Trata-se de um estudo analítico de corte transversal, que visa avaliar o risco cardiovascular de PVHA segundo o Escore de Framingham e identificar a associação entre o risco e as variáveis demográficas, comportamentais, psicossociais e clínicas de PVHA. O estudo foi aprovado na Secretaria Municipal de Saúde e no Comitê de Ética da Escola de Enfermagem de Ribeirão Preto, a coleta de dados foi realizada no período de outubro de 2014 a agosto de 2015 em cinco Serviços de Atendimento Especializado às PVHA utilizando questionário sociodemográfico, clínico e comportamental, avaliação da alimentação saudável, Inventário de Sintomas de Stress para Adultos de Lipp e avaliação do risco cardiovascular por meio do Escore de Framingham. A análise dos dados ocorreu através de estatística descritiva e teste de associação entre as variáveis, onde foi adotado nível de significância com valor de p<0,05. Identificou-se que 58,3% pertenciam ao sexo masculino, 69,1% apresentavam idade acima de 40 anos, com média de 44,4 anos, 40,6% referiram ser brancos e 40,0% pardos, e 70,9% eram heterossexuais. Observou-se que 64,0% eram sedentários, 35,4% tabagistas e 40,0% faziam uso de bebida alcóolica regularmente. Do mesmo modo, 73,7% consideraram sua alimentação saudável, no entanto, ao ser avaliado de acordo com o escore da alimentação saudável, 70,9% obtiveram score intermediário para alimentação. Com relação às variáveis psicossociais, foi identificado que 52,0% tinham menos de oito anos de estudo, e 80,6% referiram receber até três salários mínimos por mês. Quanto aos sintomas de estresse, foi visto que 29,1% e 22,3% estavam nas fases de resistência e exaustão, respectivamente. Além disso, identificou-se que 15,4% da amostra tinha diagnóstico médico para depressão e que 71,4% não realizavam atividades de lazer regularmente. Com relação às variáveis clínicas gerais, 57,7% referiram antecedentes familiares para HAS, 40,6% para DM, 21,7% para IAM e 27,4% para AVE. Quanto aos antecedentes pessoais, foi visto que 15,4% eram hipertensos, 8,0% eram diabéticos e 8,0% tinham dislipidemia. Desta mesma amostra, 45,2% apresentavam IMC maior que 25,0 kg/m² e 41,7% estavam em síndrome metabólica. Com relação às variáveis clínicas relacionadas ao HIV, observou-se que 42,2% e 32,0% possuíam o diagnóstico de soropositividade e fazem uso de TARV há mais de dez anos, respectivamente. A contagem de células TCD4+ e carga viral mostrou que 82,8% dos participantes apresentaram contagem maior que 350 cels/mm³, e 80,6% tinham carga viral indetectável. Foi identificado que 25,8% dos sujeitos apresentam risco cardiovascular de médio a alto, segundo o Escore de Framingham. Apenas as variáveis sociodemográficas sexo (p=0,006), idade (p<0,001) e estado civil (p=0,003) apresentaram associação com o risco cardiovascular calculado pelo Escore de Framingham. Nas variáveis comportamentais, as fases de estresse (p=0,039) tiveram associação com o risco cardiovascular, e com relação às variáveis clínicas, antecedentes familiares para DM (p=0,035), HAS, DM e SM (p<0,001) e DLP (p=0,030) apresentaram significância estatística. Nas variáveis clínicas relacionadas ao HIV, o tempo de diagnóstico (p=0,005) e o tempo de TARV (p=0,038) também apresentaram associação. Conclui-se que 25,8% de PVHA no município de Ribeirão Preto apresentam risco cardiovascular de moderado a alto, medido pelo Escore de Framingham / This is an analytical study, transversal research, which the goal is to assess the cardiovascular risk of PLWHA according to the Framingham score and to identify the association between the risk and the demographic, behavioral, psychosocial and clinics variables in PLWHA. The study was approved by the City Health Department and the Ethics Committee of Ribeirão Preto College of Nursing, data collection was carried out from October 2014 to August 2015 in five of Specialized Care Services using sociodemographic, clinical and behavioral questionnaire, assessment of healthy eating, Lipp\'s inventory of symptons of stress for adults and assessment of cardiovascular risk using the Framingham score. Data analysis was carried out through descriptive statistics and test of association between variables, which was adopted level of significance set at p <0.05. It was identified that 58.3% were male, 69.1% were aged over 40 years, averaging 44.4 years, 40.6% reported being white and 40.0% mulatto, and 70.9 % were heterosexual. It was observed that 64.0% were sedentary, 35.4% were smokers and 40.0% were using alcoholic beverages regularly. Similarly, 73.7% considered their healthy eating, however, when evaluated according to the healthy eating score, 70.9% had intermediate score for food. Regarding the psychosocial variables, it was identified that 52.0% had less than eight years of schooling, and 80.6% reported receiving up to