Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-24T12:28:10Z No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1193582 bytes, checksum: cad7014fa8412a61994647486edc8e93 (MD5) / Rejected by Caroline Xavier (caroline.xavier@pucrs.br), reason: Devolvido devido ? falta de capa institucional. on 2017-08-25T17:56:57Z (GMT) / Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-30T11:26:00Z No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) / Approved for entry into archive by Marcelo Texeira (marcelo.texeira@pucrs.br) on 2017-08-30T13:18:13Z (GMT) No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) / Made available in DSpace on 2017-08-30T13:19:58Z (GMT). No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) Previous issue date: 2017-03-20 / Introduction: chronic kidney disease (CKD) is characterized by structural changes or kidney function present for more than three months with health implications. Faced with these changes and complications, the patients undergo stressors capable of influencing their coping with the disease and treatment perspectives. Objective: to characterize the coping profile of patients on the waiting list for renal transplantation based on the Jalowiec Coping Scale (CJD) and to evaluate quality of life using SF-36. Method: a cross-sectional quantitative study that took place at the hemodialysis unit of Hospital S?o Lucas PUCRS, patients on the waiting list for renal transplantation, who are over 18 years of age and literate were included. Data was collected through a questionnaire with patient socio demographic information, CJD and SF36. Results: 58 patients were included, 51.7% (n = 30 males, mean age of 44.6 (? 15.2) years, 12.3% (n = 7) were above 65 years of age, more than half, 57.9% (n = 33) had elementary education. Thirty-one (54.4%) patients were married, (n = 31); 37.5% (n = 21) had one children and were of the catholic religion 62,5% (n = 35). In relation to CJD, the predominant profile was self - confident (0.455) and optimistic (0.404) 42 and 6 patients, respectively, of which 54 were focused on emotion. The dimensions evaluated with the best quality of life were: pain (67.2), social aspects (66.6) and mental health (65.4). There was a weak significant negative correlation, (r <0.333), between palliative style and vitality (r = -0.288, p = 0.028) and palliative and social aspects (r = -0.283; p = 0.031). There was a moderate negative correlation between general well being and emotive style (R = -0.424, p = 0.025) and palliative (r = -0.524, p = 0.004), as well as between Vitality and Palliative style (r = -0.530; P = 0.004). In males, there was a significant, negative moderate correlation result with a (0.300 <r?0.600) beteween Pain dimension with the Confrontive style (r = -0.413; p = 0.023) and Emotive (r = -0.370). Conclusion: the coping profile of patients on hemodialysis and in waiting list for tranplant was mostly self-confident and optimistic. The best domains in the quality of life were Pain, Social Aspects and Mental Health, and the worst physical and emotional aspects. / Introdu??o: a doen?a renal cr?nica (DRC) ? caracterizada por altera??es estruturais ou da fun??o dos rins presentes por mais de tr?s meses com implica??es para a sa?de. Diante dessas altera??es e complica??es os pacientes sofrem a??o de estressores capazes de influenciar no seu enfrentamento em rela??o ? doen?a e perspectivas de tratamento. Objetivo: caracterizar o perfil de enfrentamento dos pacientes em lista de espera de transplante renal baseado na Escala de Jalowiec Coping Scale (ECJ) e avaliar a qualidade de vida SF-36. M?todo: trata-se de um estudo transversal de abordagem quantitativa desenvolvida na unidade de hemodi?lise do Hospital S?o Lucas da PUCRS, em pacientes em lista de espera para transplante renal, com mais de 18 anos de idade e alfabetizados. Os dados foram coletados por meio de question?rio com informa??es s?cio demogr?ficas sobre o paciente, ECJ e SF36. Resultados: foram inclu?dos 58 pacientes com preval?ncia do sexo masculino 51,7% (n=30), m?dia de idade de 44,6 ?15,2 anos, 12,3% (n=7 ) acima de 65 anos e mais da metade da amostra, 57,9% (n=33) apresentou o ensino