Orientador: Fabio Ramoa Pires / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T19:21:56Z (GMT). No. of bitstreams: 1 Azevedo_RebecadeSouza_D.pdf: 3976330 bytes, checksum: c8e93167e95f91aad2f31f4a0a284024 (MD5) Previous issue date: 2009 / Resumo: O objetivo deste trabalho foi avaliar a freqüência relativa e os aspectos demográficos, clínicos, radiográficos e histopatológicos de uma série de tumores odontogênicos (TO) oriundos dos arquivos de 3 serviços de histopatologia bucal e 1 de histopatologia geral da cidade do Rio de Janeiro no período entre 1970 e 2008, após adequação de seu diagnóstico aos critérios da classificação elaborado pela Organização Mundial da Saúde (OMS) em 2005. Foram revisados 568 TO, representando 3,8% do total das amostras de biópsia da região oral e maxilofacial. A idade média dos pacientes foi de 32,4 anos, com variação entre 3 e 83 anos e maior distribuição na 2ª e 3ª décadas de vida. A relação homen-mulher foi de 1:1.2 e a maioria dos pacientes tinha cor de pele branca (57,9%). Do total, 559 tumores localizavam-se no interior dos ossos gnáticos, 393 na mandíbula (70,3%) e 147 na maxila (26,3%), especialmente na região posterior e anterior, respectivamente. A distribuição dos 568 TO encontrados indicou 191 tumores odontogênicos queratocísticos, 174 ameloblastomas, 76 odontomas, 31 tumores odontogênicos císticos calcificantes, 26 mixomas/fibromixomas odontogênico, 13 cementoblastomas, 11 fibromas odontogênicos, 10 tumores odontogênicos adenomatóides, 7 fibro-odontomas ameloblásticos, 6 tumores odontogênicos epiteliais calcificantes, 4 fibromas ameloblásticos, 3 tumores odontogênicos escamosos, 3 tumores dentinogênicos de células fantasmas, e 6 carcinomas odontogênico, incluindo 3 carcinomas espinocelulares intraósseos primários, 2 carcinomas ameloblásticos e 1 carcinoma odontogênico de células claras. Foram ainda encontrados 7 tumores odontogênicos não-classificáveis. Os TO são lesões incomuns nesta população brasileira, em que as lesões malignas são extremamente raras. O paciente é mais freqüentemente do gênero feminino, de cor de pele branca entre 10 e 29 anos de idade, e as lesões envolvem principalmente a região posterior da mandíbula como uma imagem radiolúcida unilocular de limites precisos. A freqüência relativa e a distribuição das informações demográficas, clínicas, radiográficas e histopatológicas dos subtipos histológicos mostraram semelhanças com a encontrada na literatura revisada de diferentes países, excluindo-se o tumor odontogênico queratocístico. / Abstract: The aim of this study was to evaluate the relative frequency and demographical, clinical, radiological and pathological features of a series of odontogenic tumors (OT) from the files of 3 oral histopathology services and 1 general histopathology service from the city of Rio de Janeiro in the period from 1970 to 2008, after reviewing their final diagnosis according to the diagnostic criteria elaborated by the World Health Organization in 2005. A total of 568 OT was reviewed, representing 3,8% of all oral and maxillofacial biopsy samples. Mean age of the patients was 32.4 years-old, ranging from 3 to 83 years, with most cases in the 2nd and 3rd decades of life. The male-female ratio was 1:1.2 and most patients were Caucasians (57.9%). From the total, 559 OT were centrally located on maxillary bones, being 393 in the mandible (70.3%) and 147 in the maxilla (26.3%), especially in the posterior and anterior regions, respectively. Distribution of the 568 OT revealed 191 keratocystic odontogenic tumors, 174 ameloblastomas, 76 odontomas, 31 calcifying cystic odontogenic tumors, 26 odontogenic myxomas/fibromyxomas, 13 cementoblastomas, 11 odontogenic fibromas, 10 adenomatoid odontogenic tumors, 7 ameloblastic fibro-dontomas, 6 calcifying epithelial odontogenic tumors, 4 ameloblastic fibromas, 3 squamous odontogenic tumors, 3 dentinogenic ghost cell tumors and 6 odontogenic carcinomas, including 3 cases of primary intraosseous squamous cell carcinomas, 2 ameloblastic carcinomas and 1 clear cell odontogenic carcinoma. Also, 7 OT were considered non-classifiable. OT are uncommon lesions in this Brazilian population, and malignant lesions are extremely rare. The patient is more commonly female, Caucasian, between 10 and 29 years-old, and the lesions occur in the posterior mandible as a well-defined unilocular radiolucency. The relative frequency and distribution of the demographical, clinical, radiological and pathological information obtained from each histological subtype showed similarities to the revised literature from different countries, excluding the keratocystic odontogenic tumor. / Doutorado / Patologia / Doutor em Estomatopatologia

