Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

Asma é uma doença crônica, de alta prevalência, importante causa de morbidade, responsável por gastos diretos e indiretos significativos. Apesar do cuidado padrão para esta doença estar bem consolidado em diretrizes clínicas baseadas em evidências, frequentemente seus portadores não recebem os cuidados indicados. A qualidade da assistência dispensada pelos profissionais da atenção primária é tanto problema quanto solução. Modelos de cuidados adaptados a doenças crônicas e iniciativas de educação em saúde correspondem a estratégias utilizadas para incremento de qualidade assistencial. As novas tecnologias de informação e comunicação têm encurtado progressivamente as distâncias entre as pessoas. Em saúde, têm sido utilizadas como ferramentas valiosas na disseminação de conhecimentos. Apesar da ampla disponibilidade e utilização, os recursos educativos mediados por tecnologias de informação e comunicação – teleducação – ainda carecem de evidências de maior rigor científico. Objetivo: avaliar a efetividade clínica de uma intervenção multifacetada educativa a distância sobre asma para profissionais da atenção primária à saúde. Método: ensaio clínico randomizado em cluster com 71 equipes de saúde do interior do Rio Grande do Sul. Foram indicados pela totalidade das equipes 443 pessoas com diagnóstico de asma elegíveis para acompanhamento no estudo. As equipes do grupo intervenção (n = 34) participaram de um programa de 3 sessões interativas online e receberam materiais educativos. As equipes do grupo controle (n = 37) não sofreram intervenção. Sobrecarga de sintomas nos últimos 14 dias, controle da asma no último mês, necessidade de consulta não programada nos últimos 6 meses e uso de corticosteroide inalatório preventivo nos últimos 6 meses foram avaliados nas pessoas indicadas pelas equipes na linha de base e 6 meses após a intervenção. Resultados: a assiduidade geral das equipes de saúde às sessões interativas online foi de 50%. Ambos grupos apresentaram melhora dos desfechos clínicos e menor uso de corticosteroide inalatório no seguimento. Exposição a intervenção educacional esteve associada a razões de chances com melhores desfechos clínicos, entretanto com significância estatística limítrofe. Não foram observadas diferenças no uso de corticosteroides inalatórios preventivos entre os grupos. Conclusão: a intervenção em educação a distância demonstrou potencial apesar da baixa assiduidade das equipes sob intervenção. O modelo proposto é factível e reprodutível. Integração com o sistema de registro clínico pode potencializar os resultados. A implementação de estratégias de aperfeiçoamento profissional em caráter institucional deve ser orientada pelas melhores evidências. / Asthma is a high prevalence chronic disease and an important cause of morbidity, responsible for significant direct and indirect health expenses. Although the standard care for this condition is well established in evidence-based clinical guidelines, often patients do not receive the indicated treatment. The quality of care delivered by primary care professionals is both a problem and a solution. Models of care adapted to chronic diseases and health education initiatives are strategies used to increase care quality. New information and communication technologies have progressively shortened distances between people. In healthcare, they have been used as a valuable tool for knowledge dissemination. Despite widespread availability and use, educational resources mediated by information and communication technologies still lack evidence of greater scientific rigor. Objective: to evaluate the clinical effectiveness of a multifaceted distance educational intervention on asthma for primary health care professionals. Methods: cluster randomized clinical trial with 71 health teams from country towns of Rio Grande do Sul. The teams identified a total of 443 persons diagnosed with asthma who were eligible for follow-up in the study The teams in the intervention group (n = 34) participated in a program of 3 interactive online sessions and received educational materials. There was no intervention in the control group teams (n = 37). Symptoms overload in the last 14 days, control of asthma in the last month, need for unplanned consultation in the last 6 months and use of preventive inhaled corticosteroids in the last 6 months were evaluated in the individuals indicated by the teams at the baseline and 6 months after the intervention. Results: The