proposition d’un modèle intégratif d’acceptabilité des technologies en santé basé sur le modèle de l’UTAUT, complété par une dimension affective et une dimension interpersonnelle, apparaît être un modèle prometteur pour comprendre les perceptions des usagers face aux technologies. / Introduction: In health psychology, few studies have been conducted to understand patients' perceptions of health technologies and need to be carried out. This work aims to identify and evaluate the determinants that make up the acceptability of new technologies in health, by associating developments from social psychology and health psychology.Methodology: To investigate patient and health professional acceptability of health technologies, we conducted three studies. We chose to use a multiple methods approach (Ajzen, 1991, Fisher & Tarquinio, 2006) in order to identify the different determinants predicting the intention to use technologies.Objectives and studies: The first objective of our work was to select the most suitable models of behavioral intention, and then tailor it by adding pertinent variables. The results, using the qualitative focus group methodology, revealed that the determinants proposed in the UTAUT model (Venkatesh, 2003) supplemented with affective and interpersonal determinants, seemed the most appropriate to evaluate the process of acceptability. In a second study, we proposed adapting the UTAUT model, associating an affective dimension composed of anxiety and trust in technology, and then testing the predictive power of this model with patients and health professionals. This model showed quite satisfactory results in predicting acceptability. In patients, the technologies are initially perceived through emotional and general components (perceived anxiety and attitude) whereas among experienced and familiar health professionals, the technologies are understood through cognitive and specific components (perceived utility and control). To optimize our model we added two new variable of the doctor-patient relationship representing the level of patient’s trust in the doctor and the effectiveness of the explanation of the technology (interpersonal dimension).Discussion: The proposal of an integrative model of acceptability of health technologies based on the UTAUT model, supplemented by an affective dimension and an interpersonal dimension, appears to be a promising model to understand users' perceptions of technologies.

Estudos têm mostrado que a atividade da enzima glutationa peroxidase (GPx) se encontra reduzida na presença do polimorfismo de nucleotideo único (SNP) Pro198Leu no gene que codifica para a GPx1. Associado a isso, polimorfismos na região promotora do gene do fator de transcrição Nrf2, o qual se liga ao elemento de resposta antioxidante na via de expressão de genes de enzimas antioxidantes, também pode alterar a expressão gênica da GPx1. Como o mineral selênio faz parte do sítio catalítico desta enzima antioxidante, muitos estudos têm associado o estado nutricional relativo a este nutriente com doenças relacionadas ao estresse oxidativo, como o diabetes mellitus tipo 1 (DM1). Nesse sentido, este estudo visou avaliar a presença dos SNPs Pro198Leu e -617 C/A no Nrf2, bem como da expressão gênica da GPx1 em pacientes com diabetes mellitus tipo 1 e relacioná-los com marcadores do estado nutricional relativo ao selênio e de estresse oxidativo, comparados com um grupo controle sem a doença. Este é um estudo caso e controle, constituído por dois grupos experimentais, um grupo composto por 77 pacientes com diabetes mellitus tipo 1 (DM1) atendidos no Setor de Endocrinologia do Hospital das Clínicas, com idade entre 10 e 19 anos, de ambos os gêneros, e um grupo controle (GC) constituído por 74 indivíduos da mesma faixa etária, os quais relataram ausência de doenças crônicas. Foi realizada avaliação antropométrica e da ingestão alimentar. Além disso, foram determinados parâmetros bioquímicos de status de selênio, controle glicêmico (glicose sérica, HbA1c), atividade enzimática, concentração de malondialdeído e 8-isoprostanos. A determinação dos SNPs e da expressão gênica foi realizada por PCR em tempo real. O grupo DM1 apresentou média de idade de 15,9 anos e o GC de 13,4 anos. A concentração de glicose sérica e HbA1c foi significativamente diferente entre os grupos (p<0,001). As frequências dos genótipos do SNP da GPx1 para o grupo DM1 e GC foram, respectivamente, 60% e 