three minimum wages per month. As symptoms of stress, it was seen that 29.1% and 22.3% were in resistance and exhaustion phases, respectively. In addition, it was found that 15.4% of the sample had medical diagnosis for depression and 71.4% did not perform leisure activities regularly. With respect to general clinical, 57.7% reported family history of hypertension, 40.6% for DM, 21.7% to 27.4% for AMI and stroke. As for personal history, it was seen that 15.4% were hypertensive, 8.0% were diabetic and 8.0% had dyslipidemia. In the same sample, 45.2% had a BMI greater than 25.0 kg/m² and 41.7% were in metabolic syndrome. Regarding the clinical variables related to HIV, it was observed that 42.2% and 32.0% had a diagnosis of HIV and use HAART for more than ten years, respectively. The CD4 + T cell count and viral load showed that 82.8% of participants had levels over 350 cells/mm³, and 80.6% had an undetectable viral load. It was identified that 25.8% of subjects present cardiovascular risk medium to high, according to the Framingham score. Only the sociodemographic variables gender (p=0.006), age (p <0.001) and marital status (p=0.003) were associated with cardiovascular risk estimated by the Framingham score. In behavioral variables, the phases of stress (p=0.039) were associated with cardiovascular risk, and with regard to clinical, family history of diabetes (p=0.035), hypertension, DM and SM (p <0.001) and DLP (p=0.030) were statistically significant. In clinical variables related to HIV, the time of diagnosis (p=0.005) and time of HAART (p=0.038) were also associated. It is conclude that 25.8% of PLWHA in Ribeirão Preto have cardiovascular risk moderate to high, as measured by the Framingham score

O paciente portador de necessidades especiais pode ser descrito como aquele indivíduo que não se adapta de maneira física, intelectual ou emocional aos parâmetros normais, considerando os padrões de crescimento, desenvolvimento mental e controle emocional, além dos relacionados à conservação da saúde. A Organização Mundial de Saúde (OMS) estima que a prevalência das deficiências no mundo seja de uma pessoa a cada dez e mais de dois terços não recebe nenhum tipo de assistência odontológica. O objetivo do estudo foi verificar a percepção dos profissionais odontólogos sobre a acessibilidade do paciente com Síndrome da Imunodeficiência Adquirida (SIDA/AIDS) em estabelecimentos odontológicos na cidade de São Paulo e comparar com um grupo controle, representados por pacientes com Diabetes Mellitus. A informação para o estudo foi baseada em conversações telefônicas com cirurgiões-dentistas, onde foi realizada uma entrevista semi-estruturada. A análise de conteúdo das entrevistas foi executada segundo método de Lefèvre e Lefèvre (2000) e foi realizada destacando-se a idéia central. Do total de entrevistados, 55,14% eram do gênero feminino e 53,27% trabalhavam em consultório particular. Em relação à acessibilidade, 96,26% já tinham tratado de pacientes com Diabetes, 55,14% com SIDA/AIDS. Concluiu-se que a principal dificuldade para tratar pacientes com diabetes é a prática clínica, principalmente relacionada com problemas de coagulação. Entre os pacientes com SIDA/AIDS embora tenham sido citadas dificuldades clínicas, pôde ser verificado que a maior dificuldade ainda é o preconceito contra eles. / The patient who has special needs can be described as the individual that can´t adapt himself to normal physical, intellectual or emotional parameters, considering the growing patterns, mental development and emotional stability, in addition to those related to the health maintenance. The World Health Organization (WHO) estimates that the deficiencies prevalence is about one in ten individuals allover the world and more than two thirds don´t have any dental assistance. The objective of the study was to verify the dental professional perception with relation to the accessibility among patients with Acquired Immunodeficiency Syndrome (SIDA/AIDS) in clinical settings in the city of São Paulo, and to compare this perception with a control group, patients with Diabetes Mellitus. The study information was based on telephone conversations with Dentistis. A semi-structured interview was prepared. Content analysis was performed as per Lefèvre and Lefèvre (2000) with the relief of the central ideas. Among the participants, 55.14% were female and 53.27% worked in private settings. Regarding the accessibility, 96.26% had already treated patients with Diabetes, 55.14% with SIDA/AIDS. It was concluded that the main difficulty to treat diabetes patients is the clinical practice, mainly with problems related to blood coagulation. Among SIDA/AIDS patients, even though it had been listed clinical difficulties, it could be verified that the main difficulty is still prejudice amongst them.

