Made available in DSpace on 2014-06-11T19:30:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-28Bitstream added on 2014-06-13T19:18:35Z : No. of bitstreams: 1 oliveira_ap_me_botfmvz.pdf: 248983 bytes, checksum: d4b76402bf8f6b3836e11a75c57b5f0f (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O Brasil é líder mundial na produção de embriões por fertilização in vitro (FIV). A FIV contribui para o melhoramento genético do rebanho, contudo, alguns trabalhos indicam que os bezerros nascidos por FIV são mais susceptíveis à doença neonatal e têm maiores taxas de mortalidade neonatal quando comparados a outras técnicas de produção de bezerros como a inseminação artificial (IA) e monta natural. Portanto, o objetivo desta pesquisa foi avaliar a influência da forma de concepção, FIV e IA, na sanidade e desenvolvimento de bezerros Brahman nascidos por FIV (Grupo FIV, n = 80) e IA (Grupo IA, n = 20) do nascimento à desmama. Todos os bezerros amostrados eram provenientes de uma mesma propriedade e mamaram o colostro de forma direta ou indireta até seis horas após o nascimento. Amostras sanguíneas destinadas à determinação da atividade sérica da gamaglutamiltransferase (GGT), da gamaglobulina e da concentração sérica de proteína total (PT) foram colhidas de todos os bezerros às 24 horas de vida com o objetivo de avaliar a transferência de imunidade passiva. A duração da gestação e o peso ao nascimento foram significantemente maiores nos bezerros do grupo FIV. Contudo, não foi observada diferença estatística no peso à desmama nos bezerros dois grupos estudados. Também não foi evidenciada diferença significante na ocorrência de partos distócicos, de assistência à ingestão do colostro, de falha de transferência de imunidade passiva (FTIP) e de enfermidades do nascimento à desmama entre os bezerros dos grupos FIV e IA. O peso ao nascimento, a forma de ingestão do colostro e a ocorrência de distocia não foram correlacionados com a FTIP em nenhum dos grupos estudados. Portanto, nas condições estudadas a forma de concepção, FIV ou IA, não influenciou a sanidade e desenvolvimento de bezerros da raça Brahman, e nem interferiu na aquisição de imunidade passiva / Recent data ranked Brazil as the leading country in the production of in vitro-fertilization (IVF) bovine embryos. IVF embryos contributes to the genetic improvement, however, some reports indicate that calves derived from IVF embryos are more susceptible to neonatal disease and have higher rates of neonatal mortality than calves produced through artificial insemination (AI) or natural mating. Therefore the goal of the present study was to evaluate the influence of conception method, IVF embryos and AI, in health and development of Brahman calves derived from IVF (Group IVF, n = 80) and from AI (Group AI, n = 20) from birth to weaning. All of the calves were from same farm and received colostrum within 6 hours of birth. Blood samples were obtained from calves at 24 hours of life to determine the activity gammaglutamyltransferase (GGT) and gammaglobulin and serum total protein (PT) concentration to evaluate passive transfer of maternal immunity. Gestation period and birth weight were significantly higher in claves from IVF group. However, there was no statistically difference in the weaning weight calves in both groups. The occurrence of dystocia, to assistance to provide colostrums, passive transfer of maternal immunity and of diseases from birth to weaning was not significantly different in the two groups. No correlation was observed among birth weight, the form of colostrum ingestion and dystocia occurrence, and passive immunity failure in both groups. Therefore, under study conditions the conception method, IVF or AI, did not influence the health and performance of Brahman calves, and not interfere with the acquisition of passive immunity

Orientador: Roberto Calderon Gonçalves / Banca: Nereu Carlos Prestes / Banca: Francisco Leydson Formiga Feitosa / Resumo: O Brasil é líder mundial na produção de embriões por fertilização in vitro (FIV). A FIV contribui para o melhoramento genético do rebanho, contudo, alguns trabalhos indicam que os bezerros nascidos por FIV são mais susceptíveis à doença neonatal e têm maiores taxas de mortalidade neonatal quando comparados a outras técnicas de produção de bezerros como a inseminação artificial (IA) e monta natural. Portanto, o objetivo desta pesquisa foi avaliar a influência da forma de concepção, FIV e IA, na sanidade e desenvolvimento de bezerros Brahman nascidos por FIV (Grupo FIV, n = 80) e IA (Grupo IA, n = 20) do nascimento à desmama. Todos os bezerros amostrados eram provenientes de uma mesma propriedade e mamaram o colostro de forma direta ou indireta até seis horas após o nascimento. Amostras sanguíneas destinadas à determinação da atividade sérica da gamaglutamiltransferase (GGT), da gamaglobulina e da concentração sérica de proteína total (PT) foram colhidas de todos os bezerros às 24 horas de vida com o objetivo de avaliar a