fundamental. Trinta e um (54,4%) pacientes eram casados (n=31); com um filho, 37,5% (n=21) e de religi?o cat?lica 62,5% (n=35). Em rela??o ? ECJ, o perfil predominante foi o Autoconfiante (0,455) e Otimista (0,404) 42 e 6 pacientes, respectivamente, sendo que 54 focados na emo??o . As dimens?es avaliadas com a melhor qualidade de vida foram: a dor (67,2), aspectos sociais (66,6) e sa?de mental (65,4). Houve correla??o significativa, fraca e negativa( r<0,333), entre o estilo paliativo e vitalidade (r=- 0,288; p=0,028) e paliativo e aspectos sociais (r=-0,283; p=0,031) . houve correla??o significativa, negativa classificada como moderada entre o Estado Geral de Sa?de e os estilos Emotivo (r=-0,424; p=0,025) e Paliativo (r=-0,524; p=0,004), bem como, entre a Vitalidade e o estilo Paliativo (r=-0,530; p=0,004). No sexo masculino, ocorreu resultado significativo, negativo com grau moderado (0,300<r?0,600) na compara??o da dimens?o Dor com os estilos Confrontivo (r=-0,413; p=0,023) e Emotivo (r=-0,370; ;p=0,044). Conclus?o: o perfil de enfrentamento dos pacientes em hemodi?lise e em lista de espera de transplante renal, foi em sua maioria autoconfiante e otimista. Os melhores dom?nios na qualidade de de vida foram Dor, Aspectos sociais e Sa?de mental, e os piores aspectos os f?sicos e os emocionais.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2017-02-21T21:34:19Z No. of bitstreams: 1 Disserta??o FINAL com ficha catalogr?fica.pdf: 2423200 bytes, checksum: a285bac8f62ce27de8224377ba93c71e (MD5) / Made available in DSpace on 2017-02-21T21:34:19Z (GMT). No. of bitstreams: 1 Disserta??o FINAL com ficha catalogr?fica.pdf: 2423200 bytes, checksum: a285bac8f62ce27de8224377ba93c71e (MD5) Previous issue date: 2016-09-21 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Introduction: Lichen Planus is a chronic inflammatory disease of uncertain etiology that may affect skin or mucosa, especially the oral mucosa. Objective: Evaluate the clinical epidemiological profile, and psychological and salivary factors of patients with oral lichen planus. Materials and Methods: The clinical epidemiological profile was assessed by descriptive analysis of 38 dental records of individuals with clinical/pathological diagnosis of oral lichen planus, treated at an Oral Lesions Reference Center in the period between 2005 and 2015 (Article 1). A case control study was conducted to evaluate the levels of anxiety, depression and stress, and both flow and pattern of secretion of salivary cortisol in 42 adults. The experimental group was composed of 21 individuals with a clinical/histopathological diagnosis of oral lichen planus. The control group originated from the same population of cases, consisted of 21 individuals without the disease, randomly admitted and matched to the cases by sex and age. Both groups underwent clinical examination of the oral cavity, structured interview, psychological tests (Beck Anxiety and Depression Inventory and Perceived Stress Scale) and saliva collection at three different times of the day (Article 2). Data was initially analyzed by means of descriptive statistics, by means of absolute and relative frequency and centralization and dispersion steps. Bivariate analysis was performed between the study variables and the presence of oral lichen planus, estimating the odds ratio (OR) as a measure of association, and using confidence intervals at 95%. The Mann-Whitney test was used to compare the groups with regard to scores of anxiety, depression and stress, and the pattern of salivary cortisol secretion. The Friedman test was used to evaluate the pattern of salivary cortisol secretion throughout the day. We used the t-Student test to compare the mean salivary flow between the groups, as well as the area under the curve of the cortisol response to awakening. The correlation between cortisol concentrations with the scores of depression, anxiety, stress and salivary flow was measured through the Spearman correlation coefficient. The adopted significance level was 5%. Results: In Article 1, we observed that 68.42% of the subjects were aged greater than or equal to 40 years; 65.80% were women and 78.90%, had black or brown skin. Most