Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-01-26T10:40:40Z No. of bitstreams: 1 arquivototal.pdf: 1055131 bytes, checksum: bf7d588867a0f2d651fefe75b108fb0f (MD5) / Made available in DSpace on 2016-01-26T10:40:40Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1055131 bytes, checksum: bf7d588867a0f2d651fefe75b108fb0f (MD5) Previous issue date: 2015-04-10 / INTRODUCTION - Parkinson's disease (PD) was first described in the early nineteenth century by James Parkinson. It is characterized by the presence of involuntary trembling movements, decreased muscle strength, tendency to body lean forward and gait. In Parkinson's disease occur several changes that affect the voice and speech. OBJECTIVE - The aim of this study was to compare the immediate effect of exercises Lee Silverman Voice Treatment® method (LSVT) versus Semi-occluded vocal tract in the vocal behavior of patients with Parkinson's disease. METHOD - The chapters have been described in the form of scientific articles, the first is a systematic review of the literature article entitled "Scientific evidence and restrictions of voice treatment in Parkinson's disease: a systematic review", the second is entitled "Evaluation of quality of life and vocal symptoms in view of the patient with Parkinson's disease ", and the third with the title" Comparison of the immediate effect of the Lee Silverman Voice exercises Treatment® versus Vocal Tract Semi-occluded in patients with Parkinson's disease. " RESULTS - The first article highlights the articles found in the forms of treatment: medication, surgical and rehabilitation for Parkinson's disease, referring to the sample of studies, the methods and techniques used and the completion of each study. The main methods and techniques used for vocal rehabilitation found in the article were: LSVT, Ear Monitoring, Wind Instrument and Music Therapy. In the second article the individuals affected by PD reported change in their quality of life and voice and vocal symptoms, which impact on their daily lives, which are arising from the vocal disorder triggered by the disease which have been achieved. And the third article showed that the immediate effects of exercise of the Lee Silverman Voice Vocal Tract Treatment® versus Semi-occluded cause the vast majority of benefits similar to the vocal parameters of acoustic analysis and perceptual evaluation of individuals with PD. CONCLUSION - The scientific production in the voice area that deals with Parkinson's disease is still scarce, the expansion of research that show new options of treatment methods and techniques for the voice that is increasingly necessary. The use of instruments of vocal self-assessment, the population of Parkinson will assist in the evaluation and therapy with the intent to facilitate individual patients' perception of the different aspects of their vocal production. The immediate effect of the vocal tract exercises Semi-occluded with high-strength tube is an effective alternative in voice therapy of Parkinson's disease. / INTRODUÇÃO - A Doença de Parkinson (DP) foi descrita pela primeira vez no início do Século XIX por James Parkinson. É caracterizada pela presença de movimentos tremulantes involuntários, diminuição da força muscular, tendência à inclinação do corpo para frente e alteração da marcha. Na DP, ocorrem diversas alterações que acometem a voz e a fala. OBJETIVO - Comparar o efeito imediato de exercícios do método Lee Silverman Voice Treatment® (LSVT) versus trato vocal semiocluído no comportamento vocal de pacientes com Doença de Parkinson. MÉTODO - Os capítulos foram descritos em forma de três artigos científicos: o primeiro é um artigo de revisão sistemática da literatura intitulado “Evidências científicas e restrições do tratamento da voz na doença de Parkinson: uma revisão sistemática”, o segundo tem o título “Avaliação da qualidade de vida e sintomas vocais na ótica do paciente com Doença de Parkinson”, e o terceiro com o título “Comparação do efeito imediato de exercícios do Lee Silverman Voice Treatment® versus Trato Vocal Semiocluído em pacientes com Doença de Parkinson”. RESULTADOS – O primeiro artigo destaca a revisão sistemática envolvendo artigos com foco no tratamento vocal na DP: medicamentoso, cirúrgico e de reabilitação, detalhou-se as amostras dos estudos, os métodos e técnicas utilizadas e a conclusão de cada estudo. Os principais métodos e técnicas utilizadas para reabilitação vocal encontradas no artigo foram: LSVT, monitoramento auditivo, instrumento de sopro e terapia musical. O segundo artigo é um estudo de campo com indivíduos acometidos pela DP, observou-se a alteração na sua qualidade de vida e voz e sintomas vocais, com impacto no seu dia a dia, sendo estes decorrentes da alteração vocal desencadeada pela doença a qual foram atingidos. O terceiro artigo, outro estudo de campo, mostrou que os efeitos imediatos dos exercícios do Lee Silverman Voice Treatment® versus Trato Vocal Semiocluído provocam, na sua grande maioria, benefícios semelhantes para os parâmetros vocais de análise acústica e de avaliação perceptivo auditiva dos indivíduos com DP. CONCLUSÃO - A produção científica na área de voz que aborda a Doença de Parkinson ainda é escassa, a ampliação de pesquisas que evidenciem novas opções de métodos e técnicas de tratamento para a voz se faz cada vez mais necessária. O uso dos instrumentos de autoavaliação vocal na população de Parkinson irá auxiliar na avaliação, monitoramento e na terapia com a intenção de facilitar a percepção dos pacientes sobre os diferentes aspectos da sua produção vocal. O efeito imediato dos exercícios de trato vocal semiocluído com tubo de alta resistência é uma alternativa eficaz na terapêutica vocal da Doença de Parkinson.