Introdução: A fisiopatologia da Doença do Refluxo Gastroesofágico (DRGE) é multifatorial, sendo a motilidade esofágica um dos fatores implicados na sua gênese. Todavia, ainda não há consenso sobre a existência de associação entre dismotilidade e Hérnia Hiatal (HH) em pacientes com DRGE. Esse estudo tem como objetivo estabelecer a prevalência de Dismotilidade Esofágica (DE) em pacientes com HH e avaliar se a herniação é fator relacionado à DE. Métodos: Foram estudados 356 pacientes com diagnóstico clínico de DRGE submetidos à Endoscopia Digestiva Alta e Manometria Esofágica. Hérnia Hiatal foi definida endoscopicamente por uma distância igual ou maior que 2 cm entre o pinçamento diafragmático e a junção escamo-colunar e Dismotilidade Esofágica quando a ME identificou amplitude das ondas peristálticas no esôfago distal < 30 mmHg e/ou menos de 80% de contrações efetivas. Foi feita a divisão dos pacientes para a análise estatística em 2 grupos, com e sem HH. Resultados: Pacientes com DRGE portadores de HH tiveram prevalência de DE igual a 14,8% e os sem HH, prevalência de 7,7% (p = 0,041). O grupo de pacientes com HH apresentou também maior frequência de esofagite erosiva (47,5% contra 24,2%, p <0,001), menor valor de pressão no EEI (10,4 versus 13,10; p < 0,001) e maior frequência de indivíduos com valores de pH-metria anormais (p < 0,001). A razão bruta de prevalências de DE, segundo a presença de HH, foi 1,92 (IC: 1,04 - 3,53; p = 0,037), porém essa associação não persistiu quando controlada por idade, esofagite, pH-metria alterada e EEI alterado (RP ajustada: 1,69; IC: 0,68 – 4,15; p = 0,257). Conclusão: Apesar da prevalência de DE no grupo HH ter sido maior do que no grupo sem HH, a associação entre HH e DE em indivíduos com DRGE desaparece ao se controlar por co-variáveis relevantes, levando a crer que neste tipo de paciente, HH não é fator de risco independente destas variáveis. / Introduction: The pathophysiology of gastroesophageal reflux disease is multifactorial, where esophageal motility is one of the factors implicated in its genesis. However, there is still no consensus on the existence of an association between esophageal dysmotility and hiatal hernia in patients with gastroesophageal reflux disease. The objective of this study was to establish the prevalence of esophageal dysmotility in patients with hiatal herina and to determine if herniation is a factor related to esophageal dysmotility. Methods: The study included 356 patients with a clinical diagnosis of gastroesophageal reflux disease submitted to upper digestive endoscopy and esophageal functional dagnostics. Hiatal Hernia was defined endoscopically by a distance equal to or greater than 2 cm between the diaphragmatic constriction and the squamo-columnar junction and esophageal dysmoyility when the esophageal manometry identified the amplitude of the peristaltic waves in the distal esophagus are < 30 mmHg and/or less than 80% of effective contractions. For statistical analysis, the patients were divided into 2 grups: with and without HH. Results: Gastroesophageal reflux disease patients with hiatal hernia had a prevalence of esophageal dysmotility equal to 14.8% and those without hiatal hernia, a prevalence of 7.7% (p = 0.041). The group of patients with hiatal hernia also showed a greater frequency of erosive esophagitis (47.5% versus 24.2%, p <0.001), lower low esophageal sphincter pressure (10.4 versus 13.10; p < 0.001) and greater frequency of individuals with abnormal pH-metry values (p < 0.001). The crude prevalence ratios for esophageal dysmotility, according to the presence of hiatal hernia, was 1.92 (CI: 1.04 - 3.53; p = 0.037), but this association did not persist when controlled for age, esophagitis, altered pH-metry and altered low esophageal sphincter (adjusted PR: 1.69; CI: 0.68 – 4.15; p = 0.257). Conclusion: Despite the prevalence of esophageal dysmotility in the hiatal hernia group being higher than that in the group without hiatal hernia, the association between hiatal hernia and esophageal dysmotility in individuals with gastroesophageal reflux disease disappeared on controlling for relevant co-variables, leading us to believe that in this type of patient, hiatal hernia is not a risk factor independent of these variables.