general assiduity of health teams to online interactive sessions was 50%. Both groups showed improved clinical outcomes and used less inhaled corticosteroids at follow-up. Exposure to educational intervention was associated with better clinical outcomes odds ratios, however, with borderline statistical significance. No differences were observed in the use of preventive inhaled corticosteroids between groups. Conclusion: The distance education intervention showed potential despite the low attendance of the intervention teams. The proposed model is feasible and reproducible. Integration with the clinical record system can boost results. The implementation of professional development strategies should be guided by the best evidence in an institutional setting. / Telemedicina

Chronic obstructive pulmonary disease (COPD) has been recognized as a leading cause of mortality in older adults involving acute exacerbations as life-threatening events that lead to frequent hospitalization for care. Informal caregivers have been essential to helping older adults with COPD during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A lack of empirical knowledge exists regarding the experience of informal caregivers of older adults with AECOPD in situation awareness for recognizing, understanding, and responding to an AECOPD in an emergent situation. This qualitative descriptive study explored situation awareness and its components of perception, comprehension and projection of next steps, including the caregiver’s confidence level during the AECOPD event. Fifteen informal caregivers, ages 31-77 years (mean age 48), who provided care for older adults with COPD were interviewed from an underserved community health center. The overarching theme derived from this study was something was wrong and something needed to be done. Subthemes emerged as a heightened sense of awareness, caregiver tipping point, planning next steps, caregiver confidence, and caregiver commitment. This study utilized situation awareness theory as a relevant guiding framework in exploring the experience of lay informal caregivers caring for older adults with AECOPD events. Study findings provided a description of the complex processes involved, including confidence level, for informal caregiver’s in situation awareness to recognize and respond to an AECOPD event in the older adult. Future targeted interventions need to address strategies to enhance individualized care for older adults with AECOPD events for managing care at home.

Submitted by JULIANA SOUZA UZELOTO null (juliana_uzeloto@hotmail.com) on 2016-06-21T17:32:29Z No. of bitstreams: 1 Defesa corrigida.pdf: 733210 bytes, checksum: 1fa0d39c72ee0d5ab9cc81d7c1b4bf2b (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-06-23T16:35:36Z (GMT) No. of bitstreams: 1 uzeloto_js_me_prud.pdf: 733210 bytes, checksum: 1fa0d39c72ee0d5ab9cc81d7c1b4bf2b (MD5) / Made available in DSpace on 2016-06-23T16:35:36Z (GMT). No. of bitstreams: 1 uzeloto_js_me_prud.pdf: 733210 bytes, checksum: 1fa0d39c72ee0d5ab9cc81d7c1b4bf2b (MD5) Previous issue date: 2016-05-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: Mulheres tabagistas apresentam maior susceptibilidade para diversas doenças, em relação ao sexo oposto. Porém não há estudos que mostrem se há diferença no comportamento do transporte mucociliar nasal entre tabagistas homens e mulheres. É certo que nem todos os tabagistas desenvolvem doenças respiratórias crônicas, no entanto, o tabagismo é considerado um importante fator de risco para essas doenças. Assim, entende-se que além de avaliar o sistema respiratório dos tabagistas, a pesquisa no desfecho da saúde do pulmão de tabagistas é essencial, já que a maioria dos pacientes atendidos na fisioterapia respiratória é doente pulmonar crônico. Objetivos: Comparar a transportabilidade mucociliar nasal de homens e mulheres tabagistas levando em consideração a idade, dados antropométricos, carga tabagística, variáveis hemodinâmicas e função pulmonar. Além de avaliar sistematicamente a qualidade de diretrizes para doenças respiratórias crônicas, relevantes para a prática da fisioterapia, por meio do instrumento AGREE II e também avaliar a confiabilidade entre os avaliadores do instrumento AGREE II. Métodos: Foram inclusos na análise um total de 70 indivíduos tabagistas (33 homens e 37 mulheres). Todos responderam a uma entrevista inicial para obtenção dos dados pessoais e carga tabagística, foram mensurados os dados antropométricos, sinais vitais e monóxido de carbono