61% (CC), 30% e 32% (CT), 10% e 7% (TT),estando em equilíbrio gênico. A concentração de selênio no plasma foi significativamente maior no grupo DM1 e, ao avaliar essa concentração de acordo com genótipos, observou-se menor concentração de selênio no plasma no genótipo TT no grupo controle (p<0,05). A expressão gênica da GPx1 não apresentou diferença estatística entre os grupos nem entre os genótipos. O mesmo foi observado quanto à concentração de 8-isoprostanos. No entanto, a atividade das enzimas GPx e SOD assim como a concentração de MDA foram significantemente maiores no grupo DM1 (p<0,05). O estado nutricional de todos participantes em relação ao selênio estava deficiente. Foi observada correlação entre a concentração de selênio no plasma e nos eritrócitos e a atividade da GPx, assim como foi observada maior atividade enzimática e concentração de MDA no grupo DM, sem apresentar diferença na distribuição segundo os alelos estudados. Desta forma, pode-se concluir que independentemente da doença todos os indivíduos apresentaram deficiência de selênio. Em ambos os grupos, foi observada maior peroxidação lipídica, na presença do alelo variante T, o que pode indicar alteração da proteção antioxidante. No entanto, a presença do alelo variante nos SNPs avaliados não apresentaram influencia sobre a expressão gênica. / Studies have shown that the activity of glutathione peroxidase (GPx) is reduced in the presence of single nucleotide polymorphism (SNP) in Pro198Leu encoding GPx1 gene. Beyond that, polymorphism of the transcription factor Nrf2 gene promoter, which binds to the antioxidant response element in the pathway of antioxidant enzymes gene expression, may also alter gene expression of GPx1. As mineral selenium is part of the catalytic site of this antioxidant enzyme, many studies have associated the nutritional status of this nutrient with oxidative stress diseases, such as type 1 diabetes mellitus (DM1). Thus, this study aimed to evaluate the presence of Pro198Leu and -617 C / A in Nrf2 SNPs, as well as GPx1 gene expression in patients with type 1 diabetes mellitus, and to associate them with nutritional status of selenium and stress oxidative markers, comparing with a control group without the disease. This is a case-control study, compound of two groups, one group containing 77 patients with type 1 diabetes mellitus (DM1) from the Service of Endocrinology of Hospital das Clinicas, aged between 10 and 19 years, of both genders, and a control group (CG) was composed for 74 individuals of the same age, who reported no chronic diseases. Anthropometric and dietary intake assessment was performed. In addition, the biochemical parameters of selenium status, glycemic control (serum glucose, HbA1c), enzyme activity, concentration of malondialdehyde and 8-isoprostane were determined. The determination of SNPs and gene expression was performed by real-time PCR. The DM1 group had a mean age of 15.9 years and 13.4 years for the CG. The concentration of serum glucose and HbA 1c were significantly different between groups (p <0.001). The genotype frequencies of the GPx1 SNP for DM1 and control group were, respectively, 60% and 61% (CC), 30% and 32% (CT), 10% and 7% (TT), which is in genetic equilibrium. The selenium concentration in plasma was significantly higher in DM1 group. To assess the selenium concentration according to genotypes, we observed lower plasma concentration in TT genotype in the control group (p <0.05). The GPx1 gene expression showed no statistical difference between groups or between genotypes. The same result was observed for the 8-isoprostane concentration. However, GPx and SOD activity and MDA concentration were significantly higher in DM1 (p <0.05). The nutritional status of all participants in relation to selenium was deficient. Correlation between selenium concentration in plasma and erythrocytes and GPx activity, as well as higher enzyme activity and MDA concentration in the DM1 group were observed, with no significant difference in the distribution according to studied alleles was observed. The presence of the variant allele in the SNPs evaluated showed influence neither on gene expression, nor on the activity of GPx. Thus, it can be concluded that, regardless of the disease, all subjects had low nutritional status of selenium, without genotype influence, and, as expected, oxidative stress was increased in individuals with DM1, as demonstrated by laboratory tests.

