Magister Artium (Psychology) - MA(Psych) / The relationship between alcohol consumption and alcohol-related violence has been firmly established in a wide array of studies concerning various forms of violence including intimate partner violence, domestic violence as well as sexual assault. One factor which has been highlighted as having a moderating effect on the relationship between alcohol consumption and alcohol-related aggression is the specific aggression-related alcohol expectancies concerning the effects of alcohol consumption on aggressive behaviour. In light of the prevalence of alcohol-related violence in South African communities it becomes important to examine the specific factors that moderate the relationship between alcohol consumption and alcohol-related aggression and violence. The aim of this study was to examine aggressionrelated alcohol expectancies as a moderating factor in the relationship between alcohol consumption and alcohol-related aggression and to examine the possible influence of exposure to community alcohol-related aggression in the formulation of aggression-related alcohol expectancies. The main objectives of this were to examine aggression-related alcohol expectancies as well as exposure to community alcohol-related aggression as domains for intervention to prevent alcohol-related violence. / South Africa

Orientador: Cristina Maria Garcia de Lima Parada Parada / Resumo: O programa de uso da imunoglobulina palivizumabe teve início em 2007 no Estado de São Paulo e em 2013 estendeu-se nacionalmente, sendo destinado a crianças com maior risco para a infecção pelo Virus Sincicial Respiratório (VSR). Desde seu início, o programa permanece sem avaliação sistemática. O objetivo dessa pesquisa foi avaliar o programa de uso da imunoglobulina palivizumabe no Estado de São Paulo. Foram avaliados os 16 locais de aplicação: cinco Centros de Referência para Imunobiológicos Especiais (CRIE) e 11 postos de aplicação existentes no Estado de São Paulo, seguindo o referencial de avaliação proposto por Donabedian. Dados de estrutura e processo foram obtidos por entrevista com os responsáveis pela aplicação da imunoglobulina; para avaliação de resultado foram entrevistadas as mães das crianças do programa, visando identificar a associação entre falha na tomada do palivizumabe e a necessidade de hospitalização em Unidade de Terapia Intensiva por doença ou sintomatologia respiratória no período de sazonalidade do VSR. Participaram desta pesquisa 693 crianças/responsáveis (85,1% da população elegível), que ingressaram no programa entre março e agosto de 2014, sendo a coleta de dados realizada entre março e setembro do mesmo ano. Para análise de resultado foi utilizado o odds ratio pontual e intervalar com intervalo de confiança de 95%, considerando-se associações estatisticamente significativas se p < 0,05. Para avaliação de estrutura foram consideradas 30 variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

This thesis deals with motivation of long-term unemployed when looking for a job. It is divided into theoretical and practical part. The theoretical part deals with basic overview of theories of motivation and motivation to work. It also defines basic concepts regarding long- term unemployment. In connection with the issue it describes a system of material poverty, unemployment and abuse of social benefits. The final chapter of this section is devoted to a summary of the theoretical part. The practical part of the work contains the results of a research. Qualitative method and semi- structured interviews with beneficiaries in material need were used for data acquisition. The aim of the research is to understand what factors influence the motivation of long-term unemployed when looking for a job and when trying to solve their social situation. Part of this section is the interpretation of the results of the research and its evaluation.

The primary objective of this research was to explore the impact of possible social factors on non-institutionalized adults 18 years of age or older residing in the United States who exhibited severe mental illness (SMI). A holistic sociological model was developed to explain SMI by incorporating elements of social learning theory, social disorganization theory, and gender socialization theory with social demographic factors. Based on the holistic sociological model, the following factors were investigated: demographic aspects of age, education, income and gender; gender socialization; influence of neighborhood area; social network influence based on communication and interaction among peers and family members; and socially deviant behaviors such as frequently smoking cigarettes, drinking alcohol and using drugs specifically marijuana. The impact of these factors on SMI was examined. A sample of 206 respondents drawn from National Survey on Drug Use and Health, 2003 was assessed. These respondents had answered all the questions related to SMI; social deviant behaviors; neighborhood environment; and communications among peers, family members and friends; and the other studied factors. Ordinary linear regression with interaction terms was employed as a statistical tool to assess the impact of social determinants on SMI. Being female, living a disorganized neighborhood, and frequent and high levels of smoking cigarettes and drinking alcohol had a significant influence on SMI. This reevaluation and reexamination of the role of gender socialization path, socially deviant behaviors like smoking and drinking, and community construction on SMI provided additional insights. This research is one of the first to develop a more holistic sociological model on SMI and explored the previously untested interactive relationships. The limitations of this study suggest the need to test a potential recursive research model and explore additional bi-directional associations.