had no systemic disease (68.42%). As for lifestyle, 42.10% were drinkers and 26.30% were smokers. Reticular lichen planus was the most prevalent clinical form (78.13%), mainly affecting the oral mucosa (68.40%). In Article 2, a significant association was found between anxiety scores (p = 0.001), depression (p = 0.005) and perceived stress (p = 0.026), but not when compared to the salivary flow (p = 0.29) or to the pattern of salivary cortisol secretion when waking up (p = 0.98), 30 minutes after waking up (p = 0.95) and at nighttime (p = 0.97). Conclusion: Most cases of lichen planus of the reticular type, usually located in the oral mucosa, occurred in aged over 40, white women. Through psychological tests, it was observed an association between oral lichen planus and anxiety, depression and stress, but not in relation to the analyzed salivary factors. / Introdu??o: O L?quen Plano ? uma doen?a inflamat?ria cr?nica de etiologia incerta que pode afetar pele e ou mucosas, especialmente a mucosa bucal. Objetivo: Avaliar o perfil cl?nico- epidemi?logico, fatores psicol?gicos e salivares em indiv?duos com l?quen plano bucal. Materiais e M?todos: O perfil cl?nico-epidemiol?gico foi avaliado atrav?s da an?lise descritiva de 38 prontu?rios odontol?gicos de indiv?duos com diagn?stico cl?nico/histopatol?gico de l?quen plano bucal atendidos em um Centro de Refer?ncia de Les?es Bucais, no per?odo de 2005 a 2015 (Artigo 1). Um estudo de caso controle foi realizado para avaliar os n?veis de ansiedade, depress?o e estresse e o fluxo e padr?o de secre??o do cortisol salivar em 42 indiv?duos adultos. O grupo de casos foi composto por 21 indiv?duos com diagn?stico cl?nico/histopatol?gico de l?quen plano bucal. O grupo controle, proveniente da mesma popula??o de origem dos casos, foi constitu?do por 21 indiv?duos sem a doen?a, admitidos de forma aleat?ria e pareados por sexo e idade em rela??o aos casos. Ambos os grupos foram submetidos a exame cl?nico da cavidade bucal, entrevista estruturada, testes psicol?gicos (Invent?rios de Ansiedade e Depress?o de Beck e Escala de Estresse Percebido) e coleta de saliva em tr?s momentos distintos (Artigo 2). Os dados foram analisados, inicialmente, por meio de estat?stica descritiva, por meio de frequ?ncia absoluta e relativa e medidas de centraliza??o e dispers?o. An?lise bivariada foi realizada entre as vari?veis do estudo e o l?quen plano bucal, estimando-se a odds ratio (OR) como medida de associa??o e seus respectivos intervalos de confian?a em 95%. O teste de Mann-Whitney foi aplicado para comparar os grupos com rela??o aos escores de ansiedade, depress?o e estresse e o padr?o de secre??o do cortisol salivar. O teste de Friedman para avaliar o padr?o de secre??o do cortisol salivar ao longo do dia. O teste t de Student para comparar as m?dias do fluxo salivar entre os grupos, bem como a resposta do cortisol ao acordar. A correla??o entre as concentra??es de cortisol com os escores de depress?o, ansiedade, estresse e fluxo salivar foi analisada pelo Coeficiente de Correla??o de Spearman. O n?vel de signific?ncia adotado foi de 5%. Resultados: No artigo 1, foi observado que 47,37% dos indiv?duos tinham idade maior ou igual a 40 anos; 65,80% eram mulheres e 78,90% pardos/pretos. A maioria n?o apresentava doen?a sist?mica (68,42%). Quanto ao estilo de vida, 42,10% faziam consumo de bebidas alco?licas e 26,30% eram fumantes. O l?quen plano reticular foi a forma cl?nica mais prevalente (78,13%) acometendo principalmente a mucosa jugal (68,40%). No artigo 2, foi encontrada uma associa??o significativa entre os escores de ansiedade (p=0,001), depress?o (p=0,005) e estresse percebido (p=0,026), mas n?o em rela??o ao fluxo salivar (p=0,29) e o padr?o de secre??o de cortisol salivar ao acordar (p=0,98), 30 minutos depois de acordar (p=0,95) e noturno (p=0,97). Conclus?o: A maioria dos casos de l?quen plano bucal do tipo reticular, localizados geralmente em mucosa jugal, ocorreu em mulheres, n?o brancas com idade igual ou superior a 40 anos. Foi observada associa??o entre o l?quen plano bucal e ansiedade, depress?o e estresse por meio dos testes psicol?gicos, mas n?o em rela??o aos fatores salivares analisados.