O aumento da proporção de idosos na população e a alta prevalência de condições crônicas torna oportuno o estudo dos aspectos epidemiológicos e sanitários relacionados à saúde bucal dessa população a fim de preservar sua capacidade funcional. Para esse propósito, foram utilizadas publicações da literatura científica e dados do Estudo SABE Saúde Bem-Estar e Envelhecimento, uma ampla pesquisa longitudinal de base populacional, que teve início em 2000 e realizou dois campos em 2006 e 2010 acrescentando em cada um, uma nova coorte de idosos de 60 a 64 anos. O trabalho, estruturado em três seções, deu origem a três manuscritos apresentados na Parte II. O primeiro manuscrito mostrou que idosos com renda insuficiente, que utilizavam somente o Sistema Único de Saúde (SUS), fumantes e que apresentaram 14 ou mais dentes tinham mais chance de necessitar de cuidado odontológico. No segundo manuscrito, concluiu-se que os idosos com maior probabilidade de perda dentária eram homens; utilizavam duas próteses removíveis; avaliavam sua saúde bucal como regular ou ruim/muito ruim; e moravam sozinhos, independentemente da idade e do hábito de fumar. No terceiro manuscrito concluiu-se com base em uma revisão sistemática, que o diabetes mellitus Tipo 2 não controlado está associado à doença periodontal, falha de implantes dentários, maior prevalência de abscessos periapicais, xerostomia, síndrome da ardência bucal, candidíase e prognóstico ruim para carcinoma primário de gengiva. As evidências reunidas reforçaram a tese de que a auto avaliação da saúde bucal, as condições clínicas e os aspectos sociodemográficos, comportamentais, e de acesso a serviços de saúde bucal, estão relacionados com a necessidade de cuidado odontológico e o risco de perda dentária entre idosos dentados. Além disso, o Diabetes Mellitus Tipo 2 quando não controlado, contribui para a deterioração da saúde bucal. Assim, as condições desfavoráveis em que a população brasileira está envelhecendo do ponto de vista socioeconômico, com a permanência de hábitos nocivos à saúde, necessidade de maior acesso aos serviços de saúde bucal, e alta carga de condições crônicas levam a fragilização do estado de saúde dificultando a manutenção da capacidade funcional. O aumento da proporção de idosos na população exigirá abordagens em saúde bucal que levem em conta as especificidades do envelhecimento na perspectiva das multimorbidades. O manejo e o cuidado em saúde dessas pessoas deveria ser transdisciplinar, tendo em vista que em se tratando das pessoas idosas, vários campos disciplinares deveriam ser ativados e a equipe de saúde bucal deveria estar preparada para transitar por esses espaços de maneira a contribuir com seus conhecimentos para a produção de ações que evitem a perda da capacidade funcional e levem em conta os fatores de risco comuns para doenças crônicas, incluindo as doenças bucais. Com isso, impacto positivo na saúde dessa população poderia ser obtido, com menor custo e maior eficiência e efetividade quando comparado ao modelo de atenção às condições agudas e/ou a doenças específicas. / The increasing proportion of elderly in the population and the high prevalence of chronic diseases are desirable to study the epidemiological and health aspects related to oral health of this population in order to preserve their functional capacity. For this purpose, publications were used in the scientific literature and data from the study SABE - Health Wellness and Aging, a large longitudinal population based survey, which began in 2000 and held two fields in 2006 and 2010 adding in each one new cohort aged 60 to 64 years. The work is structured in three sections, has produced three manuscripts presented in Part II. The first manuscript showed that elderly people with insufficient income, which only used the Unified Health System (SUS), and smokers who had 14 or more teeth were more likely to need dental care. In the second manuscript, it was found that individuals with a higher probability of tooth loss were men; used two removable prostheses; assessed their oral health as fair or poor / very poor; and lived alone, regardless of age and smoking. In the third manuscript was concluded based on a systematic review, the diabetes mellitus