Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T11:08:56Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Mestrado - Cláudia Araujo de Oliveira.pdf: 4883747 bytes, checksum: 14824518d1e891d31450a84522258e0b (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T14:33:26Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Mestrado - Cláudia Araujo de Oliveira.pdf: 4883747 bytes, checksum: 14824518d1e891d31450a84522258e0b (MD5) / Made available in DSpace on 2015-01-30T14:33:26Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação Mestrado - Cláudia Araujo de Oliveira.pdf: 4883747 bytes, checksum: 14824518d1e891d31450a84522258e0b (MD5) Previous issue date: 2014-02-13 / Increased life expectancy provides the emergence of diseases associated with aging, such as non-communicable chronic diseases, in the population. Due to the relevance of this topic, the aim of this study was to analyze the epidemiological profile of public servants assessed in admission exam for Forensic Medicine Unit of the Integrated Subsystem Attention to the Servant Health of the Federal University of Goiás, from January/2012 to January/2013. It was also established an intervention goal, aiming to develop a proposition of a course of continuing education in health to the public employees of Integrated Subsystem Attention to the Servant Health of the Federal University of Goiás, in order to propose actions for health promotion to those servants of the UFG. It was conducted a retrospective descriptive study of the health conditions of 358 servants hired at UFG, by public tender. The research was conducted through review of medical records and the sample was a convenience (census). The prevalence of overweight, hypertension, hypercholesterolemia, hypertriglyceridemia, smoking and alcohol consumption was respectively: 41.7%, 25,6%, 30.3%, 19.1%, 7.5% and 5.3%. Association was found between body mass index (weight / height ²) with males (p ≤ 0.001) and the levels of blood pressure (p ≤ 0.001). Metabolic syndrome was observed in 19 subjects aged 25-34 years (5,6%), from 339 servants that had at least three associated risk factors. Among the individuals with metabolic syndrome, most have some degree of overweight /obesity with statistical significance amongst individuals with excess of body weight (p ≤ 0.001) and in males (p = 0.002). It was concluded that among examined for admission exam at the Federal University of Goiás, from January 2012 to January 2013, there were: high prevalence of cardiovascular risk factors for the development of non-communicable chronic diseases such as systemic hypertension, hypercholesterolemia, overweight /obesity and metabolic syndrome in a population predominantly composed of young adults, associations between body mass index increased and male sex, systemic hypertension and personal history of hypertension; association between self-reported non-communicable chronic diseases and hypertension; association between metabolic syndrome and male sex and body mass index increased, the low prevalence of self-reported tobacco and alcohol consumption, aptitude in the mental sanity certificate among all the servants; high prevalence of refractive errors in the visual acuity examination and alterations in campimetry; high prevalence of inflammatory onco-parasitic cytology in female servants and low prevalence of altered mammograms; high prevalence of normal electrocardiograms. It’s necessary to intervene with promotional educational activities for UFG servants by actions on health education. Thus, initially it was proposed a course of continuing education to the servants of the Integrated Subsystem Attention to the Server Health of the Federal University of Goiás. / Com o aumento da expectativa de vida, as populações vem apresentando doenças associadas ao processo de envelhecimento, como as doenças crônicas não transmissíveis. Foi objetivo desse estudo analisar o perfil epidemiológico dos servidores avaliados em exame admissional pela Unidade de Perícia Médica do Subsistema Integrado de Atenção à Saúde do Servidor da Universidade Federal de Goiás, no período de janeiro/2012 a janeiro/2013. Também foi estabelecido um objetivo de intervenção visando a elaborar proposta de curso de educação permanente em saúde para os servidores do Subsistema Integrado de Atenção à Saúde do Servidor da Universidade Federal de Goiás, com vistas a propor ações de promoção da saúde aos servidores da UFG. Realizou-se um estudo descritivo retrospectivo das condições de saúde dos 358 servidores admitidos na UFG, por concurso público. A pesquisa ocorreu por meio de consulta aos prontuários médicos e a amostra foi de conveniência (censo). A prevalência de excesso de peso, hipertensão arterial, hipercolesterolemia, hipertrigliceridemia, tabagismo e etilismo foi respectivamente de: 41,7%; 25,6%; 30,3%; 19,1%; 7,5% e 5,3%. Houve associação do índice de massa corporal (peso/altura²) com o sexo masculino (p≤0,001) e com os níveis de pressão arterial (p≤0,001). Observou-se Síndrome Metabólica em 19 indivíduos na faixa etária de 25 a 34 anos (5,6%), entre 339 servidores que apresentavam, pelo menos, associação de três fatores de risco. Dos indivíduos com Síndrome Metabólica, a maioria apresenta algum grau de sobrepeso/obesidade com significância estatística entre indivíduos com excesso de peso corporal (p≤0,001) e no sexo masculino (p=0,002). Concluiu-se que entre os examinados para exame admissional na Universidade Federal de Goiás no período de janeiro de 2012 a janeiro de 2013 houve: alta prevalência de fatores de risco cardiovascular para o desenvolvimento de Doenças Crônicas não Transmissíveis, como Hipertensão Arterial Sistêmica, Hipercolesterolemia, Sobrepeso/Obesidade e Síndrome Metabólica numa população predominantemente composta por adultos jovens; associações entre Índice de Massa Corporal aumentado e sexo masculino, hipertensão arterial sistêmica e antecedentes pessoais de hipertensão arterial; associação entre Doenças Crônicas não Transmissíveis autorreferidas e hipertensão arterial; associação entre Síndrome Metabólica e sexo masculino e Índice de Massa Corporal aumentado; baixa prevalência no auto-relato de consumo de tabagismo eetilismo; aptidão no atestado de sanidade mental entre todos os servidores; alta prevalência de defeitos de refração no exame de acuidade visual e de alterações da campimetria; alta prevalência de citologia onco-parasitária inflamatória nas servidoras e baixa prevalência de mamografias alteradas; alta prevalência de eletrocardiogramas normais. Há necessidade de intervir com ações educativas de promoção de saúde para os servidores da UFG por meio de ações de educação em saúde. Assim, foi proposto inicialmente um curso de educação permanente para os servidores do Subsistema Integrado de Atenção à Saúde do Servidor da Universidade Federal de Goiás.

Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-03-06T13:20:11Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação_Ticiane Martins.pdf: 2135108 bytes, checksum: c6b0f89e1010ea644b1981037d1f9151 (MD5) / Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-03-06T13:36:54Z No. of bitstreams: 2 Dissertação_Ticiane Martins.pdf: 2135108 bytes, checksum: c6b0f89e1010ea644b1981037d1f9151 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-03-06T13:37:06Z (GMT) No. of bitstreams: 2 Dissertação_Ticiane Martins.pdf: 2135108 bytes, checksum: c6b0f89e1010ea644b1981037d1f9151 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-03-06T13:37:06Z (GMT). No. of bitstreams: 2 Dissertação_Ticiane Martins.pdf: 2135108 bytes, checksum: c6b0f89e1010ea644b1981037d1f9151 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-09-18 / Introduction: The gastric cancer has been considered the second leading cause of cancer mortality in the world and the fourth most common cause of malignant tumors diagnosed each year. In northern Brazil, gastric cancer has higher incidence compared than other regions of the country. Many studies of the HER2 protein are intended to improve the overall survival of gastric cancer patients, especially in advanced stages, as this protein acts as an oncogene and its overexpression is related to malignant transformation. Since the advent of adjuvant therapy for HER2 positive for breast cancer, the interest in the use of trastuzumab in gastric cancer patients has increased. However, the lack of profile patients information for that biomarker in northern Brazil, including the Amazonas state, makes it difficult even more. The importance of performing studies on the expression of HER2 is confirmed as regional incidence rates exceed the national gastric cancer rates annually. Objective: The aim of this study is to characterize the epidemiological profile of patients in Manaus-AM reference centers, with endoscopic diagnosis of gastric cancer, and verifying HER2 expression. Methods: It was a prospective study to evaluate the epidemiological profile gastric carcinoma’s pacients, submitted to radical or palliative gastrectomy, and those not eligible for surgical resection. After filling out the form, reviewing histological findings of the biopsy with diagnosis of gastric carcinoma in previously collected materials, and the investigation of HER2 expression were performed. This was performed by immunohistochemical method (IHC), using the anti-HER2/neu kit (4B5), with interpretation according to Hofmann’s criteria. Patients who underwent surgical resection during the development of the study, the surgical specimen was processed for macro and microscopic evaluations, and tissue selection for HER2. Results: In the period of April 2016 to June 2017, 59 patients were included in the project. Among them, 71.19% were males, 61.02% were under 65 years old, ranging from 26 to 85 years. On endoscopic examination, 74.58% of lesions were at antrum, and 45.76% of patients presented Borrmann III lesion and 37.29%, Borrmann IV lesion, 47.46% of the patients were submitted to surgical resection and 66.10% were staging IV. The overexpression of HER2 were investigated by IHC in 26 samples of gastric resection, with a rate of 11.54%. Conclusions: In this group of patients, gastric carcinoma was more frequent in male patients, Lauren's intestinal type, in the antrum topography, older than 65 years, with presence of lymph node metastasis, and with advanced stage. The overexpression of HER2 was 11.54% in the gastrectomy samples. The results obtained in this study is relevant for the development of future researches, with the purpose of improving the treatment and patient survival with gastric cancer in the northern region of Brazil, and especially in the state of Amazonas. / Introdução: O câncer gástrico é considerado a segunda causa de morbimortalidade por câncer no mundo e a quarta causa mais comum de tumores malignos diagnosticados anualmente. Na região Norte do Brasil, possui incidência superior quando comparada às outras regiões do país. Vários estudos sobre a proteína HER2 visam melhorar a sobrevida dos pacientes com câncer gástrico, principalmente nas formas avançadas, pois esta proteína atua como oncogene e sua superexpressão está relacionada à transformação maligna. Desde o advento da terapia adjuvante para pacientes HER2 positivos para câncer de mama, o interesse pelo uso de trastuzumab, em pacientes de câncer gástrico tem aumentado. No entanto, a falta de informações sobre o perfil dos pacientes para este marcador em estados da região Norte, incluindo o estado do Amazonas, dificulta ainda mais sua utilização. Afirma-se assim a importância da realização de estudos sobre a expressão do HER2, devido aos índices de incidência regionais superarem os índices nacionais de câncer gástrico anualmente. Objetivo: Caracterizar o perfil epidemiológico de pacientes atendidos em dois centros de referência na cidade de Manaus-AM, com diagnóstico de carcinoma gástrico, verificando a expressão de HER2. Métodos: Avaliou-se de forma prospectiva o perfil epidemiológico de pacientes com diagnóstico de carcinoma gástrico, submetidos a gastrectomias radical ou paliativa, e daqueles não elegíveis à ressecção cirúrgica. Para tanto, foram realizadas as etapas de preenchimento de formulário, revisão dos achados histológicos da biópsia com diagnóstico de carcinoma gástrico em materiais já coletados, e a pesquisa da expressão de HER2. Esta foi realizada por método imunoistoquímico (IHQ), com utilização do kit anti-HER-2/neu (4B5), com interpretação de acordo com os critérios de Hofmann. Para os pacientes que foram submetidos à ressecção cirúrgica durante o desenvolvimento da pesquisa, a peça operatória foi processada para avaliações macro e microscópicas, e seleção tecidual para pesquisa de HER2. Resultados: Entre os meses de abril de 2016 a junho de 2017, 59 pacientes foram inseridos no projeto. Destes, 71,19% eram do sexo masculino, 61,02% apresentavam idade inferior a 65 anos, com variação de 26 a 85 anos. Ao exame endoscópico, 74,58% das lesões eram antrais, e 45,76% dos pacientes apresentavam lesão Borrmann III e 37,29%, Borrmann IV. Quanto ao tratamento, 47,46% dos pacientes foram submetidos à ressecção cirúrgica e 66,10% apresentavam estadiamento IV. A expressão do HER2 foi pesquisada em 26 amostras de gastrectomia, com positividade em 11,54% dos casos. Conclusão: No grupo de pacientes avaliados, o carcinoma gástrico foi mais frequente em pacientes do sexo masculino, com idade inferior a 65 anos, os quais apresentaram neoplasia do tipo intestinal de Lauren, na topografia antro-pilórica, Borrmann III e IV, com presença de metástase linfonodal, e com estadiamento avançado. A positividade para HER2 foi de 11,54% nas amostras de gastrectomias. As informações obtidas neste trabalho são relevantes para o desenvolvimento de pesquisas futuras, com o propósito de melhorar o tratamento e sobrevida dos pacientes com câncer gástrico na região norte do Brasil, e, principalmente, no estado do Amazonas.