Introduction Chronic obstructive pulmonary disease (COPD) has emerged as a major policy focus for health systems throughout Western Europe. This reflects the increased prevalence, associated healthcare utilisation and costs of COPD, and the potential to substantially improve outcomes through achieving reductions in smoking. The aim of this PhD was to develop projections for the prevalence, healthcare costs and number of deaths in people with COPD in England and Scotland over a 20-year horizon (i.e. from 2011 to 2030). Methods I undertook a phased programme of work, which began with a systematic review of the published and unpublished literature to identify models that were suitable for estimating and/or projecting the prevalence and disease and economic burden from COPD. This involved searching Medline, Embase, CAB Abstracts, World Health Organization (WHO) Library and Information Services and WHO Regional Indexes, and Google over the time period 1980-2013. The models were then critically appraised for their quality of reporting. From these, I selected the Dutch Model developed by Erasmus University for generating projections. Suitable data sources from both England and Scotland were identified, sourced and carefully processed in order to run the modelling exercises. Rates of incidence and prevalence were calculated using English and Scottish healthcare datasets and population data were obtained from the Office for National Statistics (ONS) and the General Register Office for Scotland (GROS). Relative risks for all-cause mortality among people with COPD were calculated from the Clinical Practice Research Datalink and mortality data were obtained from the ONS and GROS. The Model was thus adjusted to apply to England and Scotland. I then travelled to the Netherlands to work with the developers of the Dutch Model and ran a baseline model and an array of sensitivity analyses with modified inputs to the Model. Finally, my Rotterdam colleagues calculated uncertainty intervals for some of the estimates using probabilistic analysis. Results Using the probabilistic means and uncertainty intervals, in England, the modelled prevalence of diagnosed COPD among males of all ages in 2011 was 1.8% (95% uncertainty interval 1.8-1.9) increasing to 2.0% (1.7-2.1) by 2030. In females, in England, the baseline estimate was 1.8% (1.7-1.8) in 2011 increasing to 2.4% (2.0-2.6) in 2030. In Scotland, the modelled prevalence among males was 1.9% (1.8-1.9) in 2011 and this was projected to stay the same at 1.9% (1.7-2.2) by 2030. In females in Scotland, the estimated prevalence was 2.2% (2.1- 2.3) in 2011 and was projected to increase to 2.5% (2.1-2.7) in 2030.Using the Model I estimated that overall in 2011 there were a total of 952,000 (941,000-966,000) people with diagnosed COPD in England and 106,000 (103,000-110,000) in Scotland and that these numbers would increase to 1,325,000 (1,117,000-1,408,000) in England in 2030 and 125,000 (113,000-136,000) in Scotland in 2030, respectively. The greatest increase in COPD was projected to be in females over 65 years of age in both countries. The total annual direct healthcare costs of COPD in England were projected to increase from £1.60 (95% uncertainty interval 1.18-2.5) billion in 2011 to £2.35 (1.85-3.08) billion in 2030. In Scotland, costs were projected to increase from £170 (128-268) million in 2011 to £210 (165-274) million in 2030. These costs were calculated in terms of 2011 costs without the application of any economic trends (i.e. no annual increase applied for inflation). The number of deaths among people with COPD in England was estimated to be 99,000 (93,000-129,000) in 2011, increasing to 129,000 (126,000-133,000) in 2030. In Scotland there were estimated to be 10,000 (9,000-12,000) deaths in 2011, increasing to 14,000 (13,000-15,000) in 2030. The Dutch Model demonstrated a 39% increase in the number of people with COPD in England and a 17% increase in Scotland between 2011 and 2030. It provided an estimate of a 30% increase in deaths among people with COPD in England and of a 43% increase in Scotland. Overall, there was a projected 46% increase in the direct healthcare costs required to care for people with COPD in England and a 23% increase in Scotland between 2011 and 2030. The reasons for these differences are largely due to higher COPD-related excess mortality in Scotland and to differences in the data used for populating the model in both countries. Conclusions There are likely to be substantial increases in the number of people with COPD, associated morbidity, direct healthcare costs and mortality in both England and Scotland over the next two decades. These increases in numbers will predominantly occur in females over 65 years of age and are likely to have substantial societal impact in terms of organising the health and social care for this frail population.