no ar exalado, além disso, foram submetidos ao teste de função pulmonar e ao teste do tempo de trânsito de sacarina (TTS). Para análise do segundo objetivo foram avaliados, por quatro avaliadores, diretrizes sobre doença respiratória crônica, indexadas na base de dados PEDro, por meio do instrumento AGREE II (seis domínios e dois itens globais). Resultados e Conclusões: Na comparação da transportabilidade mucociliar nasal entre homens e mulheres, não foi encontrada diferenças significativas dentre as análises realizadas, mesmo realizando estratificações das variáveis, ou seja, o transporte mucociliar nasal de homens e mulheres adultos tabagistas, aparentemente saudáveis, é semelhante. Além disso, a qualidade das diretrizes de prática clínica baseadas em evidência, para doenças respiratórias crônicas, relevantes para a prática da fisioterapia podem ser melhoradas, particularmente no domínio aplicabilidade. A boa confiabilidade apresentada sugere que o número de avaliadores para o AGREE II possa ser reduzido. / Introduction: Female smokers have increased susceptibility to various diseases in the opposite sex. But there are no studies that show if there are differences in the behavior of nasal mucociliary transport between smokers men and women. It is sure that not all smokers develop chronic respiratory diseases, however, smoking is considered a major risk factor for these diseases. Thus, it is understood that in addition to evaluating the respiratory system of smokers, research in the outcome of smokers lung health is essential, since most of the patients seen in respiratory therapy is chronic pulmonary patient. Objectives: To compare the nasal mucociliary transportability of male and female smokers taking into consideration the age, anthropometric data, smoking load, hemodynamics and lung function. In addition to systematically assess the quality of guidelines for chronic respiratory diseases relevant to the practice of physiotherapy, through the AGREE II instrument and also assess the reliability of the evaluators of the AGREE II instrument. Methods: We included in the analysis a total of 70 smokers (33 men and 37 women). All responded to an initial interview to obtain personal data and smoking load, anthropometric data were measured, vital signs and carbon monoxide in exhaled air, moreover, underwent lung function test and the saccharin transit time test (STT). For analysis of the second objective guidelines indexed in the Physiotherapy Evidence Database (PEDro) on chronic respiratory diseases were evaluated by four assessors using AGREE II (six domains and two global items). Results and Conclusions: In comparison of nasal mucociliary transportability between men and women, there was no significant difference among the analyzes, even performing stratifications of variables, so the nasal mucociliary transport of men and women smokers adult apparently healthy, is similar. Moreover, the quality of evidence-based clinical practice guidelines for chronic respiratory diseases relevant to physiotherapy could be improved, particularly with regard to applicability. The number of assessors for AGREE II could be reduced because of the good inter-rater reliability. / FAPESP: 2014/11970-3 / FAPESP: 2015/13353-4

Asma é uma doença crônica, de alta prevalência, importante causa de morbidade, responsável por gastos diretos e indiretos significativos. Apesar do cuidado padrão para esta doença estar bem consolidado em diretrizes clínicas baseadas em evidências, frequentemente seus portadores não recebem os cuidados indicados. A qualidade da assistência dispensada pelos profissionais da atenção primária é tanto problema quanto solução. Modelos de cuidados adaptados a doenças crônicas e iniciativas de educação em saúde correspondem a estratégias utilizadas para incremento de qualidade assistencial. As novas tecnologias de informação e comunicação têm encurtado progressivamente as distâncias entre as pessoas. Em saúde, têm sido utilizadas como ferramentas valiosas na disseminação de conhecimentos. Apesar da ampla disponibilidade e utilização, os recursos educativos mediados por tecnologias de informação e comunicação – teleducação – ainda carecem de evidências de maior rigor científico. Objetivo: avaliar a efetividade clínica de uma intervenção multifacetada educativa a distância sobre asma para profissionais da atenção primária à saúde. Método: ensaio clínico randomizado em cluster com 71 equipes de saúde do interior do Rio Grande do Sul. Foram indicados pela totalidade