Introduktion: Spelberoende är idag ett folkhälsoproblem som både drabbar den spelberoende själv och dennes anhöriga. Riskfaktorer kopplade till spelberoende är många, men det saknas samstämmighet. Dessutom är skyddsfaktorerna få. Trots att det finns en åldersgräns för pengaspel är många unga drabbade där samsjuklighet är vanligt. Kostnaden för att behandla spelberoende beräknas vara låg även om det idag finns liten evidens kring effektiva behandlingsmetoden. Få personer söker dessutom vård för spelberoende. Syfte: Syftet med denna litteraturstudie var att beskriva vilka riskfaktorer och hälsokonsekvenser som är kopplade till spelberoende, samt att beskriva utsatta grupper i befolkningen. Metod: En strukturerad litteraturstudie utfördes med 13 inkluderade artiklar. Analysen genomfördes med hjälp av tematisk analys. Resultat: Resultaten visar att genetiska, biologiska, sociala, kognitiva, geografiska faktorer tillsammans personliga beteenden samt livsstils- och miljöfaktorer är avgörande för risken att utveckla spelberoende, vilket också kan leda till samsjuklighet och hälsokonsekvenser. Främsta samsjukligheten är substansberoende tillsammans med psykisk ohälsa och ökad risk för självmord. Utsatta grupper i befolkningen är unga män med familjeproblematik och migrationsbakgrund. Slutsats: Spelberoende är ett komplex beroende med många negativa hälsokonsekvenser. Ur ett folkhälsoperspektiv är det viktigt att förstå hur faktorer samverkar för att tidigt kunna förebygga spelproblem. / Introduction: Gambling is a growing public health issue that affects both the person with gambling disorder and relatives. There are many risk factors associated with gambling disorder, but there is a lack of agreement. In addition, there are few protective factors. Although there is an age limit for gambling, many adolescents are affected where comorbidity is common. The cost of treating gambling disorder is estimated to be low, although today there is little evidence of effective methods. Few people also seek care for gambling disorder. Aim: The aim of this literature study was to describe the risk factors and the health consequences that are linked to gambling disorder, and to describe vulnerable groups in the population. Method: A structured literature study was conducted with 13 included articles. The analysis was implemented using thematic analysis. Results: The results show that genetic, biological, social, cognitive, geographical factors together personal behaviors as well as lifestyle and environmental factors are crucial for the risk of developing gambling disorder, which can also lead to comorbidity and health consequences. The main comorbidity is substance addiction together with poor mental health and increased risk of suicide. Vulnerable groups in the population are young men with family issues and migration backgrounds. Conclusion: Gambling disorder is a complex addiction with many negative health consequences. In a public health perspective, it is important to understand how factors interact in order to prevent gambling problems at an early stage.

Thesis "Employment risk groups of young people in the Czech Republic," focuses on young people leaving institutional care. In the Czech Republic, emerging from the economic crisis and unemployment is still high. For young people it is difficult to find jobs, because they lack the neccessary practical experience. The situation of young people leaving institutional care is even worse. These young people are applying for the job market disadvantage because they lack family support. The only support they are halfway houses to help them during the spin-offs and adaptations of the professional role. The experience of workers Halfway House Maják shows that what is important is the individual approach to clients. This approach should be employed during the election of a professional role that is also very important.

