The primmary theme of this diploma thesis is to analyse the prevalence of overweight and obesity of children studying at second grade of elementary school in the district of České Budějovice. The theoretical part of the thesis was focused on the characteristics of the overweight and obesity and its influence on human?s health with the aim on children?s population. Furthermore, the thesis contains the main factors affecting occurence of overweight and obesity. Prevention and treatment of obesity has been presented as well. The crucial part of the thesis was the research itself. The research consisted of evaluation of results of antropometric measurement of the sample of probands studying at second grade of elementary school in the district of České Budějovice. Based on the measurement the height, weight, waist and hips circumference was found out. Furthermore, the birth weight and height was examined too. Based on the measurement the Body mass index was calculated and the predetermined research questions were answered. 243 probands from 9 elementary schools took part at the research. 11 girls were overweight (8,9% from the sample) and 17 boys (14,16%) were overweight. The prevalence of obesity was at 0,81% rate concerning girls and 10,83% rate concerning boys.

Chagas disease is caused by the parasite Trypanosoma cruzi and transmitted by multiple triatomine vectors across the Americas. In Central America, the predominant vector is Triatoma dimidiata, a highly adaptable and genetically diverse Hemiptera. In this research, we used a novel reduced-representation DNA sequencing approach to discover community dynamics among multiple biotic factors associated with Chagas disease in Central America, and assess the infestation patterns of T. dimidiata after seasonal and chemical disturbances in Jutiapa, Guatemala. For our first study, we used a hierarchical sampling design to obtain multi-species DNA data found in the abdomens of 32 T. dimidiata specimens from Central America. We aimed to understand (1) the prevalence of T. cruzi infection, (2) the population genetics of the vector and parasite, (3) the blood meal history of the vector, and (4) gut microbial diversity. Our results indicated the presence of nine infected vectors harboring two distinct DTUs: TcI and possibly TcIV. We found significant clusters among T. dimidiata populations in countrywide and within-country levels associated with sylvatic ecotopes and diverse domestic genotypes. There was significantly higher bacteria species richness in infected T. dimidiata abdomens than those that were not infected, with further analysis suggesting that gut bacteria diversity relates to both T. cruzi infection and the local environment. We identified vertebrate blood meals from five T. dimidiata abdomens including chicken, dog, duck and human; however, additional detection methods are necessary to confidently identify blood meal sources. In our second study, we analyzed the GBS genotypes of 440 T. dimidiata specimens collected in two towns of Jutiapa, Guatemala. Our aim was to assess (1) the domestic population patterns that aid the recovery of T. dimidiata after an insecticide treatment in El Carrizal and (2) the seasonal changes that regulate the dispersal of the vector in the untreated communities of El Chaperno. Results showed that the insecticide application was effective at reducing the population abundance immediately after the application in El Carrizal; nevertheless, 18-month post-treatment the town-wide infestation and genetic diversity were recovering. Within-house relatedness among specimens recovered 18 months post-treatment, suggesting that the insecticide treatment failed to fully eliminate domiciliated colonies. In contrast, lack of change in abundance or genetic diversity in El Chaperno implied absence of dispersers from sources beyond the town periphery, while evidence of a decrease of relatedness among individuals implied dispersal among houses. After the insecticide treatment in El Carrizal, population reduction led to lack of genetic spatial autocorrelation; nevertheless, rapid dispersal into neighboring houses lead to autocorrelation 18 months after the insecticide treatment. This pattern was also observed in El Chaperno, where an increase in spatial autocorrelation during seasonal dispersal suggests spillover to close-by households. The creation of a novel genomics pipeline allowed us to understand community and dispersal patterns of T. dimidiata and other biotic factors important for the prevalence and transmission of Chagas disease at local and regional levels. Future studies should include complementary approaches for taxa verification (e.g. bacteria 16S barcoding, PCR-base detection), as well as expand the scope of local population analyses to peridomestic and sylvatic genotypes that could suggest a broader range of vector sources and region-wide patterns of temporal and spatial dispersion.