das equipes 443 pessoas com diagnóstico de asma elegíveis para acompanhamento no estudo. As equipes do grupo intervenção (n = 34) participaram de um programa de 3 sessões interativas online e receberam materiais educativos. As equipes do grupo controle (n = 37) não sofreram intervenção. Sobrecarga de sintomas nos últimos 14 dias, controle da asma no último mês, necessidade de consulta não programada nos últimos 6 meses e uso de corticosteroide inalatório preventivo nos últimos 6 meses foram avaliados nas pessoas indicadas pelas equipes na linha de base e 6 meses após a intervenção. Resultados: a assiduidade geral das equipes de saúde às sessões interativas online foi de 50%. Ambos grupos apresentaram melhora dos desfechos clínicos e menor uso de corticosteroide inalatório no seguimento. Exposição a intervenção educacional esteve associada a razões de chances com melhores desfechos clínicos, entretanto com significância estatística limítrofe. Não foram observadas diferenças no uso de corticosteroides inalatórios preventivos entre os grupos. Conclusão: a intervenção em educação a distância demonstrou potencial apesar da baixa assiduidade das equipes sob intervenção. O modelo proposto é factível e reprodutível. Integração com o sistema de registro clínico pode potencializar os resultados. A implementação de estratégias de aperfeiçoamento profissional em caráter institucional deve ser orientada pelas melhores evidências. / Asthma is a high prevalence chronic disease and an important cause of morbidity, responsible for significant direct and indirect health expenses. Although the standard care for this condition is well established in evidence-based clinical guidelines, often patients do not receive the indicated treatment. The quality of care delivered by primary care professionals is both a problem and a solution. Models of care adapted to chronic diseases and health education initiatives are strategies used to increase care quality. New information and communication technologies have progressively shortened distances between people. In healthcare, they have been used as a valuable tool for knowledge dissemination. Despite widespread availability and use, educational resources mediated by information and communication technologies still lack evidence of greater scientific rigor. Objective: to evaluate the clinical effectiveness of a multifaceted distance educational intervention on asthma for primary health care professionals. Methods: cluster randomized clinical trial with 71 health teams from country towns of Rio Grande do Sul. The teams identified a total of 443 persons diagnosed with asthma who were eligible for follow-up in the study The teams in the intervention group (n = 34) participated in a program of 3 interactive online sessions and received educational materials. There was no intervention in the control group teams (n = 37). Symptoms overload in the last 14 days, control of asthma in the last month, need for unplanned consultation in the last 6 months and use of preventive inhaled corticosteroids in the last 6 months were evaluated in the individuals indicated by the teams at the baseline and 6 months after the intervention. Results: The general assiduity of health teams to online interactive sessions was 50%. Both groups showed improved clinical outcomes and used less inhaled corticosteroids at follow-up. Exposure to educational intervention was associated with better clinical outcomes odds ratios, however, with borderline statistical significance. No differences were observed in the use of preventive inhaled corticosteroids between groups. Conclusion: The distance education intervention showed potential despite the low attendance of the intervention teams. The proposed model is feasible and reproducible. Integration with the clinical record system can boost results. The implementation of professional development strategies should be guided by the best evidence in an institutional setting. / Telemedicina

