This master thesis deals with infertility and its treatment. Both in the theoretical and empirical part, it focuses on the female aspects of the issue. The theoretical part summarizes an overview of key information important to understand the presented problems. We define the terms, describe the psychological and physiological causes of infertility, the process of treatment of infertility and aspects thereof. We focus on the depression rate related to infertility and its treatment, furthermore, we deal with type locus of control related to the experienced rate of depression. Our aim in the empirical part is to describe the depression rate, type of locus of control within the two samples of women acquired by us and capture the possible connections. The sample is made of 58 women who are currently undergoing a treatment for infertility and of the control group, which is made of 58 healthy women. To collect the data, we used the Beck Depression Inventory BDI-II, the Rotter's Internal- External Scale and the anamnestic questionnaire. Based on acquired data, we found out some specifity in depression rate and type of locus of control within our samples of women.

Made available in DSpace on 2016-01-26T12:51:19Z (GMT). No. of bitstreams: 1 giselacipullomoreira_dissert.pdf: 626826 bytes, checksum: 7830cd1b2ab68f2ea495821fb6fcd7a0 (MD5) Previous issue date: 2008-01-31 / Systemic hypertension (SH) is a disease with high prevalence worldwidely. It is considered one of the main risk factors for cardiovascular morbimortality. Objectives: This study aims to evaluate in individuals aged over 40 years, their level of awareness and control of SH, associated with age group, gender, socioeconomic status, educational level, body mass indexes, treatment with monotherapy or drug association; to compare the blood pressure control with the main related-drug substances; to evaluate the cost- effectiveness ratio among the main antihypertensive drugs and associations and to compare the cost of generic and conventional drugs. Casuistics and Method: In this randomized cross-transversal study, a sample of 738 individuals aged between 40 and 93 years; 345 male (46.7%) and 393 female (53.3%) was evaluated due the greatest prevalence of hypertension from this age. Results: In relation to awareness level, it was observed that 72.9% (IC 95%: 69.5 76.3%) of hypertensives were aware of their condition, predominantly the female with ages between 40-49 years and 50-59 years, and a higher prevalence of awareness among the overweighed . No significant difference of awareness was observed among socioeconomic classes and educational levels. According to blood pressure control, higher prevalence of control was observed in A B social classes than in the others; as also in the higher educational level mainly in the age group of 40-49 years. No significant difference between genders and different body mass indexes (BMI) was observed. According to the number of drugs used, 44.6% of these hypertensives have been using monotheraphy; control pressure was more effective with beta blockers. A total of 41.2% of them were using two drugs association: diuretics and ACE inhibitors, mostly used, and 14.2% were using three or more drugs. Conclusion: Higher prevalence of awareness was observed either in female gender or in the overweighed, while no differences in the socioeconomic groups and educational level were observed. In relation to the control, higher prevalence was observed in AB classes and in higher educational level, while no difference between the genders and in the different BMI groups. When comparing monotherapy with drug association, there was no significant difference in SH control. Cost-effectiveness relationship was lower with monotherapy than with association; being the diuretics mostly cost-effectiveness. Comparing the mean of the cost of conventional drugs in relation to controlled hypertensives or not, it was conclude that an appropriate blood pressure control provides a lower cost of the treatment. / A hipertensão arterial sistêmica (HAS) é uma doença com alta prevalência em quase todos os países, constituindo um dos principais fatores de risco para morbimortalidade cardiovascular. Objetivos: Os objetivos deste estudo foram avaliar na faixa etária acima de quarenta anos, o nível de conhecimento e controle da HAS, relacionados com a faixa etária, gênero, nível