Esclerose lateral amiotrófica (ELA) é uma doença neurológica progressiva e fatal, caracterizada por perda dos neurônios motores, levando à fraqueza muscular global. As funções sensitivas e mentais são preservadas durante todo o curso da doença. A esclerose lateral amiotrófica tem uma prevalência de 6 por 100.000 pessoas e o início da doença é geralmente entre os 40 a 60 anos de idade. O prognóstico é reservado e em média os pacientes vivem de 3 a 5 anos após o diagnóstico médico. Com a progressão da doença outros sintomas surgem como fraqueza dos membros, comprometimento da fala, aumento da salivação, dificuldades de deglutição, dificuldades para deambular e fadiga muscular. As alterações dos músculos respiratórios levam à falência respiratória, que é a maior causa de óbito nos pacientes com esclerose lateral amiotrófica. Fadiga é definida como a queda da máxima contração isométrica voluntária e falta de tolerância do músculo sob esforço. A máxima contração isométrica voluntária depende de uma cadeia de eventos que se inicia no córtex motor - condutor excitatório dos neurônios motores superior e inferior, e se continua na transmissão pela junção neuromuscular, no acoplamento excitação-contração e na contração da fibra muscular que depende de um suprimento energético metabólico. A fadiga muscular ocorre em pacientes com esclerose lateral amiotrófica prejudicando a função e a qualidade de vida dos pacientes. O objetivo deste trabalho foi: 1) Quantificar a freqüência da fadiga na esclerose lateral amiotrófica; 2) Analisar a evolução da fadiga nos pacientes; 3) Correlacionar a presença da fadiga com fatores como a funcionalidade, a qualidade de vida, a depressão, a dispnéia, e a sonolência, idade e duração da doença em meses. O grupo controle compôs-se de 60 indivíduos (familiares de funcionários do hospital e da equipe multidisciplinar) que não apresentavam história de doenças pregressas. O grupo teste constitui-se de 60 pacientes com diagnóstico de esclerose lateral amiotrófica. O diagnóstico foi realizado por dois neurologistas independentes e baseou-se na presença de história clínica, exame neurológico e estudos neurofisiológicos compatíveis com esclerose lateral amiotrófica, segundo os critérios de El Escorial da Federação Mundial de Neurologia; além disso, houve a investigação complementar por meio de testes hematológicos, bioquímicos, sorológicos, genéticos e radiológicos para excluir outras patologias. Os pacientes dos grupos controle e teste foram entrevistados pela pesquisadora para aplicação de questionários com escalas para verificação da presença de funcionalidade, de qualidade de vida, de depressão, de dispnéia, de sonolência e de fadiga; e os pacientes do grupo teste foram submetidos à avaliação fisioterapêutica no início do estudo e a cada 3 meses, totalizando 12 meses de coletas. O grupo teste apresentou fadiga significantemente maior em relação ao grupo controle, bem como alterações nos questionários de funcionalidade, de qualidade de vida, de depressão, de dispnéia e de sonolência. Percebeu-se que a fadiga foi evolutiva durante os meses de acompanhamento da pesquisa. A fadiga correlacionou-se com a idade, mostrando que os pacientes mais jovens apresentaram maior grau de fadiga que os pacientes mais idosos. Os resultados desta pesquisa sugerem que a fadiga é um dos problemas que afetam os pacientes com ELA; o fato de não ter correlação com outros problemas estudados sugere que a fadiga deve merecer pesquisa e tratamento individualizados no paciente com ELA, principalmente pelo fato de que os resultados sugeriram piora da fadiga no decorrer da evolução da ELA / Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurological disease, characterized by loss of the motor neurons, taking to the global muscular weakness. The sensitive and mental functions are preserved during whole the course of the disease. The ALS has a prevalence of 6 for 100.000 people and the beginning of the disease is usually among the 40 to 60 years of age. The prognostic is reserved and on average the patients live from 3 to 5 years after the medical diagnosis. With the progression of the disease other symptoms they appear as weakness of the members, compromising of the speech, increase of the salivation, deglutition difficulties, difficulties to stroll and it fatigues muscular. The alterations of the breathing muscles take to the breathing bankruptcy, that is the largest death cause in the patients with ALS. Fatigue is defined as the fall of the maxim voluntary isometric contraction and lack of tolerance of the muscle under effort. The maxim voluntary isometric contraction depends on a chain of events that begins in the motor cortex - driver excitatory of the neurons motor superior and inferior, and it is continued in the transmission by the junction neuromuscular, in the joining excitement-contraction and in the contraction of the muscular fiber that depends on a metabolic energy supply. The muscular fatigue happens in patients with ALS harming the function and the quality of the patients\' life. The objective of this work was: 1) to quantify the frequency of the fatigue in the ALS; 