Introdução: Pneumonia é uma das complicações mais frequentes após Acidente Vascular Cerebral (AVC), com incidência variando de 2,3% a 47,3%. Nesse estudo, nosso objetivo foi identificar a frequência e os fatores associados com pneumonia após AVC e avaliar o impacto da pneumonia quanto ao óbito intra-hospitalar e quanto aos desfechos dependência funcional e óbito em três meses após o AVC. Métodos: Participaram do estudo pacientes que preencheram os critérios de inclusão (Idade maior que 18 anos de ambos os sexos e diagnóstico médico de AVC isquêmico ou hemorrágico agudo, confirmado por exames de neuroimagem) e nenhum dos critérios de exclusão (Ataque Isquêmico Transitório, Hemorragia Subaracnóidea, Trombose Venosa Cerebral, outros quadros clínicos em que não foi confirmado diagnóstico de AVC, ictus antigo, AVC hemorrágico de causa secundária por malformação arteriovenosa, aneurisma cerebral, neoplasia craniana, distúrbios da coagulação, entre outros; não concordância em participar do estudo ou não assinatura do Termo de Consentimento Livre e Esclarecido). Estes pacientes foram admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e incluídos no Registro de Acidente Vascular Encefálico (REAVER) no período de abril de 2015 a setembro de 2016. Os dados demográficos e clínicos foram coletados de forma prospectiva pelos coordenadores de pesquisa do REAVER. Quando possível, os pacientes foram submetidos à avaliação clínica da deglutição por três fonoaudiólogas. Os prontuários de todos os pacientes foram revisados por um infectologista para confirmar o diagnóstico de pneumonia. Resultados: Foram estudados 478 pacientes com AVC agudo. Considerando a amostra total do estudo, encontramos uma frequência relativa de 24% de pneumonia, 11,5% de óbito intra-hospitalar e 36,8% de dependência funcional ou óbito após três meses do AVC. Dos pacientes com pneumonia, 32,2% foram a óbito intra-hospitalar e 84,3% apresentaram dependência funcional ou óbito após três meses do ictus.Na análise multivariada por regressão logística para preditores de pneumonia após AVC, a gravidade do AVC (p=0,001), AVC hemorrágico (p=0,012) e disfagia (p=0,001) foram preditores independentes para pneumonia. Conclusão: Nosso estudo confirma que a pneumonia é uma complicação frequente após o AVC, sendo associada com gravidade do AVC, AVC hemorrágico e disfagia. Os pacientes com pneumonia apresentaram alta frequência de óbito intra-hospitalar e alta dependência funcional ou óbito após três meses do AVC. / Introduction: Pneumonia is one of the most frequent complications after stroke, with an incidence varying from 2.3% to 47.3%. In this study, our goal was to identify the frequency and factors associated with post-stroke pneumonia and to assess the impact of pneumonia on in-hospital death, functional dependence outcomes and death at three months after stroke. Methods: Were included in the study, patients who met the criteria for participation (over 18 years old for both sexes and medical diagnosis of acute hemorrhagic or ischemic stroke, confirmed by neuroimaging exams) and none of the exclusion criteria (Transient Ischemic Attack, Subarachnoid Hemorrhage, Cerebral Venous Thrombosis, clinical conditions in which a diagnosis of stroke was not confirmed, not acute stroke, hemorrhagic stroke due to arteriovenous malformation, brain aneurysm, brain tumor, coagulation disorders, other diagnosis; non-agreement to participate in the study or non-signing of the Informed Consent Form). These patients were admitted to the University Hospital Emergency Unit of the Medical School of Ribeirão Preto (HCFMRP-USP) and included in the Registry of Stroke (REAVER) from April 2015 to September 2016. Demographic and clinical data were collected prospectively by the REAVER research coordinators. The patients underwent clinical evaluation of swallowing by three speech therapists whenever possible. The medical records of all patients were reviewed by an infectious disease specialist to confirm the diagnosis of pneumonia. Results: A total of 478 patients with acute stroke were included. Considering the total sample of the study, we found a relative frequency of 24% of pneumonia, 11.5% of in-hospital death and 36.8% of functional dependence or death after three months of stroke. Regarding the patients with pneumonia, 32.2% died in the hospital and 84.3% had functional dependence or death after three months of stroke. In the multivariate logistic regression analysis for predictors of poststroke pneumonia, the severity of stroke (p = 0.001), hemorrhagic stroke (p = 0.012), and dysphagia (p = 0.001) were independent predictors for pneumonia. Conclusion: Our study confirms that pneumonia is a common complication afterstroke and is associated with severity of stroke, hemorrhagic stroke and dysphagia. Patients with pneumonia had a higher frequency of in-hospital death and greater functional dependence or death after three months of stroke.