Objetivos: Descrever a frequência, e investigar fatores preditivos, de óbito fetal espontâneo (OF), em gestações com anomalias cromossômicas. Métodos: Trata-se de estudo retrospectivo, abrangendo o período de novembro de 2004 a maio de 2012, realizado na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram incluídas gestações únicas com diagnóstico pré-natal de trissomia dos cromossomos 21 (T21), 18, 13 (T13/18) e monossomia do X (45X), realizado até a 26ª semana de gestação. Resultados: Foram incluídas 92 gestantes com idade materna média de 32,7 ± 8,7 anos. O diagnóstico das anomalias cromossômicas (T21 n=36, T13/T18 n=25, 45X n=31) foi realizado em idade gestacional média de 18,3 ± 3,7 semanas, por meio de biópsia de vilo corial (n=22, 24%), amniocentese (n=66, 72%) e cordocentese (n=4, 4%). Malformação major estava presente em 45 (49%); e hidropisia foi identificada em 32 (35%) fetos, sendo mais frequente no grupo 45X (n=24/31 (77%) versus T21: n=6/36 (17%) e T13/18: n=2/25 (8%), p < 0,001). Exame ecocardiográfico fetal especializado foi realizado em 60% (55/92) das gestações. Dessas, 60% (33/55) apresentaram alterações na morfologia e/ou função cardíaca, sendo o achado mais frequente a comunicação interventricular (39%). Fetos com T13/18 apresentaram incidência maior de anomalias cardíacas (60% versus 25% (T21) e 29% (45X), p= 0,01). Óbito fetal ocorreu em 55 (60%) gestações e foi mais frequente no grupo 45X (n=26/31 (84%) versus T21: n=13/36 (36%) e T13/18: n=16/25 (64%), p < 0,01). A análise multivariada stepwise demonstrou associação entre hidropisia e OF em fetos com trissomia 21 (LR= 4,29; IC95%= 1,9-8,0, p< 0,0001). Em fetos com monossomia X, a presença de alterações ecocardiográficas esteve associada com menor risco de OF (LR= 0,56; IC95% = 0,27-0,85, p= 0,005). Não foram identificados fatores preditores no grupo T13/18. Conclusão: A letalidade intrauterina de fetos com anomalias cromossômicas é elevada. A presença de hidropisia aumenta o risco de óbito fetal, em gestações com trissomia 21. Enquanto, em gestações com monossomia X, a ocorrência de alterações ecocardiográficas reduz esse risco / Objectives: To describe the frequency, and associated factors, of intrauterine fetal death (IUD), in pregnancies with chromosomal abnormality. Methods: This was a retrospective (November 2004 to May 2012) performed at de department of obstetrics, Hospital das Clínicas, São Paulo University Medical School. Inclusion criteria were: singleton pregnancies with prenatal diagnosis of trisomy 21 (T21), 18, 13 (T13/18) and X monosomy (45X), performed up to 26 weeks gestation. Results: 92 women were included in the study with a mean maternal age of 32.7 ± 8.7 years. Fetal chromosomal abnormalities (T21 n=36, T13/T18 n=25, 45X n=31) were diagnosed at a mean gestational age of 18.3 ± 3.7 weeks, by chorionic villus sampling (n=22, 24%), amniocentesis (n=66, 72%) and cordocentesis (n=4, 4%). Major fetal structural abnormality was present in 45 (49%) cases; hydrops was diagnosed in 32 (35%) fetuses, and was more common in 45X group (n=24/31 (77%) versus T21: n=6/36 (17%) and T13/18: n=2/25 (8%), p < 0.001). Specialist fetal echocardiography was performed in 55 (60%) pregnancies and showed structural and/or functional abnormalities in 33 (60%) fetuses; ventricular septal defect was the most common finding (39%). T13/18 fetuses showed a higher incidence of cardiac abnormalities (60% versus 25% (T21) and 29% (45X), p= 0.01). IUD occurred in 55 (60%) pregnancies and was more common in 45X group (n=26/31 (84%) versus T21: n=13/36 (36%) and T13/18: n=16/25 (64%), p < 0.01). Stepwise logistic regression analysis demonstrated an association between hydrops and IUD in T21 pregnancies (LR= 4.29; 95%CI= 1.9-8.0, p < 0.0001). In 45X pregnancies, cardiac abnormalities were associated with a lower risk of IUD (LR= 0.56; 95%CI = 0.27-0.85, p= 0.005). No predictors of IUD were identified in T13/18 group. Conclusion: Intrauterine death rate is high in pregnancies with a fetal chromosomal abnormality. Presence of hydrops increases the risk of this complication in trisomy 21 fetuses. Whereas the presence of a cardiac abnormality is protective in X monosomy pregnancies