uncontrolled type 2 is associated with periodontal disease, failure of dental implants, higher prevalence of periapical abscesses, dry mouth, burning mouth syndrome, candidiasis and poor prognosis for primary carcinoma of the gingiva. The evidence gathered reinforced the view that the self-assessment of oral health, clinical conditions and sociodemographic, behavioral, and access to oral health services are related to the need for dental care and the risk of tooth loss among dentate . In addition, Type 2 diabetes mellitus when not controlled, contributes to the deterioration of oral health. Thus, the unfavorable conditions in which the Brazilian population is aging the socioeconomic point of view, with the permanence of harmful health habits, need for greater access to oral health services, and high burden of non-communicable chronic diseases lead to weakening of state health hindering the maintenance of functional capacity. The increasing proportion of elderly in the population will require approaches in oral health that take into account the specificities of aging from the perspective of multimorbidities. The management and the health care of these people should be interdisciplinary, considering that in the case of older people, several disciplinary fields should be activated and the oral health team should be prepared to move through these spaces in order to contribute their knowledge for the production of actions to prevent loss of functional capacity and take into account the common risk factors for chronic diseases, including oral diseases. Thus, positive impact on the health of this population could be obtained at a lower cost and greater efficiency and effectiveness when compared to the model of care to acute and / or specific disease conditions.

A participação ativa na autogestão da saúde individual tem sido associada com resultados positivos tanto para o indivíduo como para as instituições de saúde. O instrumento Patient Activation Measure (PAM) tem sido utilizado para mensurar a ativação, constructo que engloba o conhecimento, a habilidades e a confiança do indivíduo para realizar ativamente comportamentos saudáveis. Este estudo metodológico teve como objetivos adaptar culturalmente as versões PAM13 e PAM22 e avaliar as propriedades psicométricas das versões adaptadas em uma amostra de indivíduos com doenças crônicas. O processo de adaptação cultural ocorreu de acordo com recomendações da literatura: tradução, retrotradução e conciliação das versões traduzidas, avaliação por um comitê de juízes, avaliação semântica dos itens, obtenção das versões adaptadas e avaliação psicométrica. Os dados foram coletados entre junho e dezembro de 2014, no Ambulatório Central do Hospital de Clínicas da Universidade Federal de Uberlândia. Participaram do estudo 513 indivíduos de ambos os sexos, com diagnóstico de doenças crônicas há pelo menos seis meses, com idade entre 18 e 80 anos e que estavam em acompanhamento clínico regular no ambulatório. O PAM é respondido em uma escala ordinal com cinco pontos, que varia de discordo totalmente (1 ponto) até concordo totalmente (4 pontos), além da opção não se aplica (0 pontos). O intervalo possível do PAM22 é de 22 a 88 pontos e do PAM13 de 13 a 52 pontos. Os valores do escore bruto obtidos devem ser convertidos para uma pontuação de ativação, que varia de 0 a 100 pontos. Maiores pontuações indicam maior ativação. A validade de constructo do PAM foi avaliada pelas correlações entre as medidas de ativação e autoestima (Escala de Auto-Estima de Rosenberg), ansiedade e depressão (Hospital Anxiety and Depression Scale) e estado de saúde percebido (Escala Visual analógica); pela técnica de grupos conhecidos (sexo, idade, renda, escolaridade, tempo de diagnóstico e número de comorbidades) e sua dimensionalidade, pela variante da análise fatorial confirmatória que utiliza a análise dos caminhos, denominada de Modelagem de Equações Estruturais (MEE). A confiabilidade foi avaliada pela consistência interna e pela confiabilidade teste-reteste, num intervalo de tempo de 15 dias. O nível de significância adotado foi de 0,05. A maioria dos participantes foi do sexo feminino (62,0%), a média de idade foi 49,8 anos (DP=14,57; variação 18-80 anos). O tempo médio de ensino formal foi de oito anos (DP=4; variação 0-20 anos). Os participantes apresentaram diversificadas doenças crônicas e 75% haviam sido diagnosticados há mais de dois anos. O escore de ativação médio do PAM22 foi de 60,2 (DP=12,7) e do PAM13 foi de 63,0 (DP=15,9). Foi verificado efeito teto em todos os itens do PAM13 e PAM22. As propriedades psicométricas de validade e confiabilidade do PAM de 13 itens (PAM13) e de 22 itens (PAM22) foram consideradas adequadas. A consistência interna foi de ?