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-08-01T22:17:41Z No. of bitstreams: 1 disserta??o de mestrado JULIAN ARAUJO DA SILVA SIMOURA Completa.pdf: 3705558 bytes, checksum: ad4478af61049852fd9522965dab7c65 (MD5) / Made available in DSpace on 2018-08-01T22:17:41Z (GMT). No. of bitstreams: 1 disserta??o de mestrado JULIAN ARAUJO DA SILVA SIMOURA Completa.pdf: 3705558 bytes, checksum: ad4478af61049852fd9522965dab7c65 (MD5) Previous issue date: 2017-05-31 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Introduction: Lichen planus is a chronic inflammatory disease of uncertain etiology that can affect the skin and/or mucous membranes, especially the oral mucosa. Objective: To evaluate psychological (anxiety, depression and stress) and salivary (flow and levels of salivary alpha amylase) factors in individuals with oral lichen planus. Materials and Methods: An exploratory control case study was conducted. The case group consisted of 23 individuals with clinical and histopathological diagnosis of oral lichen planus, matched by sex and age to a control group, with an equal number of healthy individuals, from the same population that originated the cases. The population underwent clinical examination of the oral cavity, psychological tests (perceived stress scale and Beck depression and anxiety inventories) and saliva collection to determine the salivary flow and alpha-amylase levels at three moments along the day (on waking, thirty minutes after waking and before bed). The data were analyzed statistically. The Odds Ratio and its 95% confidence interval were computed. The McNemar ?2 test was used, considering a significance level of 5%. For quantitative variables, the Mann-Whitney test was used to compare the medians of salivary flow, alpha amylase response on waking, and salivary alpha amylase levels at each of the collection times, between cases and controls. The Friedman test was applied to evaluate the concentration of the alpha amylase from each of the three moments of saliva collection throughout the day. Spearman's correlation coefficient was computed to determine correlation between alpha amylase concentration and the test scores of stress, anxiety, depression, and salivary flow. Results: There was a significant correlation between anxiety, depression, stress and LPB, and between stress and ?-AS decline. Higher levels of salivary alpha amylase were found in the case group in the second collection time when compared to controls. Conclusion: The applied psychological tests indicated that factors such as stress, anxiety and depression were correlated to oral lichen planus. Salivary analyses demonstrated a higher concentration of alpha amylase thirty minutes after waking on individuals with the disease, suggesting the role of alpha amylase as a promising biomarker for further longitudinal studies on the subject. / Introdu??o: O L?quen Plano ? uma doen?a inflamat?ria cr?nica de etiologia incerta que pode afetar pele e ou mucosas, especialmente a mucosa bucal. Objetivo: Avaliar fatores psicol?gicos (estresse, ansiedade e depress?o) e salivares (fluxo e padr?o de secre??o da alfa amilase) em indiv?duos com l?quen plano bucal. Materiais e M?todos: Um estudo de caso controle do tipo explorat?rio foi realizado em 46 indiv?duos adultos. O grupo de casos foi composto por 23 indiv?duos com diagn?stico cl?nico/histopatol?gico de l?quen plano bucal. O grupo controle, proveniente da mesma popula??o de origem dos casos, foi constitu?do por 23 indiv?duos sem a doen?a, admitidos de forma aleat?ria e pareados por sexo e idade em rela??o aos casos. A popula??o foi submetida a testes psicol?gicos (Invent?rio de ansiedade e de depress?o de Beck e a escala de estresse percebido) e a coleta de saliva para determina??o do fluxo salivar e dos n?veis de alfa-amilase em tr?s momentos ao longo do dia (ao acordar, trinta minutos ap?s acordar e antes de dormir). Os dados foram analisados estatisticamente, calculou-se a Odds Ratio e o seu intervalo de confian?a a 95%. Foi utilizado o teste ?2 de McNemar, considerando-se o n?vel de signific?ncia de 5%. Para vari?veis quantitativas, aplicou-se o teste de Mann-Whitney para comparar as medianas do fluxo salivar, da resposta da alfa amilase ao acordar, e dos n?veis de alfa amilase salivar em cada um dos tempos de coleta entre casos e controles. Para avaliar a concentra??o da alfa amilase de cada um dos tr?s momentos de coleta da saliva ao longo do dia, foi aplicado o teste Friedman. No que diz respeito ? correla??o entre concentra??o de alfa amilase e scores dos testes de estresse, ansiedade, depress?o e o fluxo salivar, calculou-se o coeficiente de correla??o de Spearman para determinar. Resultados: Encontrou-se associa??o/correla??o significativa entre ansiedade, depress?o, estresse e LPB. N?veis mais elevados de alfa amilase salivar foram encontrados no grupo caso no segundo tempo de coleta quando comparados aos controles. Conclus?o: Fatores psicol?gicos como estresse, ansiedade e depress?o foram associados a ocorr?ncia do liquen plano bucal. A alfa amilase salivar pode ser uma promissora candidata para detectar fatores psicol?gicos em popula??es com l?quen plano bucal, mais estudos precisam ser realizados a fim de esclarecer os fatores fisiol?gicos relacionados ao aumento da alfa amilase salivar em portadores da doen?a.