O monitoramento da qualidade do ar em Ribeirão Preto-SP é realizado pela Cetesb por métodos convencionais e, até o momento, nenhum estudo experimental sobre biomonitoramento da poluição atmosférica foi realizado na região. O município apresenta um crescente número de veículos automotores e está localizado em uma das regiões mais importantes do país para o setor sucroalcooleiro. A frequente queima da biomassa insere a região na lista do campo de atuação do VIGIAR-Programa de Vigilância em Saúde Ambiental do Ministério da Saúde, sendo de interesse, tanto o monitoramento da poluição do ar, como o conhecimento dos indicadores de saúde da população exposta. Nesse contexto, esta pesquisa teve como objetivo avaliar a qualidade do ar em Ribeirão Preto por meio de biomonitoramento vegetal, relacionando ao quadro de morbidade respiratória da população. Os experimentos foram conduzidos em três regiões urbanas do município, durante dois períodos: março a junho e julho a outubro de 2011. Em cada região foram expostas 24 mudas de cada espécie, Tibouchina pulchra e Tradescantia pallida, a 50% de sombreamento e a pleno sol. Foram analisados parâmetros fisiológicos, anatômicos, de crescimento e a composição química foliar. Os resultados foram comparados entre regiões e tratamentos de sol e sombra, relacionado-os com parâmetros ambientais (MP10, NO2, O3, temperatura, umidade relativa do ar, precipitação e radiação solar). O quadro de morbidade respiratória da população foi analisado, buscando-se relacionar dados de internações do Datasus com indicadores ambientais obtidos na Cetesb e no CIIAgro, entre 2009 e 2011. Os resultados indicaram que os níveis de poluentes atmosféricos no município, no período do estudo, comprometeram a capacidade fotossintética das plantas, afetando significativamente o seu crescimento. Em geral, as plantas expostas na região central apresentaram maior fotoinibição, menor teor de clorofila total, menor atividade específica da SOD, menor espessura foliar, menor AFE, menor produção de biomassa e maior acúmulo foliar de elementos químicos relacionados à poluição atmosférica. Ainda, foi possível observar maior efeito genotóxico durante a formação de gametas em T. pallida, em plantas expostas nessa região, caracterizada por intenso fluxo de veículos. Quanto à relação entre a taxa de internações hospitalares por doenças respiratórias e a concentração mensal de MP10 e NO2, destaca- se que, mesmo diante de níveis de poluição abaixo dos limites permitidos pelos padrões nacionais, foi observada uma associação moderada, principalmente entre crianças menores de cinco anos de idade, no período mais seco e frio do ano. Os resultados encontrados com esta pesquisa poderão servir como subsídios para a implementação dos novos padrões de qualidade do ar, atualmente em discussão no estado de São Paulo, ao revelar importantes indicadores de estresse em plantas devido à exposição a poluentes atmosféricos, mostrando ser factível a utilização do biomonitoramento para avaliação da qualidade do ar, como ferramenta complementar, além de um importante elemento para programas de educação ambiental. Esta pesquisa também revela a importância de adoção de evidências científicas, quanto ao impacto da poluição do ar sobre a saúde, pelo sistema de gestão ambiental, estimulando o desenvolvimento de estratégias inovadoras para alcançar melhores indicadores de qualidade do ar. Ainda, esta investigação traz novas ferramentas para a identificação de áreas de atenção ambiental atmosférica de interesse para a saúde, assim como de grupos populacionais expostos à poluição do ar, o que representa um dos grandes desafios do Programa de Ações Prioritárias da Vigilância em Saúde do VIGIAR, não apenas no estado de São Paulo, mas também em realidades similares. / The air quality monitoring in Ribeirão Preto is carried out by Cetesb with conventional methods and, until now, no experimental study on air pollution biomonitoring was conducted in the region. The city has a growing number of motor vehicles and is located in one of the most important regions of the country for the sugarcane sector. The frequent burning of biomass inserts the region in the list of VIGIAR-Surveillance Program on Environmental Health of the Ministry of Health, and is of interest, both the monitoring of air pollution, such as knowledge of the health indicators of the population exposed, being of interest, both the monitoring of air pollution, and the indicators of exposed population\'s health. In this context, this study aimed to assess the air quality in Ribeirão Preto through plant biomonitoring, relating to the framework of respiratory morbidity of the population. The experiments were conducted in three points of the city during two periods: from March to June and from July to October 2011. In each point 24 seedlings of each species, Tibouchina pulchra and Tradescantia pallida, were exposed in 50% shade and full sun. Physiological, anatomical, growth parameters and chemical leaf composition were analyzed in these plants. The results were compared between