Introdução: As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil e as cirurgias cardíacas são consideradas um procedimento de alta complexidade e apesar de melhorar a sobrevida e qualidade de vida dos indivíduos não está isento de riscos. Umas das principais complicações no pós-operatório é a infecção. Objetivo: identificar os fatores de risco associados à ocorrência de IRAS em pacientes submetidos à cirurgia cardíaca em um hospital, público, geral e de ensino, de Minas Gerais, no período de julho de 2005 a novembro de 2015. Métodos: trata-se de um estudo retrospectivo, de corte transversal, com abordagem quantitativa, que analisou 725 prontuários de pacientes adultos submetidos à cirurgia cardíaca. Ressalta-se que o paciente foi considerado no estudo uma única vez. Para a coleta de dados utilizou-se um instrumento contendo variáveis sociodemográficas, clínicas e referentes ao perioperatório o qual foi validado quanto à forma e conteúdo por cinco especialistas na temática. Os dados foram inseridos em uma planilha eletrônica do programa Excel® versão para Windows XP® validados por dupla entrada (digitação) para verificação de inconsistências e após a correção dos erros, os dados foram exportados para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0 para Windows XP® onde foi construído o banco definitivo e procedeu-se a analise estatística descritiva e analítica Resultados: a população do presente estudo foi constituída por 725 prontuários, houve predominância do sexo feminino, média de idade de 55,8 anos e a taxa global de infecção relacionada à assistência à saúde (IRAS) foi de 26,9%, sendo a infecção do trato respiratório (20,8%) a mais frequente, seguida por infecção do sítio cirúrgico (ISC) (8,1%). Os principais preditores para a ocorrência de IRAS foram doença pulmonar obstrutiva crônica (DPOC), ter apresentado intercorrência no intraoperatório, tempo de intubação > 24 horas, reintubação e hemotransfusão no pós-operatório. A incidência de óbito foi maior entre os pacientes que desenvolveram IRAS (30,3%) quando comparado com os que não tiveram infecção (4,3%). O tempo médio de permanência hospitalar pós-operatória foi maior para os pacientes com IRAS (23,4 dias). Conclusão: O presente estudo permitiu identificar os principais preditores para a ocorrência de IRAS nos pacientes submetidos à cirurgia cardíaca. Medidas direcionadas para a promoção da saúde e para controle de IRAS durante a hospitalização podem contribuir para minimizar esse evento e garantir uma assistência à saúde mais segura / Introduction: Cardiovascular diseases are still the main cause of death in Brazil, and thoracic surgeries are considered a high-complexity procedure, as despite increasing the survival and improving the quality of life of individuals, it is not risk free. Infection is one of the main complications in the post-operative period. Objective: to identify the risk factors associated with the occurrence of healthcare-associated infections (HAI) in patients submitted to thoracic surgery in a public general teaching hospital, in Minas Gerais, from July 2005 to November 2015. Methods: a retrospective, cross section study, using a quantitative approach, was developed to analyze 725 medical records of adult patients submitted to thoracic surgery. It is noteworthy that patients were considered only once in the study. Data were collected using an instrument containing sociodemographic and clinical variables, as well as data on the perioperative period, which was validated as for its face and content by five experts on the theme. The collected data were inserted into an Excel® for Windows XP® spreadsheet and validated by double entry (typing) in order to verify the existence of inconsistencies and, after the correction of errors, the data were exported to the Statistical Package for the Social Sciences (SPSS) version 18.0 for Windows XP®, where the final database was built, proceeding to a descriptive and analytical statistical analysis. Results: the population of the study was made up of 725 medical records, in which there was a predominance of women, with a mean age of 55.8 years and an overall rate of HAI of 26.9%, with respiratory tract infections (20.8%) being the most frequent, followed by surgical site infection (8.1%). The main predictors for the occurrence of HAI were chronic obstructive pulmonary disease, having had a complication in the intraoperative period, length of intubation > 24 hours, reintubation and hemotransfusion in the post-operative period. The incidence of death was higher among patients who developed HAI (30.3%) when compared to those who did not have an infection (4.3%). The mean length of post-operative hospital stay was higher among patients with HAI (23.4 days). Conclusion: The present study allowed to identify the main predictors for the occurrence of HAI in patients submitted to thoracic surgery. Measures targeted at health promotion and HAI control during hospitalization can contribute to minimize this event and guarantee the delivery of safe health care