Este estudo visou a investigar fatores de risco e de proteção em crianças e adolescentes em situação de vulnerabilidade social e pessoal. Participantes que vivem com suas famílias e vão à escola e que foram definidos a priori como membros da amostra, devido à situação de pobreza, foram comparadas àqueles que vivem em abrigos. Como fatores de risco foram avaliados eventos estressores, afeto negativo e depressão. Como fatores de proteção foram avaliados satisfação de vida e afeto positivo. 297 participantes, de sete a 16 anos, de ambos os sexos foram distribuídos em dois grupos: G1, 142 crianças que vivem com sua família e G2, 155 que moram em instituições. Foram submetidos à entrevista estruturada, e a inventários de eventos estressores na infância e na adolescência, e de depressão infantil, e escalas de afeto positivo e negativo e multidimensional de satisfação de vida. Os resultados confirmaram que em relação aos contextos de desenvolvimento, as crianças institucionalizadas (p<0,001) têm mais eventos estressores, afeto negativo e depressão, e isso as coloca em uma situação de maior vulnerabilidade. No entanto, as crianças institucionalizadas não diferenciam das crianças que vivem com a família no nível de satisfação de vida e de afeto positivo (p>0,05). Entre os sexos, apenas no afeto negativo, as meninas apresentaram escores mais altos que os meninos (p<0,05). Não há diferenças entre os sexos em diversos aspectos investigados, entre eles: afeto positivo, depressão, satisfação de vida e no número de eventos estressores vividos (p>0,05). Os dados deste estudo revelaram ainda que o afeto negativo, o afeto positivo, a freqüência de eventos estressores e o índice de depressão se mostraram preditores para a satisfação de vida. Apesar das adversidades vividas foi possível identificar processos de resiliência, porque se verificaram atitudes de enfrentamento e tentativas de superação das situações adversas. / This study aimed to investigate risk and protective factors in the lives of at risk children and adolescents. Poverty was considered as an a priori inclusive condition for the participants, and those who lived with their families and attended school (G1, n= 142) were compared to those who lived in shelters (G2, n= 155). As risk factors were appraised stressing events, negative affect, and depression. As protective factors were appraised life satisfaction and positive affect. 297 participants, from seven to 16 years, of both sexes were submitted to a structured interview, and to inventories and scales to assess the mentoned factors. Sheltered children (G2; p <0,001) informed more stressing events, higher negative affect and depression than G1, which reported that they are at a situation of vulnerability. However, the institutionalized children do not differentiate when assessed the level of life satisfaction and of positive affect (p >0,05). Girls presented higher scores of negative affect than boys (p <0,05). There were no differences between gender in positive affect, depression, life satisfaction, and in the frequency of stressing events (p >0,05). The data of this study revealed although that the levels of negative and positive affect, the frequency of stressing events, and the scores of depression may be considered as preditors for the life satisfaction. In spite of the lived adversities it was possible to identify resilience processes.

Os tumores na região de cabeça e pescoço são frequentes ao redor do mundo, estando relacionados a altas taxas de morbidade e mortalidade. Recentemente, alguns estudos propuseram a associação entre doença periodontal, risco de câncer e piora na qualidade de vida de pacientes oncológicos. O objetivo deste estudo é investigar a possível associação clínica entre doença periodontal e neoplasias de cabeça e pescoço antes e após seu tratamento. Para isso, foram incluídos no grupo teste 40 pacientes de ambos os sexos, &#x2265;18 anos e com diagnóstico de câncer de cabeça e pescoço. Estes pacientes foram subdivididos em dois subgrupos: antes (T1; n=20) e após (T2; n=20) o tratamento quimio e/ou radioterápico. O grupo controle foi formado por 40 pacientes sistemicamente saudáveis selecionados aleatoriamente, sem diferenças significativas entre os grupos em relação à idade e sexo. Os pacientes responderam a um questionário de qualidade de vida relacionada à saúde oral (OHIP-14) e foram examinados periodontalmente em boca toda quanto às medidas de profundidade de sondagem (PS), recessão (REC)/hiperplasia (HP), nível de inserção clínica (NIC), índice de sangramento gengival (ISG) e índice de placa (IPl) e número de dentes perdidos. O nível ósseo proximal foi determinado a partir de imagens radiográficas pela distância entre junção cemento-esmalte e crista óssea alveolar (JCE-CA). O desfecho primário foi definido pelo