Major depressive disorder is one of the most common mental health conditions in the world while obesity, a condition tied to numerous chronic conditions throughout the lifespan, is at epidemic levels throughout most of the world. Adolescence is a crucial transition period for physical, cognitive, and social-emotional development. Adolescents, particularly girls, are at high risk of developing depression and obesity. Some studies suggest that obesity is a risk factor for the development of depression while others suggest that depression alters health habits, thereby leading to obesity. The overall goal of this work is to examine both of these questions in adolescent girls and further to explore whether the relationship between obesity (and other related risk factors) and depression is a bi-directional one. The National Heart, Lung, and Blood Institute's Growth and Health Study (NGHS) is an observational study of 2379 adolescent black and white girls. Height and weight was measured annually (and used to estimate body mass index) over 10 years from early to late adolescence. Diet and other risk factors were also measured longitudinally over 10 years. Depression was measured twice using the Centers for Epidemiologic Studies Depression Scale (CES-D): first at exam 8 and then at the final exam (exam 10). Multivariable logistic regression and longitudinal (repeated measures) mixed models were used to control for potential confounding by age, socio-economic status, physical activity, hours of television/video watching per day, and dietary factors. The first objective was to determine whether young adolescent girls who were already overweight or obese had a higher risk for developing depression during the follow-up exams in later adolescence. Overall, the prevalence of moderate (or worse) depression was much higher in girls who were classified as obese (474% with depression) than either overweight (37.8%) or normal-weight (34.3%) girls. After adjusting for baseline age, race, SES, television/video hour per day), physical activity level, diet quality (using Healthy Eating Index scores), and percent of energy from protein, obese girls had a 68% increase risk of subsequent depression (95% CI: 1.17 to 2.39) compared with normal weight girls. There was no increased depression risk for overweight girls. The risk of incident depression associated with obesity was the same for blacks and whites in the study. Finally, after controlling further for a measure of self-worth (using the Harter Scales), the effect of obesity was somewhat attenuated. The second objective of the study was to explore other risk factors for depression in these adolescent girls. In these analyses, several factors from the early adolescent years predicted the development of later depression (moderate or worse). These included hours spent watching television (risk increased by 6% for each additional hour watched per day), white race, SES, obesity, and self-worth score. While the self-worth score ranged only from 1 to 4, there was nearly a 60% reduction in risk for each increase of one point in the score. Thus, self-worth was a particularly important predictor, with higher self-worth scores protecting these girls from incident depression. The final objective of this work was to examine the change in behavioral risk factors associated with prevalent depression at exam 8. Depressed (vs. non-depressed) girls who were not obese at exam 8 were approximately 75% more likely to become obese by exam 10. The results of this study support a finding of a bi-directional relationship between obesity and depression in adolescent girls.

Introduction: Despite intense research efforts and improvements to mortality rates, breast cancer remains the leading cause of premature cancer death for women. Identifying women at highest risk is vitally important for screening decisions that may have a critical impact on diagnosis and prognosis. A family history of breast cancer is a well-established risk factor, but it can be unreliable. An easily measured and accurate biomarker of breast cancer risk would be a significant advancement to public health by allowing targeted screening of women who would benefit most. It may also reveal underlying molecular mechanism that could illuminate pathways to prevention. Incidence rates of breast cancer have remained unmoved owing to the lack of known modifiable risk factors. This may be due in part because most breast cancer research has focused on behaviors and exposures in, or recalled from, adulthood. The studies detailed in this dissertation seek to investigate the associations between oxidative stress and breast cancer risk in both adult women and adolescent girls with a family history of breast cancer. Methods: To determine the relationship between oxidative stress and breast cancer risk in adult women with a family history of breast cancer we measured and compared urinary levels of 8-OxodG and F2-Isoprostane in a prospective matched case control study nested within the New York Breast Cancer Family Registry. Cases (N=73) were individually matched with 2 controls on age, year of urine donation, menopausal status, and race. Conditional logistic regression methods were used to determine the odds of breast cancer from oxidative stress controlling for other risk factors for breast cancer and potential confounders. To better understand how oxidative stress levels change during puberty in girls and if such change is modified by a family history of breast cancer, we measured and compared levels of those same urinary biomarkers of oxidative stress in adolescent girls with and without a family history of breast cancer from the New York site of the Lessons in Epidemiology and Genetics of Adult Cancer from Youth cohort (LEGACY). Oxidative stress levels were measured both cross-sectionally at baseline and longitudinally every 6-months for up to 18-months. Linear regression was used for the cross-sectional analysis and repeated measures analysis using mixed models was employed for the longitudinal analysis. In both studies, biomarker levels were measured using well-established ELISA methods and adjusted for hydration status using specific gravity. Results: In the case control study of adult women we found that both 8-OxodG and F2-Isoprostane levels were significantly associated with a reduced risk of breast cancer after adjusting for BRCA1/2 mutation status, time between menarche and parity or menopause, and BMI (8-OxodG: β10-unit= -0.14, OR=0.87, p=0.03; F2-Isoprostane: β10-unit = -0.53, OR=0.59 , p=0.03). This inverse association was strongest among women under 50 and in women with a BMI below 25 for both biomarkers, and among women who reached menarche before age 14 for F2-Isoprostane. Overall, women in the highest tertile of either oxidative stress biomarker had approximately 50% reduced odds of breast cancer diagnosis. In our cross-sectional study of adolescent girls, we found that there was no significant difference in either oxidative stress biomarker in girls based on their family history of breast cancer. F2-Isoprostane levels were significantly associated with breast development measured by Tanner stage even after adjusting for age, age-specific BMI category and race (β=0.28, p=0.01). 8-OxodG levels were not significantly associated with age, BMI, race or Tanner stage at baseline but they were significantly associated with overweight/obese BMI but only among girls with a breast cancer family history (β=0.47, p=0.01). Change in 8-OxodG levels was significantly higher over the follow-up period in girls with a family history of breast cancer. This result remained significant after categorical measures of age, BMI, Tanner breast stage and race were added to the longitudinal model. F2-Isoprostane levels significantly increased in all girls over follow-up but this increase did not differ by family history of breast cancer, and the change was no longer significant our multivariate longitudinal analysis. Discussion: In both adult women and adolescent girls we found significant associations between oxidative stress and breast cancer risk. In adult women, low levels of urinary biomarkers of oxidative stress may promote cancer progression. During adolescence, girls with a family history of breast cancer may be exposed to higher rates of DNA oxidation that could result in genetic mutations. The relationships between oxidative stress, breast development, family history, and BMI should be the focus of future investigations.