transferência de imunidade passiva. A duração da gestação e o peso ao nascimento foram significantemente maiores nos bezerros do grupo FIV. Contudo, não foi observada diferença estatística no peso à desmama nos bezerros dois grupos estudados. Também não foi evidenciada diferença significante na ocorrência de partos distócicos, de assistência à ingestão do colostro, de falha de transferência de imunidade passiva (FTIP) e de enfermidades do nascimento à desmama entre os bezerros dos grupos FIV e IA. O peso ao nascimento, a forma de ingestão do colostro e a ocorrência de distocia não foram correlacionados com a FTIP em nenhum dos grupos estudados. Portanto, nas condições estudadas a forma de concepção, FIV ou IA, não influenciou a sanidade e desenvolvimento de bezerros da raça Brahman, e nem interferiu na aquisição de imunidade passiva / Abstract: Recent data ranked Brazil as the leading country in the production of in vitro-fertilization (IVF) bovine embryos. IVF embryos contributes to the genetic improvement, however, some reports indicate that calves derived from IVF embryos are more susceptible to neonatal disease and have higher rates of neonatal mortality than calves produced through artificial insemination (AI) or natural mating. Therefore the goal of the present study was to evaluate the influence of conception method, IVF embryos and AI, in health and development of Brahman calves derived from IVF (Group IVF, n = 80) and from AI (Group AI, n = 20) from birth to weaning. All of the calves were from same farm and received colostrum within 6 hours of birth. Blood samples were obtained from calves at 24 hours of life to determine the activity gammaglutamyltransferase (GGT) and gammaglobulin and serum total protein (PT) concentration to evaluate passive transfer of maternal immunity. Gestation period and birth weight were significantly higher in claves from IVF group. However, there was no statistically difference in the weaning weight calves in both groups. The occurrence of dystocia, to assistance to provide colostrums, passive transfer of maternal immunity and of diseases from birth to weaning was not significantly different in the two groups. No correlation was observed among birth weight, the form of colostrum ingestion and dystocia occurrence, and passive immunity failure in both groups. Therefore, under study conditions the conception method, IVF or AI, did not influence the health and performance of Brahman calves, and not interfere with the acquisition of passive immunity / Mestre

Une activité physique régulière est une stratégie efficace pour un vieillissement réussi. Quinze minutes d’activité physique par jour pourraient être une dose cible raisonnable chez les personnes âgées saines, atteintes de pathologies chroniques ou reprenant une activité physique régulière. L’épreuve d’effort au sein de la visite médicale de non contre-indication à la pratique sportive doit être réalisée dans le cadre du dépistage du risque cardiovasculaire des sujets âgés de plus de 50 ans. Cette faible dose d’activité physique requise freinerait la diminution physiologique de la régulation du système nerveux autonome et réduirait de manière significative la morbi-mortalité cardiovasculaire notamment. Ainsi, une augmentation progressive de ces 15 min pourrait leur permettre de se rapprocher des 150 minutes d’activité physique recommandées par semaine. La promotion de l’activité physique visant à diffuser le message : « même un peu c’est bien, évidemment plus c’est mieux » pourrait permettre d’encourager les sujets âgés à remplacer leurs périodes d’inactivité physique et de sédentarité par des périodes mêmes courtes d’activité physique. L’optimisation de la régulation du système nerveux autonome par l’activité physique pourrait être une des clés de réponse à la recherche d’une thérapeutique non médicamenteuse pour bien vieillir. / A regular physical activity is an effective strategy for successful aging. Fifteen minutes of physical activity per day could be a reasonable target dose for healthy older adults, chronically ill or physically active. Exercise ECG in pre-participation screening should be performed for subjects over 50 years of age. This low dose prevents the physiological decrease of autonomic nervous system and significantly reduces mortality. Small increases in physical activity may enable some older adults to incorporate more moderate activity and thus get closer to the current recommendations. The promotion of physical activity with the spread of the message: “If more may be better, even a little is already good” could encourage older adults to substitute sedentary lifestyle by physical activity, even of short duration. Autonomic nervous system regulation by physical activity may be one of physiological explanations for the efficiency of physical activity in the prevention of morbi-mortality (mainly cardiovascular) and prevention of aging. Autonomic nervous system regulation by physical activity might be key for successful aging.