diagnóstico de câncer pela equipe médica responsável, enquanto que a medida de exposição foi a doença periodontal. Houve maior número de dentes perdidos (p= 0.0017; ANOVA pós-teste Tukey) e maior quantidade de placa (p= 0.0003; Kruskal Wallis pós-teste Dunn) no grupo T2 comparativamente ao controle, porém sem diferenças em relação ao grupo T1. Não houve diferença entre os grupos (p> 0.05) quanto ao ISG, PS, REC/HP, NIC e prevalência de doença periodontal. A distância JCE-CA (p= 0.007; teste exato de Fischer) e a extensão da doença periodontal em &#x2265; 50% dos sítios (p= 0.0033; teste exato de Fischer) foram significativamente maiores no grupo teste. Foi observada associação entre câncer na região de cabeça e pescoço, presença de doença periodontal em &#x2265; 50% dos sítios (OR= 5,12; 95% CI: 1,76 14,91) e distância JCE-CA &#x2265; 4 mm (OR= 2.91; 95% CI: 1.14 7.39). Não houve associação entre câncer na região de cabeça e pescoço e exposição prévia ao fumo (p= 0.81; teste exato de Fischer) e etilismo (p= 0.15; teste exato de Fischer). Na análise da qualidade de vida relacionada à saúde oral, o grupo teste apresentou maior impacto do que o controle nas dimensões limitação funcional (p< 0.0001; Mann Whitney), dor física (p= 0.02; Mann Whitney), incapacidade social (p= 0.01; Mann Whitney), desvantagem social (p= 0.03; Mann Whitney) e na somatória das pontuações (p= 0.0092; Mann Whitney). Houve diferenças significantes entre os grupos T1 e T2 apenas no domínio limitação funcional (p= 0.0058; Kruskal Wallis pós-teste Dunn). Estes resultados sugerem que a extensão da doença periodontal em &#x2265; 50% dos sítios e a perda óssea interproximal média, determinada por meio da distância JCE-CA, &#x2265;4 mm estão associadas ao câncer na região de cabeça e pescoço. / Malignant tumors in the head and neck region are frequently observed all around the world, and are related to high morbidity and mortality rates. Recently, some studies have proposed an association among periodontal disease, risk of cancer and worsening of quality of life of oncologic patients. The aim of this study is to investigate the possible clinical association between periodontal disease and neoplastic lesions in head and neck before and after its treatment. It was included in the test group 40 patients, both genders, &#x2265;18 years old, diagnosed with cancer in the head and neck region. Patients were divided into two subgroups: before (T1; n= 20) and after (T2; n= 20) oncologic treatment. Control group was constituted by 40 systemically healthy patients randomly selected, with no significant differences in age and gender when compared with test group. All patients answered a quality of life questionnaire (OHIP-14) and were periodontally full-mouth examined according to probing depth (PD), recession (REC)/hyperplasia (HP), clinical attachment level (CAL), gingival bleeding index (GBI) and plaque index (PlI) and number of lost teeth. Interproximal bone level was determined from X-ray images as the distance between cementum-enamel junction and alveolar crest (CEJ-AC). Primary outcome was defined by the diagnosis of cancer in the head and neck region by medical staff, and the measure of exposure was periodontal disease. A higher number of missing teeth (p= 0.0017; ANOVA post hoc Tukey) and plaque accumulation (p= 0.0003; Kruskal Wallis post hoc Dunn) was observed at T2 compared to control, but with no differences when compared to T1. No differences between groups (p> 0.05) were found in GBI, PD, REC/HP, CAL and prevalence of periodontal disease. CEJ-AC (p= 0.007; Fischers exact test) and extension of periodontal disease in &#x2265; 50% of sites (p= 0.0033; Fischers exact test) were significantly higher in test than control group. It was observed a significant association between head and neck cancer, presence of periodontal disease in &#x2265; 50% sites (OR= 5,12; 95% CI: 1,76 14,91) and CEJ-AC distance &#x2265; 4 mm (OR= 2.91; 95% CI: 1.14 7.39). There was no association between head and neck cancer and previous exposition to smoking (p= 0.81; Fischers exact test) and alcohol consumption (p= 0.15; Fischers exact test). In the analysis of quality of life related to oral health, test group showed more impact than controls in the domains functional limitation (p< 0.0001; Mann Whitney), physical pain (p= 0.02; Mann Whitney), social disability (p= 0.01; Mann Whitney), handicap (p= 0.03; Mann Whitney) and total score (p= 0.0092; Mann Whitney). Significant differences between T1 and T2 groups were found only at functional limitation domain (p= 0.0058; Kruskal Wallis pós-teste Dunn). These results suggest that extension of periodontal disease in &#x2265; 50% sites and mean interproximal bone loss, determined by the distance CEJ-AC, &#x2265;4 mm are associated to head and neck cancer.

