Mit der vorliegenden Arbeit werden aktuelle Anwendungsbereiche der Lebensqualitätsforschung innerhalb der klinischen Medizin dargestellt. Besonderes Gewicht wurde dabei auf die Erläuterung der Grundlagen der Lebensqualitätsforschung und der derzeit verbreiteten Konzepte, die Diskussion aktueller und zukünftiger Messmethoden sowie die Darstellung einiger typischer Anwendungen gelegt. Der letzte Teil der Arbeit weist auf die bereits erkennbaren Grenzen und ethischen Konsequenzen dieser Forschungsrichtung hin. In der Habilitationsschrift werden verschiedene Originalarbeiten zusammengefasst, denen jeweils eine allgemeine Einführung zur leichteren thematische Einordnung vorangestellt ist. / This volume demonstrates the present scope of 'Quality of Life' research within a clinical context. Different chapters describe the foundations and the development of 'Quality of Life' research, presently used concepts, discussions about appropriate measurement models and some perspectives for an improvement of psychometric methods. Further, different applications and purposes to use 'Quality of Life' instruments in a clinical context are demonstrated. The last part discusses particular ethical consequences and other limitations of 'Quality of Life' research. All chapters combine introductory sections with published original works.

The diploma thesis deals with the issue of catering of employees, three selected workplaces, with regard to the job position, the way of meals and also the possible health problems related to the performance of their work. The aim of this diploma thesis is to find out whether there is an influence of the working environment on employees' meals, as well as how eating habits reflect their health status during working hours. The theoretical part deals with health issues, the Health 2020 program and also with procedures to protect and prevent disease. The practical part analyzes and evaluates the data obtained through the questionnaire survey among the three selected workplaces. It is clear from the questionnaire survey that the position affects not only the way of eating, but also the possible health problems. KEYWORDS Health, Health 2020 Program, Health Protection, Employees, Questionnaire Surveys, Chronic Diseases, Workplace Relations, Catering

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-04-20T12:48:24Z No. of bitstreams: 1 Kévin Cardoso de Sá_.pdf: 3208171 bytes, checksum: dfc5ea787aaa256079d1f84d750608ff (MD5) / Made available in DSpace on 2018-04-20T12:48:24Z (GMT). No. of bitstreams: 1 Kévin Cardoso de Sá_.pdf: 3208171 bytes, checksum: dfc5ea787aaa256079d1f84d750608ff (MD5) Previous issue date: 2018-02-27 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Chronic diseases are the main cause of mortality in the last few decades, accounting for 59% of all deaths in the world. It is possible to prevent the development of such diseases using tools and methods that instruct the population. One way to achieve this goal is by using games, since they make it possible to teach subjects to the users, without them actively knowing that they are learning new concepts. Through a mapping study, it was possible to identify existing works that employ games focused on chronic conditions, however these works cover a reduced range of these conditions, are mainly targeted towards a younger audience and the majority is of a specific genre, exergames. In this context, this work proposes a model, named CCMUG, for the development of mobile and ubiquitous games that address chronic diseases. The contribution of our work is the definition of a model for the development of games for awareness focused on chronic diseases, subdividing the model into components with relationships between them. Unlike the related work considered, there are no restrictions regarding the type of game target audience and chronic disease addressed. The model aids in the development of games of the most varied genres, for different chronic conditions and individuals of all ages. We conceived the design and developed a mobile game focused on HIV/AIDS, based on the model proposed in this work. We then conducted a individual evaluation with a group of Digital Games undergraduate students of Universidade do Vale do Rio dos Sinos (Unisinos), with the objective to qualify the design of the game. The results obtained show that the game assumes its role of entertaining the players and teaching them concepts regarding the chronic condition. Furthermore, we identified aspects of the design to be improved in the development of the game prototype. Afterwards, we conducted a second evaluation, employing the focus group methodology, with a group of six students who participated in the first evaluation. The aim of this evaluation was to identify if a narrative should be used in the game and, if so, how it should be designed. The participants agreed that the use of a narrative would be beneficial in a game that tries to teach new concepts to the players, but it should be well elaborated. Through the focus group, we conceived a narrative for the game as well as additional features originated from the story. Then, we conducted an evaluation on the prototype after its development to assess the user enjoyment of the game. It was based on a modified version of EGameFlow, a survey that serves as a scale of measurement of the enjoyment and fun of the users in e-learning games. EGameFlow