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-26T14:04:02Z No. of bitstreams: 2 Dissertação - Daniella Carpaneda Machado - 2015.pdf: 2199589 bytes, checksum: 80dfa32195908d14c34b1e91c06e3de7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-26T14:04:23Z (GMT) No. of bitstreams: 2 Dissertação - Daniella Carpaneda Machado - 2015.pdf: 2199589 bytes, checksum: 80dfa32195908d14c34b1e91c06e3de7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-05-26T14:04:23Z (GMT). No. of bitstreams: 2 Dissertação - Daniella Carpaneda Machado - 2015.pdf: 2199589 bytes, checksum: 80dfa32195908d14c34b1e91c06e3de7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-02-27 / The hantavirus is an emerging zoonosis, considered a public health problem due to its high mortality and hospitalization. Transmission occurs by exposure to excreta of infected wild rodents, primarily via aerosol. The aim of this study is to evaluate the hantavirus monitoring system in the State of Goiás, in the period 2007 to 2012. This is an observational, descriptive and cross-sectional study in which the clinical and epidemiological features of hantavirus were analyzed and their attributes according to models proposed by the Updated Guidelines for Evaluating Public Health Surveillance Systems and Framework for Evaluating Public Health Surveillance Systems for Early Detection of outbreaks of the Center for Disease Control and Prevention and the Department of Health Surveillance. 63 cases were confirmed in the analyzed period. The disease has the highest number of confirmed cases in absolute numbers in 2009, with higher positivity of the relationship notification / confirmation in 2008. The municipalities of greater nudges Annapolis, Goiânia and Jataí. The hantavirus predominantly hit men, race / brown color, living in an urban area with high school education, being related to agricultural occupations and largest exhibitions in environments cleaning situations and in direct contact or with traces of a mouse . Most cases were reported in the first four days of the onset of symptoms, with signs of fever, dyspnea, and myalgia. He has performed many laboratory tests and imaging. However, it was demonstrated deficit of completeness in these fields in the reporting forms. The most notable changes are nonspecific hematocrit> 45% and thrombocytopenia, and on imaging, diffuse pulmonary infiltrates. More than 85% of the cases were confirmed by laboratory testing (IgM) and clinical form of hantavirus cardiopulmonary syndrome. High hospitalization rate, especially on the first day of care, was quite considerable and demand for organ support. The municipalities with the highest indication of Infection Likely Place are Annapolis and Jataí, in rural areas and work environment, with closure in time in just over 60% of cases. Although theoretically the system is useful in practice, low valuation is observed quantitative attributes (sensitivity, predictive value of positive, opportunity, stability) and qualitative (simplicity, flexibility and acceptability - in the question data quality assessment is average the bad). As for the management indicators was observed weaknesses in their use. From the analysis of the hantavirus surveillance system in Goias, 2007-20012, it was concluded that the current system is fragile. It is suggested a number of recommendations in order to give more useful reducing the socioeconomic impact of the disease through the continuous improvement of services provided by various levels and professional sectors, as well as the construction of an education service in health and prevention mainly for environmental management measures that prevent / reduce the risk of the presence of possible rodents infected with the human environment. / A hantavirose é uma zoonose emergente, considerada um problema de saúde pública devido seu alto grau de letalidade e hospitalização. A transmissão ocorre pela exposição aos excretas de roedores silvestres infectados, principalmente via aerossol. O objetivo do presente estudo é avaliar o sistema de vigilância da hantavirose no Estado de Goiás, no período de 2007 a 2012. Trata-se de um estudo observacional, descritivo e transversal, no qual foram analisadas as características clínicas e epidemiológicas da hantavirose e seus atributos segundo modelos propostos pelo Updated Guidelines for Evaluating Public Health Surveillance Systems e Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks do Center for Disease Control and Prevention e Secretaria de Vigilância em Saúde. Foram confirmados 63 casos no período analisado. A doença tem o maior número de casos confirmados em números absolutos em 2009, com maior positividade da relação notificação/confirmação em 2008. Os municípios de maior notificação foram Anápolis, Goiânia e Jataí. A hantavirose atingiu predominantemente homens, da raça/cor parda, residentes em zona urbana, com ensino médio completo, mostrando-se relacionada às ocupações agrícolas e com maiores exposições em situações de limpeza de ambientes e em contato direto ou com vestígios da presença de ratos. A maior parte dos casos foi notificada nos primeiros quatro dias do surgimento dos sintomas, com sinais de febre, dispneia e mialgia. Apresentou-se grande número de exames laboratoriais e de imagem. Entretanto, demonstrou-se déficit de completitude nestes campos nas fichas de notificação. As alterações inespecíficas mais marcantes são hematócrito >45% e trombocitopenia, e no exame de imagem, infiltrado pulmonar difuso. Mais de 85% dos casos foram confirmados por critério laboratorial (IgM) e na forma clínica de Síndrome Cardiopulmonar por Hantavírus. Elevada taxa de internação, principalmente no primeiro dia do atendimento, foi bastante considerável e com demanda de terapias de suporte. Os municípios com maior indicação de Local Provável de Infecção são Anápolis e Jataí, em zona rural e ambiente ocupacional, com encerramento em tempo oportuno em pouco mais de 60% dos casos. Apesar de teoricamente o sistema ser útil, na prática, observa-se baixa avaliação dos atributos quantitativos (sensibilidade, valor preditivo de positividade, oportunidade, estabilidade) e qualitativos (simplicidade, flexibilidade e aceitabilidade – no quesito qualidade dos dados a avaliação é de média a ruim). Quanto aos indicadores de gerenciamento, observou-se fragilidades em sua utilização. A partir da análise do sistema de vigilância da hantavirose em Goiás, 2007-20012, concluiu-se que o atual sistema é frágil. Sugere-se uma série de recomendações com o objetivo de lhe dar maior utilidade reduzindo o impacto socioeconômico da doença por meio da melhoria contínua dos serviços prestados pelos diversos níveis e setores de profissionais, bem como pela construção de um serviço de educação em saúde e prevenção, principalmente por medidas de manejo ambiental, que evitam/reduzem o risco da presença de possíveis roedores infectados no meio antrópico.

