Acquired Immune Deficiency Syndrome (AIDS) which is caused by the Human Immunodeficiency Virus (HIV) is not only an epidemiological problem but also one of the developmental challenges in developing countries. The epidemic is severely affecting the productive part of the population (15 to 49 age range), that is believed to be ‘the motor of development’. Ethiopia is one of the Sub-Saharan African countries whose economy is affected by the epidemic. The country is assigned along with India, China, Nigeria and Russia as the ‘next wave of HIV/AIDS’ with large populations at risk from HIV infection, that will overtake the current epidemic prevalence rate in central and southern Africa (NIC, 2002). The epidemic is also among the challenges facing the agricultural sector of the country which provides half of the country’s GDP. Although agriculture is the backbone of the economy, little effort has been made to estimate the impact of the epidemic and many existing studies focus on urban areas instead of rural areas. Therefore, the research reported on in this thesis assesses the extent and channels of the impact of HIV/AIDS on agricultural production. The research measured the extent of the impact of the epidemic on factors of production such as labor, capital stock and land use, which are the determinants of agricultural production. The research was conducted in Ada’a district in Eastern Showa province, Ethiopia, which is one of the top agricultural production areas of the country and also one of the most vulnerable areas for HIV/AIDS. Stratified random sampling and judgmental sampling techniques were employed to identify sample cases. In addition, both primary and secondary data sources were used to gather the required data/information. The primary sources of data collection methods include PRA, individual interviews, focus groups, photographs and observations. Secondary sources include reports from governmental and nongovernmental organizations, health centers, agricultural bureaus, books, newspapers, the internet, etc. The collected data was analyzed by using spread sheets-2003. The interpretation of the results was supported by graphs, tables and photos. Two stages of ordinary least square (OLS) estimation were done. The first stage was to estimate the impact of HIV/AIDS on production factors whereas the second stage estimation was done to estimate the impact of HIV/AIDS on output (income) of farmers via the impacts on factors of production. The findings of the analysis indicated that HIV/AIDS has been affecting factors of production significantly, i.e. by reducing labor-hours, depleting the capital stock of farmers and by its impact on the use of land (reducing the amount of land cultivated). The findings also indicated that HIV/AIDS has been decreasing the agricultural income of farmers. / Magister Artium (Development Studies) - MA(DVS)

INTRODUCCION: La mayoría de los pacientes con pancreatitis aguda exhibe una evolución clínica autolimitante y relativamente libre de complicaciones mayores. Varios scores han sido creados con la intensión de lograr predecir adecuada y precozmente la gravedad de la pancreatitis para así poder disminuir esta mortalidad. El score BISAP fue validado en el 2008 como predictor de mortalidad para pancreatitis aguda, mientras que la obesidad es un factor de riesgo independiente que incrementa el riesgo de severidad en pacientes que presentan pancreatitis aguda. El objetivo del presente estudio es determinar si la obesidad añadida a un score BISAP mejora la predicción de severidad en pacientes con pancreatitis aguda MATERIAL Y METODOS: El presente estudio fue realizado en el Hospital Nacional Daniel Alcides Carrión, provincia del Callao, departamento de Lima, Perú. Los datos de los pacientes fueron recolectados en el servicio de emergencia de dicho nosocomio, se trató de un estudio retrospectivo transversal, realizado entre enero del 2009 y