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2017-07-06T13:21:53Z No. of bitstreams: 1 arquivototal.pdf: 3483112 bytes, checksum: 875c98f02b865d33871e8bf6439b7afc (MD5) / Made available in DSpace on 2017-07-06T13:21:53Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3483112 bytes, checksum: 875c98f02b865d33871e8bf6439b7afc (MD5) Previous issue date: 2016-02-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Voice disorders may be associated with inappropriate or abusive vocal behavior and, when present, are characterized by hearing and/or sensory symptoms, resulting of the exposure to environmental, organizational and/or personal risk factors. When the prevalence of these disorders in the Brazilian population are wondered, imprecise data is observed by the fact that those researches didn’t used probabilistic sampling procedures for the sample size composition. The purpose of this study is to estimate the prevalence of voice disorders in the adult’s population from the city of João Pessoa – PB, as using a decision model that helps to explain which risk factors are more associate to this disorder. To this achievement, we used a random stratified sampling, where each layer corresponded to one of the five sanitary districts of the city. This way, a minimal sample of 384 volunteers was stipulated. The data collection were realized on 15 family health units and the volunteers were asked to read and, if they agreed, to sign a free and informed agreement term. Then, the participants orally answered to the adapted Vocal Screening Protocol, that had the objective of realize a self-assessment of vocal complaints and vocal satisfaction grade, as verify the frequency of hearing and sensory symptoms and environmental, organizational and personal risk factors. The cutoff point of 16 or more points in the total score of the Vocal Symptoms Scale (VoiSS) was used to determine which of the subjects had a vocal disorder. In positive case, the volunteers were asked to the recording of the /e/ sustained vowel and 1 to 10 counting for further hearing-perceptual evaluation. To determine which of the risk factors were more associated to the upshot “present a vocal disorder by the VoiSS”, a decision model based on logistic regression was used. We verified in our study, the prevalence of 19,8% of voice disorders in the adult’s population from the city of João Pessoa – PB, according to the total score of the Vocal Symptoms Scale. The prevalence of self-referred voice complaints was 16,9%. The more frequent complaints were hoarseness, wrongly speaking, voice failure and stuttering. Individuals with vocal complaints by the VoiSS has smaller satisfaction grade with the own voice, in relation to the others. The population with voice problems according to the VoiSS, has mild to moderate vocal deviation in the parameters of general grade, roughness and breathiness. The most frequent hearing and sensory vocal symptoms were respectively, voice failure and cervical pain. Participants with vocal problems, by the VoiSS, has more vocal symptoms than the others. The most frequent environmental, organizational and personal risk factors were, respectively, dust and/or mold, excessive vocal demand and talking a lot. Vocal risk factors are more common on people with voice problems according to the VoiSS. The decision model based on logistical regression defined that the risk factors more associated to the upshot “present a vocal disorder by the VoiSS” are: stressfully environment, inadequate equipment, irritative products, intense social life, family history of dysphonia, emotional and respiratory problems. / Os distúrbios vocais podem estar associados ao comportamento vocal inadequado ou abusivo e, quando presentes, são caracterizados por sintomas vocais auditivos e/ou sensoriais, decorrentes da exposição a fatores de risco ambientais, organizacionais e/ou pessoais. Quando se aborda a prevalência destes distúrbios na população brasileira, observam-se dados imprecisos pelo fato de que as pesquisas existentes não utilizaram um processo de amostragem probabilística para a composição do tamanho de amostra. Assim, o objetivo deste estudo foi estimar a prevalência dos distúrbios vocais na população de adultos do município de João Pessoa – PB, bem como utilizar um modelo de decisão que ajude a explicar quais os fatores de risco estão mais associados com este distúrbio. Para isto, utilizou-se uma amostragem probabilística por estratificação, onde cada estrato correspondeu a um dos cinco distritos sanitários do município. Dessa forma, uma amostra mínima de 384 voluntários foi estipulada. A coleta de dados foi realizada em 15 unidades de saúde da família e os voluntários foram solicitados a ler e caso concordassem, assinar um Termo de Consentimento Livre e Esclarecido. Em seguida, respondiam oralmente ao Protocolo de Triagem Vocal adaptado, que tinha como objetivo realizar uma autoavaliação de queixas e do grau de satisfação com a voz e verificar apresença frequência de sintomas vocais auditivos e sensoriais e a exposição a fatores de risco ambientais, organizacionais e pessoais. O ponto de