Orientador: José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T18:48:20Z (GMT). No. of bitstreams: 1 Souza_RenatoTeixeira_M.pdf: 10640708 bytes, checksum: 93bc984ddc636a415fed23ea6ca3a333 (MD5) Previous issue date: 2015 / Resumo: Introdução: Mais de 15 milhões de bebês nascem prematuros anualmente no mundo, sendo a prematuridade a maior causa de óbitos no período neonatal. A prematuridade terapêutica tem papel importante nesse contexto, pois se estima que 20 a 40% dos partos prematuros ocorrem por indicação dos provedores de assistência obstétrica. Dessa forma, a redução dos partos prematuros terapêuticos adquire cada vez mais importância para o controle da taxa de prematuridade e da morbimortalidade neonatais. O conhecimento dos fatores relacionados ao parto prematuro terapêutico é ponto fundamental para atingir essa redução. Objetivos: Avaliar a ocorrência do parto prematuro terapêutico e seus fatores associados na população do Estudo Multicêntrico de Investigação em Prematuridade (EMIP). Métodos: Análise secundária do EMIP, um estudo brasileiro de caso-controle aninhado a um corte transversal multicêntrico. O estudo ocorreu em 20 hospitais de referência em 3 regiões do Brasil de abril de 2011 a julho de 2012 e realizou a vigilância de 33.740 partos nesse período. O principal desfecho a ser avaliado é a ocorrência de parto prematuro terapêutico, definido como o parto que ocorreu antes de 37 semanas e que foi indicado pela equipe de assistência devido uma condição materna ou fetal. O grupo controle foi composto pelas mulheres com parto a termo. Os partos prematuros foram categorizados, conforme recomendações da Organização Mundial da Saúde, em prematuro extremo, muito prematuros e pretermo moderado Uma quarta categoria de idade gestacional, contemplando apenas os prematuros tardios, também foi analisada. Variáveis relacionadas a características sociodemográficas, pôndero-estaturais e de estilo de vida maternos, características da assistência ao pré-natal e ao parto e sobre a presença de morbidade ou complicação durante a gravidez, parto ou puerpério foram avaliadas na análise de risco para parto prematuro terapêutico. Foi realizada uma análise bivariada para estimar o risco de parto prematuro terapêutico para cada e uma análise multivariada com regressão logística não condicional para obter os fatores independentemente associados ao desfecho. Resultados: O parto prematuro terapêutico foi responsável por 35,4% dos partos prematuros na amostra estudada. As síndromes hipertensivas, o descolamento prematuro de placenta e a diabetes foram as condições que mais frequentemente motivaram a resolução prematura da gravidez. A idade materna avançada, a hipertensão crônica, a obesidade e a gravidez múltipla foram as principais condições maternas relacionadas à ocorrência de parto prematuro terapêutico. Houve uma tentativa de tratamento da condição materna que motivou a resolução em mais de 50% dos casos e 74,5% das mulheres com parto entre 28 e 31 semanas receberam corticoterapia. A cesariana foi a via de parto mais frequente. A proporção de mortalidade neonatal, do Apgar do quinto minuto menor que sete e da admissão em unidade intensiva neonatal foi muito maior nos prematuros terapêuticos do que no termo, mesmo considerando os prematuros tardios. Conclusões: Os resultados do estudo corroboram com a crescente importância do parto prematuro terapêutico, devido sua prevalência e impacto nos resultados perinatais. A gravidez múltipla, idade materna avançada, a obesidade e a presença de morbidades pré-gestacionais são os fatores que requerem especial atenção nas estratégias de prevenção da prematuridade terapêutica / Abstract: Background: More than 15 million babies are born prematurely each year worldwide and its the leading cause of deaths in the neonatal period. Provider-initiated preterm birth (piPTB) plays an important role in this context because it is estimated that 20-40% of preterm births occur by indication of obstetric care providers. Thus, the reduction in piPTB rate acquires more importance to decrease the rate of prematurity and neonatal morbidity and mortality. Knowledge of the factors related to piPTB is a key factor to achieve this reduction. Objectives: To evaluate the occurrence of provider-initiated preterm birth and the associated factors in the Multicenter Study on Preterm Birth in Brazil (EMIP) population. Methods: Secondary analysis of EMIP, a Brazilian multicenter cross-sectional study plus a nested case-control. The study took place in 20 referral hospitals in 3 regions of Brazil from April 2011 to March 2012 and conducted surveillance of 33,740 deliveries in this period. The primary outcome to be evaluated is the occurrence of provider-initiated preterm birth, defined as birth that occurred before 37 weeks and was medically indicated due to maternal or foetal condition. The control group was composed of women with term delivery. Preterm birth was categorized into extremely premature, very premature and moderate preterm, according to the World Health Organization. Another category that includes only the late preterm was also evaluated. Maternal, socio-demographic, obstetrical, prenatal care, delivery and postnatal characteristics were assessed as factors associated with piPTB. A bivariate analysis to estimate the risk for piPTB