Orientador: Manoel Barros Bertolo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T03:46:59Z (GMT). No. of bitstreams: 1 Pina_FabianaPompeode_M.pdf: 947949 bytes, checksum: 7e9310579d25142d2d37758ff60f7796 (MD5) Previous issue date: 2009 / Resumo: A associação de antígenos de histocompatibilidade com a Artrite Reumatóide (AR) vem sendo demonstrada em inúmeros estudos. No entanto, a avaliação em populações afro-descendentes ainda foi pouco estudada. Os propósitos deste estudo foram os de determinar a freqüência dos alelos HLA-DRB1 e as contribuições do polimorfismo desses alelos na susceptibilidade da AR na população afrobrasileira. Este estudo avaliou também, se a teoria do epitopo semelhante (SE) e o modelo de proteção da Artrite Reumatóide (RAP Model) se aplicam aos pacientes afro-brasileiros com AR. Os alelos HLA-DRB1 de 72 pacientes afro-brasileiros com AR, diagnosticados pelos critérios do American College of Rheumatology (ACR), e de 75 indivíduos saudáveis foram tipados e subtipados utilizando-se a técnica de reação em cadeia de polimerase de DNA amplificado hibridizado, com seqüência de primers específicos de alta e baixa resolução, e depois comparados. Os alelos HLADRB1 *0404 e *0405 apresentaram freqüência maior nos pacientes do que no grupo controle. Já, alelo HLA-DRB1*0102 apresentou uma freqüência aumentada no grupo controle (9,3%), quando comparada com a freqüência nos pacientes. Os alelos DRB1 considerados como pertencentes ao grupo do epitopo semelhante estavam presentes em 39 pacientes (54,2%) e em 20 controles (26,7%), indicando que teoria do epitopo semelhante se aplica à população afro-brasileira com Artrite Reumatóide. Os alelos HLA-DRB1 que apresentavam a sequência DERAA (alelos protetores) reduziram, de forma independente, o risco de desenvolver AR. Os dados obtidos apontam para uma intensa miscigenação racial presente no Brasil. Assim, como nos faz concluir que a susceptibilidade da Artrite Reumatóide em afro-brasileiros é, provavelmente, mediada pela interação de fatores genéticos e étnicos / Abstract: The association of histocompatibility antigens with Rheumatoid Arthritis (RA) comes being demonstrated in innumerable studies. However, the evaluation in afrodescendents populations still little was studied. The aim of this study has been to determine the frequency of HLA-DRB1 alleles, and the contributions of the polymorphism of these alleles in the susceptibility of RA in the Afro-Brazilian population as well. This study, also evaluated, if the theory of the shared epitope (SE) and the model of protection of the Rheumatoid Arthritis (RAP Model) can also be applied to the Afro-Brazilian patients suffering RA. The HLA-DRB1 alleles in 72 Afro-Brazilian patients suffering RA, diagnosed in accordance to the criteria of the American College of Rheumatology (ACR), and of 75 healthful volunteers had been typed and sub-typed using the technique of the polymerase chain reaction of the amplified hybridized DNA, with specific sequence of primers of high and low resolution, were then compared. The HLA-DRB1 *0404 and *0405 alleles had presented higher frequency in the patients group than in the control group. The HLADRB1 *0102 alleles presented a frequency increased (9,3%) in the control group, when compared with the patients group. The DRB1 alleles considered as pertaining to the group of shared epitope were present in 39 patients (54.2%) and in 20 members of the control group(26.7%), indicating that the theory of the shared epitope it is also applied to the Afro-Brazilian population with Rheumatoid Arthritis. The HLADRB1 alleles that presented DERAA sequence (protectors alleles), had reduced, of independent form, the risk to develop RA. The gotten data point to an intense racial miscegenation in Brazil. Thus, as in it makes them to conclude that the susceptibility of the Rheumatic Arthritis in Afro-Brazilian is, probably, determined by the interaction of genetic and ethnic factors / Mestrado / Clinica Medica / Mestre em Clinica Medica

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-08-12T19:31:16Z No. of bitstreams: 2 Tese - Renata Carvalho dos Santos - 2016.pdf: 4216067 bytes, checksum: ddcb3d7a0053d67a782d1528c6bcbf7e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-15T13:59:50Z (GMT) No. of bitstreams: 2 Tese - Renata Carvalho dos Santos - 2016.pdf: 4216067 bytes, checksum: ddcb3d7a0053d67a782d1528c6bcbf7e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-15T13:59:50Z (GMT). No. of bitstreams: 2 Tese - Renata Carvalho dos Santos - 2016.pdf: 4216067 bytes, checksum: ddcb3d7a0053d67a782d1528c6bcbf7e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-05-06 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Quilombolas communities are ethnic group defined by self-definition criteria and presumption of black ancestry. There are few studies and data about health of these subjects, and between available study highlight higher prevalence of overweight and related diseases. However, national survey data also show that anemia and malnutrition are prevalent among black women and children. Nevertheless, lacking most comprehensive studies to understand the health profile of quilombo population from Brazil. The objective of this research was to evaluate nutritional status, anemia