Made available in DSpace on 2015-04-14T13:35:40Z (GMT). No. of bitstreams: 1 447910.pdf: 2718272 bytes, checksum: 970052e8ca9abce5d0dd93f2976d56d7 (MD5) Previous issue date: 2013-03-15 / The emergence and spread of resistance mechanisms in Gram-negative bacilli have complicate the treatment of serious nosocomial infections. Due to the ineffectiveness of the automated detection of KPC producer isolates there is a need to develop better methodologies. One possibility is to evaluate the ertapenem resistance, which has greater sensitivity to detect the expression of KPC producing isolates. However, the specificity may be reduced due to the resistance attributed to other mechanisms, such as AmpC gene expression or ESBL production associated with the loss of porin. This study included 128 samples of Gram-negative bacilli of Klebsiella pneumoniae and Enterobacter spp. resistant to ertapenem. Disk diffusion and E-test? method were applied to determine the susceptibility to imipenem, meropenem and ertapenem. Isolates intermediate and resistant to ertapenem were evaluated and additional resistance mechanisms conferred by blaTEM, blaSHV, blaCTX-M, blaCTX-M-2 and blaKPC for Klebsiella pneumoniae and Enterobacter cloacae genes were investigated by PCR technique. The presence of outer membrane protein (OMP) was investigated by dot blot. The gene blaTEM was detected in 52.9% and 10.3%; blaSHV in 29.4% and 0.94%; blaCTX-M in 41.4% and 1.9%, and blaCTX-M-2 in 23.5% and 1.9% of K. pneumoniae and Enterobacter cloacae isolates, respectively. blaKPC gene was present in 12.6% of Enterobacter spp. isolates. The OmpC and OmpF were present in 3.8% of Enterobacter cloacae isolates. Resistance genes and outer membrane proteins carbapenemases producing strains indicates that several resistance mechanisms contribute to therapeutic failure and point to the need for better detection methods and surveillance strategies. / A emerg?ncia e dissemina??o dos mecanismos de resist?ncia em bacilos Gram-negativos t?m complicado o tratamento de s?rias infec??es nosocomiais. Devido ? inefic?cia dos sistemas automatizados na detec??o de isolados produtores de KPC (Klebsiella pneumoniae produtora de carbapenemase) h? a necessidade do desenvolvimento de melhores metodologias. Uma possibilidade ? avaliar os isolados quanto ? resist?ncia ao ertapenem, o qual tem maior sensibilidade para detectar a express?o dos isolados produtores de KPC. Contudo, a especificidade pode ser reduzida devido ? resist?ncia conferida por outros mecanismos, tais como a express?o do gene AmpC ou a produ??o de ESBL associado a perda de porina. Este estudo incluiu 128 amostras de bacilos Gram-negativos de Klebsiella pneumoniae e Enterobacter spp. resistentes ao ertapenem. O m?todo de disco difus?o e E-test? foram aplicados para determinar a suscetibilidade para imipenem, meropenem e ertapenem. Os isolados com suscetibilidade intermedi?ria e resistentes para ertapenem foram avaliados e posteriormente foram investigados os mecanismos de resist?ncia atrav?s da presen?a dos genes blaTEM, blaSHV, blaCTX-M, blaCTX-M-2 e blaKPC para Klebsiella pneumoniae e Enterobacter spp., por meio da t?cnica de PCR. A presen?a de prote?na da membrana externa (OMP) foi investigada por meio de dot blot. O gene blaTEM foi detectado em 52,9% e 10,3%; blaSHV em 29,4% e 0,94%; blaCTX-M em 41,4% e 1,9% e blaCTX-M-2 em 23,5% e 1,9% dos isolados de K. pneumoniae e Enterobacter spp., respectivamente. O gene blaKPC estava presente em 12,6% dos isolados de Enterobacter spp. As porinas OmpC e OmpF estavam presentes, concomitantemente, em 3,8% dos isolados de Enterobacter cloacae. A detec??o da presen?a dos genes de resist?ncia e as prote?nas da membrana externa nos isolados produtores de carbapenemases indica que eles podem estar associados aos diversos mecanismos de resist?ncia, contribuindo para a falha terap?utica e apontando para a necessidade de melhores m?todos de detec??o e estrat?gias de vigil?ncia.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-27T20:00:58Z No. of bitstreams: 1 DIS_DANIELE_LINDERN_PARCIAL.pdf: 1742576 bytes, checksum: 219ac7953476d97332da350cfaebc57e (MD5) / Made available in DSpace on 2016-06-27T20:00:58Z (GMT). No. of bitstreams: 1 DIS_DANIELE_LINDERN_PARCIAL.pdf: 1742576 bytes, checksum: 219ac7953476d97332da350cfaebc57e (MD5) Previous issue date: 2016-03-01 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Young soccer athletes suffer pressure for high performance and face intense workout routines. These youth also have to deal with their own expectations toward their career as well as their family expectations. The fault routine of these soccer players is characterized by the sports practices and school tasks and, in many cases, they have few social interaction, besides of being physically distant from their family and hometown. The life of these youth may be influenced by many risk factors, at the same time protective factors may also be diminished. This dynamic justifies the need for preventive intervention programs focusing on social and coping skills. In this sense, this study - part of a Master Degree thesis- aimed to understand the meaning of soccer in the lives of young athletes from a Brazilian soccer club and to develop an intervention based on Cognitive-Behavioral Therapy and Positive Psychology for young soccer players of a football club in Brazil And was presented in two manuscripts. The design of the manuscript I was cross-qualitative, and individual semi structured interviews with four athletes from the soccer club were held, aiming to achieve athletes' perceptions in order To respect and attend their demands to develop the intervention. Data analysis was performed using Content Analysis. The results of the manuscript I point to the many adversities that these athletes go through to achieve the dream of being a soccer player. Thus, it is emphasized the important role of psychology in this context, that should value and reinforce, beyond the risk factors, the personal meanings that these youth attribute to their practice and role as soccer players. From the manuscript I results, an intervention was planned, which effects Were assessed and described in the second manuscript of this thesis. The manuscript II design was quasi-experimental with pre-and post-test. Twenty soccer athletes aged between 15 and 16 years, allocated in an experimental group (n=10) and control group (n=10) participants at the study. Manuscripts I and II included different participants. The intervention took place through eight meetings of 90 minutes each, once a week. The elements of the well-being of Positive Psychology, resilience, social skills, cognitive distortions and coping skills were the intervention focus. Participants answered the Inventory of Social Skills for Adolescents, Athletic Coping Skills Inventory, Screen for Child Anxiety Related Emotional Disorders, Life Satisfaction Global Scale and Positive and Negative Affect Scale for Adolescents pre and post-intervention. The control group didn't received any treatment. There was no significant difference between the experimental and control group pre and post intervention. However, the athletes of the experimental group showed significant difference in the coping skills ?Under Pressure Performance?, ?Trust? and ?Freedom of Concerns?, and significant