is divided in several dimensions that are assessed with the mean and standard deviation of the answers of the participants. The participants played the game and answered the questionnaire. Overall, all dimensions scored satisfactorily, showing that the prototype is considered to be fun and enjoyable for the players. The last evaluation of this work gathered opinions of game developers to ascertain the validity of our model, its components and relations for developing games focused on chronic conditions. This step occurred as a individual structured interview that followed a explanation of the proposed model and the developed prototype. There were no requests to remove, add or drastically change any component of our model, only minor corrections were applied. Overall, the results are positive and all developers fully agree that our model can be used to develop games, mobile or ubiquitous, focused on chronic conditions without the restrictions identified in the related works. The results confirm that CCMUG can be used as a guideline to develop games in this context. However, more evaluations with different prototypes focusing on other chronic diseases are planned as future works. / Doenças crônicas são a principal causa de mortalidade, representando 59% de todas as mortes do mundo. É possível prevenir o desenvolvimento da doença por intermédio de ferramentas e métodos que instruem a população. Uma forma de alcançar esse objetivo é utilizando jogos, visto que eles possibilitam ensinar assuntos sem que os usuários tenham consciência de estarem aprendendo novos conceitos. Através de um mapeamento sistemático, foi possível identificar trabalhos existentes que empregam jogos no âmbito de condições crônicas, entretanto tais trabalhos abrangem uma gama reduzida dessas condições, são principalmente direcionados para um público jovem e a maioria é de um gênero específico, exergames. Nesse contexto, este trabalho propõe um modelo, chamado CCMUG, para o desenvolvimento de jogos móveis e ubíquos com o foco em doenças crônicas. A contribuição do nosso trabalho é a definição de um modelo para o desenvolvimento de jogos móveis e ubíquos para conscientização focados em doenças crônicas, subdividindo o modelo em componentes com relações entre eles. Diferentemente dos trabalhos relacionados considerados, não há restrições quanto ao tipo de jogo, público-alvo e doença crônica abordada. O modelo auxilia no desenvolvimento de jogos dos gêneros mais variados, para diferentes condições crônicas e indivíduos de todas as idades. Foi concebido o design e desenvolvido um jogo móvel que aborda o tema HIV/AIDS com base no modelo proposto neste trabalho. Em seguida, realizamos uma avaliação individual com uma turma de graduandos de Jogos Digitais da Universidade do Vale do Rio dos Sinos (Unisinos), com o objetivo de qualificar o design do jogo. Os resultados obtidos constatam que o jogo concebido desempenha sua função de entreter os jogadores e ensiná-los conceitos sobre a condição crônica. Além disso, foram identificados aspectos do design a serem aprimorados no desenvolvimento do protótipo do jogo. Posteriormente, realizamos uma segunda avaliação, empregando a metodologia do grupo focal, com um grupo de seis alunos que participaram da primeira avaliação. O objetivo desta avaliação foi identificar se uma narrativa deve ser usada no jogo e, em caso afirmativo, como ela deve ser projetada. Os participantes concordaram que o uso de uma narrativa seria benéfico em um jogo que tenta ensinar novos conceitos aos jogadores, mas ela deve ser bem elaborada. Através do grupo focal, criamos uma narrativa para o jogo, bem como features adicionais originadas a partir dessa história. Em seguida, realizamos uma avaliação do protótipo, após o seu desenvolvimento, para avaliar a diversão do jogo pelo usuário. Essa avaliação foi baseada em uma versão modificada do EGameFlow, um questionário que serve como uma escala de medida do prazer e diversão dos usuários em jogos de aprendizado. EGameFlow é dividido em várias dimensões que são avaliadas através do desvio padrão e média das respostas dos participantes. Os participantes jogaram o jogo e responderam ao questionário. No geral, os resultados de todas as dimensões foram satisfatórios, mostrando que o protótipo é considerado prazeroso e divertido para os jogadores. A última avaliação deste trabalho reuniu opiniões de desenvolvedores de jogos para verificar a validade de nosso modelo, seus componentes e relações para o desenvolvimento de jogos focados em condições crônicas. Este passo ocorreu como uma entrevista estruturada individual que seguiu uma explicação do modelo proposto e do protótipo desenvolvido. Não houveram solicitações para remover, adicionar ou alterar drasticamente qualquer componente do nosso modelo, apenas foram aplicadas pequenas correções. No geral, os resultados são positivos e todos os desenvolvedores concordam plenamente que nosso modelo pode ser usado para desenvolver jogos, móveis ou ubíquos, focados em condições crônicas sem as restrições identificadas nos trabalhos relacionados. Os resultados confirmam que o CCMUG pode ser usado como base para desenvolver jogos neste contexto. No entanto, mais avaliações com diferentes protótipos com foco em outras doenças crônicas estão planejadas como trabalhos futuros.