frequency and cardiometabolic risk factors in adults and elderly from quilombolas communities of Goias state/Brazil. We carried out an analytical cross-sectional study with 287 subjects. Were performed anthropometric measurements (weight, height, waist circumference, and calculated BMI and Waist to height ratio - WHtR) blood tests (complete blood count, serum ferritin, fasting glucose and lipid profile), and socioeconomic and demographic questionnaire. The first article discussed the rate of anemia and iron deficiency and its relationship to overweight. Frequency of anemia and iron deficiency was low (5,9% and 4,7% respectively) and wasn’t association with overweight. Women had higher overweight than men, and men had higher underweight. BMI was higher in urban communities and in adults. Hemoglobin was lower in urban communities (p<0,05). The correlation indicated that increasing BMI is accompanied by decreases in hemoglobin and ferritin. RBC indices indicated 10,9% of microcytosis and 9,4% of anisocytosis. The second article discusses the assessment of nutritional status and association with cardiometabolic risk factors. Participants presented 54,4% of overweight and 67,9% higher waist-to-height ratio. The group with overweight differs from the eutrophic group in relation to HDL, VLDL, TG, leukocytes, lymphocytes, and platelets. And 15.2% of the population had three or more metabolic risk factors, moreover, in this group, leukocytes and lymphocytes were significantly higher. Women had more metabolic abnormalities than men. In conclusion, the main health problem in these communities refers to overweight and related diseases. Metabolic abnormalities increase the risk of developing cardiovascular disease, which are the leading cause of death in Brazil. The low prevalence of anemia and iron deficiency needs to be better investigated together food consumption. It’s must also be investigated genetics anemia, such as thalassemia and sickle cell due the abnormalities found in RBC indices without decreasing hemoglobin and ferritin. / Comunidades quilombolas são grupos étnicos, definidos pelo critério de auto atribuição que possuem presunção da ancestralidade negra. Existem poucos estudos sobre a saúde desses sujeitos e, entre os existentes destacam-se aqueles que indicam maior prevalência de excesso de peso corporal e doenças associadas. Porém, dados de pesquisas nacionais apontam que a anemia e o baixo peso são altamente prevalentes entre mulheres e crianças negras. Apesar disso, faltam estudos mais abrangentes para compreender o perfil de saúde especificamente da população quilombola. Portanto, o objetivo dessa pesquisa foi avaliar o estado nutricional, frequência de anemia e fatores cardiometabólicos de adultos e idosos de comunidades quilombolas de Goiás. Realizou-se uma pesquisa transversal analítica com 287 sujeitos. Foram realizadas avaliações antropométricas (peso, estatura, circunferência da cintura, cálculo do índice de massa corporal - IMC e da relação cintura-estatura - RCE), exames de sangue (hemograma completo, ferritina sérica, glicemia de jejum e lipidograma) e questionário socioeconômico e demográfico. O primeiro artigo abordou o índice de anemia e deficiência de ferro e sua relação com o excesso de peso. A frequência de anemia e deficiência de ferro foi baixa (5,9% e 4,7 respectivamente) e não apresentou associação significativa com o IMC. A frequência de excesso de peso foi elevada (52,0%), e as mulheres apresentaram maior porcentagem de sobrepeso/obesidade do que os homens. Na análise comparativa dos valores médios, observou-se que o IMC foi maior nas comunidades urbanas e entre os adultos, e a hemoglobina foi menor nas comunidades urbana (p<0,05). A correlação indicou que o aumento do IMC esteve acompanhado de diminuição da hemoglobina e ferritina Os índices hematimétricos indicaram 10,9% de microcitose e 9,4% de anisocitose. O segundo artigo abordou a avaliação do estado nutricional e a associação com fatores de risco cardiometabólicos. A frequência do excesso de peso foi de 54,4%, e 67,9% dos sujeitos tinham RCE elevada. As variáveis do perfil lipídico, glicêmico e de células brancas apresentaramse alteradas nos grupos com excesso de peso e RCE aumentada. Porém, os parâmetros metabólicos com diferença estatística entre os grupos foram o CT, HDL, VLDL, Triglicerídeos, Leucócitos, Linfócitos e Basófilos. E 15,2% dos participantes tinham três ou mais fatores de risco metabólico, sendo que as mulheres apresentaram mais alterações metabólicas do que os homens. Conclui-se que o principal agravo à saúde nas comunidades investigadas refere-se ao excesso de peso e doenças associadas. As alterações metabólicas aumentam o risco de desenvolvimento de doenças cardiovasculares, que são a principal causa de óbito no Brasil. A baixa prevalência de anemia e deficiência de ferro precisa ser melhor investigada aliada ao consumo alimentar. Considera-se necessário investigar as anemias de causa genética como as talassemias e a falciforme devido as alterações que ocorreram nos índices hematimétricos sem diminuição da hemoglobina e ferritina.