Orientador: Luiz Antônio de Lima Resende / Banca: Luiz Antônio de Lima Resende / Banca: Pasqual Barretti / Banca: Heloisa Almeida de Lima Castro / Resumo: Este trabalho analisa alterações odontológicas em pacientes com insuficiência renal crônica, em programa de hemodiálise. As alterações odontológicas estudadas foram índice de dentes cariados, perdidos e obturados (CPOD), presença ou ausência de doença periodontal, número de desdentados totais e parciais. Os pacientes foram submetidos a exame neurológico dos nervos cranianos. Foi determinado o pH da saliva antes e após diálise. Dentre os 44 pacientes estudados, foram encontrados 23 desdentados totais, 7 desdentados parciais e 14 dentados. Vários apresentaram cáries, sem diferenças estatisticamente significativas em relação ao grupo controle; 7 pacientes apresentaram doença periodontal. Alterações de nervos cranianos foram encontradas em 36 pacientes. Os nervos cranianos mais freqüentemente acometidos foram VIII - vestíbulo-coclear, II - óptico e V - trigêmio. Alterações trigeminais foram encontradas em 20 pacientes. É provável que as alterações trigeminais aferentes estejam relacionadas com as perdas dentárias, na insuficiência renal crônica. / Abstract: This paper analyzes odontological alterations in hemodialysis patients with chronic renal failure. Odontological alterations were: index of decayed, lost, or filled teeth (DLFT); presence or absence of periodontal disease; and totally and partially toothless. Patients were submitted to neurological examination of the cranial nerves. Saliva pH was recorded before and after dialysis. Out of 44 patients, 23 were totally toothless, 7 partially toothless, and 14 dentate. Several had decay, but this was not statistically significant to controls; 7 had periodontal disease. Cranial nerve alterations were found in 36 patients. The most frequently compromised nerves were the VIII - vestibulocochlear, II - optic, and V - trigeminal. Trigeminal alterations were found in 20 patients. Probably afferent trigeminal alterations are related to tooth loss in chronic renal failure. / Mestre

Orientador: Maria Aparecida Marchesan Rodrigues. - / Banca: Carlos Antonio Caramori / Banca: Érika Veruska Paiva Ortolan / Banca: Francisco Agostinho Júnior / Banca: Gisele Alborghetti Nai / Resumo: Avaliar as características histopatológicas da mucosa gástrica, duodenal e esofágica de crianças e adolescentes brasileiros infectados por Helicobacter pylori (H. pylori) e submetidas à endoscopia digestiva alta para investigar dispepsia crônica. As correlações entre variáveis clínicas e histopatológicas também foram analisadas. Foi realizado estudo prospectivo de biópsias do trato gastrointestinal superior (mucosa gástrica, duodenal e esofágica) em crianças e adolescentes de 4 a 17 anos de idade. A análise histopatológica foi realizada com coloração por Hematoxilina & Eosina, as lesões gástricas e duodenais foram classificadas de acordo com o Sistema Sydney atualizado e a intensidade da esofagite foi graduada. O estudo incluiu um grupo de crianças infectadas por H. pylori (Hp+), com resultados positivos para dois testes (teste da urease e histologia) e um grupo de não infectadas (Hp-). Utilizou-se teste de Mann-Whitney, Qui-Quadrado, exato de Fisher e correlação de Spearman, sendo p<0,05 considerado significativo. Foram estudadas 185 crianças dispépticas (idade 9.5±2.7 anos), 63,2% (117/185) do sexo feminino, 96 (51,8%) H. pylori positivos (Hp+) e 89 (48,2%) H. pylori negativos (Hp-). O grupo Hp+ foi significativamente mais velho (9.9±2.8 anos) do que o grupo Hp- (9.0±2.6 anos) (p=0,02). Não houve diferença entre a proporção de sintomas entre os grupos Hp+ e Hp-. Não foram encontradas úlcera gástrica ou duodenal durante o procedimento endoscópico. Gastrite crônica ativa moderada/grave esteve presente em 70,5% das biópsias do antro e em 45,2% das biópsias do corpo no grupo Hp+, com intensidade significativamente maior no antro do que no corpo (p<0,05). A pontuação para densidade de H. pylori foi significativamente maior (p=0,005) nas biópsias do antro do que no corpo. Houve uma... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To evaluate the histopathological features of the gastric, duodenal and esophageal mucosa from Brazilian children and adolescents infected with Helicobacter pylori (H. pylori), submitted to upper gastrointestinal endoscopy to investigate chronic dyspepsia. The correlations between clinical and histopathological variables were also analyzed. A prospective study of biopsies from the upper gastrointestinal tract (gastric, duodenal and esophageal mucosa) was performed on children and adolescents 4 to 17 years-old. The histopathological analysis was performed on Hematoxylin-and-Eosin-stained slides, the gastric and duodenal lesions were graded according to the updated Sydney System and the intensity of esophagitis was recorded. The study included one group of H. pylori infected children (Hp+), with positive results for two tests (rapid urease test and histology) and one uninfected group (Hp-). Mann-Whitney, Chi-square, Fisher exact test and Spearman rank correlation were performed and p<0.05 considered significant. We studied 185 dyspeptic children (age 9.5±2.7 years), 63.2% (117/185) female, 96 (51.8 %) H. pylori positive (Hp+) and 89 (48.2%) H. pylori negative (Hp-). H. pylori-positive were significantly older (9.9±2.8 years) than Hp- (9.0±2.6 years) (p=0.02). There was no difference among the proportion of symptoms between Hp+ and Hp- groups. Gastric or duodenal ulcers were not found during the endoscopic procedure. Moderate/severe chronic active gastritis was present in 70,5% of antrum biopsies and in 45,2% of corpus biopsies in the Hp+ group, with significantly higher grading in antrum than in corpus (p<0.05). The scores for H. pylori density were significantly higher (p=0.005) in the antrum biopsies than in the corpus. There was a significant positive association... (Complete abstract click electronic access below) / Doutor

Orientador: Dionei Ramos / Banca: José Roberto Brito Jardim / Banca: Ercy Mara Cipulo Ramos / Resumo: Pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) apresentam comumente intolerância ao exercício físico de intensidade variável e relacionada à disfunção muscular esquelética. Assim, o exercício físico tornou-se importante no processo de reabilitação desses pacientes. Objetivo: avaliar a eficácia de um programa de treino resistido com corda elástica na força muscular periférica, capacidade funcional e qualidade de vida de pacientes com DPOC. Métodos: foram avaliados 34 pacientes (24 homens; 10 mulheres) com DPOC, idade de 62 ± 8,27 anos e IMC de 21,29 ± 3,73, alocados em dois grupos: treino resistido convencional e com corda elástica pelo período de oito semanas e frequência de três vezes semanais. As varáveis avaliadas foram força muscular periférica com dinamômetro, capacidade funcional pelo teste de caminhada de seis minutos e qualidade de vida pelo questionário Chronic Respiratory Questionnaire (CRQ). Resultados: a avaliação da força muscular periférica apresentou melhoras nos dois grupos estudados para todos os movimentos realizados durante o protocolo. O desempenho no TC6 (metros) apresentou melhora após oito semanas de treinamento, tanto no grupo corda elástica... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In general, patients with Chronic Obstructive Pulmonary Disease (COPD) patients have intolerance to exercise of variable intensity and related to skeletal muscle dysfunction. So, the exercise has become important in the process of rehabilitation. Objective: To evaluate the effectiveness of a program of resistance training with elastic band in peripheral muscle strength, functional capacity and quality of life of patients with COPD. Methods: We evaluated 34 patients (24 men, 10 women) with COPD, age 62 ± 8.27 years and BMI 21.29 ± 3.73 divided into two groups: conventional resistance training and with elastic band for the period of eight weeks and frequency of three times weekly. Peripheral muscle strength was assessed with a dynamometer, the functional capacity for the six-minute walking test and quality of life for the Chronic Respiratory Questionnaire (CRQ). Results: the assessment of peripheral muscle strength had improved in both groups for all muscle groups exercised during the protocol. Performance on the 6MWT (meters) showed improvement after eight weeks of training, both in the elastic band... (Complete abstract click electronic access below) / Mestre