junio del 2010. RESULTADOS: Se evaluaron un total de 99 pacientes con diagnóstico de pancreatitis aguda. La etiología de las 99 pancreatitis fueron catalogadas como biliares. Solo 2 terminaron en defunción (2%). La mayoría de casos se presentaron en pacientes del sexo femenino 77 (77,8%). Dieciséis de los 99 pacientes (16%), fueron considerados como pancreatitis aguda grave. El 90% de los pacientes (89 /99), tuvieron un BISAP < 3, 10% un BISAP ≥ 3, quince de los 99 pacientes tuvieron un BISAP-O > 3, de ellos 12 fueron realmente considerados como una pancreatitis severa. De 16 pacientes con pancreatitis severa, 14 pacientes tuvieron un IMC > 25. (p = 0,03; OR = 4,39). BISAP-O tiene una sensibilidad, especificidad, Valor predictivo positivo VPP y Valor predictivo negativo VPN de 75%; 96,4%; 80% y 95,2% respectivamente con una exactitud de 92,3%. El área bajo la curva para el BISAP-O fue 0,94 (IC 95%: 0,89 a 0,99). No hubo diferencias cuando se comparó con los otros scores estudiados (p=0,45). CONCLUSIONES: El score de BISAP es un método sencillo y rápido que puede ser utilizado para predecir la gravedad de los pacientes con pancreatitis aguda al momento del ingreso a un servicio de emergencia. BISAP asociado a Obesidad (BISAP-O) otorga una mayor sensibilidad y exactitud diagnóstica al score BISAP y puede servir como un parámetro de ayuda para predecir la severidad en los pacientes con pancreatitis aguda. No fue posible evaluar el score de BISAP-O como predictor de mortalidad para los pacientes con pancreatitis aguda, debido a la baja tasa de mortalidad en el presente estudio. Se requieren más estudios para poder validar el score BISAP asociado a la Obesidad para predecir severidad. / INTRODUCTION: Most patients with acute pancreatitis exhibits a self-limiting clinical course and relatively free of major complications. Several scores have been created with the intention of achieving adequate and early predict the severity of pancreatitis in order to reduce this mortality. BISAP score was validated in 2008 as a predictor of mortality for acute pancreatitis, obesity is an independent risk factor that increases the risk of severity in patients with acute pancreatitis. The aim of this study is to determine whether obesity BISAP added a score improves prediction of severity in patients with acute pancreatitis MATERIAL AND METHODS: This study was conducted in Daniel Alcides Carrión Hospital, Lima, Peru. The patient data were collected in the Emergency Service, it was a cross-sectional retrospective study, between January 2009 and June 2010. RESULTS: We evaluated a total of 99 patients with acute pancreatitis. Etiology of the 99 were biliary pancreatitis. Only 2 ended in death (2%). Most cases occurred in female patients 77/22 (77.8%). Sixteen of the 99 patients (16%) were considered severe acute pancreatitis. 90% (89/99) had a BISAP <3, 10% a BISAP ≥ 3, fifteen of the 99 patients had a BISAP-O> 3, of them 12 were actually considered a severe pancreatitis. Of 16 patients with severe pancreatitis, 14 patients had a BMI> 25. (P = 0.03, OR = 4.39). BISAP-O has a sensitivity, specificity, PPV and NPV of 75%, 96.4%, 80% and 95.2% respectively, with an accuracy of 92.3%. The area under the curve for BISAP-O was 0.94 (95% CI 0.89 to 0.99). There was no difference when compared with the other studied scores (p = 0.45). CONCLUSIONS: BISAP The score is a simple method that can be used to predict the severity of acute pancreatitis. Obesity associated BISAP (BISAP-O) provides higher sensitivity and diagnostic accuracy to score BISAP and can serve as a parameter to help predict severity in patients with acute pancreatitis. It was not possible to assess the BISAP-O score as a predictor of mortality for patients with acute pancreatitis, due to the low mortality rate in the present study. Further studies are required to validate the score BISAP associated with obesity in predicting severity.