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-03T12:16:13Z No. of bitstreams: 2 Dissertação - Priscila Olin Silva - 2016.pdf: 4128507 bytes, checksum: a3681ddc67fbc4ddd0fc3b6b27960072 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-10-03T12:17:13Z (GMT) No. of bitstreams: 2 Dissertação - Priscila Olin Silva - 2016.pdf: 4128507 bytes, checksum: a3681ddc67fbc4ddd0fc3b6b27960072 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-10-03T12:17:13Z (GMT). No. of bitstreams: 2 Dissertação - Priscila Olin Silva - 2016.pdf: 4128507 bytes, checksum: a3681ddc67fbc4ddd0fc3b6b27960072 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-25 / Financiadora de Estudos e Projetos- Finep / Despite the recognized importance in the construction process of the history and identity of Brazil, the quilombo remnants still suffer with lack of access to rights, such as education. In the course of fighting for a contextualized education, the reference point is the National Curriculum Guidelines for Quilombola School Education, which recommend the inclusion of history and culture in quilombola education offered to students of these communities. The study aimed to investigate how the quilombola issue has been addressed in educational and political project of a school that attends students from a remnant quilombo community in Goiás. This is an exploratory and strategic social research with a qualitative approach to information. Semi-structured interviews, conversation wheel, observation of daily activities and analysis of the educational and political school project were conducted. The leadership of quilombola community, school staff and county nutritionist composed the study population.The investigation included aspects related to the general characterization of the school, the school feeding, as well as insertion of quilombola theme at school. The information was analysed in the light of the content analysis in the thematic mode. The municipality has a rural school that attends students from the quilombo. Although not in the community territory, is registered as quilombola school in the School Census, receiving different financial resources to school feeding. Three thematic categories were built: School and food; Quilombola community culture and Quilombola school education. School feeding does not meet the recommended by law and the quilombo food culture is not inserted in school activities. The lack of teacher training and the lack of teaching materials were cited as difficulties to work the quilombola subject in school. The educational and political project does not include everyday aspects of the quilombolastudents‟reality and there is a weak interaction between the school, community, municipal management of education and nutritionist. It is suggested greater coordination of these actors, so that the school's pedagogical proposal has tune with the reality of students, translating into a strengthening of quilombola culture and responding to recommended by law and demands of the community / Apesar da reconhecida importância no processo de construção da história e identidade do Brasil, os remanescentes de quilombos ainda sofrem com falta de acesso a direitos, como a educação. Na trajetória de luta por uma educação contextualizada, o marco referencial são as Diretrizes Curriculares Nacionais para a Educação Escolar Quilombola, que recomendam a inserção da história e cultura quilombola na educação ofertada aos estudantes destas comunidades. O objetivo desse estudo foi investigar como a temática quilombolatem sido contemplada noprojeto político pedagógico de escola que atende estudantes de uma comunidade remanescente de quilombo em Goiás.Trata-se de uma pesquisa social exploratória e estratégica, com abordagem qualitativa das informações. Foram realizadas entrevistas semiestruturadas, roda de conversa, observação das atividades cotidianas e análise do projeto políticopedagógico da escola. A população do estudo foi composta pela liderança da comunidade quilombola, equipe escolar e nutricionista do município. A investigação incluiu aspectos relacionados à caraterização geral da escola, àalimentação escolar, além da inserção da temática quilombolana escola. As informações foram trabalhadas à luz da análise de conteúdo na modalidade temática. O município conta com uma escolarural que atende os estudantes oriundos da comunidade quilombola. Apesar de não estar no território da comunidade, está cadastrada como escola quilombola no Censo Escolar, recebendo recurso financeiro diferenciado para a alimentação dos estudantes. Foram construídas três categorias temáticas: Escola e alimentação; Cultura da comunidade quilombola e Educação escolar quilombola. A alimentação escolar não atende ao preconizado pela legislação e a cultura alimentar quilombola não está inserida nas atividades escolares. Afalta de formação docentee a inexistência de materiais didáticos foram citadas como dificuldades para trabalhar a temática quilombola na escola. O projeto político pedagógico não contempla aspectos cotidianos da realidade dos estudantes quilombolas e há uma interação frágilentre a escola, a comunidade, a gestão municipal da educação e a nutricionista. Sugere-se maior articulação desses atores, a fim de que a proposta pedagógica da escola tenha sintonia com a realidadedos estudantes, se traduzindo em um fortalecimento da cultura quilombola e respondendo ao preconizado pela legislação e demandas da comunidade.

