Made available in DSpace on 2014-12-17T15:36:39Z (GMT). No. of bitstreams: 1 AnaATS_TESE.pdf: 4274123 bytes, checksum: 50f286f423e0b4c4e687ba8d81bb4d69 (MD5) Previous issue date: 2012-07-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment / Introdu??o: O Acidente Vascular Cerebral (AVC) ? uma importante causa de comprometimento neurol?gico. Poucos dados ? respeito dos fatores associados ? morbidade do AVC s?o encontrados no Brasil. Objetivos: Avaliar as caracter?sticas sociodemogr?ficas, h?bitos de sono, estado cognitivo e funcional de pacientes com AVC. M?todos: Os pacientes foram avaliados atrav?s do question?rio Step 1 para levantamento das caracter?sticas sociodemogr?ficas e Escala Modificada de Rankin para avalia??o funcional. O grau neurol?gico foi avaliado pela National Institute of Health Stroke Scale (NIHSS), o sono pelo Question?rio de H?bitos de sono e o estado cognitivo pelo Mini-Exame do Estado Mental (MEEM). Os dados foram analisados atrav?s do teste Qui-quadrado para verificar diferen?as nas propor??es das vari?veis estudadas e an?lise de regress?o linear. Resultados: Foram avaliados 305 pacientes e o maior n?mero de indiv?duos estava entre 50 e 69 anos (40%), grande parte dos pacientes n?o possu?a estudo formal (40,3%) e tinham AVC do tipo isqu?mico (72,5%). Na an?lise da funcionalidade constatou-se que a maioria dos pacientes tinha incapacidade moderada (55,1%). Os resultados dos h?bitos de sono apontaram que 63,6% dos pacientes apresentavam mais uma pessoa no quarto de dormir, 12,3% se queixavam de muito barulho no quarto e 35% de muita ilumina??o. Dos pacientes avaliados 5,8% fumavam, 7,8% bebiam e 70,1% tomavam caf?, 28,6% apresentavam dificuldade de iniciar o sono e 37,6% acordavam no meio da noite. Foram apresentadas queixas de pesadelos (11%), sensa??o de sufoco (37,7%) e 35% sentiam muito sono durante o dia. Al?m disso, 95% n?o trabalhavam, 80,5% n?o realizavam atividades f?sicas e 95,4% n?o realizavam atividades mentais. O rastreamento cognitivo realizado determinou uma associa??o do estado cognitivo com a idade e escolaridade e o grau neurol?gico. Conclus?o: O estudo conseguiu evidenciar uma frequ?ncia elevada de casos de AVC com depend?ncia funcional de grau moderado, identificou que muitos pacientes n?o seguem medidas de higiene do sono e verificou que a avalia??o de 10 d?ficits cognitivos deve levar em considera??o a idade, escolaridade e o grau neurol?gico dos pacientes. Sugerimos a necessidade de programas de aten??o aos pacientes v?timas do AVC, com uma abordagem multidimensional incluindo a equipe de reabilita??o, a atua??o da Medicina do sono e da Neuropsicologia, a fim de que os pacientes tenham acesso a uma reabilita?ao funcional mais adequada, desenvolvam um estilo de vida que garanta uma boa qualidade de sono e sejam bem avaliados e reabilitados quanto aos comprometimentos cognitivos

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-28T20:31:43Z No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-30T00:04:50Z (GMT) No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) / Made available in DSpace on 2017-03-30T00:04:50Z (GMT). No. of bitstreams: 1 LucianaProtasioDeMelo_TESE.pdf: 3341432 bytes, checksum: 30bddef9c5bdbeed79dbce1b402a8b04 (MD5) Previous issue date: 2016-11-29 / O Acidente Vascular Cerebral (AVC) ? um importante problema de sa?de p?blica, por isso foi realizado um estudo com o objetivo de avaliar os fatores epidemiol?gicos, cl?nicos e funcionais de pacientes com AVC. Participaram do estudo 433 pacientes (229 mulheres e 204 homens). Em Natal/RN, os pacientes foram avaliados atrav?s do Step 1 e Escala de Rankin Modificada. Os dados foram analisados pelo teste Qui-quadrado e an?lise de regress?o log?stica. Resultados: Verificou-se maior frequ?ncia de pacientes na