Institution spécialisée du système des Nations Unies créée à la sortie de la Seconde guerre mondiale, l'Organisation mondiale de la santé (OMS) s'est vu confiée, par l'article premier de sa Constitution, le but « d'amener tous les peuples au niveau de santé le plus élevé possible ». Pour atteindre cet objectif, les États membres lui ont conféré vingt-deux fonctions dont une normative. Cette dernière lui permet, en théorie, d’adopter à la fois des instruments de santé non contraignants et d'autres contraignants. L'étendue du champ d'application de cette fonction permet à l'OMS d'élaborer des normes au contenu très divers et varié dès lors qu'elle agit dans le cadre de son objectif sanitaire. Parallèlement, en raison de difficultés internes, propres à son organisation régionalisée et à une concurrence externe accrue par la multiplication d'acteurs de santé mondiale, l'OMS est à un tournant de son histoire comme en atteste l'envergure de la réforme qui est toujours en cours depuis 2010. Dans ce contexte, il s'agit de comprendre et d'analyser l'influence du rôle normatif de l'OMS dans les systèmes de santé nationaux. D'abord, une évaluation de son autorité normative, qui apparaît affaiblie, est proposée afin de présenter des évolutions pour la renforcer et ainsi améliorer la protection de la santé mondiale au sein d'un droit international de la santé consolidé. Ensuite, l'étude approfondie de son activité normative est envisagée pour délimiter la conception de la norme de l'OMS par le prisme de son efficacité. L'objectif in fine est de proposer une réflexion sur l'avenir du rôle normatif de l'OMS. / The World health organization (WHO), as a specialized agency, was created, after the Second world war with the objective of, according to article 1 of its Constitution, the "attainment by all peoples of the highest possible level of health”. For that purpose, the WHO was granted twenty two functions by the Member States including a normative one. This normative function allows, in theory, the WHO to adopt both binding and non binding health instruments. The extent of the scope of this function offers a wide and diverse content to theses norms with the only limit that it pursues a health purpose. At the same time, the WHO shows internal difficulties, in part, due to its regional structure and overall lack of financing. Further, the increase number and diversity of actors of global health result in potential external competition with the WHO. The reform initiated in 2010 and still ongoing proves that the WHO is a turning point in its history. In this context, this research seeks to understand and analyze the influence of the normative role of the WHO on national health systems. First, we study the normative authority of the WHO which appears weakened. With the objective of increasing health protection based on a reinforced global health law paradigm, our proposals aim at strengthening the normative authority of WHO. Then, our in-depth analysis of the normative activity of the WHO allows to the define the conception of norm by the WHO using effectiveness as our analytical frame. Finally, this research offers an opportunity to reflect on the future of the normative role of the WHO.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-1Oand DSM-IlI-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-II-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