O peso ao nascer é um fator importante na determinação da morbi-mortalidade neonatal e da mortalidade pós-neonatal, sendo assim de grande importância para a saúde pública, dada a freqüência com que o mesmo ocorre. A Organização Mundial de Saúde considera o baixo peso ao nascer (BPN) como o fator isolado mais importante na sobrevivência infantil. Inúmeros fatores de risco têm sido descritos como associados à ocorrência de BPN, por exemplo, o tabagismo materno e o baixo nível sócioeconômico. Mais recentemente, a poluição do ar tem sido investigada como possível determinante do BPN. A distribuição do peso ao nascer na cidade de São Paulo (média 3.160g com 8,9% de BPN) é inferior àquela esperada quando se têm ótimas condições de crescimento fetal (média de 3.400-3.500g com 4-5% de BPN). Esta distribuição tem se mantido estável nos últimos 22 anos, apesar da evolução favorável do estado nutricional das gestantes, da assistência pré-natal e do hábito de fumar durante a gestação. No entanto, são altos os índices de poluição atmosférica em São Paulo, fator que pode estar afetando o desenvolvimento intra-uterino das crianças que aqui nascem. Este estudo foi realizado com a intenção de avaliar uma possível associação do baixo peso ao nascer e a poluição do ar no município de São Paulo. Para tanto foram analisados todos os nascimentos de mães residentes neste município nos anos de 1998 a 2000. As informações sobre esses nascidos vivos foram obtidas do SINASC (Sistema de Informação sobre Nascidos Vivos) através de seu instrumento, a Declaração de Nascido Vivo (DN). Os dados de poluição do ar foram obtidos junto à Companhia de Tecnologia de Saneamento Ambiental (CETESB) que forneceu os registros diários das concentrações de dióxido de enxofre (SO2), partículas em suspensão (PM10), monóxido de carbono (CO), ozônio (O3) e dióxido de nitrogênio (NO2). O efeito da exposição materna à poluição do ar, em cada trimestre da gestação sobre a incidência de recémnascidos de baixo peso foi examinado através de modelos de regressão linear e logística. A exposição materna ao PM10, CO, NO2 e SO2 durante o 1º trimestre de gestação mostrou associação estatisticamente significante com a diminuição no peso do recémnascido. Para um aumento na exposição média materna, durante o 1º trimestre de gestação, de 1ppm de CO, observou-se uma diminuição no peso de nascimento de 11,9g. / The birth weight is an important factor of the morbi-mortality neonatal determination and of the mortality neonatal, and then of big importance to public health, due frequency that it occurs. Therefore, the Health World Organization considers the low birth weight (LBW) the most important isolated factor in childhood survival. A lot of risk factors have been described as associated to LBW occurrence, for example, the mother smoker and low social-economic level(nível sócio-econômico). Recently, the air pollution has been investigated as possible LBW determinant. The distribution of birth weight in the city of São Paulo (average 3.160g with 8.9% of LBW) is inferior to that one expected when having good conditions of fetal growth (average between 3400-3500g with 4-5% of LBW). This distribution has been kept stable for the last 22 years, despite of favorable evolution of the nutritional state of the pregnants, pre-birth assistance and the habit of smoking during the pregnancy. However, the indices of atmospheric pollution are high in São Paulo, this factor can be affecting the development intra-uterine of the children that are born here. Considering the factor that the LBW prevalence in the city of São Paulo city has stayed stable for the last twenty years, that is, a high prevalence, and the fact of São Paulo has high rates of air pollution, its possible to suppose that the air pollution can be affecting the intra-uterine development of childhood are born. Therefore, it claims to realize a study to value a possible association of LBW and the air pollution in the city of São Paulo. All the births of mothers living in this city between 1998- 2000 were analysed. The information about these born-alive was obtained from Sistema de Informação sobre Nascidos Vivos (SINASC) through of yours instrument, the Declaração de Nascido Vivo (DN). The information about air pollution was obtained from Compahia de Tecnologia de Saneamento Ambiental (CETESB), that supplied the daily registers of sulphur dioxide (SO2), particulate matter (PM10), carbon monoxide (CO), ozone (O3) and nitrogen dioxide (NO2). The effect of mother exposure to air pollution, each pregnancy trimester about the LBW prevalence was made on linear and logistic models. The maternal exposure to PM10, CO, NO2 and SO2 during the first trimester of pregnancy showed association statistically significant with the decrease in the weight of the new-born child. For an increasing in the maternal average exposure, during the first trimester of pregnancy, in 1 ppm of CO, was observed a decrease of 11.9g in the weight born.