2) to analyze the evolution of the fatigue in the patients; 3) to correlate the presence of the fatigue with factors as the functionality, the life quality, the depression, the dispnéa, and the sleepiness, age and duration of the disease in months. The group control was composed of 60 individuals (family of employees of the hospital and of the team multidisciplinar) that didn\'t present history of past diseases. The group test is constituted of 60 patients with diagnosis of ALS. The diagnosis was accomplished by two independent neurologists and he/she based on the presence of clinical history, neurological exam and studies compatible neurophisiologycs with ALS, according to the criteria of El Escorial of the World Federation of Neurology; besides, there was the complement investigation through tests and exams to exclude other pathologies. The patients of the groups control and test were interviewed by the researcher for application of questionnaires with scales for verification of the functionality presence, of life quality, of depression, of dispnéa, of sleepiness and of fatigue; and the patients of the group test they were submitted to the evaluation physiotherapy in the beginning of the study and every 3 months, totaling 12 months of collections. The group test presented fatigue larger significantly in relation to the group it controls, as well as alterations in the functionality questionnaires, of life quality, of depression, of dispnéa and of sleepiness. It was noticed that the fatigue was evolutionary during the months of accompaniment of the research. The fatigue was correlated with the age, showing that the youngest patients presented larger degree of fatigue than the most senior patients. The results of this research suggest that the fatigue is one of the problems that affect the patients with ALS; the fact of not having correlation with other studied problems suggests that the fatigue should deserve research and treatment individualized in the patient with ALS, mainly for the fact that the results suggested worsening of the fatigue in elapsing of the evolution of the ALS

Made available in DSpace on 2014-07-29T15:29:04Z (GMT). No. of bitstreams: 1 Gustavo Carvalho.pdf: 688659 bytes, checksum: 64c90851349790785086b6829b1f9537 (MD5) Previous issue date: 2011-03-21 / Background: The concomitance of asymptomatic coronary heart disease in patients with Chagas cardiomyopathy with heart failure is not well known in medical literature, and both are very prevalent in some regions of Brazil. Objective: Determine the prevalence of coronary disease (lesion>50%) in a specific group of patients with Chagas cardiomyopathy and heart failure, in functional class III and IV, with no previous symptoms or diagnosis of coronaryopathy. Methods: Coronary angiography was performed in 61 consecutive patients with Chagas cardiomyopathy with heart failure, functional class III and IV, to exclude coronary heart disease. These patients were part of study protocol of cell therapy in heart disease, which required the implementation of coronary angiography before injecting stem cells. Risk factors for atherosclerosis also analyzed in this population were: age, hypertension, diabetes, dyslipidemia, smoking and overweight. Results: ages 51.6 + 9.6 years 65.5%(n = 40) men. The prevalence of coronary disease found in this population was 1.6%(1). The prevalence of risk factors were: hypertension 18%(11), smoking 59%(36), diabetes 1.6%(1) and dyslipidemia 6.5%(4). Conclusion: The prevalence of asymptomatic coronary disease in patients with chagasic etiology severe heart failure is low and among the risk factors for coronary heart disease, smoking was the most prevalent. / Fundamento: A concomitância da doença arterial coronária assintomática em pacientes com cardiomiopatia chagásica em IC não é bem definida na literatura médica, sendo ambas muito prevalentes em algumas regiões do Brasil. Objetivo: Determinar a prevalência da coronariopatia(lesões > 50%) em uma população específica de pacientes com cardiomiopatia chagásica e IC em classe funcional III e IV, que não apresentavam clínica ou diagnóstico prévio de coronariopatia. Métodos: Foi realizada a cineangiocoronariografia em 61 pacientes consecutivos, portadores de cardiomiopatia chagásica, em IC classe funcional III e IV, para se excluir coronariopatia. Estes pacientes faziam parte do protocolo do Estudo de Terapia Celular em Cardiopatias, que exigia a realização da cineangiocoronariografia antes de se injetar as células-tronco. Os fatores de risco para aterosclerose, também analisados nesta população, foram: idade, hipertensão arterial, diabetes, dislipidemia, tabagismo e sobrepeso. Resultados: Idade média 51,6 + 9,6 anos, 65,5%(n=40) homens. A prevalência de coronariopatia encontrada nesta população foi de 1,6%(1). As prevalências dos fatores de risco foram: hipertensão arterial 18%(11), tabagismo 59%(36), diabetes 1,6%(1) e dislipidemia 6,5%(4). Conclusão: A prevalência da coronariopatia assintomática em pacientes com IC grave de etiologia chagásica é baixa e entre os fatores de risco para doença coronária o tabagismo foi o mais prevalente.