Introdução: Atualmente, muito tem se estudado a respeito de a esquizofrenia e do transtorno afetivo-bipolar (TAB) pertencerem a um continuum de sinais e sintomas que caracterizam o espectro da psicose, com etiologias que se sobrepõem parcialmente. O estudo comparativo de crianças filhas de pacientes com esquizofrenia e com transtorno bipolar pode ajudar na compreensão do quanto à vulnerabilidade para o desenvolvimento dessas patologias se assemelha e em quais momentos se diferencia. Os objetivos deste estudo foram comparar crianças e adolescentes em risco para esquizofrenia, para transtorno bipolar e um grupo sem risco para estes transtornos em relação a: 1) presença de problemas de saúde mental, diagnóstico psiquiátrico, competência social, quociente intelectual (QI); 2) associação entre presença de diagnóstico ou sintomas psiquiátricos nas crianças e a presença de diagnóstico psiquiátrico materno (esquizofrenia ou transtorno bipolar do humor), gravidade do diagnóstico materno, complicações obstétricas, nível socioeconômico dos pais, escolaridade da mãe. Métodos: Foi realizado estudo transversal comparando filhos de mulheres com diagnóstico de esquizofrenia e transtorno afetivo bipolar, segundo critérios do DSM-IV, e filhos de mulheres sem transtornos mentais graves, na faixa etária de 6 a 18 anos. Os instrumentos utilizados para avaliação da psicopatologia das crianças e adolescentes foram o Child Behavior Checklist (CBCL), Youth Self Report (YSR) e o Schedule for affective disorders and schizophrenia for school aged children-lifetime version (KSADS- PL). A psicopatologia das mães foi avaliada com o uso da escala Structured Clinical Interview for DSM-IV Disorders (SCID-I/P) e o funcionamento/gravidade destas mulheres com a Global Assessment of Functioning (GAF). Para a avaliação do QI e funcionamento social das crianças foram utilizados as escalas Wechsler Abbreviated Scale of Intelligence (WASI) e Children\'s Global Assessment Scale (CGAS) respectivamente. O nível socioeconômico foi avaliado com o uso da escala da Associação Brasileira de Empresas de Pesquisa (ABEP) e um instrumento contendo dados demográficos e de gestação e parto foi criado para ser utilizado neste estudo. Resultados: Foram incluídos no estudo 67 filhos de mães com esquizofrenia, 65 filhos de mães com transtorno bipolar e 63 controles. Os filhos de mulheres com transtorno bipolar apresentaram maior prevalência de problemas comportamentais que os outros grupos, com maior prevalência tanto de problemas de internalização quanto de externalização, e apresentaram maior prevalência de diagnóstico de transtorno de déficit de atenção e hiperatividade e de transtorno de conduta. Os filhos de mulheres com esquizofrenia apresentaram pior eficiência intelectual quando comparados aos jovens em risco para transtorno bipolar, e pior ajustamento social quando comparados aos controles. Foi detectada uma diferença na presença de comportamentos agressivos entre os gêneros no grupo em risco para esquizofrenia. Os meninos em risco para esquizofrenia apresentaram prevalência muito menor de comportamentos agressivos que as meninas deste grupo e que tanto meninas quanto meninos dos demais grupos. Os fatores que se associaram à presença de problemas comportamentais nestas crianças e adolescentes além do diagnóstico materno foram: gravidade da doença materna, moradia com a mãe, ter sofrido riscos pela presença de psicopatologia materna, nível socioeconômico, escolaridade da mãe, possuir pai com problemas com uso de álcool ou outras substâncias, intercorrências durante a gestação e parto, mãe não ter sido internada durante crise na gestação. Conclusões: Os filhos de mães com TAB apresentaram mais problemas comportamentais e diagnósticos psiquiátricos, enquanto os filhos de mulheres com esquizofrenia apresentaram mais prejuízos cognitivos e de competência social e funcional. Contribuindo, assim, para a discussão de que as duas patologias possam ser entendidas como entidades diagnósticas distintas na medida em que diferenças aparecem nos jovens vulneráveis a elas / Introduction: Nowadays a lot has been studied about schizophrenia and bipolar affective disorder being part of a continuum of signals and symptoms which characterize the spectrum of psychosis, with etiologies that are partially superseded. The comparative study of children who were sons of patients with schizophrenia and bipolar disorder can help understanding how much this vulnerability for these pathologies development is similar and in what moments it differs. The aims of this study have been to compare children and adolescents at risk for schizophrenia, bipolar disorder and a group without risk for these disorders in relation to: 1) The presence of mental health problems, psychiatric diagnosis, social competence, intelligence quotient; 2) The association between diagnosis presence or psychiatric symptoms in children and the presence of maternal psychiatric diagnosis (schizophrenia or mood bipolar disorder), severity of maternal diagnosis, obstetric complications, socioeconomic level, mother\'s educational level. Methods: A cross-sectional study has been done comparing the sons of women with schizophrenia and bipolar disorder, according to DSM-IV