and a multivariate analysis using unconditional logistic regression for the factors independently associated with piPTB was performed. Results: The therapeutic preterm labor accounted for 35.4% of premature births in the sample. Hypertensive disorders, placental abruption and diabetes were the main conditions related to pi-PTB indications. Advanced maternal age, chronic hypertension, obesity and multiple pregnancy were the main maternal conditions related to pi-PTB. There was an attempt to treat maternal condition that led to the resolution in over 50% of cases and 74.5% of women with birth between 28 and 31 weeks received corticosteroid therapy. Cesarean section was the most frequent mode of delivery. The proportion of neonatal mortality, Apgar score<7 at 5 minutes and NICU admission were much higher in provider-initiated preterm newborns than in term newborns, even considering the late preterms. Conclusions: The results of our study corroborate the increasing notability of provider-initiated preterm birth, due to its prevalence and impact on perinatal outcomes. Multiple pregnancies, advanced maternal age, obesity and the presence of pre-gestational morbidities are the main factors that require special attention in prematurity prevention strategies / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Orientadores: João Paulo Dias de Souza, José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T16:41:03Z (GMT). No. of bitstreams: 1 Chaves_SolangedaCruz_M.pdf: 1613021 bytes, checksum: 7d4197dbf48569d759c9b1315425c34b (MD5) Previous issue date: 2015 / Resumo: Objetivos: Avaliar se as características propostas da Transição Obstétrica ¿ um modelo conceitual criado para explicar as mudanças graduais que os países apresentam ao eliminar a mortalidade materna evitável ¿ são observadas em um grande banco de dados multipaíses sobre a saúde materna e perinatal.Métodos: Trata-se de análise secundária de um estudo transversal da OMS que coletou informações de todas as mulheres que deram à luz em 359 unidades de saúde de 29 países da África, Ásia, América Latina e Oriente Médio, durante um período de 2 a 4 meses entre 2010 e 2011. As razões de Condições Potencialmente Ameaçadoras da Vida (CPAV), Resultados Maternos Graves (RMG), Near Miss Materno (NMM), e Mortalidade Materna (MM) foram estimadas e estratificadas por estágio de transição obstétrica. Resultados: Dados de 314.623 mulheres incluídas neste estudo demonstram que a fecundidade das mulheres, indiretamente estimada pela paridade, foi maior nos países que estão em estágio menor da transição obstétrica, variando de uma média de 3,0 crianças por mulher no Estágio II para 1,8 crianças por mulher no Estágio IV. O nível de medicalização do nascimento nas instituições de saúde dos países participantes, avaliada pelas taxas de cesárea e de indução de trabalho de parto, tendeu a aumentar à medida que os estágios de transição obstétrica aumentam. No Estágio IV, as mulheres tiveram 2,4 vezes a taxa de cesáreas (15,3% no Estágio II e 36,7% no Estágio IV) e 2,6 vezes a taxa de indução de trabalho de parto (7,1% no Estágio II e 18,8% no Estágio IV) que as mulheres de países no Estágio II. À medida que os estágios da transição obstétrica aumentaram, a média de idade das primíparas também aumentou. A ocorrência de ruptura uterina apresentou uma tendência decrescente, caindo aproximadamente 5,2 vezes, de 178 para 34 casos para 100 000 nascidos vivos à medida que os países transicionaram do Estágio II para o Estágio IV. Conclusões: Esta análise corroborou o modelo da Transição Obstétrica utilizando um banco de dados de grande porte e multipaíses. O modelo da Transição Obstétrica pode justificar a individualização da estratégia de redução da mortalidade materna de acordo com os estágios da transição obstétrica de cada país / Abstract: Objectives: To test whether the proposed features of the Obstetric Transition Model¿a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality¿are observed in a large, multicountry, maternal and perinatal health database. Methods: This was a secondary analysis of a WHO cross-sectional study that collected information on all women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2¿4-month period in 2010 ¿ 2011. The ratios of Potentially Life-threatening Conditions (PLTC), Severe Maternal Outcomes (SMO), Maternal Near Miss (MNM) and Maternal Death (MD) were estimated and stratified by stages of obstetric transition. Results: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. The level of medicalization in health facilities in participating countries, defined by the number of caesarean deliveries and number of labor inductions, tended to increase as the stage of obstetric transition increased. In Stage IV, women had 2.4 times the caesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) than women in Stage II. As the stages of obstetric transition increased, the mean age of primiparous women also increased. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. Conclusions: This analysis supports the concept of obstetric transition using multicountry data. The obstetric transition model could provide justification for customizing strategies for reducing maternal mortality according to a country¿s stage in the obstetric transition / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Submitted by Renata Lopes (renatasil82@gmail.com) on 2015-12-09T14:33:14Z No. of bitstreams: 1 tatianeribeirodesiqueira.pdf: 1746220 bytes, checksum: 01a239ee1ea9876e3d413b78f8f1446b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2015-12-09T14:56:33Z (GMT) No. of bitstreams: 1 tatianeribeirodesiqueira.pdf: 1746220 bytes, checksum: 01a239ee1ea9876e3d413b78f8f1446b (MD5) / Made available in DSpace on 2015-12-09T14:56:33Z (GMT). No. of bitstreams: 1 tatianeribeirodesiqueira.pdf: 1746220 bytes, checksum: 01a239ee1ea9876e3d413b78f8f1446b (MD5) Previous issue date: 2015-02-26 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A infecção por dengue vírus (DENV) tem sido considerada atualmente a mais importante arbovirose no mundo. Até o presente momento foram descritos quatro diferentes sorotipos do DENV: DENV-1, DENV-2, DENV-3 e DENV-4. A infecção pelo DENV pode produzir uma ampla variedade de distúrbios a febre do dengue ou formas graves da doença, como a febre hemorrágica do dengue (FHD) e síndrome do choque do dengue (SCD), onde os quatro sorotipos de DENV podem causar desde uma infecção assintomática até FHD e SCD. A patogênese da FHD/SCD é multifatorial e vários estudos mostram algumas hipóteses para explicar as manifestações mais graves na infecção por DENV: (i) fatores virais, (ii) associação entre FHD/SCD em casos de infecção heterotípica pelo DENV e (iii) fatores do próprio hospedeiro, que poderiam estar relacionados à resposta imune. Estudos que buscam entender o porquê de pacientes com dengue apresentarem diferentes prognósticos são de grande importância para a Saúde Pública. Embora a doença causada por DENV seja considerada um grande problema de saúde pública, ainda não estão disponíveis drogas antivirais e vacinas a fim de tratar ou prevenir a infecção. O combate do vetor tem sido ineficiente, permitindo o aparecimento de novas epidemias. A cidade de Juiz de Fora vem passando por diversas epidemias de dengue nos últimos anos, com o registro de casos graves e óbitos. Diante deste contexto, este trabalho visou investigar os fatores sorológicos e genéticos relacionados com a predisposição ao desenvolvimento das formas graves de dengue em Juiz de Fora. Em setembro e outubro de 2013 e fevereiro e maio de 2014, amostras de sangue total foram coletadas. As amostras foram estudas para estudos de SNPs, pequisa de anticorpos e do DENV. No grupo estudado, foi observada uma soroprevalência de 16,1%. Foram detectados genótipos predisponentes e genótipos protetores de FHD, nos genes FCRIIa, JAK-1 e DCSIGN, em moradores de Juiz de Fora, entretanto, não foi observada associação desses genótipos individualmente e/ou em combinação com a distribuição de gênero, diferentes regiões de Juiz de Fora onde os participantes residiam e relato de apresentação de sintomas de dengue pelos pacientes. Foram detectados três pacientes que apresentaram material genético de DENV. O conhecimento de áreas e pessoas predispostas à FHD constituem informações valiosas do ponto de vista epidemiológico e na estruturação de políticas públicas que visem o controle da dengue. / Dengue virus infection (DENV) is considered the most important arbovirose in the world and the greatest impact on public health. Four different serotypes of DENV: DENV-1, DENV-2, DENV-3 and DENV-4 have been described. DENV infection may produce a wide variety of disorders, dengue fever or severe disease, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (SCD). Any of the four DENV can cause asymptomatic infection from one to DHF and DSS. The pathogenesis of DHF / DSS is multifactorial and several studies showed some hypotheses to explain the most serious manifestations of infection by DENV: (i) viral factors (ii) secondary infection DENV and (iii) the host factors could be related to exaggerated immune response. Studies trying to understand why dengue patients have different prognoses are of great importance for public health. Although dengue is considered one major public health problem, there are not available antiviral drugs and vaccines to treat or prevent the infection. The vector control has been inefficient, allowing the emergence of new outbreaks. The city of Juiz de Fora has experienced several dengue epidemics in recent years, with the record of serious cases and deaths. Given this context, this study aimed to investigate the serological and genetic factors related to the predisposition to severe forms of dengue in Juiz de Fora. In September/ October 2013 and February to May 14 342 samples of whole blood were collected were collected. Samples were used to investigate the immune response do dengue, SNPs and DENV. In the study group, a seroprevalence of 16.1% was observed. Predisponent and protector genotypes were detected genes FCyRIIa, JAK-1 and DCSIGN in Juiz de Fora residents, however, there was no association of these genotypes individually and / or in combination with the gender distribution, different Juiz de Fora regions where the participants lived and report presentation of dengue symptoms by patients. Three patients were detected with DENV infection, by the time of sample collection.The knowledge of areas and persons who are more prone to have FHD is a valuable information from the epidemiological point of view and the structuring of public policies aimed at controlling dengue.