Orientador: José Carlos Peraçoli / Resumo: Introdução: Nos últimos 20 anos, o conceito de near miss (risco de morte iminente) é abordado na saúde materna como adjuvante dos inquéritos confidenciais de morte materna. No sistema de saúde, o Hospital Terciário/Quaternário é centro de referência para pacientes em situações graves que as colocam em risco de morte. A Maternidade do HC-FMB-Unesp é um dos centros terciário/quaternário de referência para patologias obstétricas do DRS-VI do Estado de São Paulo. A análise da frequência de situações de risco que chegam à maternidadegestantes portadoras de hipertensão arterial, bem com a assistência que receberam até serem referenciadas e ao chegarem à maternidade, poderá identificar deficiências e propor o seu aprimoramento, reduzindo-se assim o risco do binômio mãe-feto. Objetivo: Determinar a frequência de casos de morbidade materna grave não near missque evoluíram para situação de near miss, associados à hipertensão arterial e propor protocolo clínico de assistência pré-natal, bem como aprimorar o protocolo de assistência praticada no centro terciário com finalidade de reduzir o risco do binômio mãe-feto. Sujeitos e métodos: Foram identificados todos os casos de gestantes ou puérperas com diagnóstico de morbidade materna grave e de near miss,relacionados à hipertensão arterial, que receberam assistência obstétrica durante os anos de 2015 e 2016.De forma descritiva os resultados foram apresentados em porcentagem sob a forma de tabelas. O projeto foi aprovado pelo Comitê de Étic... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Between 10% and 15% of maternal deaths are related to hypertensive gestational diseases, and most of these deaths are avoided by effective and timely care. Over the past 20 years, the concept of near miss has been addressed in maternal health as an adjunct to confidential maternal death surveys. Objective: To determine the frequency of evolution of cases of severe maternal morbidity not near miss (SMM not MNM) for maternal near miss (MNM) associated with hypertension in the reference center of the Polo Cuesta and Jurumirim Vale subareas of the Regional Health Division - VI (DRS-VI) of the State of São Paulo. Methods: A cross-sectional retrospective study was carried out between 2015 and 2016 at a tertiary/quaternary reference center for the Polo Cuesta and Jurumirim Vale sub-areas of DRS-VI in the state of São Paulo. A total of 167 pregnant women or postpartum women with a diagnosis of hypertension with signs of severity were included. In addition to the frequency of near miss, demographic, clinical and origin data were obtained according to the subarea of the regional health study population. The project was approved by the Research Ethics Committee of the Faculty of Medicine of Botucatu - Unesp (Opinion No. 2,309,947). The categorical variables were analyzed by the statistical program SPSS. Results: The demographic characteristics of the population studied were predominantly between 20-35 years old (68%), Caucasian (75.4%), stable union (71.9%), and no paid oc... (Complete abstract click electronic access below) / Mestre

Student Number : 0411802R - MSc (Med) research report - Faculty of Health Sciences / Unintended pregnancy among the youth is a serious public health problem for it exposes the young women and the foetuses to higher risk of morbidity and mortality. Although recognised as a major public health problem, studies on it have been limited and localised in South Africa. Using the 1998 South African Demographic and Health Survey (SADHS) data set, this study examines the distribution of and factors associated with unintended pregnancy among South African youth. The 1998 SADHS was a nationally representative cross-sectional survey with a probability sample of twelve thousand (12 000) women between the ages of 15 and 49. The survey used a structured questionnaire to collect information on fertility issues in general from the respondents. Analysis was based on 1 395 observations which was arrived at after sub setting observations of women aged 15-24 that had pregnancy at the time of and/or three years preceding the survey. Logistic regression model was employed to estimate the effects of identified predictors on unintended pregnancy. The results show a high level of unintended pregnancy with only 29% of the pregnancies wanted. The level of unintended pregnancy varies by region and some socio-economic variables. Respondents from KwaZulu Natal had the highest percentage (81%) of unintended pregnancy while North West had the lowest at 56%. It was also found that the higher the educational level of the respondents, the higher the incidence of unwanted pregnancy. Among the respondents using modern method of contraception, 74% reported having unintended pregnancy while the probability of unintended pregnancy was found to decrease with increase in age at first intercourse. Overall, about 69% of respondents who reported unintended pregnancy had last sexual relation with their regular partners, 21% with marital partners and 10% with casual partners. Using stepwise logistic regression, five critical predictors of unintended pregnancy among South African youth were identified. These are: age group, region, marital status, education and relationship to the last sexual partner. The findings of this study have implications for reproductive health policies and programs in designing appropriate national programs for reducing the incidence of unintended pregnancy among South African youth. The need for further research into this area using triangulated methodology is recommended.

Analysis of morbidity in Czechia investigating health care provision and take-up in relation to diabetes mellitus Abstract Diabetes mellitus is a life-threatening disease which presents as hyperglycaemia or raised blood glucose. Late detection or a failure to follow treatment guidelines may lead to complications that significantly impact on the sufferer's daily life and require expensive medical treatment. The growing prevalence of this disease, which no longer only affects developed countries, therefore presents enormous risks to health care systems and society as a whole. The aim of this thesis is to analyse the geodemographic characteristics of the current diabetic population in Czechia. Particular attention will be paid to the age of diabetes sufferers, since in Czechia data on this is lacking. In pursuit of this aim the thesis makes use of anonymised data from the largest Czech health insurance company (Czech General Health Insurance). The first part of the thesis looks at diabetes mellitus as a medical condition, concentrating primarily on the basic types of the disease but also considering the potential health complications this disease causes. The theoretical part will discuss the main risk factors of developing the disease, such as genetic predisposition, age, obesity and other potential factors...