= 0,83 para o PAM13 e de ?=0,86 para o PAM22. A confiabilidade teste-reteste foi de fraca a moderada magnitude para ambos os instrumentos (p<0,05). A correlação entre os escores das duas versões do PAM com as medidas de autoestima, de ansiedade e depressão e do estado de saúde percebido foram de magnitude fraca a moderada (p<0,05). No que se refere aos grupos conhecidos, nenhuma das variáveis apresentou diferença estatística, no entanto a medida de ativação correlacionou com a escolaridade e com o numero de comorbidades (p<0,05). A modelagem de equações estruturais indicou a necessidade de exclusão de alguns itens, para que em as versões adaptadas do PAM se ajustassem ao modelo da unidimensionalidade. Concluímos que as versões brasileiras PAM13 e PAM22 apresentaram adequadas e aceitáveis propriedades psicométricas para medir a ativação de pacientes brasileiros com doenças crônicas. Portanto, as versões adaptadas do PAM podem ser utilizadas na prática clínica e em pesquisas de intervenção em pacientes com doenças crônicas / The active participation in the individual health self-management has been associated with positive outcomes as for the individual as for the health institutions. The Patient Activation Measure (PAM) instrument has been used for measuring the activation, a construct which includes the knowledge, skills and confidence of the individual to actively accomplish healthy behaviors. This methodological study aimed adapting culturally the PAM13 and PAM22 versions and evaluating the psychometric properties of the adapted versions in a sample of subjects with chronic diseases. The cultural adaptation process occurred according to literature recommendations: translation, back translation and conciliation of translated versions, an evaluation by a committee of judges, a semantics evaluation of the items, the obtainment of the adapted versions of the PAM and psychometric assessment. The data were collected between June and December of 2014, in the Central Ambulatory of Hospital de Clínicas of the Federal University of Uberlândia. The study included 513 subjects of both genders, with a diagnosis of chronic diseases for at least six months, with ages between 18 and 80 years old and that had regular medical monitoring in the ambulatory. The PAM is answered in an ordinal scale with five points, ranging from disagree strongly (1 point) to agree strongly (4 points) and the option does not apply (0 points).The possible range in the PAM22 is 22 to 88 points and of PAM13 is 13 to 52 points. The values obtained raw score must be converted to an activation score, ranging from 0 to 100 points. High scores indicate greater activation. The construct validity of the PAM was evaluated by the correlations between by activation measures and self-esteem (Rosenberg Self- Esteem Scale), anxiety and depression (Hospital Anxiety and Depression Scale) and perceived health status (Analogical Visual Scale); by the known groups techniques (sex, age, income, education, time of diagnosis and number of comorbidities) and its dimensionality, by the confirmatory factorial analysis variation which uses the paths analysis, called Structural Modeling Equations (SEM). The reliability was assessed through the internal consistency and through the test-retest reliability, in a time of 15 day interval. The significance level adopted was of 0.05. The majority of the subjects were female (62.0%), the age average was 49.8 years old (DP=14.57; variation 18-80 years). The study average was eight years (DP=4; variation 0-20 years). The participants presented diverse chronic diseases and 75% had been diagnosed for more than two years. The average activation score of PAM22 was of 60.2 (DP=12.7) and of PAM13 was of 63.0 (DP=15.9). The ceiling effect was verified in all items of PAM13 and PAM22. The psychometric properties of validity and reliability of PAM of 13 items (PAM13) and of 22 items (PAM22) were considered adequate. The internal consistency was of ?