Magister Legum - LLM / This study investigates the the impact of armed conflict on child education in the Democratic Republic of Congo. Naturally, armed conflict affects negatively on people‟s life. In particular, armed conflict affects the education of children as military groups attack schools, schools children and teachers. Ultimately, armed conflicts also affect the quality of education children receive during hostilities. In light of this, the study assesses how the Congolese government, in line with international and regional human rights obligations, responds to the educational needs of children affected by armed conflict.

Broad personality or global traits are unlikely to assist in solving capital crimes, so forensic psychologists have begun to focus on characteristics of the crime to create differentiating profiles. The purpose of this study was to determine if offender and victim characteristics and method of murder could provide cluster profiles differentiating familial relationship between offender and victim. Guided by classical conditioning theory and social learning theory, an archival database of 147 capital offenders responsible for 506 victims was analyzed. Cluster analysis yielded 3 distinct profiles. Compared to other clusters, Cluster 1 offenders tended to be Black and unfamiliar with their victims, who tended to be male between 20 and 50 years old that were typically shot. Cluster 2 offenders tended to be White and familiar with their typically female victims under the age of 20 who they typically murdered by use of blunt force or strangulation. Cluster 3 offenders were distinguished from the other 2 clusters only by having accounted for 90.6% of all victims who were stabbed, but no other associations with variables in the data set were discovered to explain this finding. Though limited in sample size, range of variables, and supplemental insights that could have been gained from case files or interviews, the results contribute to positive social change with offender-victim characteristics and method of murder profiles that begin to differentiate the familial offender-victim relationship and that future research can prospectively build on to create retrospective profiling models, which could potentially lead to resolving unsolved serial murder cases.

In the southern part of the county of Jämtland seven rich finds of iron artefacts from the Vendel Period have been found. These finds contain similar sets of hunting weapons and tools of iron and they are all found close to lakes or river banks in the hunting ground area. In most cases no human bones or grave structures have been found in connection with the finds. The combination of artefacts is similar to combinations found in hunting ground graves in Dalarna and Norway. Therefore, archaeologists have discussed whether the finds in Jämtland should be classified as graves or hoards. The purpose of this thesis is to widen the discussion. An important point of departure has been to refrain from classifying the archaeological material in advance as graves or hoards, as sacred or profane, or as anything else, since such assumptions risk leading to circular reasoning. The analysis and discussion in the thesis are inspired by practice theory and focus on how actions performed can reflect people's relationships. Symbolism and beliefs, or what people thought, are of secondary importance. The results suggest that the finds of iron artefacts discussed in this thesis can be considered remains of ritualised activities. These activities may have been performed for a variety of reasons. For the moment, it may be fruitful to shift the focus from the classification problem to a discussion where these rich finds of iron artefacts are considered in a broader context. The results also suggest that these iron artefacts were deposited in the ground during a time when there was an increase in the construction of trapping pit systems in Jämtland. The rich finds of iron artefacts may well reflect changes taking place in the organisation of the surrounding community as a result of the increasing importance of hunting.

