Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [117]-142).

1. Today honey bee colonies face a wide range of challenges in modern agricultural landscapes which entails the need for a comprehensive investigation of honey bees in a landscape context and the assessment of environmental risks. Within this dissertation the pollen foraging of honey bee colonies is studied in different agricultural landscapes to gain insight into the use of pollen resources and the influence of landscape structure across the season. General suggestions for landscape management to support honey bees and other pollinators are derived. 2. Decoding of waggle dances and a subsequent spatial foraging analysis are used as methods in Chapters 4 and 5 to study honey bee colonies in agricultural landscapes. The recently developed metabarcoding of mixed pollen samples was applied for the first time in honey bee foraging ecology and allowed for a detailed analysis of pollen, that was trapped from honey bees in front hive entrances (Chapter 6). 3. Pollen identification through molecular sequencing and DNA barcoding has been proposed as an alternative approach to light microscopy, which still is a tedious and error-prone task. In this study we assessed mixed pollen probes through next-generation sequencing and developed a bioinformatic workflow to analyse these high-throughput data with a newly created reference database. To evaluate the feasibility, we compared results from classical identification based on light microscopy from the same samples with our sequencing results. Abundance estimations from sequencing data were significantly correlated with counted abundances through light microscopy. Next-generation sequencing thus presents a useful and efficient workflow to identify pollen at the genus and species level without requiring specialized palynological expert knowledge. 4. During maize flowering, four observation hives were placed in and rotated between 11 landscapes covering a gradient in maize acreage. A higher foraging frequency on maize fields compared to other landuse types showed that maize is an intensively used pollen resource for honey bee colonies. Mean foraging distances were significantly shorter for maize pollen than for other pollen origins, indicating that effort is put into collecting a diverse pollen diet. The percentage of maize pollen foragers did not increase with maize acreage in the landscape and was not reduced by grassland area as an alternative pollen resource. Our findings allow estimating the distance-related exposure risk of honey bee colonies to pollen from surrounding maize fields treated with systemic insecticides. 5. It is unknown how an increasing area of mass-flowering crops like oilseed rape (OSR) or a decrease of semi-natural habitats (SNH) change the temporal and spatial availability of pollen resources for honey bee colonies, and thus foraging distances and frequency in different habitat types. Sixteen observation hives were placed in and rotated between 16 agricultural landscapes with independent gradients of OSR and SNH area within 2 km to analyze foraging distances and frequencies. SNH and OSR reduced foraging distance at different spatial scales and depending on season, with possible benefits for the performance of honey bee colonies. Frequency of pollen foragers per habitat type was equally high for SNH, grassland and OSR fields, but lower for other crops and forest. In landscapes with a small proportion of SNH a significantly higher density of pollen foragers on SNH was observed, indicating the limitation of pollen resources in simple agricultural landscapes and the importance of SNH. 6. Quantity and diversity of collected pollen can influence the growth and health of honey bee colonies, but little is known about the influence of landscape structure on pollen diet. In a field experiment we rotated 16 honey bee colonies across 16 agricultural landscapes (see also Chapter 5), used traps to get samples of collected pollen and observed the intra-colonial dance communication to gain information about foraging distances. Neither the amount of collected pollen nor pollen diversity were related to landscape diversity. The revealed increase of foraging distances with decreasing landscape diversity suggests that honey bees compensate for a lower landscape diversity by increasing their pollen foraging range in order to maintain pollen amount and diversity. 