Introdução: A Síndrome da Imunodeficiência Adquirida (SIDA) é uma doença infecciosa causada por um retrovírus chamado Human Immunodeficiency Virus - HIV. Os principais alvos do HIV são as células que exibem a molécula CD4 e as células gliais do Sistema Nervoso Central (SNC) possuem estas moléculas. Uma das alterações possíveis de acontecer em virtude da infecção pelo HIV é a alteração de linguagem, pois o processamento desta ocorre no SNC. Dentre todas as dimensões da linguagem a semântica é a parte que compreende o significado das palavras tanto na compreensão quanto na produção. Esta dimensão pode influenciar o processo da leitura. Objetivo: Comparar o desempenho entre crianças portadoras de HIV por transmissão vertical e crianças com baixo risco para o HIV em atividades de vocabulário receptivo e na leitura de palavras e pseudopalavras e quanto aos Recursos do Ambiente Familiar (RAF) que podem estar envolvidos com o aprendizado, identificar: a relação entre a gravidade da doença com o vocabulário receptivo e com a leitura, considerando o nível de CD4 e da carga viral (CV), a classificação CDC (Centers for Disease Control), adesão ao tratamento e tempo de uso da medicação; a classificação econômica das crianças portadoras de HIV e sua relação com RAF e o desempenho em vocabulário receptivo e leitura. Método: A população estudada foi de 11 crianças com HIV e 20 crianças com baixo risco para HIV, com idades entre 8 anos e 10 anos. Para a avaliação foi utilizado o Teste de Vocabulário por Figuras USP (TVfusp-139o) e o Teste de Competência de Leitura de Palavras e Pseudopalavras (TCLPP). Foi realizada a classificação econômica das crianças e a avaliação do RAF através de dois questionários respondidos pelos responsáveis, considerando que estes fatores podem estar envolvidos com a aprendizagem escolar. Resultados: Houve diferença entre os grupos para as variáveis RAF e o vocabulário, sendo que o grupo com baixo risco para o HIV apresentou desempenho significativamente superior ao grupo com HIV. As perguntas relacionadas aos passeios que a criança realizou, presença de brinquedos, jornais, livros e revistas em casa foram as que diferiram. Não houve diferença para a variável leitura. Não teve correlação entre as variáveis clínicas e laboratoriais e o vocabulário. Embora não significativa, houve correlação positiva entre a classificação CDC e leitura. Conclusão: Crianças portadoras de HIV apresentam desempenho inferior em vocabulário e o RAF significativamente inferior; não foi encontrada diferença em leitura. Os recursos do ambiente familiar que possivelmente podem contribuir para o aprendizado escolar é a presença de objetos, brinquedos, livros e revistas em casa e passeios; todas as variáveis laboratoriais e clínicas não apresentaram correlação significativa com o desempenho em vocabulário; a maior parte nos portadores de HIV encontravam-se na classificação econômica C ou D (82,1%). Houve correlação positiva com a classificação econômica, RAF e leitura. / Introduction: Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by a retrovirus called Human Immunodeficiency Virus - HIV. The main targets of HIV are the cells that display the CD4 molecule and the glial cells of the Central Nervous System (CNS) possess these molecules. One of the possible changes to occur due to HIV infection is the language change, as the processing of this occurs in the CNS. Of all the dimensions of language, semantics is the part that understands the meaning of words in both comprehension and production. This dimension can influence the reading process. Objective: To compare the performance of HIV-infected children by vertical transmission and children with low HIV risk in activities of receptive vocabulary and reading of words and pseudowords and Family Environment Resources (RAF) that may be involved in learning , To identify: the relationship between the severity of the disease with the receptive vocabulary and reading, considering CD4 and viral load (CV), CDC (Centers for Disease Control) classification, adherence and time of medication use; The economic classification of children