A definição clara de doença periodontal é fundamental para se estabelecer critérios de risco ao desenvolvimento de outras condições sistêmicas e definir fenótipos biológicos que representem os eventos microbiológicos, moleculares e imunológicos subjacentes à manifestação clínica da doença. O objetivo deste estudo foi avaliar a prevalência dos diferentes fenótipos biológicos dentre os pacientes atendidos na Faculdade de Odontologia de Bauru-USP, correlacionando os achados clínicos às condições sistêmicas dos pacientes e aos achados microscópicos. Foram incluídos na amostra dados do prontuário clínico de 313 pacientes de ambos os sexos, com idade entre 12 e 76 anos. Após a coleta dos dados relativos à identificação, história médica e odontológica e parâmetros periodontais (profundidade de sondagem P.S.; recessão - REC ou hiperplasia HP; nível de inserção clínica NIC; índice de sangramento à sondagem SS e índice de placa IPl), a amostra foi dividida em cinco grupos: IBG-S (Interface Biofilme Gengiva - Saúde)- SS <10% e P.S. 3mm (n=24); IBG-G (Gengivite)- SS&#x2265;10% e P.S.&#x2264;3mm (n=39); IBG-LP/SL (Lesão Profunda- Sangramento Leve)- SS< 10% e 1 sítio ou mais P.S.&#x2265;4 mm (n=47); IBG-LP/SM (Lesão Profunda -Sangramento Moderado)- 10%-49% de SS e 1 sítio ou mais com P.S.&#x2265;4 mm (n=131); IBG-LP/SS (Lesão Profunda -Sangramento severo)- SS&#x2265;50% dos sítios e 1 sítio ou mais com P.S.&#x2265;4 mm (n=72). Foram obtidas biópsias de tecido mole de 25 pacientes dos diferentes grupos para análise em microscopia ótica convencional por dois examinadores experientes, desconhecedores da identificação dos pacientes. Os resultados demonstraram maior prevalência de IBG-LP/SM (41,85%) e menor prevalência de IBG-S (7,65%). A idade média foi de 42,93 ± 14,48 anos, sem diferenças entre os grupos (p=0.42; Kruskal-Wallis), com prevalência de mulheres (63,8%). A avaliação pelo teste Chi-quadrado demonstrou que IBG-LP/SL, IBG- LP/SM e IBG-LP/SS apresentaram maior número de fumantes do que IBG-S e IBG-G (p=0.015), sem diferenças entre os grupos em relação à presença de diabetes e doenças cardiovasculares (p>0.05). O risco de pacientes com SS>10% apresentarem doenças cardiovasculares foi significativamente elevado (p= 0.04, teste exato de Fischer). A P.S. média e NIC foram maiores no grupo IBG-PL/SS (2.95±1.55; 1.94±2.24, respectivamente) e menores no grupo IBG-G (1.71±0.65 e 0.51±0.99, respectivamente), com diferenças significantes entre os grupos (p<0.001; Kruskal-Wallis). O SS e IPl foram maiores nos grupos IBG-LP/SS e IBG-G, seguido pelos grupos IBG-LP/SM, IBG-LP/SL e IBG-S (p<0.001; Kruskal-Wallis). A análise microscópica demonstrou que o diagnóstico clínico foi compatível com o diagnóstico microscópico em 10 das 25 amostras investigadas (40%), observando-se correlação entre os achados clínicos e microscópicos em 100% das amostras do grupo IBG-G (n=4), 83,3% do grupo IBG-LP/SS (n=6), 50% do grupo IBG-S (n=2), 16,67% do grupo IBG-LP/SM (n=6) e 0% do grupo IBG-LP/SL (n=7). Esses achados sugerem que a manifestação clínica da doença periodontal é heterogênea, não compatível com a resposta inflamatória observada no tecido conjuntivo gengival. / A clear definition of periodontal disease is essential to establish criteria of risk of developing other systemic conditions, as well as to determine biological phenotypes that represent the microbiological, molecular and immunological features underlying clinical manifestation of the disease. The aim of this study was to evaluate the prevalence of different biological phenotypes among patients attended at School of Dentistry at Bauru-USP, correlating the clinical findings with systemic conditions and microscopic findings. It was included in the sample data collected from dental file records of 313 patients, both genders, age ranged 12-76 years. After collection of data related to the identification, medical and dental history and periodontal parameters (probing depth PD; recession REC or marginal hyperplasia HP; clinical attachment level CAL; bleeding on probing BOP; plaque índex IPl), sample was divided into Five groups: BGI-H (Health)- BOP <10% and PD&#x2264; 3mm (n=24); BGI-G (Gingivitis)- BOP&#x2265;10% and PD&#x2264;3mm (n=39); BGI-DL/LB (Deep lesion/low bleeding)- SS<10% and 1 or more sites PD&#x2265;4 mm (n=47); BGI-DP/MB (Deep lesion/moderate bleeding)- 10%-49% BOP and 1 or more sites PD&#x2265;4 mm (n=131); BGI-DL/SB (Deep lesion/severe bleeding)- BOP 50% and 1 ore more sites PD&#x2265;4 mm (n=72). Soft tissue excisional biopsies were removed from 25 patients of all groups for analysis in optical microscopy by two expertise blinded examiners. The results showed more prevalence of BGI-DP/MB (41.85%) and lesser prevalence of BGI-H (7.65%). Mean age was 42.93±14.48 years, without significant differences among groups (p=0.42; Kruskal-Wallis), and prevalence of women (63.8%). Evaluation by Chi-squared test showed that BGI-DL/LB, BGI-DL/MB and BGI-DL/SB presented more smokers than BGI-H and BGI-G (p=0.015), without significant differences in diabetes and cardiovascular diseases (p>0.05). The risk of patients with BOP> 10% present CVD was significantly higher (p= 0.04, Fischers exact test). Mean PD and CAL were deeper in BGI-DL/SB (2.95±1.55; 1.94±2.24, respectively) and shallower in BGI-G (1.71±0.65; 0.51±0.99, respectively), with significant differences among groups (p<0.001; Kruskal-Wallis). BOP and IPl were higher at BGI-DL/SB and BGI-G, followed by BGI-DL/MB, BGI-DL/LB and BGI-H (p<0.001; Kruskal-Wallis). Clinical diagnosis was compatible with microscopic diagnosis in 10 out of 25 samples (40%), noticing correlation between clinical and microscopic finding in 100% of BGI-G samples (n=4), 83.3% of BGI-DL/SB samples (n=6), 50% of BGI-H samples (n=2), 16,67% of BGI-DL/MB (n=6) and 0% of BGI-DL/LB (n=7). These findings suggest that clinical manifestation of periodontal diseases is heterogeneous, not corresponding to the inflammatory response observed at gingival connective tissue.