Introdução: Os afro-brasileiros compreendem um grupo de negros e pardos com uma ancestralidade diversa. Como as diferenças raciais podem estar associadas a apresentações distintas, torna-se relevante realizar uma análise de associações clínicas e sorológicas de pacientes afro-brasileiros com esclerose sistêmica (ES). Objetivos: Analisar a apresentação clínica e laboratorial, características demográficas e sobrevida dos afro-brasileiros com ES. Métodos: Foram avaliados soros de 260 pacientes adultos com ES (57 afro-brasileiros e 203 brancos). Pacientes com síndromes de sobreposição foram excluídos. Dados clínicos e demográficos foram obtidos de um banco de dados de registros eletrônicos. A análise laboratorial incluiu anti-CENP-A/ CENP-B, Scl70, RNA polimerase III, Ku, fibrilarina, Th/To, PM/Scl75 e PM/Scl100 por line imunoblotting e anticorpos antinucleares por imunofluorescência indireta em células HEp-2. Resultados: Em relação aos brancos, os pacientes afro-brasileiros com ES apresentaram menor tempo de doença (9,0±5,4 anos vs. 11,3±7,5 anos, P=0,001), maior frequência do padrão nucleolar (28% vs. 13%, P=0,008) e menores frequências do padrão centromérico (14% vs. 29%, P=0,026) e CENP-B (18% vs. 34%, P=0,017). Comparações adicionais entre grupos étnicos de acordo com a forma clínica revelaram que pacientes afro-brasileiros com ES difusa apresentaram maior frequência de hipertensão pulmonar (P=0,017), envolvimento cardíaco (P=0,037), padrão nucleolar (P=0,036) e anticorpos antifibrilarina (P=0,037). De maneira diferente foi observado para a forma limitada apenas uma menor frequência de envolvimento esofágico (P=0,050) e padrão centromérico (P=0,049). A análise de sobrevida mostrou que os afro-brasileiros apresentaram maior mortalidade quando ajustados para sexo e forma clínica (risco relativo 3,65; intervalo de confiança de 95% 1,05-12,62, P=0,041). Conclusão: Os pacientes afro-brasileiros com ES, apesar de sua forte impressão de ancestralidade europeia, apresentam características distintas de acordo com a forma clínica e uma doença mais grave do que os brancos, com um padrão muito semelhante ao descrito para negros de outros países / Introduction: African-Brazilians comprise a group of blacks and \"pardos\" with a diverse ancestry. As racial differences can be associated with distinct presentations, it becomes relevant to assess the clinical and serological associations of African-Brazilians with systemic sclerosis (SSc). Objectives: To analyze clinical and laboratory presentation, demographic features and survival of Afro-Brazilians with SSc. Methods: Sera from 260 adult SSc patients (57 African-Brazilians and 203 whites) were evaluated. Patients with overlap syndromes were excluded. Clinical and demographic data were obtained from an electronic register database. Laboratory analysis included: anti-CENPA/CENP-B, Scl70, RNA polymerase III, Ku, fibrillarin, Th/To, PM/Scl75 and PM/Scl100 by line immunoassay and antinuclear antibodies by indirect immunofluorescence on HEp-2 cells. Results: In relation to whites, African-Brazilian patients with SSc presented shorter disease duration (9.0±5.4 years vs. 11.3±7.5 years, P=0.001), higher frequency of nucleolar pattern (28% vs. 13%, P=0.008) and lower frequencies of centromeric pattern (14% vs. 29%, P=0.026) and CENP-B (18% vs. 34%, P=0.017). Further comparison of ethnic groups according to subsets revealed that African-Brazilian patients with diffuse SSc presented higher frequency of pulmonary hypertension (P=0.017), heart involvement (P=0.037), nucleolar pattern (P=0.036) and anti-fibrillarin antibodies (P=0.037). A different pattern was observed for the limited subset with solely a lower frequency of esophageal involvement (P=0.050) and centromeric pattern (P=0.049). Survival analysis showed that African-Brazilians had a higher mortality, when adjusted for gender and clinical subset (relative risk 3.65, confidence interval 95% 1.05-12.62, P=0.041). Conclusion: African-Brazilian patients with SSc, despite their strong imprint of European ancestry, have distinct characteristics according to clinical subset and an overall more severe disease than whites, with a pattern very similar to the described for blacks from other countries