My thesis is focused on the composition and countries' representation in the professional staff of the World Health Organization. The thesis will analyse the overrepresentation and underrepresentation of the WHO's member states and explain possible patterns in the staff. The thesis will focus on the relationship between the number of Member State's professional staff in the WHO and the state's GDP growth, expenditure on education and population size. My thesis aims to research the characteristics of staff's composition in the WHO. I will analyse professional staff structure and apply the Principal-Agent theoretical framework. The research will show how the state's representation of member states changed over time and see also the gender composition of the Secretariat. The timeline of this work is from 1999 till 2019. The thesis works with official documents from human resources of the WHO and datasets of the World Bank. Analysis of data is provided by the statistical programme SPSS and Microsoft Excel. Key words World Health Organization, representation, professional staff, principal-agent theory, correlation coefficients, regression analysis

>Magister Scientiae - MSc / Background: Despite the effort of scientific research on HIV therapies and to reduce the rate of HIV infection, AIDS still remains one of the major causes of death in the world and mostly in Sub-Saharan Africa. To date, neither a cure, nor an HIV vaccine had been found and the disease can only be managed by using High Active Antiretroviral Therapy (HAART) if detected early. The need for an effective early diagnostic and non-toxic therapeutic treatment has brought about the necessity for the discovery of additional HIV diagnostic methods and treatment regimens to lower mortality rates. Antimicrobial Peptides (AMPs) are components of the first line of defence of prokaryotes and eukaryotes and have been proven to be promising therapeutic agents against HIV. Methods: With the utility of computational biology, this work proposes the use of profile search methods combined with structural modelling to identify putative AMPs with diagnostic and anti-HIV activity. Firstly, experimentally validated anti-HIV AMPs were retrieved from various publicly available AMP databases, APD, CAMP, Bactibase and UniprotKB and classified according to super-families. Hidden Markov Model (HMMER) and Gap Local Alignment of Motifs (GLAM2) profiles were built for each super-family of anti- HIV AMPs. Putative anti-HIV AMPs were identified after scanning genome sequence databases using the trained models, retrieved AMPs and ranked based on their E-values. The 3-D structures of the 10 peptides that were ranked highest were predicted using 1-TASSER. These peptides were docked against various HIV proteins using PatchDock and putative AMPs showing highest affinity and having the correct orientation to the HIV -1 proteins gp 120 and p24 were selected for future work so as to establish their function in HIV therapy and diagnosis. Results: The results of the in silica analysis showed that the constructed models using the HMMER algorithm had better performances compare to that of the models built by the GLAM2 algorithm. Furthermore, the former tool has better statistical and probability explanation compared to the latter tool. Thus only the HMMER scanning results were considered for further study. Out of 1059 species scanned by the HMMER models, 30 putative anti-HIV AMPs were identified from genome scans with the family specific profile models after elimination of duplicate peptides. Docking analysis of putative AMPs against HIV proteins showed that from the 10 best performing anti-HIV AMPs with the highest Escores, molecules 1,3, 8 and 10 firmly binds the gp120 binding pocket at the VIN2 domain and at the point of interaction between gp120 and T cells, with the 1st and 3rd highest scoring anti-HIV AMPs having the highest binding affinities. However, all 10 putative anti-HIV AMPs bind to the N-terminal domain of p24 with large surface interaction, rather than the C-terminal. Conclusion: The in silica approach has made it possible to construct computational models having high performances, and which enabled the identification of putative anti-HIV peptides from genome sequence scans. The in silica validation of these putative peptides through docking studies has shown that some of these AMPs may be involved in HIV/AIDS therapeutics and diagnostics. The molecular validation of these findings will be the way forward for the development of an early diagnostic tool and as a consequence initiate early treatment. This will prevent the invasion of the immune system by blocking the VIN2 domain and thus designing of a successful vaccine with broad neutralizing activity against this domain.