faixa et?ria de 70 a 89 anos (40,9%). A hipertens?o arterial foi o fator de risco mais frequente (85,4%) e o AVC isqu?mico (68,5%). Foi observada maior frequ?ncia de pacientes com incapacidade de andar e realizar higiene pessoal (48,8%) (p= 0,001). Observou-se uma correla??o entre o grau de comprometimento neurol?gico e a funcionalidade (r= 0,53; p= 0,006). Considerando as atividades b?sicas da vida di?ria (ABVDs), 25% dos pacientes n?o podiam levantar da cama e 70,8% n?o conseguiam ir ao banheiro sozinhos (ambos p< 0.05). Os modelos de regress?o apontaram os fatores preditores da depend?ncia funcional para as atividades: "banho", quantidade de fatores de risco (OR=0,4; IC=0,2-0,7; p=0,005) e quantidade de medica??o usada previamente ao AVC (OR=1,7; IC=1,1-27; p=0,013). Para "higiene pessoal", realiza??o de Fisioterapia ap?s a alta (OR=2,5; IC=1,2-5,1; p=0,014) e sexo feminino (OR=1,6; IC=1,06-2,4; p=0,026); para "transfer?ncia", quantidade de fatores de risco (OR=0,4; IC=0,2-0,9; p=0,025); para "contin?ncia", tipo de AVC (OR=2,2; IC=1,1-3,8; p=0,003 ? 10? dia; OR=1,9; IC=1,1-3,3; p=0,013 ? 28? dia) e realiza??o de Fisioterapia ap?s a alta (OR=4,1; IC=1,5-11,3; p=0,005); e para atividade "alimenta??o", quantidade de AVC pr?vio (OR=0,5; IC=0,2-0,9; p=0,036) e realiza??o de Fisioterapia ap?s a alta (OR=4,2; IC=1,6-11,1; p=0,003). Para as seis atividades, a idade acima de 60 anos e a falta de realiza??o da fisioterapia durante a interna??o hospitalar foram os mais fortes fatores preditivos para a depend?ncia funcional. Os resultados indicam fatores importantes que influenciam a depend?ncia funcional dos pacientes com AVC, trazem uma contribui??o cient?fica para que os prestadores de sa?de possam identificar oportunidades de interven??o e apontam a necessidade urgente de implanta??o de Unidades de AVC no Estado Rio Grande do Norte. / Stroke is an important public health problem, thus one study was carried out with the aim to evaluate epidemiological, clinical and functional factors of stroke patients. Materials and Methods: Four hundred thirty-three patients participated in the study (229 women and 204 men). In Natal/RN, the patients were assessed through the Step 1 and the Modified Rankin Scale. The data were analysed through the chi-squared test and logistic regression analysis. Results: It was noticed that the higher frequency of patients were in the age range of 70 to 89 years (40,9%). Arterial hypertension was the most frequent risk factor (85,4%) as well as the ischemic stroke (68,5%). There was a higher frequency of patients with incapacity to walk and do their personal hygiene (48,8%) (p= 0,001). It was also observed a correlation between the degree of neurological impairment and functionality (r= 0,53; p= 0,006). Regarding the basic activities of daily living (BADL), 25% of the patients could not rise from bed and 70,8% could not go to bathroom on their own (both p< 0.05). The regression models pointed out to the predictive factors of functional dependence to the activities: ?bathing?, quantity of risk factors (OR=0,4; IC=0,2-0,7; p=0,005) and quantity of medication used prior to stroke (OR=1,7; IC=1,1-27; p=0,013). To ?personal hygiene?, attendance to physiotherapy after discharge (OR=2,5; IC=1,2-5,1; p=0,014) and female sex (OR=1,6; IC=1,06-2,4; p=0,026); to ?transfer?, quantity of risk factors (OR=0,4; IC=0,2-0,9; p=0,025); to ?continence?, type of stroke (OR=2,2; IC=1,1-3,8; p=0,003 ? day 10; OR=1,9; IC=1,1- 3,3; p=0,013 ? day 28) and attendance to physiotherapy after discharge (OR=4,1; IC=1,5-11,3; p=0,005); and to the activity ?eating?, frequency of stroke (OR=0,5; IC=0,2-0,9; p=0,036) and attendance to physiotherapy after discharge (OR=4,2; IC=1,6- 11,1; p=0,003). To the six activities, age above 60 years and nonattendance to physiotherapy during hospital stay were the strongest predictive factors for functional dependence. Conclusion: The results indicate important factors that affect the functional dependence of stroke patients, thus bringing about a scientific contribution so that the healthcare providers may identify opportunities of intervention; they also point out the urgent need of implanting a Stroke Unit in the state of Rio Grande do Norte.