with HIV and their relationship with RAF and o, performance in receptive and reading vocabulary. Method: The study population was 11 children with HIV and 20 children with low HIV risk, aged 8 years and 10 years. For the evaluation we used the Vocabulary Test for Figures USP (TVfusp-139o) and the Test of Competence of Reading of Words and Pseudowords (TCLPP). The economic classification of the children and the RAF evaluation were performed through two questionnaires answered by those responsible, considering that these factors may be involved with school learning. Results: There was a difference between the groups for the RAF and vocabulary variables, and the group with low HIV risk presented a significantly superior performance to the HIV group. The questions related to the trips that the child performed, the presence of toys, newspapers, books and magazines at home were the ones that differed. There was no difference for the reading variable. There was no correlation between clinical and laboratory variables and vocabulary. Although not significant, there was a positive correlation between the CDC classification and reading. Conclusion: HIV-positive children have lower vocabulary performance and significantly lower RAF; no difference was found in reading; the resources of the family environment that can possibly contribute to the school learning are the presence of objects, toys, books and magazines at home and walks realized in the last 12 months; all laboratory and clinical variables did not show a significant correlation with vocabulary performance, ie there was no correlation between viral load, CD4 cell count, CDC score, adherence and medication with vocabulary performance; the majority of those with HIV were in the economic classification C or D (82.1%); there was a positive correlation for the economic classification and the RAF score and the economic classification and performance in reading and strong tendency between the economic classification and the vocabulary.

Na infecção pelo HIV o equilíbrio entre antioxidantes e pró-oxidantes e a produção de citocinas encontram-se alterados, causando estresse oxidativo crônico. Presume-se que o estresse oxidativo crônico e a ativação do sistema imunológico favorecem a replicação do vírus através da ativação do NF-kB e a apoptose de células mononucleares do sangue periférico. O objetivo deste estudo foi avaliar o efeito da suplementação, durante 180 dias, com 600mg/dia de N-acetilcisteína (NAC), sobre a carga viral, os níveis de sub-populações de linfócitos, a viabilidade de linfócitos e sobre os níveis séricos de citocinas, proteínas, lipídeos, &#946;2 microglobulina e outros marcadores da ativação do sistema imunológico em pacientes assintomáticos, submetidos ao primeiro tratamento anti-retroviral. Participaram deste estudo, duplo cego controlado por placebo, que teve a duração de 180 dias, 30 indivíduos que iniciaram a terapia anti-retroviral. O grupo estudo foi constituído por 14 indivíduos que além do tratamento anti-retroviral foram suplementados com NAC, enquanto o grupo controle foi constituído por 16 indivíduos que além do tratamento anti-retroviral receberam placebo. Os marcadores avaliados foram determinados no dia anterior ao início do tratamento a que foram submetidos e após 60, 120 e 180 dias. Verificou-se aumento significante dos linfócitos CD4+, da relação CD4/CD8, de linfócitos viáveis, albumina, cisteína e glutationa, bem como diminuição significante dos níveis de TNF-&#945;, IL-8, haptoglobina e &#945;1-glicoproteína ácida, &#946;2-microglobulina, IgA e IgM, nos dois grupos estudados. Os níveis séricos de IL-6, colesterol total, LDL-colesterol, VLDL-colesterol e triglicerídeos não apresentaram alteração significante ao final deste estudo. Concluindo, a suplementação com 600 mg/dia de NAC, em pacientes submetidos ao tratamento anti-retroviral, não proporcionou benefícios adicionais àqueles decorrentes deste tratamento. / In HIV infection, the balance between antioxidants and pró-oxidants and the production of citokines are disturbed leading to a chronic state of oxidative stress