No description available.

Orientador: Lúcia Helena Simões Costa Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:41:26Z (GMT). No. of bitstreams: 1 GodoyJunior_CarlosEduardode_M.pdf: 3229802 bytes, checksum: b1f86c528adec46a35b4dc29dfd94438 (MD5) Previous issue date: 2011 / Resumo:Introdução: Os pólipos endometriais são achados freqüentes em mulheres durante a investigação de sangramento uterino anormal ou sangramento pósmenopausa. Apesar da baixa malignidade associada aos pólipos, a ressecção histeroscópica das lesões é conduta de rotina, levando diversas pacientes portadoras de lesões benignas à realização de tratamentos cirúrgicos. A partir disso, surge a necessidade de identificar fatores de risco para malignidade e métodos propedêuticos que tornem a indicação cirúrgica mais criteriosa. Objetivos: Avaliar a prevalência de pólipos endometriais pré-malignos e malignos em mulheres na pré e na pós-menopausa e fatores clínicos, ultrassonográficos e histeroscópicos associados à malignidade. Sujeitos e Métodos: Foram selecionadas mulheres submetidas a ressecção histeroscópica de pólipos endometriais de janeiro de 1998 a dezembro de 2008, utilizando-se a base de dados informatizada do Hospital da Mulher Prof. Dr. José Aristodemo Pinotti - CAISM/UNICAMP. Foram incluídas 870 mulheres, com idades entre 25 e 85 anos, agrupadas em pré-menopausa ou pós-menopausa. Os dados clínicos, ultrassonográficos, histeroscópicos e histológicos foram obtidos através da revisão dos prontuários médicos. As variáveis clínicas avaliadas foram idade, sangramento pós-menopausa, tempo de menopausa, paridade, hipertensão arterial, obesidade, diabetes mellitus, uso de terapia hormonal e uso de tamoxifeno. Os pólipos foram classificados em benignos (pólipos endometriais, pólipos com hiperplasia simples ou complexa sem atipias), pré-malignos (pólipos com hiperplasia simples ou complexa com atipias) e pólipos malignos. Resultados: A média etária foi de 57,5 anos (+ 10,6), sendo que 76,4% encontravam-se na pós-menopausa. Foram diagnosticadas 95,8% de lesões benignas. Pólipos pré-malignos foram 1,6% dos casos. Pólipos malignos representaram 2,5% do total da amostra. O sangramento pós-menopausa e a idade avançada foram os únicos fatores clínicos associados ao maior risco de malignidade com RP de 3,67 (IC95% 1,69 - 7,97) e RP de 1,05 (IC95% 1,01 - 1,09), respectivamente. A avaliação ultrassonográfica da linha endometrial revelou maior espessura média nos pólipos malignos. Na histeroscopia cirúrgica, os maiores pólipos ressecados foram aqueles com hiperplasia complexa sem atipias, seguidos pelos pólipos carcinomatosos e pólipos com hiperplasia complexa com atipias. A medida ultrassonográfica da espessura endometrial de 13mm mostrou uma acurácia de 68,6% para o diagnóstico de malignidade, com sensibilidade de 69.6%, especificidade de 68,5%, VPP de 9,3% e VPN de 98%. Os pólipos de 30mm medidos pela histeroscopia mostraram uma acurácia de 65,3% para o diagnóstico de malignidade com sensibilidade de 47,8%, especificidade de 66,1%, VPP de 6,1% e VPN de 96,5%. Conclusões: A prevalência de malignidade nos pólipos endometriais foi baixa e esteve associada ao sangramento pós-menopausa e maior idade. A espessura endometrial à ultrassonografia e o tamanho dos pólipos endometrias à histeroscopia tiveram baixa acurácia para predizer malignidade nos pólipos endometriais / Abstract: Introduction: Endometrial polyps are frequent findings in women during investigation of abnormal uterine bleeding or postmenopausal bleeding. Despite the low malignancy rate associated with polyps, hysteroscopic resection of the lesions is routine practice, leading to surgical treatment in various patients with benign lesions. Therefore, there is a need to identify risk factors for malignancy and propaedeutic methods that can permit a more judicious indication for surgery. Objectives: To evaluate the prevalence of premalignant and malignant endometrial polyps in premenopausal and postmenopausal women, as well as clinical, ultrasound and hysteroscopic factors associated with malignancy. Subjects and Methods: Women undergoing hysteroscopic resection of endometrial polyps from January 1998 to December 2008 were selected, using a computerized database from the Prof. Dr. José Aristodemo Pinotti Women's Hospital- CAISM/UNICAMP. Eight hundred and seventy (870) women, aged between 25 and 85 years, grouped into premenopausal or postmenopausal were included in the study. Clinical, ultrasound, hysteroscopic and histologic data were obtained by medical chart review. The clinical variables evaluated were age, postmenopausal bleeding, time since menopause, parity, arterial hypertension, obesity, diabetes mellitus, hormonal therapy use and tamoxifen use. Polyps were classified as benign (endometrial polyps, polyps with non-atypical simple or complex hyperplasia), premalignant (polyps with atypical simple or complex hyperplasia) and malignant polyps. Results: The mean age of the patients was 57.5 years (+ 10.6), and 76.4% of these women were postmenopausal. Benign lesions were diagnosed in 95.8% of the patients. Premalignant polyps represented 1.6% of the cases. Malignant polyps accounted for 2.5% of the total sample. Postmenopausal bleeding and advanced age were the only clinical factors associated with a higher risk of malignancy with RP of 3.67 (95%CI 1.69 - 7.97) and RP of 1.05 (95%CI 1.01 - 1.09), respectively. Ultrasound evaluation of the endometrial thickness revealed that malignant polyps had a greater median thickness. On surgical hysteroscopy, the