corte de 16 ou mais pontos do escore total da Escala de Sintomas Vocais foi utilizada para determinar quais dos indivíduos apresentava distúrbios vocais, em caso positivo o voluntário era convidado a gravação da emissão sustentada da vogal /e/ e contagem de 1 a 10 para posterior análise perceptivo-auditiva. Para determinar quais fatores de risco estavam mais associados com o desfecho “apresentar distúrbio vocal de acordo a ESV”, utilizou-se um modelo de decisão baseado em regressão logística. Verificamos em nosso estudo, a prevalência de 19,8% de distúrbios da voz na população de adultos do município de João Pessoa – PB, de acordo com o escore total da Escala de Sintomas Vocais. A prevalência de queixas vocais autorreferidas nesta população é de 16,9%. As queixas mais frequentes foram rouquidão, falar errado, falhas na voz e gagueira. Indivíduos com problemas vocais a partir da ESV possuem menor grau de satisfação com a própria voz em relação aos demais. A população com problema de voz a partir da ESV apresentam desvio vocal de grau leve a moderado nos parâmetros grau geral, rugosidade e soprosidade. Os sintomas vocais auditivo e sensorial mais prevalentes, são respectivamente falhas na voz e dor cervical. Participantes com problemas vocais apresentam mais sintomas vocais que os demais. Os fatores de risco ambientais, organizacionais e pessoais mais prevalentes são respectivamente, poeira e/ou mofo, demanda vocal excessiva e falar muito. Todos os fatores de risco foram mais frequentes em participantes com problemas na voz através da ESV. O modelo de decisão baseado em regressão logística utilizado define que os fatores de risco mais associados com o desfecho “apresentar distúrbio vocal de acordo a ESV” são: ambiente estressante, equipamento inadequado, produtos irritativos, vida social intensa, histórico familiar de disfonia, problemas emocionais e problemas respiratórios.

Influenza A virus infections are a major cause of morbidity and mortality in the United States and throughout the world. The current vaccine elicits primarily a humoral response that is specific for the external glycoproteins hemagglutinin (HA) and neuraminidase (NA). However, these are the viral proteins that are most susceptible to antigenic shift and drift, and can evade the humoral response. Cytotoxic T lymphocytes (CTL) recognize and lyse virus-infected cells and are important in clearing influenza A virus infections. CTL can recognize epitopes on both the external glycoproteins and the more conserved internal viral proteins. This thesis investigates the hypothesis that there is a broad CTL memory response in humans, and, if boosted by vaccines, these CTL may help clear influenza A virus strains of different subtypes. The CTL repertoire specific for influenza A viruses reported in inbred mice is extremely limited and has focused on a few immunodominant epitopes. We perfonned preliminary bulk culture chromium release assays using human peripheral blood mononuclear cells (PBMC) stimulated with influenza virus strain A/PR/8/34 (H1N1) in vitro. CTL activity was observed against autologous B-lymphoblastoid cell lines (B-LCL) infected with vaccinia constructs that expressed several influenza A viral proteins, including nucleoprotein (NP), matrix (M1), nonstructural 1 (NS1) and polymerase (PB1). This was more diverse than the limited response reported in inbred mice. To further characterize the CTL repertoire in humans, PBMC from healthy adult donors were stimulated and CTL were cloned by limiting dilution. Isolated cell lines were further characterized by their CD4/CD8 surface expression, histocompatibility leukocyte antigen (HLA) restriction, cross-reactive or subtype-specific influenza A subtype recognition, and epitope recognition. CTL lines isolated from three donors recognized epitopes on many different influenza virus proteins. The ELISPOT assay was used to identify the number of IFN-γ- secreting cells and determine the precursor frequency of the CTL specific for the epitopes that were mapped. The precursor frequency of IFN-γ producing CTL ranged from 1 in 4,156 PBMC to 1 in 31,250 PBMC. The precursor frequency for one epitope was below the level of detection of this assay, but most of the memory CTL were readily detected. The cross-reactive or subtype-specific recognition of various human influenza A subtypes by these T cell lines was determined by chromium release assays. Most of the CTL lines recognized B-LCL infected with any of the three influenza A subtypes that have caused epidemics in the last century (H1N1, H2N2, and H3N2) and recognized epitopes on conserved internal influenza viral proteins. Most of the subtype-specific cell lines recognized the surface HA or NA glycoproteins, which are not well conserved between influenza subtypes. Although most of the T cell lines that were characterized were cross-reactive with influenza viruses of human origin, infection of humans with a divergent swine or avian derived strain could cause a global pandemic. To study the human CTL responses to non-human influenza viruses, B-LCL were infected with an Hsw1N1 influenza A virus of swine origin, and cell lines were tested for recognition of these targets in a chromium release assay. Most cell lines lysed the targets infected With the Hsw1N1 subtype to the same degree as targets infected with the human H1N1 strain. Two influenza viruses of duck origin were also tested and were recognized