Breast cancer incidence, particularly late-stage disease, is increasing in U.S. women under 40 years of age, pointing to the importance of exposures acting early in the life course to increase breast cancer risk. Earlier onset of breast development has recently been identified as an independent risk factor for breast cancer. Thus, identifying modifiable factors that can delay the onset of breast development may provide an opportunity for breast cancer primary prevention starting early in life. This dissertation examined the influence of the early-life environment on the age at onset of breast development through: 1) a systematic review of the literature relating maternal pre-pregnancy body size, gestational weight gain (GWG), birth size, and infant growth to the timing of breast development and menarche; 2) analyses assessing the associations between these factors and the onset of breast development in a pubertal cohort enriched for breast cancer family history (BCFH); and 3) a pilot study assessing whether these factors are associated with serum levels of insulin-like growth factor(IGF)-1 and insulin-like growth factor binding protein(IGFBP)-3 during puberty. Our systematic review identified 96 studies, the majority of which examined the association between birthweight and age at menarche. Although low birthweight is often cited as a risk factor for early menarche, the majority of studies (40/73 total) that examined this association did not observe a statistically significant association. Differences in exposure assessment, inadequate control for confounders, and differences in postnatal growth across studies may drive inconsistencies in the birthweight literature. In contrast, higher maternal body mass index (BMI) prior to pregnancy, GWG in excess of recommended guidelines and faster rates of weight gain between birth and 2 years of age were consistently associated with earlier age at breast development and menarche. We used data from the LEGACY Girls Study, a prospective cohort of girls primarily ages 6-13 years at baseline in which approximately 50% of girls had a family history of breast cancer, to examine the relations between maternal factors, birth size and infant growth and the onset of breast development, defined as a maternal report of breast Tanner stage 2 or greater. Daughters of women with a pre-pregnancy BMI of 25 or greater and who gained 30lbs or more during pregnancy experienced breast development at an earlier age than daughters of women with a pre-pregnancy BMI less than 25 and who gained less than 30lbs. This association was similar in girls with and without a BCFH. Birthweight and birthlength were not associated with the timing of breast development. In a subset of LEGACY girls with height and weight data during infancy available from medical records, we examined the associations between changes in weight-for-age and length-for-age Z-scores from birth to 1 year of age and the onset of breast development. We observed a modest association between faster rates of weight gain from 0-12 months and earlier age at breast development. When we examined smaller age intervals within infancy, faster weight gain from 2-4 months and 6-9 months were each associated with an earlier age at breast development. A similar pattern was observed for growth in length, and these associations did not vary by BCFH. In our pilot study including 109 girls with available serum samples between 6-17 years of age at the LEGACY New York site, rapid weight gain from 0-12 months was associated with higher mean levels of IGF-1 relative to IGFBP-3. Although not statistically significant, girls with a maternal pre-pregnancy BMI≥25 and GWG≥30lbs also had higher mean levels of the IGF-1/IGFBP-3 ratio. Since serum IGF-1 and IGFBP-3 are objective measures that are known to increase rapidly during puberty, the results of our pilot study support that the maternal BMI, GWG and rapid infant weight gain are associated with biological changes in the girls. Our findings suggest that measurement error in outcome assessment or confounding did not drive the associations that we observed between these factors and earlier onset of breast development. In conclusion, we identified higher maternal pre-pregnancy BMI, excess GWG and rapid growth during infancy as modifiable factors associated with earlier onset of breast development in girls across the spectrum of familial risk for breast cancer. While this suggests that modifying these factors may decrease breast cancer risk later in life, further research should consider additional and potentially opposing pathways, such as childhood body size, through which the early-life environment affects breast cancer risk.

Stressiga arbetsförhållanden är vardag för sjuksköterskan och samtidigt som kraven blir allt fler förväntas hen ge en god, trygg och säker vård. Syftet med studien är att undersöka vilka faktorer som bidrar till arbetsrelaterad stress hos sjuksköterskan inom hospital vård. Studien är utformad som en litteraturstudie och med hjälp av Fribergs analysmodell har artiklar sökts fram i olika elektroniska databaser. De artiklarna med relevant innehåll har kvalitétsgranskats och sedan analyserats enligt Fribergs analysprocess. Totalt användes nio artiklar där nyckelord identifierats och teman sedan utformats, den information om stressframkallande faktorer som tagits fram strukturerades slutligen upp i fyra teman, rädsla att göra fel, ensamhet, uteblivet stöd, och otillräcklighet. Resultatet visar att en hög andel sjuksköterskor upplever arbetsrelaterad stress på sin arbetsplats, men också att de största orsakerna till detta är rädsla att göra fel, ensamhet, uteblivet stöd och en känsla av att otillräcklighet. Denna stress kan i sin tur leda till brister i patientsäkerheten och möjligheten att bedriva den goda vård som är önskvärd, är ej möjlig. Relaterat till tidsbrist för sjuksköterskan finns risk för moralisk stress, där den vård som ser till patientens bästa ej hinns med. Med denna studie finns därför en förhoppning att informera allmänsjuksköterskor inom hospital vård och organisationen runt omkring om faktorer för arbetsrelaterad stress, för att bidra till ökad förståelse och därmed en hållbar utveckling.

