Introdução: A religiosidade e a espiritualidade, o enfrentamento religioso e espiritual, crença em algo superior, estão associados com a redução do estresse, à taxas reduzidas de mortalidade, além de melhorar a qualidade de vida (QV) das pessoas. Objetivo Geral: Analisar a relação entre o bem estar espiritual, a religiosidade, o enfrentamento religioso e espiritual, as variáveis sociodemográficas, econômicas, religiosas e de saúde com a QV dos idosos em tratamento hemodialítico do município de Ribeirão Preto - SP. Material e Métodos: Estudo transversal e correlacional, com abordagem quantitativa, desenvolvido nas cinco Unidades de Diálise do município de Ribeirão Preto - SP. Os critérios de inclusão dos participantes foram: ser idoso; possuir Doença Renal Crônica em tratamento hemodialítico regular; ter iniciado o tratamento em um período superior a seis meses, ser capaz de comunicar-se verbalmente e apresentar funções cognitivas preservadas, de acordo com o Mini Exame do Estado Mental. A técnica utilizada para coletar os dados foi à entrevista, na qual foram aplicados os instrumentos: Mini Exame do Estado Mental; Instrumento de caracterização sociodemográfica, econômica, religiosa e de saúde; Escala de Bem Estar Espiritual; Índice de Religiosidade de Duke; Escala de Coping Religioso e Espiritual Abreviada - CRE abreviada; Questionários de Qualidade de Vida WHOQOL bref e WHOQOL-old. Foram realizadas as análises estatísticas descritivas, de frequência bivariada (correlação de Person) e regressão linear simples. O nível de significância adotado foi de 5%. Os preceitos éticos em pesquisa foram respeitados conforme Resolução 466/2012 do Ministério da Saúde. Resultados: Participaram do estudo 169 idosos, a maioria era homem (74%), com idade entre 60 e 69 anos (53,3%), cor da pele branca (69,3%), casado ou que residia com companheiro(a) (65,1%), sabia ler e escrever (94,1%) e renda menor de cinco salários mínimos (60,2%). A religião católica, seguida da evangélica e espírita foram as mais relatadas. Com relação ao Bem Estar Espiritual, os participantes apresentaram moderado Bem Estar Espiritual total e Bem Estar Existencial e alto Bem Estar Religioso. E referente à religiosidade 54,4% dos idosos possuíam alta Religiosidade Organizacional, 83,4% alta Religiosidade Não Organizacional e 90% alta Religiosidade Intrínseca. Todos os idosos da pesquisa utilizavam de estratégias do CRE. A média global de QV do WHOQOL bref dos idosos da pesquisa foi de 64,0 e os maiores escores dos domínios do WHOQOL bref, foram o psicológico e relações sociais (66,8). Com relação ao WHOQOL old, o maior escore médio foi para a faceta intimidade (76,3) e em seguida a faceta morte e morrer (69,4). Os idosos fizeram uso do CRE religioso e espiritual total, positivo e negativo, e estes se relacionaram com a QV. Houve significância estatística para a associação entre a medida da QV global dos idosos, com o nível de Bem Estar Espiritual total, uso de CRE total e religiosidade Organizacional e Intrínseca dos idosos. Considerações finais: A QV dos idosos que realizavam tratamento hemodialítico estava relacionada, seja de forma positiva ou negativa, com os constructos, bem estar espiritual, religiosidade e o uso de coping religioso e espiritual. / Introduction: The religiosity and spirituality, the religion and spiritual coping, and something higher belief are associate with stress reduction, reduced mortality rates, besides to improve people´s quality of life (QoL). Overall Objective: Analyze the relation between Spiritual Well-Being (SWB), religiosity, religion