increase of the frequency of total score of social skills and of the ability to ?Affective approach? after the intervention. The results of this study point to the importance of interventions that aim, the learning of other life skills beyond sports for these athletes, as promotion their mental health. / Atletas de futebol sofrem press?es por elevado desempenho e rotinas de treino intensas. Esses jovens tamb?m t?m de lidar com as suas pr?prias expectativas em rela??o ? sua carreira, bem como as expectativas de seus familiares. A rotina destes jogadores ? caracterizada por cobran?as tanto na pr?tica esportiva quanto nas obriga??es escolares e em muitos casos estes t?m pouca intera??o social, al?m de estarem fisicamente distantes de sua fam?lia e cidade natal. A vida destes jovens ? permeada por muitos fatores de risco, ao mesmo tempo em que os fatores de prote??o podem estar diminu?dos. Esta din?mica justifica a necessidade de programas de interven??o de cunho preventivo e com foco em habilidades sociais e de coping. Neste sentido, este estudo desta disserta??o de mestrado teve como objetivo compreender o significado do futebol na vida de jovens atletas de um clube de futebol do Brasil, bem como desenvolver uma interven??o baseada na Terapia Cognitivo-Comportamental e na Psicologia Positiva para esta popula??o e foi apresentado em dois manuscritos. O delineamento do manuscrito I foi qualitativo transversal, e foi realizada uma entrevista individual semiestruturada com quatro atletas do clube de futebol, visando a conhecer as percep??es destes para, posteriormente, respeitar e contemplar estas demandas no desenvolvimento da interven??o. A an?lise dos dados foi realizada atrav?s da An?lise de Conte?do. Os resultados do manuscrito I apontam para as muitas adversidades que estes atletas passam para alcan?ar o sonho de ser jogador de futebol. Assim, ressalta-se o importante papel da Psicologia neste contexto, que deve reconhecer, para al?m dos fatores de risco, os significados pessoais que estes jovens atribuem a sua pr?tica e papel enquanto atletas de futebol. A partir dos resultados do manuscrito I, foi planejada uma interven??o cujo impacto foi avaliado e descrito no manuscrito II. O manuscrito II teve delineamento quantitativo quase experimental com avalia??o pr? e p?s-interven??o. Vinte atletas de futebol com idades entre 15 e 16 anos foram alocados em um grupo de interven??o (n=10) e um grupo de compara??o (n=10). Os manuscritos I e II contaram com participantes diferentes. A interven??o teve 8 encontros de 90 minutos, com freq??ncia semanal. Os elementos do bem-estar da Psicologia Positiva, resili?ncia, habilidades sociais, distor??es cognitivas e habilidades de coping foram o foco da interven??o. Os participantes responderam ao Invent?rio de Habilidades Sociais para Adolescentes, Athletic Coping Skills Inventory, Screen for Child Anxiety Related Emotional Disorders, Escala Global de Satisfa??o de Vida e ? Escala de Afetos Positivos e Negativos para Adolescentes, antes e ap?s a interven??o. O grupo de compara??o n?o passou por nenhuma forma de interven??o. Os atletas do grupo de interven??o apresentaram diferen?a significativa nas habilidades de coping ?Desempenho sob press?o?, ?Confian?a? e ?Liberdade de preocupa??es?, e aumento significativo da freq??ncia total das habilidades sociais, bem como da habilidade ?Abordagem afetiva? ap?s a interven??o. N?o houve diferen?a significativa pr? e p?s-interven??o entre os grupos de interven??o e compara??o. Os resultados deste estudo apontam para a import?ncia de interven??es que visem a aprendizagem de outras habilidades para a vida al?m das esportivas para estes atletas, como a promo??o de sua sa?de mental.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-07-04T19:38:22Z No. of bitstreams: 1 TES_CRISTIANE_RIOS_PETRARCA_COMPLETO.pdf: 2589282 bytes, checksum: 52270debca013b954c56d75d899d3ff8 (MD5) / Made available in DSpace on 2016-07-04T19:38:22Z (GMT). No. of bitstreams: 1 TES_CRISTIANE_RIOS_PETRARCA_COMPLETO.pdf: 2589282 bytes, checksum: 52270debca013b954c56d75d899d3ff8 (MD5) Previous issue date: 2016-03-18 / Introduction: Colorectal cancer is the third most common cancer in men and the second in women worldwide. It presents multifactorial, heterogeneous and complex etiopathogeny, still not fully elucidated. The evolution of the disease is often distinct from the exhaustive surgical and pathological staging, eventually (possibly) patients with focal disease develop an aggressive pattern presenting poor prognosis. Recent evidence shows the molecular heterogeneity of colorectal cancer. In this context the microRNAs (miRNAs), small non-coding RNAs (containing 19-25 nucleotides) capable of regulating gene expression in post-transcriptional level, have been identified with different expressions for numerous diseases, including cancer. Colorectal cancer shows change in expression of several miRNAs. These changes have been associated with the diagnosis, prognosis, gene expression, chemosensitivity and staging, being a potential biomarker. Methods: Clinical and pathological data of patients submited to surgical resection of the primary tumor and regional lymph nodes diagnosed from September 2002 to October 2011 have been reviewed and analyzed, and included in the colorectal cancer tumor bank of the S?o Lucas Hospital's Oncology Department - PUCRS. The analysis of the expression of miRNAs was performed in the laboratory of the Institute of Biotechnology of the Catholic University of Brasilia where they were analyzed in primary tumor and regional lymph nodes for descriptive purposes and versus the clinical-pathological data of the cases studied. The quantification analysis of the following miRNA (mir-570, mir-16, mir-338, Let-7, miR-1, miR-150, mir-183, mir-650 and mir-31) were determined by qPCR. Statistical analysis tests: Fisher's, Wilcoxon and Kruskal Wallis Exact, considered a significance level of 5%. Results: Of the 28 cases studied, 28.6% were less than 60 years old at diagnosis and 71.4% aged 60 or over. The average age was 66.7 years (26 to 86). The mean (average) follow-up (period, age) was 3.9 years (0 to 9), SD= 2.8 and a median of 4 years. The expression of miRNAs in the primary tumor (N=28) showed more homogeneous pattern, with a tendency to overexpression; whereas, in ill lymph nodes (N=15) this pattern was more heterogeneous, with mir-570, mir-338, mir-1, mir-183 and mir-31 being presented overexpressed and mir-16, Let-7, mir-150 and mir-650 with a more repressed expression. The suppressed expression of mir-570 was associated with mortality when evaluated in the primary tumor (N=28), where the prevalence of death in individuals with suppressed expression was 63.64% and those overexpressed was 17.65%, with p=0.020. In the primary tumor of patients with lymph node metastasis (N=15) the median expression of mir-183 was 4.42 with interquartile range (IQR) p25 of 1,66 and p75 of 43.01; whereas in the samples from patients with no ill lymph nodes (N=13) the median expression of mir-183 was 54.17 with IQR p25 of 13.12 and p75 of 223.14, with p=0.01, suggesting focal disease at diagnosis. In the subgroup of patients with lymph node metastasis (N=15), the expression of mir-650 in lymph node was associated with the prevalence of recurrence. The expression of mir-650 showed suppressed