Made available in DSpace on 2014-07-29T15:04:45Z (GMT). No. of bitstreams: 1 Dissertacao Carlos Roberto Caixeta.pdf: 262265 bytes, checksum: a9808efbfa64d535642727610bfa9bca (MD5) Previous issue date: 2006-03-27 / Transport accidents are currently one of the world s main public health problems. The aim of this investigation is to describe the profile of transport injury victims attended at Hospital de Urgências de Goiânia (HUGO) and of victims who deceased in these accidents, with age 15 to 24 years, residents in Goiânia, Goiás - Brazil. It also describes the circumstances involved in these accidents. This descriptive transversal study was carried out in the city of Goiânia from August 2005 to August 2006 with systematic sampling, considering the day of the week and the time of the day. At that period were interviewed 301 victims attended at HUGO, the main Emergency Service Center of the city, and the family of 62 cases of death occurred in the municipality. The data were treated by descriptive statistics. Most victims attended at HUGO and most of those who died were male, mean age 19.94 ± 2.73 years. The main transport used by the victims attended at HUGO was the motorcycle (67.33%), followed by the bicycle (16.67%). The motorcycle was the most used by fatal victims (66.67%) as well. The accidents usually occurred at night, especially around 6 pm to 9 pm and at weekends (fridays and sundays). The victims were generally on the way to do physical, sportive, school, leisure or entertaining activities at that time. Those who were doing paid work had the accident between 6 am and 9 am. Suspicion of alcohol use was confirmed in 15.16% of the cases attended at HUGO and by 26.31% of the family of fatal victims. The victims attended at HUGO were the drivers in 77.11% of the motorcycle accidents and 92.00% of bicycle accidents, as well as in 76.92% of the fatal victims. There were victims under 18 years of age identified as drivers of automobiles and motorcycles. In proportion (p<0.05), more motorcyclists (66.48%) believed that there was imprudence/ negligence than the cyclists (47.72%) attended at HUGO. Security equipment was not used by 8.58% of motorcyclists, by 95.45% of cyclists attended at HUGO and by 12.5% of the motorcyclists who died. The safety belt was not used by 50.00% of the attended at HUGO and by 60.00% of who died. The results indicate a need for a differentiated look at motorcyclists, which justifies a specific approach to this group, as well as measures of inspection, giving priority to the periods of night and weekends. The service of attending victims must be planned, adjusting the amount of human, material and equipment resources, and the seasonality of accidents. The epidemiologic profile of the victims provides important information for administrators to implement politics of promoting health and preventing injury transport, which takes intersectional and multiprofessional actions to confront the problem. Keywords: Transport accidents are currently one of the world s main public health problems. The aim of this investigation is to describe the profile of transport injury victims attended at Hospital de Urgências de Goiânia (HUGO) and of victims who deceased in these accidents, with age 15 to 24 years, residents in Goiânia, Goiás - Brazil. It also describes the circumstances involved in these accidents. This descriptive transversal study was carried out in the city of Goiânia from August 2005 to August 2006 with systematic sampling, considering the day of the week and the time of the day. At that period were interviewed 301 victims attended at HUGO, the main Emergency Service Center of the city, and the family of 62 cases of death occurred in the municipality. The data were treated by descriptive statistics. Most victims attended at HUGO and most of those who died were male, mean age 19.94 ± 2.73 years. The main transport used by the victims attended at HUGO was the motorcycle (67.33%), followed by the bicycle (16.67%). The motorcycle was the most used by fatal victims (66.67%) as well. The accidents usually occurred at night, especially around 6 pm to 9 pm and at weekends (fridays and sundays). The victims were generally on the way to do physical, sportive, school, leisure or entertaining activities at that