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Background: According to the World Health Organization (WHO), hypertension is a major risk factor for cardiovascular disease (CVD), renal impairment, peripheral vascular disease, and blindness. In Panama, a recent study estimated the prevalence of hypertension at 38.5% in the two main provinces of the country, with a rate of uncontrolled hypertension of 47.2%. Objectives: The aims of this study were to assess the feasibility of the study design and to describe the characteristics of the hypertensive population and the physician's adherence to Panamanian antihypertensive protocols and their relationship with uncontrolled hypertension. Methods: This is a cross-sectional study of adult hypertensive patients attending a primary healthcare facility in Panama City. Clinical charts from eligible participants were examined to describe the demographic and clinical characteristics related to uncontrolled hypertension and the use of antihypertensive protocols by medical doctors. Descriptive and central tendency statistics were used to characterize the study population. Bivariate relationships between demographic and clinical characteristics, and uncontrolled hypertension were explored using specific test for no association. Logistic regression modeling was used to examine the association between physician's adherence to antihypertensive protocols and the presence of uncontrolled hypertension. Results: In this study the mean age was 56.7 years (±13.6); 58.1% of participants were females; 71.3% of participants had body mass index >25.0kg/m2; and 53.0% of participants had stage 2 hypertension. Uncontrolled hypertension was present in 66.7% of the study sample. 82.9% of participants had one or more comorbidities. The medical doctors were compliant with antihypertensive protocols in 43.6% of participants, primarily due to lower compliance with lifestyle modification recommendations. In the multivariate analysis, a significant interaction was found with age, suggesting that age is a potential effect modifier. Conclusions: The rate of uncontrolled hypertension was high among this study population. Nearly half of the attending physicians did not follow the recommendations given by current antihypertensive protocols. Further research is necessary to explore the relationships between subject characteristics, such as age, number of comorbidities, and the presence of diabetes mellitus with uncontrolled hypertension

While dieting is relatively normative in our society, it is controversial within the fields of eating disorders and obesity. Dieting for weight loss has been touted by the obesity prevention field as a solution to the growing obesity epidemic, yet a body of research in the eating disorders field has also implicated it in the etiology and maintenance of eating pathology. Thus, a divergence in approaches toward dieting has emerged, with both prodieting and anti-dieting messages being recommended. Little is known, however, about the impact of these two types of messages on immediate and short-term psychological functioning and weight control intentions and behaviors. The current study sought to explore this gap in the extant literature by conducting an experimental study that evaluated the two messages. Undergraduate women (N=139) were randomly assigned to either a pro-dieting, anti-dieting, or no-dieting (control) message condition. Psychological functioning and weight control variables were assessed at baseline, posttest, and a two-week follow-up. Results indicated that the pro-dieting message resulted in significantly greater post-test perceived pressure to lose weight, dieting intentions, and thin-ideal internalization intentions while the anti-dieting message yielded significantly lower post-test bulimic intentions. Healthy eating behavior significantly increased from baseline to follow-up in the pro-dieting condition while there were no changes in the other two conditions. Post-test perceived pressure was found to fully mediate the relationship between diet message and post-test dieting, bulimic, thin-ideal internalization, and healthy eating intentions as well as follow-up healthy eating behavior. Trait thin-ideal internalization levels moderated the relationship between diet message and post-test perceived pressure and thin-ideal internalization intentions. Exploratory analyses revealed that overweight participants in the pro-dieting condition increased significantly from pre to post-test on state body dissatisfaction and had the highest level of post-test perceived pressure compared to all other groups. Nonoverweight participants in the pro-dieting condition also had significantly greater posttest perceived pressure to lose weight than both weight status groups in the other two conditions. Findings are discussed in the context of the prevention goals of the obesity and eating disorders fields. Limitations of the study and directions for future research are offered.