ContexteSi l’efficacité de la stratégie de prise en charge du paludisme au niveau communautaire n’est pas remise en cause à Madagascar, la mise en place de la nouvelle politique nationale incluant le remplacement de la chloroquine par la combinaison artésunate plus amodiaquine et l’introduction des tests de diagnostic rapide (TDR) dans la prise en charge des fièvres chez les enfants de moins de cinq ans suscite plusieurs inquiétudes. ObjectifsLe principal objectif de notre travail a été d’évaluer la stratégie de prise en charge des fièvres chez les enfants de moins de 5 ans au niveau communautaire. Pour évaluer la stratégie de prise en charge,trois objectifs spécifiques ont été abordés, à savoir, (i) l’étude de l’efficacité thérapeutique de la combinaison fixe « artesunate-amodiaquine » dans la prise en charge des fièvres chez les enfants de moins de 5 ans au niveau communautaire, (ii) l’évaluation des performances des tests de diagnostic rapide utilisés au niveau communautaire et (iii) la description de la situation épidémiologie du paludisme au niveau communautaire et l’évaluation de l’impact des stratégies de lutte actuellement mises en œuvre.MéthodologiesDeux études longitudinales ont été mises en place. La première étude (objectifs 1 & 2) a été conduite de février 2008 à février 2010 (24 mois) chez les enfants de moins de 5 ans en zone de transmission stable (district de Manakara) et en zone de transmission instable (district de Moramanga). La deuxième (objectif 3) s’est déroulée entre février 2009 et mars 2011 en zone de transmission stable (district de Manakara). Résultats & ConclusionObjectif 1 : les données obtenues lors de notre étude, nous permettent d’affirmer l’excellente efficacité thérapeutique de la combinaison fixe « artesunate-amodiaquine ». Nous avons observé que le taux de guérison clinique global était de 98,4% au bout de 28 jours et 97,9% au bout de 42 jours. La compliance au traitement a été estimée à 83,4%. Aucun effet indésirable grave n'a été observé. : Objectif 2 : Cette étude a permis de confirmer que les performances diagnostiques des agents de santé communautaire utilisant les TDR en termes de sensibilité, spécificité, VPP et VPN étaient supérieures à 85%, que la concordance entre les résultats de la microscopie et des TDRs, estimée par la valeur Kappa était excellente (83%) et que les TDR étaient stable même conservés au niveau communautaire. L’introduction des TDR au niveau communautaire semble être une stratégie efficace pour améliorer la prise en charge des malades fébriles, pour réduire la surconsommation d’antipaludiques (et donc le coût des traitements inutilement utilisés) et pour réduire la pression de sélection exercée par cette surconsommation. Objectif 3 : Nous avons pu démontrer que les mesures de prévention et de traitement prises au niveau communautaire étaient efficaces avec la mesure objective de la réduction de la prévalence du paludisme. Nous avons également mis en évidence une variation importante de la prévalence du paludisme inter-villages dans une même commune de quelques kilomètres carrés, suggérant des interventions ciblées en fonction des risques liés à la situation géographique, agricole, et climatique. Ce travail a permis de proposer une première approche méthodologique qu’il serait souhaitable d’étendre pour collecter les données de prévalence et d’incidence dans les autres communes, et préciser ainsi les besoins ciblés en TDR et ACTs à Madagascar. / Context:One should think back of the effectiveness of malaria case management strategy at the community level Otherwise, questions will remain unanswered on the setting up of the new national Policy including the replacement of the chloroquine with combination artesunate and amodiaque and the introduction of rapid diagnostic test (RDT) for fever case management among children under five.Objective:The principal goal of our essay is to assess fever case management strategy among children under five years old at the community level. To proceed to the assessment, three specific objectives were tackled: (i) Therapeutic effectiveness of the fixed combination (artesunate-amodiaque) in fever case management among children under five at the community level. ii)the assessment of RDT performances used at the community level and iii) description of malaria epidemiological situation at the community level and the assessment of the impact of the fight against malaria strategies implementedMethodology: Two long depth studies were applied. The first study (Objective 1 and 2) was