Orientador: Selma Maria Michelin Matheus / Resumo: A ingestão de etanol compromete a estrutura do cérebro, apresentar efeitos bifásicos sobre a atividade motora, agindo como um estimulante ou depressor dependendo da dose ou a duração de utilização. Ele interfere na absorção e metabolismo de vitamina D3, o que se correlaciona com alguns distúrbios neurológicos e neuropsiquiátricos. Há relatos sobre a associação de etanol com alterações ósseas, incluindo baixos níveis de vitamina D3. Com base nisso, o objetivo deste estudo foi avaliar os efeitos em testes de comportamento da administração isolada de vitamina D3 ou a sua administração em associação com etanol, durante alcoolismo crônico. A fim de conseguir isso, foram utilizados dois grupos experimentais: ratos Wistar machos (n = 20) e ratos UChB linhagem machos (n = 20) (bebedores voluntários de etanol). Ambos os grupos foram divididos em dois subgrupos: Vitamina D3 - 12.5μg / kg / dia (500 UI) de colecalciferol (WV, n = 10, e UV, n = 10), e de controle (CC, n = 10, e UC, n = 10), durante um período de 75 dias. O peso corporal análises e testes de comportamento (reflexo de sobressalto acústico e campo aberto) foram realizados em 90 e 165 dias de idade. Além disso, os níveis de plasma de corticosterona foram medidos a 165 dias, sem diferença estatística entre os grupos experimentais. O grupo Wistar apresentou valores mais baixos ASR no momento final (Controle e completada), enquanto as percentagens PPI foram maiores no grupo inicial. No grupo UChB houve nenhuma diferença em perc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Ethanol intake compromises brain structure, presenting biphasic effects over motor activity, acting as a stimulant or depressor depending on the dose or duration of use. It interferes in vitamin D3 absorption and metabolism, what correlates to some neurologic and neuropsychiatric disorders. There are reports on the association of ethanol with bone alterations, including low levels of vitamin D3. Based on that, the objective of this study was to evaluate the effects in behavior tests of isolated administration of vitamin D3 or its administration in association with ethanol, during chronic alcoholism. In order to achieve that, two experimental groups were used: male Wistar rats (n=20), and UChB lineage male rats (n=20) (volunteer ethanol drinkers). Both groups were divided in two subgroups: Vitamin D3 – 12.5µg/kg/day (500 UI) of cholecalciferol (WV, n=10, and UV, n=10), and Control (WC, n=10, and UC, n=10), for a period of 75 days. Body weight analyses and behavior tests (acoustic startle reflex and open field) were conducted at 90 and 165 days of age. In addition to that, corticosterone plasma levels were measured at 165 days, with no statistical difference between the experimental groups. The Wistar group presented lower ASR values in the final moment (Control and supplemented), while the PPI percentages were higher in the initial group. In the UChB group there was no difference in PPI percentages with the pre-stimuli used. When the ASR responses were compared between groups ... (Complete abstract click electronic access below) / Mestre

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A periodontite crÃnica inflamatÃria (PC) caracteriza-se por um processo inflamatÃrio nos tecidos de suporte dos dentes. à causada inicialmente por bactÃrias, mas sua progressÃo està relacionada à resposta individual do hospedeiro. à uma doenÃa multifatorial e complexa, na qual fatores genÃticos e ambientais interagem, promovendo e modificando a expressÃo clÃnica da doenÃa. Polimorfismos de genes envolvidos no processo inflamatÃrio tÃm sido estudados no intuito de identificar possÃveis marcadores genÃticos e elucidar diferenÃas na expressÃo de citocinas mediadoras da inflamaÃÃo. ApolipoproteÃna E (apoE) à uma proteÃna de importÃncia no metabolismo lipÃdico e està envolvida em processos fisiopatolÃgicos. O objetivo deste estudo foi