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-06-11T18:12:05Z No. of bitstreams: 1 Fábio Pittoli_.pdf: 14844169 bytes, checksum: eced950e683430e4d8c741f0429ded20 (MD5) / Made available in DSpace on 2015-06-11T18:12:05Z (GMT). No. of bitstreams: 1 Fábio Pittoli_.pdf: 14844169 bytes, checksum: eced950e683430e4d8c741f0429ded20 (MD5) Previous issue date: 2015-03-27 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / A computação ubíqua quando na forma de sistemas ubíquos e utilizados no suporte e cuidado de Doenças Crônicas priorizam o monitoramento do paciente e a geração de diversos tipos de alerta, porém, o suporte à tomada de decisões por parte dos sistemas ubíquos existentes é ainda pouco utilizado em sistemas específicos para o gerenciamento e controle de Doenças Crônicas Não Transmissíveis. Como o cuidado de doença crônica deve ser feito de forma contínua, torna-se importante para o paciente ter um conhecimento prévio sobre o andamento do seu tratamento e se as ações por ele feitas no dia a dia estão lhe ajudando com o tratamento ou não. Como mecanismo de predição, uma das principais técnicas utilizadas atualmente são as Redes Bayesianas. Sendo assim, esta dissertação propõe um modelo computacional ubíquo de prognóstico de fatores de risco de Doenças Crônicas Não Transmissíveis, denominado ChronicPrediction. O modelo ChronicPrediction utiliza Redes Bayesianas criadas a partir do mapeamento de relações de causalidade existentes entre cada um dos fatores de risco da DCNT a qual se deseja observar. Essas relações são definidas a partir de opinião de especialistas ou geradas automaticamente através de dados históricos e com base em dados fornecidos pelos próprios pacientes sobre seus hábitos alimentares diários, rotina de exercícios físicos e a medição de suas taxas. São discutidas também características pertencentes a trabalhos relacionados, além de descrever o modelo em detalhes e apresentar os aspectos considerados no desenvolvimento e avaliação por meio de um protótipo desenvolvido. O processo de avaliação se apresenta na forma de experimentos descritos através de cenários, os quais possuem como objetivo avaliar as hipóteses relacionadas a cada um deles. O ponto inicial para a formulação de cada uma das hipóteses é o fato de que se tem uma ideia de uma causa e o efeito relacionado a ela. Cada um dos cenários visa descrever situações comuns que possam ocorrer durante o dia a dia de pacientes (causas e efeitos) com algum tipo de Doença Crônica Não Transmissível. Além disso, a diversidade entre os cenários torna-se importante para aperfeiçoar a abrangência da avaliação do modelo. Ao efetuar as avaliações conclui-se que o modelo ChronicPrediction amplia as funcionalidades do Modelo UDuctor e do assistente pessoal ChronicDuctor, passando a oferecer suporte a ao monitoramento de múltiplas DCNT simultaneamente, fornecendo feedbacks e recomendações ao paciente com o intuito de ajudá-lo a acompanhar seu tratamento de forma contínua e podendo readequá-lo de forma a promover seu bem-estar e aprimorando sua qualidade de vida. / The ubiquitous computing in the form os ubiquitous systems and used in the support and care of Chronic Diseases prioritize the patient monitoring and the generation of differents alert types, however, the support decision making by the existing ubiquitous systems is still little used on specific systems for the management and control of Chronic Non-Communicable Diseases. As the care of chronic disease should be done continuosly, becomes important for the patient has a prior knowledge about the progress of your treatment and if the actions taken by him in his daily life are helping you with treatment or not. As a predictive mechanism one of the main techniques used nowadays are the Bayesian Networks. Thus, this thesis proposes an ubiquitous computing prognostic model of risk factors of Chronic Noncommunicable Diseases, called ChronicPrediction. The ChronicPrediction model uses Bayesian Networks created from mapping of existing causal relationships between each of the risk factors of NCDs which you wish to observe. These reationships are defined from expert opinion or automatically generated by historical data and based on data provided by patients themselves about their dayli eating habits, exercise routine and the measuring of their rates. Are also discussed characteristics belonging to related work, addition to describing the model in detail and present the aspects considered in developing and evaluating through a prototype. The evaluation process is presented in the form of experiments described through scenarios, which have to evaluate hypotheses realted to each. The starting point for the formulation of each of the hypotheses is the fact that we have an idea of a cause and effect related to it. Each scenario aims to describe common situations that may occur during the daily lives of patients (causes and effects) with some kind of Chronic Non-Communicable Disease. Furthermore, the diversity between the scenarios is important to improve the coverage of the model evaluation. Making the evaluationsit was concluded that the ChronicPrediction model expands the functionality of UDuctor model and the ChronicDuctor personal assistant, offering support to the monitoring of multiple NCDs simultaneously, providing feedbacks and recommendations to the patients in order to help them to monitor their treatment continuously, to modify them in order to promote their well-being and improving their quality of life.