Introdução: As doenças cardiovasculares são a principal causa de morte no Brasil e no mundo e apresentam importante contribuição para a carga global de doenças. A dieta tem sido considerada um dos determinantes primários do estado de saúde dos indivíduos, atuando na modulação dos fatores de risco metabólicos para doença cardiovascular. Objetivos: Desenvolver um modelo conceitual para a relação entre fatores de risco metabólicos e investigar sua associação com padrões de dieta de adultos e idosos residentes no município de São Paulo. Métodos: Estudo transversal de base populacional com amostra probabilística de adultos e idosos, residentes em área urbana do município de São Paulo, que participaram do Inquérito de Saúde do Município de São Paulo, realizado em duas fases entre os anos de 2008 e 2011 (estudo ISA Capital 2008). Na primeira fase do estudo, 1.102 adultos e idosos, de ambos os sexos, foram entrevistados no domicílio, por meio da aplicação de questionário estruturado e do recordatório alimentar de 24 horas. Na segunda fase, 642 indivíduos adultos e idosos foram reavaliados quanto ao consumo alimentar por meio da aplicação, por telefone, do segundo recordatório alimentar, e, destes, 592 participaram da coleta domiciliar de amostras de sangue venoso, da medição antropométrica e da aferição da pressão arterial por técnico de enfermagem. Os alimentos relatados em ambos os recordatórios foram agrupados segundo a similaridade do valor nutricional e hábitos alimentares da população, e corrigidos pela variância intrapessoal da ingestão por procedimentos estatísticos da plataforma online Multiple Source Method. Os grupos de alimentos foram analisados por meio de análise fatorial exploratória e confirmatória (manuscrito 1) e por modelos de equações estruturais exploratórios (manuscrito 3), a fim de obter os padrões de dieta. O modelo conceitual da relação entre os fatores de risco metabólicos (leptina sérica, proteína C-reativa de alta sensibilidade sérica, pressão arterial sistólica e diastólica, razão colesterol total/lipoproteína de alta densidade, razão triacilglicerol/lipoproteína de alta densidade, glicemia de jejum plasmática, circunferência da cintura e peso corporal) foi obtido por modelos de equações estruturais estratificados por sexo (manuscrito 2). Por fim, a associação dos padrões de dieta com o modelo conceitual proposto (manuscrito 3) foi investigada por modelos de equações estruturais exploratórios. Índices de qualidade de ajuste foram estimados para avaliar a adequação de todos os modelos. As análises foram realizadas no programa Mplus versão 6.12. Resultados: No manuscrito 1, a análise fatorial exploratória revelou a existência de dois padrões de dieta, os quais apresentaram boa qualidade de ajuste na análise fatorial confirmatória quando aplicados os pontos de corte de cargas fatoriais |0,25| na rotação oblíqua Promax. No manuscrito 2, a relação entre os fatores de risco metabólicos foi diferente entre os sexos. Nas mulheres, a leptina sérica apresentou efeitos indiretos e positivos, mediados pelo peso corporal e pela circunferência da cintura, em todos os fatores de risco avaliados. Já nos homens, a leptina sérica apresentou efeitos diretos e positivos sobre a proteína C-reativa de alta sensibilidade e efeitos indiretos e positivos (mediados pelo peso corporal e pela circunferência da cintura) sobre a razão triacilglicerol/lipoproteína de alta densidade, colesterol total/lipoproteína de alta densidade e glicemia de jejum plasmática. No manuscrito 3, foram obtidos três padrões de dieta, dos quais o Tradicional apresentou relação direta e negativa com a leptina sérica e relação indireta e negativa com o peso corporal e a circunferência da cintura, bem como com os demais fatores de risco metabólicos. Já o padrão Prudente apresentou relação direta e negativa com a pressão arterial sistólica, enquanto o padrão Moderno não se associou aos fatores de risco metabólicos investigados. Conclusão: Diferenças nos padrões de dieta de acordo com o tipo de rotação fatorial empregada foram observadas. A relação entre os fatores de risco metabólicos para doença cardiovascular foi distinta entre homens e mulheres, sendo a leptina um dos possíveis hormônios envolvidos. Os padrões de dieta Tradicional e Prudente associaram-se inversamente com os fatores de risco metabólicos, desempenhando uma importante estratégia de prevenção e controle às doenças cardiovasculares no país. / Introduction: The cardiovascular diseases are the main causes of death in Brazil and worldwide, presenting an important contribution to the global burden of diseases. The diet has been considered one of the primary determinants of the population health, by modulating metabolic risk factors for cardiovascular diseases. Objectives: To develop a conceptual model for the relationship between metabolic cardiovascular disease risk factors and investigate its association with dietary patterns of adults and elderly residents in the city of São Paulo. Methods: This is a population-based cross-sectional study with a probabilistic sample of adults and elderly living in the city of São Paulo, Brazil, whom participated in the Health Survey of São Paulo (HS-SP): a study performed in two stages between 2008 and 2011. In the first stage, a total of 1,102 adults and elderly, both sexes, were interviewed at home by trained interviewers, who applied a structured questionnaire and collected a 24-hour dietary recall. In the second stage, a total of 642 adults and elderly were re-evaluated