Premenstrual dysphoric disorder (PMDD) is a severe dysphoric form of premenstrual syndrome (PMS) that is included as a diagnosis for further study in the DSM-IV (APA, 2000). A primary aim of the present study was to characterize the co-occurrence of PMDD and major depression, in a sample that spans the entire range of depressive severity. The range included non-depressed controls, women meeting criteria for dysthymia, and women meeting criteria for current Major Depressive Disorder (MDD). Co-occurrence of MDD and PMDD were only statistically significant when considering Lifetime MDD. Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized to tap a diathesis toward depression or other emotion-related psychopathology. Another primary aim was to assess Frontal EEG asymmetry in college women who meet criteria for Pre-Menstrual Dysphoric Disorder (n = 25) and 25 matched controls. Participants were assessed four times in a two week period. Women reporting low premenstrual dysphoric symptomatology exhibited greater relative left frontal activity at rest than did women high in premenstrual dysphoric symptomatology. These results are consistent with a diathesis-stress model for premenstrual dysphoric symptomatology. A secondary aim was to assess whether individuals with PMDD or menstrual related mood variability, but no current diagnosis of depression, have an increased family history of depression. Promising evidence of a relationship between family history of MDD and a likelihood of PMDD was discovered. A trend was found for Spectrum PMDD women: a higher rate of Family History of MDD (36%) than non PMDD women (19.6%). Ideally, resting frontal electroencephalographic (EEG) asymmetry could help us learn more about the etiology of depression and hormonal-related depression specifically, and test whether they may share etiological factors.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成25年3月30日 川上ちひろ氏の博士論文として提出された

A mixed methods approach was applied to investigate horse health and performance in Pony Club horses. The qualitative phase (in-depth interviews) explored owners’ perceptions of horse health and performance, whilst the quantitative phase (prospective longitudinal study) identified key health and performance problems with associated risk factors in a cohort of Pony Club horses. Quantitative analytical methods included descriptive, logistic regression and negative binomial regression analyses. Data quality and therefore internal and external validity were improved by preceding the longitudinal study with the qualitative phase. Horse health was not a well defined concept among participants, preventive health care was rarely practiced and other routine health care were administered on an ad hoc basis. Owners of Pony Club horses were concerned about their horses’ welfare, but resorted to non-veterinary sources for advice on horse health. Farriers, chiropractors and equine dentists performed the majority of health care. This observed absence of veterinary involvement in preventive and routine health care matched owners’ perceptions of veterinarians as disease experts whom they consulted for emergencies or as a last resort. Coupled with the apparent absence of pre-purchase examinations these findings raise serious concerns about the veterinary impact on the health of Pony Club horses. It was concluded that opportunities exist to improve the veterinary involvement with Pony Clubs and facilitate the extension of appropriate horse health type information. The health of Pony Club horses was found to be suboptimal with musculoskeletal and dermatological problems the most common diseases identified. High prevalences of lameness and sore backs were observed, but owner sensitivity of their detection was extremely low. Several of the horse-level risk factors identified, including height and breed for lameness, and height breed and gender for sore backs, were only alterable at the time of purchase. This suggests that owners may be at risk of purchasing horses with existing disease conditions, particularly in the absence of a veterinary examination. Other risk factors for sore backs, including housing, exercise, and body condition score could be reasoned on biomechanical grounds. An important outcome of this study was the following definition of a healthy horse: one free from pain and mentally and physically fit to participate regularly in the full range of required activities. An inextricable link between horse performance, exercise and behaviour was revealed during in-depth interviews. Initial intentions of using misbehaviour as a surrogate