Today global warming mitigation, natural resource conservation and energy saving are some of the significant concerns of different industries, such as cement and concrete industries. For that reason, a streamlined life cycle assessment (LCA) model of one ton of a Portland cement, CEM I produced in Cementa AB’s Degerhamn plant, has been developed by using the LCA software KCL-ECO. LCA is a tool that identifies in which stages of a product’s life cycle the most environmental burdens occur. The environmental analysis was limited to identify total energy consumption and total carbon dioxide (CO2) emissions per ton of Portland cement. Results show that the most significant energy consumption and CO2 emissions are related to clinker kiln, due to the process of calcination of limestone and fuel combustion in the kiln. Of total CO2 emissions, 52 % and 46 % result from the calcination process and fuel combustion respectively.  One of the applications of CEM I is in construction of concrete bridges. Therefore an LCA model of a concrete bridge located north of Stockholm was developed in KCL-ECO. Environmental indicators calculated are: total CO2 emissions and energy consumption through the entire life cycle of the bridge. CO2 uptake or carbonation of the concrete during the service life of the product and end of life treatment is one of the advantages of concrete products. During the carbonation process, some of the total CO2 released from calcination will be absorbed into the concrete. Results indicate that production of raw materials and transports during the life cycle of the concrete bridge, are main contributors to total CO2 emissions. Among raw materials, cement production has the highest CO2 emissions. Energy consumption is mainly related to concrete and concrete products production. CO2 uptake during the use phase of the bridge is small compared to total CO2 emissions from calcination. Furthermore, the results show that different waste handling practises result in different CO2 uptake behaviours. The total CO2 uptake from crushing and storing of the demolished concrete (scenario 1) and landfilling of the demolished concrete (scenario 2) is 10 % and 5 % of the total CO2 emissions from calcination respectively.  Since comparison of different construction materials from an environmental point of view is always desirable, the LCA tool was used to compare the total energy consumption and the CO2 emissions from a concrete bridge and a wooden bridge. The functional unit was defined as 1 square meter of bridge surface area, since the bridges were of different sizes and shapes. In this comparison the total emissions and energy consumption were much higher for the concrete bridge than for the wooden bridge.  In order to show how different assumptions could affect the results, a virtual concrete bridge with the same shape and size as the wooden bridge was designed and compared with the wooden bridge. The functional unit selected for this case was one bridge. In this case the virtual concrete bridge requires less energy, while the wooden bridge emits less CO2 to the atmosphere. For the wooden bridge, CO2 in growing forests was included, which could be debated. Overall, a comparison of the environmental performance of the wooden bridge and the concrete bridges was more complex than initially expected and great care is recommended in choosing material and application. With concrete, the design (and quantity of material used) seems to be a very sensitive parameter and may result in much larger energy used and CO2 emissions than a wooden bridge. On the other hand, the virtual bridge comparison showed that concrete advantages such as higher durability and lower maintenance may be theoretically combined with a comparable energy and climate performance as a wooden alternative.

I have statistically worked up a material from 228 graves from the late Iron Age in the area of Mälardalen. In my material I have gathered the incidence of combs, knifes, beads, weapons whetstones and torshammarsrings. I have found that beads are overrepresented in graves of women and whetstones in graves of men. I only found weapons in graves from male. I found no indication from my statistic hypothesis (Z-test) that a grave that contains more than three beads should define the grave of a woman. A grave that contains a lot of beads, more than 20, consider I as a female gender. Combs, knifes and torshammarsring are considered as gender neutral.

Here we present a bioarchaeological analysis of a Postclassic (ca. A.D. 950-1524) Maya mass grave from the site of Zacpetén in northern Guatemala. Osteological and spatial analyses (including a Ripley's K function) found evidence of cutting, drilling, and grinding of long bones and teeth as well as the intentional removal and manipulation of skeletal elements based on the left or right sides of the body. The remains were enveloped in layers of cut blocks and fist-sized chunks of white limestone and were placed in a depression on the western side of the ceremonial core of the site. The western orientation of the depression was explicitly associated with the underworld in contrast with the temple on the eastern side of the ceremonial core. The grave was the product of exhumation and violation of enemies' bodies, sacrifice, or the burial of war dead (or some combination thereof) and was created when the Kowoj group emerged as a political force in the Petén lakes region. It served to symbolically rupture the past inhabitants' links to the site and to create an enduring symbol of their defeat.

El estigma asociado a la enfermedad mental grave se ha convertido en una barrera importante para la integración social de las personas que la padecen, así como la atención especializada de las mismas. La presente tesis doctoral tiene como objetivo la reducción del estigma hacia las personas con enfermedad mental grave mediante la educación física. La intervención se desarrolló con 394 estudiantes universitarios y de primero de bachillerato a través de tres estrategias para reducir el estigma: intervención teórica de contenidos sobre salud y enfermedad mental, intervención de contacto directo a través de la educación física y a través de la combinación de ambas estrategias. Se utilizó el cuestionario Community Attitudes towards Mental Illness (CAMI) para la recogida de información y su posterior análisis. Se obtuvieron resultados estadísticamente significativos en cada una de las intervenciones en comparación con el grupo control, concluyendo que la Educación Física puede ser una estrategia adecuada para la mejora del estigma asociado a la enfermedad mental grave.