by many of the cell lines. The subtypes of these duck strains were Hav1N1 and H5N2. The isolates of influenza A virus from the Hong Kong outbreak of 1997 were also used to infect targets and analyze recognition by these CTL. We found that approximately 50% of the human T cell lines tested recognized both of the Hong Kong isolates, 25% recognized at least one isolate, and 25% recognized neither isolate to the same degree as the A/PR/8/34 (H1N1) virus. We analyzed the amino acid (aa) changes in the epitopes of the T cells lines from the 25% of cell lines that did not recognize either Hong Kong virus isolate. Non-conservative mutations were found in all of the epitopes that lost recognition by the human CTL lines. Bulk cultures of PBMC from three donors that were stimulated with A/PR/8/34 (H1N1) influenza A virus of human origin recognized all of the non-human virus strains tested. Thus, humans have memory CTL that recognize influenza viruses of avian and swine species. This may provide a second line of defense against influenza infection in case of exposure to a novel influenza A virus derived from these species. These results made it clear that humans have broad CTL memory to influenza A virus. In order to determine whether these T cells could be boosted in a vaccine, immune-stimulatory complexes (Iscom) incorporating inactivated influenza particles were tested in vitro. Iscoms containing inactivated influenza A vaccine (Flu-Iscom) were used to pulse autologous B-LCL overnight that were then used as targets in chromium release assays with human CTL lines as effectors. A CD8+ HA-specific CTL line lysed these targets, but not targets pulsed with Iscoms alone or with inactivated influenza A vaccine alone. An NS1-specific cell line recognized targets pulsed with NS1 protein and Iscoms, but not targets pulsed with Iscoms or NS1 protein alone. Therefore, CTL could recognize in vitrotarget cells that were exposed to the Iscom vaccines containing their specific epitope. Flu-Iscom and Iscom mixed with inactivated influenza virus particles (Flu-Iscomatrix) were then used as vaccines in a clinical trial to test CTL and neutralizing antibody induction against influenza. Fifty-five donors were bled pre-vaccination, and on days 14 and day 56 post-vaccination. Bulk culture chromium release assays were performed using targets infected with live vaccine strain viruses. There were significantly more increases in the influenza A specific CTL activity in the PBMC of donors that were vaccinated with the Flu-Iscom and Flu-Iscomatrix vaccines than in recipients of the standard vaccine. In order to determine whether these increases in cytotoxicity were due to an increase in the precursor frequency of influenza specific CTL, the PBMC were used in ELISPOT assays to assess the changes pre-and post-vaccination. When there was an increase in the level of cytotoxicity detected in bulk culture CTL, there was often also an increase in the precursor frequency of influenza-specific CTL. Peptide-specific increases in the number of CTL that recognize epitopes such as M1 aa 58-66 were detected in several donors confirming the increase in influenza-specific CTL post-vaccination. Another type of T cell that may be involved in defense against viruses is the γδ T cell. T cells expressing the γδ T cell receptor (TCR) have been found extensively in mucosal tissues in mice and humans. Influenza A viruses enter via the airway tract, infecting the epithelial cells at the mucosal surface. These epithelial cells have been shown in vitro to be targets for influenza-specific cytolytic recognition of αβ T cells. To analyze whether γδ T cells can respond to influenza A-infected APCs, PBMC were stimulated with influenza A virus. Intracellular IFN-γ staining was used to determine whether γ/δ T cells can secrete IFN-γ in response to the influenza A virus infection. We observed an increase in the percentage of γ/δ T cells secreting IFN-γ post-influenza A virus infection of PBMC compared to uninfected or allantoic fluid-stimulated cultures. These T cells also upregulated CD25 and CD69 in response to live influenza A virus. We focused on the responses in the CD8- population of γδ T cells, which are the majority of γδ T lymphocytes. Furthermore, the increases in IFN-γ production and activation marker expression were much more clear in the CD8- γδ+ T cells. The level of CD8- γδ T cell activation with inactivated influenza A virus was much less, and in some cases no higher than uninfected PBMC. The CD8+ αβ and γδ responses could be partially blocked by anti-class I antibodies, but the CD8- γδ responses could not. Vaccinia virus infection did not activate the CD8- γδ T cells to the same degree as influenza virus infection. γδ T cells are thought to have a regulatory role that includes the secretion of cytokines and epithelial growth factors to help restore tissue back to health. Humans have broad multi-specific T lymphocyte responses by αβ T cells to influenza A viruses and those responses are cross-reactive with human, avian, and swine virus strains. These CTL can be activated in vitro and boosted in number in vivo by Iscom incorporating vaccines. There is also a population of γδ+ T lymphocytes in humans that responds to influenza virus infection by producing cytokines and becoming activated. Increasing memory CTL as a second line of defense against influenza A viruses may be important in future vaccine development.