criteria, and sons of women without severe mental disorder, within the age group of 6 to 18. The instruments used for the evaluation of the children\'s and adolescents\' psychopathology were the Child Behavior Checklist (CBCL), the Youth Self Report (YSR) and the Schedule for affective disorders and schizophrenia for school aged children-lifetime version (KSADS-PL). The psychopathology of the mothers was evaluated with the use of the scale Structured Clinical Interview for DSM-IV Disorders (SCID) and the functioning/severity of these women with Global Assessment of Functioning (GAF). For the evaluation of the intelligence quotient and children social function were used Wechsler Abbreviated Scale of Intelligence (WASI) and Children\'s Global Assessment Scale (CGAS) respectively. The socioeconomic level was evaluated with the use of the scale from Associação Brasileira de Empresas de Pesquisa (ABEP) and an instrument containing demographic data and gestation/childbirth was created to be used in this study. Results: 67 sons of schizophrenic mothers were included in the study, 65 sons of mothers with bipolar disorder and 63 controls. The sons of women with bipolar disorder presented higher prevalence of behavior problems compared to the other groups, with a higher prevalence of both internalization and externalization problems, and they also presented higher diagnosis prevalence of attention deficit /hyperactivity disorder, and conduct disorder. The sons of women with schizophrenia presented worst intellectual efficiency when compared to youngsters with risk of bipolar disorder, and worst social adjustment when compared to the controls. A difference in the presence of aggressive behavior was detected among the genders in the group at risk for schizophrenia. Boys at risk for schizophrenia presented a much smaller prevalence of aggressive behavior compared to the girls in this group and also compared to boys and girls from the other groups. Besides the maternal diagnosis, the factors which were associated to the presence of behavior problems in these children and adolescents were: severity of the maternal disease, sharing residence with the mother, having suffered risk because of the presence of maternal psychopathology, socioeconomic level, mother\'s educational level, father who has a history of alcohol or other substance abuse, complications during gestation and childbirth, mother not being hospitalized when suffering a psychiatric crisis during pregnancy. Conclusions: The sons of mothers with bipolar disorder presented more behavior problems and psychiatric diagnosis, while the sons of mothers suffering from schizophrenia presented more cognitive, social and functional competence impairments. This conclusion corroborates for the discussion that both pathologies may be understood as distinct diagnostic entities insofar as differences appear in the youngsters who are vulnerable to them

INTRODUÇÃO: A crescente incidência de câncer de mama, que cada vez mais acomete mulheres jovens, tem despertado muito interesse no diagnóstico precoce e na busca do tratamento mais eficaz e minimamente agressivo. Da mesma forma, vem aumentando a parcela da população com alto risco para câncer de mama, para a qual as atenções têm se voltado no sentido de se encontrar um caminho que permita prevenir o surgimento da neoplasia. Inspirados por Peyrat, que primeiro associou o câncer de mama com a presença de fator de crescimento insulina like tipo 1 (IGF-1), vários autores se lançaram nesta procura e, apesar de controversa, a literatura internacional tende a mostrar uma relação direta entre IGF-1 e câncer de mama na pré-menopausa. A proteína carreadora de IGF do tipo 3, ou IGFBP-3, também foi adicionada ao rol de sustâncias com possibilidade de promover câncer, porém, não tem demonstrado clara regularidade em seu mecanismo de ação. Tendo como alvo a população com alto risco para câncer de mama, quer histopatológico, quer familiar, e direcionada pelos cálculos matemáticos de Gail e Tyrer-Cuzick, essa tese objetivou avaliar a relação entre IGF-1 e IGFBP-3 em mulheres brasileiras atendidas pelo Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: estudo transversal em que foram comparados os níveis séricos de IGF-1 e IGFBP-3, dosados pelo método imunométrico quimioluminescente, em 3 diferentes grupos: mulheres com câncer de mama não tratado (n= 51), mulheres com risco populacional (n= 66) e mulheres com alto risco para câncer de mama (n= 108). Foram considerados fatores de comparação: idade, estado menopausal e índice de massa corpórea. RESULTADOS: 1) não houve diferenças entre os grupos com respeito ao IMC; 2) foi estatisticamente significativa a diferença das médias de idades