Made available in DSpace on 2014-12-17T14:46:43Z (GMT). No. of bitstreams: 1 GysellaRPCO_DISSERT.pdf: 1882123 bytes, checksum: 567dfcacd19a39b99bb1408ecf7decc2 (MD5) Previous issue date: 2008-12-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / We believe that the dissatisfaction arising from the lack of belief in the possibilities of change in the workplace, which cause difficulties to achieve professional results in the professional psychological distress that currently fits into the context of mental health. This is a qualitative, descriptive and representational research aiming to discover how the professional nurses represent the very psychological distress from work in the hospital environment. Aided and supported by specific objectives of identifying factors that generates this suffering and strategies for defense and confronting these professionals in the hospital. 22 nurses participated in this research, officials of the University Hospital Onofre Lopes, located in the city of Natal / RN, with length of service in the institution more than one year and less than five, and they accepted, by signing the Term of Free and Informed Consent, participate in the study. We use plurimethodological approach: a questionnaire, a semi-structured interview and the design-story with a theme adapted from Trinca with the support of the Theory of Social Representations and that nurses do in their psychological distress of the Central Core. We reviewed the data from the results generated by the ALCESTE software, based on hierarchical categorization downward, leading seven classes used as categories: Work process: completeness vs. incompleteness; labor contradiction of the nurse; qualitative aspects of interpersonal relationships; hospital surveillance: Challenges, muteness and neglect; Expectations, conflicts and feelings in the work process; Leisure: the other side of the work process, and Suffering generating aspects of in the work process. We consider the analysis of quarters generated by the program, which SLQ houses in the central core of the representations; the SRQ and the DLQ the intermediaries elements and the DRQ the peripheral elements that nurses do in their psychological distress. We analytically adequate results in the three belonging dimensions of social representations: the Subjectivity, the Intersubjectivity and Trans-subjectivity. We infer that the interpersonal relationship, the extra work, the deviation in the role of nurse show themself as the factors responsible for psychological distress of it. In that sense, the central core of SR of this profession is based on the level of trans-subjectivity and understood as a Social Representation controversy / Entendemos que a insatisfa??o advinda da falta de cren?a nas possibilidades de mudan?a do contexto laboral que originam dificuldades para a realiza??o profissional resulta no sofrimento ps?quico do profissional que, atualmente se insere no contexto da sa?de mental. Trata-se de uma pesquisa qualitativa, descritiva e representacional objetivando apreender como os profissionais enfermeiros representam o pr?prio sofrimento ps?quico decorrente do trabalho no ambiente hospitalar. Auxiliado e amparado pelos objetivos espec?ficos de identificar fatores geradores deste sofrimento e de identificar estrat?gias de defesa e enfrentamento desses mesmos profissionais em ambiente hospitalar. Participaram desta pesquisa 22 enfermeiros, funcion?rios do Hospital Universit?rio Onofre Lopes, situado no munic?pio de Natal/RN, com tempo de servi?o na institui??o maior que um ano e menor que cinco e que aceitaram, mediante a assinatura do Termo de Consentimento Livre e Esclarecido, participar do estudo. Utilizamos abordagem plurimetodol?gica: um question?rio, uma entrevista semi-estruturada e o Desenho-est?ria com tema adaptado de Trinca com o suporte da Teoria das Representa??es Sociais e a que os enfermeiros fazem do seu sofrimento ps?quico do N?cleo Central. Analisamos os dados a partir dos resultados gerados pelo software ALCESTE com base na categoriza??o hier?rquica descendente, derivando sete classes usadas como categorias: processo de trabalho: completude vs. incompletude; antinomia laboral do enfermeiro; aspectos qualitativos do relacionamento interpessoal; vigil?ncia hospitalar: desafios, silenciamento e neglig?ncia; expectativas, conflitos e sentimentos no processo de trabalho; lazer: o outro lado do processo de trabalho e, aspectos geradores de sofrimento no processo de trabalho. Consideramos pela an?lise dos quadrantes gerados pelo programa, que o Quadrante Superior Esquerdo abriga o n?cleo central das representa??es; o Quadrante Superior Direito e o Quadrante Inferior Esquerdo os elementos intermedi?rios e o Quadrante Inferior Direito os elementos perif?ricos que os enfermeiros fazem do seu sofrimento ps?quico. Adequamos analiticamente os resultados nas tr?s dimens?es de pertencimento das representa??es sociais: a Subjetividade, a Inter-subjetividade e a Trans-subjetividade. Inferimos que a rela??o interpessoal, a sobrecarga de trabalho, o desvio da fun??o do enfermeiro apresentou-se como os fatores respons?veis pelo sofrimento ps?quico do mesmo. Nesse sentido, o n?cleo central da representa??o social desta categoria profissional, insere-se no n?vel da trans-subjetividade e est? compreendida como uma Representa??o Social Pol?mica