7. Our results show the importance of diverse pollen resources for honey bee colonies in agricultural landscapes. Beside the risk of exposure to pesticides honey bees face the risk of nutritional deficiency with implications for their health. By modifying landscape composition and therefore availability of resources we are able to contribute to the wellbeing of honey bees. Agri-environmental schemes aiming to support pollinators should focus on possible spatial and temporal gaps in pollen availability and diversity in agricultural landscapes. / 1. Honigbienen stehen heutzutage vor einer Vielzahl von Herausforderungen in der modernen Agrarlandschaft, was umfassende Untersuchungen von Honigbienen im Landschafskontext erforderlich macht. Im Rahmen dieser Arbeit wurde das Pollensammeln von Honigbienenvölkern in verschiedenen Agrarlandschaften studiert, um Einblick in die Nutzung von Pollenressourcen und auf den Einfluss der Landschaftsstruktur zu gewinnen. 2. Die Dekodierung von Schwänzeltänzen und eine anschließende räumliche Analyse des Sammelverhaltens werden als Methoden in den Kapiteln 4 und 5 eingesetzt, um Bienenvölker in Agrarlandschaften zu untersuchen. Das kürzlich entwickelte Metabarcoding von gemischten Pollenproben wurde zum ersten Mal in der Honigbienenökologie angewandt und ermöglichte eine detaillierte Analyse von Pollenproben, die per Pollenfallen vor den Stockeingängen gesammelt wurden (Kapitel 6). 3. Pollenbestimmung durch molekulare Sequenzierung und DNA Barcoding wurde als Alternative zur Lichtmikroskopie vorgeschlagen, die immer noch sehr mühsam und fehlerbehaftet ist. In dieser Studie bestimmten wir gemischte Pollenproben durch Next-Generation-Sequenzierung und entwickelten einen bioinformatischen Arbeitsablauf um diese Hochdurchsatz-Daten mit einer neu kreierten Referenzdatanbank zu analysieren. Um die Durchführbarkeit zu evaluieren verglichen wir Ergebnisse aus der klassischen Identifizierung via Lichtmikroskopie derselben Proben mit unseren Sequenzier-Ergebnissen. Häufigkeitsschätzungen auf Basis der Sequenzierdaten waren signifikant mit den gezählten Häufigkeiten via Lichtmikroskopie korreliert. Next-Generation-Sequenzierung stellt daher einen nützlichen und effizienten Arbeitsablauf dar, um Pollen auf dem Gattungs- und Artniveau zu bestimmen ohne spezielles palynologisches Expertenwissen zu benötigen. 4. Während der Maisblüte wurden vier Beobachtungsstöcke in 11 Landschaften mit einem Maisflächengradienten platziert und zwischen diesen rotiert. Maisfelder wurden intensiver genutzt als Flächen anderer Landnutzungstypen. Die mittleren Sammeldistanzen waren signifikant niedriger für Maispollen als Pollen anderer Herkunft, was darauf hinweist, dass Aufwand in das Sammeln einer diversen Pollendiät gesetzt wird. Der Anteil an Maispollensammlerinnen stieg nicht mit der Maisanbaufläche in der Landschaft und wurde nicht durch Grünlandfläche als alternative Pollenressource reduziert. Unsere Ergebnisse ermöglichen die Schätzung des entfernungsbezogenen Expositionsrisikos von Honigbienenvölker auf Pollen aus den umliegenden Maisfeldern, die mit systemischen Insektiziden behandelt werden. 5. Es ist nicht bekannt, wie eine Zunahme von Massentrachten wie Raps (OSR) oder eine Abnahme von halbnatürlichen Habitaten (SNH) die zeitliche und räumliche Verfügbarkeit von Pollenressourcen für die Honigbienen, und damit Sammeldistanzen und -frequenzen in verschiedenen Lebensraumtypen verändert. Sechzehn Beobachtungsstöcke wurden in 16 Agrarlandschaften mit unabhängigen Gradienten an OSR- und SNH-Fläche innerhalb von 2 km platziert und regelmäßig rotiert, um Sammeldistanzen und -frequenzen zu analysieren. SNH und OSR reduzierten die Sammeldistanzen auf verschiedenen räumlichen Skalen und je nach Saison, mit möglichen Vorteilen für die Leistungsfähigkeit von Bienenvölkern. Die Häufigkeit der Pollensammler pro Habitattyp war gleich hoch für SNH, Grünland und OSR, aber niedriger für andere Kulturen und Wald. In Landschaften mit einem kleinen Anteil von SNH wurde eine deutlich höhere Dichte von Pollensammlerinnen auf SNH beobachtet, was auf die Begrenzung der Pollenressourcen in einfachen Agrarlandschaften und die Bedeutung von SNH hinweist. 