expression in 25% of the recurrence cases and was overexpressed in 85% of cases, with p=0.04. Conclusions: The expression pattern of miRNAs differs depending on the site of the disease studied (primary tumor or metastatic disease). The suppressed expression of mir-570 in the primary tumor is likely to be predictor of mortality. Overexpression of mir-183 in the primary tumor suggests focal disease at diagnosis. The overexpression of mir-650 in the metastatic lymph node is a recurrence predictor. New studies including functional tests and meta-analyzes may confirm these findings and optimize the use of these miRNAs in clinical practice. / Introdu??o: O c?ncer colorretal ? o terceiro c?ncer mais comum em homens e o segundo em mulheres no mundo. Apresenta etiopatogenia multifatorial, heterog?nea e complexa, ainda n?o totalmente elucidada. A evolu??o da doen?a ? muitas vezes distinta do exaustivo estadiamento cir?rgico e patol?gico, eventualmente pacientes com doen?a localizada evoluem com padr?o agressivo apresentando mal progn?stico. Evid?ncias recentes demonstram a heterogeneidade molecular do c?ncer colorretal. Neste contexto os microRNAs (miRNAs), pequenos RNAs com 19-25 nucleot?deos n?o codificadores, que s?o capazes de regular a express?o de genes em n?vel p?s-transcricional, t?m sido identificados com diferentes express?es em diversas doen?as, inclusive no c?ncer. O c?ncer colorretal apresenta altera??o na express?o de diversos miRNAs. Estas altera??es t?m sido associadas ao diagn?stico, progn?stico, express?o de genes, quimiossensibilidade e estadiamento, sendo potencial biomarcador. M?todos: Foram revisados e analisados dados cl?nicos e anatomopatol?gicos de pacientes submetidos a ressec??o cir?rgica do tumor prim?rio e linfonodos regionais diagnosticados de setembro de 2002 ? outubro de 2011 e inclu?dos no banco de tumores de c?ncer colorretal do Servi?o de Oncologia do Hospital S?o Lucas ? PUCRS. A an?lise da express?o dos miRNAs foi realizada no laborat?rio do Instituto de Biotecnologia da Universidade Cat?lica de Bras?lia onde foram analisadas nos tumores prim?rios e nos linfonodos regionais, com fins descritivos e frente aos dados cl?nico-patol?gicos dos casos estudados. A an?lise da quantifica??o dos seguintes miRNA (mir-570, mir-16, mir-338, Let-7, mir-1, mir-150, mir-183, mir-650 e mir-31) foi realizada por qPCR. Para an?lise estat?stica os testes: Exato de Fisher, Wilcoxon e de Kruskal Wallis, considerado n?vel de signific?ncia de 5%. Resultados: Dos 28 casos estudados, 28,6% tinham menos de 60 anos na ocasi?o do diagn?stico e 71,4% 60 anos ou mais. A idade m?dia foi de 66,7 anos (26 ? 86). A m?dia de seguimento foi de 3,9 anos (0 ? 9), DP=2,8 e mediana de 4 anos. A express?o dos miRNAs no tumor prim?rio (N=28) apresentou padr?o mais homog?neo, com uma tend?ncia a superexpress?o; enquanto que, nos linfonodos doentes (N=15) este padr?o foi mais heterog?neo, com o mir-570, mir-338, mir-1, mir-183 e mir-31 apresentando-se superexpressos e mir-16, Let-7, mir-150 e mir-650 com express?o reprimida. A express?o reprimida do mir-570 apresentou associa??o com mortalidade quando avaliado no tumor prim?rio (N=28), onde a preval?ncia de ?bito nos indiv?duos com express?o reprimida foi de 63,64% e naqueles superexpressos foi de 17,65%, com valor p=0,020. No tumor prim?rio dos pacientes com met?stase linfonodal (N=15) a mediana de express?o do mir-183 foi de 4,42 com intervalo interquartil p25 de 1,66 e p75 de 43,01; enquanto que, nas amostras de pacientes com linfonodos n?o doentes (N=13) a mediana de express?o do mir-183 foi de 54,17 com intervalo interquartil p25 de 13,12 e p75 de 223,14, com valor p= 0,01, sugerindo doen?a localizada ao diagn?stico. No subgrupo de pacientes com met?stase linfonodal (N=15), a express?o do mir-650 no linfonodo foi associada a preval?ncia de recidiva. A express?o do mir-650 esteve reprimida em 25% dos casos que recidivaram e superexpresso em 85% dos casos, com valor p=0,04. Conclus?es: O padr?o de express?o dos miRNAs difere conforme o s?tio da doen?a estudada (tumor prim?rio ou doen?a metast?tica). A express?o reprimida do mir-570 no tumor prim?rio provavelmente seja preditora de mortalidade. Superexpress?o do mir-183 no tumor prim?rio sugere doen?a localizada ao diagn?stico. A superexpress?o do mir-650 no linfonodo metast?tico ? preditor de recidiva. Novos estudos incluindo testes funcionais e metan?lises poder?o ratificar estes achados e otimizar a utiliza??o destes miRNAs na pr?tica cl?nica.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-07-21T18:39:03Z No. of bitstreams: 1 DIS_MARIA_MERCEDES_CARACCIOLO_PICARELLI_COMPLETO.pdf: 1479254 bytes, checksum: 1fc931d06c940f809dbcf8825a640251 (MD5) / Made available in DSpace on 2016-07-21T18:39:03Z (GMT). No. of bitstreams: 1 DIS_MARIA_MERCEDES_CARACCIOLO_PICARELLI_COMPLETO.pdf: 1479254 bytes, checksum: 1fc931d06c940f809dbcf8825a640251 (MD5) Previous issue date: 2016-03-31 / Introduction: Recent advances in juvenile idiopathic arthritis (AIJ) treatment promoted free disease survival. Cardiovascular disease (DCV) may emerge as an important cause of morbidity and mortality. Pulse wave velocity (VOP) and telomere length (TL) are considered as potential predictors of cardiovascular DCV. There are growing evidences of chronic and persistent inflammatory activity role on these processes. VOP and TL are potential early predictors of DCV and its outcomes. Objective: Access VOP and TL in a sample of AIJ patients, without cardiovascular risk factors, compare them with a group of healthy individuals sex and age matched and to test the correlation of these variables. Patients and Methods: 24 AIJ patients and 21 controls for TL and 20 controls for VOP were included. VOP was estimated by an oscillometric device (CardioSDyna ? MAPA +). TL was accessed by polimerase chain reaction in real time (qPCR). Inflammatory activity was accessed by Juvenile Disease Activity Score (JADAS-27).Obesity, systemic hypertension, diabetes mellitus, impaired renal function and other inflammatory diseases were excluded. Results: Oligoarticular (65, 2%) and polyarticular subtypes were included, with 73,9% females and 82,6% were Caucasian. The average age was 15,5 + 6,3 years and the median disease duration was 9 [5-19] years. Between cases and controls for LTL there was significant difference in age no differences in sex, ethnics and BMI. The JADAS median was 8 [0, 00 ? 20, 1], considered active when above 1, 0. PWV was normal in all patients, JIA and control (5.1 + 0.20 m/s vs. 4.98 + 0.06 m/s, P = 0, 66). TL expressed by T/S ratio (amplification telomere product and single copy gene) was significantly reduced between JIA patients and controls (0. 