investigar se hà associaÃÃo do polimorfismo do gene da apoE com a susceptibilidade à PC em indivÃduos que procuraram o serviÃo odontolÃgico da clÃnica de Periodontia da Universidade Federal do Cearà e avaliar achados sociodemogrÃficos relacionados com essa doenÃa. Foram selecionados 109 indivÃduos entre 30 e 70 anos (mÃdia = 44,5  9,64) de ambos os gÃneros e agrupados da seguinte forma: grupo controle n=53 e grupo Periodontite CrÃnica n=56. Foi extraÃdo DNA a partir de um bochecho e esfregaÃo da mucosa oral e o polimorfismo da apoE foi identificado pelo mÃtodo de PCR-RFLP (reaÃÃo de polimerase em cadeia â polimorfismo com restriÃÃo de fragmentos) e submetidos à eletroforese em gel de agarose a 5%. As distribuiÃÃes da frequÃncia alÃlica e dos genÃtipos foram avaliadas pelo teste qui-quadrado (p&#706;0,05). O risco associado com alelos e genÃtipos foi calculado como odds ratio (OR) com intervalo de confianÃa (IC) de 95%. Para relacionar os achados sociodemogrÃficos com a PC em indivÃduos com alelos especÃficos foi utilizada a anÃlise de regressÃo logÃstica. Os resultados da anÃlise individual do polimorfismo da apoE nÃo evidenciaram associaÃÃo dos alelos e genÃtipos com a susceptibilidade à PC. Observou-se associaÃÃo entre a doenÃa e a renda familiar mensal, de maneira que a chance de adoecer aumenta 3 vezes quando a renda diminui de mais que 3 salÃrios-mÃnimos para a renda de 1 a 3 salÃrios-mÃnimos. Ainda, hà um aumento significativo na chance de desenvolver a doenÃa em 5,1% a cada ano de vida. IndivÃduos que reportaram hipertensÃo arterial tiveram uma chance quase 2,5 vezes maior de ter a PC do que o grupo controle apesar de nÃo ter dado significado estatÃstico. Da mesma forma, foi encontrada maior chance de desenvolver a doenÃa em indivÃduos com baixo nÃvel de escolaridade (OR=3,7). O polimorfismo da apoE nÃo està associado à PC na populaÃÃo estudada. / Chronic periodontitis (CP) is characterized by an inflammation in the supporting tissues of the teeth. It is primarily caused by bacteria, but progression is associated with individual host response. CP is a complex and multifactorial disease. Genetic and environmental factors interacting can modify the clinical cause of the disease. Genetic polymorphisms have been studied to identify possible genetic markers and explain differences in the inflammatory cytokines expression. Apolipoprotein E (apoE) is an important protein in lipid metabolism and is also envolved in pathophysiological processes. The aim of this study was to investigate whether there is an association of the APOE polymorphisms with the CPÂs susceptibility in subjects that sought periodontal treatment at Dental School of Federal University of Ceara and evaluate sociodemographic status related with the disease. A sample of 109 subjects between 30 and 70 years (mean age = 44,5  9,64) were grouped into: 53 controls and 56 subjects with CP. DNA was obtained through a mouthwash and oral mucosa scraping and genotyped by PCR-RFLP method (Polimerase Chain Reaction â Restrict Fragment Length Polymorphism). Differences in the allele and genotype frequencies were assessed by Chi-squared test (p&#706;0.05). The risk associated with alleles and genotypes was calculated as odds ratio (OR) with 95% confidence intervals (CI). Logistic regression was used to associate sociodemographic status with CP and genotypes. No differences were observed in the apoE allelic distribution regarding control and periodontitis groups. Age and socio-economic status increase the risk for having CP, since individuals with lower socio-economic status was about 3-fold more likely to develop periodontitis (OR=3.1) and increase in age enhances the risk in 5.1% to develop disease in each year of age. Hypertension was a factor of clinic importance in development of CP, since subjects who self-reported hypertensive have 2,5-fold more likely to develop disease than individuals who not self-reported hypertension, although no statistic difference was reached. Similarly, CP was also associated with lower education level (OR=3.7). The polymorphism in the APOE gene was not associated with the susceptibility to CP in the studied population.