6. Menge und Diversität des gesammelten Pollens können das Wachstum und die Gesundheit von Honigbienenvölkern beeinflussen, aber es ist wenig über den Einfluss der Landschaftsstruktur auf die Pollendiät bekannt. In einem Feldexperiment rotierten wir 16 Honigbienenkolonien über 16 Agrarlandschaften (siehe auch Kapitel 5), nutzten Pollenfallen um Proben des gesammelten Pollens zu nehmen und beobachteten die intrakoloniale Tanzkommunikation, um Informationen über die Sammeldistanzen zu erhalten. Weder Pollenmenge noch -diversität waren von der Landschaftsdiversität abhängig. Der offenbarte Anstieg von Sammeldistanzen mit abnehmender Landschaftsdiversität legt nahe, dass Honigbienen durch die Erweiterung des Pollensammelbereichs eine niedrigere Landschaftsdiversität kompensieren, um Pollenmenge und -diversität zu erhalten. 7. Unsere Ergebnisse zeigen die Bedeutung eines diversen Pollenangebots für Bienenvölker in der Agrarlandschaft. Neben dem Risiko einer Exposition gegenüber Pestiziden, stehen Bienenvölker vor der Gefahr von Mangelernährung mit Auswirkungen auf ihre Gesundheit. Durch eine Änderung der Landschaftzusammensetzung und damit der Verfügbarkeit von Ressourcen können wir zum Wohlergehen der Honigbienen beitragen. Agrarumweltmaßnahmen mit dem Ziel Bestäuber zu unterstützen, sollten sich auf mögliche räumliche und zeitliche Lücken in der Pollenverfügbarkeit und Vielfalt in der Agrarlandschaft konzentrieren.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Feb. 19, 2010). Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 11, 2009). Includes bibliographical references (p. 93-97).

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 90-93).

Sob a perspectiva teórica da psicopatologia do desenvolvimento, a presença de riscos biológicos no desenvolvimento de uma criança, tais como o baixo peso ao nascer e a prematuridade podem maximizar condições de vulnerabilidade e, a longo prazo, influenciar sua adaptação. Ao analisar a literatura observou-se variedade de resultados quanto aos desfechos cognitivos, comportamentais e emocionais associados a tais adversidades. Neste contexto, propôs-se um estudo prospectivo de coorte, com três objetivos gerais: 1) verificar a possível associação entre aspectos cognitivos, comportamentais e emocionais de uma coorte de crianças em idade escolar, avaliadas aos 10-11 anos de idade, estratificada por três critérios: peso ao nascer (muito baixo peso MBP, baixo peso BP, peso insuficiente PI, peso normal PN e muito alto peso MAP; idade gestacional (prematuros e a termo) e tamanho ao nascer (pequenos para a idade gestacional PIG e adequados para a idade gestacional AIG); 2) identificar as variáveis preditoras para os desfechos cognitivo, comportamental e emocional da referida coorte, baseado em variáveis biológicas, clínicas e socioeconômicas e; 3) estabelecer as taxas de problemas comportamentais da coorte estudada, independente do critério adotado. Procedeu-se a avaliação de 677 crianças, aos 10-11 anos de idade, de ambos os sexos, procedentes de uma coorte de Ribeirão Preto (SP). Para a avaliação cognitiva utilizaram-se os Testes de Raven e o Desenho da Figura Humana (DFH); para a avaliação comportamental e emocional, os pais responderam ao Questionário de Capacidades e Dificuldades (SDQ), além de um questionário complementar. Os dados foram analisados de maneira descritiva, comparativa e preditiva, por estatística não-paramétrica (p0,05). Os resultados indicaram que o peso ao nascer não se mostrou associado ao desfecho cognitivo e nem ao desfecho comportamental, com exceção da escala de hiperatividade, onde o MBP apresentou mais indicadores de problemas em comparação aos outros grupos de peso. No desfecho emocional, o grupo BP mostrou mais problemas emocionais que MBP e PN. A idade gestacional não se mostrou associada a nenhum desfecho investigado