85 + 0, 34 vs. 1, 67 + 1, 38, Mann-Whitney test P = 0.025). When age adjusted by ANCOVA, the difference remained significant (P= 0,032). There was no correlation between TL and age (P =0, 449, r=0, 166), sex (P=0, 521), disease duration (P =0, 358, r=-0, 318), JADAS (P = 0, 184, r=-0, 287) e VOP (P = 0, 843, r=0, 044) in patients with AIJ. Conclusions: TL was significantly shorter in long disease duration and high to moderate disease activity with no DCV risk factors AIJ patients and compared to controls.VOP was normal and no significant difference between controls were found. No correlations were observed between TL or VOP and disease duration, age and sex. / Introdu??o: os avan?os na terap?utica da artrite idiop?tica juvenil (AIJ) promoveram o prolongamento da sobrevida livre de doen?a. A doen?a cardiovascular (DCV) pode emergir como importante causa de morbimortalidade. A velocidade de onda de pulso (VOP) e o comprimento de tel?meros (TL) s?o vistos como potenciais preditores de DCV. H? evid?ncias crescentes da import?ncia do papel da atividade inflamat?ria cr?nica e persistente nesses processos. VOP e TL s?o potenciais preditores precoces de DCV e seus desfechos. Objetivo: Avaliar a VOP e TL em uma amostra de pacientes com AIJ, sem fatores de risco para DCV, compar?-los com um grupo de indiv?duos saud?veis pareados por sexo e idade e testar a correla??o destas vari?veis. Pacientes e M?todos: 24 pacientes com AIJ e 21 controles para TL e 20 controles para VOP foram inclu?dos. A VOP foi estimada por um equipamento de an?lise oscilom?trica (CardioSDyna ? MAPA +). O TL foi avaliado atrav?s da rea??o em cadeia da polimerase em tempo real (qPCR). A atividade inflamat?ria foi medida atrav?s do Juvenile Disease Activity Score (JADAS-27). Pacientes com obesidade, hipertens?o arterial sist?mica, diabetes mellitus e perda de fun??o renal e outras doen?as inflamat?rias foram exclu?dos. Resultados: Foram inclu?dos os subtipos oligoarticular (65, 2%) e poliarticular, sendo que 73,9% eram meninas, 82,6% eram caucasianos. A m?dia de idade foi 15,5 + 6, 3 anos e a mediana de dura??o da doen?a foi de 9 [5-19] anos. Entre casos e controle para TL, houve diferen?a significativa em rela??o ? idade e n?o foi encontrada diferen?a quanto a sexo, etnia, IMC, peso e altura. A mediana do JADAS foi 8 [0,00 ? 20,1],considerado ativo acima de 1 . Os valores da VOP foram normais em todos os pacientes (5,1 + 0,2 vs.4,98 + 0,06 m/s) (P = 0,66). TL expresso pela raz?o T/S (produto da amplifica??o dos tel?meros e gene de c?pia ?nica) estava reduzido nos pacientes com AIJ (0, 85 + 0, 34 vs.1,67 ? 1,38), Teste de Mann-Whitney: P=0, 025. Quando ajustado para idade atrav?s da ANCOVA, a diferen?a permaneceu significativa (P=0, 032). N?o houve correla??o entre TL e idade (P =0, 449, r=0, 166), sexo (P=0, 521) , dura??o da doen?a (P =0, 358, r=-0, 318), JADAS (P = 0, 184, r=-0, 287) e VOP (P = 0, 843, r=0, 044) em crian?as com AIJ. Conclus?o: O TL foi significativamente menor nessa amostra de pacientes com AIJ de longa dura??o e com atividade da doen?a alta a moderada e sem fatores de risco para doen?a cardiovascular em compara??o aos controles. A VOP foi normal e sem diferen?a significativa em rela??o aos controles. N?o foram observadas correla??es significativas do TL ou do VOP com atividade e dura??o da doen?a, idade e sexo.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-08-01T16:54:22Z No. of bitstreams: 1 DIS_JULIANA_JASPER_PARCIAL.pdf: 388351 bytes, checksum: 6af0aff0490b73b53ede7bf4fe93485c (MD5) / Made available in DSpace on 2016-08-01T16:54:22Z (GMT). No. of bitstreams: 1 DIS_JULIANA_JASPER_PARCIAL.pdf: 388351 bytes, checksum: 6af0aff0490b73b53ede7bf4fe93485c (MD5) Previous issue date: 2016-04-18 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Radiation-induced oral mucositis (OM) is a highly debilitating side effect, which affects almost all patients with head and neck malignancies undergoing radiotherapy (RT). The severity of this injury is directly related to factors associated with the therapy itself and the individual characteristics of each patient. To date, there is no standard treatment protocol for this condition. Therefore, the present study aimed to evaluate clinically and histologically the effect of granulocyte colony-stimulating factor (G-CSF) on the healing of traumatic ulcers produced in the tongue of Wistar rats undergoing RT. The animals were randomly divided into 4 groups: 1) RT + traumatic ulcer + Filgrastim; 2) RT + traumatic ulcer + saline; 3) no RT + traumatic ulcer + Filgrastim; 4) no RT + traumatic ulcer. Filgrastim (r-metHuG-CSF), a recombinant G-CSF, was injected subcutaneously into the animals once daily, beginning 1 day after a single-dose radiation protocol (30 Gy), immediately after the traumatic ulcer was made. At the end of a 7-day experimental period, animals were euthanized and had their tongue surgically removed, processed, and stained with hematoxylin and eosin (HE). Clinically, all groups differed significantly in presence and size of traumatic ulcers, and the irradiated groups also differed significantly in severity of radiation-induced OM. Filgrastim-treated groups, submitted or not to RT, showed a better performance in this aspect. Histologically, there was an increased inflammatory response in the nonirradiated groups, with no statistically significant difference between the study drug and the respective control groups. Based on the present clinical results, we conclude that the use of Filgrastim reduced the manifestation and severity of trauma-induced ulcers and radiation-induced OM. This condition has a complex pathogenesis, which requires further detailed investigations on the actual role of G-CSF in its management before a formal recommendation regarding its use for this purpose can be made. / A mucosite oral (MO) radioinduzida ? um efeito colateral altamente debilitante, que afeta a quase totalidade dos indiv?duos portadores de neoplasias malignas na regi?o de cabe?a e pesco?o, submetidos ? radioterapia (RT). A gravidade desta inj?ria est? diretamente relacionada a fatores pertinentes ? terapia em si e ?s caracter?sticas individuais de cada paciente. N?o h?, at? o momento, um protocolo padr?o para o tratamento desta enfermidade. Sendo assim, o presente estudo objetivou analisar clinica e histologicamente a a??o do fator estimulador de col?nias de granul?citos (G-CSF) em ?lceras traum?ticas confeccionadas na l?ngua de ratos Wistar submetidos ? RT. Os animais foram alocados randomicamente em quatro grupos distintos: 1) RT + ?lcera traum?tica + Filgrastim; 2) RT + ?lcera traum?tica + soro fisiol?gico; 3) sem RT + ?lcera traum?tica + Filgrastim; 4) sem RT + ?lcera traum?tica. O Filgrastim (r-metHuG-CSF), um G-CSF recombinante, foi injetado diariamente nos animais pela via subcut?nea, iniciando um dia depois do protocolo ?nico de irradia??o (30 Gy), imediatamente ap?s a confec??o da ?lcera traum?tica. Uma vez conclu?do o tempo experimental de sete dias, os animais foram eutanasiados e tiveram a l?ngua excisada, processada e corada com hematoxilina e eosina (HE). A avalia??o cl?nica diferiu significativamente entre todos os grupos quanto ? presen?a e ao tamanho da ?lcera traum?tica, al?m do grau de severidade da MO radioinduzida, entre os grupos irradiados. Os grupos tratados com Filgrastim, submetidos ou n?o ? RT, apresentaram uma melhor performance neste quesito. Histologicamente, houve maior resposta inflamat?ria nos grupos n?o irradiados, sem diferen?a estatisticamente significante entre a medica??o estudada e os respectivos grupos controle. Baseado nos resultados cl?nicos encontrados, pode-se concluir que o uso do Filgrastim reduziu a manifesta??o e o grau de severidade da ?lcera confeccionada e da MO radioinduzida. Esta ? uma doen?a de patogenia complexa, a qual necessita investiga??es mais detalhadas sobre o real papel do G-CSF no seu manejo, para que uma indica??o formal do seu uso possa ser recomendada com esta finalidade.