Introdução: A internação em unidade neonatal está intimamente ligada à mortalidade neonatal e compartilham muitas causas e determinantes. Apesar de inúmeros estudos sobre os fatores de risco para mortalidade neonatal, pesquisas sobre os determinantes da internação dos recém-nascidos em unidade neonatal logo após o nascimento são iniciativas recentes. Objetivos: Analisar os fatores determinantes da internação de neonatos nas primeiras 24 horas de vida em uma unidade neonatal da região Oeste do município de São Paulo. Método: Tratou-se de um estudo retrospectivo, do tipo caso-controle não pareado, realizado em uma maternidade municipal. A amostra foi composta por 205 casos e 205 controles, no período de 01 de janeiro de 2016 a 31 de dezembro de 2017. Para verificar a associação entre a variável dependente internação na unidade neonatal nas primeiras 24 horas de vida e as variáveis independentes, foram realizadas análises bivariadas com cálculo de Odds Ratio (OR), com nível de significância de 5%, e intervalo de confiança 95%, por meio de testes qui-quadrado ou testes exatos (teste da razão de verossimilhanças ou teste exato de Fisher). As variáveis com valor de p<0,20 foram analisadas pelo modelo de regressão logística múltipla hierarquizada. No entanto, fizeram parte do modelo final apenas as variáveis com significância estatística. Resultados: as variáveis que permaneceram no modelo final associadas à internação nas primeiras 24 horas de vida em unidade neonatal de uma maternidade da região Oeste do município de São Paulo, por ordem decrescente de associação ao desfecho foram: índice de apgar no 1º <7 (OR=227,56; IC95% 35,49 - 1458,66), idade gestacional < 37 semanas (OR= 31,66; IC95% 7,47-134,121), não ter realizado consulta de pré-natal (OR=21,224; IC95% 1,65 - 271,91), peso ao nascer <2500g (OR=9,88; IC95% 2,01 - 48,57), uso de drogas ilícitas durante a gestação (OR= 5,31; IC95% 1,18 - 23,87), presença de líquido amniótico com mecônio (OR= 2,69; IC95% 1,25 - 7,54), tempo decorrido entre admissão e parto > 24 horas (OR= 2,68; IC95% 1,08 - 6,63),. A variável raça/cor da pele da mãe não branca apresentou-se como um fator protetor, com uma chance de internação de recém-nascidos nas primeiras 24 horas de vida em unidade neonatal 69% menor que os recém-nascidos de mães brancas.(OR=0,314; IC95% 0,157 -0,627; p=0,001).Conclusão: Comportamentos maternos de risco e problemas no acompanhamento pré-natal, e de assistência ao trabalho de parto e parto podem desencadear situações que aumentam a demanda por internação em unidade neonatal nas primeiras 24 horas de vida. Os achados deste estudo corroboram a importância de se investigar fatores associados à internação em unidade neonatal logo após o nascimento, pois possibilita identificar grupos expostos a diferentes conjuntos de fatores e detectar distintas necessidades de saúde, fornecendo subsídios para ações direcionadas aos recém-nascidos graves ou potencialmente graves, e a consequente redução dos óbitos neonatais. / Introduction: Neonatal unit hospitalization is closely linked to neonatal mortality and shares many causes and determinants. Despite numerous studies on risk factors for neonatal mortality, researches on the determinants in neonatal hospital admission to the neonatal unit right after birth are recent. Studying those aspects makes it possible to identify groups exposed to different sets of circumstances and to detect different health needs, providing resources for actions directed towards the serious or potentially serious ill newborns, and therefore reducing neonatal deaths. Objectives: To assess the determinants of neonatal hospitalization in the first 24 hours of life in a neonatal unit in the Western region of the city of São Paulo. Method: This was a retrospective, unpaired case-control study carried out in a municipal maternity hospital in the western region of the city of São Paulo (SP). The sample consisted of 205 cases and 205 controls. The criteria to be considered as a case was to be born alive by hospital delivery and admitted in a Neonatal Unit (Neonatal ICU or Regular Neonatal Intermediate Care Unit) during the first 24 hours of life, from January 1, 2016 to December 31, 2017. The controls are the babies that were born alive in the same period of cases and who were referred together with their mothers to the joint maternal accommodation unit. Twin neonates, anencephalic, home-delivered babies who were later admitted in the hospital, and newborns whose medical records were in external file, being unavailable for analysis. In order to assess the association between the dependent variable \"hospitalization in the neonatal unit in the first 24 hours of life\" and the independent