e o tamanho ao nascer se associou aos três desfechos examinados, tendo as crianças nascidas PIG apresentado mais comprometimentos cognitivos, comportamentais e emocionais em comparação às crianças nascidas AIG. Nas análises de predição, verificou-se que: a escolaridade materna e a classificação econômica foram preditoras para os três desfechos; a condição de nascimento PIG favoreceu o aumento de problemas emocionais e os meninos apresentaram mais riscos para problemas comportamentais. As taxas de identificação de problemas comportamentais foram altas, 38,2% para problemas gerais e 53,9% para sintomas emocionais. Conclui-se que o critério do tamanho ao nascer se mostrou mais específico em detectar diferenças nos desfechos avaliados de crianças em idade escolar. Destacam-se como contribuições do estudo a identificação de variáveis preditoras e as comparações incluindo fatores de risco biológicos e socioeconômicos em uma mesma coorte, estratificada por três critérios, as quais poderão subsidiar a elaboração de programas de prevenção. / Under the theoretical viewpoint of developmental psychopathology, the existence of biological risks in the development of children, such as low birth weight and prematurity, may maximize conditions of vulnerability and, in long term, bias their adaptation. In reviewing the literature it is noticed the wide range of results concerning cognitive, behavioral, and emotional outcomes associated with these hindrances. In this context, it was proposed a prospective cohort study, with three general objectives: 1) verify the possible association between cognitive, behavioral, and emotional outcomes of a cohort of school-age children, assessed at 10-11 years of age, stratified by three criteria: 1) birth weight (very low birth weight - VLBW, low birth weight - LBW, insufficient birth weight - IBW, normal birth weight NBW, and high birth weight HBW; gestational age (preterm and at term); and size at birth (small for gestational age SGA and appropriate for gestational age AGA); 2) identify the predictors for the cognitive, behavioral, and emotional outcomes, based on biological, clinical and socioeconomic variables; and 3) establish the rates of behavioral problems in the studied cohort, regardless of the criterion that was adopted. For this purpose, we evaluated 677 children, 10-11 years old, of both sexes, from a cohort of Ribeirão Preto, State of São Paulo, Brazil. For the cognitive evaluation were utilized the Raven tests and the Human Figure Drawing (HFD); for behavioral and emotional assessment, parents answered the Strengths and Difficulties Questionnaire (SDQ), and a supplementary questionnaire. Data were analyzed under descriptive, comparative, and predictive approaches, by using non-parametric statistics (p 0.05). Results indicated that birth weight was not associated with cognitive and behavioral outcomes, except for the hyperactivity scale, in which the VLBW had more indicators of difficulties in comparison to other weight groups. Concerning the emotional outcome the LBW group showed more emotional problems than VLBW and NBW groups. Gestational age was not associated with any of the investigated outcomes and size at birth was associated with the three outcomes examined, with children born SGA displaying more cognitive, behavioral, and emotional problems when compared to children born AGA. In the analysis of prediction, it was found that: maternal education and socioeconomic status were predictive for the three outcomes, the SGA status favored an increase in emotional problems, and boys had greater risks of behavioral problems. The rates of identification of behavioral problems were high, 38.2% for general problems and 53.9% for emotional symptoms. It is concluded that the criterion of size at birth was more accurate for detecting differences in the analyzed outcomes of school-age children. Among the contributions of this study, it is highlighted the identification of predictive variables and comparisons including factors of biological and socioeconomic risk across a single cohort, stratified by three criteria, which may support the development of prevention programs.