sócio-econômico, escolaridade, índice de massa corpórea, utilização de monoterapia e associação de fármacos; comparar o controle pressórico obtido com as principais classes de fármacos; avaliar a relação custo-efetividade comparando as principais classes de anti-hipertensivos e associações e comparar o custo dos medicamentos de referência e genéricos. Casuística e Método: Neste estudo de corte transversal randomizado, avaliou-se uma amostra de 738 indivíduos hipertensos com idade entre 40 e 93 anos de idade, sendo 345 do gênero masculino (46,7%) e 393 do gênero feminino (53,3%), em virtude da maior prevalência da HAS nesta faixa etária. Resultados: Avaliando-se o conhecimento, observou-se que 72,9% (IC 95%: 69,5 -76,3) dos hipertensos conheciam sua condição, com predomínio no gênero feminino nas faixas etárias de 40-49 anos e 50-59 anos, e maior prevalência de conhecimento no grupo obeso.Não se observou diferença significativa no conhecimento entre as classes sociais e níveis de escolaridade. Analisando-se o controle pressórico não se observou diferença significante entre os gêneros, nas faixas etárias e nas diferentes faixas de índice de massa corpórea. Observou-se maior prevalência de controle na classe social AB e no nível E-3 de escolaridade. De acordo com o número de fármacos utilizados, 44,6% dos hipertensos tratados utilizavam monoterapia sendo os betabloqueadores o grupo mais efetivo no controle pressórico; 41,2% dos indivíduos utilizavam associação de dois fármacos, sendo diuréticos + IECA a mais utilizada e 14,2% faziam uso de três ou mais fármacos. Conclusões: Não se observou diferença significante no controle da HAS comparando-se a monoterapia com a associação de fármacos. A relação custo-efetividade foi menor com monoterapia do que com associação, sendo os diuréticos os mais custo-efetivos. Na comparação entre as médias de custo dos medicamentos de referência em relação aos hipertensos controlados ou não, concluiu-se que com o controle pressórico adequado, o custo de tratamento torna-se menor.

The intensification of freshwater aquaculture worldwide has facilitated the propagation of the parasitic ciliate protozoan Ichthyophthirius multifiliis Fouquet, 1876 commonly known as “fish white spot” or “Ich”. Ichthyophthirius multifiliis infections lead to high mortalities, generating significant economic losses in most cultured freshwater fish species worldwide. Until recently, malachite green was the chemical treatment traditionally used to control I. multifiliis infections. Its reclassification as carcinogenic to humans and its subsequent ban for use in food fish has left the industry without any suitable treatments. Currently, in-bath formaldehyde and sodium chloride treatments are the most common option used in farm systems to control I. multifliis infections. Given their low efficacy, however, they are not considered as sustainable long–term options. There is, therefore, an urgent necessity to find efficacious alternatives for controlling I. multifliis infections. The general aim of this research project was to improve the management of I. multifiliis infections in order to develop more comprehensive, environmentally friendly and sustainable therapeutic strategies for use in freshwater food fish aquaculture. The present PhD-thesis present first a literature review chapter providing an overview and critical assessment of chemotherapeutants and physical interventions tested within the last 30 years against I. multifiliis infections. The experimental worked consisted of a number of in vitro and in vivo trials were conducted using experimental scale flow-through, static tank systems and commercial scale raceways within a rainbow trout hatchery, in addition to molecular work on different isolates of the parasite. The results of this research are organised into three experimental chapters which describe the testing of chemical and non-chemical treatments against I. multifiliis infections and work undertaken to determine the most suitable molecular markers to identify I. multifiliis isolates. In the first experimental chapters, the possibility of efficiently controlling I. multifliis infections through the administration of novel environmentally-friendly chemical treatments (e.g. bronopol and peracetic acid-based products) was investigated. The results clearly showed that bronopol and peractic acid-based