variables, bivariate analyzes were performed as Odds Ratio (OR), with significance level of 5%, and a confidence interval of 95%, by Chi-square tests or exact tests (likelihood ratio test or Fisher\'s exact test). The variables that presented a p value <0.20 were analyzed by the hierarchical multiple logistic regression model. However, only the statistically significant variables were part of the final model. Results: Independently of the other characteristics evaluated, the variables that remained in the final model associated to the hospitalization in the first 24 hours of life in a neonatal unit of a maternity hospital in the western region of the city of São Paulo, in decreasing order of association to the outcome were: first minute Apgar Score < 7 (OR=227,56; IC95% 35,49 - 1458,66), gestational age <37 weeks (OR= 31,66; IC95% 7,47-134,121), absence of a prenatal visit appointment (OR=21,224; IC95% 1,65 - 271,91), birth weight <2500g (OR=9,88; IC95% 2,01 - 48,57), use of illicit drugs during the pregnancy (OR= 5,31; IC95% 1,18 - 23,87), presence of amniotic fluid with meconium(OR= 2,69; IC95% 1,25 - 7,54), time elapsed between admission and delivery > 24 hours (OR= 2,68; IC95% 1,08 - 6,63). The race / color variable of the non-white mother presented as a protective factor, with a chance of hospitalization of newborns in the first 24 hours of life in a neonatal unit 69% lower than the newborns of white mothers. Conclusion: Maternal risk behaviors and problems in prenatal care, assistance to labor and delivery may trigger situations that increase the demand for hospitalization in neonatal unit in the first 24 hours of life. The findings of this study corroborate the importance of investigating factors associated with hospitalization in a neonatal unit shortly after birth, as it allows the identification of groups exposed to different sets of factors and the detection of different health needs, providing resources for actions aiming the serious ill newborns or potentially seriously ill newborns, and consequent reduction of neonatal deaths.

Background: Black South African women are known to have a high usage rate of injectable contraceptives. Breast cancer is the second leading cancer after malignant cervical neoplasms in black South African women. There is evidence that sex hormones are associated with an increased risk of developing breast cancer. In the Western Cape, investigators suggested that injectable contraceptives, more specifically DMPA, may increase breast cancer risk. In another study conducted in the same province, a weak association between breast cancer and women taking combined oestrogen/progesterone oral contraceptives was found, though no risk associated with injectable progestogen contraceptives (DMPA) was confirmed. Study Objective: This study aimed to determine whether there is an association between hormonal contraceptive use and an increased risk of cancer of the breast. Methods: Data was obtained from an ongoing case control study set up by MRC/Wits/NHLS Cancer Epidemiology Research Group (CERG) in 1995 to investigate risk factors associated with cancer among the black population in Johannesburg. Data was processed using STATA, version8 and analysed using univariate, bivariate and multivariate unmatched logistic regression models. Results: There was evidence that an overall use of oral contraceptives increases the risk of breast cancer; cases (n= 221), controls :( n= 153), OR=2.01 (95% CI:1.45, 2.80), p<0.0001. There was evidence of an association between use of injectable contraception and the risk of breast cancer; cases (n=244), controls (n=202), OR=1.51(CI: 1.14, 2.01),p=0.004 Surprisingly, no other use characteristic of either hormonal contraceptive method was statistically significantly associated with the risk of breast cancer in our dataset. The combined use of both oral and injectable contraception was associated with an increased risk of breast cancer, OR=1.68(1.21, 2.33), p =0.002. There was a strong effect modification (interaction) between oral contraceptive use and injectable progesterone associated with the risk of breast cancer, (p=0.008). Conclusion: After adjusting for all potential risk and confounding factors, as collected in the dataset, there was evidence of an association between combined oral contraceptive use and breast cancer. An association between cancer of the breast and overall use of injectable progesterone use was also established. There was evidence of association between the use of both hormonal contraceptive methods and an increased risk of breast cancer. However, whether these findings reflect the reality in terms of causal relationship or are the result of bias must be ascertained.