measure of poor performance were discarded resulting in an investigation of poor performance associated with misbehaviour, but not poor performance attributable to factors other than misbehaviour. Horses were generally exercised infrequently during each month, and this varied with season, with individual sessions lasting less than one hour. In terms of horse fitness these infrequent riding days suggest lack of strategy towards improving horse and rider skills and fitness. Another key outcome was a universally applicable definition of horse performance for Pony Club horses: good performance is considered to have occurred when the horse meets rider expectations. This is the first time that incidence of misbehaviour and associated risk factors have been described in a population of horses. Misbehaviour was more common during schooling and competing relative to pleasure riding, and more than half of the misbehaviour events were considered dangerous. Horse height, breed, and rider age were identified as risk factors for horse misbehaviour with tall Pony breeds ridden by teenagers the most likely to misbehave. The results highlighted the need to consider non-veterinary stakeholders, such as riders and Pony Club instructors, in programs to reduce misbehaviour in Pony Club horses. The study horses were kept predominantly at pasture in paddocks. The pastures these horses grazed represented an underused nutritional resource. Dietary supplements were commonly fed and often in excess. Involving agronomists to improve these horse pastures and employing simple monitoring tools such as body condition scoring more effectively will reduce reliance on expensive supplemental feeds as well as reduce the risk of obesity related disorders. Furthermore, pasture improvement coupled with strategic pasture rotation of horses and other livestock offers prospects for internal parasite control through less reliance on anthelmintics. The incidence of colic was very low in study horses, possibly due to the predominantly pasture-based diet and lifestyle of study horses. However, this same diet may have contributed to the high frequency of laminitis. Laminitis affected 24% of horses for part or all of the study, with 85 % of affected horses suffering recurring lameness and / or laminitis. Purchase of horses with chronic laminitis must be carefully considered due to this high frequency of recurrence. These findings suggest that more regular veterinary contact with Pony Club horses is desirable and would provide opportunities for owners to obtain veterinary advice on preventive health care. This veterinary contact could commence with a pre-purchase examination, and continue with comprehensive annual health checks. To achieve this, Pony Club veterinarians may have to become pro-active in marketing services beyond the treatment of disease to this sector of the equine industry.

The following study aims to identify the relationship between emotional dependency and intimate partner violence in a sample of women who utilize the psychology service of a national health establishment. A quantitative approach is followed with a comparative associative strategy. The sample consisted of two groups of women, female victims of intimate partner violence (25 women) and women who were not victims of intimate partner violence (26 women). The results suggest that there is a statistically significant relationship between the variables of study, since differences between the two study groups was found and it was found that the value assumed correlation coefficient between variables was highly significant. / El siguiente estudio tiene como objetivo identificar la relación entre la dependencia emocional y la violencia de pareja en una muestra conformada por mujeres usuarias del servicio de psicología de un establecimiento de salud nacional. Para esto, se sigue un enfoque cuantitativo y se utiliza una estrategia asociativa comparativa. La muestra estuvo constituida por dos grupos de mujeres, mujeres víctimas de violencia de pareja (25 usuarias) y mujeres que no fueron víctimas de violencia de pareja (26 usuarias). Los resultados sugieren que existe relación estadísticamente significativa entre las variables de estudio, puesto que se encontró diferencias entre los dos grupos de estudio y se halló que el valor que asumió el coeficiente de relación entre las variables fue altamente significativo.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-05-20T18:18:03Z No. of bitstreams: 1 Tese Matilde Perguero Payano. 