Os serviços de saúde destinados ao atendimento às urgências e emergências encontram-se, em sua grande maioria, superlotados ocasionando longas filas de espera, o que pode resultar em prejuízo para o atendimento às pessoas com agravos que demandam urgência no atendimento. Diante deste cenário, faz-se necessário uma organização do sistema, a fim de evitar danos aos pacientes que aguardam por atendimento médico. Neste contexto, o Acolhimento com Classificação de Risco traz ao atendimento de urgência e emergência um norteador para classificar os pacientes e realizar atendimento segundo o potencial de risco, atendendo os casos prioritários e não mais por ordem de chegada. Sendo assim, este estudo teve como objetivo avaliar a capacidade de um protocolo de Classificação de Risco adaptado do Ministério da Saúde em predizer o desfecho clínico dos pacientes. O estudo foi realizado em uma unidade de urgência e emergência de um hospital privado do interior paulista, compreendendo os meses de julho de 2014 a junho de 2015, com uma amostra de 1674 prontuários de pacientes que buscaram atendimento clínico. Dos prontuários avaliados, 65% eram de pacientes do sexo feminino, com média de idade de 42,0 anos, a queixa mais frequente estava relacionada ao trato digestório (14,8%). A maioria dos pacientes atendidos foi classificada como pouco urgente (verde) 91,2%, seguido de 8,8% de urgentes (amarelos) e 0,1% classificados como emergentes (vermelho). O tempo de atendimento pela classificação de risco e atendimento médico se mostrou-se mais breve nas classificações com maior prioridade. Na análise dos desfechos, 98,7% receberam alta após atendimento médico, tendo como prevalente a classificação não urgente. Dos pacientes encaminhados à internação 59,1% foram classificados como emergentes/urgentes. Ao relacionarmos a classificação de risco com o escore de alerta precoce (MEWS), observamos uma pontuação superior nos pacientes classificados como emergentes/urgentes, sendo que os pacientes internados obtiveram pontuação maior dos que foram liberados de alta. Os resultados encontrados demonstraram que a classificação de risco foi efetiva em definir a prioridade de atendimento dos pacientes em uma unidade de urgência e emergência / The health services intended to provide urgent and emergency care are mostly overcrowded, which causes long waiting queues and may entail damage to the care of injured people requiring urgent care. Faced with this scenario, there is a need to organize the system, with the purpose of avoiding losses to the patients waiting for medical care. In such a context, the Welcoming with Risk Classification provides the urgent and emergency care with a guiding principle to classify patients and accomplish care actions in line with the potential risk, thereby caring for priority cases, and no longer on a first-come first-served basis. Accordingly, this study was aimed to assess the ability of a Risk Classification protocol adapted from the Ministry of Health to envisage the clinical outcome of the patients. The study was held in an urgent and emergency unit in a private hospital in the countryside of São Paulo, between the months of July 2014 and June 2015, with a sample of 1674 medical charts of the patients that sought clinical care. Of the assessed medical charts, 65% belonged to female patients, with an average age of 42.0 years, where the most frequent complaint was related to the digestive tract (14.8%). Most of patients served were classified as less urgent (green), 91.2%, followed by 8.8% classified as urgent (yellow) and 0.1% classified as emergency (red). The service time by the risk classification and medical care has proved to be shorter in the classifications with greater priority. Upon analyzing the outcomes, 98.7% were discharged after medical care, where the non-urgent classification was prevalent. Of the patients referred for hospitalization, 59.1% were classified as emergency/urgent. When relating the risk classification with the early warning score (MEWS), we noted a higher score in the patients classified as emergency/urgent, and the hospitalized patients have reached scores higher than those who were discharged. The results found have shown that the risk classification was effective in defining the priority of care of patients in an urgent and emergency unit

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-02-09T17:51:56Z No. of bitstreams: 1 alinefioridossantosfeltrin_dissert.pdf: 1340040 bytes, checksum: d901839308dbb1675eb0688559f70299 (MD5) / Made available in DSpace on 2017-02-09T17:51:56Z (GMT). No. of bitstreams: 1 alinefioridossantosfeltrin_dissert.pdf: 1340040 bytes, checksum: d901839308dbb1675eb0688559f70299 (MD5) Previous issue date: 2015-12-09 / Introduction: Tuberculosis is an infectious disease caused by Mycobacterium Tuberculosis, better known as Koch's bacillus. It is a priority in public health in Brazil, as it is estimated that 129,000 cases occur annually in the country, which are notified only about 90,000. For the development of the disease some factors may be triggering for individuals who came into contact with the bacillus and are infected, including diabetes mellitus. Diabetes is a chronic, multi-source, weakening the immune system of individuals with the disease. As well as tuberculosis, diabetes is a public health priority. Recent studies show that diabetics are more likely to develop pulmonary tuberculosis, which can be up to four times higher than in non-diabetic subjects. Both