Esclerose lateral amiotrófica (ELA) é uma doença neurológica progressiva e fatal, caracterizada por perda dos neurônios motores, levando à fraqueza muscular global. As funções sensitivas e mentais são preservadas durante todo o curso da doença. A esclerose lateral amiotrófica tem uma prevalência de 6 por 100.000 pessoas e o início da doença é geralmente entre os 40 a 60 anos de idade. O prognóstico é reservado e em média os pacientes vivem de 3 a 5 anos após o diagnóstico médico. Com a progressão da doença outros sintomas surgem como fraqueza dos membros, comprometimento da fala, aumento da salivação, dificuldades de deglutição, dificuldades para deambular e fadiga muscular. As alterações dos músculos respiratórios levam à falência respiratória, que é a maior causa de óbito nos pacientes com esclerose lateral amiotrófica. Fadiga é definida como a queda da máxima contração isométrica voluntária e falta de tolerância do músculo sob esforço. A máxima contração isométrica voluntária depende de uma cadeia de eventos que se inicia no córtex motor - condutor excitatório dos neurônios motores superior e inferior, e se continua na transmissão pela junção neuromuscular, no acoplamento excitação-contração e na contração da fibra muscular que depende de um suprimento energético metabólico. A fadiga muscular ocorre em pacientes com esclerose lateral amiotrófica prejudicando a função e a qualidade de vida dos pacientes. O objetivo deste trabalho foi: 1) Quantificar a freqüência da fadiga na esclerose lateral amiotrófica; 2) Analisar a evolução da fadiga nos pacientes; 3) Correlacionar a presença da fadiga com fatores como a funcionalidade, a qualidade de vida, a depressão, a dispnéia, e a sonolência, idade e duração da doença em meses. O grupo controle compôs-se de 60 indivíduos (familiares de funcionários do hospital e da equipe multidisciplinar) que não apresentavam história de doenças pregressas. O grupo teste constitui-se de 60 pacientes com diagnóstico de esclerose lateral amiotrófica. O diagnóstico foi realizado por dois neurologistas independentes e baseou-se na presença de história clínica, exame neurológico e estudos neurofisiológicos compatíveis com esclerose lateral amiotrófica, segundo os critérios de El Escorial da Federação Mundial de Neurologia; além disso, houve a investigação complementar por meio de testes hematológicos, bioquímicos, sorológicos, genéticos e radiológicos para excluir outras patologias. Os pacientes dos grupos controle e teste foram entrevistados pela pesquisadora para aplicação de questionários com escalas para verificação da presença de funcionalidade, de qualidade de vida, de depressão, de dispnéia, de sonolência e de fadiga; e os pacientes do grupo teste foram submetidos à avaliação fisioterapêutica no início do estudo e a cada 3 meses, totalizando 12 meses de coletas. O grupo teste apresentou fadiga significantemente maior em relação ao grupo controle, bem como alterações nos questionários de funcionalidade, de qualidade de vida, de depressão, de dispnéia e de sonolência. Percebeu-se que a fadiga foi evolutiva durante os meses de acompanhamento da pesquisa. A fadiga correlacionou-se com a idade, mostrando que os pacientes mais jovens apresentaram maior grau de fadiga que os pacientes mais idosos. Os resultados desta pesquisa sugerem que a fadiga é um dos problemas que afetam os pacientes com ELA; o fato de não ter correlação com outros problemas estudados sugere que a fadiga deve merecer pesquisa e tratamento individualizados no paciente com ELA, principalmente pelo fato de que os resultados sugeriram piora da fadiga no decorrer da evolução da ELA / Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurological disease, characterized by loss of the motor neurons, taking to the global muscular weakness. The sensitive and mental functions are preserved during whole the course of the disease. The ALS has a prevalence of 6 for 100.000 people and the beginning of the disease is usually among the 40 to 60 years of age. The prognostic is reserved and on average the patients live from 3 to 5 years after the medical diagnosis. With the progression of the disease other symptoms they appear as weakness of the members, compromising of the speech, increase of the salivation, deglutition difficulties, difficulties to stroll and it fatigues