Made available in DSpace on 2015-04-22T22:06:19Z (GMT). No. of bitstreams: 1 INARA CAVALCAANTE.pdf: 3883238 bytes, checksum: 8ee251556494013f2f879216e196df45 (MD5) Previous issue date: 2011-02-25 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The quilombola populations are among the most vulnerable groups of Brazil related to health services. This qualitative study aimed to know the access and accessibility to the health services in quilombos in the Paraense Amazonia, in three communities, África/Lanranjituba in Abaetetuba, Santo Antonio/Foz do Cravo in Concórdia do Pará and Mangueiras, in Salvaterra in the Marajó island. The subjects of the research were the residents and the managers and health professionals of the municipal district. Other sources were: the primary data of the socioeconomic conditions of the families and documental analysis of reports and information from the Ministry of Health. The research describes the access to the health services from four dimensions, Geographical, Functional, Cultural and Economical, and presents a transverse analysis of the access while analytical category of the planning and administration of the services in agreement with the re-interpretation of welfare care models in health. It was detected the difficulty and/or impossibility of the quilombolas in having access and accessibility to all the levels of complexity of health attendance, being this a result of a group of processes that involve several aspects as the distance of the urban centers and the lack of services that offer access by land and fluvial; the high financial costs (transport, feeding, medicines, permanence in the city, etc.) of the search for health services; the adaptation lack to the afro-descending habits from the managers and health professionals that assist them; and the functionality of the health services offered. We concluded that the health services are just offered by the municipal managers that adopt the Economic and ―Planificador‖ Models due to the Brazilian system of allocation of budgets for health, so there is not a National Politics of access and accessibility to health services that allows the National Politics of Integral Health of the Black Population to become real. Therefore it is fundamental the planning of health public politics of access and accessibility starting from a participative and promoter of the health equity logic, compatible with the geographical and socio-cultural dynamics of the Brazilian Amazonia. / As populações quilombolas estão entre os grupos em situação de vulnerabilidade no Brasil, no que diz respeito a serviços de saúde. Este estudo qualitativo se desenvolveu com o objetivo de conhecer o acesso e a acessibilidade aos serviços de saúde em quilombos na Amazônia Paraense, em três comunidades: África/Lanranjituba, em Abaetetuba, Santo Antonio/Foz do Cravo, em Concórdia do Pará e Mangueiras, em Salvaterra, na ilha do Marajó. Os sujeitos da pesquisa foram os moradores, os gestores e os profissionais de saúde dos municípios. Outras fontes foram os dados das condições socioeconômicas das famílias do ―Projeto Corpo Presente‖ e análise documental de relatórios e informações do Ministério da Saúde. A pesquisa descreve o acesso aos serviços de saúde a partir de quatro dimensões, Geográfica, Funcional, Cultural e Econômica. Faz uma análise transversal do acesso enquanto categoria do planejamento e gestão dos serviços de acordo com a re-interpretação de modelos assistenciais em saúde. Constatou-se a dificuldade e/ou impossibilidade dos quilombolas em terem acesso e acessibilidade a todos os níveis de complexidade de assistência em saúde, sendo isto, resultado de um conjunto de processos que envolvem vários aspectos como: a distância dos centros urbanos; a falta de serviços que ofereçam acesso a estes por via terrestre e fluvial; os elevados custos financeiros (transporte, alimentação, medicamentos, estadia na cidade, etc.) da busca por serviços de saúde; a falta de adequação aos hábitos e costumes afrodescendentes por parte dos gestores e profissionais de saúde que os atendem e a funcionalidade dos serviços de saúde ofertados. Conclui-se que os serviços de saúde são apenas ofertados pelos gestores municipais a partir dos Modelos Economista e Planificador em virtude do sistema brasileiro de alocação de verbas para saúde, portanto, não existe uma Política Nacional de acesso e acessibilidade aos serviços de saúde que permita concretizar a Política Nacional de Saúde Integral da População Negra. Assim, é fundamental o planejamento de políticas públicas de saúde de acesso e acessibilidade a partir de uma lógica participativa e promotora da equidade em saúde, compatíveis coma a dinâmica geográfica e sócio-cultural da Amazônia Brasileira.