products have a strong biocidal/cytotoxic effect against all free-living stages of I. multifiliis (e.g. tomonts, cysts and theronts). The administration of high concentrations of bronopol (e.g. 20, 50 and 100 mg L-1) over short periods of exposure (e.g. 30 min) significantly reduced the survival of tomonts, cysts and theronts and delayed the development of I. multifiliis tomonts and cysts. Prolonged low concentrations of bronopol (e.g. 1 mg L-1) greatly reduced the survival of infective theronts, although such treatment did not affect the ability of surviving theronts to subsequently infect a host. When tested in vivo, the continuous prolonged exposure (e.g. 27 days) of low concentrations of bronopol (e.g. 2 and 5 mg L-1) had an impact on the population dynamics of I. multifiliis, this being demonstrated by a significant reduction in the number of trophonts developing within the fish. Low concentrations of bronopol (e.g. 2 mg L-1) administrated as a preventive treatment prior to infection also proved to be very successful at reducing the colonisation success of I. multifiliis. Peracetic acid administrated at low concentrations (e.g. 8, 12 and 15 mg L-1) over a short window of exposure (e.g. 1 h) displayed a strong biocidal effect against all the free-living stages of I. multifiliis (e.g. tomonts, cysts and theronts). The bronopol and peracetic acid-based products tested here both appear to be capable of disrupting the development of the cyst stage of I. multifiliis which is seldom reported for chemotherapeutants currently used against this parasite. These results suggest that bronopol and peracetic acid-based products have a place in the arsenal of treatment options for controlling I. multifiliis infections in commercial aquaculture systems. The use of a mechanical device or a biological control agent to remove the cyst stage of I. multifiliis and the impact of such control on the population dynamics and the levels of infection of fish were also investigated. The results revealed that tomonts preferentially settle and encyst on the base of culture systems and on biofilm–covered substrates. The survival of the tomont stage is greatly affected by the composition of the substrate upon which it settles and is significantly lower on polypropylene-based plastic. The lining of raceways in a commercial rainbow trout hatchery with a low-adhesion polymer created a smooth surface facilitating the dislodgement and elimination of the cyst stage of I. multifilis by natural flushing or brushing. The physical removal of the cyst stage alone, through the use of a mechanical device or substrate detrivorous/algae feeder as a biological control agent, significantly reduced the propagation of I. multifiliis to a low level of infection without the need to deploy an additional chemical treatment. These studies demonstrate that the cyst is a key stage in the dynamics of I. multifiliis infection and its removal from the fish culture systems could constitute an effective and simple mean of managing I. multifiliis infections. The third experimental chapter explores the utilisation of molecular marker to characterise different isolates of I. multifiliis. The results highlight the unsuitability of the rDNA region (ITS-1 and ITS-2) and the strong potential of the mtDNA (COI) as molecular markers to discriminate isolates of I. multifiliis from distant geographical locations. It is suggested that genetic “barcoding” using mtDNA is the most effective method to identify I. multifiliis isolates. Importantly, genetic “barcoding” could allow associating I. multifiliis strains or geographical isolates with particular properties as regards their ecophysiology, pathogenicity and sensitivity to treatment, in order to improve the management of I. multifiliis infections according to the specific genetic isolate encountered. This research project demonstrates the efficacy of a range of new approaches against the propagation of I. multifiliis. Together, our findings contribute towards the development of a more effective and integrated system for managing I. multifliis infections in farm systems. The utilisation of physical methods and of environmentally friendly chemotherapeutants holds great potential for the control of I. multifiliis infections in organic fish production and in a broader context to any freshwater food fish farms affected by I. multifiliis.