largest resected polyps were those with complex non-atypical hyperplasia, followed by carcinomatous polyps and polyps with atypical complex hyperplasia. A sonographically measured endometrial thickness of 13mm showed a diagnostic accuracy of 68.6% for malignancy, with a sensitivity of 69.6%, a specificity of 68.5%, PPV of 9.3% and NPV of 98%. Polyps of 30mm measured by hysteroscopy showed a diagnostic accuracy of 65.3% for malignancy with a sensitivity of 47.8%, a specificity of 66.1%, a VPP of 6.1% and a VPN of 96.5%. Conclusions: There was a low prevalence of malignancy in endometrial polyps that was associated with postmenopausal bleeding and more advanced age. Endometrial thickening on ultrasound evaluation and endometrial polyp size on hysteroscopy is able to predict malignancy in endometrial polyps with a low level of accuracy / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

by Amy, Chan Shiu Yu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 189-210). / Questionaire also in Chinese. / Acknowledgement --- p.iv / List of Tables --- p.v / List of Figures --- p.ix / Abstract --- p.1 / Chapter Chapter 1 --- Introduction --- p.3 / Chapter 1.1 --- Demographic Aging in Hong Kong / Chapter 1.2 --- Rationale of the Present Study / Chapter 1.3 --- Longitudinal Studies on Elderly Health / Chapter 1.4 --- Brief Summary of the Baseline Study / Chapter 1.5 --- Objectives of the Present Study / Chapter 1.6 --- Outline of the Thesis / Chapter Chapter 2 --- Literature Review: Review of Health Surveys of the Elderly 226}0ؤ International and Local --- p.11 / Chapter 2.1 --- Introduction / Chapter 2.2 --- Health Surveys of the Elderly in Developed Countries 一 Selected Issues / Chapter 2.3 --- Health Surveys of the Elderly in the Asian Pacific Rim / Chapter 2.4 --- Health Surveys of the Elderly in Hong Kong / Chapter 2.5 --- Conclusion / Chapter Chapter 3 --- Methodology --- p.81 / Chapter 3.1 --- Research Design / Chapter 3.2 --- Study population一 Sampling Method and Sample Size / Chapter 3.3 --- Data Collection / Chapter 3.4 --- Data Analysis / Chapter Chapter 4 --- Results: Change in Functional Status and Factors Associated with Change --- p.91 / Chapter 4.1 --- Socio-demographic Profile / Chapter 4.2 --- Mental Health Status / Chapter 4.3 --- Functional Disability / Chapter 4.4 --- Physical Health / Chapter 4.5 --- Physical Impairment / Chapter 4.6 --- Use of Health Services / Chapter 4.7 --- Physical Exercise / Chapter 4.8 --- Social Supportive Network / Chapter Chapter 5 --- Results: Logistic Regression Analysis of Change in Functional Status Associated with Various Risk Factors --- p.110 / Chapter 5.1 --- Socio-demographic Profile / Chapter 5.2 --- Mental Health Status / Chapter 5.3 --- Functional Disability / Chapter 5.4 --- Physical Health / Chapter 5.5 --- Physical Impairment / Chapter 5.6 --- Use of Health Services / Chapter 5.7 --- Physical Exercise / Chapter 5.8 --- Social Supportive Network / Chapter Chapter 6 --- Results: Institutionalization and Associated Factors --- p.131 / Chapter 6.1 --- Socio-demographic Profile / Chapter 6.2 --- Mental Health Status / Chapter 6.3 --- Functional Disability / Chapter 6.4 --- Physical Health / Chapter 6.5 --- Physical Impairment / Chapter 6.6 --- Use of Health Services / Chapter 6.7 --- Physical Exercise / Chapter 6.8 --- Social Supportive Network / Chapter Chapter 7 --- Results : Logistic Regression Analysis of Institutionalization At Follow Up Associated with Various Risk Factors --- p.149 / Chapter 7.1 --- Socio-demographic Profile / Chapter 7.2 --- Mental Health Status / Chapter 7.3 --- Functional Disability / Chapter 7.4 --- Physical Health / Chapter 7.5 --- Physical Impairment / Chapter 7.6 --- Use of Health Services / Chapter 7.7 --- Physical Exercise / Chapter 7.8 --- Social Supportive Network / Chapter Chapter 8 --- Discussion and Conclusion --- p.167 / Chapter 8.1 --- Change of Functional Status Related to Various Risk Factors / Chapter 8.2 --- Institutionalization Associated with Various Risk Factors / Chapter 8.3 --- Validity and Reliability / Chapter 8.4 --- Implications on Health Care / Chapter 8.5 --- Conclusion / References --- p.189 / Appendix --- p.211 / Chapter I. --- Projected Additional Old Age Home (OAH) Places required for Aged70 and above / Chapter II. --- The Questionnaire Used at the Baseline Interviews / Chapter - --- English Version / Chapter - --- Chinese Version / Chapter III. --- The Questionnaire Used at Follow Up Interviews / Chapter - --- Chinese Version

Hui Lai Ling. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 180-204). / Abstracts in English and Chinese. / acknowledgements --- p.I / contents --- p.II / list of abbreviation --- p.IX / list of tables --- p.X / LIST OF FIGURES --- p.XII / abstract --- p.XIII / Chapter chapter 1 --- introduction --- p.1 / Chapter 1.1 --- Overview --- p.1 / Chapter 1.2 --- Objectives & Hypotheses --- p.2 / Chapter chapter 2 --- literature review --- p.6 / Chapter 2.1 --- Definition of obesity --- p.6 / Chapter 2.1.1 --- Densitometric measurement --- p.6 / Chapter 2.1.2 --- Anthropometric measurement --- p.6 / Chapter 2.1.2.1 --- Body circumferences --- p.7 / Chapter 2.1.2.2 --- Skinfold thickness --- p.8 / Chapter 2.1.2.3 --- Weight and height ratios --- p.8 / Chapter 2.1.3 --- Body Mass Index to define obesity --- p.9 / Chapter 2.1.3.1 --- In adults --- p.9 / Chapter 2.1.3.2 --- In children & Adolescents --- p.9 / Chapter 2.2 --- Epidemic of obesity --- p.13 / Chapter 2.2.1 --- Worldwide prevalence & trends of obesity --- p.13 / Chapter 