Introdução A educação médica sofreu transformações ao longo do século XX. Alguns educadores médicos já reconheceram o problema do modelo centrado na doença e focado em condições não usuais de pacientes hospitalizados e a carência do ensino sobre problemas comuns de saúde. O termo ecologia do cuidado médico é como se conhece a relação entre as pessoas e os cenários de saúde. Esse conceito foi introduzido em 1961 por K. White (e atualizado por Green em 2001), que mostrou graficamente a proporção de pessoas que utilizaram serviços de saúde no período de um mês. Esses resultados influenciaram organizações do sistema de saúde, pesquisa científica e educação médica ao longo dos anos. Objetivos Reavaliar a ecologia médica, agora na população brasileira, identificando, no período de um mês, o número de pessoas que apresentaram sintomas, qual atitude tomaram em relação a eles e comparar as queixas apresentadas com o conteúdo dos livros tradicionais de clínica médica. Métodos Entrevistas telefônicas realizadas por auxiliares de enfermagem a 1.065 participantes consecutivos de uma empresa de convênio médico no período de maio de 2008 a fevereiro de 2009 em São Paulo. Resultados Dos entrevistados, 70% eram mulheres e a idade média foi de 68 anos. No período de 30 dias, em 1.000 pessoas: 398 apresentaram algum sintoma; a maioria (292) procurou consulta ambulatorial; 99 buscaram resolver a queixa no pronto-socorro; 59 foram internadas e 1 foi internada em um hospital universitário. Os sintomas mais encontrados foram: dor em extremidades (10%), mal-estar (10%), lombalgia (8%), cefaleia (6%) e dor articular (6%). Foram 5 livros selecionados; Harrinson, Cecil, Current e Tratado de Clínica Médica AC Lopes e Clinica Médica Milton Arruda e colaboradores, um dos sintomas mais frequentes, como lombalgia, é abordado em 4 a 13 páginas, dor em membros em 0 a 4 páginas e fadiga/mal-estar são discutidos em 2 a 4 páginas dentre todo o conteúdo desses livros. Os sintomas inespecíficos não foram abordados nesses livros. Discussão O cenário que as pessoas procuram com maior frequência é o ambulatorial e também o prontoatendimento. A internação em um hospital universitário ocorreu para 1 em 1.000 participantes. Os sintomas encontrados foram abordados muito pouco nos livros consagrados de medicina. O ensino do estudante de medicina hoje, na maioria das universidades, não guarda correlação direta com o perfil epidemiológico da população, sendo necessário formar melhor os estudantes de medicina para manejarem as doenças dos pacientes nos locais de atendimento em que futuramente prestarão serviços / Background Medical education has gone through several transitions during the twentieth century, and medical educators recognize the problems inherent to hospital-centered learning: treating rare conditions and involving medical subspecialties very frequently resulting in lack of continuity care. Today, we talk about fragmentation of medical education for both students and patients. This goes far from meeting the real needs of the general population. The expression medical ecology is a conceptual framework to describe the relationship and utilization of medical care by a given population. Introduced by White in 1961 (updated by Green in 2001), the results of these studies have had great impact and influenced ideas regarding organization of health services, research and education. Objectives To analyze the ecology of medical care in a Brazilian population. First, we have aimed to quantify the number of people who demonstrated symptoms in a previous month and considered seeking health care in any one of the following settings: patient does not seek medical care; a physicians office; office of complementary/alternative medicine professional; emergency department; patients home; hospital and university hospital. We have also compared the prevalence of reported symptoms with number of pages of traditional textbooks that discussed these symptoms. Design and Participants The survey was based on telephone interviews in a health insurance company of São Paulo from may/2008 to feb/2009 Results Patients responding (1.065) included 70% women with a mean age of 68 years old; 398 people felt some symptoms in a month; 292 people were in a consultation; 99 have visited an emergency room; 59 were hospitalized and 1 per thousand was admitted in a university hospital. The most prevalent symptoms were: pain in extremities (10%), fatigue (10%), back pain (8%), headache (6%), and joint pain (6%). They are not discussed enough in medical graduation. 5 books were analyzed: Harrinson, Cecil, Current, Tratado de Clínica Médica AC Lopes and Clinica Médica Milton Arruda et al. One of the most prevalent symptoms such as back pain is covered in 4 to13 pages, joint pain in 0 to 4 pages, and fatigue corresponded to 2 to 4 pages, medically unexplained symptoms werent found. Discussion The services people have sought most frequently were ambulatory settings, followed by emergency rooms. Admission to a teaching hospital occurred for one participant in 1,000. The symptoms observed were little discussed in medicine textbooks. The teaching of medical students today in most universities has no direct correlation with the epidemiological profile of the population, being necessary to train medical students to manage the illness of patients in scenarios where they will serve in the future