diseases are difficult to treat and control due to side effects and life changing habits. Objective: To analyze the factors associated with the outcomes of tuberculosis treatment in diabetic and nondiabetic patients in a regional state of Sao Paulo from 1996 to 2014. Methods: Secondary data were used of tuberculosis cases reported in the information system TBWEB in the period 1996 to 2014, residents in the cities on the scope of the Regional Department of Health of São José do Rio Preto, which has 102 municipalities and a population of approximately 1,500,000 inhabitants, were excluded cases that had as outcome the change in diagnosis or patient transfer to another State, notifications without closing cases where the municipality notifying did not belong to the area, totaling 4,820 cases in the period. Bivariate analysis was performed in a model of logistic regression through the Software R, which is an open-access software for statistical analysis and graphics, considering a significance level of 5% (p <0.05) . Adjusted measurements were obtained odds ratio (OR) in order to evaluate the strength of association between independent variables and the abandonment and identify possible relationships protection risk. Results: There was a predominance of males, accounting for 72.6% and 64.4% in non-diabetics and diabetics. The age group with the highest prevalence was 20-59 years, and 78.1% in non-diabetics and 65.3% in diabetics, those with importance aged 60 and over with 34.4% of cases . Diabetes and the age of 60 years and more were presented as risk factors for dropping out, with p <0.05 and adjusted odds ratio OR = 2.8 and OR = 2.51, respectively. To death have diabetes appeared as a protective factor, with p <0.05 and OR = 0.68. Conclusion: Whereas the association tuberculosis and diabetes, major diseases and impact on public health, has been increasingly common and expected, it is essential to deepen the studies to understand the implications of comorbidity in the success or failure of treatment and evaluate the as population characteristics, regions and health care can be linked directly or indirectly in this process in order to facilitate action planning in the prevention, monitoring and treatment appropriate to this reality. / Introdução: A tuberculose é uma doença infecciosa causada pelo Mycobacterium Tuberculosis, mais conhecido como Bacilo de Koch. É uma prioridade na saúde pública no Brasil, pois estima-se que ocorram 129.000 casos por ano no país, dos quais são notificados apenas cerca de 90.000. Para o desenvolvimento da doença alguns fatores podem ser desencadeantes para os indivíduos que entraram em contato com o bacilo e estão infectados, entre eles o Diabetes Mellitus. O Diabetes é uma doença crônica, de origem múltipla, fragilizando o sistema imunológico do indivíduo portador. Assim como a tuberculose, o Diabetes é uma prioridade de Saúde Pública. Estudos recentes mostram que os diabéticos tem maior chance de desenvolver a tuberculose pulmonar, podendo ser até quatro vezes maior do que nos indivíduos não-diabéticos. Ambos os agravos são de difícil tratamento e controle devido aos efeitos colaterais dos medicamentos e mudança de hábitos de vida. Objetivo: Analisar os fatores associados aos desfechos do tratamento da tuberculose entre os doentes diabéticos e não diabéticos em uma regional do estado de São Paulo no período de 1996 a 2014. Método: foram utilizados dados secundários dos casos de tuberculose notificados no sistema de informação TBWEB no período de 1996 a 2014, residentes nos municípios na área de atuação do Departamento Regional de Saúde de São José do Rio Preto, que conta com 102 municípios e população de aproximadamente 1.500.000 habitantes, foram excluídos do estudo os casos que tiveram como desfecho a mudança de diagnóstico ou transferência do paciente para outro Estado, notificações sem encerramento, casos onde o município notificante não pertencia a área, totalizando 4.820 casos no período. Foi realizada análise bivariada, em um modelo de regressão logística não condicional, por meio do Software R, software de acesso livre de análise estatística e gráficos, considerando-se um nível de significância de 5% (p<0,05). Foram obtidas medidas ajustadas de odds ratio (OR), permitindo avaliar a força de associação entre as variáveis independentes e o abandono e óbito para identificar possíveis relações de proteção e risco. Resultados: Houve predomínio do sexo masculino, correspondendo a 72,6% e 64,4% em não-diabéticos e diabéticos. A faixa etária com maior predominância foi de 20 a 59 anos, sendo de 78,1% em não-diabéticos e 65,3% em diabéticos, nestes, com importância na faixa etária de 60 e mais anos com 34,4% dos casos. O diabetes e a idade de 60 anos e mais apresentaram-se como fatores de risco para o abandono, com valor de p<0,05 e odds ratio ajustado 2,8 e 2,51, respectivamente. Para o óbito ter diabetes apresentou-se como fator de proteção, com p<0,05 e OR=0,68. Conclusão: Considerando que a associação tuberculose e diabetes, doenças de grande impacto para a Saúde Pública, tem sido cada vez mais frequente, é fundamental aprofundar os estudos para compreender a implicação da comorbidade no sucesso ou insucesso do tratamento , avaliando o quanto as características da população, e assistência em saúde podem estar ligadas direta ou indiretamente neste processo, de maneira a viabilizar ações de planejamento no âmbito da prevenção, acompanhamento e tratamento adequados à essa realidade.