and spiritual coping, socio-demographic, economic, religious and health variables with QoL of elderly in hemodialysis treatment at Ribeirão Preto - SP. Material and Methods: It was developed a cross-sectional, correlational study with a quantitative approach, in five Dialysis Units of Ribeirão Preto - SP. The inclusion criteria for participants were: They must be elderly; have Chronic kidney Disease under regular hemodialysis treatment; have started treatment in a period bigger than six months; be able to communicate verbally and to present preserved cognitive functions according to the Mini Mental State Examination (MMSE). The interview was the technique used to collect the data. The Mini Mental State Examination (MMSE), Socio-demografic, Economic, Religious and Health Characteristics Instrument, Spiritual Well-Being Scale (SWBS), Duke Religiosity Index (P-DUREL), Brief Spiritual/Religious Coping Scale (SRCOPE Scale), Questionnaires Quality of Life WHOQOL Bref and WHOQOL-old were the instruments applied. Descriptive statistic, bivariate frequency (correlation Person) and simple linear regression were realized to analyze the data. The statistical significance level was established as 5%. The ethical principles to research were respected, according to Resolution 466/2012 of the Ministry of Health. Results: One hundred and sixty nine participants were enrolled in the study. In most they were male (74%), aged between 60 and 69 years (53,3%), white skin color (69,3%), married or lived together a partner (a) (65,1%), know how read and write (94,1%) and with income less than R$ 780,00 (60,2%). The catholic religion, followed by evangelical and spiritist was the most reported. Regarding Spiritual Well-Being, the participants showed moderate total Spiritual Well-Being and Existential Well-Being, and high Religion Well-Being. Concerning to religiosity, 54,4% of the elderly had high Religiosity Organizational, 83,4% high Religiosity Non Organizational and 90% high Intrinsic Religiosity. All searched elderly used Religious and Spiritual Coping strategies. The searched elderly QOL from WHOQOL bref was 64,0 and the highest domain scores from WHOQOL bref were the psychological and the social relations (66,8). With respect to WHOQOL old, the highest mean score was to the intimacy facet (76,3), then death and dying (69,4). The elderly used the total, positive and negative religious and spiritual coping, and these were related to QOL. There was statistical significance to the association between elderly global measurements of QoL, with the Spiritual Well-Being total level, total religious and spiritual coping uses and Organizational and Intrinsic Religiosity. Final Considerations: The elderly QOL that realized hemodialysis treatment is related to, in a positive or negative way, with the constructs: Spiritual Well-Being, Religiosity and the use of Religious and Spiritual Coping.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A anemia falciforme (AF) à uma hemoglobinopatia hereditÃria autossÃmica causada por uma mutaÃÃo pontual no gene da beta globina gerando uma hemoglobina anormal denominada de hemoglobina S (HbS), em homozigose. A doenÃa se caracteriza por apresentar uma variabilidade do quadro clÃnico, que se deve à mÃltiplos fatores, dentre eles a concentraÃÃo de hemoglobina fetal (HbF), os haplÃtipos do gene da beta globina e os polimorfismos do gene BCL11A, entre outros. A avaliaÃÃo dos moduladores genÃticos na AF tem sido desenvolvida com a finalidade de melhorar o entendimento da sua fisiopatologia e