O presente trabalho teve como objetivo o estudo de experimentos em delineamentos em esquema fatorial duplo com tratamento adicional do tipo testemunha. Para este esquema usa-se a notação A x B +1, em que A representa o primeiro fator com i níveis (i = 1, 2, ..., a) e B representa o segundo fator com j níveis (j = 1, 2, ..., b) com a adição do tratamento adicional. Para a análise de variância deste caso, consideraram-se os modelos lineares yijk = μ + αi + βj + γij + εijk e yh = μ + τ + εh; relacionados, em que yijk é a variável observada no i-ésimo nível do fator α com o j-ésimo nível do fator β da k-ésima repetição (k = 1, 2, ..., r), μ é a média amostral, αi é o efeito do i-ésimo nível do primeiro fator, βj é o efeito do j-ésimo nível do segundo fator, γij é o efeito da interação do i-ésimo nível do fator α com o j-ésimo nível do fator β, εijk é o erro associado independente e identicamente distribuído, εijk~N(0,σ2), yh é a variável observada na h-ésima repetição do tratamento adicional, τ é o efeito do tratamento adicional e εh é o erro associado ao tratamento adicional, independente e identicamente distribuído εh~N(0,σ2). Considerou-se os delineamentos experimentais inteiramente casualizado e blocos casualizados. Para a análise do delineamento em blocos ao acaso, a adição do efeito de blocos λv (v = 1, 2, ..., w) aos modelos, se fez necessária. Foi realizada a dedução da soma de quadrados de tratamentos e sua decomposição para os efeitos dos fatores, sua interação e o contraste com o tratamento adicional. Os graus de liberdade foram deduzidos a partir do posto da matriz núcleo da forma quadrática das somas de quadrados. A técnica do diagrama de Hasse também foi adotada para dedução das somas de quadrados e graus de liberdade. Uma ilustração do método obteve os mesmos resultados da análise de variância do pacote ExpDes no programa R. Curvas de regressão linear foram ajustadas considerando o tratamento controle como um nível de fatores quantitativos. O teste de Dunnett foi empregado para comparar as médias do fatorial com o tratamento controle. / The present study aimed to study the experiments in two-way factorial designs with additional treatment of type control. For this scheme uses the notation A x B +1, where A represents the first factor levels with i (i = 1, 2, ..., a) and B is the second factor with levels j (j = 1 , 2, ..., b) with the addition of one more treatment. For the analysis of variance of this case, we considered the linear models yijk = μ + αi + βj + γij + εijk and yh = μ + τ + εh; related, wherein yijk is the variable observed in the ith level of factor α with the jth level of factor β of k-th iteration (k = 1, 2, ..., r), μ is the sample mean, αi is the effect of the ith level of the first factor, βj is the effect of the jth level of the second factor, γij is the interaction effect of the ith level of factor α with the jth level of factor β, εijk is the error associated with independent and identically distributed, εijk~N(0,σ2), yh is the variable observed in the hth repetition of the additional treatment, τ is the effect of the additional treatment and εh is the error associated to the additional treatment, independent and identically distributed εh~N(0,σ2). It was considered the completely experimental designs and randomized block design. For the analysis of the randomized block design, the addition of blocks effect λv (v = 1, 2, ..., w) to the models, was necessary. Was performed the deduction of the sum of squares of treatments and their decomposition to the effects of the factors, their interaction and the contrast with the additional treatment. The degrees of freedom were deducted from the posto of the matrix core of the quadratic form of sums of squares. The Hasse diagram technique has also been adopted for deduction of sums of squares and degrees of freedom. An illustration of the method has obtained the same results of analysis of variance program package ExpDes in R. Linear regression analysis was fitted control treatment as a level of the quantitative factors. The Dunnett test was used to compare the means of the factorial with the control treatment.

O presente trabalho teve como objetivo o estudo de experimentos em delineamentos em esquema fatorial duplo com tratamento adicional do tipo testemunha. Para este esquema usa-se a notação A x B +1, em que A representa o primeiro fator com i níveis (i = 1, 2, ..., a) e B representa o segundo fator com j níveis (j = 1, 2, ..., b) com a adição do tratamento adicional. Para a análise de variância deste caso, consideraram-se os modelos lineares yijk = μ + αi + βj + γij + εijk e yh = μ + τ + εh; relacionados, em que yijk é a variável observada no i-ésimo nível do fator α com o j-ésimo nível do fator β da k-ésima repetição (k = 1, 2, ..., r), μ é a média amostral, αi é o efeito do i-ésimo nível do primeiro fator, βj é o efeito do j-ésimo nível do segundo fator, γij é o efeito da interação do i-ésimo nível do fator