muscular. The alterations of the breathing muscles take to the breathing bankruptcy, that is the largest death cause in the patients with ALS. Fatigue is defined as the fall of the maxim voluntary isometric contraction and lack of tolerance of the muscle under effort. The maxim voluntary isometric contraction depends on a chain of events that begins in the motor cortex - driver excitatory of the neurons motor superior and inferior, and it is continued in the transmission by the junction neuromuscular, in the joining excitement-contraction and in the contraction of the muscular fiber that depends on a metabolic energy supply. The muscular fatigue happens in patients with ALS harming the function and the quality of the patients\' life. The objective of this work was: 1) to quantify the frequency of the fatigue in the ALS; 2) to analyze the evolution of the fatigue in the patients; 3) to correlate the presence of the fatigue with factors as the functionality, the life quality, the depression, the dispnéa, and the sleepiness, age and duration of the disease in months. The group control was composed of 60 individuals (family of employees of the hospital and of the team multidisciplinar) that didn\'t present history of past diseases. The group test is constituted of 60 patients with diagnosis of ALS. The diagnosis was accomplished by two independent neurologists and he/she based on the presence of clinical history, neurological exam and studies compatible neurophisiologycs with ALS, according to the criteria of El Escorial of the World Federation of Neurology; besides, there was the complement investigation through tests and exams to exclude other pathologies. The patients of the groups control and test were interviewed by the researcher for application of questionnaires with scales for verification of the functionality presence, of life quality, of depression, of dispnéa, of sleepiness and of fatigue; and the patients of the group test they were submitted to the evaluation physiotherapy in the beginning of the study and every 3 months, totaling 12 months of collections. The group test presented fatigue larger significantly in relation to the group it controls, as well as alterations in the functionality questionnaires, of life quality, of depression, of dispnéa and of sleepiness. It was noticed that the fatigue was evolutionary during the months of accompaniment of the research. The fatigue was correlated with the age, showing that the youngest patients presented larger degree of fatigue than the most senior patients. The results of this research suggest that the fatigue is one of the problems that affect the patients with ALS; the fact of not having correlation with other studied problems suggests that the fatigue should deserve research and treatment individualized in the patient with ALS, mainly for the fact that the results suggested worsening of the fatigue in elapsing of the evolution of the ALS

Background: Epidemiological data on the prevalence of Parkinson’s disease (PD) in Germany are limited. The aims of this study were to estimate the age- and gender-specific prevalence of PD in Germany as well as the severity and illness duration. Summary: A systematic literature search was performed in 5 different databases. European studies were included if they reported age- and gender-specific numbers of prevalence rates of PD. Meta-analytic approaches were applied to derive age- and gender-specific pooled prevalence estimates. Data of 4 German outpatient samples were incorporated to calculate the proportion of patients with PD in Germany grouped by Hoehn and Yahr (HY) stages and disease duration. In the German population, 178,169 cases of PD were estimated (prevalence: 217.22/100,000). The estimated relative illness duration was 40% with less than 5 years, 31% with 5–9 years, and 29% with more than 9 years. The proportions for different HY stages were estimated at 13% (I), 30% (II), 35% (III), 17% (IV), and 4% (V), respectively. Key Message: We provide an up-to-date estimation of age and gender-specific as well as severity-based prevalence figures for PD in Germany. Further community studies are needed to estimate population-based severity distributions and distributions of non-motor symptoms in PD.

Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.