Submitted by PPG Filosofia (filosofia-pg@pucrs.br) on 2018-09-25T20:17:37Z No. of bitstreams: 1 TES_M?RCIA DE C?SSIA CASSIMIRO.pdf: 2463749 bytes, checksum: 385f8cdc256f0fbd00f0f9b9f4ee466b (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-09-27T12:04:42Z (GMT) No. of bitstreams: 1 TES_M?RCIA DE C?SSIA CASSIMIRO.pdf: 2463749 bytes, checksum: 385f8cdc256f0fbd00f0f9b9f4ee466b (MD5) / Made available in DSpace on 2018-09-27T12:11:57Z (GMT). No. of bitstreams: 1 TES_M?RCIA DE C?SSIA CASSIMIRO.pdf: 2463749 bytes, checksum: 385f8cdc256f0fbd00f0f9b9f4ee466b (MD5) Previous issue date: 2018-08-29 / This thesis investigates based on Axel Honneth's Theory of Recognition, Conflicts of Interest [COIs] and integrity in the process of emancipation and management of a diversity of border issues such as: disrespect [Mi?achtung] and violation [Verletzung] to the citizen, capable of provoking profound transformations and changes to society in the face of the peculiar characteristics of a concrete social reality of participatory democratic domination. The thesis discusses the impact of violations on patients, research participants, society, and institutions; besides issues related to injustice and dishonesty arising from misconduct. COIs and misconduct provoke political, technical, ethical, and moral offenses when individuals are affected | violated in nonrecognition dynamics. The three patterns [affective, legal, solidarity] can have as consequence: [i] psychic death in the first pattern of [affective] recognition; [ii] social death in the second [legal] standard; and [iii] social humiliation in the third standard [solidarity]. The struggle for recognition is the condition for conflicts to be normative. There are models of justice such as: redistributive; economist, and recognition. But this thesis is delimited around the contribution of recognition to the theoretical confrontation of COIs and integrity. It is presumed that the struggle for recognition is a fundamental element in order to initiate research on COIs and integrity, thus articulating an interdisciplinary approach [Philosophy and Health]. COIs is a set of circumstances or conditions in which professional judgment of a primary interest such as integrity and quality in research tends to be unduly influenced by a secondary interest such as personal financial gain. COIs are classified into primary and secondary interests. Primary interests are determined by the professional duties of the researcher, physician, counselor and other professionals of the institution, and are related to the integrity of these different actors, and to the patient's well-being. Secondary interests are any type of interest that may affect the primary interest priority. They are harmful when they influence, corrupt or distort integrity and affect the judgment of the practitioner in relation to patient health and integrity. In addition to the definition proposed by Emanuel et al. [2008], this research comprehensively covers several areas of knowledge and institutions [universities, pharmaceutical industries, editors, professional and patient associations, and Research Ethics Committees]. Integrity has broad domain with many emphases, and demands commitment from various actors [institution, citizen, governors, patients, development agencies, etc.], that is, it involves a more reflective point of view on guidelines focusing on the development of multiple spheres, abilities or even virtues of the individual. It is imperative to recognize that COIs in clinical research and violations of integrity affect not only health professionals but every society, thus justifying the citizen's struggle not only against social order but against the social place to which, at present, science is being condemned. This is not the sole responsibility of scientists, but of the whole society and in particular of its rulers, researchers and professionals. Partnerships between researchers, teaching and research institutions, universities, patient associations, government, laboratories and universities are important for the development of science. Therefore, there is no pretense of stigmatizing these partnerships involving different actors. / Esta tese investiga com base na Teoria do Reconhecimento de Axel Honneth, os Conflitos de interesses [COIs] e a integridade no processo de emancipa??o e manejo de uma diversidade de quest?es lim?trofes tais como: desrespeito [Mi?achtung] e viola??o [Verletzung] ao cidad?o, capazes de provocar profundas transforma??es e mudan?as ? sociedade em face das caracter?sticas peculiares de uma realidade social concreta de dom?nio democr?tico participativo. A tese discute o impacto das viola??es causadas aos pacientes, aos participantes de pesquisa, a sociedade, e as institui??es; al?m de quest?es relacionadas a injusti?a e desonestidade decorrentes da m? conduta. COIs e m? conduta provocam impasses pol?ticos, t?cnicos, ?ticos, e ofensa moral, quando os indiv?duos s?o afetados | violados em din?micas de n?o reconhecimento [nonrecognition]. Os tr?s padr?es [afetivo, jur?dico, solidariedade] podem ter como consequ?ncia: [i] morte ps?quica no primeiro padr?o de reconhecimento [afetivo]; [ii] morte social no segundo padr?o [jur?dico]; e [iii] humilha??o social no terceiro padr?o [solidariedade]. A luta por reconhecimento ? a condi??o para que os conflitos sejam normativos. H? modelos de justi?a tais como: redistributivo; economicista, e de reconhecimento. Mas esta tese ? delimitada em torno da contribui??o do reconhecimento para o enfrentamento te?rico dos COIs e da integridade. Presume-se que a luta por reconhecimento constitui elemento fundamental para instanciar a investiga??o sobre COIs e integridade, articulando desta forma uma abordagem interdisciplinar [Filosofia e Sa?de]. COIs ? um conjunto de circunst?ncias ou condi??es nas quais o julgamento profissional de um interesse prim?rio como integridade e qualidade na pesquisa tende ser influenciado indevidamente por um interesse secund?rio, como ganho financeiro pessoal. Os COIs s?o classificados em interesses prim?rios e secund?rios. Os interesses prim?rios s?o determinados pelos deveres profissionais do pesquisador, m?dico, orientador e demais profissionais da institui??o, e est?o relacionados ? integridade destes distintos atores, e ao bem-estar do paciente. Os interesses secund?rios s?o qualquer tipo de interesse que possa afetar a prioridade do interesse prim?rio. S?o prejudiciais quando influenciam, corrompem ou distorcem a integridade e afetam o julgamento do profissional em rela??o ? sa?de do paciente, e a integridade. Para al?m da defini??o proposta por Emanuel et al. [2008], de maneira ampla esta pesquisa abrange diversas ?reas do conhecimento e institui??es [universidades, ind?strias farmac?uticas, editores, associa??es profissionais e de pacientes, e Comit?s de ?tica em Pesquisa]. Integridade possui dom?nio amplo com v?rias ?nfases, e demanda compromisso de diversos atores [institui??o, cidad?o, governantes, pacientes, ag?ncias de fomento, etc.], ou seja, envolve um ponto de vista mais reflexivo sobre diretrizes com foco no desenvolvimento de m?ltiplas esferas, capacidades ou mesmo virtudes do indiv?duo. ? imprescind?vel reconhecer que os COIs em pesquisa cl?nica e as viola??es de integridade n?o afetam apenas os profissionais da sa?de, mas toda sociedade, justificando assim a luta do cidad?o n?o apenas contra a ordem social, mas contra o lugar social ao qual, na atualidade, a ci?ncia est? sendo condenada. Esta n?o ? uma responsabilidade exclusiva dos cientistas, mas de toda a sociedade e em particular dos seus governantes, pesquisadores e profissionais. Parcerias entre pesquisadores, institui??es de ensino e pesquisa, universidades, associa??es de pacientes, governo, laborat?rios e universidades s?o importantes para o desenvolvimento da ci?ncia. Portanto, n?o h? pretens?o de estigmatizar estas parcerias envolvendo distintos atores.