Cardiovascular diseases (CVDs) are a leading cause of death worldwide, emphasizing the need for advanced and effective intervention and treatment measures. Hypertension, a significant risk factor for CVDs, is characterized by reduced vascular compliance in arterial vessels. There is a significant rise in interest in exploring the viscoelastic properties of arteries in the last few years, for the treatment of these diseases. This study aims to develop an experimental setup using 3D Printing Technology to test viscoelastic arterial models for the validation of a diagnostic device for cardiovascular diseases. The research investigates the selection of polymer-based materials that closely mimic the viscoelastic properties of arterial vessels. An experimental setup is designed and fabricated to perform mechanical tests on 3D-printed specimens. The study utilizes a mathematical model to describe the viscoelastic behavior of the materials. The model's predictions are validated using experimental data obtained from the mechanical tests. This study demonstrates the potential of 3D printing technology in fabricating specimens using elastic and flexible resin materials. These specimens closely replicate the mechanical properties of native arteries, offering a tangible platform for controlled mechanical testing. Stress relaxation tests on the3D printed specimens highlight the viscoelastic properties of fabricated materials, shedding light on their behavior under strain. The study goes further to model the mechanics of these materials, utilizing the Fractional Voigt model to capture the intricate balance between elastic and resistive behaviors under varying deformation levels. The results highlight the successful fitting of the Fractional Voigt model to the experimental data, confirming the viscoelastic behavior of the specimens. The obtained values of α and RMSE indicate a good representation of arterial mechanical properties within the viscoelastic arterial model, under different loading conditions. This research contributes to improving cardiovascular device validation and offers a practical and reliable alternative to invasive experiments. Future works include exploring different materials and conditions for arterial modeling and enhancing the precision and scope of the viscoelastic model. Overall, this study advances the understanding of cardiovascular biomechanics, contributing to the development of more effective diagnostic devices for cardiovascular diseases.

Vaccine Hesitancy is a critical public health issue that threatens global health security, increases rates of transmission of deadly diseases, and poses additional infectious risk to everyone. This dissertation uses records from the National Archives and Records Administration of the United States, National Archives of Mexico, World Health Organization, multiple Presidential Libraries, and an assortment of digital records to examine the historical roots of vaccine hesitancy. I argue that the choice to delay vaccination or outright refusal of vaccination often constitutes a form of political protest. This anti-vaccine sentiment has historically functioned as political protest that opposes American and Western presence in developing countries. Illustrative case studies of Pakistan and Mexico between 1947 and 1990 illustrate how the manner in which vaccines are distributed within the context of Cold War disease eradication campaigns can influence vaccine hesitancy. Horizontal vaccine programming in Mexico wherein vaccines were distributed using a robust, native public health infrastructure found more epidemiological success than Pakistani vaccination programs that relied on vertically-oriented, Western-led mass vaccination programming to mitigate the burden of infectious diseases including smallpox and polio. Rhetorical analysis of archival vaccine-related media in these countries also reflects the politicized nature of Cold War vaccine hesitancy. Additionally, this dissertation broadly considers the array of weaponry in the American diplomatic arsenal and compares the diplomatic utility of vertical mass vaccination campaigns with military assistance that was also provided to developing nations in the pursuit of American anti-communist goals in the midst of the Cold War. I argue that certain programmatic ambiguities in Cold War American Foreign Policy led to the production of a uniquely militarized form of American diplomacy. An examination of biosurveillance networks constructed to support the global eradication of smallpox and subsequently replicated to eradicate polio illustrate the long-standing historical intersection between public health programming and military force that underlie historical and modern vaccine hesitancy.