2012.pdf: 1690294 bytes, checksum: 8b86e7c86033d26c9f292a02f9611d05 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-20T18:19:58Z (GMT) No. of bitstreams: 1 Tese Matilde Perguero Payano. 2012.pdf: 1690294 bytes, checksum: 8b86e7c86033d26c9f292a02f9611d05 (MD5) / Made available in DSpace on 2013-05-20T18:19:58Z (GMT). No. of bitstreams: 1 Tese Matilde Perguero Payano. 2012.pdf: 1690294 bytes, checksum: 8b86e7c86033d26c9f292a02f9611d05 (MD5) Previous issue date: 2012 / Segundo a Organização Mundial da Saúde, as infecções respiratórias agudas das vias inferiores (IRAVIs)constituem as principais causas de morbidade e mortalidade em crianças menores de cinco anos de idade no mundo. Dos atendimentos ambulatoriais em pediatria, entre 40 a 60% são devidos a IRAVIs. Nos países de renda baixa são a primeira causa de morte. Das IRAVIs a pneumonia (PN) é a mais frequente. É responsável por 18% do total de morte nesta faixa etária. Aproximadamente 99% dos casos ocorrem nos países de baixa renda. Uma parcela importante da PN pode ser prevenida pelo uso da vacina contra o Hib. OBJETIVO. Estudar a ocorrência da PN em crianças menores de cinco anos. METODO. Trata-se de um estudo de caso-controle pareado por idade e vizinhança. Os casos (n=527) foram crianças de 6 até 47 meses de idade hospitalizadas por IRAVIs, de junho 2006 até maio 2008, nos principais hospitais da rede do SUS em Salvador. Os controles (n=1.045) foram crianças da comunidade da mesma idade do que o caso (mais/menos 6 meses do que o caso). Os dados foram submetidos à análise bivariada e multivariada por meio de regressão logística condicional. A análise foi feita usando STATA V.10. RESULTADOS. Os determinantes sociais em saúde modelam o caminho causal das IRAVIs em crianças menores de cinco anos e incluem fatores socioeconômicos, médio ambiente e fatores individuais. Na população estudada, a média e mediana de idade foi de 19 e16 meses respectivamente. Foram encontrados como fatores de risco: ter mãe empregada (OR 1,34 IC95% 1,06 1,69), morar em casa construída de material inapropriado (OR 2,38 IC95% 1,23 4,62), freqüentar a creche (OR 2,12 IC95% 1,49 3,01), o fumo da mãe durante a gravidez (OR 2,02 IC95% 1,42 2,89) e a prematuridade (OR 2,15 IC95% 1,28 3,63). O fato de ter mãe empregada contribui com 9% da ocorrência de IRAVIs (PAF 9%), seguido de freqüentar creche (PAF 8%), fumo da mãe durante a gravidez (PAF 7%), entanto que a construção de casa de material inapropriado e a prematuridade 3% cada (PAF 3%). A efetividade da vacina contra o Hib na redução de internações devida a PN foi de 3% (OR 0.97 IC 95% 0,71 1,37). CONCLUSÃO. Os fatores de risco para IRAVIs na população estudada estão ligada as condições de vida da família. A vacina conjugada contra o Hib, sob condições de aplicação do calendário regular de vacinação do SUS, mostra evidencias inconclusas relativo ao efeito protetor na prevenção de internações devida a PN em crianças de 6 até 47 meses de idade em Salvador, provavelmente devido ao efeito da vacina na eliminação de portadores do Hib. / Salvador

Introdução: Devido ao uso indiscriminado de antibióticos, infecção por Clostridium difficile (ICD) tem aumentado significativamente em frequência e severidade ao longo dos anos, acarretando em maior morbidade e mortalidade além de maiores custos hospitalares. Objetivo: O objetivo deste estudo é avaliar os fatores de risco e fatores associados à pior prognóstico por colite Clostridium difficile em pacientes adultos internados. Desenho do estudo: Estudo de caso-controle retrospectivo Métodos: Em um Hospital terciário, durante o período de 1° de janeiro de 2010 a 31 de julho de 2012, foram comparados 75 pacientes com colite por Clostridium difficile documentada com 75 controles correspondentes com diarreia de origem nosocomial devido a outras etiologias. Foram identificados pacientes com ICD aqueles cuja pesquisa de toxinas A ou B, exame imunoenzimático VIDAS®, foi positiva ou aqueles com exames negativos ou indeterminados para estas toxinas com colonoscopia compatível com colite por Clostridium difficile. Todas variáveis clínicas e microbiológicas com P <0,10 na análise univariada, foram incluídos na análise de regressão logística múltipla afim de avaliar potenciais fatores de risco e fatores de pior prognóstico associados a colite por C. difficile entre pacientes com diarréia internados. Na análise multivariada, variáveis independentes permaneceram se P < 0,05. Resultados: Uso prévio de antibióticos (OR, 13.3; 95% CI, 1.40-126.90), presença de distensão abdominal (OR, 3.85; 95% CI, 1.35-10.98) e leucócitos fecais (OR, 8.79; 95% CI, 1.41-54.61) diante a apresentação de diarreia foram de preditores de