conducted in February 2008 to February 2010 (24 months) among children under five years old in stable transmission area (Manakara district) and in changeable transmission area (Moramanga district). The second study (objective 3) was held in February 2009 and March 2011 in stable transmission area (Manakara).Outputs and Conclusion:Objective 1: Data collected during our study enabled us to confirm the excellent therapeutically effectiveness of the fixed combination “artesunate-amodiaque”. We have noticed that the global clinical recovery rate is 98.4% after 28 days and 97.9% after 42 days of treatment. Compliance with the treatment was estimated at 83.4%. Not any adverse effect was noticed.Objective 2: This study enabled us to confirm the diagnostic performances of community health workers using RDT in terms of sensitiveness, specification. VPP and VPN were more 85% than the reliability between microscopic results and the RDTs estimated by the kappa value was excellent (83%) and RDTs were stable even kept at the community level. The introduction of RDT at the community level seems to be an effective strategy to improve sick people case management, to reduce overconsumption of products anti-malaria (and so reduce the cost of treatments used uselessly) and to reduce the selection pressure from this overconsumption.Objective 3: We could prove that prevention and treatment measures at the community level were effective with the objective measure of reducing malaria rate. We could bring to evidence an important variation of malaria rate between villages of one same commune from few kilometers of distance, suggesting targeted interventions depending on the risks linked to the geographic, agricultural and climate situations. This work enabled us to suggest a first methodological approach that is better to extend to collect prevalence data and in adverse circumstances in other communes and to mention the RDT targeted needs and ACTs in Madagascar.

O presente trabalho analisa as saídas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e descreve o perfil da demanda através da aplicação do sistema de classificação de internações hospitalares \"Diagnosis Related Groups - DRGs\". Verifica o uso de DRGs como instrumento de mensuração do produto hospitalar no que tange ao volume de produção, nível de utilização de recursos, casemix do hospital e complexidade assistencial. Resultados desse trabalho apontam o sistema DRG como de fácil utilização com dados rotineiramente coletados pelos serviços de informação dos hospitais e que pode ser utilizado como instrumento para qualificação da gestão de unidades hospitalares e do sistema de saúde / This study analyzes the discharges from the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, and describes the demand profile through the application of the classification system for hospital admissions \"Diagnosis Related Groups - DRGs\" as measuring instrument of the hospital service concerning production volume, resource utilization level, hospital casemix and complexity of the assistance provided. The results of the study show the easy application of the DRG system, using data routinely collected by hospitals information systems, and its usefulness to be used as an instrument to qualify hospital management as well as the health system as a whole

A Atenção Básica (AB), através da Estratégia Saúde da Família (ESF), caracteriza-se por um conjunto de ações de saúde, no âmbito individual e coletivo, que abrangem a promoção e a proteção da saúde, a prevenção de agravos, o diagnóstico, o tratamento. A AB fundamenta-se em quatro atributos essenciais: atenção ao primeiro contato, coordenação do cuidado, integralidade e longitudinalidade, que operados, possibilitam o acesso, a produção do cuidado e a identificação do perfil da população do território de adscrição. Considerando que dentro do território municipal encontram-se grupos heterogêneos, com perfis e necessidades particulares, traçar as características sociais e as singularidades do adoecer dos territórios de adscrição das ESF pode permitir adequar os serviços da equipe a essas necessidades. O objetivo do presente trabalho epidemiológico, é caracterizar, através do perfil de morbidade e sócio demográfico, os grupos cadastrados nas diferentes equipes e territórios de implantação da Estratégia Saúde da Família, tendo como campo de estudo o município de Patrocínio/MG. Nele existem 16 equipes da ESF, das quais três localizam-se na área central, uma na área rural e 12 na região periférica da cidade (três estratos). A fonte de dados foi os prontuários de pacientes usuários destas unidades assistenciais. Após calculado o tamanho amostral em 596 prontuários, o processo de amostragem ocorreu em múltiplas etapas. Foi feita uma amostragem estratificada das ESF com partilha proporcional entre os estratos, e dentro de cada ESF feita uma amostragem sistemática dos prontuários familiares. Um sorteio casual simples permitiu que fosse selecionado um indivíduo daquela família. Nos prontuários foram coletados os seguintes dados: idade, sexo, ocupação, escolaridade e diagnósticos referentes a última consulta médica realizada no ano de 2010. As variáveis foram transferidas para um banco de dados e descritas posteriormente. Os 564 prontuários analisados, trouxeram os seguintes resultados: na região periférica predominaram mulheres, na faixa etária de 40 60, maioria alfabetizadas (82%), com ocupações consideradas fora da População Economicamente Ativa (PEA) e uma maior freqüência das doenças do aparelho circulatório (18%). Na região central predominaram as mulheres, na faixa etária dos 20 40, pessoas alfabetizadas (92%), aposentados e doenças do aparelho circulatório. Na região rural houve maior prevalência de mulheres, idosos, alfabetizados (94%), fora da PEA e as doenças do aparelho circulatório também prevaleceram. Apesar das regiões apresentarem características parecidas, os achados posteriores de idades, ocupações e morbidades foram diferentes, o que confirma a idéia de diferenças regionais dentro de um mesmo município. Os resultados podem servir de instrumento para um melhor planejamento direcionado das ações em saúde. / Primary Care (PC), through the Family Health Strategy (FHS), is characterized by a set of health actions, both individually and collectively, covering the promotion and protection of health, disease prevention, diagnosis and the disease treatment. The PC is based on four essential attributes: attention to the first contact, care coordination, comprehensiveness and longitudinality. If worked properly, these attributes provide access to care production and helps to identify the population profile of the territory of ascription. Considering that within the municipal area there are heterogeneous groups, with different profiles and particular needs, outline the characteristics and peculiarities of the illness of the ascription territories allows the FHS team to adapt the services to its population profile of the health area. The aim of this epidemiological study, with a transversal nature, is to characterized, by the morbidity and social profiles, the groups registered in different teams and territories of the Family Health Strategy launching, having as a field study the city of Patrocínio / MG. In such study there are 16 teams of FHS, of which two are located in the central area, two in rural areas and 12 in the peripheral region of the city (three strata). The data source was the medical records of patients using these assistance units. After calculating the sample size of 596 records, the sampling process occurred in multiple steps. We conducted a stratified sampling with proportional share of the FHS between the strata, and within each FHS it was made a systematic sampling of family records. A simple casual draw permitted that it was selected one individual of each family. In the records it was collected the following data: age, sex, occupation, education, and diagnostics for the final medical evaluation conducted in 2010. Variables were transferred to a database and were described later. The 564 records analyzed, brought the following results: in the peripheral region there were the predominance of women, aged 40 60, most literate (82%), with occupations considered outside Economically active population (brasilian classification), and a higher frequency of cardiovascular diseases (18%). In the central region there were the predominance of women, aged 20 40, literate (92%), with a higher frequency of retirees and the circulatory diseases showed a higher frequency. In the country region, remembering that it has a small sample, there is a higher prevalence of women, the elderly (aged 60 90), literate (94%), outside of the PEA and circulatory diseases also prevailed. Although at first glance, the regions present similar characteristics, the later findings of ages, occupations and morbidity were different, which confirms the idea of regional differences within the same municipality. The results can serve as a tool for a better planning of directed health actions.