Objetivo: Rastreamento de anemia em adultos usuários de um serviço de Atenção Básica atendidos pelo Programa de Saúde da Família em área de baixa renda da cidade de São Paulo Desenho: Transversal Local: O estudo foi conduzido numa Unidade de Atenção Básica usando a estrutura do Programa Saúde da Família Casuística: Todos os 1067 adultos, dos 18 aos 65 anos, moradores de três micro-áreas atendidas por uma equipe de saúde da família numa Unidade de Atenção Básica foram convidados para participarem do estudo. Métodos: Os participantes responderam a questionários sobre aspectos sociodemográficos, sintomas de anemia, alcoolismo, transtornos mentais comuns (SRQ-20) e qualidade de vida (SF-36), eles também foram submetidos a uma avaliação clínica e coleta de sangue para realização do hemograma. Resultados: De 1048 indivíduos elegíveis, 532 responderam aos questionários e 475 destes tiveram seus hemogramas realizados. A freqüência encontrada de anemia foi de 6,5% (4,5- 9,1), e 87% dos casos foram de anemia leve (>=10g/dL). Houve predomínio de anemia ferropriva (41,9%). Observou-se que entre os portadores de anemia o desemprego foi mais freqüente (p=0,04). Os sintomas associados com anemia foram anorexia (p=0,03) e intolerância ao frio (p=0,03). Entre os indivíduos do sexo masculino, os portadores de anemia tiveram mais sintomas psiquiátricos (p=0,04) em relação ao sexo feminino. Os domínios do SF-36 que tiveram relação com anemia foram limitação física (p<0,01) e aspectos sociais (p=0,03). Não se encontrou associação com alcoolismo (p=0,76) e com sinais de anemia. Não se encontrou correlação entre valores de hemoglobina e escores de transtornos mentais comuns, alcoolismo e qualidade de vida. Após regressão logística dos fatores relacionados à anemia - desemprego, anorexia, intolerância ao frio, transtornos mentais comuns em homens, limitação física e aspectos sociais, apenas o domínio limitação física, do questionário de qualidade de vida, teve associação com anemia. Discussão: A freqüência de anemia foi de 6,5% (4,5- 9,1), houve predomínio de anemia leve e do tipo ferropriva. A limitação física, após ajuste multivariado foi o único domínio do SF-36 associado com a anemia. / Objective: Screening for anemia in adult users of a primary care unity of the Family Health Program in a low income area of the city of Sao Paulo. Design: Cross-sectional study. Setting: The study was carried out at a primary care unit using the structure of the Family Health Program. Subjects: All 1067 adults aged between 18-65 years living in three particular micro-areas attended by a family health team were invited to take part in the study. Methods: The participants answered questionnaires about socio-demographic factors, anemia symptoms, alcoholism, common mental disorders (SRQ-20) and quality of life (SF-36). They were also submitted to a clinical examination in which a blood sample was taken for total blood cell count. Results: Of the 1067 adult residents in the three micro-areas, 1048 took part in the study. However, only 532 of those responded to the questionnaires and 475 had their total blood cell count accomplished. The frequency of anemia found was 6.5 % (4.5- 9.1), 87% of which showed a mild form (>=10g/dL) of the disease. Anemia was observed to be more frequent among unemployed subjects (p=0.04). The most common symptoms associated with the disease were anorexia (p=0.03) and cold intolerance (p=0.03). Male anemia sufferers displayed more psychiatric symptoms (p = 0.04) than female ones. The SF-36 factors found to be more related to anemia were physical limitations (p<0.01) and social aspects (p=0.03). No association was found between anemia and alcoholism (p=0.76). No correlation was found between hemoglobin values and scores of common mental disorders, alcoholism and quality of life. After logistical regression of the factors related to anemia (i.e. unemployment, anorexia, cold intolerance, mental disorders common to men, physical limitation and social aspects), only the physical limitation domain of the questionnaire about quality of life had association with anemia. Discussion: The frequency of anemia was 6.5% (4.5- 9.1), most anemia cases were of mild form and caused by iron deficiency. After a multi-varied logistical adjustment, physical limitation was found to be the only SF-36 domain associated with anemia.

Made available in DSpace on 2014-07-29T15:30:38Z (GMT). No. of bitstreams: 1 Dissertacao Jose Laerte Rodrigues da Silva Junior.pdf: 1539460 bytes, checksum: 734766715ffd43b1be965ce4c8870c7a (MD5) Previous issue date: 2011-11-17 / Objectives: To evaluate the effect of the climate seasonality on the occurrence of respiratory symptoms in patients attending a primary health unit in a tropical city. Methods: We conducted a cross-sectional study on subjects attending an out-patient primary health unit in relation with meteorological data collected daily. During one year, forty-four cross-sectional observations categorized by season were made. The observations were chosen randomly, in twelve-hour intervals (7am to 7pm). Analysis of variance was used to compare means across seasons. Pairwise correlation was conducted to verify the association between the number of patients and each meteorological variable. A model of autoregressive moving average with exogenous variables was conducted to evaluate the ability of the meteorological variables to predict the proportions of subjects with respiratory symptoms on each season. Results: Among the 3,354 subjects enrolled, 14.6% had respiratory symptoms. The temperature variation was not enough to change the number of individuals with respiratory symptoms, however there was an increase of subjects with respiratory symptoms coinciding with low levels of humidity during winter, with a statistically significant difference between seasons (p=0,01). Correlation showed that the mean of previous three days minimum air