time. Those who were doing paid work had the accident between 6 am and 9 am. Suspicion of alcohol use was confirmed in 15.16% of the cases attended at HUGO and by 26.31% of the family of fatal victims. The victims attended at HUGO were the drivers in 77.11% of the motorcycle accidents and 92.00% of bicycle accidents, as well as in 76.92% of the fatal victims. There were victims under 18 years of age identified as drivers of automobiles and motorcycles. In proportion (p<0.05), more motorcyclists (66.48%) believed that there was imprudence/ negligence than the cyclists (47.72%) attended at HUGO. Security equipment was not used by 8.58% of motorcyclists, by 95.45% of cyclists attended at HUGO and by 12.5% of the motorcyclists who died. The safety belt was not used by 50.00% of the attended at HUGO and by 60.00% of who died. The results indicate a need for a differentiated look at motorcyclists, which justifies a specific approach to this group, as well as measures of inspection, giving priority to the periods of night and weekends. The service of attending victims must be planned, adjusting the amount of human, material and equipment resources, and the seasonality of accidents. The epidemiologic profile of the victims provides important information for administrators to implement politics of promoting health and preventing injury transport, which takes intersectional and multiprofessional actions to confront the problem. / Os acidentes de transporte constituem na atualidade um dos principais problemas de saúde pública em todo mundo, especialmente nos países em desenvolvimento. Este estudo teve como objetivo descrever o perfil das vítimas dos acidentes de transportes atendidos no Hospital de Urgências de Goiânia (HUGO) e das vítimas que foram a óbito, na faixa etária de 15 a 24 anos e residentes em Goiânia - Goiás, bem como descrever as circunstâncias envolvendo esses acidentes. Trata-se de estudo descritivo, transversal, conduzido em Goiânia de agosto/2005 a agosto/2006, com amostragem sistemática considerando dia da semana e horários do dia. Foram entrevistadas 301 vítimas atendidas no HUGO, principal Serviço de Emergência da cidade, e familiares de 62 casos de óbitos ocorridos no município naquele período. Os dados foram tratados por meio de estatística descritiva. Dentre as vítimas atendidas no HUGO e das que foram a óbito a maioria era do sexo masculino, com idade média de 19,94 ± 2,73 anos. O meio de transporte mais utilizado pelas vítimas atendidas no HUGO foi a motocicleta (67,33%), seguido da bicicleta (16,67%). A motocicleta também foi a mais usada entre as vítimas fatais (76,36%). Os acidentes ocorreram mais no período noturno, especialmente entre as 18h e 21h e aos finais de semana (6ª feira e domingo). As vítimas estavam principalmente no trajeto para atividades físicas, esportivas, escolares, lazer e entretenimento nesses horários. Aquelas que realizavam trabalho pago acidentaram-se principalmente entre 06 e 09 h. A suspeita do uso de álcool foi confirmada por 15,14% dos atendidos no HUGO e por 26,31% dos familiares das vítimas fatais. Eram condutores 77,11% dos motociclistas e 92% ciclistas atendidos no HUGO, bem como 76,92% das vítimas fatais. Foram identificadas vítimas menores de 18 anos condutores dos automóveis e motocicletas. Proporcionalmente mais motociclistas (66,48%) julgaram que houve imprudência / negligência que os ciclistas (47,72%) atendidos no HUGO (p<0,05). Os equipamentos de segurança não eram usados por 8,58% dos motociclistas e 95,45% dos ciclistas atendidos no HUGO e por 12,50% motociclistas que morreram. O cinto de segurança era não era usado por 50,00% dos atendidos no HUGO e por 60,00% das vítimas fatais. Os resultados indicam que um olhar diferenciado deve ser dirigido aos motociclistas, justificando uma abordagem específica para este grupo, bem como são necessárias medidas de fiscalização que priorizem o período noturno e os finais de semana. Os serviços de atendimento às vítimas devem planejar o atendimento adequando a quantidade de recursos humanos, materiais e equipamentos, considerando a sazonalidade dos acidentes. O perfil epidemiológico das vítimas fornece informações importantes aos gestores para implementar políticas de promoção da saúde e de prevenção dos acidentes de transporte.