Evidências científicas trazem importantes associações entre a vivência de eventos estressores por gestantes e prejuízos a saúde mental materna. Identifica ainda que tal exposição possa estar relacionada ao aumento de consumo de álcool e tabaco por mulheres. Visto os prejuízos para a saúde materna relacionada a esta vivência, este estudo teve por objetivo analisar a relação entre a ocorrência de eventos estressores, morbidade psiquiátrica e consumo de álcool e tabaco em mulheres no terceiro trimestre gestacional. Trata-se de um estudo epidemiológico clínico, observacional, transversal, sobre amostra de 449 gestantes de uma maternidade pública na cidade de Ribeirão Preto-SP. Os instrumentos de coleta foram: um questionário para obtenção de dados sócio-demográficos, relato de uso de tabaco, Questionário de Morbidade Psiquiátrica de Adultos (QMPA) e entrevista para eventos recentes de vida (IRLE). Para avaliação do consumo de álcool foi utilizado o instrumento T-ACE (Tolerance, Annoyed, Cut-down, Eye-Opener) e um questionário para avaliação segundo critérios de pesquisa da CID-10 para uso nocivo ou síndrome de dependência. Os eventos estressores receberam três tipos de análises: isolados, agrupados em categorias e através da somatória total. Os resultados demonstraram que todas as participantes reportaram ter vivenciado algum evento estressor durante o período avaliado (µ = 5; dp = 2,2; min = 1, máx = 14) com destaque para a categoria saúde (99,1%). Quanto aos eventos estressores específicos, a gravidez indesejada (60,5%; n = 272) e dificuldade financeira média (31,8%; n = 143) foram os mais freqüentes. O primeiro evento estressor recebeu elevado impacto de estresse, 97 gestantes referiram estresse alto ou acentuado, 128 estresse baixo ou moderado e apenas 47 nenhum estresse. A somatória total de eventos estressores (p< 0,001) e as categorias Educação, Finanças, Aspectos legais, Migração e Trabalho apresentaram correlação estatística significante em relação à morbidade psiquiátrica (p< 0,001). Os eventos dificuldade financeira média ou grande e brigas com familiares foram cerca de 3,5 vezes maior em gestantes com suspeição de transtorno psiquiátrico (p< 0,001; 95%IC:2,16-3,84). Em relação ao consumo de álcool, o número total de eventos e a categoria Finanças apresentaram correlação estatística significante com o consumo de risco e uso nocivo ou dependência. O uso de tabaco foi associado à categoria finanças (p< 0,05) e aos eventos gravidez indesejada (p< 0,001; 95%IC:1,4-4,9) e brigas com o marido (p< 0,05; 95%IC:0,8-3,1). Os dados apontam alta vivência materna de eventos estressores durante o período gestacional e associação entre eventos estressores (isolados ou em categorias), sintomas psiquiátricos, consumo de álcool e tabaco. A avaliação dos eventos estressores por profissionais de saúde torna-se, portanto útil para o tratamento, educação e promoção da saúde pública visto que pode ajudar as mulheres a reforçar os seus estilos de enfrentamento ao estresse e prevenir o consumo de substâncias lícitas e danos à saúde mental materna. / Scientific evidences provide important associations between the experience of stressful events by pregnant women and harm to mental health. It identifies that such exposure may be related to increased consumption of alcohol and tobacco by women. Considering the damage to maternal health related to this experience, this study aimed to analyze the relationship between the occurrence of stressful events, psychiatric morbidity and alcohol and smoking consumption in pregnant women. This is a clinical epidemiological study, observational, cross-sectional sample of 449 pregnant women at a public maternity hospital in Ribeirão Preto. The instruments used to collect the data were a questionnaire to obtain socio-demographic data, history of tobacco use, Psychiatric Morbidity Questionnaire for Adults (QMPA) and interview for recent life events (IRLE). To assess alcohol consumption it was used the instrument T-ACE (Tolerance, Annoyed, Cut down, Eye-Opener) and a second questionnaire to evaluate the search criteria of CID-10 criteria for harmful use or dependence syndrome. The stressful events were three types of analysis: individual, grouped into categories and through the total sum. The results showed that all participants reported having experienced some stressful event during the period study ( = 5, SD = 2.2, min = 1, max = 14) with emphasis on the category \"health\" (99.1%). Considering the specific stressful events, the \"unwanted pregnancy\" (60.5%, n = 272) and \"average financial difficulty\" (31.8%, n = 143) were the most frequent. The first stressor received high impact stress, 97 pregnant women reported high stress or severe, 128 moderate stress and only low or no stress 47. The total sum of stressful events (p < 0.001) and the categories of \"education\", \"finance\", \"legal aspects\", \"migration\" and \"work\" showed statistically significant correlation in relation to psychiatric morbidity of patients (p < 0.001) . The events \"mean and great financial difficulty\" and \"fights with family members\" were about 3.5 times higher in women with suspected psychiatric disorder (p < 0.001, 95% IC : 2,16-3, 84 ). In relation to alcohol consumption, the total number of events and the category \"Finances\" showed statistically significant correlation with the risk and consumption of alcohol abuse or dependence. Tobacco use was associated with the category \"Finances\" (p < 0.05) and events \"unwanted pregnancy\" (p <0.001, 95% IC :1,4-4, 9) and \"fights with her husband\" ( p < 0.05, 95% IC :0,8-3, 1). The data indicate high maternal experiences of stressful events during pregnancy and association between stressful events (singly or in categories), psychiatric symptoms, alcohol and tobacco. The evaluation of stressful events by health professionals it is therefore useful for treatment, education and promotion of public health, because it can help women strengthen their coping styles with stress and prevent the consumption of licit and damage to mental health.