humidity correlates negatively with the number of respiratory subjects (p < 0.04). An ARMAX model that included the same variable showed a statistically significant coefficient (p < 0.0001). Conclusion: In a Brazilian city with tropical weather, the number of subjects with respiratory symptoms attending a primary health unit is increased with the reduction of air humidity and it is possible that this increase could be predicted by meteorological data. / Objetivo: Avaliar o efeito da sazonalidade climática na ocorrência de sintomas respiratórios nos indivíduos que procuraram uma Unidade Básica de Saúde em uma cidade de clima tropical. Métodos: Foi realizado um estudo de corte transversal relacionando os indivíduos que procuraram assistência médica em uma Unidade Básica de Saúde com dados meteorológicos coletados diariamente. Durante um ano, quarenta e quatro observações foram realizadas, onze em cada estação. O dia de cada corte transversal foi escolhido de forma aleatória e ocorreu em intervalos de 12 horas. Análise de variância (ANOVA) foi usada para comparação das médias das variáveis dependentes em cada estação. Correlação pareada foi conduzida entre as variáveis dependentes e cada variável meteorológica. Um modelo auto-regressivo, de média móvel com variável exógena (ARMAX) foi empregado para avaliar a capacidade das variáveis meteorológicas em prever a proporção de indivíduos com sintomas respiratórios em cada estação do ano. Resultados: Entre os 3.354 indivíduos incluídos, 14,6% possuíam sintomas respiratórios. A variação de temperatura não foi suficiente para provocar mudanças no número de indivíduos com sintomas respiratórios, porém houve aumento destes indivíduos coincidindo com baixos níveis de umidade no inverno, com diferença estatisticamente significativa entre as estações (p=0,01). Foi observado que a média da umidade relativa mínima dos três dias que antecederam as observações correlacionou-se negativamente com o número de indivíduos com sintomas respiratórios (p<0,04) e um modelo ARMAX que incluiu a mesma variável apresentou um coeficiente estatisticamente significativo (p<0,0001). Conclusão: Em uma Unidade Básica de Saúde de uma cidade de clima tropical, o número de indivíduos com sintomas respiratórios aumenta com a redução da umidade relativa do ar e existe possibilidade de esse aumento ser previsto a partir de dados meteorológicos.

INTRODUÇÃO: O envelhecimento é um processo contínuo e dinâmico que produz alterações biopsicossociais que culminam com a morte. Embora normais, tais alterações acabam por comprometer a Qualidade de Vida (QV) dos idosos. Dentre elas cabe citar: aposentadoria, viuvez, mudanças de papéis na família e na sociedade, falta de motivação e dificuldade de planejar o futuro, deficiências orgânicas, entre outras. Muitos idosos conseguem adaptar-se e conviver com essas alterações enquanto outros não as aceitam e se tornam vulneráveis ao surgimento de doenças tais como a insônia e a depressão. OBJETIVOS: identificar a presença de insônia em idosos institucionalizados; avaliar a presença de sinais e sintomas depressivos em idosos institucionalizados; verificar a percepção dos idosos institucionalizados em relação à sua QV; comparar a QV nos idosos institucionalizados insones e nãoinsones; comparar os idosos institucionalizados no que se refere à presença de sinais e sintomas depressivos entre insones e não- insones; correlacionar sinais e sintomas depressivos e QV no grupo de insones comparado ao de não-insones; comparar com grupo comparativo os itens citados acima. MÉTODOS: o estudo foi realizado no asilo \"São João Bosco\" e no centro de convivência dos idosos \"João Nogueira Vieira\", ambos situados em Campo Grande-MS; Utilizou-se o Mini-Exame do Estado Mental, o WHOQOL-breve, a Escala de Avaliação para Depressão de Hamilton e o Questionário de Sono do Adulto de Giglio. RESULTADOS: no que se refere aos idosos institucionalizados: 77,8% apresentou insônia inicial, 47,2% apresentou insônia intermediária e 16,7%, insônia final enquanto que no grupo comparativo 25,8% apresentou insônia inicial, 42,8% insônia intermediária e 18%, insônia final; em relação aos sinais e sintomas depressivos, 52,8% dos idosos institucionalizados e 18% do grupo comparativo apresentou-os; quanto à percepção da \"Qualidade de Vida\", 72,2% dos idosos institucionalizados referiu estar \"nem satisfeito/nem insatisfeito\" em relação ao \"domínio social\" assim como 91,6% em relação ao domínio \"psicológico\" e 50% quanto ao domínio \"físico\" enquanto 88,9% relatou estar \"insatisfeito\" quanto ao domínio \"ambiente\" enquanto 79,4% do grupo comparativo referiu estar \"satisfeito\" em relação ao domínio \"relações sociais\", 84,6% relatou estar \"insatisfeito\" em relação ao domínio \"ambiente\" e a maioria informou estar \"nem satisfeita/nem insatisfeita\" quanto ao domínio \"psicológico\" (61,5%) e \"físico\" (87,2%). CONCLUSÃO: houve maior ocorrência de insônia nos idosos institucionalizados; houve maior ocorrência de sinais e sintomas depressivos nos idosos institucionalizados; houve diferença na percepção da QV entre os idosos institucionalizados e o grupo comparativo; ocorreu diferença na percepção da QV entre os idosos institucionalizados insones e não-insones; os sinais e sintomas depressivos foram mais freqüentes nos idosos institucionalizados insones em relação aos não-insones; houve diferença na percepção negativa da QV entre os idosos institucionalizados insones e com sinais e sintomas depressivos em relação aos nãoinsones e com sinais e sintomas depressivos / INTRODUCTION: Growing old is a dynamic and continuous process, however biopsychosocial ordinary