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-04-03T13:51:17Z No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-03T19:01:36Z (GMT) No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) / Made available in DSpace on 2017-04-03T19:01:36Z (GMT). No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) Previous issue date: 2009-03-26 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / As parasitoses intestinais são um importante problema de saúde pública principalmente nos países subdesenvolvidos ou em desenvolvimento. Embora o parasitismo intestinal seja amplamente reconhecido como relevante no contexto epidemiológico de diversas comunidades, os estudos sobre o assunto são ainda insuficientes, principalmente no Brasil. Em vista da dificuldade de diagnóstico específico das parasitoses, muitas vezes são realizados tratamentos empíricos com mais de uma droga. O objetivo principal do presente estudo foi avaliar a efetividade e segurança do uso de nitazoxanida no tratamento de poliparasitoses comparado à terapêutica tradicional ofertada pelo serviço público. Além deste objetivo, foi possível investigar a prevalência e os fatores associados às parasitoses intestinais na população de Colônia do Paiol, uma comunidade quilombola, na Zona da Mata, Minas Gerais. Na comunidade analisada, procedeuse um estudo transversal por censo, sendo que dos 425 moradores, 391 (92%) foram avaliados através de questionário estruturado e exame coproparasitológico. Os resultados mostraram uma alta positividade (63,8%), sendo as espécies patogênicas mais freqüentes Ascaris lumbricoides (22,4%) e Trichuris trichiura (17,9%). O poliparasitismo ocorreu em 36,5% dos investigados. O ensaio clínico, controlado, duplo cego, randomizado avaliou 65 indivíduos em dois grupos de tratamento. A taxa de cura foi de 32,4% e 38,7% com a nitazoxanida e com o tratamento convencional, respectivamente, mas esta diferença não foi estatisticamente significativa (p=0,599). A ocorrência de vômito (p= 0,031) esteve associada ao tratamento convencional e de urina esverdeada ao uso de nitazoxanida (p=0,002). Os outros efeitos adversos foram independentes da droga. Houve diferença estatisticamente significativa em relação à cor da pele e a taxa de cura para ambos os tratamentos. A menor eficácia efetividade foi apresentada pelos indivíduos de cor preta. São necessários outros estudos para esclarecer a baixa efetividade nos casos de poliparasitismo, assim como, reavaliar as práticas preventivas e terapêuticas, com o uso de novas drogas e de agentes de largo espectro, podendo a nitazoxanida ser uma droga alternativa neste contexto. Agrega-se às novas possibilidades terapêuticas, a necessidade de políticas públicas que garantam qualidade de vida, através de saneamento básico, educação para saúde e acesso ao sistema público de saúde, minimizando as iniqüidades na sociedade. / Intestinal parasitism is an important public health concern, chiefly in underdeveloped or developing countries. Although widely recognized as a relevant community epidemiological issue, intestinal parasitism has not been sufficiently studied in Brazil. Because specific diagnosis is difficult and generally cumbersome, empiric treatment, sometimes with more than one drug, is frequently employed. The main aim of this study was the assessment of the effectiveness and safety of nitazoxanide for the treatment of intestinal polyparasitism, as compared to traditional therapy provided by the public service. The study also investigated the prevalence of and factors associated with intestinal parasitism in the population of Colônia do Paiol, a quilombola community from the Zona da Mata, Minas Gerais, Brazil. A census-based cross-sectional study used a structured questionnaire and stool examination to assess 391 people (92%) of the 425 inhabitants of the community. The frequency of intestinal parasitism was as high as 63.8%, with predominance of Ascaris lumbricoides (22.4%) and Trichuris trichiura (17.9%). Polyparasitism occurred in 36.5% of those investigated. A double-blind randomized controlled trial assessed 65 individuals in two treatment groups. Cure rates were 32.4% and 38.7% with nitazoxanide and conventional treatment, respectively, but the difference was not statistically significant (p = 0.599). Vomiting (p = 0.031) was associated with conventional treatment and greenish urine with nitazoxanide use (p = 0.002). Other untoward effects were independent of which drug was used. There was a statistically significant difference concerning skin color and cure rates for both treatments. Dark-skinned subjects had lower cure rates. Further studies are necessary to clarify the reasons for the low effectiveness found in these cases of polyparasitism, and to reevaluate preventive and therapeutic approaches with new and broad-spectrum drugs, nitazoxanide being an option in this context. In addition to new therapeutic approaches, there is a clear need to develop public policies that, through the provision of basic sanitation, health education and access to the public health system, assure quality of life and minimize inequity.