and immune activation. It is presumed that HIV takes advantage of the proinflammatory and prooxidative environment to replicate through the NF-kB pathway leading to the apoptosis of peripheral blood mononuc1ear cells. The aim of this work was to study the effect of oral administration of N-acetylcysteine (NAC) 600 mg per day during 180 days on viral load, viability of lymphocytes, cytokines, proteins, lipids, &#946;2-microglobulin and other immune activation markers in asymptomatic patients under their first antiretroviral therapy. This was a double-blind, placebo-controlled study with 30 individuals who started antiretroviral therapy and were followed for 180 days. These individual were divided into two subgroups: the study group consisted of 14 participants who received NAC supplementation, whereas the control group had 16 individuals who received placebo. The studied markers were determined on the day before the beginning of treatment and after 60, 120 and 180 days of treatment. A significant increase was seen for CD4+ lymphocytes, the CD4/CD8 ratio, albumin, cysteine and glutathione; also, a significant reduction was found for levels of TNF-&#945;, IL-8, &#946;2 microglobulin, IgA, IgG, IgM, haptoglobin, and acid &#945;1-glycoprotein as a consequence of antiretroviral treatment. After 180 days of treatment, the levels of total protein, globulins and HDL-cholesterol presented significant alteration on1y in the control group, while the serum levels of IL-6, total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride did not show significant alteration at the end of the present study. In conclusion, the supplementation of HIV-positive patients with 600 mg/day of NAC did not bring additional benefits to those resulting from antiretroviral treatment.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-27T16:53:12Z No. of bitstreams: 1 Santos, Monique Luiza Aguiar dos [Dissertação, 2014].pdf: 5528413 bytes, checksum: ee7fde929572abea4d1a8749c2310571 (MD5) / Made available in DSpace on 2017-03-27T16:53:12Z (GMT). No. of bitstreams: 1 Santos, Monique Luiza Aguiar dos [Dissertação, 2014].pdf: 5528413 bytes, checksum: ee7fde929572abea4d1a8749c2310571 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A síndrome da imunodeficiência humana adquirida (AIDS, acquired immunodeficiency syndrome) é causada pelo vírus da imunodeficiência humana (HIV, human immunodeficiency virus) que infecta as células do sistema imune, destruindo-as ou causando prejuízos ao seu funcionamento. Dentre as enzimas do HIV, a integrase é responsável pela inserção do DNA viral no DNA do hospedeiro. Atualmente, existem apenas três fármacos em uso clínico pertencentes à classe dos inibidores de integrase: raltegravir (um derivado pirimidinona carboxamida), elvitegravir (um derivado quinolina) e dolutegravir (um derivado diazatriciclo carboxamida). Entretanto, diversos casos de resistência a estes fármacos são descritos na literatura e as mutações da enzima responsáveis por este perfil são conhecidas. Neste trabalho foram empregados estudos de relação entre a estrutura química e atividade biológica (SAR) e docking molecular, aplicados a uma série de 68 derivados azaindóis do ácido hidroxâmico sintetizados e avaliados farmacologicamente como inibidores de integrase do HIV (PLEWE et al., 2009; TANIS et al., 2010; JOHNSON et al., 2011). Entre os resultados obtidos, no estudo da relação entre a estrutura química e a atividade biológica foi observado que a ausência do hidrogênio ligado ao oxigênio da porção ácido hidroxâmico leva a perda de atividade biológica. E as simulações de docking molecular revelaram que este oxigênio deve possuir carga parcial -1 para realizar interação iônica com os íons Mg²+ presentes no sítio ativo da enzima integrase que funcionam como cofatores. A complexação dos derivados azaindóis com estes íons leva a inibição enzimática. Os compostos mais ativos, 1c e 21c, foram os que apresentaram melhor perfil de interação com a enzima / The acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) that infects cells of the immune system, destroying them or causing damage to