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-13T19:58:38Z No. of bitstreams: 1 RodrigoGerentMattos_DISSERT.pdf: 1595220 bytes, checksum: 949e075a4c6fb1a1cc2d60f951fe99b9 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-15T23:36:09Z (GMT) No. of bitstreams: 1 RodrigoGerentMattos_DISSERT.pdf: 1595220 bytes, checksum: 949e075a4c6fb1a1cc2d60f951fe99b9 (MD5) / Made available in DSpace on 2017-02-15T23:36:09Z (GMT). No. of bitstreams: 1 RodrigoGerentMattos_DISSERT.pdf: 1595220 bytes, checksum: 949e075a4c6fb1a1cc2d60f951fe99b9 (MD5) Previous issue date: 2016-09-12 / A presente disserta??o possui como tema a Independ?ncia Funcional do Advogado P?blico Federal na Constitui??o da Rep?blica Federativa do Brasil em uma Advocacia de Estado atenta aos Direitos dos Cidad?os. A Constitui??o Federal confere ? Advocacia P?blica o status de Fun??o Essencial ? Justi?a. A atividade est? regulada nos arts. 131 e 132 da Constitui??o Federal. No ?mbito federal, a Advocacia P?blica ? exercida pela Advocacia-Geral da Uni?o, integrada pelas carreiras de Advogado da Uni?o, Procurador da Fazenda Nacional, Procurador Federal e Procurador do Banco Central. Cumpre ao Advogado P?blico realizar a defesa do Estado e viabilizar juridicamente a concretiza??o das pol?ticas p?blicas. Imp?e-se, no entanto, verificar como se pode compatibilizar a tarefa de defesa dos interesses do Estado sem negar direitos aos cidad?os. Desse modo, tem-se como objetivo geral analisar a exist?ncia, ou n?o, da independ?ncia funcional para o Advogado P?blico desenvolver suas atribui??es, pois a Constitui??o n?o destaca essa prerrogativa expressamente, tal como fez em rela??o ao Minist?rio P?blico e ? Defensoria P?blica. Como objetivos espec?ficos procurar-se-? verificar como a independ?ncia funcional do Advogado P?blico poderia contribuir para a redu??o da litigiosidade estatal; analisar as incongru?ncias do paradigma atual de uma Advocacia de Governo e conceber aspectos inerentes ao paradigma ideal de uma Advocacia de Estado. Adotase a metodologia dedutiva, partindo-se dos conhecimentos gerais para o espec?fico, com a abordagem do tema proposto sob a ?tica da t?cnica da pesquisa bibliogr?fica, buscando elementos na legisla??o, na doutrina nacional e estrangeira, bem como na jurisprud?ncia p?tria e em normas internas da Advocacia-Geral da Uni?o. Realiza-se uma abordagem exemplificativa para demonstrar o quanto o paradigma da Advocacia P?blica est? centrado em uma Advocacia de Governo e o que se poderia esperar de uma Advocacia de Estado em um modelo republicano atento aos direitos dos cidad?os. Na forma republicana de governo a atua??o estatal deve ser dirigida para atender aos interesses e ?s necessidades prim?rias da sociedade, visando sempre ? promo??o do bem comum. A atua??o do Advogado P?blico deve ent?o estar calcada no fio t?nue entre defender o Estado, viabilizar a realiza??o das pol?ticas p?blicas ao mesmo tempo em que exerce importante papel preventivo para a observ?ncia da legalidade pelos ?rg?os estatais. Conclui-se que a independ?ncia funcional do Advogado P?blico constitui princ?pio constitucional impl?cito ao exerc?cio da atividade jur?dica decorrente da pr?pria investidura constitucional. Em um Estado Republicano e Democr?tico de Direito que possui como fundamento a constru??o de uma sociedade justa (CF, art. 3?, I) o