No / Initiation of breast feeding and duration of any breast feeding are known to differ by ethnic group, but there are limited data on differences in exclusive breast feeding. This study aimed to determine if there are ethnic differences in the initiation and duration of any and exclusive breast feeding. METHODS: Breast-feeding data were obtained from a subsample of 1365 women recruited to a multi-ethnic cohort study (Born in Bradford) between August 2008 and March 2009. Poisson regression was used to investigate the impact of socio-economic, life style and birth factors on ethnic differences in the prevalence of breast feeding. RESULTS: Compared with white British mothers, initiation of breast feeding was significantly higher in all ethnic groups and this persisted after adjustment for socio-economic, life style and birth factors [Pakistani: prevalence rate ratio (PRR) = 1.19 (95% confidence interval 1.10, 1.29); Other South Asian: PRR = 1.29 (1.18, 1.42); Other ethnicities: PRR = 1.33 (1.21, 1.46)]. There were no differences in exclusive breast feeding at 4 months [Pakistani: PRR = 0.77 (0.54, 1.09); Other South Asian: PRR = 1.55 (0.99, 2.43); Other ethnicities: PRR = 1.50 (0.88, 2.56)]. Any breast feeding at 4 months was significantly higher in mothers of all non-white British ethnicities [Pakistani: PRR = 1.27 (1.02, 1.58); Other South Asian: PRR = 1.99 (1.52, 2.62); Other ethnicities: 2.45 (1.86, 3.21)]. CONCLUSIONS: Whilst women of ethnic minority groups were significantly more likely to initiate breast feeding and continue any breast feeding for 4 months compared with white British women, the rates of exclusive breast feeding at 4 months were not significantly different once socio-economic, life style and birth factors were accounted for.

Africa has always aspired for the economic integration of its markets. This endeavour is evident right from the 1960s clamour for independence and shortly thereafter, as newly independent states. During this period African countries under the umbrella of the OAU underscored economic cooperation as the basis for intra-African relations. However, it was not until the year 1991, with the conclusion of the AEC Treaty, that the continent formally adopted a framework and roadmap towards continental economic integration. The 40-year roadmap towards a continental economic community was premised upon the two principles of harmonisation and devolution. Moreover, the six-stage integration process set out in Article 6 of the AEC Treaty identifies the eight RECs in Africa as the building blocks for the continent’s proposed single market and economic union. It also underpinned the economic integration of the continent on the harmonious co-existence of the RECs. A step-wise ambitious integration model was adopted under Article 6 of the AEC Treaty. The model envisaged the creation of a Free Trade Area (FTA), followed by a Customs Union, a Common Market and ultimately a fully-fledged Economic Union. As a first step towards the continental integration, the African Continental Free Trade Area (AfCFTA) was unveiled in 2018. Cross border, intra-African trade, is bound to lead to a rise in investment and commercial transactions on the continent. This, in turn, will inevitably lead to disputes which require resolution. The economic integration of the continent is fast evolving under the aegis of the AU; whose dispute settlement system is currently also under review. Significantly, the AU has consolidated its dispute settlement mechanism, following the merger in 2008 of the ACJ and ACH&PR, into a single AU court, known as the African Court of Justice and Human Rights (ACJ&HR). It is within the context of the merged AU single court that this thesis grounds itself. It seeks to interrogate the adequacy of the continental trade and investment dispute settlement system and examines its viability within the consolidated AU dispute settlement system. While the AU led continental economic integration gains pace, the dispute settlement system, critical for the integration, is either lagging behind or is not receiving adequate attention. As a result, the dispute settlement systems created under the AEC and AfCFTA are incongruent with the principles of harmonisation and devolution, which underpin the continent’s economic integration goals. The recommendations proffered, align with the philosophy of harmonising and devolving the continental trade and investment dispute settlement system. The research proposes to locate the continental trade and investment dispute settlement within the AU single court system. The principal recommendation is not only to expand the Court’s jurisdiction in order to accommodate the trade and investment mandate, but also to use sub-regional REC judicial organs as courts of first instance for the ACJ&HR. A hierarchical order of the continental court system, with the single AU Court at the apex, is also proposed in this study as the supreme overarching supranational judicial organ. / Public, Constitutional, and International Law / LL.D.