its operation. Among all the HIV enzymes, integrase is responsible for the insertion of viral DNA in the host DNA. Currently, there are only three drugs in clinical use that belong to the class of integrase inhibitors: raltegravir (a pirimidinone carboxamide derivative, elvitegravir (a quinoline derivative) and dolutegravir (a diazatricyclo carboxamide derivative). However, several cases of resistance to drugs of this class are described in the literature, and the mutations of the enzyme responsible for this profile are known. In this work were employed studies of structure activity relationship (SAR) and molecular docking, applied to a series of 68 derivatives of azaindole hydroxamic acid synthesized and pharmacologically evaluated as HIV-1 Integrase inhibitors (PLEWE et al., 2009; TANIS et al., 2010; JOHNSON et al., 2011). Among the results obtained in the study of the relationship between the chemical structure and the biological activity was observed that the absence of hydrogen bound to oxygen of the hidroxamic acid takes to loss of biological activity. And molecular docking simulations showed that this oxygen must have partial charge -1 to perform ionic interaction with Mg²+ ions present in the active site of the integrase enzyme, which act as cofactors. The complexation of azaindole derivatives with these ions takes to enzymatic inhibition. The most active compounds, 1c and 21c, were the ones who presented best profile of interaction with the enzyme

Magister Pharmaceuticae - MPharm / Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. / South Africa

Master of Public Health - MPH / Background: The repercussions of being HIV positive coupled by the complications of antiretroviral therapy are likely to cause distress, emotional and psychological problems particularly among children infected by the virus. The limited support services for children experiencing distress intensify the urgency to address this challenge. Despite the availability of social workers and nurses' interventions currently in place, the number of children in need of psychological care continues to increase. This is particularly true at Deborah Retief Memorial (DRM) hospital, one of the main antiretroviral therapy facilities in Kgatleng district, Botswana. Method: The purpose of this study was to explore and describe the perceptions of social workers, nurses and caregivers on key factors contributing to psychological distress of HIV positive children. A descriptive, exploratory qualitative study design that employed the use of in-depth interviews was used to conduct this study. Participants included four caregivers of HIV positive children who seek antiretroviral therapy at DRM hospital Infectious Diseases Control Clinic, together with five nurses and two social workers who worked in the same clinic. Conventional content analysis was used to analyse the in-depth interview transcripts. Results: Perceived psychological stressors for HIV positive children included disclosure of HIV status, orphanhood, social problems, lifelong treatment, stigma, poor caregiver-child relationship and lack of caregiver‟s love, care and support. However the caregivers did not fully understand the psychological distress the HIV positive children were experiencing, hence were unable to recognize it in these children. The study highlighted that major challenges faced by the health-workers included lack of qualified personnel, lack of adequate knowledge and skills, and a non-conducive working environment required to effectively assist children with psychological distress. The findings also indicated the need for education and support of caregivers and HIV positive children by the educators, family and health-worker systems. Conclusion: The profile of key stressors of psychological distress, the challenges and support needs suggested by the participants in this study can provide a framework for improving the existing services for HIV positive children with psychosocial problems. This information is important for use in training nurses and social workers involved with children with psychological behaviours.