Made available in DSpace on 2015-04-14T13:22:10Z (GMT). No. of bitstreams: 1 446386.pdf: 211369 bytes, checksum: 13312dd2aeb4a8b540096d5d60f5cf53 (MD5) Previous issue date: 2013-01-17 / The adolescent in conflict with the law is the one who gets involved with the practice of illegal acts, being an aspect of violence that most concern these days and that has shown an increase over the years since violence itself is considered a public health problem. The study of this subject is of fundamental importance in order to deepens psychological understanding of the dynamics between factors that affect the criminal conduct and deviant behaviors. The present study proposes to investigate aspects that influence these individuals to become involved with practice of violent acts. It s composed of two sections. The first section, theoretical, aimed to, through contributions from psychoanalytic theory, understand how the adolescent identifies himself with this behavior as from his life history and role models in the family. It was observed that the parent patterns are of fundamental importance in how these individuals identify themselves with deviant behaviors, therefore, liable of state intervention through the condemnation of the adolescent said in conflict with the law to fulfill a SocioEducative Measure (SEM). The second section, of empirical nature, was developed from qualitative methodological assumptions, this study had a sample of ten teenager under SEM in one unit of the Socioeducative Assistance Foundation of Rio Grande do Sul. All adolescents answered a Personal Information Data Sheet and Socio demographic, to the interview InternationalNeuropsychiatric MINI Interview and a semistructured interview. This interview was guided by three axes: a) the life history of participants; b) the experiences of violence; and c) the role models. The results were analyzed through the content analysis method and interpreted in the light of Psychoanalytic theoretical assumptions.Record units were identified which resulted in three final categories, which were illustrated with vignettes of the participants reports: a) childhood marked by a context of abandon and violence; b) identification and parental models; and c) uncertain future. The issues raised in the study allow to understand the involvement of teenagers with violence and the practice of criminal transgressions as result of a life story with meaningful experiences of dropout within a context marked by experiences of violence. The family, also inserted in this context, is incapable of breaking with the dynamic of the disharmonious relationships and consequently is the first and most important identification model that the child finds. Being, in large part, on parental models identified with the practice of offenses, that the young will shape his personality. The construction of an alternative life project is essential to break this cycle of violence, since most part of the participants envisions a unreal future in which recidivism in the commission of offenses is what presents itself closer to reality of these adolescents. / O adolescente em conflito com a lei ? aquele que se envolve com a pr?tica de atos infracionais, um dos aspectos da viol?ncia que mais preocupam nos dias de hoje e que tem apresentado um aumento ao longo dos anos, a ponto de pr?pria viol?ncia ser considerada um problema de sa?de p?blica. O estudo deste tema ? de fundamental import?ncia, a fim de aprofundar a compreens?o dos fatores que incidem na conduta delitiva e nos comportamentos desviantes. Assim a presente disserta??o se prop?e a investigar aspectos que influenciam estes sujeitos a se envolverem com a pr?tica de atos violentos. ? composta por duas se??es. A primeira se??o, te?rica, objetivou, por meio das contribui??es da teoria psicanal?tica, compreender como o adolescente se identifica com esse comportamento desviante e violento. Observou-se que os modelos parentais s?o de fundamental import?ncia na forma como esses sujeitos se identificam com as condutas desviantes, fatores que os tornam pass?veis da interven??o do Estado, atrav?s da condena??o ao cumprimento de uma Medida Socioeducativa (MSE). A segunda se??o, de cunho emp?rico, foi desenvolvida a partir de pressupostos metodol?gicos qualitativos. Este estudo contou com dez participantes em cumprimento de MSE em uma unidade da Funda??o de Atendimento Socioeducativo do Rio Grande do Sul. Todos os adolescentes responderam a uma Ficha de Dados Pessoais e S?cio demogr?ficos, ? entrevista International Neuropsychiatric Interview MINI e a uma Entrevista Semiestruturada, norteada por tr?s eixos: a) a hist?ria de vida dos participantes, b) as viv?ncias de viol?ncia e c) os modelos de identifica??o. Os resultados foram analisados atrav?s do m?todo de An?lise de Conte?do e interpretados ? luz dos pressupostos te?ricos psicanal?ticos. As unidades de registro identificadas resultaram em tr?s categorias finais, as quais foram ilustradas com vinhetas dos relatos dos participantes: a) inf?ncia marcada pelo contexto de abandono e viol?ncia, b) identifica??o e modelos parentais e c) futuro incerto. O estudo possibilitou compreender o envolvimento dos adolescentes com a viol?ncia e a pr?tica de atos infracionais como resultante de uma hist?ria de vida permeada por abandono, dentro de um contexto marcado pela viol?ncia. A fam?lia, tamb?m inserida nesse contexto, ? incapaz de romper com a din?mica das rela??es desarmoniosas e, consequentemente, ? o primeiro e mais importante modelo de identifica??o violento que a crian?a encontra, sendo, em grande parte, nos modelos parentais identificados com a pr?tica de delitos que o jovem ir? moldar sua personalidade. A constru??o de um projeto de vida alternativo ? imprescind?vel para interromper este ciclo de viol?ncia, visto que grande parte dos participantes vislumbra um futuro irreal, no qual a reincid?ncia no cometimento de delitos ? o que se apresenta de modo mais pr?ximo ? realidade desses adolescentes.

Made available in DSpace on 2015-04-14T13:22:11Z (GMT). No. of bitstreams: 1 447221.pdf: 1151139 bytes, checksum: 47916015df78938c7a9d15a76f7017a0 (MD5) Previous issue date: 2012-12-21 / Family is the first group that a human being takes part of. The scientific field is showing more and more interest in the family institution and when we talk about it we should always keep in mind that each of its members is unique and singular. The Systems Theory understand the families work in order to maintain their homeostatic balance and they avoid any form of change, too. However, this constant search for homeostasis can cause dysfunctional behaviors in the families if these represent a constant in their structures. Then when one of the members of the group decides to search for healthier operation patterns it creates an imbalance in this system that generates conflicts. However family conflicts are not undesirable since they conduct to the growth of the individuals and of the group. It is considered undesirable, when these conflicts are not solved and this is generally caused by lack of communication between the members of the family. Communication is an inherent ability of man and this shows up even through gestures and glances. This phenomenon is characterized as the transmission of information from one person to another and may be intentional or unintentional. Within the family context, the communication shows itself capable of being a mediator and even facilitator of conflicts generated by dissonant attitudes and opinions and it should be open, clear and it should allow a positive problem solving. Many scientific studies have been conducted in the theme of family conflicts and their resolutions, especially in the field of childhood and adolescence.An example of this is the Family Apperception Test (FAT) that is a projective and systemic instrument indicated for children and adolescents aged between six and fifteen years old. This test collects data from the family structure and functioning process from the point of view of the person who answers to it and it is told throughout stories elaborated by this person. FAT is originally American and because of this it must be submitted to studies of adaptation to the Brazilian reality before being marketed in the country. As a result of this, there have been studies of reliability among evaluators, content validity of the instrument and the popular responses. In order to complement this major project, this thesis brings the study of evidence of validity based on internal structure of the Answers Categorization System of FAT, and it is organized into two sections. The first one is theoretical and it analyzes the issues of communication and how it can be a facilitator of family conflicts. The second section is empirical and it performs an exploratory factor analysis made with principal component analysis and varimax rotation to account for the study of evidence of validity. Throughout this work it was possible to reach five factors that were grouped in a theoretically coherent way. This survey had a total sample of 451 children and adolescents that were divided into