No / School leavers with intellectual disabilities (ID) often face difficulties in making a smooth transition from school to college, employment or more broadly to adult life. The transition phase is traumatic for the young person with ID and their families as it often results in the loss of friendships, relationships and social networks. The aim of this study was to explore the family carers' views and experiences on transition from school to college or to adult life with special reference to ethnicity. Forty-three families (consisting of 16 White British, 24 Pakistani, 2 Bangladeshi and one Black African) were interviewed twice using a semi-structured interview schedule. The carers were interviewed twice, Time 1 (T1) and Time 2 (T2), T2 being a year later to observe any changes during transition. The findings indicate that although transition planning occurred it was relatively later in the young person's school life. Parents were often confused about the process and had limited information about future options for their son or daughter. All family carers regardless of ethnicity, reported lack of information about services and expressed a sense of being excluded. South Asian families experienced more problems related to language, information about services, culture and religion. The majority of families lacked knowledge and awareness of formal services and the transition process. Socio-economic status, high levels of unemployment and caring for a child with a disability accounted for similar family experiences, regardless of ethnic . The three key areas relevant for ethnicity are interdependence, religion and assumptions by service providers.

Foreign investments in SADC are regulated by Annex 1 of the SADC Protocol on Finance and Investments (SADC FIP), as well as the laws of SADC Member States. At present, SADC faces the challenge that this regime for the regulation of foreign investments is unstable, unsatisfactory and unpredictable. Furthermore, the state of the rule of law in some SADC Member States is unsatisfactory. This negatively affects the security of foreign investments regulated by this regime. The main reasons for this state of affairs are briefly explained below. The regulatory regime for foreign investments in SADC is unstable, due to recent policy reviews and amendments of key regulatory instruments that have taken place. Major developments in this regard have been the suspension of the SADC Tribunal during 2010, the amendment of the SADC Tribunal Protocol during 2014 to bar natural and legal persons from access to the Tribunal, and the amendment of Annex 1 during 2016 to remove investor access to international investor-state arbitration, better known as investor-state dispute settlement (ISDS). The regulation of foreign investments in SADC has been unsatisfactory, among others because some SADC Member States have failed or neglected to harmonise their investment laws with both the 2006 and the 2016 Annex 1. Furthermore, SADC Member States such as Angola, Democratic Republic of Congo (DRC), Malawi, Mauritius, Seychelles, Eswatini, Tanzania, Zambia, and Zimbabwe have multiple Regional Economic Community (REC) memberships. This places these Member States in a position whereby they have conflicting interests and treaty obligations. Finally, the future of the regime for the regulation of foreign investments in SADC is unpredictable, due to regional integration efforts such as the recent formation of the COMESA-EAC-SADC Tripartite Free Zone (T-FTA) and the African Continental Free Trade Area (AfCFTA). The T-FTA is entitled to have its investment protocol, while the AfCFTA investment protocol will be negotiated from 2018 until 2020. These developments entail that the 2016 Annex 1 will soon be replaced by an investment protocol at either the T-FTA or AfCFTA levels, thereby ushering a new regime for the regulation of foreign investments in SADC. The unknown nature of the future regulations create uncertainty and instability among foreign investors and host states alike. This study analyses the regulation of foreign investments in terms of Annex 1 and selected laws of SADC Member States. In the end, it makes the three findings mentioned above. In order to address these findings, the study makes four recommendations. The first is that foreign investments in SADC must be regulated at African Union (AU) level, by means of an AfCFTA investment protocol (which incidentally is now the case). Secondly, investor-state disputes must be referred to the courts of a host state, optional ISDS, the African Court of Justice and Human Rights (ACJ&HR) or other agreed forum. Thirdly, an African Justice Scoreboard (AJS) must be established. The AJS will act as a gateway to determine whether an investor-state dispute shall be referred to the courts of a host state, ISDS, the ACJ&HR or other forums. Fourthly, the office of an African Investment Ombud (AIO) must be created. The AIO shall facilitate the early resolution of investor-state disputes, so as to reduce the number of disputes that may end-up in litigation or arbitration. / Mercantile Law / LL. D.