Introdução: Os aminoácidos de cadeia ramificada (ACR) compreendem três aminoácidos essenciais tais como, leucina (Leu), isoleucina (Ile) e valina (Val). Estes aminoácidos desempenham um papel importante no corpo humano, como a produção de energia, síntese de proteínas e de muitos neurotransmissores. São escassos os estudos que investigam o consumo de ACR e sua associação com as doenças cardiometabólicas. No entanto, estudos metabolômicos sugerem que os ACR encontrados no plasma podem ser preditores de doenças cardiometabólicas. Objetivos: Avaliar a ingestão de aminoácidos de cadeia ramificada (ACR), leucina (Leu), isoleucina (Ile) e valina (Val) e sua associação com fatores demográficos, socioeconômicos e estilo de vida, e com fatores de risco cardiometabólicos. Metodologia: Os dados foram provenientes do Inquérito de Saúde de São Paulo, estudo transversal de base populacional com amostra representativa de residentes do município de São Paulo, de ambos os sexos e com idade igual ou superior a 12 anos. O consumo alimentar foi avaliado por meio de dois recordatórios de 24 horas, não consecutivos. Utilizou-se um questionário estruturado para obter informações socioeconômicas, demográficas e de estilo de vida. Também foram coletadas amostras de sangue, pressão arterial, o peso, a estatura e circunferência da cintura dos indivíduos. Os analitos avaliados foram glicemia plasmática de jejum, triacilgliceróis (TG), lipoproteína de alta densidade (HDL), lipoproteína de baixa densidade (LDL), colesterol total (CT), proteína C reativa ultrassensível (PCRu), homocisteína e leptina séricas (LEP). As análises estatísticas foram realizadas utilizando o software Stata®, versão 13 com nível de significância de 0,05. Resultados: A ingestão total de ACR foi de 217,14 mg / kg×d (Leu: 97,16 mg / kg×d, Ile: 56,44 mg / kg×d, Val: 63,54 mg / kg×d). Em adolescentes a ingestão de ACR foi negativamente associada ao sexo feminino e a raça autodeclarada não branca. Nos adultos a ingestão de ACR foi negativamente associada ao sexo feminino e fumantes. A renda familiar per capita foi positivamente associada nos adolescentes e adultos. E não foram observadas associações no grupo de idosos. Os principais alimentos contribuintes para a ingestão de ACR foram carne vermelha não processada, aves não processadas, pão e torrada, feijão e arroz. Após o ajuste para potenciais fatores de confusão, o maior consumo de ACR total para o grupo de adultos e idosos (OR = 1,89, 95 por cento IC = 1,09 - 3,27), leucina (OR = 1,93, 95 por cento IC = 1,11 - 3,35), isoleucina (OR = 2,09, 95 por cento IC = 1,23 - 3,54) e valina (OR = 1,98, 95 por cento IC = 1,17 - 3,32) foram positivamente associados com hipertensão. E o mesmo foi observado para o modelo ajustado entre o maior consumo de ACR total (OR = 2,06, 95 por cento IC = 1,18 - 3,59), leucina (OR = 2,08, 95 por cento IC = 1,20 - 3,59), isoleucina (OR = 1,93, 95 por cento IC = 1,10 - 3,39) e valina (OR = 1,98, 95 por cento IC = 1,14 - 3,42) com hipertrigliceridemia. Conclusão: Os adolescentes e os adultos foram os grupos que mais se associaram a ter a ingestão de ACR influenciada por fatores demográficos, socioeconômicos e de estilo de vida. Dentre os fatores de risco cardiometabólicos, destacaram-se a hipertensão e a hipertrigliceridemia como fatores positivamente associados com o maior consumo de ACR total, leucina, isoleucina e valina. Esses resultados reforçam a importância da investigação do limite tolerável de ingestão dos ACR, bem como sua associação nos diferentes desfechos em saúde. / Introduction: Branched chain amino acids (BCAA) comprise three essential amino acids such as leucine (Leu), isoleucine (Ile) and valine (Val). These amino acids play an important role in the human body, such as energy production, protein synthesis and many neurotransmitters. There are few studies that investigate BCAA consumption and its association with cardiometabolic diseases. However, metabolic studies suggest that BCAA found in plasma may be a predictor of cardiometabolic diseases. Objectives: To evaluate the intake of branched chain amino acids (BCAA), leucine (Leu), isoleucine (Ile) and valine (Val) with demographic, socioeconomic and lifestyle factors, and to investigate the intake of BCAA with cardiometabolic risk factors. Methods: Data were obtained from the Health Survey of São Paulo, a population-based cross-sectional study with a representative sample of residents of the city of São Paulo, of both sexes and aged over 12 years. Dietary intake was evaluated by two 24-hour dietary recalls and a structured questionnaire was used to obtain socioeconomic, demographic and lifestyle information. Blood samples were collected and blood pressure, weight, height and waist circumference were measured. The analyzed analytes were fasting plasma glucose, triacylglycerols (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), C-reactive protein (PCRu), homocysteine and serum leptin (LEP). All analyses were performed with Stata®, version 13 and a p-value < 0.05 was considered statistically significant. Results: Total BCAA intake was 217.14 mg/kg.day (Leu: 97.16 mg/kg.day; Ile:56.44 mg/kg.day; Val: 63.54 mg/kg.day). BCAA intake was negatively associated with female sex in adolescents and adult groups, with no white race in adolescents, and with former smoker status in adults. Conversely, BCAA was positively associated with household per capita income in adolescents and adults. No associations