2.2.2 --- Obesity rates in Hong Kong --- p.16 / Chapter 2.3 --- Consequences of obesity --- p.17 / Chapter 2.3.1 --- Health consequences --- p.77 / Chapter 2.3.1.1 --- Adulthood obesity --- p.17 / Chapter 2.3.1.2 --- Childhood & adolescent obesity --- p.19 / Chapter 2.3.1.3 --- Controversy of health risk studies --- p.20 / Chapter 2.3.2 --- Quality of life --- p.21 / Chapter 2.3.3 --- Economic consequences of obesity --- p.21 / Chapter 2.3.4 --- Persistence of childhood obesity into adulthood --- p.22 / Chapter 2.5 --- Risk factors for childhood obesity --- p.24 / Chapter 2.5.1 --- Genetic factors --- p.24 / Chapter 2.5.1.1 --- Parental weight status --- p.24 / Chapter 2.5.1.2 --- Birth weight --- p.28 / Chapter 2.5.2 --- Demographic factors --- p.30 / Chapter 2.5.2.1 --- Socio-economic Status --- p.30 / Chapter 2.5.2.2 --- Family environment --- p.31 / Chapter 2.5.3 --- Dietary factors --- p.33 / Chapter 2.5.3.1 --- Infancy diet --- p.33 / Chapter 2.5.3.2 --- Dietary intake --- p.34 / Chapter 2.5.3.3 --- Eating behaviour --- p.39 / Chapter 2.5.4 --- Physical activity factors --- p.42 / Chapter 2.5.4.1 --- Inactivity --- p.42 / Chapter 2.5.4.2 --- Determinants of physical activity level --- p.44 / Chapter 2.5.4.3 --- Television-watching --- p.46 / Chapter 2.5.5 --- Other risk factors --- p.47 / Chapter 2.6 --- Management of childhood obesity --- p.49 / Chapter 2.6.1 --- Goals & Difficulties in childhood obesity treatment --- p.49 / Chapter 2.6.2 --- Dietary approach --- p.50 / Chapter 2.6.2.1 --- General healthy eating --- p.50 / Chapter 2.6.2.2 --- Decrease fat intake --- p.51 / Chapter 2.6.2.3 --- Increase fibre intake --- p.52 / Chapter 2.6.2.4 --- Reducing meal Glycaemic Index --- p.53 / Chapter 2.6.3 --- Increase activity level --- p.56 / Chapter 2.6.3.1 --- Reinforce active behaviour --- p.56 / Chapter 2.6.3.2 --- Decrease sedentary lifestyle --- p.57 / Chapter 2.6.4 --- Roles of parents and schools in obesity managements --- p.58 / Chapter CHAPTER 3 --- METHODOLOGY --- p.59 / Chapter 3.1 --- Overview --- p.59 / Chapter 3.2 --- Study population --- p.59 / Chapter 3.2.1 --- Reason for selecting 6-7 years old children --- p.59 / Chapter 3.2.2 --- Classification of case and control groups --- p.60 / Chapter 3.2.3 --- Reasons for using BMI --- p.62 / Chapter 3.2.4 --- Development of BMI cut-offs --- p.63 / Chapter 3.3 --- Estimation of sample size --- p.64 / Chapter 3.4 --- Subject recruitment --- p.65 / Chapter 3.4.1 --- Sample Source --- p.65 / Chapter 3.4.2 --- Inclusion criteria --- p.61 / Chapter 3.4.3 --- Recruitment --- p.67 / Chapter 3.4.4 --- Pilot Testing --- p.70 / Chapter 3.5 --- Data collection --- p.70 / Chapter 3.5.1 --- Overview --- p.70 / Chapter 3.5.2 --- Lifestyle data --- p.77 / Chapter 3.5.2.1 --- Scope of data --- p.71 / Chapter 3.5.2.2 --- References for questionnaire design --- p.71 / Chapter 3.5.2.3 --- Questionnaire content --- p.72 / Chapter 3.5.2.4 --- Data validity --- p.73 / Chapter 3.5.3 --- Dietary data --- p.76 / Chapter 3.5.3.1 --- The assessment method --- p.76 / Chapter 3.5.3.2 --- Data validity --- p.76 / Chapter 3.6 --- Data entry & analyses --- p.77 / Chapter 3.6.1 --- Data entry --- p.77 / Chapter 3.6.2 --- Dietary data analyses --- p.78 / Chapter 3.6.2.1 --- Nutrient intake --- p.78 / Chapter 3.6.2.2 --- Meal Glycaemic response --- p.78 / Chapter 3.6.3 --- Risk factor analyses --- p.79 / Chapter 3.6.3.1 --- Univariate analyses --- p.79 / Chapter 3.6.3.2 --- Multivariate analyses --- p.79 / Chapter 3.6.3.3 --- Further analyses --- p.80 / Chapter 3.6.4 --- Childhood lifestyle descriptive analyses --- p.80 / Chapter CHAPTER 4 --- RESULTS --- p.81 / Chapter 4.1 --- Overview --- p.81 / Chapter 4.2 --- Descriptive analyses --- p.82 / Chapter 4.2.1 --- Sample Size & sample source --- p.82 / Chapter 4.2.2 --- Sample Characteristics --- p.83 / Chapter 4.2.3 --- Demographic background --- p.86 / Chapter 4.3 --- Risk factors identification --- p.90 / Chapter 4.3.1 --- Overview --- p.90 / Chapter 4.3.2 --- Univariate analyses --- p.90 / Chapter 4.3.3 --- Multivariate analyses --- p.90 / Chapter 4.3.3.1 --- Variable selection --- p.90 / Chapter 4.3.3.2 --- Test for Multicollinearity --- p.91 / Chapter 4.3.3.3 --- Logistic regression results --- p.91 / Chapter 4.3.4 --- Further analyses --- p.98 / Chapter 4.3.4.1 --- Purposes --- p.98 / Chapter 4.3.4.2 --- Parental BMI --- p.99 / Chapter 4.3.4.3 --- Child's birth weight --- p.102 / Chapter 4.3.4.4 --- Eating Behaviour --- p.105 / Chapter 4.3.4.5 --- Dietary intake --- p.108 / Chapter 4.3.4.6 --- Physical activity --- p.109 / Chapter 4.3.4.7 --- Parental smoking --- p.110 / Chapter 4.3.4.8 --- Socio-economic status --- p.111 / Chapter 4.4 --- Children lifestyle descriptive analyses --- p.113 / Chapter 4.4.1 --- Inactivity in young children --- p.113 / Chapter 4.4.1.1 --- Exercise time and frequency --- p.113 / Chapter 4.4.1.2 --- Exercise preference & encouragement --- p.115 / Chapter 4.4.1.3 --- Determinants of exercise time --- p.117 / Chapter 4.4.2 --- Weight beliefs & Nutrition knowledge --- p.118 / Chapter 4.4.2.1 --- Weight and health beliefs --- p.118 / Chapter 4.4.2.2 --- Nutrition knowledge --- p.121 / Chapter 4.4.3 --- Dietary habits & Nutrient intake --- p.123 / Chapter 4.4.3.1 --- Dietary practice --- p.123 / Chapter 4.4.3.2 --- Nutrient intake --- p.129 / Chapter CHAPTER 5 --- DISCUSSION --- p.137 / Chapter 5.1 --- Risk factors for childhood overweight development --- p.137 / Chapter 5.1.1 --- Overview --- p.137 / Chapter 5.1.2 --- Genetic factors --- p.138 / Chapter 5.1.2.1 --- Parental BMI --- p.138 / Chapter 5.1.2.2 --- Birth weight --- p.142 / Chapter 5.1.3 --- Dietary factors --- p.144 / Chapter 5.1.3.1 --- Eating behaviours --- p.144 / Chapter 5.1.3.2 --- Infancy diet --- p.150 / Chapter 5.1.3.3 --- Current dietary intake --- p.151 / Chapter 5.1.4 --- Physical activity --- p.154 / Chapter 5.1.4.1 --- Exercise --- p.154 / Chapter 5.1.4.2 --- Sedentary activities --- p.155 / Chapter 5.1.5 --- Family environment --- p.157 / Chapter 5.1.5.1 --- Social class & Custody --- p.157 / Chapter 5.1.5.2 --- Parental smoking --- p.159 / Chapter 5.2 --- Lifestyle in Hong Kong young children --- p.161 / Chapter 5.2.1 --- Childhood inactivity --- p.161 / Chapter 5.2.2 --- Weight perception & Nutrition knowledge --- p.163 / Chapter 5.2.3 --- Dietary habits & Nutrient intake --- p.165 / Chapter 5.3 --- Limitations --- p.169 / Chapter 5.3.1 --- Study sample --- p.169 / Chapter 5.3.2 --- Study method --- p.171 / Chapter 5.4 --- Implication of the study results --- p.173 / Chapter 5.4.1 --- Overview --- p.173 / Chapter 5.4.2 --- Strategies on obesity treatments and prevention --- p.173 / Chapter 5.4.3 --- Conclusion --- p.775 / Chapter 5.5 --- Suggestions for further study --- p.176 / CONCLUSION --- p.178 / REFERENCES --- p.180 / APPENDICES --- p.205 / Chapter A. --- Communications for sample recruitment / Appendix A1 Invitation to Parents --- p.A-l / Appendix A2 Contact Details Form --- p.A-3 / Appendix A3 Letter of thanks to SHSC Nurses --- p.A-4 / Appendix A4 Second letter to parents --- p.A-12 / Appendix A5 Written consent from parents --- p.A-14 / Chapter B --- Study Tools / Appendix B1 The Questionnaire --- p.B-l / Appendix B2 3-day dietary record --- p.B-49 / Chapter C --- Childhood overweight risk factors - univariate analyses / Appendix C1 Genetic factors --- p.C-1 / Appendix C2 Demographic factors --- p.C-2 / Appendix C3 Custody & Home environments --- p.C-3 / Appendix C4 Infant feeding factors --- p.C-4 / Appendix C5 Dietary manipulation & Eating desire --- p.C-5 / Appendix C6 Eating habits & Food preference --- p.C-6 / Appendix C7 Physical activity factors --- p.C-7 / Appendix C8 Factors influencing physical activity --- p.C-8 / Appendix C9 Nutrition knowledge & weight perception --- p.C-9 / Appendix C10 Nutrients factors --- p.C-10 / Appendix C11 School life & unclassified factors --- p.C-11 / Chapter D --- Miscellaneous / Appendix D1 Research questions and related questions in the questionnaire --- p.D-l / Appendix D2 Food GI estimation list --- p.D-3

No Brasil, as doenças cardiovasculares constituem-se nas principais causas de mortalidade, sendo o infarto agudo do miocárdio a entidade nosológica mais freqüente dentre as doenças isquêmicas do coração. Os fatores de risco que predispõem as pessoas a essa doença estão relacionados a hábitos do estilo de vida e história familiar. Assim, esta investigação, de natureza descritiva, pretende identificar os fatores de risco relacionados ao meio ambiente, à biologia humana, estilo de vida, e sistema de saúde de pacientes internados em um hospital privado, até 48 horas após a ocorrência de infarto agudo do miocárdio, identificar o conhecimento quanto aos fatores de risco para o desenvolvimento de novos problemas de saúde e verificar se algumas variáveis, relacionadas aos fatores de risco de pacientes infartados em hospital público e privado, são semelhantes. O referencial teórico foi o Modelo de Campo de Saúde que compõe elementos relacionados ao meio ambiente, biologia humana, estilo de vida e sistema de saúde. Foram entrevistados 31 pacientes internados, em um hospital privado de uma cidade do interior do Estado de São Paulo, no período de janeiro a julho de 2003, após assinatura do termo de consentimento informado. Os resultados revelam que, quanto ao meio ambiente, a maioria dos pacientes era alfabetizada, 11 (35,5%) tinha o primeiro grau completo, 10 (32,2%) eram aposentados e donas-de-casa, 24 (77,4%) trabalhavam em torno de 8 a 10 horas por dia e tinham somente um emprego, e a renda familiar mensal, para 19 (61,3%), encontrava-se na faixa de 5 a 15 ou mais salários-mínimos, 22 (70,9%) eram casados e 15 (48,3%) tinham três ou mais filhos, 21 (67,7%) eram procedentes de Ribeirão Preto e região e todos residiam em zona urbana. Em relação à biologia humana, 19 (61,3%) eram do sexo masculino, aproximadamente metade 17 (54,8%) encontrava-se na faixa etária de 40 a 59 anos, 18 (58,1%) encontravam-se com sobrepeso ou obesidade classes I e II. Quanto aos antecedentes familiares, os dados mais expressivos apontam que 23 (74,2%) apresentavam hipertensão arterial sistêmica, 15 (48,3%) diabetes melittus, 17 (54,8%) infarto agudo do miocárdio e 6 (19,3%) acidente vascular cerebral. Das mulheres entrevistadas, 7 (22,6%) faziam uso algum tipo de terapia de reposição hormonal. No tocante ao estilo de vida relacionado aos hábitos alimentares, 29 (93,6%) utilizavam frituras nas refeições, 14 (45,2%) ingeriam doces e refrigerantes diariamente e 13 (41,9%) tomavam três xícaras ou mais de café ao dia, 18 (58,1%) faziam uso de bebidas alcoólicas, 10 (32,2%) eram fumantes, 9 (29,0%) ex-fumantes e 18 (58,1%) sedentários. Quanto ao estresse, 12 (38,7%) sentiam-se estressados no local de trabalho e 19 (61,3%) dormiam menos que oito horas por noite. Em relação ao sistema de saúde, 16 (51,6%) conheciam o diagnóstico, 12 (38,7%) apresentaram dúvidas acerca da doença, 21 (67,7%) utilizavam os serviços de saúde oferecidos pelo plano de saúde e 17 (54,8%) realizavam tratamento de hipertensão arterial sistêmica e diabetes