nÃo hà / O transplante renal à a terapia que oferece maior sobrevida e melhor qualidade de vida (QV) para pacientes com doenÃa renal crÃnica (DRC). Entretanto, mundialmente observa-se carÃncia de ÃrgÃos para realizaÃÃo de transplantes ocasionando grande tempo de permanÃncia dos pacientes em terapia dialÃtica. Objetivos: Identificar mudanÃa de nÃvel de QV e verificar associaÃÃo de variÃveis com nÃvel inicial e mudanÃa de QV em portadores de DRC submetidos à hemodiÃlise (HD) durante seguimento de 24 meses. Materiais e mÃtodos: A amostra foi formada pelos pacientes em HD regular na Ãnica unidade de diÃlise da regiÃo norte do CearÃ, Brasil. Foram incluÃdos maiores de 18 anos, nunca submetidos a transplante renal e com pelo menos trÃs meses sob terapia dialÃtica. Cento e sessenta e quatro pacientes foram submetidos a uma avaliaÃÃo e tiveram seus dados analisados de forma transversal. Noventa e dois foram submetidos a pelo menos duas avaliaÃÃes e foram analisados longitudinalmente. Ao serem incluÃdos no estudo os pacientes tiveram seus dados demogrÃficos, clÃnicos e laboratoriais coletados; foram classificados de acordo com grau de comorbidade pelo Ãndice de Khan; e foram submetidos ao instrumento de medida de QV SF-36. Anualmente os pacientes eram re-avaliados laboratorialmente e submetidos à nova avaliaÃÃo pelo instrumento SF-36. RegressÃo linear pelo mÃtodo stepwise foi utilizada para estimar a correlaÃÃo entre as variÃveis e o nÃvel inicial de QV. A mudanÃa de nÃvel de QV foi determinada pela anÃlise de variÃncia para medidas repetidas com uso de co-variÃveis (ANCOVA) considerando pontuaÃÃo inicial e final, e pelo cÃlculo da taxa de variaÃÃo mensal (pontuaÃÃo final menos pontuaÃÃo inicial com divisÃo do resultado pelos meses de seguimento). As variÃveis contÃnuas foram testadas quanto a sua associaÃÃo com mudanÃa de QV por regressÃo linear, e as variÃveis categÃricas pela estratificaÃÃo da amostra de acordo com a taxa de variaÃÃo mensal em trÃs grupos: melhora, piora, e sem mudanÃa. Resultados: O nÃvel de QV apresentou melhora em relaÃÃo Ãs dimensÃes Aspectos sociais (63,8 vs. 75,0; p=0,001), Aspectos emocionais (39,7 vs. 63,1; p<0,001) e SaÃde mental (63,1 vs. 69,0; p=0,009). Entre os pacientes com baixo grau de comorbidade, alÃm das dimensÃes citadas, houve melhora das dimensÃes Capacidade funcional (56,7 versus 63,5; p=0,014) e Dor (56,7 vs. 66,5; p=0,009). Idade e albumina foram as principais variÃveis correlacionadas com nÃvel inicial de QV. A idade se associou negativamente com as oito dimensÃes de QV: Capacidade funcional (r=-0,312; p<0,001), LimitaÃÃo por aspectos fÃsicos (r=-0,262; p<0,001), Dor (r=-0,157; p=0,049), Estado geral de saÃde (r=-0,232; p=0,003), Vitalidade (r=-0,298; p<0,001), Aspectos sociais (r=-0,293; p=<0,001), LimitaÃÃo por aspectos emocionais (r=-0,260; p=0,001) e SaÃde mental (r=-0,217; p=0,006). O nÃvel de albumina se correlacionou positivamente com Capacidade funcional (r=0,218; p=0,006), Dor (r=0,276; p<0,001), Estado geral de saÃde (r=0,268; p<0,001), Vitalidade (r=0,270; p<0,001) e Aspectos sociais (r=0,250; p=0,001). A idade e o nÃvel de creatinina se correlacionaram com mudanÃa do nÃvel de QV estimada pela taxa de variaÃÃo mensal. A idade se associou negativamente com Dor (r=-0,031; p=0,024), explicando 9,0% da variaÃÃo, e creatinina se correlacionou positivamente com Estado geral de saÃde (r=0,096; p=0,040), explicando 4,6% da variaÃÃo. Mais mulheres do que homens evoluÃram com piora da Capacidade Funcional [19 (50,0%) vs. 11 (21,2%); p=0,006]. ConclusÃes: Houve melhora dos aspectos mentais de qualidade de vida entre os pacientes. Essa melhora deve ser encarada como fator favorÃvel para implementaÃÃo de intervenÃÃes sobre os aspectos fÃsicos de qualidade de vida, com especial atenÃÃo aos pacientes do sexo feminino e com maior grau de comorbidade. O avanÃar da idade e nÃveis baixos dos marcadores do estado nutricional (albumina e creatinina) devem ser considerados indicadores de risco para pior nÃvel de QV. / Kidney transplantation is the therapy that offers longest lifetime and best quality of life (QL) in patients with chronic kidney disease (CKD). However, worldwide there is lack of organs to transplant, causing the need for long-term dialysis therapy. Objectives: To identify changes in QL level and verify the association between variables and initial level and changes in QL in CKD patients undergoing hemodialysis (HD) during a follow-up of 24 months. Materials and methods: The sample consisted of patients undergoing regular HD in the only renal unit in the north of Cearà state, Brazil. We included those older than 18 years who never had kidney transplant and had been under dialysis at for least three months. Hundred and sixty-four patients were submitted to one evaluation and their data composed a transversal analysis. Ninety-two were submitted at least to two evaluations and were studied by longitudinal analysis. At baseline we collected demographic, clinical and laboratory data; classified the patients according