infecção por Clostridium difficile. Por outro lado, presença de anorexia esteve negativamente associado com ICD (OR, 0.15; 95% CI, 0.03-0.66). Em relação a análise multivariada, alimentação por sonda naso-entérica (SNE) mostrou-se o único fator independente associado a pior prognóstico, este avaliado como: pacientes admitos em unidade de terapia intensiva (UTI), mortalidade hospitalar e falência de tratamento (OR, 3.75; 95% CI, 1.24-11.29). Conclusão: Uso de antibiótico foi fator de risco para colite por Clostridium difficile observado neste estudo. O uso de suporte nutricional por SNE foi o único fator associado a pior prognóstico. / Background: Due to the indiscriminate use of antibiotics, Clostridium difficile infections (CDI) is increasing in frequency and severity over the years, resulting in increased morbidity and mortality as well as higher hospital costs. Objective: The aim of this study was to evaluate factors associated with Clostridium difficile infection among adult patients with hospital-acquired diarrhea and factors associated with poor prognosis. Study design: Retrospective case-control study. Methods: In a terciary hospital, during the period of january 1° 2010 to 31 july 2012, were compared 75 patients with documented Clostridum difficile colitis with 75 matched controls with hospital-acquired diarrhea secondary to an etiology other than Clostridium difficile. Patients with colits were identified by a positive toxins A or B, an immunoenzymatic test VIDAS®, or by a negative or indeterminate test for these toxins with colonoscopy compatible with Clostridium difficile colitis. All clinical and microbiological variables with a P value <0.10 in the univariate analysis were included in the stepwise multiple logistic regression to identify potential factors associated with C. difficile etiology among patients with hospital-acquired diarrhea and factors associated with poor prognosis among those patients with documented C.difficile colitis. In the multivariate model, independent variables remained in the model if the P value was < 0.05. Results: Previous antibiotic treatment (OR, 13.3; 95% CI, 1.40-126.90), presence of abdominal distension (OR, 3.85; 95% CI, 1.35-10.98) and fecal leukocytes (OR, 8.79; 95% CI, 1.41-54.61) at the onset of diarrhea were predictors of CDI. On the other hand, presence of anorexia was negatively associated with C.difficile etiology (OR, 0.15; 95% CI, 0.03-0.66). Upon multivariate analysis, enteral tube feeding was the only factor independently associated with a composite endpoint which included in-hospital mortality, ICU admission and treatment failure (OR, 3.75; 95% CI, 1.24-11.29). Conclusion:.Previous antibiotic use was risk factor for clostridium difficile colits. In this study tube feeding was the only factor associated with poor prognosis.

This Diploma Thesis focuses on the use of key Czech media in the prevention of diseases, on an analysis of their levels and on the possible impact on recipients. It also investigates to what extent are topics interconnected with commercial communication and how commercial background determines such communication. In the theoretical part of this Diploma Thesis I attempted to give a brief and comprehensible outline of the issues conserning the prevention of diseases and the mass media according to the most up-to-date information. The main aim of the practical part of this Diploma Thesis was to map the frequency by which health-related preventive material is published in key Czech media. A further aim of this Diploma Thesis was to discover the main topics that key media deal with. The quantitative data collection method and media analyses were applied in this part of the Diploma Thesis. It ensues from my research that key media mostly concentrate on topics conserning the prevention of malignant tumors. Advertisements that are concerned with the prevention of selected illnesses usually refer food supplements and curative preparations. The results of this Diploma Thesis further indicate that prevention of diseases mass media is not neglected; nonetheless, I am the opinion that the frequency of publication could be higher. On the contrary, there could be less commercial communication that goes along with material that focuses on health-related prevention issues. I am convinced that the prevention of diseases with use of the news media is the basic step to a healthy population without which we cannot envisage our future. The result of this Diploma Thesis can be applied in the creation of preventive programmes and information strategies regarding disease prevention.