Introdução: O deslocamento ativo tem estreita relação com problemas de saúde pública da atualidade e sua promoção pode contribuir para melhorias quanto à mobilidade urbana, estado de saúde e proteção do meio ambiente. Entretanto, a maior parte das pesquisas sobre o tema tem sido desenvolvida em países de renda alta. A presente tese busca ampliar a investigação sobre o deslocamento ativo no Brasil. Objetivos: i) Descrever a frequência, a distribuição e a variação temporal de indicadores do deslocamento ativo em populações brasileiras; ii) Avaliar o impacto de mudanças no padrão de transporte da população sobre o deslocamento ativo, o tempo sedentário e desfechos de saúde em populações brasileiras. Métodos: Tese composta por sete manuscritos. O primeiro apresenta revisão sistemática de estudos com informações sobre a prática de deslocamento ativo na América Latina e Caribe; o segundo descreve estimativas representativas da população brasileira sobre a prática de deslocamento ativo para o trabalho; o terceiro e o quarto descrevem a frequência e tendência temporal do deslocamento ativo na Região Metropolitana de São Paulo (ciclistas e escolares); o quinto discute a questão da mobilidade urbana e do direito à cidade em São Paulo; o sexto e o sétimo avaliam o impacto de mudanças no padrão de mobilidade da metrópole paulistana sobre a prática de deslocamento ativo, tempo não-ativo de deslocamento e tempo total de deslocamento, bem como sobre a poluição do ar e saúde da população. Resultados: A prevalência mediana de deslocamento ativo encontrada em diferentes locais do Brasil foi de 12 por cento , variando entre 5,1 por cento em Palmas (Tocantins) a 58,9 por cento em Rio Claro (São Paulo) (Manuscrito 1). Um terço dos homens e das mulheres desloca-se a pé ou de bicicleta de casa para o trabalho no país. Em ambos os sexos, esta proporção diminui com o aumento da renda e da escolaridade e é maior entre os mais jovens, entre os que residem em áreas rurais, e na região Nordeste. Em todas as regiões metropolitanas estudadas, o quinto das pessoas de menor renda apresenta uma maior frequência de deslocamento ativo (Manuscrito 2). Entre os anos de 2007 e 2012, observamos redução no número de ciclistas em São Paulo e diferenças expressivas na proporção de ciclistas entre homens e mulheres (9,7 por mil habitantes versus 1,4 por mil habitantes em 2012) (Manuscrito 3). Também verificamos uma queda na proporção de crianças que se deslocam ativamente para a escola entre os anos de 1997 e 2012 (Manuscrito 4). O cenário epidemiológico do deslocamento ativo no país é resultante da disputa pelo direito à cidade, com repercussões na transição de mobilidade humana e na saúde e qualidade de vida da população, como podemos observar no caso de São Paulo (Manuscrito 5). A construção de uma São Paulo mais inclusiva, com menores distâncias para os deslocamentos cotidianos e maior frequência de caminhada e bicicleta, levaria à substancial redução do tempo total e do tempo sedentário despendidos nos deslocamentos, sem diminuir a duração do deslocamento ativo (Manuscrito 6). Traria também ganhos à saúde da população, sobretudo pelo aumento da prática de atividade física e da redução da poluição do ar (Manuscrito 7). Conclusões: A prática de deslocamento ativo no Brasil apresenta marcadas diferenças segundo região e características sociodemográficas. De um modo geral, esta prática vem diminuindo no país, o que deve contribuir negativamente para a saúde da população. A promoção de cidades mais inclusivas e compactas, com o favorecimento a modos ativos de deslocamento, pode contribuir para reverter esta preocupante tendência. / Introduction: Active commuting is closely related to current public health issues and its promotion can contribute to improvements in urban mobility, health and environmental protection. However, research on the subject is largely concentrated in high-income countries. This thesis aims to expand research on active commuting in Brazil. Objectives: i) To describe the frequency, distribution and time trend of active commuting indicators in Brazilian populations; ii) To assess the impact of travel pattern changes on active commuting, sedentary time and health outcomes in Brazilian populations. Methods: The thesis consists of seven manuscripts. The first manuscript is a systematic review of studies with information on active commuting practice in Latin America and the Caribbean; the second describes nationally representative estimates about active commuting to work in Brazil; the third and fourth describe active commuting frequency and time trends in São Paulo metropolitan area (cyclists and schoolchildren); the fifth discusses the issue of urban mobility and the right to the city of São Paulo; the sixth and seventh assess the impact of changes in São Paulo travel pattern on active commuting, non-active