to comorbidity by the Khan index; and submitted them to the SF-36 questionnaire in order to measure QL. Every year the patients were re-evaluated with laboratory tests and submitted again to the SF-36. Linear regression by the stepwise method was used to estimate the correlation between variables and initial level of QL. Change in QL level was detected by analysis of variance using co-variables (ANCOVA), considering the initial and final scores, and by the monthly variation rate (final minus initial score divided by number of months of follow-up). Continuous variables were tested for their association with change in QL by linear regression, and the categorical variables were stratified according to monthly variation rate into three groups: improving, worsening, and no change. Results: QL level improved with respect to Social functioning (63.8 vs. 75.0; p=0.001), Role-emotional (39.7 vs. 63.1; p<0.001) and Mental health (63.1 vs. 69.0; p=0.009). Among low comorbidity patients, besides improvement in these dimensions, there was improvement in Physical functioning (56.7 vs. 63.5; p=0.014) and Bodily pain (56.7 vs. 66.5; p=0.009). Age and albumin were strong correlators due to the initial QL level. Age was negatively associated with all eight QL dimensions: Physical functioning (r=-0,312; p<0,001), Role-physical (r=-0,262; p<0,001), Bodily pain (r=-0,157; p=0,049), General health (r=-0,232; p=0,003), Vitality (r=-0,298; p<0,001), Social functioning (r=-0,293; p=<0,001), Role-emotional (r=-0,260; p=0,001) and Mental health (r=-0,217; p=0,006). Albumin was positively associated with: Physical functioning (r=0,218; p=0,006), Bodily pain (r=0,276; p<0,001), General health (r=0,268; p<0,001), Vitality (r=0,270; p<0,001) and Social functioning (r=0,250; p=0,001). Age and creatinine level were associated with changes in QL estimated by monthly variation rate. Age was negatively associated with Bodily pain (r=-0,031; p=0,024), responsible for 9.0% of its variation, and creatinine was positively correlated with General health (r=0,096; p=0,040), responsible for 4.6% in its variation. More women than men worsened in Physical functioning [19 (50.0%) vs. 11 (21.2%); p=0.006]. Conclusions: There was improvement in mental aspects of QL among the patients. This improvement should be seen as a favorable factor to implement interventions aimed at the physical aspects of QL, with special attention to women and high-grade comorbidity patients. Ageing and low level of the laboratory markers related to nutritional status (albumin and creatinine) should be considered as risk markers of poorer QL level.

M.Tech. / Purpose: This study aims to compare the effects of chiropractic adjustment to the lumbar spine and/or pelvis, and chiropractic adjustment to the lumbar spine and/or pelvis in conjunction with a muscle stability exercise programme in the treatment of chronic low back pain in former ballet and modern dancers with regards to pain, disability and lumbar spine and pelvic range of motion. These effects were based on a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Index, and on lumbar spine range of motion (ROM) readings taken using a digital inclinometer. The questionnaire was completed and the ROM readings taken prior to treatment on the first, fourth and seventh visits. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of two different groups of fifteen participants each. One group received chiropractic adjustments to the lumbar spine and/or sacroiliac joints, with an added muscle stability exercise programme. The second group received chiropractic adjustments to the lumbar spine and/or sacroiliac joints alone. Treatment took place over a period of three weeks, and participants were treated six times out of a total of seven visits. Procedure: Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale (NPRS) as well as an Oswestry Low Back Pain and Disability Index to assess pain and disability levels. Objective data was collected at the first and fourth consultations prior to treatment, and at the seventh consultation by means of a digital inclinometer for assessing lumbar spine range of motion (ROM). Data collected was analysed by a statistician. Results: Clinically and statistically significant improvements in group 1 and group 2 were noted over the duration of the study with regards to pain and disability, however the lumbar spine range of motion results were inconsistent with regards to the expected outcome of increased range of motion. Conclusion: The results show that both chiropractic adjustment, as well as chiropractic adjustment in conjunction with a muscle stability exercise programme, are effective treatment protocols both clinically and statistically in decreasing pain and disability in former ballet and modern dancers with chronic low back pain, however, neither treatment protocol proved to be preferential over the other. The results also showed a larger decrease in lumbar spine range of motion than the expected increase in lumbar spine range of motion.