were observed in the older adults group. Main food contributors to BCAA for all ages were unprocessed red meat, unprocessed poultry, bread and toast, beans and rice. For the group of adults and older adults, after adjusting for potential confounding factors, higher intakes of total BCAA (OR = 1,89, 95 per cent CI = 1,09 - 3,27), leucine (OR = 1,93, 95 per cent CI = 1,11 - 3,35), isoleucine (OR = 2,09, 95 per cent CI = 1,23 - 3,54) e valine (OR = 1,98, 95 per cent CI = 1,17 - 3,32) were positively associated with hypertension. The same was observed for the adjusted model between the highest consumption of total BCAA (OR = 2,06, 95 per cent CI = 1,18 - 3,59), leucine (OR = 2,08, 95 per cent CI = 1,20 - 3,59), isoleucine (OR = 1,93, 95 per cent CI = 1,10 - 3,39) and valine (OR = 1,98, 95 per cent CI = 1,14 - 3,42) with hypertriglyceridemia. Conclusion: Adolescents and adults were the most vulnerable to having their BCAA intake influenced by demographic, socioeconomic and lifestyle factors. Among the cardiometabolic risk, hypertension and hypertriglyceridemia were positively associated with higher intake of total BCAA, leucine, isoleucine and valine. These results reinforce the importance of investigating the tolerable limit of intake of BCAA, as well as its association in different health outcomes.

Introdução: as infecções de sítio cirúrgico (ISC) estão entre as infecções relacionadas à assistência à saúde (IRAS) de maior frequência. Autoridades governamentais devem estabelecer prioridades para a vigilância epidemiológica, reconhecida como um importante instrumento para a redução das taxas de ISC. Vários países em desenvolvimento não possuem condições de conduzir um Sistema de Vigilância das Infecções de Sítio Cirúrgico (SVISC) que inclua todos os tipos de cirurgia; portanto, critérios devem ser utilizados para selecionar os indicadores mais adequados a serem monitorados. Desde 2004, o SVISC do estado de São Paulo tem focado somente as taxas de ISC dos procedimentos classificados como limpos; entretanto, em 2011 reconheceu a necessidade de implementar alterações no sistema vigente até então. Objetivos: o principal objetivo deste estudo foi selecionar e implementar indicadores para o novo SVISC do estado de São Paulo. Métodos: o estudo foi conduzido de agosto de 2011 a julho de 2013; uma combinação de três métodos foi utilizada sequencialmente: 1) Estudo metodológico de revisão da literatura e consulta a especialistas objetivando identificar os critérios mais adequados para a seleção dos indicadores a serem monitorados em âmbito governamental; 2) Elaboração de ferramenta documental para apoiar a implementação do novo sistema de VE das ISC; 3) Estudo epidemiológico descritivo dos resultados dos indicadores de ISC após a implementação do sistema. As instituições de saúde notificantes do novo sistema (n=555) representaram 82,7% de todas as instituições consideradas com potencial para notificação. Resultados: os principais critérios identificados para a seleção dos indicadores de ISC foram a) magnitude da realização do procedimento cirúrgico pelo Sistema Único de Saúde brasileiro; b) severidade do dano em caso de ISC; c) potencial impacto de estratégias de prevenção; d) recomendação por norma federal; e) potencial para futuro benchmarking com pelo menos três outros SVISC. A seguir são apresentados os procedimentos cirúrgicos selecionados para a vigilância no novo sistema e suas respectivas taxas de ISC para o percentil 75 e número de procedimentos cirúrgicos notificados referentes ao ano de 2012: parto cesariano: 0,79% (n=304.198), revascularização do miocárdio: 9,0% (n=12.000); artroplastia do joelho: 2,2% (n=10.225), artroplastia do quadril: 3,9% (n=9.984), craniotomia: 6,8% (n=8.514), mastectomia: 0,0% (n=9.515) e os seguintes procedimentos realizados por laparoscopia: colecistectomia: 0,0% (n=54.960), herniorrafia: 0,0% (n=21.627), histerectomia: 0,0% (n=9.071), apendicectomia: 0,0% (n=8.122) e colectomia 0,0% (n=1.963). Conclusões: o desenvolvimento de critérios suporta a seleção racional de indicadores de ISC para o monitoramento no âmbito governamental. Apesar da adesão satisfatória das instituições, os dados obtidos sugerem que algumas taxas podem ser subnotificadas. Esforços devem focar a melhoria da qualidade dos dados / Introduction: the surgical site infections (SSI) are among the most frequently healthcare associated infection (HAI). Governmental authorities should establish priorities for the epidemiologic surveillance which is recognized as an important strategy to reduce the SSI rates. Many developing countries cannot afford to manage Surgical Site Infection Surveillance System (SSISS) that includes all types of surgeries; therefore a criterion should be used to select the most appropriate indicators to be monitored. Since 2004, the SSISS in São Paulo have been focused on only crude rates of SSI in clean surgeries; however, in 2011 it was recognized that was necessary to implement changes in the ongoing system. Objective: the present study aimed to select and to implement indicators for the new SSISS in the São Paulo State. Methods: this study was carried out from August 2011 to July 2013; three methods were used sequentially 1) Methodological study carried out by means of literature review and consulting to HAI experts aiming to identify the best criteria for selection of SSI indicators to be monitored at the governmental level; 2) Development of a written tool to support