by the application of the second 24-hour dietary recall by telephone. Of these individuals, a total of 592 underwent a household collection of blood samples, anthropometric measurements, and blood pressure assessment by a nurse assistant. The foods reported in both 24-hour recalls were collapsed into food groups according to nutritional composition and dietary habits of the population, and adjusted for the within-person variation of intake by statistical procedures of the web-based platform Multiple Source Method. The food groups were analyzed by exploratory and confirmatory factorial analysis (manuscript 1) and by exploratory structural equation model (manuscript 3) in order to extract the dietary patterns. The conceptual model for the relationship of the metabolic cardiovascular disease risk factors (serum leptin, serum high-sensitivity C-reactive protein, systolic blood pressure, diastolic blood pressure, total cholesterol/HDL-cholesterol ratio, triacylglycerol/HDL-cholesterol ratio, fasting plasma glucose, waist circumference and body weight) was obtained by a structural equation model stratified by sex (manuscript 2). Finally, the association of dietary patterns with the proposed model (manuscript 3) was investigated by exploratory structural equation model. Goodness-of-fit indexes were estimated to evaluate model fit. All analyzes were executed in Mplus software, version 6.12. Results: In manuscript 1, the exploratory factor analysis extracted two dietary patterns. These patterns exhibited a good model fit in the confirmatory factor analysis with the oblique Promax rotation and the factor loading cut-off |0,25|. In manuscript 2, sex differences in the relationship between metabolic cardiovascular disease risk factors were observed. Among women, serum leptin showed positive and indirect effects by mediation of body weight and waist circumference on all metabolic risk factors evaluated. Differently, among men, serum leptin showed positive and direct effects on high-sensitivity C-reactive protein and positive indirect effects (mediated by body weight and waist circumference) on triacylglycerol/HDL-cholesterol ratio, total cholesterol/HDL-cholesterol ratio and fasting plasma glucose. In manuscript 3, three dietary patterns were extracted, with the Traditional one showing negative and direct association with serum leptin and negative indirect effects on the other metabolic risk factors. The Prudent pattern showed a negative and direct association with systolic blood pressure, while the Modern pattern was not associated with any metabolic risk factors investigated. Conclusion: Differences in dietary patterns were observed according to the factor rotation method applied. The relationship between metabolic cardiovascular disease risk factors was distinct between men and women, with leptin emerging as one of the possible hormones involved. The dietary patterns labeled Traditional and Prudent were inversely associated with metabolic risk factors, playing an important strategy for prevention and control of cardiovascular diseases in this country.

Abstract About 11% of infants are born preterm (before 37 weeks of gestation) worldwide. Adults born preterm with very low birth weight show enhancement of cardiometabolic risk factors such as elevated blood pressure and impaired glucose regulation compared with their peers born at term. Not all the cardiometabolic risk factors related to preterm birth are known, or whether they apply to those born less preterm, although about 80% of premature infants are born late preterm. The association between preterm birth and cardiometabolic risk factors in adolescence and adulthood was investigated in three cohort studies: The Helsinki Study of Very Low Birth Weight Adults, the Northern Finland Birth Cohort 1986, and the ESTER study. Preterm birth over its whole range has a long-term impact on a child’s health in later life: adults born preterm with very low birth weight had lower resting energy expenditure, but higher resting energy expenditure per unit lean body mass than their peers born at term. Adolescent girls born before 34 weeks of gestation had higher blood pressure and boys have elevated levels of LDL cholesterol and apolipoprotein B. Adults born preterm were more likely to be obese and to have hypertension or metabolic syndrome than their peers born at term. In addition to conventional biomarkers of cardiometabolic disorders, they had alterations in other cardiometabolic biomarkers, such as uric acid and liver transaminases. Adolescents and adults born preterm are at greater risk of developing cardiometabolic disorders than their peers born at term. Most of the cardiometabolic risk factors related to preterm birth are modifiable. Favorable early life circumstances of premature infants, such as optimal nutrition and reduction of stress in neonatal intensive care units, might reduce the risk of later cardiometabolic disorders. In addition, children and adults born preterm might particularly benefit from primary prevention such as screening for additional risk factors and promotion of healthy lifestyles. / Tiivistelmä Noin joka yhdeksäs lapsi maailmassa syntyy ennenaikaisesti, ennen 37. raskausviikkoa. Keskosena syntyneillä aikuisilla on todettu enemmän joitakin sydän- ja verisuonisairauksien riskitekijöitä kuin heidän täysaikaisena syntyneillä ikätovereillaan. Näistä eniten on tutkittu etenkin kohonneen verenpaineen ja heikentyneen sokerin siedon esiintyvyyttä, mutta kaikkia myöhempien