= 0.83 to PAM13 and of ?= 0.86 to PAM22. The test-retest reliability was from weak to moderate magnitudes for both instruments (p<0.05). The correlation between the scores of the Brazilian versions of the PAM with the measures of self steem, anxiety and depression and the perceived health status was the weak and moderate magnitudes (p<0.05). Concerning known groups validity, none of the variables presented statistics difference, however the activation measure correlated to the education and the number of comorbidities (p<0.05). The structural equations modeling indicated the exclusion need of some items, so that in adapted PAM versions adjusted themselves to the one- dimensionality model. We conclude that the Brazilian versions of PAM13-B and PAM22-B presented adequate and acceptable psychometric properties to measure the activation of Brazilian patients with chronic diseases. Therefore, the adapted versions of PAM can be used in clinical practice and intervention studies in patients with chronic diseases

Submitted by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-09-27T13:47:07Z No. of bitstreams: 1 ANA ZILDA CEOLIN COLPO 2017.pdf: 6048240 bytes, checksum: 62bfa1f3557cbe81c077e11ac86b15a3 (MD5) / Approved for entry into archive by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2017-09-27T13:47:29Z (GMT) No. of bitstreams: 1 ANA ZILDA CEOLIN COLPO 2017.pdf: 6048240 bytes, checksum: 62bfa1f3557cbe81c077e11ac86b15a3 (MD5) / Made available in DSpace on 2017-09-27T13:47:30Z (GMT). No. of bitstreams: 1 ANA ZILDA CEOLIN COLPO 2017.pdf: 6048240 bytes, checksum: 62bfa1f3557cbe81c077e11ac86b15a3 (MD5) Previous issue date: 2017-08-09 / O consumo de bebidas a base de erva-mate é parte dos hábitos e costumes de populações do sul do Brasil, Argentina e Uruguai. Seu consumo é um símbolo cultural vinculado à sociabilidade e demonstrações de cordialidade. Aprimorar o conhecimento sobre a associação de seu consumo com a saúde humana pode levar a formulação de paradoxos de grande relevância econômica e social. Assim, esta pesquisa teve como objetivos: i) avaliar a capacidade dos extratos de erva-mate modularem o equilíbrio redox a nível sistêmico em Drosophila melanogaster e em nível de sistema nervoso central (SNC) em ratos; ii) observar como os extratos podem afetar eventos genotóxicos relacionados a perda da heterozigose em asas de Drosophila melanogaster. Dietas acrescidas de colesterol foram usadas como indutoras de danos no estudo com moscas da fruta e imobilização no estudo com animais. Para avaliar a relação do extrato com mutagênese e antimutagênese empregou-se o Teste de Mutação e Recombinação Somáticas (SMART). Além disso, no delineamento experimental deste trabalho projetou-se o uso de extratos (mates) obtidos mimetizando a forma tradicional de consumo, assim nas abordagens com moscas da fruta empregaram-se extratos obtidos por extrações sequenciais. Com animais, por limitações impostas pelo experimento, empregou-se o extrato bruto obtido de forma convencional. Nesta vertente também se incluiu a avaliação dos efeitos do composto majoritário em extratos de erva-mate, o ácido clorogênico (CGA). Os resultados demostram que extratos de erva-mate, em Drosophila melanogaster expostas à dieta hipercolesterolêmica, são capazes de aumentar significativamente a capacidade de resistir a estresse induzido melhorando a homeostase redox. O que foi constatado pela redução dos níveis de produtos da peroxidação lipídica, recuperação da atividade enzimática da glutationa S-transferase (GST) e aumento do tempo de vida dos insetos. Nas regiões cerebrais córtex (CTX), hipocampo (HIP) e corpo estriado (STR) a indução de estresse por imobilização produz danos a lipídeos e proteínas. Mate e CGA foram capazes de atenuar esses prejuízos, demostrando seu potencial de melhorar a resistência a estresse induzido, efeito possivelmente mediado por sua capacidade antioxidante. Para completar, os resultados obtidos para a atividade genotóxica mostraram que mate não induz danos