the implementation of the new SSISS; 3) Epidemiological descriptive study on SSI indicators results after implementation. The participating healthcare institutions (n=555) represented 82.7% of total acute care hospitals in the State which were considered to be potential participants. Results: the main criteria identified to select the SSI indicators were: a) magnitude of the surgery in the Brazilian Universal Health System; b) severity of harm in case of SSI; c) potential impact of prevention strategies; d) recommendation by federal normative; d) potential for benchmarking against at least other three SSISS worldwide. The surgical procedures selected, the SSI rates identified (3rd quartiles) and the number of surgeries monitored in 2012 were respectively: cesarean section: 0.79% (n=304,198); coronary artery bypass graft: 9.0% (n=12,000); knee arthroplasty: 2.2% (n=10,225), hip arthroplasty: 3.9% (n=9,984), craniotomy: 6.8% (n=8,514), mastectomy: 0.0% (n=9,515) and the following laparoscopic procedures: cholecystectomy: 0.0% (n=54,960), herniorrhaphy: 0.0% (n=21,627), histerectomy: 0.0% (n=9,071), apendicectomy: 0.0% (n=8,122) and colectomia 0.0% (n=1,963). Conclusion: The development of criteria supported the rational selection of indicators for governmental monitoring of SSI. Despite good adherence to the project, data suggest that SSI may be underestimated. Efforts should be focused on the improvement of data quality for SSISS

A epidemia da AIDS é considerada a mais importante ocorrida no século XX, segue sendo um importante problema de saúde pública e está relacionada a múltiplos fatores clínicos e epidemiológicos. Este estudo teve os objetivos de analisar e descrever o perfil epidemiológico e clinico dos pacientes portadores HIV que são admitidos numa Unidade de Emergência em serviço de alta complexidade, descrever o perfil sociodemográfico, avaliar as causas de internações, a evolução clinica desses pacientes e a aderência aos antirretrovirais. Trata-se de um estudo transversal, realizado na Unidade de Emergências do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de Março a Dezembro de 2016. Para verificação de associação entre variáveis foi empregado como medida de associação a Razão de Prevalência (RP) e seu Intervalo de Confiança a 95% (IC95%), inicialmente através de analises univariadas e posteriormente por analises multivariadas empregando-se regressão logística. Na comparação de medidas de tendência central, foi utilizado teste t Student para amostras independentes. Os resultados apresentados mostraram o predomínio dos pacientes do sexo masculino e da raça caucasiana, sendo em sua maioria moradora da cidade de Ribeirão Preto, com media de idade em 44 anos. As mulheres apresentaram tempo maior convivendo com o diagnostico de HIV em relação aos homens, a forma de contagio predominante foram as relações sexuais desprotegidas, os pacientes do sexo masculino apresentaram maior incidência na utilização de álcool, drogas e tabaco. Na comparação entre a carga viral e a contagem de células CD4 não houve diferenças estatísticas significantes (>0,05), na avaliação entre a carga viral e o uso da terapia antirretroviral houve diferenças estatísticas, no entanto, sendo observado que quem faz uso regular da terapia apresenta menor copias do vírus no organismo. Conclui-se que se faz necessária a melhora das políticas de saúde direcionadas à informação, educação e prevenção das DST/AIDS, bem como, adotar praticas de combate aos fatores que interferem na adesão á terapia medicamentosa. / The AIDS epidemic is considered to be the most important one occurred in the 20th century. It is still an important matter of public health and is related to multiple clinical and epidemiological factors. The objective of this study is to analyze and describe the epidemiological and clinical profile of patients with HIV who are admitted to an Emergency Unit in highly complex service, to describe the sociodemographic profile, to assess the causes of hospitalizations, clinical evolution of these patients and adherence to antiretrovirals. This is a cross-sectional study carried out at the Emergency Unit of the Clinics Hospital of Ribeirao Preto Medical School, University of Sao Paulo from March to December 2016. To verify the association between variables, the Prevalence Ratio (PR) and its Confidence Interval a 95% (95% CI) were employed as a measure of association, initially through univariate analyzes and later by multivariate analyzes using logistic regression. In the comparison of measures of central tendency, Student test for independent samples was used. The results presented showed the prevalence of male and Caucasian patients, being mostly residents of the city of Ribeirão Preto, with a mean age of 44 years, women presented greater time living with the diagnosis of HIV in relation to men, the predominant form of infection was unprotected sexual intercourse; male patients had a higher incidence of alcohol, drug and tobacco use; in the comparison between viral load and CD4 count, there was no, there were statistically significant differences between the viral load and the use of antiretroviral therapy, observing that those who regularly use the therapy have fewer copies of the virus in the body. In conclusion, it is necessary to improve health policies aimed at information, education and STD/AIDS prevention, and adopt practices to combat factors that interfere in adherence to drug therapy.