Introdução: No Brasil há uma carência de estudos sobre a prevalência e incidência da Paralisia Cerebral (PC), sendo que as taxas são de extrema importância para a orientação das políticas de saúde operacionais e no auxílio da alocação de recursos adequados. Devido à escassez de pesquisa em âmbito nacional e à importância de se conhecer mais profundamente a relação entre ocorrências pré e perinatais e a incidência da PC, fica clara a necessidade de um estudo que possibilite a identificação dos fatores de risco presentes nestes períodos, permitindo a criação de estratégias melhores planejadas para as políticas de saúde que tornem o cuidado com o recém-nascido mais rápido e eficaz. Objetivo: Realizar um estudo retrospectivo dos fatores de risco para PC no período de 5 anos (2010 - 2014) no município de Ribeirão Preto - SP, com os objetivos específicos de: identificar a porcentagem de crianças nascidas no município e que foram identificadas como apresentando risco de atraso de desenvolvimento e, dentre estas, as que foram diagnosticadas com PC; identificar os fatores de riscos mais prevalentes no município; verificar a associação dos fatores de risco com o diagnóstico de PC. Método: Estudo epidemiológico descritivo, de levantamento retrospectivo de prontuários de um ambulatório de saúde especializado. A coleta de dados foi realizada em três etapas buscando identificar os nascidos vivos, os bebês de risco e verificar os prontuários. Através de uma amostra de conveniência, foram coletados os fatores de risco materno, gestacional e do parto, onde o desfecho final observado era o diagnóstico de PC. Resultados: Foram realizadas a análise descritiva e testes de associação. Dos nascidos vivos no período, 23,3% das crianças nascidas no SUS foram consideradas com risco de atraso desenvolvimento, sendo a maioria do sexo feminino, residente no distrito oeste do município. Em 76,92% dos prontuários não continha a informação da saúde prévia da mãe, 13% das mães fumaram na gestação e a maioria não planejou a gravidez. Quando analisadas as intercorrências na gestação e no parto foi identificada maior frequência de uma única intercorrência. Cerca de 65% das crianças apresentavam relatos de indícios de alterações neurológicas, 73,4% tiveram alta por abandono e em nenhum prontuário foi encontrado o diagnóstico de PC. Conclusão: Verificamos os riscos mais frequentes e o perfil das características pré-natais e perinatais, no entanto, devido ao alto número de altas porabandono neste serviço de saúde analisado, não foi possível verificar o desfecho do acompanhamento, bem como saber se a criança evoluiu para o diagnóstico de PC. Estas ausências de dados comprometeram as análises de associação e a estimativa da prevalência de PC. Sugere-se uma adequação na detecção de riscos com avaliações padronizadas, com a criação de um check list, além de um sistema de informação que seja capaz de criar um banco de dados de registros para acompanhamento já que através destes dados futuras estratégias de prevenção podem ser melhor definidas. / Introduction: In Brazil, there is a lack of studies on the prevalence and incidence of Cerebral Palsy (CP), with rates being extremely important for the orientation of operational health policies and for the allocation of adequate resources. Due to the lack of research at the national level and the importance of a deeper understanding of the relationship between pre and perinatal events and the incidence of CP, it is clear that a study is needed to identify the risk factors present in these periods, strategies for health policies that make newborn care faster and more effective. Objective: To carry out a retrospective study of the risk factors for CP in the period of 5 years (2010 - 2014) in the city of Ribeirão Preto, SP, with the specific objectives of: identifying the percentage of children born in the municipality and identified as presenting a risk of developmental delay and, among these, those diagnosed with CP; identify the most prevalent risk factors in the municipality; to verify the association of risk factors with the diagnosis of CP. Method: Descriptive epidemiological study, from a retrospective survey of medical records of a specialized health clinic. Data collection was performed in three stages to identify the live births, the at-risk babies and to verify the medical records. Through a convenience sample, the maternal, gestational and labor risk factors were collected, where the outcome observed was the diagnosis of PC. Results: Descriptive analysis and association tests were performed. 23.3% of the children were considered at risk of development, the majority being female, living in the western district of the municipality. In 76.92% of the medical records did not contain the information of the previous health of the mother, 13% of the mothers smoked in the gestation and the majority did not plan the pregnancy. When the intercurrences during pregnancy and delivery were analysed, a greater frequency of a single intercurrence was identified. About 65% of the children had reports of neurological changes, 73.4% were discharged from the hospital, and in none of the files was the diagnosis of PC. Conclusion: We verified the most frequent risks and the profile of prenatal and perinatal characteristics, however, due to the high number of discharges, it was not possible to verify the follow-up outcome, as well as whether the child evolved to the diagnosis of CP. These data absences compromised the association analysis and the estimation of PC prevalence. It is suggested an adequacy in the detection of risks withstandardized assessments, with the creation of a check list, as well as an information system that can create a database of records for follow-up since, through this data, future prevention strategies can be better defined.