sairauksien riskitekijöitä ei tunneta. Suurin osa aiemmista keskostutkimuksista on tehty hyvin tai erittäin ennenaikaisesti syntyneillä, vaikka yli 80% keskosista syntyy lievästi ennenaikaisena. Ei ole juurikaan tutkimuksia siitä, ovatko sydän- ja verisuonitautien riskitekijät lisääntyneet myös tässä suuressa lievemmin ennenaikaisesti syntyneiden joukossa. Eriasteisen ennenaikaisen syntymän vaikutuksia nuoruus- ja aikuisiän sydän- ja verisuonitautien riskitekijöihin tutkittiin kolmessa kohorttitutkimuksessa: Helsingin Pikku-K -tutkimuksessa, Pohjois-Suomen syntymäkohortti 1986 -tutkimuksessa sekä ESTER-tutkimuksessa. Ennenaikaisella syntymällä sinänsä on pitkäaikaiset vaikutuksen syntyneen lapsen terveyteen myös nuoruudessa ja aikuisuudessa: Hyvin pienipainoisena ennenaikaisesti syntyneillä on korkeampi lepoenergian kulutus rasvatonta painoyksikköä kohden kuin täysiaikaisena syntyneillä ikätovereilla. Hyvin ennenaikaisena (ennen 34. raskausviikkoa) syntyneillä tytöillä on 16-vuotiaina korkeampi verenpaine, ja pojilla suuremmat LDL-kolesterolin ja apolipoproteiini B:n pitoisuudet. Keskosena syntyneet puolestaan täyttivät aikuisina todennäköisemmin lihavuuden, verenpainetaudin ja metabolisen oireyhtymän kriteerit. Perinteisten sydän- ja verisuonitautien riskitekijöiden lisäksi heillä oli muutoksia myös monissa muissa sydän- ja verisuonitautien merkkiaineissa, kuten uraatin ja maksa-arvojen pitoisuuksissa. Ennenaikaisesti syntyneillä nuorilla ja aikuisilla on suurentunut riski sairastua sydän- ja verisuonitauteihin myöhemmällä iällä. Näitä riskejä on mahdollista ennaltaehkäistä, minkä vuoksi ennenaikaisesti syntyneet nuoret ja aikuiset voivat hyötyä terveellisistä elämäntavoista erityisen paljon.

Abstract The aim of this study was to investigate whether risk factors for psychosis are different among those with and without parental psychosis, and to study the interaction between parental psychosis and risk factors. Protective factors for psychosis were also examined. Data from the Northern Finland Birth Cohort 1966 (N&#160;=&#160;10,458) was used. Biological risk factors in particular increased the risk for schizophrenia and other psychosis among those with parental psychosis. In the same group, the risk for schizophrenia was increased if the achievement of holding the head up and touching the thumb with the index finger was delayed. A new born’s large size, advanced maternal age and mother’s antenatal depressed mood had interactions with parental psychosis regarding risk for schizophrenia and the mother’s smoking during pregnancy regarding risk for other psychosis. Parental psychosis and delayed touching the thumb with the index finger had an interaction regarding risk for schizophrenia and other psychosis. Several variables were associated with the decreased risk for psychosis in the total sample. In the parental psychosis group, only a mother’s non-depressed mood and a mother’s working outside the home or studying associated to remaining unaffected. This study is one of the few studies to investigate risk factors for psychosis among those with and without parental psychosis and to examine interactions between parental psychosis and risk factors. This study showed that many risk factors increased the risk for schizophrenia and other psychosis only among those with parental psychosis. Hence, parental psychosis might even explain part of the association between some risk factors. Surprisingly few protective factors were found among those with parental psychosis. Further studies on the protective factors for psychosis are important in order to prevent psychosis in individuals at high risk. / Tiivistelmä Tämän tutkimuksen tavoitteena oli selvittää, eroavatko psykoosien riskitekijät henkilöillä, joiden vanhemmalla oli psykoosi verrattuna niihin joiden vanhemmalla ei ollut psykoosia sekä tutkia vanhemman psykoosin ja riskitekijöiden yhdysvaikutusta. Myös psykoosilta suojaavia tekijöitä tutkittiin. Tutkimusaineistona oli Pohjois-Suomen vuoden 1966 syntymäkohortti (N&#160;=&#160;10458). Erityisesti biologiset tekijät lisäsivät skitsofrenian ja muiden psykoosien riskiä henkilöillä, joiden vanhemmalla oli psykoosi. Viivästynyt pään kannattelun ja pinsettiotteen oppiminen lisäsivät skitsofreniariskiä henkilöillä joiden vanhemmalla oli psykoosi. Vastasyntyneen suurella koolla, äidin korkealla iällä ja raskaudenaikaisella masentuneella mielialalla oli yhdysvaikutus vanhemman psykoosin kanssa skitsofreniariskin osalta ja äidin raskaudenaikaisella tupakoinnilla muiden psykoosien riskin osalta. Vanhemman psykoosilla ja viivästyneellä pinsettiotteen oppimisella oli yhdysvaikutus sekä skitsofrenian että muiden psykoosien riskin osalta. Koko aineistossa useat tekijät liittyivät alentuneeseen psykoosiriskiin. Vain äidin ei-masentunut mieliala ja työskentely kodin ulkopuolella tai opiskelu suojasivat psykoosilta henkilöitä, joiden vanhemmalla oli psykoosi. Tämä on yksi harvoista tutkimuksista, jossa on tutkittu psykoosien riskitekijöitä erikseen henkilöillä, joiden vanhemmalla oli tai ei ollut psykoosia sekä vanhempien psykoosin ja riskitekijöiden yhdysvaikutusta. Useat riskitekijät lisäsivät skitsofreniariskiä ainoastaan henkilöillä, joiden vanhemmalla oli psykoosi, joten vanhemman psykoosi voisi selittää osan psykoosien riskitekijöistä. Psykoosilta suojaavia tekijöitä löydettiin yllättävän vähän niillä, joiden vanhemmalla oli psykoosi. Suojaavien tekijöiden tutkiminen on tärkeää, jotta suuressa psykoosiriskissä olevien sairastumista voidaan ennaltaehkäistä.