Made available in DSpace on 2014-08-20T14:30:17Z (GMT). No. of bitstreams: 1 Dissertacao_Fabiana_Chiapinotto.pdf: 2959787 bytes, checksum: 637ef42043b24eb57bc0d4a7a20e6df3 (MD5) Previous issue date: 2011-07-08 / Periodontal disease in its destructive form is characterized as a public health problem due to its high incidence and prevalence worldwide, and may cause a negative impact on the quality of life of individuals, depending on its severity. However, few population-based studies were conducted to measure the nondestructive form of periodontal disease, gingivitis, and the factors associated with it. The aim of this study is to estimate the prevalence and severity of gingivitis in schoolchildren and test its association with demographic, socioeconomic and behavioral factors. The study had a cross-sectional school based in the city of Pelotas, Brazil. The sample consisted of children between the ages of 8 and 12 years of both sexes, attending public and private schools, randomly selected through a process of conglomerate in two stages. Data were obtained through semi-structured questionnaire directed to parents or guardians and interview and clinical oral examination performed on schoolchildren. The diagnosis of gingivitis was achieved by the Gingival Bleeding Index (GBI). The dependent variable was the presence of gingival bleeding and gingivitis and the independent variables consisted of demographic, family socioeconomic status and the behavior of children towards oral health, use of dental services, and clinical variables. For statistical analysis the data were organized into a database using Epi-Data 6.0 and the description of absolute and relative frequencies being held later. Soon after, the associations between exposures and outcomes were tested using bivariate analysis, estimating prevalence ratios and confidence intervals at 95%. Multivariate analysis was performed using Poisson regression with robust variance and a significance level of 5%. The prevalence of bleeding on probing was 78.4% (95% CI: 76.1 to 81.0), the mean and median number of sites with gingival bleeding was 3.10 and 2 (SD ± 3.22), respectively. In multivariable adjusted analysis, the presence of a greater number of sites with plaque was significantly associated with gingivitis [PR 1.89 (95% CI: 1.50 to 2.37)]. Children whose mothers had less education, were 55% more likely to have gingivitis than mothers with more years of schooling ≥ 8. Mulatto children had a 39% lower chance of having gingivitis [PR 0.61 (95% CI: 0.43 to 0.85)] compared to children of white skin. This association was observed after adjusting for other variables such as gender, skin color and age. The reported high prevalence of gingivitis among schoolchildren and the socioeconomic and behavioral factors associated whit it confirm the need for dental care as a priority in preventive measures at earlier ages, when this condition is reversible and healthy oral hygiene habits are better understood and strengthened, taking into account the role of the mother in this process / O objetivo do presente estudo é estimar a prevalência de gengivite em escolares e testar a associação com fatores demográficos, socioeconômicos e comportamentais. O estudo apresentou delineamento transversal de base escolar, realizado na cidade de Pelotas, RS, Brasil. A amostra foi formada por crianças entre 8 a 12 anos de idade de ambos os sexos, de escolas públicas e privadas, selecionadas aleatoriamente através de um processo de conglomerado em duplo estágio. Os dados foram obtidos por meio de aplicação de questionário semi-estruturado direcionado aos pais e/ou responsáveis e de entrevista e exame clínico odontológico nos escolares. O diagnóstico de gengivite foi obtido através do Índice de Sangramento Gengival (ISG). Os desfechos foram sangramento gengival e gengivite. As variáveis independentes foram constituídas por características demográficas, socioeconômicas da família e comportamentais das crianças como os cuidados com a saúde bucal, utilização de serviços odontológicos, além das variáveis clínicas. Para a análise estatística os dados foram organizados em um banco de dados, utilizando-se o programa Epi-Data 6.0 sendo, posteriormente, realizada a descrição das freqüências absolutas e relativas. Logo após, as associações entre desfecho e exposições foram testadas utilizando-se análise bivariada, estimando-se as razões de prevalência e seus intervalos de confiança em 95%. A análise multivariada foi realizada pela Regressão de Poisson com variância robusta e um nível de significância de 5%. A prevalência de sangramento gengival foi de 78,4% (IC95%: 76,1;81,0), a média e a mediana do número de sítios com sangramento gengival foi de 3,10 e 2 (±DP 3,22), respectivamente. A prevalência de gengivite foi de 44,5% (IC95%: 42,3;46,4). Na análise multivariada ajustada, a presença de maior número de sítios com placa teve associação significativa com gengivite [RP 1,89 (IC95%: 1,50;2,37)], crianças cujas mães não tinham estudado, tiveram 55% maior probabilidade de gengivite em relação às mães com ≥ 8 anos de estudo. Crianças pardas apresentaram 39% menor risco de apresentar gengivite [RP 0,61 (IC95%: 0,43;0,85)] comparado às crianças de cor da pele branca. Essas associações foram verificadas após ajuste para outras variáveis como sexo, cor da pele e idade. A considerável prevalência de gengivite relatada nos escolares e os fatores sociais e clínicos associados confirmam a necessidade de haver prioridade no atendimento odontológico quanto às medidas preventivas em idades mais precoces, quando o agravo é reversível e os hábitos saudáveis de higiene bucal são mais bem entendidos e reforçados, levando em conta o papel fundamental que a mãe desempenha neste processo.

Although the association between social inequality and poor adult health is well established, the mechanisms by which inequality is translated into poor adult health are less clear. Increasingly, evidence suggests that many adult health problems and health disparities have their origins in early life; the developmental origins of health and disease (DOHaD) hypothesis provides an explanatory mechanism linking adverse early life conditions with permanent structural or functional changes that increase the risk for disease. This hypothesis is consistent with bioarchaeological research noting reduced lifespan among individuals exhibiting signs of childhood stress. The principal aim of this dissertation is to contribute a bioarchaeological perspective to health disparities research by investigating how health disparities can be measured and understood in the past. This study focuses on early life conditions as a source of adult health disparity by examining a skeletal sample for the association between childhood stress and adult longevity; the relationship between childhood stress and the presence of adult health conditions; and sex, ancestry, and regional differences in these relationships. The study sampled 830 age-documented, U.S. born African American males and females and Euro-American males from the Terry and the Hamann-Todd anatomical collections, representing socially-marginalized individuals from the late 19th- to early 20th centuries. Enamel hypoplasia, femoral length, and vertebral neural canal diameters represented childhood stress; skeletal fractures, tibial periostosis, and the diseased, missing, and filled tooth index represented adult health. Longevity was modeled with Kaplan-Meier survival curves and adult health relationships were modeled with logistic regression. Additionally, cause of death data from historic health department publications and the study sample morgue records were examined for disparity in the epidemiological transition from infectious to degenerative cause of death. The study found mixed results for all analyses. There was no reduction