melittus. Os dados revelam que os pacientes infartados estão expostos a hábitos autocriados que são passiveis de modificação havendo a necessidade de iniciar este processo educativo inclusive no período de internação hospitalar. / The cardiovascular diseases in Brazil, constitute nowadays death’s first cause and myocardial infarction is the most frequent nosological entity amonmg heart isquemical diseases. Among risk factors which predispose people committed by this disease are their life style’s and familiar history’s habits. This descriptive investigation intended to identify the risk factors related to the environment, human biology, life style and health systems of patients admitted in a private hospital, until 48 hours after the myocardial infarction; identify the knowledge’s blanket concerning to the risk factors related to new health problems’ development and verify if some variables are related to the risk factors which are similar to those of admitted patients in private and public hospitals. The theoretical referential used was the Health Model Field which constitutes the elements linked to the environment, human biology, life style an health system. We interviewed 31 internee patients in a private hospital in São Paulo’s interior, from January through July, 2003. Concerning to the environment 93,5% of the patients were literate; among them 11 (35,5%) had completed high school; related to their occupation 10 (32,2%) were retired and housewives; concerning to their working hours and job numbers, 24 (77,4%) work around 8 or 10 hours a day and have only one job; when referring to their familiar monthly income, 19 (61,3%) obtained from 5 to or more minimum salaries; 22 (70,9%) were married and 15 (48,3%) had three or more children; 21 (67,7%) were from Ribeirão Preto and its region and all of them lived in urban areas. When referring to the human biology, 19 (61,3%) were masculine and their ages varied between 40 and 59 years old; 18 (58,1%) were over weighted or fat, belonging to classes I and II; concerned to the familiar preceding, the most expressive data showed that 23 (74,2%) presented systemic arterial hypertension; 15 (48,3%) mellitus diabetes; 17 (54,8%) myocardial infarction and 6 (19,3%) cerebral vascular accident; 7 (22,6%) were feminine and were using hormones. Concerned to their life style, related to the feeding habits, 29 (93,6%) were accustomed to eat fried food; 14 (45,2%) used to eat sweeties and drink soft drinks daily; 13 (41,9%) used to drink 3 or more cups of coffee a day. When referring to the use of alcoholic drinks, 18 (58,1%) used to drink it; 10 (32,2%) were smokers and 9 (29,0%) were ex-smokers; 18 (58,1%) were sedentary. When referring to the stressing environment and sleeping patterns, 12 (38,7%) mention the work place and 19 (61,3%) sleep less than 8 hours a day. Concerning to the health system, 16 (51,6%) knew their diagnosis; 12 (38,7%) presented doubts about their diseases; 21 (67,7%) used the health services offered by their health insurance and 17 (54,8%) were under arterial hypertension and mellitus diabetes treatment. The data showed the patients who suffered by myocardial infarction are exposed to “selfcreated” habits, which may be modified and it is important to mention the necessity of raising educative programs including the patient’s permanence at the hospital.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) in children, as defined by the American Thoracic Society, is a disorder of breathing during sleep characterized by prolonged partial airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. Objective: This study aimed to investigate retrospectively the prevalence of OSAS among children aged 6 to 12 years old, evaluated through polysomnography and sleep questionnaires between 2011 and 2012, analyzing severity, symptoms and associated risk factors. Methods: We evaluated 63 children referred to the Sleep Laboratory of the Dell Childrenâs Hospital in Austin, Texas (USA) with suspition of Sleep Disordered Breathing. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 8,8 Â1,9 years old, and 55,6% of the children were male. Children without OSAS accounted for 30,2% of the sample. The OSAS observed in the remainder was mild in 49,2%, moderate in 11,1% and severe in 9,5%. Gender and age were not associated with OSAS. Hispanic and African-American children were at higher risk for OSAS. Twenty two hispanic children presented OSAS ( 88%) and ten African-american children presented OSAS (83,3%). In children with OSAS, the most common symptoms were: snoring (86%), periodic limb movements (64,3%), arousals during sleep (60,5%) and restless sleep (58,1%). Excessive daytime sleepiness was reported in only 33,3% of the patients. Bruxism was more prevalent among the patients without OSAS (52,6%) than in the patients with OSAS (31%). Overweight children were at higher risk for OSAS. Conclusions: Overweight children are at a higher risk for developing OSAS. Hispanic and African American children presented a higher risk for developing OSAS. Age and gender were not associated to the diagnose of OSAS. Bruxism was more prevalent among the children who did not present OSAS. / IntroduÃÃo: Em crianÃas, a SÃndrome da Apneia Obstrutiva do Sono (SAOS) à um distÃrbio respiratÃrio caracterizado por obstruÃÃo parcial prolongada e/ou episÃdios intermitentes de obstruÃÃo completa da via aÃrea superior, que interrompe a ventilaÃÃo normal e o padrÃo normal de sono. Objetivo: Este trabalho buscou investigar a prevalÃncia de SAOS entre crianÃas