Background: The COVID-19 pandemic posed an unparalleled challenge to worldwide public health systems, characterized by its high transmissibility and the initial absence of accessible testing, treatments, and vaccines. The deficiency in public awareness and the scarcity of readily available public health information regarding this century's disaster further intensified the critical need for innovative solutions to bridge these gaps. In response, Shaman Labs1,2, leveraging its deep expertise in forecasting for influenza3, Ebola, and various SARS viruses, initiated the development of country-wide COVID-19 projections within weeks following the WHO's declaration of the pandemic4–6. Almost immediately thereafter, it became necessary to create a sophisticated online platform—a system capable of displaying county-specific COVID-19 forecasts, including daily estimated infections, cases, and deaths. This platform was designed to allow users to select any county, state, or national geography and compare it with another, under various scenarios of social distancing measures. Additionally, the architecture of this system was required to facilitate the regular integration of updated data, ensuring the tool's ongoing relevance and utility. Columbia University's data visualization system aimed to communicate epidemiological forecasts to various stakeholders. At the onset of the COVID-19 pandemic, amid escalating uncertainty and the pressing need for reliable data, Dr. Rundle played a pivotal role in briefing key stakeholders on the unfolding crisis. His efforts were directed towards providing Congressman Ron Johnson, Chairman of the U.S. Senate Committee on Homeland Security & Governmental Affairs, and Congresswoman Anna Eshoo, as well as their staff, with up-to-date projections and analyses derived from the Classic Data Visualization tools. Dr. Rundle’s consultative role extended to a diverse array of institutions including the U.S. Army Corps of Engineers, the U.S. Air Force, and the Federal Reserve Board, as well as advising private entities such as Pfizer, MetLife, and Unilever. His expertise facilitated informed planning and response efforts across various levels of government and sectors, underscoring the critical role of sophisticated data visualization from the earliest stages of the pandemic. This Integrated Learning Experience (ILE) examines the development and implementation of the Time Machine platform, focusing on its application in visualizing and analyzing COVID-19 epidemiological forecasts. The study explores methods for improving forecast data presentation, analysis, and accuracy assessment. Methods: The body of this work unfolds through a series of critical chapters that collectively address the multifaceted functionality and impact of the Time Machine platform. Initially, the work focuses on the construction of the Time Machine platform, a web-based R interactive user interface coupled with cloud-based database system, specifically tailored for the intuitive visualization of epidemiological forecasts, detailing the technical and design considerations essential for enabling users to interpret complex data more effectively. Following this, the implementation of a rigorous data-discovery framework is presented, examining case reporting inconsistencies across different regions, using low-level GitHub and Windows scripting technologies, thereby highlighting the significance of accurate data collection and the impact of discrepancies on public health decisions. The narrative then transitions to the implementation of advanced statistical models, such as strictly proper scoring and weighted interval scoring, to assess the accuracy of the forecasts provided by the Time Machine platform, using a dedicated R library and testing with the help of MS Excel sandbox, underscoring the importance of reliable predictions in the management of public health crises. Lastly, a detailed analysis is conducted, encompassing countrywide data (3142 counties) over an extended period (147 weeks), utilizing Generalized Estimating Equations (GEE) to identify key predictors that influence forecast accuracy, offering valuable insights into the factors that either enhance or detract from the reliability of epidemiological predictions. Results: The deployment of the Classic Data Visualization and the subsequent evolution of the Time Machine platform have significantly advanced epidemiological forecast visualization capabilities. The Time Machine platform was designed with an automated data refresh system, allowing for regular updates of epidemiological forecast data and reported actuals. The project developed tools for monitoring and evaluating the quality of public health reporting, aiming to improve the accuracy and timeliness of data used in public health decisions. Additionally, the research implemented methods for standardizing forecast accuracy assessments, including the normalization of scores to enable comparisons across different geographical scales. These approaches were designed to support both local and national-level pandemic response efforts. The accuracy analyses throughout different phases of the pandemic revealed a 42% improvement in forecast accuracy from Phase 1 to Phase 7. Larger populations (27% increase per unit increase on a base-10 logarithmic scale) and higher county-level activity (45% increase from the lowest to the highest quartile) resulted in better estimations. Additionally, the analysis highlighted the significant impact of reporting quality on forecast accuracy. On the other hand, the study identified the challenges in predicting case surges, showing a 27% decline in accuracy during periods of rising infections compared to declining periods. The regression results highlight the potential benefits of improving data collection and providing timely feedback to forecasting teams. Conclusion: This study demonstrates the potential of advanced data visualization and accuracy measurement techniques in improving epidemiological forecasting. The findings suggest that factors such as urbanicity, case reporting quality, and pandemic phase significantly influence forecast accuracy. Further research is needed to refine these models and enhance their applicability across various public health scenarios.

No / The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public health approach to dying, death, and loss. Modeled after the World Health Organization's 1986 Ottawa Charter, our charter includes a call to action. It has the potential to bring about significant change on local, societal, and global levels as exemplified by four projects from three countries. Public health and end-of-life services and organizations need to form partnerships with the community to develop a public health approach to dying, death, and loss. Learning from each other, they will affirm and enhance community beliefs and practices that make death part of life.