O peso ao nascer é um fator importante na determinação da morbi-mortalidade neonatal e da mortalidade pós-neonatal, sendo assim de grande importância para a saúde pública, dada a freqüência com que o mesmo ocorre. A Organização Mundial de Saúde considera o baixo peso ao nascer (BPN) como o fator isolado mais importante na sobrevivência infantil. Inúmeros fatores de risco têm sido descritos como associados à ocorrência de BPN, por exemplo, o tabagismo materno e o baixo nível sócioeconômico. Mais recentemente, a poluição do ar tem sido investigada como possível determinante do BPN. A distribuição do peso ao nascer na cidade de São Paulo (média 3.160g com 8,9% de BPN) é inferior àquela esperada quando se têm ótimas condições de crescimento fetal (média de 3.400-3.500g com 4-5% de BPN). Esta distribuição tem se mantido estável nos últimos 22 anos, apesar da evolução favorável do estado nutricional das gestantes, da assistência pré-natal e do hábito de fumar durante a gestação. No entanto, são altos os índices de poluição atmosférica em São Paulo, fator que pode estar afetando o desenvolvimento intra-uterino das crianças que aqui nascem. Este estudo foi realizado com a intenção de avaliar uma possível associação do baixo peso ao nascer e a poluição do ar no município de São Paulo. Para tanto foram analisados todos os nascimentos de mães residentes neste município nos anos de 1998 a 2000. As informações sobre esses nascidos vivos foram obtidas do SINASC (Sistema de Informação sobre Nascidos Vivos) através de seu instrumento, a Declaração de Nascido Vivo (DN). Os dados de poluição do ar foram obtidos junto à Companhia de Tecnologia de Saneamento Ambiental (CETESB) que forneceu os registros diários das concentrações de dióxido de enxofre (SO2), partículas em suspensão (PM10), monóxido de carbono (CO), ozônio (O3) e dióxido de nitrogênio (NO2). O efeito da exposição materna à poluição do ar, em cada trimestre da gestação sobre a incidência de recémnascidos de baixo peso foi examinado através de modelos de regressão linear e logística. A exposição materna ao PM10, CO, NO2 e SO2 durante o 1º trimestre de gestação mostrou associação estatisticamente significante com a diminuição no peso do recémnascido. Para um aumento na exposição média materna, durante o 1º trimestre de gestação, de 1ppm de CO, observou-se uma diminuição no peso de nascimento de 11,9g. / The birth weight is an important factor of the morbi-mortality neonatal determination and of the mortality neonatal, and then of big importance to public health, due frequency that it occurs. Therefore, the Health World Organization considers the low birth weight (LBW) the most important isolated factor in childhood survival. A lot of risk factors have been described as associated to LBW occurrence, for example, the mother smoker and low social-economic level(nível sócio-econômico). Recently, the air pollution has been investigated as possible LBW determinant. The distribution of birth weight in the city of São Paulo (average 3.160g with 8.9% of LBW) is inferior to that one expected when having good conditions of fetal growth (average between 3400-3500g with 4-5% of LBW). This distribution has been kept stable for the last 22 years, despite of favorable evolution of the nutritional state of the pregnants, pre-birth assistance and the habit of smoking during the pregnancy. However, the indices of atmospheric pollution are high in São Paulo, this factor can be affecting the development intra-uterine of the children that are born here. Considering the factor that the LBW prevalence in the city of São Paulo city has stayed stable for the last twenty years, that is, a high prevalence, and the fact of São Paulo has high rates of air pollution, its possible to suppose that the air pollution can be affecting the intra-uterine development of childhood are born. Therefore, it claims to realize a study to value a possible association of LBW and the air pollution in the city of São Paulo. All the births of mothers living in this city between 1998- 2000 were analysed. The information about these born-alive was obtained from Sistema de Informação sobre Nascidos Vivos (SINASC) through of yours instrument, the Declaração de Nascido Vivo (DN). The information about air pollution was obtained from Compahia de Tecnologia de Saneamento Ambiental (CETESB), that supplied the daily registers of sulphur dioxide (SO2), particulate matter (PM10), carbon monoxide (CO), ozone (O3) and nitrogen dioxide (NO2). The effect of mother exposure to air pollution, each pregnancy trimester about the LBW prevalence was made on linear and logistic models. The maternal exposure to PM10, CO, NO2 and SO2 during the first trimester of pregnancy showed association statistically significant with the decrease in the weight of the new-born child. For an increasing in the maternal average exposure, during the first trimester of pregnancy, in 1 ppm of CO, was observed a decrease of 11.9g in the weight born.