commuting and total travel time as well on air pollution and population health. Results: The median prevalence of active commuting found in Brazilian settings was 12 per cent , ranging from 5.1 per cent in Palmas (Tocantins) to 58.9 per cent in Rio Claro (Sao Paulo) (Manuscript 1). One-third of men and women walk or cycle for commuting to work in Brazil. In both sexes, this proportion decreases with increasing income and education and is higher among younger people, those living in rural areas, and in the Northeast. In all Brazilian metropolitan areas studies, people in the lowest quintile of income had a higher frequency of active commuting (Manuscript 2). Between 2007 and 2012, we observed a decreasing number of cyclists in São Paulo and marked sex differences in the proportion of cyclists (9.7 per thousand inhabitants for men versus 1.4 per thousand inhabitants for women in 2012) (Manuscript 3). We also found a decrease in the proportion of children who are actively commuting to school between 1997 and 2012 (Manuscript 4). The epidemiological scenario of active commuting in Brazil is the result of a historical dispute for the right to the city, with repercussions for human mobility transition and people\'s health and quality of life, as can be seen in the case of São Paulo (Manuscript 5). Building a more inclusive São Paulo, with shorter distances and more walking and cycling, would lead to substantial reductions of total and sedentary commuting time, without reducing active commuting time (Manuscript 6). It would also result in improvements for peoples health, particularly due to the increasing physical activity and decreasing air pollution (Manuscript 7). Conclusions: Active commuting in Brazil shows marked regional and socioeconomic contrasts. Overall, this practice has decreased, which should contribute negatively to the health of Brazilians. The promotion of more inclusive and compact cities, favoring active travel, can help reverse this worrying trend.

Background. The kidney is one of the major organs involved in whole-body homeostasis and it is well understood that chronic renal impairment is further complicated with deranged carbohydrate metabolism, dyslipidemia, altered abdominal fat distribution and the activation of renin-angiotensin system (RAS). Recently, RAS blockades of angiotensinconverting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) have been noticed for their potential effects on improve glucose and lipid metabolisms and lowering the risk of new-onset diabetes. However, underlying cellular and molecular mechanisms are not fully established. / Conclusions. (1) UNX induces progressive renal impairment and dysregulation of pancreatic and renal RAS in rats. (2) Pancreatic RAS activation leads to intra-islet fibrosis, insulin-secreting beta-cell deficit and insulin secretory deficiency. (3) Renal cortex RAS dysregulation induces ectopic adipocyte differentiation and lipid infiltration, in combination with lipodystrophy and lipid peroxidation, results to insulin resistance. (4) Pancreatic insulin-secretion deficit and insulin resistance contribute to the development of glucose intolerance and hyperglycemia. (5) Kidney impacting on glucose and lipid metabolism by affecting pancreatic islet and adipocyte, suggesting an essential role of the kidney in maintaining the whole-body homeostasis. (6) RAS blockade with ACEI or ARB may prevent the development of chronic renal impairment and glucose and lipid dysmetabolisms in UNX rats. (7) Common pathways modulating blood pressure, glucose and lipid metabolism warrant future studies for the better management of the global epidemic of metabolic syndrome. / Materials and methods. Chronic renal impairment and RAS disturbance were induced by unilateral nephrectomy (UNX) in adult Sprague-Dawley rats undergoing as long as 10 months of observation. Three-month old male rats were randomized into 4 groups: (1) sham operated control rats (n=10), (2) untreated UNX model rats (n=10), (3) ACEI---lisinopril treated UNX rats (n=10), and (4) ARB-olmesartan treated UNX rats (n=10). Blood glucose levels during fasting and oral glucose tolerance test (OGTT) conditions, lipids, insulin and renal function were measured at 3, 6, 8 and 10 months after operation. Histological changes of kidney, pancreas, liver, and adipose tissue were examined at 10 months post-operation. / Objectives. (1) To set up a rat model with persistent chronic renal impairment and RAS activation. (2) To examine changes of fasting blood glucose, glucose tolerance, blood lipids and insulin sensitivity. (3) To examine changes of pancreatic islets and the factors contributing to pancreatic islet damage such as RAS, transforming growth factor (TGF)-beta and alpha-smooth muscle actin (SMA). (4) To examine changes of systemic and renal adipose tissue and the factors