direcionar a abordagem terapÃutica objetivando sua individualizaÃÃo. A pesquisa se propÃs a determinar a modulaÃÃo genÃtica dos polimorfismos do gene BCL11A (rs4671393, rs7557939 e rs1186868) sobre o perfil inflamatÃrio, hemolÃtico, no estresse oxidativo e nas concentraÃÃes das HbF, HbS nos pacientes portadores de AF, em estado estacionÃrio. O estudo foi do tipo transversal e analÃtico com 42 pacientes adultos, em acompanhamento ambulatorial no Hospital UniversitÃrio Walter CantÃdio (HUWC), com diagnÃstico molecular e haplÃtipos do gene da beta globina S previamente realizados. Os pacientes estavam em uso de HidroxiurÃia (HU), em mÃdia, 20mg/kg de peso corporal. Amostras biolÃgicas de sangue perifÃrico foram obtidas para a realizaÃÃo dos exames laboratoriais: as dosagens das citocinas prà inflamatÃrias IL-6, IL-17, TNF-alpha e das antiinflamatÃrias IL-10 e TGF-beta, por Elisa; contagem de reticulÃcitos por metodologia manual, dosagem de metemoglobina (MetHb) e lactato desidrogenase (LDH), por espectrofotometria; do nitrito (NOx), malonaldeÃdo (MDA) sÃricos, as enzimas antioxidantes eritrocitÃrias, catalase (CAT) e da glutationa peroxidase (GPx) por kits e espectrofotometria. Os polimorfismos genÃticos do gene BCL11A nas regiÃes, rs4671393, rs7557939 e rs1186868 foram determinados por Real Time PCR. As dosagens da HbF e HbS foram realizadas por HPLC (High Performance Liquid Chromatography). Os dados idade, sexo e eventos clÃnicos foram obtidos dos prontuÃrios. Toda a anÃlise estatÃstica foi realizada usando o software livre R, na versÃo 3.1.2. Para anÃlise da frequÃncia do sexo e dos genÃtipos, por regiÃo e das associaÃÃes entre o tipo de haplÃtipo e dos eventos clÃnicos com as regiÃes do BCL11A, foram usados os testes de Qui-quadrado e o exato de Fisher. Realizou-se o teste paramÃtrico de ANOVA (obtido sob suposiÃÃes distribucionais), bem como o teste nÃo-paramÃtrico de Kruskal-Wallis para a anÃlise da associaÃÃo dos genÃtipos do gene BCL11A com a idade, os nÃveis de HbS, HbF, perfil inflamatÃrio, hemolÃtico e do estresse oxidativo. Foi considerado significante ao nÃvel de 5%. A maioria dos pacientes (57,14%) era do sexo feminino. A idade dos pacientes incluÃdos foi de 18 a 65 anos, com valor mÃdio e mediano de 35,1 e 33 anos, respectivamente. Somente a rs7557939 do BCL11A, o genÃtipo A/G foi o mais prevalente e a prevalÃncia do genÃtipo A/G foi maior nas mulheres , enquanto nos homens a prevalÃncia maior foi do genÃtipo A/A. No entanto, a rs1186868 do BCL11A, a maioria (56,52%) das mulheres apresentaram o genÃtipo C/T e a metade dos homens apresentaram o genÃtipo T/T. Nenhuma regiÃo do gene BCL11A apresentou associaÃÃo significativa com os haplÃtipos do gene da beta globina S. Em relaÃÃo a moduÃÃo do gene BCL11A com os nÃveis de HbS e HbF, verificou-se que na rs1186868 houve resultado significativo do genÃtipo mutante T/T, que apresentou maiores nÃveis de HbS e menores nÃveis de HbF. Na rs7557939 houve uma diminuiÃÃo significante de HbF no alelo mutante A/A, porÃm, nÃo houve relaÃÃo com a HbS. NÃo houve associaÃÃo entre os SNPs, nas trÃs regiÃes estudadas, com relaÃÃo ao nÃmero mÃdio/mediano dos moduladores inflamatÃrios, marcadores de hemÃlise, do estresse oxidativo e dos eventos clÃnicos, ao nÃvel de 5%.Os achados reforÃam a hipÃtese da moduÃÃo genÃtica dos polimorfismos do gene BCL11A em relaÃÃo aos nÃveis de HbF, onde os alelos selvagens, nas regiÃes rs7557939 e rs1186868 apresentaram um carÃter protetor no prognÃstico em decorÃncia de terem apresentado aumento dos nÃveis de HbF, nos pacientes com AF do estudo.