princ?pio da independ?ncia funcional do Advogado P?blico ? extra?do do exame do art. 131 em conjunto com o art. 37, caput, da Constitui??o Federal, bem como pela observ?ncia dos princ?pios e direitos fundamentais. No entanto, ante a realidade do paradigma vigente de uma Advocacia de Governo o princ?pio da independ?ncia funcional do Advogado P?blico Federal vem sendo inobservado na realidade emp?rica, sendo uma das causas para o excesso de litigiosidade estatal e da dificuldade de reconhecimento de direitos pertencentes aos cidad?os. / This dissertation has as its theme the Functional Independence of the Federal Public Attorney in the Constitution of the Federative Republic of Brazil in a Advocacy of the State Attentive to the Rights of Citizens. The Federal Constitution gives the Public Advocacy status of Essential Function to justice. The activity is regulated in arts. 131 and 132 of the Federal Constitution. At the federal level, the Public Advocacy is exercised by the Advocacy General of the Union, composed by the careers of the Union Attorney, Attorney of the National Treasury, Federal Attorney and Attorney of the Central Bank. Meets the Public Attorney conduct the defense of the state and legally enable the implementation of public policies. It is necessary, however, to see how one can reconcile the defense task of state interests without denying rights to citizens. Thus, it has as general objective to analyze the existence or not of functional independence for the public attorney to develop his/her tasks, because the Constitution does not highlight this prerogative expressly, as it did in relation to the Public Ministry and the Public Defender's Office. Specific objectives will be sought to verify how the functional independence of the Public Attorney could contribute to the reduction of state litigation; analyze the inconsistencies of the current paradigm of a Government Advocacy and shape aspects of the ideal paradigm of an Advocacy of the State. It is adopt the deductive methodology, starting from the general knowledge to a specific one, with the theme of the approach proposed from the perspective of the literature technique, seeking elements in legislation, national and foreign doctrine and the country law and internal rules of the Advocacy General of the Union. It is realized an exemplary approach to demonstrate how the paradigm of Public Advocacy is focused on a Government Advocacy and what could be expected from an Advocacy of the State in a republican model attentive to the rights of citizens. The republican way of government the state action should be directed to meet the interests and basic needs of society, always seeking to promote the common good. The role of the Public Attorney should then be feet in the thin thread between defending the state, enabling the implementation of public policies and at the same time plays an important preventive role for the observance of the law by state bodies. It is concluded that the functional independence of the Public Attorney is implicit constitutional principle to the exercise of legal activity deriving from the constitutional endowment. In a Republican and Democratic State of Law that has the foundation to build a just society (CF, art. 3, I) the principle of functional independence of the Public Attorney is extracted from examination of art. 131 in conjunction with art. 37, caput, of the Federal Constitution, and the observance of fundamental principles and rights. However, given the reality of the current paradigm of a Government Advocacy the principle of functional independence of the Federal Public Attorney has being unobserved in empirical reality, being one of the causes for the excess state litigation and the difficulty of recognition of rights belonging to citizens.