changes can compromise quality of life and also lead senior citizens to death. Several elderly citizens can adapt themselves to those changes and live longer, while others become vulnerable to the emergence of illnesses like insomnia and depression. OBJECTIVES: identify insomnia in institutionalized senior citizens; evaluate depressive signs and symptoms in institutionalized senior citizens; check institutionalized senior citizens\'s perceptions as to their quality of life; compare signs and citizens and quality of life in institutionalized senior citizens; compare depressive signs and symptoms and quality of life in senior citizens; correlate depressive signs and symptoms and quality of life between the insomniac and non-insomniac group of institutionalized senior citizens and compare the items above with comparative group; METHODOLOGY: the study was conducted at \"São João Bosco\" Asylum and with senior citizens who joined a contact center for the elderly called \"João Nogueira Vieira\" (composing the comparative group), both in the city of Campo Grande, MS. Data were obtained from Mini-Mental State, brief - WHOQOL test, Hamilton Depression Rating Scales and Giglio\'s Sleep Questionnaire. RESULTS: concerning occurrence of insomnia 77.8% of institutionalized senior citizens reported initial insomnia, 47.2% had intermediate insomnia and 16,7% had final insomnia while 25.8% presented initial insomnia, 42.8% intermediate insomnia and 18.0% final insomnia; as to depressive signs and symptoms 52.8% of institutionalized senior citizens showed those while the larger part of comparative group did not manifest either feature; the subjective perception of institutionalized senior citizens regarding \"quality of life\" pointed that 72.2% of them felt neither \"satisfied nor unsatisfied\" as to \"social relationship\", \"psychological\" (91.6%) and \"physical\" (50.0%) and 88.9% referred \"unsatisfied\" about \"environmental\" domain of WHOQOL-bref while comparative group members showed 79.5% being \"satisfied\" with \"social relationship\" domain, the large majority neither \"satisfied nor unsatisfied\" with \"physical\" (87.2%) and \"psychological\" domains and 84.6% were \"unsatisfied\" about \"environmental\" domain of WHOQOL-bref. CONCLUSIONS: greater occurrence of insomnia was found in institutionalized senior citizens than in comparative group; greater occurrence of depressive signs and symptoms in institutionalized senior citizens than in comparative group; significant difference was detected in perception of quality life among institutionalized senior citizens and comparative group; institutionalized senior citizens displayed worse quality of life in physical environmental and social relationship domains of WHOQOL, and global and subjective perception of quality of life, results showed and in health, more incidence of depressive signs and symptoms in insomniac institutionalized senior citizens; insomniac institutionalized senior citizens with depressive signs and symptoms referred being more affected in environmental and social relationship

Master of Public Health - MPH / Introduction:Highest-risk malaria areas in South Africa share borders with Mozambique, Swaziland and Zimbabwe. Ongoing migration between these neighbouring areas impacts on malaria control interventions. For example, 30% of the adult population in Bushbuckridge originate from Mozambique. Despite these dynamics, no studies were found which investigated knowledge,attitudes and behaviours towards malaria in Bushbuckridge. Methods:This study was undertaken as a descriptive cross-sectional survey. A field-piloted structured questionnaire was administered to 602 randomly selected households, where only one household member was interviewed. Interviewees were heads of households, but in their absence, responsible adults above 18 years were included.Results:Of 602 respondents, 93% (n=559, 95% CI: 90.4 – 94.7%) had heard about malaria, mainly from health facilities (29%, n=175) and radios (20%,n=119). Most respondents correctly associated malaria with mosquito bites. There were no differences in knowledge of the causes of malaria between males and females, whereas age and educational level influenced malaria knowledge.Younger and more educated respondents were more knowledgeable than their older and less educated counterparts. Despite 91% of respondents (n=546, 95% CI: 88.0 – 92.8%) knowing that malaria can kill if untreated; only 48% could identify one or two symptoms of malaria. Most (99%, n=595, 95% CI: 97.5 – 99.5%) of the respondents would seek treatment at health facilities,82% (n=488) of whom would do so within 24 hours of onset of malaria symptoms.Discussion and conclusion : Most respondents showed a fair amount of knowledge on the causes of malaria, but not enough people were able to correctly identify the key symptoms of malaria. Health facility and radio were the main sources of malaria information. Most respondents sought treatment at health care facilities, contrary to most African countries where treatment is first sought at non-public health facilities.Word count: 288

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines. Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured. Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity. Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.

Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification. Aims and Findings: (1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). (2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks. (3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB. Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.