Studien undersökte hur de tre demografiska variablerna kön, ålder och civilstatus samt de fem grundläggande personlighetsdimensionerna extraversion, vänlighet, samvetsgrannhet, neuroticism och öppenhet  relaterar till spel om pengar samt att börja spela i tidig ålder. Detta gjordes utifrån fem frågeställningar. 163 personer besvarade en enkät. Materialet undersöktes genom att utföra Pearson korrelationskofficienter samt t-test. Slutsatserna som drogs i studien var att män spelar mer samt börjar spela tidigare än kvinnor. Personligheten har ej någon påverkan på spel om pengar. Däremot fungerar samvetsgrannhet som en skyddsfaktor mot att börja spela om pengar i tidig ålder. Det noterades även att spel om pengar i tidig ålder är en riskfaktor för att utveckla ett problematiskt spelande. Studien påvisade en skillnad i personlighetsdimensionerna, där kvinnor har högre grad av neuroticism än män.  Slutligen noterades det att 7% av respondenterna i studien har ett problematiska spelande, vilket är i linje med tidigare forskning.

INTRODUCTION. Les troubles neurocognitifs sévères ou démences sont notamment définis par la CIM-10 et le DSM-5. Ils englobent un cadre nosographique large : démence d’Alzheimer, démence vasculaire, démence à corps de Lewy, dégénérescence lobaire fronto-temporale, etc. Chaque type de démence possède des critères diagnostiques propres et des facteurs de risque partiellement identifiés. Identifier les troubles cognitifs dans les grandes bases de données est une question complexe, qui doit tenir compte de l’évolution des connaissances. Notre premier objectif était de décrire l’évolution des codages de démences dans la base nationale du Programme de Médicalisation des Systèmes d’Information (PMSI) de court séjour, au fil de l’évolution des critères diagnostiques. Notre deuxième objectif était d’énumérer les principaux facteurs associés connus de maladie d’Alzheimer. Notre troisième objectif était de déterminer les facteurs associés à l’apparition d’une maladie d’Alzheimer dans la base nationale du PMSI de court séjour.METHODES. Pour le premier travail, nous avons utilisé les diagnostics principaux sur le site ScanSanté pour le PMSI de court séjour de 2007 à 2017. Pour le deuxième travail, nous avons effectué une synthèse des revues de littérature et méta-analyses en utilisant les moteurs de recherche PubMed et LiSSa. Pour le troisième travail, nous avons réalisé une étude analytique par fouille de données dans la base nationale du PMSI de court séjour chez les patients âgés de 55 ans ou plus en 2014 : nous avons sélectionné 137 variables explicatives potentielles en 2008 ; la variable à expliquer était la maladie ou démence d’Alzheimer en 2014.RESULTATS. Notre premier travail sur l’identification des démences met en évidence une diminution des séjours hospitaliers avec pour diagnostic principal une maladie ou démence d’Alzheimer, avec un glissement vers d’autres troubles mentaux organiques ; une stabilité des séjours hospitaliers avec pour diagnostic principal une démence vasculaire mais avec une modification des sous-diagnostics (diminution des diagnostics principaux d’infarctus multiples et augmentation de tous les autres sous-types) ; une augmentation importante des séjours hospitaliers avec pour diagnostic principal une démence ou autre trouble cognitif persistant ou tardif liés à la consommation d’alcool ; une évolution homogène sur l’ensemble du territoire français. Ces résultats sont en faveur d’un codage respectueux des évolutions de la littérature. Nos deux travaux suivants sur l’identification des populations à risque permettent d’identifier plusieurs facteurs associés à la maladie ou démence d’Alzheimer, notamment l’âge, le sexe féminin, le diabète de type 2, la dépression, la dénutrition, les troubles bipolaires, psychotiques et anxieux, le faible niveau de scolarité, l’excès d’alcool, l’épilepsie, les chutes après 75 ans et l’hypertension intracrânienne. Ces facteurs associés peuvent être des facteurs de risque, des symptômes précoces, révélateurs ou précipitants.CONCLUSION. Identifier les troubles cognitifs dans les grandes bases de données implique de bien comprendre l’évolution des codages de démence, qui semble respecter l’évolution des connaissances. L’identification des patients ayant des facteurs associés aux démences permet un repérage précoce plus ciblé, puis une bonne identification du diagnostic étiologique nécessaire à une prise en charge adaptée. / INTRODUCTION. Severe neurocognitive disorders or dementias are defined by ICD-10 and DSM-5. They encompass a broad nosographic framework: Alzheimer's dementia, vascular dementia, Lewy body dementia, frontal-temporal lobar degeneration, etc. Each type of dementia has its own diagnostic criteria and partially identified risk factors. Identifying cognitive disorders in large databases is a complex issue, which must take into account changes in knowledge. Our first objective was to describe the evolution of dementia coding in the national database of the Medicalization of Information Systems Program (PMSI) for short stays, as diagnostic criteria evolved. Our second objective was to summarize the main known associated factors