dos grupos, sendo as mulheres com alto risco para câncer de mama mais jovens (p<0,001); 3) quanto ao estado menopausal, houve significativa diferença entre os grupos, com predomínio de mulheres pós-menopausa no grupo de pacientes com câncer de mama (58,8%), com p <0,001; 4) não foi encontrada relação estatisticamente significante entre percentual de IGF-1 em relação à mediana, percentual de IGFBP-3 em relação à mediana e razão dos percentuais de IGF-1 e IGFPB-3 em relação à mediana para os 3 grupos estudados;4) não houve variações nas dosagens de acordo com o tipo de situação determinante do alto risco para câncer de mama (familiar ou histopatológico); 5) não houve alteração estatisticamente significativa das variáveis estudadas, mesmo após subdivisão do grupo de alto risco (risco vitalício entre 20 e 29% X risco vitalício superior a 29%). CONCLUSÃO: Não foi observada variação dos níveis séricos de IGF-I e IGFBP-3 em mulheres com câncer de mama, com alto risco para câncer de mama ou com risco populacional / INTRODUCTION: The rising incidence of breast cancer, a disease that is increasingly affecting young women, has aroused a great deal of interest in early diagnosis and the search for a more efficient and minimally aggressive treatment. Likewise, the population at high risk for breast cancer has been growing, and it is now the focus of research efforts in the struggle to prevent neoplasia. Inspired by Peyrat, who was the first to associate breast cancer with insulin-like growth factor type 1 (IGF-1), several authors have taken on the challenge, and the international literature now leans towards a direct relationship, albeit still controversial, between IGF-1 and breast cancer in premenopause. The IGF binding protein 3 (IGFBP-3) has also been added to the list of cancer-causing agents, but its mechanism of action has not shown to be clearly regular. Targeting a population at high risk for breast cancer for histopathologic or familial reasons, and guided by the mathematical calculations of Gail and Tyrer-Cuzick, this thesis aimed at evaluating the relationship between IGF-1 and IGFB-3 in Brazilian female outpatients at the Mastology Sector of the Gynecology Discipline of the Department of Obstetrics and Gynecology of the School of Medicine of the University of São Paulo. METHODS: Transverse study to compare the serum levels of IGF-1 and IGFBP- 3 measured by the chemiluminescent immunometric method. The patients were divided into 3 different groups: women with untreated breast cancer (n=51), women with a population-based risk of breast cancer (n=66), and women at high risk for breast cancer (n=108). The comparison factors were age, menopausal state, and body mass index. RESULTS: 1) there were no differences among the groups with respect to BMI; 2) but there were statistically significant differences among the groups regarding mean age, and the younger women were those at a higher risk for breast cancer (p<0.001); 3) as for menopausal state, the groups were significantly different, and the postmenopausal women were prevalent among the patients with breast cancer (58.8%; p<0.001); 4) no statistically significant relationship was found between the IGF-1 percentage and the median, the IGFBP-3 percentage and the median, or the IGF-1 and IGFBP-3 ratio and the median in any of the groups; 5) measurements did not vary according to the determinant reason for high breast cancer risk (familial or histopathologic); 6) statistically significant changes in the variables under consideration did not take place, even after subdivision of the high-risk group (lifelong risk between 20% and 29% X lifelong risk over 29%). CONCLUSION: The serum levels of IGF-I and IGFBP-3 showed no variation among women with breast cancer, at high risk for cancer, or with populationbased risk

INTRODUÇÃO: A crescente incidência de câncer de mama, que cada vez mais acomete mulheres jovens, tem despertado muito interesse no diagnóstico precoce e na busca do tratamento mais eficaz e minimamente agressivo. Da mesma forma, vem aumentando a parcela da população com alto risco para câncer de mama, para a qual as atenções têm se voltado no sentido de se encontrar um caminho que permita prevenir o surgimento da neoplasia. Inspirados por Peyrat, que primeiro associou o câncer de mama com a presença de fator de crescimento insulina like tipo 1 (IGF-1), vários autores se lançaram nesta procura e, apesar de controversa, a literatura internacional tende a mostrar uma relação direta entre IGF-1 e câncer de mama na pré-menopausa. A proteína carreadora de IGF do tipo 3, ou IGFBP-3, também foi adicionada ao rol de sustâncias com possibilidade de promover câncer, porém, não tem demonstrado clara regularidade