This study describes hospital nurses' experiences caring for patients with AIDS. A modified version of Speigelberg's phenomenological approach was used which explored the nurses' experiences from their perspective. A total of eight nurses who had cared for patients with AIDS were interviewed. The findings indicated that caring for these patients is stressful. The researcher identified sources of stress as both internal and external. Internal stressors included: (1) fear of contracting AIDS; (2) homophobia; and (3) caring for dying AIDS patients. The two external stressors were patient variables and societal views. Lack of perceived emotional support from nursing administration further increased the stress. These nurses believed this form of support was essential. In order to cope with these experiences, the nurses utilized their usual coping strategies. Common ones were being physically active, relaxing, and talking with others. Different coping strategies were used to deal with the specific stressors. These were identified by the researcher as: (1) rationalization; (2) knowledge-seeking; (3) withdrawal; and (4) involvement. This study's findings emphasize the need for support for all nurses caring for patients with AIDS. Implications for nursing education, practice, and research were identified. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientadores: Lúcia Helena Simões da Costa Paiva, Ana Lúcia Ribeiro Valadares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:45:11Z (GMT). No. of bitstreams: 1 Akl_LiviaDrumond_D.pdf: 1659743 bytes, checksum: 05cc93759e4280105f72769b37386da1 (MD5) Previous issue date: 2015 / Resumo: A terapia antirretroviral (TARV) impactou drasticamente na taxa mortalidade e expectativa de vida de pessoas vivendo com HIV (PVHS), mas tem sido associada a uma série de alterações metabólicas, incluindo a síndrome metabólica (SM). Tal como para as consequências clínicas da SM, existe evidência de que as mulheres são particularmente afetadas negativamente. Objetivos: Determinar a prevalência de SM e fatores associados em mulheres climatéricas com e sem o vírus da imunodeficiência humana (HIV). Métodos: Realizou-se um estudo de corte transversal, entre outubro de 2010 e julho de 2012, em uma amostra com 537 mulheres (273 mulheres climatéricas HIV soropositivas e 264 mulheres climatéricas HIV soronegativas) entre 40 e 60 anos em dois centros de referência no tratamento ambulatorial de HIV. A SM foi diagnosticada de acordo com o critério da IDF, 2006. Foi realizada uma entrevista para avaliação dos fatores sociodemográficos, clínicos, comportamentais e fatores associados com a infecção pelo HIV. Todas foram submetidas à medida do peso corporal, altura, circunferência da cintura, pressão arterial e realizaram coleta de sangue periférico para dosagem de colesterol total e frações, triglicérides, glicemia de jejum e dosagens hormonais. Foram utilizadas a análise bivariada e a análise de regressão múltipla para selecionar os principais fatores associados à SM. Resultados: A média de idade foi de 47,7 anos nas mulheres HIV soropositivas e 49,8 anos nas mulheres HIV soronegativas (p<0,001). A prevalência de SM no grupo soropositivo foi de 46,9% em comparação com 42,2% no grupo soronegativo (p=0,340). A análise bivariada mostrou maior prevalência de SM no grupo HIV soropositivo em mulheres que estavam na pós-menopausa em comparação ao grupo soronegativo (p=0,032), em uso de terapia hormonal (TH) (p=0,040), quando a autopercepção de saúde foi considerada excelente/boa (p=0,011) e em mulheres com índice de massa corporal (IMC) > 25 kg/m² (p=0,005). A análise bivariada somente do grupo HIV soropositivo mostrou associação entre SM e idade ? 50 anos (p=0,002), escolaridade < 8 anos (p=0,003), pós-menopausa (p<0,001), IMC > 25 Kg/m² (p<0,001) e FSH ? 40 mUI/mL (p=0,002). Não houve associação entre SM e o uso de Lopinavir e Indinavir no grupo HIV soropositivo. A análise de regressão múltipla no grupo geral mostrou que os fatores associados a SM foram IMC > 25 kg/m² (RP: 2,34; IC95%%: 1,70-3,21; p<0,001), envelhecimento (RP: 1,05; IC95%%: 1,02-1,07; p<0,001) e uso de TARV (RP: 1,48; IC95%%: 1,13-1,94; p=0,005). A análise múltipla somente do grupo soropositivo mostrou associação entre SM e IMC em kg/m² (RP: 1,09; IC95%%: 1,05-1,13; p<0,001) e dosagem de hormônio folículo estimulante (FSH) ? 