Este estudo desenvolveu-se no município de Bananal, São Paulo, uma área endêmica para esquistossomose com prevalência menor que 10% e baixa carga parasitária dos infectados. Teve como objetivo a identificação de formas clínicas da esquistossomose mansônica entre 109 pacientes diagnosticados parasitoscopicamente e medicados com oxamniquine, durante a realização do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica (1998-2000). Utilizou-se a ultra-sonografia abdominal e o exame de fezes (Kato-Katz) realizado, em média, quatro anos após o término do plano. Nesta casuística, foram identificados cinco pacientes com imagens ultra-sonográficas abdominais compatíveis com fibrose periportal periférica e central e hipertensão portal que tinham diagnósticos clínicos de esquistossomose na sua forma intestinal. A ultra-sonografia é um método de diagnóstico sensível, incruento, que possibilitou a identificação de casos de esquistossomose com comprometimento hepático mais extenso do que se expressava pelo exame físico. Mesmo considerando uma prevalência baixa de alterações hepáticas e de circulação portal nesta casuística, evidencia-se a importância do emprego do método ultra-sonográfico na avaliação individual dos pacientes esquistossomóticos, por permitir a detecção de alterações morfológicas e funcionais que podem ter conseqüências clínicas relevantes. Deve-se assinalar ainda que, no momento do exame, todos os pacientes tiveram coproscopias negativas, revelando a efetividade das ações de controle no médio prazo. Devemos considerar que a realização do estudo ultra-sonográfico em média quatro anos após o tratamento específico dessa população, provavelmente detectou menos alterações do que aconteceria se o estudo fosse feito no momento do diagnóstico parasitológico, pois se sabe que a involução, ainda que parcial da fibrose e de alterações funcionais conseqüentes a ela, ocorre após tratamento específico. Por fim, apesar do pequeno número de casos avaliados, a estratégia utilizada no presente trabalho começou a preencher a lacuna de avaliação do impacto da esquistossomose sobre a saúde do cidadão bananalense, percebida durante o desenvolvimento do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica, período de 1998 a 2000. / This study was developed in the municipality of Bananal, São Paulo, an endemic area for schistosomiasis with prevalence of less than 10% and low parasite load among infected individuals. The objective was to identify the clinical forms of intestinal schistosomiasis among 109 patients who had been diagnosed through parasitological tests and medicated with oxamniquine at the time of the Plan for Intensification of Schistosomiasis Control Actions (1998-2000). Abdominal ultrasonography and feces examination (Kato-Katz) were utilized: this was on average done four years after the ending of the plan. In this sample, five patients were identified whose abdominal ultrasound images were compatible with peripheral and central periportal fibrosis and portal hypertension who had had a clinical diagnosis of schistosomiasis in its intestinal form. Ultrasonography is a sensitive noninvasive diagnostic method that enables identification of the extent of liver involvement in schistosomiasis cases better than through its expression in physical examination. Even considering that there was a low prevalence of liver abnormalities and portal circulation in this sample, the importance of utilizing the ultrasound method for individual evaluations on the schistosomiasis patients was demonstrated. Through this, it was possible to detect morphological and functional alterations that could have important clinical consequences. It also should be noted that, at the time of the ultrasound examination, all the patients presented negative coproscopic test results, thus showing the effectiveness of the control actions over the medium term. It needs to be borne in mind that, because the ultrasound study was carried out on average four years after the specific treatment of this population, it is likely that fewer abnormalities were detected than there would have been if this study had been performed at the time of the parasitological diagnosis. This comes from the knowledge that involution occurs following specific treatment, even if only partially with regard to fibrosis and its consequent functional alterations. Finally, despite the small number of cases evaluated, the strategy utilized in the present study has started to fill the gap regarding assessing the impact of schistosomiasis on the health of the citizens of Bananal that was perceived during the development of the Plan for Intensification of Schistosomiasis Control Actions between 1998 and 2000.