contributing to adipopathy such as RAS, peroxisome proliferator-activated receptor-gamma (PPAR-gamma) and hydroxy-3-methylglutary coenzyme A reductase (HMGCR). (5) To investigate preventive effect of RAS blockades by the ACEI-lisinopril (4 mg/kg body weight) and ARB-olmesartan (4 mg/kg body weight) on the rat model of progressive renal deficiency. / Results. (1) UNX rats developed time-dependent progressive renal functional impairment and marked glomerulosclerosis and tubulointerstitial lesions. (2) UNX rats showed fasting hyperglycemia, progressive glucose intolerance, hyperlipidemia and insulin resistance. (3) UNX rats demonstrated insulin secretory deficiency in parallel to pancreatic islet fibrosis, beta-cell deficit, and overexpression of RAS components, TGF-beta, and alpha-SMA. (4) UNX rats displayed adipopathy evidenced by shifts the subcutaneous and visceral fats to the ectopic fat with lipid accumulation, lipofuscin pigmentation and adipocytes transformation. The adipopathy associated with down-regulation of AT1R and over-expression of angiotensin, AT2R, PPAR-gamma and HMGCR in the remnant kidney. (5) Treatment with lisinopril and olmesartan significantly attenuated the development of chronic renal impairment, RAS dysregulation and aberrant proteins expression, islet damage, adipose redistribution, and glucose and lipid dysmetabolism. / Sui, Yi. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3422. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 195-220). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Pesquisas recentes em medicina genômica sugerem que fatores de risco que incidem desde a concepção de uma criança até o final de sua adolescência podem influenciar no desenvolvimento de doenças crônicas da idade adulta. Artigos científicos com descobertas e estudos inovadores sobre o tema indicam que a epigenética deve ser explorada para prevenir doenças de alta prevalência como doenças cardiovasculares, diabetes e obesidade. A grande quantidade de artigos disponibilizados diariamente dificulta a atualização de profissionais, uma vez que buscas por informação exata se tornam complexas e dispendiosas em relação ao tempo gasto na procura e análise dos resultados. Algumas tecnologias e técnicas computacionais podem apoiar a manipulação dos grandes repositórios de informações biomédicas, assim como a geração de conhecimento. O presente trabalho pesquisa a descoberta automática de artigos científicos que relacionem doenças crônicas e fatores de risco para as mesmas em registros clínicos de pacientes. Este trabalho também apresenta o desenvolvimento de um arcabouço de software para sistemas de vigilância que alertem profissionais de saúde sobre problemas no desenvolvimento humano. A efetiva transformação dos resultados de pesquisas biomédicas em conhecimento possível de ser utilizado para beneficiar a saúde pública tem sido considerada um domínio importante da informática. Este domínio é denominado Bioinformática Translacional (BUTTE,2008). Considerando-se que doenças crônicas são, mundialmente, um problema sério de saúde e lideram as causas de mortalidade com 60% de todas as mortes, o presente trabalho poderá possibilitar o uso direto dos resultados dessas pesquisas na saúde pública e pode ser considerado um trabalho de Bioinformática Translacional. / Genomic medicine has suggested that the exposure to risk factors since conception may influence gene expression and consequently induce the development of chronic diseases in adulthood. Scientific papers bringing up these discoveries indicate that epigenetics must be exploited to prevent diseases of high prevalence, such as cardiovascular diseases, diabetes and obesity. A large amount of scientific information burdens health care professionals interested in being updated, once searches for accurate information become complex and expensive. Some computational techniques might support management of large biomedical information repositories and discovery of knowledge. This study presents a framework to support surveillance systems to alert health professionals about human development problems, retrieving scientific papers that relate chronic diseases to risk factors detected on a patient\'s clinical record. As a contribution, healthcare professionals will be able to create a routine with the family, setting up the best growing conditions. According to Butte, the effective transformation of results from biomedical research into knowledge that actually improves public health has been considered an important domain of informatics and has been called Translational Bioinformatics. Since chronic diseases are a serious health problem worldwide and leads the causes of mortality with 60% of all deaths, this scientific investigation will probably enable results from bioinformatics researches to directly benefit public health.