This thesis describes and evaluates an optical method utilizing ultra violet (UV) absorbance for on-line monitoring of haemodialysis treatment. Increased efficiency of haemodialysis treatment is considered to correlate to decreased morbidity and mortality when urea clearance (Kt/V) is elevated. However, further improvements have not been achieved at a higher Kt/V. The mortally rate in the haemodialysis population is still high (27% in Sweden). Urea as the clinical marker is under discussion, partly due to urea being non-toxic, but also that the uraemic syndrom is the result of a cumulative retention of innumerable involved compounds. On-line monitoring systems based on urea determination for improved dialysis efficiency have been suggested and developed in different settings over the last two decades, but have not achieved worldwide utilisation as routine clinical equipment. This thesis demonstrates that the UV-technique utilising 280, 285 and 297 nm is capable of estimating dialysis efficiency in therms of Kt/V, nutritional status in terms of protein catabolic rate (PCR), with the same characteristics as existing methods. One novel finding using UV-absorbance with high sampling rates is the on-line visualisation of the clearance process for following variations in clearance caused by clinical events and disturbances as well as during and after adjustments. The fact that the UV-absorbance technique does not measure urea directly but has high correlation to several other both UV-absorbing and not-absorbing solutes makes it suitable to reflect a more overall solute retention process. Finally, a new efficiency parameter based on the calculation of the area under UV- curve (clearance curve), is suggested to reflect the total removal of some solutes. In summary the UV-technique has the potential to be an additional tool to evaluate improvements of dialysis efficiency, which may result in decreased morbidity, longer life span and enhanced quality of life for the haemodialysis patients.

Involving patients in medical decisions by acknowledging patients personal values and individual preferences has become an important goal of providing ethical medical care. Despite a general movement towards a model of shared decision-making, many patients do not fully meet their preferred role in practice. The decision whether or not to accept a kidney once it is offered to a patient awaiting transplant has historically been made predominantly by the transplant surgeon with little involvement from the patient. Because dialysis can provide long-term renal replacement, declining a kidney is a viable option. Patient changes over time and inherent heterogeneity of donor kidneys make this an authentic decision requiring careful analysis of costs and benefits from the patient perspective. The purpose of this study is to improve our understanding of how patients and transplant surgeons prioritize different factors when deciding whether or not to accept a kidney that has become available, in order to empower patients to become more involved in the decision-making process. Phase I: We developed a comprehensive list of factors that patients might consider important through qualitative interviews with patients, and deliberation with a transplant surgeon (SK) and a transplant nephrologists (RF). Phase II: We quantified the relative importance of each factor for patients on the transplant list and for transplant surgeons with a computerized survey using Maximum Differences Scaling. We developed relative importance scores using Heirarchical Bayes analysis, and tested for associations between patient characteristics and relative importance scores using Spearmans correlation coefficient and the Mann Whitney U test for continuous and categorical variables respectively. Of the factors evaluated, patients placed the greatest value on Kidney quality, How closely matched you are to the kidney, and How strongly your surgeon feels you should accept the kidney. Relative importance of different factors did not change based on patient demographic characteristics. Patients who are on the waiting list longer give less importance to kidney quality (standard beta estimate -0.23, p value 0.03) and more importance to How difficult it is for you to be matched to a donor (ie whether or not you are sensitized) (standard beta estimate 0.28, p value 0.01). Surgeons placed the greatest value on Kidney quality, How difficult it is for the patient to be matched to a kidney (ie whether or not the patient is sensitized), and The age of the donor. This pilot study suggests a role for standardized education tools to help empower patients to be involved in this difficult decision. Development of decision aids can be guided by the results of this project.

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

Thesis (M.Sc.), Memorial University of Newfoundland, Faculty of Medicine, 1998. / Restricted until June 1999. Bibliography: leaves 123-133.

Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 2 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Thesis ( M.Sc.). / Written for the Dept. of Epidemiology and Biostatistics. Title from title page of PDF (viewed 2008/05/29). Includes bibliographical references.

Thesis (M.N.)--Memorial University of Newfoundland, 2003. / Typescript. Bibliography: leaves 176-183. Also available online.