Os serviços de saúde destinados ao atendimento às urgências e emergências encontram-se, em sua grande maioria, superlotados ocasionando longas filas de espera, o que pode resultar em prejuízo para o atendimento às pessoas com agravos que demandam urgência no atendimento. Diante deste cenário, faz-se necessário uma organização do sistema, a fim de evitar danos aos pacientes que aguardam por atendimento médico. Neste contexto, o Acolhimento com Classificação de Risco traz ao atendimento de urgência e emergência um norteador para classificar os pacientes e realizar atendimento segundo o potencial de risco, atendendo os casos prioritários e não mais por ordem de chegada. Sendo assim, este estudo teve como objetivo avaliar a capacidade de um protocolo de Classificação de Risco adaptado do Ministério da Saúde em predizer o desfecho clínico dos pacientes. O estudo foi realizado em uma unidade de urgência e emergência de um hospital privado do interior paulista, compreendendo os meses de julho de 2014 a junho de 2015, com uma amostra de 1674 prontuários de pacientes que buscaram atendimento clínico. Dos prontuários avaliados, 65% eram de pacientes do sexo feminino, com média de idade de 42,0 anos, a queixa mais frequente estava relacionada ao trato digestório (14,8%). A maioria dos pacientes atendidos foi classificada como pouco urgente (verde) 91,2%, seguido de 8,8% de urgentes (amarelos) e 0,1% classificados como emergentes (vermelho). O tempo de atendimento pela classificação de risco e atendimento médico se mostrou-se mais breve nas classificações com maior prioridade. Na análise dos desfechos, 98,7% receberam alta após atendimento médico, tendo como prevalente a classificação não urgente. Dos pacientes encaminhados à internação 59,1% foram classificados como emergentes/urgentes. Ao relacionarmos a classificação de risco com o escore de alerta precoce (MEWS), observamos uma pontuação superior nos pacientes classificados como emergentes/urgentes, sendo que os pacientes internados obtiveram pontuação maior dos que foram liberados de alta. Os resultados encontrados demonstraram que a classificação de risco foi efetiva em definir a prioridade de atendimento dos pacientes em uma unidade de urgência e emergência / The health services intended to provide urgent and emergency care are mostly overcrowded, which causes long waiting queues and may entail damage to the care of injured people requiring urgent care. Faced with this scenario, there is a need to organize the system, with the purpose of avoiding losses to the patients waiting for medical care. In such a context, the Welcoming with Risk Classification provides the urgent and emergency care with a guiding principle to classify patients and accomplish care actions in line with the potential risk, thereby caring for priority cases, and no longer on a first-come first-served basis. Accordingly, this study was aimed to assess the ability of a Risk Classification protocol adapted from the Ministry of Health to envisage the clinical outcome of the patients. The study was held in an urgent and emergency unit in a private hospital in the countryside of São Paulo, between the months of July 2014 and June 2015, with a sample of 1674 medical charts of the patients that sought clinical care. Of the assessed medical charts, 65% belonged to female patients, with an average age of 42.0 years, where the most frequent complaint was related to the digestive tract (14.8%). Most of patients served were classified as less urgent (green), 91.2%, followed by 8.8% classified as urgent (yellow) and 0.1% classified as emergency (red). The service time by the risk classification and medical care has proved to be shorter in the classifications with greater priority. Upon analyzing the outcomes, 98.7% were discharged after medical care, where the non-urgent classification was prevalent. Of the patients referred for hospitalization, 59.1% were classified as emergency/urgent. When relating the risk classification with the early warning score (MEWS), we noted a higher score in the patients classified as emergency/urgent, and the hospitalized patients have reached scores higher than those who were discharged. The results found have shown that the risk classification was effective in defining the priority of care of patients in an urgent and emergency unit