Le cholangiocarcinome (CC) est une tumeur maligne au pronostic péjoratif dont le traitement repose sur la résection chirurgicale. Il représente 3 % de l’ensemble des cancers digestifs et il est la deuxième tumeur primitive du foie, en fréquence, derrière le carcinome hépatocellulaire. L’âge moyen est de 70 ans avec une prédominance masculine. On distingue actuellement les cholangiocarcinomes intra et extra-hépatiques. La survie est inférieure à 5% à 5 ans tous stades confondues. 60 à 70 % sont des tumeurs de la convergence des canaux biliaires appelées également tumeurs de Klatskin.Le but de ce travail était de répondre aux interrogations persistantes concernant le cholangiocarcinome péri-hilaire (CCPH) en appliquant différentes méthodes statistiques sur différentes bases de données et revue de la littérature.Les trois axes principaux de ce travail s’articulent selon la temporalité de prise en charge, du diagnostic aux suites post-opératoires en passant par la mise en condition préopératoire.Le premier axe repose sur une base de données locale (registre de cancer digestif du Calvados). Les résultats montrent que le CCPH constitue seulement un tiers des cholangiocarcinomes dans la population générale, que son taux d’incidence est stable avec néanmoins une diminution d’incidence, bien que non-significative, chez les femmes ayant un CCPH et que le sexe féminin est un facteur pronostic négatif pour la survie à 5 ans. Le deuxième axe concernait la prise en charge préopératoire des patients, notamment l’optimisation préopératoire du foie restant par le drainage biliaire. Ce travail repose sur deux méta-analyses. Il a permis de mettre en évidence la supériorité de la voie radiologique sur la voie endoscopique concernant les complications liées à la procédure mais en revanche, l’absence de différence significative sur la morbi-mortalité post-résection hépatique, la survie à 5 ans, la survie sans récidive et le taux de dissémination liée à la procédure quand les procédures sont étudiées en intention de traiter. Nos résultats suggèrent qu’un mauvais choix de voie d’abord pour réaliser le drainage biliaire conduit à des échecs répétés qui influencent la récidive tumorale et donc la survie. Le troisième axe s’intéressait aux facteurs pronostiques de morbi-mortalité immédiates post-résection hépatique à partir d’une base de données Européenne (base de l’association Française de chirurgie). Les résultats montrent que la surface corporelle ≥ 1.82 m², l’hyperbilirubinémie > 50 µmol/l et la résection hépatique droite sont des facteurs prédictifs indépendants influençant la mortalité post-opératoire à 30 jours. / Cholangiocarcinoma (CC) is a malignant tumor with a poor prognosis. Its treatment is based on surgical resection. It accounts for 3% of all digestive cancers and is the second primary tumor of the liver, in frequency, after hepatocellular carcinoma. The average age is 70 years old with male predominance. At present intra and extrahepatic cholangiocarcinomas are distinguished. Survival rate is less than 5% at 5 years in all stages. 60 to 70% are tumors of the biliary convergence also called Klatskin tumors.The aim of this work was to answer persistent questions about peri-hilar cholangiocarcinoma (PHCC) by applying different statistical methods on different databases and review of the literature.The three main axes of this work are articulated according to the temporality of management, from the diagnosis to the postoperative follow-up, going through the preoperative setting.The first axis is based on a local database (registry of digestive cancer of Calvados). The results show that PHCC accounts for only one third of cholangiocarcinomas in the general population, that its incidence rate is stable with a decrease in incidence, although not significant, in women having PHCC and that female gender is a negative prognostic factor for 5-year survival. The second axis concerned the preoperative management of patients, including preoperative optimization of the remaining liver by biliary drainage. This work is based on two Meta-analyzes. It made it possible to highlight the superiority of the radiological way in the endoscopic way concerning the complications related to the procedure but on the other hand, the absence of significant difference on the morbi-mortality post hepatic resection, the survival at 5 years, the recurrence free survival and the rate of dissemination related to the procedure when the procedures are studied in intent to treat. Our results suggest that a poor choice of pathway for achieving biliary drainage leads to repeated failures that influence tumor recurrence and thus survival. The third axis was concerned with the prognostic factors of immediate morbidity and mortality after hepatic resection from a European database (base of the French association of surgery). The results show that body surface area ≥ 1.82 m², hyperbilirubinemia > 50 μmol / l and right hepatic resection are independent predictors influencing post-operative mortality at 30 days.

Made available in DSpace on 2011-05-04T12:36:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O Objetivo é correlacionar a mortalidade por câncer de colode útero nos 157 bairros do Município do Rio de Janeiro, no período de 1999-2006, com variáveis socioeconômicas e demográficas, além de descrever o perfil da mortalidade por câncer de útero no período. (...)