regions, under treatments of sun and shade, relating them with environmental parameters (PM10, NO2, O3, temperature, air relative humidity, rainfall and solar radiation). Still, the respiratory morbidity of the population was analyzed, relating Datasus data on respiratory hospitalizations with environmental indicators obtained in Cetesb and CIIAgro between 2009 and 2011. The results indicated that the levels of air pollutants in the city undertook the photosynthetic capacity of the plants, significantly affecting their growth. In general, the plants exposed in the central region showed greater photoinhibition, lower total chlorophyll content, lower specific activity of SOD, lower leaf thickness, lower AFE, lower biomass production and higher accumulation of leaf chemical elements related to air pollution. It was also possible to notice greater genotoxic effect during the gametes formation in T. pallida, in plants exposed in this region, characterized by intense traffic flow and consequently higher concentration of air pollutants. Even with pollution levels below the limits allowed by national standards, it was observed a moderate association between the rate of hospitalization for respiratory diseases and the monthly concentration of PM10 and NO2, especially among children under five years old, in the driest and coldest period of the year. The results of this research may serve as subsidies for the implementation of new air quality standards, currently under discussion in the São Paulo state, revealing important indicators of stress in plants due to exposure to air pollutants, showing to be feasible the use of biomonitoring assessment of air quality as a complementary tool, and an important element for environmental education programs. This research also shows the importance of adopting scientific evidence about the impact of air pollution on health, by the environmental management system, stimulating the development of innovative strategies to achieve better indicators of air quality. Still, this research provides new tools for identifying areas of atmospheric environmental attention, of interest to health, and population groups exposed to air pollution, which is one of the great challenges of the Priority Actions Programme of Surveillance health of VIGIAR, not only for the state of São Paulo but also in similar situations.

Diversos estudos afirmam que a exposição à poluição atmosférica pode resultar em aumento de casos de doenças cardiovasculares e respiratórias. Esses desfechos estão relacionados, principalmente, a altas taxas de internações e óbitos em países desenvolvidos. O presente trabalho objetivou estimar os efeitos da variação diária na concentração dos poluentes atmosféricos nos atendimentos de emergência por hipertensão arterial ou doenças respiratórias estratificados por sexo e por faixa etária. Trata-se de estudo ecológico de séries temporais realizado a partir dos registros de prontuários de atendimentos de emergência por hipertensão arterial ou doenças respiratórias de adultos e idosos atendidos no Hospital de Emergências Albert Sabin, do município de São Caetano do Sul, entre janeiro de 2010 a dezembro de 2011. Para a análise dos dados foram utilizados o modelo linear generalizado de regressão de Poisson e o modelo de defasagem de distribuição polinomial de terceiro grau, explorando estruturas de defasagens até seis dias após a exposição aos poluentes. As estimativas foram controladas para variáveis meteorológicas, sazonalidade e tendência de curta duração (dias da semana). Os indivíduos mais idosos se mostraram mais sensíveis aos efeitos dos poluentes do ar. Na estratificação por sexo, os homens foram mais susceptíveis quando expostos ao PM10 para os atendimentos por pneumonias e as mulheres para os atendimentos por doenças chiadoras. Para cada aumento de 22,4ug/m3 de PM10, houve um aumento de 16,2% (25,5% - 7,6%) nos atendimentos de hipertensão arterial nos idosos no dia da exposição ao poluente. Para infecções de vias aéreas superiores, o aumento mais robusto foi notado entre os homens no dia da exposição ao PM10, com 8,6% (3,6% - 14%) e entre os idosos, também de forma aguda, com 7,6% (0,7% - 15%). As mulheres expostas ao PM10 tiveram um aumento de 15,7% (5,4% - 26,3%) nos atendimentos por doenças chiadoras. Entre os idosos, esse aumento foi de 25,4% (12,1% - 40,2%) para este mesmo desfecho. Para pneumonias, o efeito mais robusto foi observado entre os idosos no dia da exposição ao PM10, com um aumento de 15,8% (0,9% - 32,8%) nos