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

This study applies bereavement and media use theoretical perspectives to examine how survivors use media to cope with spousal loss during the first two years. Specifically, this study explores whether survivors’ television use is associated with grief intensity. Potential associations between television use and grief intensity are explored using an online survey. A media use for coping scale is developed. The relationship between television oscillation (i.e., equal use of television for respite, and to cope with primary and secondary stressors) and grief intensity is also explored, and ten specific moderators of this relationship are examined: recency of loss, type of loss, social support, family proximity and contact, marital relationship quality, economic stability, pre-existing physical and mental health issues, and change in television use. Results were collected from 356 spousal survivors and indicate that television use to cope is associated with grief intensity. Survivors that report high television use in general are using more television for relaxation, companionship, acceptance, positive reinterpretation and growth, and emotional and instrumental support. The most dramatic effects are observed with television use for relaxation and companionship, and the smallest effects with television use for emotional and instrumental support. However, there was no association between television use for respite, or to cope with primary and secondary stressors and grief intensity. Results support the value of social support, family contact at the time of loss, fewer physical health issues, and decreasing general television use in promoting more positive bereavement outcomes. Results support television oscillation as a predictor of grief intensity, but only under certain circumstances. Four of the models show significant moderator effects between television oscillation and grief intensity: social support at the time of loss, family contact at the time of loss, pre-existing physical health issues, and change in television use since the loss. When survivors have less social support at the time of loss, television oscillation is associated with less grief intensity as predicted. However, when survivors have more social support, television oscillation is marginally associated with more grief intensity. Likewise, when survivors have less family contact, television oscillation is associated with less grief intensity as predicted. Conversely, when survivors have more family contact, television oscillation is associated with more grief intensity. When survivors have more pre-existing physical health issues, television oscillation is not associated with grief intensity as predicted. For survivors with fewer pre-existing physical health issues, television oscillation is associated with less grief intensity. When survivors decrease television use by approximately one hour, television oscillation is marginally associated with less grief intensity. On the other hand, when survivors increase television use, television oscillation is not associated with grief intensity. Current general television use was a highly significant control variable in all moderator analyses indicating more television use to cope is associated with more grief intensity. Recency, type of loss, marital relationship quality, family proximity, economic stability, and pre-existing mental health issues did not significantly moderate the relationship between television oscillation and grief intensity. This study extends previous work by merging the bereavement and media use literatures, and in the development of a media use for coping scale. Moreover, it provides important empirical evidence on theoretical models about bereavement. This expands the potential for discussions about the association of individual vulnerabilities with more positive bereavement outcomes.