40 mUI/mL (RP: 1,66; IC95%%: 1,14-2,40; p=0,008). Conclusão: Não houve associação de SM e infecção pelo HIV. Verificou-se que as mulheres HIV soropositivas tiveram prevalência significativamente maior de SM quando na pós-menopausa, com alto IMC e em uso da TARV. Observa-se a necessidade de uma melhor abordagem de mulheres HIV soropositivas e soronegativas para evitar o ganho de peso e SM / Abstract: Antiretroviral therapy (ART) dramatically impacted mortality and life expectancy in people living with HIV (PLWH), but has been associated with a number of metabolic abnormalities, including metabolic syndrome (MetS). As to the clinical consequences of MetS, there is evidence that females are particularly negatively affected. Objectives: To determine the prevalence of MetS and associated factors in climacteric women with and without human immunodeficiency virus (HIV). Methods: A cross-sectional study between october 2010 and july 2012, in a sample of 537 women (273 HIV seropositive climacteric women and 264 HIV seronegative climacteric women) between 40 and 60 years at two referral centers in the HIV outpatient¿s clinic. MetS was diagnosed according to IDF, 2006. Interviews to assess sociodemographic, clinical, and behavioral factors associated with HIV infection was performed. All women were submitted to body weight, height, waist circumference, blood pressure and performed peripheral blood collection for total cholesterol dosage and fractions, triglycerides, fasting glucose and hormone levels. Bivariate analysis and multiple regression analysis to select the main factors associated with MetS were performed. Results: The mean age was 47.7 years in HIV seropositive women and 49.8 years in the HIV seronegative women (p<0.001). The prevalence of MetS in HIV seropositive climacteric women was 46.9% compared to 42.2% in the HIV seronegative group (p=0.340). Bivariate analysis revealed a higher prevalence of MetS in HIV seropositive group in women who were postmenopausal compared to HIV seronegative group (p=0.032), in use of hormone therapy (HT) (p=0.040), when the self-rated health was considered excellent/good (p=0.011) and in women with body mass index (BMI) > 25 kg/m² (p=0.005). The bivariate analysis of such HIV seropositive group showed an association between MetS and age ? 50 years (p=0.002), formal education < 8 years (p = 0.003), being postmenopausal (p<0.001), BMI > 25 kg/m² (p<0.001) and FSH ? 40 mIU/mL (p=0.002). There was no association between MetS and the use of Lopinavir and Indinavir in HIV seropositive group. Multiple regression analysis showed that in the whole group, factors associated with MetS were BMI > 25 kg/m² (PR: 2.34; 95 % CI: 1.70 to 3.21; p<0.001), aging (PR: 1.05; 95 % CI: 1.02 to 1.07; p<0.001) and the use of HAART (PR: 1.48; 95 % CI: 1.13 to 1.94; p = 0.005). Multiple analysis of such HIV seropositive group showed an association between MetS and BMI in kg/m² (PR: 1.09; 95 % CI: 1.05-1.13; p<0.001) and follicle stimulating hormone dosage (FSH) ? 40 mIU/mL (PR: 1.66; 95 % CI: 1.14 to 2.40; p=0.008). Conclusion: There was no association of MetS and HIV infection. It was found that HIV seropositive women had significantly higher prevalence of MetS when being postmenopausal, with high BMI and in use of HAART. There is a need of a better approach to both HIV seropositive and seronegative women to prevent weight gain and MetS / Doutorado / Fisiopatologia Ginecológica / Doutora em Ciências da Saúde

Os bancos de dados atualizados constituídos a partir de informações dos prontuários de pacientes HIV+ são importantes fontes para a realização de pesquisas clínicas e epidemiológicas de forma rápida e eficiente. A elevada variabilidade do HIV-1, resultado, entre outros fatores, da ausência de mecanismos eficientes de reparo durante os estágios da replicação viral, contribui para a emergência de cepas resistentes aos antiretrovirais. O objetivo deste trabalho é desenvolver e implementar um banco dados inteligente utilizando a Rede Neural Artificial Paraconsistente (RNAP), assentada na Lógica Paraconsistente Anotada, para auxiliar o mapeamento de informações contidas nos diversos formulários a fim de apoiar o mapeamento das informações provenientes dos diferentes registros médicos produzidos. O banco de dados será usado principalmente para apoiar o processo de decisão sobre a prescrição da terapia antiretroviral. Os resultados obtidos durante a pesquisa mostram que a técnica pode se tornar uma ferramenta promissora. / Updated databases made from information collected from HIV+ patients are important references to quickly and efficiently design clinical and epidemiologic studies. The high levels of variability of the HIV-1 virus, among other factors, the result of the absence of repair mechanisms during replication, strongly contribute to the establishment of resistance to antiretroviral therapy. The main objective of this study is the design and implementation of an inteligent database using the concept of Paraconsistent Artificial Neural Network (PANN) based on the Paraconsistent Annotated Logic, in order to support the mapping of the information coming from the different medical records produced. The database will be used primarily to support the decision process on the antiretroviral therapy prescription. Results obtained during the research show that the technique may become a promising tool.