in longevity for the presence of enamel hypoplasia, short femoral length, or reduced thoracic neural canal diameter. African American males had statistically significant reduced longevity for small lumbar vertebral neural canal diameters. African American males from the Hamann-Todd Collection and Euro-American males from both collections had significant relationships between vertebral neural canal diameters and adult conditions; these relationships varied among the groups but in most cases demonstrated reduced odds for having the adult condition for individuals with smaller canal diameters. African American females had no differential survival or relationships between variables over the lifecourse. All groups except for the Terry Collection Euro-American males continued to have more infectious disease deaths than degenerative disease deaths. The study results contribute to disparities research by demonstrating that the consequences of childhood stress varied by sex and ancestry and by demonstrating within-population variation in timing of the epidemiological transition. Additionally, the study results support the contention of greater male sensitivity to environmental conditions and contributes evidence supporting the DOHaD hypothesis.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Laboratory studies, epidemiological investigations and human clinical trials indicate that flavonoids have important effects on cancer chemoprevention and therapy. Flavonoids may interfere in several steps that lead to cancer development but may also lead to toxicity as the inhibition of carcinogen-activating enzymes may also cause potential toxic flavonoid-drug interactions. However, the potential toxicity of these dietary components has not been well studied. The use of polyphenol enriched supplements prepared from South African herbal teas, rooibos(Aspalathus linearis)and honeybush (Cyclopia spp.) are being marketed to alleviate symptoms that are known to be “cured” by the herbal teas. However, there is a lack of information regarding the possible health promoting effects of these polyphenol-enriched extracts on xenobiotic metabolism. In the present study, the modulating effects of aspalathinenriched rooibos and mangiferin-enriched C. genistoides and C. subternata extracts on the gene expression of xenobiotic metabolising enzymes (XMEs) were investigated in vivo in the rat liver and kidneys. An in vitro study, utilising a primary rat hepatocyte cell model, was included to further evaluate changes in the expression of selected XMEs by the herbal tea extracts, including their major polyphenolic constituents, aspalathin and mangiferin. The use of the in vitro primary hepatocytes assay as a predictive cell model for the modulation of the expression of XMEs genes by the herbal tea extracts in vivo was critically evaluated.In the liver and kidneys, the C. subternata polyphenol-enriched herbal tea extract effected the majority of changes regarding the expression of XMEs genes when compared to the rooibos and C. genistoides. Variations in the modulation of gene expression of the XMEs by the herbal tea extracts were related to differences in their polyphenol constituents, although non-polyphenolic constituent could also be involved.Overall the herbal teas regulated alcohol,energy, drug and steroid metabolism in the liver, whereas in the kidneys the gene expression of phase I, phase II, steroid metabolising enzymes, as well as drug transporters were modulated. It would appear that the herbal teas are likely to exhibit both beneficial and adverse effects in vivo,depending on the specific organ, the xenobiotic and/or drug that are involved. The primary rat hepatocytes model display varying effects with respect to modulating gene expression of specific XMEs by the polyphenol-enriched herbal tea extracts. Apart from the reduction in 17 -hydroxysteroid dehydrogenase gene expression care should be taken to directly extrapolate the in vitro findings to changes that prevail in vivo.However, interesting results regarding the masking effect of complex mixture on the modulation of XME gene expression of individual polyphenols were encountered. In addition differences in the dose and duration of exposure between the in vitro and in vivo studies were not comparable and should be further explored to validate the in vitro primary hepatocytes model to predict changes in vivo. Future studies should investigate the effects of the herbal tea extracts, its polyphenols and metabolites on XME induction at a protein level as well as varying herb-drug-enzyme interactions.

Les maladies infectieuses posent un problème majeur de santé publique à travers le monde. En effet, les maladies infectieuses étaient la cause en 2004 de près de 15 millions de décès, que ce soit pour des pathogènes émergents, des pathogènes connus de l’homme depuis de nombreuses années ou encore des pathogènes ré-émergents (Estimation 2004 de l’OMS). Ce nombre a diminué. Cette évolution à la baisse touche la plupart des maladies infectieuses, mais une augmentation reste du domaine du possible comme l’a démontré la récente épidémie d’Ebola. Pour lutter contre ces maladies infectieuses, de nombreux outils de surveillance épidémiologique ont vu le jour à travers le monde. Ces systèmes ont pour but de détecter et d’identifier le plus précocement possible des évènements épidémiques favorisant l’alerte auprès des autorités compétentes et la mise en place de contre-mesures. L’objectif de notre travail a été de construire et de développer un système de surveillance épidémiologique à partir des données de laboratoire de microbiologie de la région Provence-Alpes Côte d’Azur (PACA). Ce système doit nous permettre d’identifier de possibles évènements anormaux de façon hebdomadaire à partir des données des différents laboratoires participants. Le système de surveillance nous a par la suite permis de déclarer plusieurs alertes auprès de l’Agence Régionale de Santé (ARS) PACA, de valoriser notre travail par des publications et enfin de valoriser le travail des laboratoires en leur transmettant une rétro-information contenant les principales alarmes de la semaine. / Infectious diseases are a major public health problem worldwide. Indeed, infectious diseases were the cause in 2004 to nearly 15 million deaths, whether for emerging pathogens, pathogens known to man for many years or even re-emerging pathogens (2004 Estimation of WHO). It has fallen since we moved, for example, 1.27 million cases of malaria in 2004 to 854,600 in 2013. This downward trend affecting most infectious diseases, but an increase is still the realm of possibility as the demonstrated by the recent outbreak of Ebola.To fight against these infectious diseases, many epidemiological surveillance tools have emerged worldwide. These systems are designed to detect and identify as early as possible of possible epidemic events to promote the warning to the competent authorities and the establishment of counter-measures. The objective of our work was to build and develop an epidemiological surveillance system from the microbiology laboratory data of the Provence-Alpes Côte d'Azur (PACA). This system should enable us to identify possible abnormal events weekly data from the different participating laboratories. The monitoring system has enabled us later to declare several warnings from the Regional Health Agency (ARS) PACA, enhance our work through publications and finally to promote the work of laboratories by providing them a feedback containing the main alarms of the week.The development and automation of the system through the creation of an IT platform developed within the Mediterranean Institute University Hospital Infection (IHU) and by increasing the number of participants and the extension of this system to other regions in France or other countries.