a non-clinical sample (329 participants) and a psychiatric clinical sample (122 subjects). This clinical sample was divided into five groups according to diagnosis hypotheses. Was reached five factors, which were theorecally coherent. The findings identified that FAT has validity based on the internal structure of the test / A institui??o familiar ? o primeiro grupo ao qual o ser humano se insere. Quando se trata do sistema familiar, ? fundamental se ter em mente que cada um de seus integrantes ? ?nico e singular, o que somente refor?a a premissa cl?ssica da Teoria Sist?mica de que o todo ? maior do que a soma das partes. As fam?lias funcionam de forma a manterem seu equil?brio homeost?tico, evitando qualquer forma de mudan?a. No entanto, esta busca constante pela homeostase pode fazer com que as fam?lias refor?arem comportamentos disfuncionais, desde que estes representem uma constante em sua estrutura. Assim, quando um de seus membros busca padr?es mais saud?veis de funcionamento, este cria um desequil?brio neste sistema, o que gerar? conflitos. A partir do entendimento sist?mico, os conflitos n?o s?o indesej?veis, j? que levam ao crescimento dos indiv?duos e do grupo. Indesej?vel, ent?o, ? a falta de resolu??o destes conflitos, que geralmente ? potencializada por falta de comunica??o entre seus membros. A comunica??o ? uma habilidade inerente do homem e mostra-se presente mesmo atrav?s de gestos e olhares. Este fen?meno caracteriza-se como a transmiss?o de informa??o de uma pessoa a outra, podendo ser intencional ou n?o. Dentro do contexto familiar, a comunica??o mostra-se capaz de ser mediadora, e at? mesmo facilitadora, de conflitos gerados por opini?es e posturas divergentes, devendo ser aberta e clara, permitindo uma resolu??o de problemas positiva. Na tem?tica dos conflitos familiares e de suas resolu??es, muitos estudos cient?ficos t?m sido realizados, especialmente no campo da inf?ncia e da adolesc?ncia.Nesta linha, surge o Teste de Apercep??o Familiar (FAT), instrumento projetivo aperceptivo sist?mico. Ele possibilita colher dados sobre estrutura e funcionamento familiar, a partir da percep??o de um de seus membros. ? indicado a crian?as e adolescentes, com idades entre seis e quinze anos, sendo do tipo elaborar hist?rias. Por ser originalmente americano, ? necess?rio que o mesmo passe por estudos de adapta??o ? realidade brasileira antes de ser comercializado no pa?s. J? foram realizados estudos de fidedignidade entre avaliadores, de validade de conte?do e de respostas populares do instrumento. A presente Disserta??o, traz o estudo de evid?ncia de validade com base na estrutura interna do Sistema de Categoriza??o de Respostas do FAT. Para tal, ? organizada em duas se??es. A primeira, de cunho te?rico, aborda a tem?tica da comunica??o como ferramenta facilitadora dos conflitos familiares. J? a segunda se??o, emp?rica, retrata a operacionaliza??o da an?lise fatorial explorat?ria, por componentes principais e rota??o varimax, para dar conta do estudo de evid?ncia de validade. A amostra total ? composta por 451 crian?as e adolescentes, divididas em dois grupos, um n?o cl?nico (329 participantes) e outro cl?nico psiqui?trico (122 sujeitos). Esta amostra cl?nica dividiu-se em cinco subgrupos, conforme hip?tese diagn?stica. Foi poss?vel chegar a cinco fatores, que se agruparam de forma teoricamente coerente. Com base nos achados, foi poss?vel identificar que o FAT apresenta qualidades psicom?tricas adequadas no que diz respeito ? validade com base na estrutura interna do teste.

Made available in DSpace on 2015-04-14T13:22:12Z (GMT). No. of bitstreams: 1 447894.pdf: 1745624 bytes, checksum: 63d4be9335c9c7e3bca96098ac6b3d04 (MD5) Previous issue date: 2013-01-18 / The prevalence of smoking among illicit drug users is significantly higher than the prevalence of smoking in the general population. It is known that in patients who use tobacco and cocaine, tobacco exposure may activate and increase crack cocaine administration. When treating a patient in parallel with comorbid dependencies you need to understand the differences and specificities of each substance, and realize their internship and their motivational readiness to change for each one separately. The goal of the empirical study was to determine, among patients who were in treatment for cocaine and crack use and were smokers, readiness to change for illicit substances and tobacco and its possible association. A methodology descriptive and correlational design, quantitative and cross. From a simple probability sample of 88 patients were admitted to a Therapeutic Farm in the metropolitan region of Porto Alegre. The instruments used to check the readiness to change for illicit substances and tobacco were the Algorithm, the Ruler of Readiness and URICA, using also a socio-economic questionnaire semi-structured questionnaire and the Fagerstrom for nicotine dependence. Regarding the results identified significant differences between the readiness for tobacco and illicit substances (p <0.001). According to the three instruments, individuals are more ready to change in relation to illicit substances than tobacco. While the prevalence of pre-contemplation is among tobacco users (79.5%), the highest prevalence of action and maintenance are among users of illicit substances (33% and 28.4%) for the URICA. In relation to the algorithm for the tobacco sample also prevailed in the stage of precontemplation (39.3%), whereas for illicit substances, the majority (75.3%) was found in the preparation. Thus concludes that tobacco users are less ready to change with regard to readiness to change in crack and cocaine. We also performed a systematic review, which was aimed to investigate the association of smoking on treatment of cocaine users and crack. Regarding the results, there was a direct association between following smoking during treatment for cocaine and worst results for the same treatment in the short and long term. From the systematic review concluded that consuming tobacco negatively affects the outcome of treatment for cocaine users. Thus it is suggested that treatments are offered concurrently and that health professionals also consider the readiness for change in motivational approaches related to tobacco consumption. / A preval?ncia de tabagismo entre os usu?rios de drogas il?citas ? significativamente mais alta do que a preval?ncia de tabagismo na popula??o geral. Sabe-se que, em pacientes que consomem tabaco e coca?na, a exposi??o ao tabaco pode ativar a fissura e aumentar a administra??o de coca?na. Ao tratar paralelamente um paciente com depend?ncias com?rbidas ? preciso entender as diferen?as e especificidades de cada subst?ncia, assim como perceber o seu est?gio motivacional e a sua prontid?o para a mudan?a para cada uma, isoladamente. O objetivo do estudo emp?rico foi verificar, entre os pacientes que estavam em tratamento para uso de crack e coca?na e que eram tabagistas, a prontid?o para mudan?a para as subst?ncias il?citas e para o tabaco e sua poss?vel associa??o. Foi utilizada uma metodologia descritiva, com delineamento correlacional, quantitativo e transversal. A partir de uma amostra aleat?ria simples foram avaliados 88 pacientes internados em uma Fazenda Terap?utica da regi?o metropolitana de Porto Alegre. Os instrumentos utilizados para verificar a prontid?o para mudan?a para subst?ncias il?citas e para o tabaco foram o Algor?timo, a R?gua de Prontid?o e a URICA, utilizando-se, ainda, um question?rio socio-econ?mico semi-estruturado e o Question?rio de Fagerstrom para depend?ncia de nicotina. Em rela??o aos resultados se identificou diferen?a significativa entre a prontid?o para o tabaco e a para as subst?ncias il?citas (p<0,001). De acordo com os tr?s instrumentos utilizados, os indiv?duos encontram-se mais prontos para a mudan?a em rela??o ?s subst?ncias il?citas do que em rela??o ao tabaco. Enquanto que a maior preval?ncia de pr?-contempla??o est? entre os usu?rios de tabaco (79,5%), a maior preval?ncia de a??o e manuten??o est? entre os usu?rios de subst?ncias il?citas (33% e 28,4%) pela URICA. Em rela??o ao algoritmo, para o tabaco a amostra prevaleceu tamb?m no est?gio de pr?-contempla??o (39,3%), ao passo que para as subst?ncias il?citas, a grande maioria (75,3%) se encontrou em prepara??o. Assim se conclui que os usu?rios de tabaco est?o menos prontos para mudar em rela??o ? prontid?o para mudan?a de usu?rios de crack e coca?na. Tamb?m foi realizada uma revis?o sistem?tica, cujo objetivou foi verificar a associa??o do tabagismo no tratamento de usu?rios de coca?na e crack. Em rela??o aos resultados, se verificou uma associa??o direta entre seguir fumando ao longo do tratamento para coca?na e piores resultados no tratamento para a mesma, em curto e longo prazos. A partir da revis?o sistem?tica se concluiu que consumir tabaco interfere negativamente no resultado de tratamento para usu?rios de coca?na. Dessa forma sugere-se que os tratamentos sejam oferecidos concomitantemente e que os profissionais da sa?de tamb?m considerem a prontid?o para mudan?a em abordagens motivacionais relacionadas ao consumo de tabaco.