Thesis (M.A. (Psychology)) -- University of Limpopo, 2000 / Refer to document

Chronic diseases are a significant cause of illness and mortality in the United States. Hereditary predisposition to chronic diseases is a useful indicator for identifying people at risk for disease development. An ideal tool for determining this predisposition is the CDC, NIH, and AAFP recommended third-degree family health history (FHH). The aim of this quantitative, cross-sectional study, based on the theoretical frameworks of social constructivism and the health belief model, was to assess the possible influence between the completed third-degree FHH and the participant's perception of disease risk. Two-hundred seventy-three participants were recruited from health care facilities and from the general population using convenience sampling. Bivariate and multivariate tests were applied to analyze the obtained data. Binary regression indicated a statistically significant association between the presence of heart disease, stroke, breast cancer, ovarian/cervical cancer, prostate cancer, colon cancer, and diabetes, and the perception of risk for the particular disease as noted in the FHH. A familial history of stroke appeared to be the strongest predictor of perception of disease risk. Moreover, increasing age, particularly within the age range of 40 to 57, was associated with increasing levels of perception of disease risk for heart disease, stroke, and prostate cancer. Individuals from the general population significantly indicated higher-than-average risk for colon cancer compared to those from health care facilities. Social change implication of this study may be the widespread implementation of a familial health history questionnaire that leads to an impactful, higher degree of disease risk awareness, prompting preventive action on the part of the individual, and leading to improved individual and population health.

Les objectifs de l’étude de l’évolution du risque cardiométabolique (RCM) sur une période de quatre ans (2006-2010) chez des adultes béninois consistaient à: • Examiner les relations entre l’obésité abdominale selon les critères de la Fédération Internationale du Diabète (IFD) ou l’insulino-résistance mesurée par le Homeostasis Model Assessment (HOMA) et l’évolution des autres facteurs de RCM, • Examiner les liens entre les habitudes alimentaires, l’activité physique et les conditions socio-économiques et l’évolution du RCM évalué conjointement par le score de risque de maladies cardiovasculaires de Framingham (FRS) et le syndrome métabolique (SMet). Les hypothèses de recherche étaient: • L’obésité abdominale telle que définie par les critères de l’IDF est faiblement associée à une évolution défavorable des autres facteurs de RCM, alors que l’insulino-résistance mesurée par le HOMA lui est fortement associée; • Un niveau socioéconomique moyen, un cadre de vie peu urbanisé (rural ou semi-urbain), de meilleures habitudes alimentaires (score élevé de consommation d’aliments protecteurs contre le RCM) et l’activité physique contribuent à une évolution plus favorable du RCM. L’étude a inclus 541 sujets âgés de 25 à 60 ans, apparemment en bonne santé, aléatoirement sélectionnés dans la plus grande ville (n = 200), une petite ville (n = 171) et sa périphérie rurale (n = 170). Après les études de base, les sujets ont été suivis après deux et quatre ans. Les apports alimentaires et l’activité physique ont été cernés par deux ou trois rappels de 24 heures dans les études de base puis par des questionnaires de fréquence simplifiés lors des suivis. Les données sur les conditions socioéconomiques, la consommation d’alcool et le tabagisme ont été recueillies par questionnaire. Des mesures anthropométriques et la tension artérielle ont été prises. La glycémie à jeun, l’insulinémie et les lipides sanguins ont été mesurés. Un score de fréquence de consommation d’« aliments sentinelles » a été développé et utilisé. Un total de 416 sujets ont participé au dernier suivi. La prévalence initiale du SMet et du FRS≥10% était de 8,7% et 7,2%, respectivement. L’incidence du SMet et d’un FRS≥10% sur quatre ans était de 8,2% et 5%, respectivement. Le RCM s’était détérioré chez 21% des sujets. L’obésité abdominale définie par les valeurs seuils de tour de taille de l’IDF était associée à un risque plus élevé d’insulino-résistance: risque relatif (RR) = 5,7 (IC 95% : 2,8-11,5); d’un ratio cholestérol total/HDL-Cholestérol élevé: RR = 3,4 (IC 95% : 1,5-7,3); mais elle n’était pas associée à un risque significativement accru de tension artérielle élevée ou de triglycérides élevés. Les valeurs seuils de tour de taille optimales pour l’identification des sujets accusant au moins un facteur de risque du SMet étaient de 90 cm chez les femmes et de 80 cm chez les hommes. L’insulino-résistance mesurée par le HOMA était associée à un risque élevé d’hyperglycémie: RR = 5,7 (IC 95% : 2,8-11,5). En revanche, l’insulino-résistance n’était pas associée à un risque significatif de tension artérielle élevée et de triglycérides élevés. La combinaison de SMet et du FRS pour