de seis a doze anos de idade, avaliadas por meio de polissonografia e questionÃrio sobre o sono, no perÃodo de 2011 a 2012, avaliando gravidade, sintomatologia e fatores de risco associados. MÃtodos: Foram estudadas 63 crianÃas encaminhadas ao LaboratÃrio do Sono do Dell Childrenâs Hospital em Austin, Texas (EUA) com suspeita de Transtornos RespiratÃrios do Sono. Os pais preencheram um questionÃrio sobre o sono, jà rotineiramente utilizado como padrÃo para todos os pacientes encaminhados para polissonografia no Dell Childrenâs Hospital (ApÃndice A). Em seguida, as crianÃas foram submetidas ao exame polissonogrÃfico. Resultados: A idade mÃdia foi de 8,8Â1,9 anos, sendo 55,6% das crianÃas do sexo masculino. NÃo apneicos corresponderam a 30,2% dos investigados. SÃndrome da Apneia Obstrutiva do Sono em grau leve ocorreu em 49,2%, moderado em 11,1% e grave em 9,5%. NÃo foi encontrada diferenÃa entre a incidÃncia de SAOS entre meninos e meninas. Observou-se uma associaÃÃo estatisticamente significante entre raÃa e presenÃa/ausÃncia de SAOS, sendo que as crianÃas negras e hispÃnicas apresentaram maior risco de SAOS do que as crianÃas brancas. Entre os hispÃnicos, 88% dos pacientes apresentaram SAOS (n=22); nos negros 83,3% (n=10) e nos brancos 46,7% (n=7). Dentre as crianÃas diagnosticadas com SAOS, os sintomas mais frequentes foram: ronco (86%) movimentos periÃdicos de membros (64,3%), despertares durante o sono (60,5%) e sono agitado (58,1%). SonolÃncia excessiva foi relatada apenas em 33,3% dos casos. O bruxismo foi relatado com maior frequÃncia no grupo sem SAOS (52,6%) do que no grupo de pacientes com diagnÃstico de SAOS (31%). CrianÃas com sobrepeso apresentaram maior risco de desenvolver SAOS (100%) (Testes Qui quadrado e exato de Fisher). ConclusÃes: Sobrepeso à um fator de risco para SAOS. CrianÃas da raÃa hispÃnica e negra apresentaram maior risco a SAOS. Sexo e idade nÃo se associaram a SAOS. O bruxismo foi mais frequentemente relatado por pacientes que nÃo demonstraram SAOS.

A infecção pelo vírus da hepatite C acomete cerca de 180 milhões de pessoas em todo mundo. Trata-se de doença com pouca manifestação clinica, onde cerca de 75% a 85% dos casos evolui para cronificação e aproximadamente 15% para hepatocarcinoma. Entre os fatores de risco mais conhecidos estão a realização de transfusões de sangue e hemoderivados anterior a 1993, uso de drogas endovenosas e relações sexuais desprotegidas. Este trabalho tem por objetivo estimar a prevalência de sorologia positiva para hepatite C e seus possíveis fatores de risco no distrito de Botafogo, município de Bebedouro, SP, onde a elevada freqüência de casos de hepatite chamou a atenção dos seus próprios moradores. Da população de 1318 habitantes, 353 foram sorteados para participar da pesquisa, sendo submetidos a questionário padronizado e coleta de sangue. Infecção pelo vírus da hepatite C foi pesquisada através de exames imunoenzimáticos e de PCR, no Instituto Oswaldo Cruz (Fiocruz), e por teste imunocromatográfico, no Laboratório de Sorologia do Hospital da Clínicas de Ribeirão Preto-USP . A prevalência encontrada foi de 8,8% (IC95%: 5,8 11,7). As variáveis que mostraram associação na análise univariada foram submetidas a um procedimento multivariado por aplicação do modelo de log binomial. As variáveis preditoras independentes de infecção pela hepatite C foram sexo masculino, tempo de residência acima de trinta anos e uso de medicações parenterais com material esterilizado por técnica de fervura. Uma possível explicação para a elevada prevalência nessa população reside na possibilidade de disseminação do vírus a partir de um antigo morador, que exercia informalmente atividades ligadas ao atendimento à saúde, especialmente aplicação de injeções, numa época anterior ao uso de seringas descartáveis. / Approximately 180 million people worldwide are infected by the hepatitis C virus. It is an illness with little clinical manifestation where about 75% - 85% of the cases evolve to chronification and about 15% to hepatocarcinoma. Among the bestknown risk factors are blood and blood by-product transfusions prior to 1993, use of intravenous drugs and unprotected sexual relations. This study has the objective of estimating the prevalence of positive serology for hepatitis C and its possible risk factors in the district of Botafogo, municipality of Bebedouro, São Paulo, where the high frequency of hepatitis cases caught the attention of the population itself. Out of a population of 1318 inhabitants, 353 were selected to participate in the research, being submitted to a standard questionnaire and blood collection. Hepatitis C infection was researched through immunoenzimatic and PCR exams at the Oswaldo Cruz Institute (FIOCRUZ), and by immunochromatographic tests at the Serology Laboratory of the Hospital das Clinicas in Ribeirão Preto USP. The prevalence found was of 8,8% (CI95%: 5,8 11,7). The variables that demonstrated an association in the univariate analysis were submitted to a multivariate procedure through the application of the binomial log model. The independent predictors for hepatitis C infection were male sex, local residence time over thirty years and use of parenteral medication with material sterilized through boiling technique. A possible explanation for the high prevalence in this population lies in the possibility of dissemination of the virus from an older inhabitant who informally exercised medical activities, especially the application of injections in a period before there was use of dischargeable syringes.