Le cancer broncho-pulmonaire du non-fumeur est considéré comme une entité à part du fait de ses particularités épidémiologiques. Il est en outre un excellent modèle pour l'étude des facteurs de risque de cancer bronchique autres que le tabagisme actif. Il n'existe que très peu de données non-asiatiques concernant cette entité d'intérêt. Le bio-observatoire national des cancers bronchiques de non-fumeurs (BioCAST I IFCT-1002) est une étude épidémiologique multicentrique prospective. Son objectif principal est de décrire une population de patient strictement non-fumeur (moins de 100 cigarettes au cours de la vie) atteint de cancer bronchique, notamment sur le plan de leur profil moléculaire somatique et de leur exposition aux facteurs de risque. Les objectifs secondaires étaient d'étudier si l'exposition aux différents facteurs de risque pouvait influencer le profil moléculaire ; et d'utiliser cette cohorte particulière (grande fréquence et diversité de mutations somatiques attendue) afin de développer un test multiplex pour le diagnostic non-invasif du profil moléculaire somatique tumoral à partir d'ADN circulant. Au total, 384 patients non-fumeurs atteints de cancer broncho-pulmonaire ont été inclus dans cette cohorte. Deux-tiers d'entre eux étaient exposés au tabagisme passif, et il s'agissait essentiellement d'une exposition domestique touchant les femmes. Inversement, 35% des hommes étaient exposés de manière certaine à au moins un cancérogène professionnel, contre 8% des femmes. Au total, 72% des patients présentait une anomalie moléculaire, essentiellement au niveau de l'EGFR (51% de l'ensemble de la cohorte). Le genre, ou l'exposition à différents facteurs de risque (tabagisme passif, exposition professionnelle, exposition hormonale chez les femmes) n'affectait pas de manière significative et cliniquement pertinente le profil mutationnel, avec les limites liée à de faibles effectifs dans certains groupes et aux expositions multiples. Seule l'exposition professionnelle à l'amiante et / ou à la silice semble avoir pour effet de diminuer la fréquence des mutations de l'EGFR / Lung cancer in never smokers (LCINS) is considered as a separate entity given its epidemiological specificities. It is also a very interesting template to assess alternative risk factors for lung cancers than tobacco smoking. However, there is very little non-Asian data about this particular topic. The BioCAST / IFCT1002 study is a prospective, nationwide, and multi-centric epidemiological study. Its main objective was to describe a French population of lung cancers in lifelong never smokers (less than 100 cigarette during all lifetime); with a special focus on molecular somatic profile and risk-factors exposure. Secondary objectives were to assess the interaction between risk-factor exposure and molecular profile; and to use this particular cohort to develop a multiplex test for non-invasive diagnosis of tumor mutations in circulating free DNA. Overall, 384 patients were recruited in the cohort. Two-third were exposed to passive smoking (mainly women and in domestic setting). By contrast, 35% of men were definitely exposed to occupational carcinogens versus 8% of women. Finally, 72% were found with a somatic mutation, mainly in the EGFR gene (51% of the whole population). Gender or exposure to risk factors such as passive smoking, occupational exposure, or hormonal status in women, were not significantly associated with a specific and/or clinically meaningful molecular profile in tumor. These findings should be interpreted with caution given that some subgroups were small and/or with many simultaneous exposures. However, exposure to asbestos and/or silica was significantly associated to a decreased risk for EGFR mutation. On the pilot study (n=106), circulating free DNA was associated with tumor burden. The multiplex diagnosis (12 amplicons on 5 genes) by next-generation sequencing was feasible and gave encouraging results in stage 4 patients (67% sensitivity, 73% concordance rate). LCINS is an interesting entity for the study of non-tobacco-related cancer risk factors; or to optimize liquid biopsy strategy

Den tidigare forskning som finns kring barn som utsätter barn för våld är begränsad och det saknas forskning kring hur dessa barn stöttas upp av socialtjänsten. Studiens syfte är därför att undersöka hur socialsekreterare uppmärksammar och arbetar med barn som utsatt barn för våld. Detta undersöks genom en kvalitativ forskningsmetod där det empiriska materialet inhämtas genom tio strukturerade intervjuer med socialsekreterare. Studiens resultat presenteras genom en tematisk analys och analyseras med hjälp av Bourdieus perspektiv. Senare diskuteras resultatet i relation till tidigare forskning. De främsta slutsatser som dras från resultatet är att barns våld mot barn inte alltid uppmärksammas och att socialsekreterares bedömningar av barn som utsatt barn för våld påverkas av faktorer som ålder, kön, allvarlighetsgrad i brottet samt socioekonomi. I resultatet framgår att socialtjänsten har ett flertal insatser att tillgå, men att utbudet av dessa varierar mellan kommuner och vissa socialsekreterare upplever därför en brist i insatser. Risk- och skyddsfaktorer som uppmärksammas extra mycket är närmiljön som omfattar familj, skola och umgänge. / Previous research on children exposing children to violence is limited and there is no research on how these children are being supported by social services. The purpose of the study is therefore to examine how social workers pay attention to and work with children who have exposed children to violence. This is conducted through a qualitative research method, in which the empirical material is obtained through ten structured interviews with social workers. The studys’ result is presented through a thematic analysis and analyzed with help of Bourdieus’ perspective. Later on, the result is being discussed in relation to previous research. The main conclusions drawn from the result are that violence between children are not always noticed and the social workers’ assessments of children who has exposed children to violence are affected by factors such as age, gender, severity of crime and socioeconomics. The result shows that the social services have a number of interventions available, but the range of these vary between municipalities and some social workers therefore experience a lack of interventions. Risk and protective factors that are given extra attention are the immediate environment that conclude family, school and social life.