α com o j-ésimo nível do fator β, εijk é o erro associado independente e identicamente distribuído, εijk~N(0,σ2), yh é a variável observada na h-ésima repetição do tratamento adicional, τ é o efeito do tratamento adicional e εh é o erro associado ao tratamento adicional, independente e identicamente distribuído εh~N(0,σ2). Considerou-se os delineamentos experimentais inteiramente casualizado e blocos casualizados. Para a análise do delineamento em blocos ao acaso, a adição do efeito de blocos λv (v = 1, 2, ..., w) aos modelos, se fez necessária. Foi realizada a dedução da soma de quadrados de tratamentos e sua decomposição para os efeitos dos fatores, sua interação e o contraste com o tratamento adicional. Os graus de liberdade foram deduzidos a partir do posto da matriz núcleo da forma quadrática das somas de quadrados. A técnica do diagrama de Hasse também foi adotada para dedução das somas de quadrados e graus de liberdade. Uma ilustração do método obteve os mesmos resultados da análise de variância do pacote ExpDes no programa R. Curvas de regressão linear foram ajustadas considerando o tratamento controle como um nível de fatores quantitativos. O teste de Dunnett foi empregado para comparar as médias do fatorial com o tratamento controle. / The present study aimed to study the experiments in two-way factorial designs with additional treatment of type control. For this scheme uses the notation A x B +1, where A represents the first factor levels with i (i = 1, 2, ..., a) and B is the second factor with levels j (j = 1 , 2, ..., b) with the addition of one more treatment. For the analysis of variance of this case, we considered the linear models yijk = μ + αi + βj + γij + εijk and yh = μ + τ + εh; related, wherein yijk is the variable observed in the ith level of factor α with the jth level of factor β of k-th iteration (k = 1, 2, ..., r), μ is the sample mean, αi is the effect of the ith level of the first factor, βj is the effect of the jth level of the second factor, γij is the interaction effect of the ith level of factor α with the jth level of factor β, εijk is the error associated with independent and identically distributed, εijk~N(0,σ2), yh is the variable observed in the hth repetition of the additional treatment, τ is the effect of the additional treatment and εh is the error associated to the additional treatment, independent and identically distributed εh~N(0,σ2). It was considered the completely experimental designs and randomized block design. For the analysis of the randomized block design, the addition of blocks effect λv (v = 1, 2, ..., w) to the models, was necessary. Was performed the deduction of the sum of squares of treatments and their decomposition to the effects of the factors, their interaction and the contrast with the additional treatment. The degrees of freedom were deducted from the posto of the matrix core of the quadratic form of sums of squares. The Hasse diagram technique has also been adopted for deduction of sums of squares and degrees of freedom. An illustration of the method has obtained the same results of analysis of variance program package ExpDes in R. Linear regression analysis was fitted control treatment as a level of the quantitative factors. The Dunnett test was used to compare the means of the factorial with the control treatment.

Background: Although the relationship between body weight and blood pressure (BP) is well established, there is a lack of data regarding the impact of obesity on the prevalence of hypertension in primary care practice. The objective of this study was to assess the prevalence of hypertension and the diagnosis, treatment status, and control rates of hypertension in obese patients as compared to patients with normal weight. Methods: A cross-sectional point prevalence study of 45,125 unselected consecutive primary care attendees was conducted in a representative nationwide sample of 1912 primary care physicians in Germany (HYDRA). Results: Blood pressure levels were consistently higher in obese patients. Overall prevalence of hypertension (blood pressure ≥140/90 mm Hg or on antihypertensive medication) in normal weight patients was 34.3%, in overweight participants 60.6%, in grade 1 obesity 72.9%, in grade 2 obesity 77.1%, and in grade 3 obesity 74.1%. The odds ratio (OR) for good BP control (<140/90 mm Hg) in diagnosed and treated patients was 0.8 (95% confidence interval [CI] 0.7– 0.9) in overweight patients, 0.6 (95% CI 0.6–0.7) in grade 1, 0.5 (95% CI 0.4–0.6) in grade 2, and 0.7 (95% CI 0.5– 0.9) in grade 3 obese patients. Conclusions: The increasing prevalence of hypertension in obese patients and the low control rates in overweight and obese patients document the challenge that hypertension control in obese patients imposes on the primary care physician. These results highlight the need for specific evidence-based guidelines for the pharmacologic management of obesity-related hypertension in primary practice.