Made available in DSpace on 2015-04-14T13:22:19Z (GMT). No. of bitstreams: 1 456258.pdf: 326164 bytes, checksum: 4d80c19cc789dadf3190298918876566 (MD5) Previous issue date: 2014-03-10 / The global fight against drug consumption and its devastating effects has already spanned throughout many decades. Indicators of production and consumption of psychoactive substances continue to be alarming, since there is an estimate that, by 2010, the number of problematic drug users reached the mark of 27 million people (UNODC, 2012). Since the phenomenon of Drug Addiction/Substance Abuse is fully aligned with the frantic search for substances that relieve the discomfort, one needs to recognize the heterogeneity of the use, of the understanding and of the intervention of this phenomenon. We opted, in this PhD thesis for, from the epistemological perspective of psychoanalysis, considering modalities of drug use involving a state of slavery of the subject(s) to the elected substance(s). Throughout the Thesis, we use the classification already established - Drug Addiction because it highlights essential points of the phenomenon as a pathological dependence, in which the subject cannot do without the drug-object and a choice uniquely marked by precariousness of himself in a psychic economy mainly composed of death instincts. Being the contribution to the Psychoanalytic Metapsychology its aim, questioning the choice of object-drug, its dynamics and its role in the psychic economy from the effects of the subject's history. This Thesis is organized in four sections, being two of which theoretical and two empirical. The first section proposes theoretical characterizations of the notion of subject throughout History. Its main objective was to characterize the epistemological break produced by the advent of Psychoanalysis and the expansion of the notion of subject caused by it. It also questioned discomfort settings that affect the contemporary subject and the risks that arise from the understanding that reduces human phenomena to a normative model of psychopathology. The second theoretical section concerns the presentation of the research strategy design built throughout the layout of this research. Built on the Psychoanalytic Method, the proposition of the Clinical-Interpretative Strategy rests on the consideration that the Listening is a broader process than the stricto sensu psychoanalytic clinics. The stages of Clinical-Interpretative Strategy are presented, fostering it as a valid resource for the psychoanalytic research in the Academy. The third section is an empirical study conducted with seven drug addicts, located according to convenience. Each participant of the study was heard by a psychoanalyst in a series of interviews, which were analyzed in the light of Clinical-Interpretative Strategy. Significant differences were identified in terms of investments from participants with regard to the choice and the function of the object-drug, which led to the proposition of two defensive resources, called autoerotic servitude and narcissistic servitude. The fourth and last section presents a second empirical study through the case study of a participant whose story allowed us question the concept of narcissism and its positive and negative aspects, how the negative side works and its relationship with the addiction. The results obtained allow us to claim to be the Clinical-Interpretative Strategy a legitimate alternative to the research with the Psychoanalytic Method contemplating its rigor and specificity. Furthermore, it is considered that the proposal of the notions of autoerotic servitude and narcissistic servitude offers an important contribution to Metapsychology, highlighting different nuances in terms of ego investment present in the psychic and dynamic economy of Drug Addiction / O combate mundial ao avan?o das drogas e seus efeitos devastadores j? atravessa muitas d?cadas. Os indicadores de produ??o e consumo de subst?ncias psicoativas seguem alarmantes, pois se estima que, em 2010, o n?mero de usu?rios problem?ticos de drogas alcan?ava cerca de 27 milh?es de pessoas (UNODC, 2012). Sendo o fen?meno da Drogadi??o/Toxicomania totalmente alinhado ? busca fren?tica por subst?ncias que aliviem o mal-estar, ? preciso reconhecer a heterogeneidade do uso, da compreens?o e da interven??o sobre esse fen?meno. Optou-se, nessa Tese de Doutorado por, desde a perspectiva epistemol?gica da Psican?lise, contemplar modalidades de uso de drogas que envolvam um estado de escravid?o do sujeito ?(s) subst?ncia(s) eleita(s). Ao longo da Tese, utilizam-se as nomenclaturas j? consagradas Drogadi??o ou Toxicomania por ressaltarem pontos essenciais do fen?meno como a depend?ncia patol?gica, na qual o sujeito n?o pode prescindir do objeto-droga e a elei??o singular marcada pela precariedade do si mesmo em uma economia ps?quica predominantemente tan?tica. Objetivou-se contribuir com a Metapsicologia Psicanal?tica, problematizando a elei??o do objeto-droga, sua din?mica e sua fun??o na economia ps?quica a partir dos efeitos da hist?ria do indiv?duo. Esta Tese est? organizada em quatro se??es, sendo duas de cunho te?rico e duas de cunho emp?rico. A primeira se??o te?rica prop?e caracteriza??es de no??o de sujeito ao longo da Hist?ria. Seu objetivo principal foi caracterizar a ruptura epistemol?gica produzida pelo advento da Psican?lise e a amplia??o da no??o de sujeito provocada por ela. Problematizou, tamb?m, as configura??es de mal-estar que acometem o sujeito contempor?neo e os riscos oriundos da leitura que reduz os fen?menos humanos a um modelo normativo de psicopatologia. A segunda se??o te?rica diz respeito ? apresenta??o do delineamento da estrat?gia de investiga??o constru?da ao longo da execu??o desta pesquisa. Sustentada no M?todo Psicanal?tico, a proposi??o da Estrat?gia Cl?nico-Interpretativa est? apoiada na considera??o de ser a Escuta um processo mais amplo que a cl?nica psicanal?tica stricto sensu. Apresentam-se as etapas da Estrat?gia Cl?nico-Interpretativa, sustentando-a como um recurso v?lido ? pesquisa psicanal?tica na Academia. A terceira se??o ? um estudo emp?rico, realizado com sete participantes toxic?manos, localizados por conveni?ncia. Cada participante foi escutado por um psicanalista em um conjunto de entrevistas, as quais foram analisadas ? luz da Estrat?gia Cl?nico-Interpretativa. Identificaram-se importantes diferen?as nas modalidades de investimentos dos participantes em rela??o ? elei??o e ? fun??o do objeto-droga, o que levou ? proposi??o de dois recursos defensivos, denominados servid?o autoer?tica e servid?o narc?sica. A quarta e ?ltima se??o apresenta um segundo estudo emp?rico realizado atrav?s do Estudo de Caso de uma participante, cuja hist?ria permitiu problematizar o conceito de narcisismo em suas vertentes positiva e negativa, o trabalho do negativo e sua rela??o com a Toxicomania. Os resultados obtidos permitem afirmar ser a Estrat?gia Cl?nico-Interpretativa uma leg?tima alternativa ? pesquisa com o M?todo Psicanal?tico contemplando seu rigor e sua especificidade. Considera-se, ainda, que a proposi??o das no??es de servid?o autoer?tica e narc?sica oferecem uma importante contribui??o ? Metapsicologia, destacando nuances diferentes nas modalidades de investimento do Eu presentes na economia e din?mica ps?quica da Drogadi??o.