M.Tech. (Biomedical Technology) / Malawi is located in the south eastern Africa. It is a landlocked country covering an area of 118,484 Square Kilometres (45,747Sq.Miles) of which 20.6% is water. It is bordered with Zambia to the north-west, Tanzania to the north and Mozambique surrounding it on the south, east and west (refer map of Malawi on page 2). Malawi is one of the sub-Sahara heavily populated countries, having a population of about 13 million people of which about 80% live in the rural areas relying on small scale farming. The country is divided into three regions, south, centre and north and these regions are further divided into districts. The southern region has most districts and is the most heavily populated. Malawi’s economy heavily depends on agriculture. Cash crops such as tobacco, tea and sugar canes are grown by commercial farmers while smallholder farmers grow a variety of crops such as tobacco, coffee, beans, fava beans, cotton, rice, sorghum, soybeans, groundnuts, cassava, potatoes, wheat, millet, peas, bananas, citrus fruits, sugar canes, vegetables and maize which is the main staple food. Malawi has a subtropical climate with the rainy season starting from mid October up to April and the dry season is from May to October. During the dry season it is hot and humid in most parts of the country especially along the lake and the lower Shire valley, while the rest of the country can be cold at night with temperatures between 5ºC and 14ºC. The southern region has the highest annual rainfall and is humid most part of the year. This is where many tea plantations are and the climate allows growth of almost all types of crops and fruits. Most Malawians consume home grown unprocessed food commodities. There are only commodities are imported, mainly from South Africa. Malawi is self reliant on maize but when drought strikes, Malawi is forced to import from neighbouring countries or from South Africa and other countries as was the case in 2004 and 2005

It is widely believed that sleep and mood are interrelated and that prolongation of sleep may have beneficial effects on subsequent mood and general well-being. In the present investigation, it is hypothesised that excess sleep is in fact, detrimental to mood and is associated with a 'Wornout Syndrome', characterised by feelings of fatigue and lethargy, that can persist for up to 5 hours. The studies to be presented here compare the differential effects of Sleep Extension and Sleep Restriction on mood in healthy adults. The experimental design required subjects to undergo one night of Sleep Extension [+2h] and, following an interval of one-week, one night of Sleep Reduction [-2h]. The conditions were counterbalanced. Subjective assessments were conducted hourly on mood states and sleepiness using an adapted Profile of Mood States Questionnaire and the Stanford Sleepiness Scale. Actometers were worn throughout the experimental days and nights. In the first study of 10 subjects results indicated that four subjects were adversely affected by oversleep. Study 2 investigated the effects of sleep duration on mood in 20 healthy adults. Personality factors were assessed using Cattell's 16PF Questionnaire. Subjects maintaining regular sleep schedules reported negative effects of oversleep on subsequent mood. Results indicated that certain personality types were predisposed to the 'Wornout Syndrome' following Sleep Extension. In Study 3, thirty-four subjects were selected on the basis of personality type. It was hypothesised that Introverts, Morning types, Emotionally Tenderminded and Low Impulsives would report symptoms characteristic of the 'Wornout Syndrome' following one night of Sleep Extension. This was confirmed by reports of increased fatigue, diminished vigor, and increased confusion following Sleep Extension. Oversleeping produced greater detrimental effects on mood than a comparable reduction in sleep duration. There are many similarities in symptomatology between the 'Wornout Syndrome' and Chronic Fatigue Syndrome (CFS), specifically, intense fatigue and impaired concentration. Interestingly, chronically fatigued patients often complain of sleep disturbance, and spend much of their time resting in bed. It was hypothesised that the 'Wornout Syndrome' may be a confounding factor in the symptomatology of CFS. As a clinical dimension, twelve subjects were investigated polysomnographically [six were CFS patients]. Findings indicated that CFS patients acquired sleep of longer duration than controls. In addition to excess nocturnal sleep, CFS patients were taking daytime naps. EEG data indicated that these individuals obtained twice the normal amount of slow wave sleep. CFS sufferers may be better advised to regulate their sleep habits and reduce their total sleep time to avoid the confounding effects of the 'Wornout Syndrome'.