l’évaluation du RCM identifiait davantage de sujets à risque que l’utilisation de l’un ou l’autre outil isolément. Le risque de détérioration du profil de RCM était associé à un faible score de consommation des «aliments sentinelles» qui reflètent le caractère protecteur de l’alimentation (viande rouge, volaille, lait, œufs et légumes): RR = 5,6 (IC 95%: 1,9-16,1); et à l’inactivité physique: RR = 6,3 (IC 95%: 3,0-13,4). Les sujets de niveau socioéconomique faible et moyen, et ceux du milieu rural et semi-urbain avaient un moindre risque d’aggravation du RCM. L’étude a montré que les relations entre les facteurs de RCM présentaient des particularités chez les adultes béninois par rapport aux Caucasiens et a souligné le besoin de reconsidérer les composantes du SMet ainsi que leurs valeurs seuils pour les Africains sub-sahariens. La détérioration rapide du RCM nécessité des mesures préventives basées sur la promotion d’un mode de vie plus actif associé à de meilleures habitudes alimentaires. / The objectives of this study on four-year trends (2006-2010) in cardiometabolic risk (CMR) in Benin adults were: • To examine whether abdominal obesity according to International Diabetes Federation (IDF) waist circumference cut-offs, or insulin resistance measured by the homeostasis model assessment (HOMA) was associated with more unfavourable changes in other CMR factors, • To examine the effects of diet, physical activity and socioeconomic status including place of residence on the evolution of CMR assessed by both the Framingham risk score for cardiovascular diseases (FRS) and the metabolic syndrome (MetS). We hypothesized that: • Abdominal obesity as currently defined by IDF anthropometric criteria is weakly associated with unfavourable changes in other CMR factors while IR exacerbates other CMR factors in sub-Saharan Africans, • Medium income status, less urbanized place of residence (rural or semi-urban), physical activity and healthy eating patterns (higher score of consumption of foods that may protect against CMR) contribute to more favourable evolution of CMR. The study included initially 541 apparently healthy adults aged 25-60 years and randomly selected in a large city (n = 200), a small town (n = 171) and its surrounding rural area (n = 170). After baseline survey, subjects were followed-up after two and four years. Dietary intake and physical activity were assessed by two or three 24-hour recalls in baseline studies and then by short frequency questionnaires at follow-ups. Data on alcohol intake and smoking patterns were collected in personal interviews. Anthropometric data, blood pressure, insulin resistance based on homeostasis model assessment (HOMA), blood glucose and blood lipids were measured. Education, income (proxy) and place of residence were the socioeconomic variables appraised in interviews. A food score based on consumption frequency of “sentinel foods” was developed and used. Complete data at last follow-up was available in 416 subjects. Baseline prevalence of MetS and FRS ≥ 10% was 8.7% and 7.2%, respectively. The incidence of MetS, and a FRS ≥ 10% over four years was 8.2% and 5%, respectively. The CMR deteriorated in 21% of subjects. Abdominal obesity as defined by IDF thresholds of the waist circumference was associated with a higher likelihood of insulin resistance: relative risk (RR) = 5.7 (CI 95%: 2.8-11.5), high total cholesterol/HDL-Cholesterol ratio: RR = 3.4 (CI 95%: 1.5-7.3). However, abdominal obesity was not associated with a significantly increased risk of high blood pressure or high triglycerides. In the study population, the optimal cut-offs of waist circumference that predicted at least one component of MetS were 90 cm in women and 80 cm in men. Insulin resistance measured by HOMA was associated with an increased risk of hyperglycemia: RR = 5.7 (CI 95%: 2.8-11.5). However, the insulin resistance was not associated with a significant risk of high blood pressure and high triglycerides. The combination of MetS and the FRS depicted more at-risk subjects than the use of either tool alone. Diet and lifestyle mediated location and income effects on CMR evolution. Low “sentinel food” scores (foods that may reflect the protective effect of the diet against CMR): meat, poultry, milk and milk products, eggs and vegetables; and inactivity increased the likelihood of CMR deterioration: RR = 5.6 (CI 95%: 1.9-16.4) and RR = 6.3 (CI 95%: 3.0-13.4), respectively. Subjects with medium or low socioeconomic levels, and those living in the rural and semi-urban areas had a lower risk of CMR deterioration. The study showed some differences in the relationship between abdominal obesity, insulin resistance and other CMR factors in Blacks compared to Caucasians and it also highlighted the need to reconsider MetS components and their cut-offs for sub-Saharan Africans. Combining MetS and FRS might be appropriate for surveillance purposes in order to better capture CMR. The results of the present study call for urgent measures to reduce CMR deterioration focusing on more active lifestyle and dietary inadequacies.