em asas de Drosophila, quer seja por processos mutacionais ou recombinatórios. Dados relativos à avaliação da antigenotoxicidade indicaram que os extratos reduziram a frequência de manchas mutantes em co-tratamento. No entanto, podem apresentar efeitos genotóxicos quando administrados após danos, isto pode ser resultado de sua ação na modulação de funções detoxificantes no organismo, relacionadas principalmente ao citocromo P450 (CYP). Com base em dados da literatura estas informações levam a suposição que compostos fenólicos podem provocar inibição do CYP reduzindo a metabolização e a eliminação de drogas, o que produz acumulação e aumento da toxicidade. Conclui-se, por meio do uso dos diferentes modelos experimentais e das propostas deste estudo, que a erva-mate possui significativa atividade antioxidante e não produz efeito genotóxico per se, mas sua relação com antigenotoxidade e metabolização de xenobióticos precisa ser confirmada por estudos aprofundados nesta abordagem. / The consumption of yerba-mate based beverages is part of the habits of the population from South Brazil, Argentina and Uruguay. Its consumption is a cultural symbol linked to sociability and demonstrations of cordiality. Improving the knowledge about the association of yerba-mate consumption with human health can lead to the creation of great economic and social relevant paradoxes. Thus, this research had as objectives: i) to evaluate the capacity of yerba-mate extracts on modulating the redox balance at systemic level in Drosophila melanogaster and at the central nervous system (CNS) in rats; ii) to observe how the extracts can affect genotoxic events related to heterozygosity loss on Drosophila melanogaster wings. Diets with high cholesterol added were used as damage inducers on the study with fruit flies and immobilization with animals. The Somatic Mutation and Recombination Test (SMART) was used to evaluate the relation of the extract with mutagenesis and antimutagenesis. In addition, in the experimental design of this work, were used extracts (mates) obtained mimicking the traditional form of consumption. Thus, in the approaches with fruit flies, extracts obtained by sequential extractions were used. Because of the limitations imposed by the experiment, the crude extract obtained by the conventional manner was used in the animals. In this strand, the evaluation of the effects of the major compound in yerba-mate extracts, the chlorogenic acid (CGA), was also included. The results showed that yerba-mate extracts, in Drosophila melanogaster exposed to hypercholesterolemic diet, are able to increase significantly the capacity to resist the induced stress, improving the redox homeostasis. This was evidenced by the reduction of the levels of lipid peroxidation products, glutathione S-transferase (GST) activity recovery and increase of the insects’ lifespan. In the brain regions: cortex (CTX), hippocampus (HIP) and striatum (STR), the induction of immobilization stress produces damage to lipids and proteins. Mate and CGA were able to mitigate these damages, demonstrating their potential to improve induced stress resistance. This effect was possibly mediated by its antioxidant capacity. To complete, the results obtained for the genotoxic activity showed that mate does not induce damage in Drosophila wings, either by mutational or recombinant processes. Data for the evaluation of the antigenotoxicity indicated that the extracts reduced the frequency of mutant stains in co-treatment. However, they can present genotoxic effects when given after damage. This may be due to its action on modulating detoxifying functions in the organism, related mainly to the P450 cytochrome (CYP). Based on the literature data, this information lead to the assumption that phenolic compounds may cause CYP inhibition, reducing metabolization and drug elimination, which produces accumulation and increased toxicity. Were possible to conclude, by using different experimental models and the study proposals, that yerba-mate has significant antioxidant activity and does not produce genotoxic effect per se, but its relation with antigenotoxicity and xenobiotic metabolization needs to be confirmed by deepened studies focused on this approach.