of Alzheimer's disease. Our third objective was to determine the factors associated with the onset of Alzheimer's disease in the national database of the short stay PMSI.METHODS. For the first work, we used the main diagnoses on the ScanSanté site for the short stay PMSI from 2007 to 2017. For the second work, we synthesized the literature reviews and meta-analyses using the PubMed and LiSSa search engines. For the third work, we conducted an analytical study by data mining in the national database of the short stay PMSI for patients aged 55 years or older in 2014: we selected 137 potential explanatory variables in 2008; the dependant variable was Alzheimer's disease or dementia in 2014.RESULTS. Our first work on the identification of dementias shows a decrease in inpatient stays with a main diagnosis of Alzheimer's disease or dementia, with a shift towards other organic mental disorders; stability of inpatint stays with a main diagnosis of vascular dementia but with a modification of under-diagnosis (decrease in main diagnoses of multiple heart attacks and increase in all other subtypes); a significant increase in inpatient stays with a main diagnosis of dementia or other persistent or late cognitive disorders related to alcohol consumption; a homogeneous evolution throughout the French territory. These results support a coding that respects the evolution of the literature. Our next two studies on the identification of at-risk populations identify several factors associated with Alzheimer's disease or dementia, including age, gender, diabetes mellitus, depression, undernutrition, bipolar, psychotic and anxiety disorders, low education, excess alcohol, epilepsy, falls after age 75 and intracranial hypertension. These associated factors may be risk factors, early, revealing or precipitating symptoms.CONCLUSION. Identifying cognitive disorders in large databases requires a good understanding of the evolution of dementia coding, which seems to respect the evolution of knowledge. The identification of patients with factors associated with dementia allows a more focused early identification and then proper identification of the etiological diagnosis necessary for appropriate management.

Orientador: Luís Antônio Francisco de Souza / Banca: André Rosemberg / Banca: Alessandra Teixeira / Banca: Paulo Eduardo Teixeira / Banca: Rivail Carvalho Rolim / Resumo: A presente investigação parte de levantamento institucional de 2007, realizado entre Policiais Militares do Estado do São Paulo, que aponta sobrepeso e obesidade com elevados Índices de Massa Corporal (IMC) no efetivo. O intento é investigar os impactos das experiências laborais cotidianas, acionadas na subjetivação das expectativas, dos riscos e interações na prática profissional, sobre a saúde e condução do corpo do policial militar. Submetidos às normas que asseguram a produtividade para o uso da força e para o controle da ordem social, os policiais na prática profissional têm seu IMC aumentado, adoecem e contrariam as normatividades presentes no gerenciamento institucional e nos discursos sociais. Diferentes abordagens metodológicas de viés qualitativo operacionalizadas pelo conceito de biopolítica de Michel Foucault permitiram entender os fatores de adoecimento e a dinâmica do aumento de peso entre policiais, as relações de poder voltadas para o controle dessas anormalidades, e seus perigos para a instituição, em busca de uma vida saudável. A observação proposta tem como base empírica um Batalhão de Polícia Militar do Interior do estado de São Paulo, que mensurou incidências de obesidade entre seus policiais, e desenvolveu uma ação de enfrentamento da doença a partir do ano de 2011, com o "Programa de Redução de Peso e Melhoria de Qualidade de Vida da PM". / Abstract: This investigation comes from an institutional survey made in 2007, performed between Military Police from the State of São Paulo which points overweight and obesity with high body mass index (BMI) in the effective. The intent is to investigate the impacts of the daily work experience, triggered in the subjectivity of expectations, risks and interactions in the professional practice about health and conduction of the military police body. Submitted to the rules that ensure the productivity for the use of strength and to the control of social order, the policemen have their BMI increased in professional practice, get sick and contradict the normativities present in the institutional management and social speeches. Different methodological approaches of qualitative bias operationalized by the biopolitcs concept of Michel Foucault will allow us to understand the disease factors and the dynamic of the increase of weight among policemen, the power relations focused on the control of these abnormalities, and its dangers to the institution, in search for a healthy life. The observation proposed has as an empirical basis the Military Police Battalion from the country - state São Paulo, that measured incidences of obesity among their policemen, and develops an action of facing the disease since 2011 with a program of "Weight Reduction & Improvement of Quality of Life" for the Military Police. / Doutor