atendimentos. A cidade de São Caetano do Sul possui um perfil de poluição semelhante às grandes metrópoles, caracterizada por emissão de veículos e indústrias. Os resultados apresentados neste trabalho alertam para a necessidade da elaboração de políticas públicas na região para um melhor monitoramento e controle da poluição atmosférica, com o intuito de prevenir futuros agravos à saúde da população / Several studies claim that exposure to air pollution can result in increased cases of cardiovascular and respiratory diseases. These outcomes are mainly related to high rates of hospital admissions and deaths in developed countries. This study aimed to estimate the effects of daily variation in the concentration of air pollutants in emergency treatment for high blood pressure or respiratory diseases, stratified by sex and age group. It is an ecological time series study, conducted from emergency visits for high blood pressure or respiratory disease of adults and elderly assisted at the Emergency Hospital Albert Sabin in São Caetano do Sul between January 2010 December 2011. For data analysis was used generalized linear model Poisson regression model and polynomial distribution lag third degree, exploring lags structures up to six days after exposure to pollutants. The estimates were controlled to weather variables, seasonal and short-term trend (weekdays). Older individuals were more sensitive to the effects of air pollutants. In stratification by sex, men were more susceptible when exposed to PM10 to care for pneumonia and women to care for diseases wheezing. For each increase of 22.4 ug / m3 of PM10, there was an increase of 16.2% (25.5% - 7.6%) in hypertension in the elderly care on the day of exposure to the pollutant. For upper respiratory tract infections, the strongest increase was noted among men on the day of exposure to PM10, with 8.6% (3.6% - 14%) and among the elderly, too acutely, with 7, 6% (0.7% - 15%). Women exposed to PM10 increased by 15.7% (5.4% - 26.3%) in treated for wheezing. Among the elderly, the increase was 25.4% (12.1% - 40.2%) for the same outcome. Pneumonias for the most robust effect was observed among the elderly on the day of exposure to PM10, with an increase of 15.8% (0.9% - 32.8%) in attendance. The city of São Caetano do Sul has a pollution profile similar to large cities, characterized by emission vehicles and industries. The results presented in this study point to the need of public policy development in the region for better monitoring and control of air pollution, in order to prevent future health problems of the population

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines. Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured. Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity. Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.

Many steps go into developing a clinical viral gene therapy. The course starts with appropriate disease selection and moves through the many hurdles of in-vitro testing, animal model validation and proof-of-concept studies, all the way through pre-clinical large animal studies. In this thesis, I propose to outline the process of developing a translation pathway for a gene therapy using recombinant adeno-associated virus (rAAV). I will expand on this outline using data that I have generated during the course of my Ph.D. that ranges from animal model validation all the way through pre-clinical vector stability studies. Two disease models will be discussed throughout this thesis, Cockayne Syndrome (CS) and Alpha-1 Antitrypsin Deficiency (AATD). Cockayne Syndrome is a rare autosomal recessive genetic disorder involving mutations in either the CSA or CSB gene, leading to defects in DNA repair. Clinically this presents as progressive degeneration of the central nervous system, retina, cardiovascular system, and cochlea, which leads to mental retardation, post-natal growth defects, ocular abnormalities, and shortened life expectancy. Alpha-1 antitrypsin is a serine protease inhibitor largely produced in the liver that mainly functions to inhibit neutrophil elastase within the lung. AATD leads to an increased risk of emphysema, with shortened life expectancy, and also results in accumulations of mutant AAT polymers in the liver, sometimes leading to liver failure. Using these two disease models I will outline the upstream and downstream pre-clinical work as well as the transition to clinical trials of a rAAV based gene therapy.

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.