em seu mecanismo de ação. Tendo como alvo a população com alto risco para câncer de mama, quer histopatológico, quer familiar, e direcionada pelos cálculos matemáticos de Gail e Tyrer-Cuzick, essa tese objetivou avaliar a relação entre IGF-1 e IGFBP-3 em mulheres brasileiras atendidas pelo Setor de Mastologia da Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: estudo transversal em que foram comparados os níveis séricos de IGF-1 e IGFBP-3, dosados pelo método imunométrico quimioluminescente, em 3 diferentes grupos: mulheres com câncer de mama não tratado (n= 51), mulheres com risco populacional (n= 66) e mulheres com alto risco para câncer de mama (n= 108). Foram considerados fatores de comparação: idade, estado menopausal e índice de massa corpórea. RESULTADOS: 1) não houve diferenças entre os grupos com respeito ao IMC; 2) foi estatisticamente significativa a diferença das médias de idades dos grupos, sendo as mulheres com alto risco para câncer de mama mais jovens (p<0,001); 3) quanto ao estado menopausal, houve significativa diferença entre os grupos, com predomínio de mulheres pós-menopausa no grupo de pacientes com câncer de mama (58,8%), com p <0,001; 4) não foi encontrada relação estatisticamente significante entre percentual de IGF-1 em relação à mediana, percentual de IGFBP-3 em relação à mediana e razão dos percentuais de IGF-1 e IGFPB-3 em relação à mediana para os 3 grupos estudados;4) não houve variações nas dosagens de acordo com o tipo de situação determinante do alto risco para câncer de mama (familiar ou histopatológico); 5) não houve alteração estatisticamente significativa das variáveis estudadas, mesmo após subdivisão do grupo de alto risco (risco vitalício entre 20 e 29% X risco vitalício superior a 29%). CONCLUSÃO: Não foi observada variação dos níveis séricos de IGF-I e IGFBP-3 em mulheres com câncer de mama, com alto risco para câncer de mama ou com risco populacional / INTRODUCTION: The rising incidence of breast cancer, a disease that is increasingly affecting young women, has aroused a great deal of interest in early diagnosis and the search for a more efficient and minimally aggressive treatment. Likewise, the population at high risk for breast cancer has been growing, and it is now the focus of research efforts in the struggle to prevent neoplasia. Inspired by Peyrat, who was the first to associate breast cancer with insulin-like growth factor type 1 (IGF-1), several authors have taken on the challenge, and the international literature now leans towards a direct relationship, albeit still controversial, between IGF-1 and breast cancer in premenopause. The IGF binding protein 3 (IGFBP-3) has also been added to the list of cancer-causing agents, but its mechanism of action has not shown to be clearly regular. Targeting a population at high risk for breast cancer for histopathologic or familial reasons, and guided by the mathematical calculations of Gail and Tyrer-Cuzick, this thesis aimed at evaluating the relationship between IGF-1 and IGFB-3 in Brazilian female outpatients at the Mastology Sector of the Gynecology Discipline of the Department of Obstetrics and Gynecology of the School of Medicine of the University of São Paulo. METHODS: Transverse study to compare the serum levels of IGF-1 and IGFBP- 3 measured by the chemiluminescent immunometric method. The patients were divided into 3 different groups: women with untreated breast cancer (n=51), women with a population-based risk of breast cancer (n=66), and women at high risk for breast cancer (n=108). The comparison factors were age, menopausal state, and body mass index. RESULTS: 1) there were no differences among the groups with respect to BMI; 2) but there were statistically significant differences among the groups regarding mean age, and the younger women were those at a higher risk for breast cancer (p<0.001); 3) as for menopausal state, the groups were significantly different, and the postmenopausal women were prevalent among the patients with breast cancer (58.8%; p<0.001); 4) no statistically significant relationship was found between the IGF-1 percentage and the median, the IGFBP-3 percentage and the median, or the IGF-1 and IGFBP-3 ratio and the median in any of the groups; 5) measurements did not vary according to the determinant reason for high breast cancer risk (familial or histopathologic); 6) statistically significant changes in the variables under consideration did not take place, even after subdivision of the high-risk group (lifelong risk between 20% and 29% X lifelong risk over 29%). CONCLUSION: The serum levels of IGF-I and IGFBP-3 showed no variation among women with breast cancer, at high risk for cancer, or with populationbased risk