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2017-03-27T20:51:58Z No. of bitstreams: 1 DISSERTA??O_FINAL.pdf: 3379696 bytes, checksum: b3c0124af898773bfbceb2efab8c0f5b (MD5) / Made available in DSpace on 2017-03-27T20:51:58Z (GMT). No. of bitstreams: 1 DISSERTA??O_FINAL.pdf: 3379696 bytes, checksum: b3c0124af898773bfbceb2efab8c0f5b (MD5) Previous issue date: 2016-03-29 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Periodontitis is a multifactorial disease, bacterial primary etiology, but presents external factors that influence its development. It has also been considered exposure to systemic diseases, such as the circulatory system. Objective: To investigate the role of psychological factors in periodontitis, considering it as the outcome as well as the influence of the level of periodontitis severity, as the exposure factor on acute myocardial infarction. Methods: This investigation is a result of data from a previous case-control study that estimated the association between periodontitis and acute myocardial infarction and it was divided into two stages. At first, it was conducted two cross-sectional studies to assess the association between common mental disorders and periodontitis (study 1) and between stress and periodontitis (study 2) in 621 individuals. The application of a questionnaire was carried out to obtain socioeconomic, demographic, lifestyle and health-related information. The common mental disorder was assessed by the Self Reporting Questionnaire (SRQ-20) and stress, the Perceived Stress Scale. The diagnosis of periodontitis was conducted from complete periodontal examination using: clinical attachment level, probing depth and bleeding on probing. Prevalence ratios (PR) and confidence intervals at 95% (95%CI) were obtained by Poisson regression analysis. In the second stage, a case-control study estimated the effect of the levels of periodontitis severity on acute myocardial infarction (study 3), with 207 individuals in the case group treated in the emergency Hospitals Santa Izabel and Ana Nery in Salvador, Bahia, Brazil, diagnosed with first acute myocardial infarction event, and 407 in the control group, without a diagnosis of acute myocardial infarction. Two criteria were used to define the levels of periodontitis severity. Unconditional logistic regression analysis was used to investigate the association between the levels of periodontitis severity and acute myocardial infarction: odds ratio (OR) and 95%CI.Results: The findings were presented in articles. Article 1 - showed that the occurrence of periodontitis among those exposed to common mental disorders was approximately 50% higher than in those without this mental condition, even after adjustment for age, sex, family income, current smoking habit, alcohol beverage consumption and cardiovascular disease (RPadjusted = 1.54, 95% CI: [1.13 to 2.10]). Article 2 - the measurements have demonstrated a positive association between stress and periodontitis, regardless the definition of the outcome: probing depth ? 4 mm (RPadjusted = 1.28, 95%CI: [1.04 to 1.58]), clinical attachment level ? 5mm (RPadjusted= 1.15, 95%CI: [1.01 to 1.31]) and periodontitis (RPadjusted= 1.36, 95%CI: [1.01 to 1.83]), after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease and body mass index.Article 3 - strong positive association was found between severe and moderate periodontitis (RPadjusted = 2.21 to 3.92, and 1.96 to 2.51, respectively) with acute myocardial infarction, with statistical significance (p ? 0.05) for both diagnostic criteria of periodontitis. Conclusions: positive association between psychological factors and periodontitis has been demonstrated, as well as the dose-response effect of levels of periodontitis severity on acute myocardial infarction. / A periodontite ? uma enfermidade multifatorial,de etiologia prim?ria bacteriana, por?m apresenta fatores externos que influenciam no seu desenvolvimento. Tamb?m tem sido considerada exposi??o para doen?as sist?micas, a exemplo do aparelho circulat?rio. Objetivo: Investigar o papel dos fatores psicol?gicos na periodontite, considerando-a como desfecho, bem como a influ?ncia do n?vel de gravidade da periodontite, como fator de exposi??o, sobre o infarto agudo do mioc?rdio. M?todo: Esta investiga??o? decorrente de dados de um estudo caso-controle pr?vio que estimou a associa??o entre a presen?a de periodontitee o infarto agudo do mioc?rdio e foi dividida em duas etapas. Na primeira, foram conduzidos dois estudos de corte transversal, para avaliar a associa??o entre o transtorno mental comume a periodontite (estudo 1) e entre o estresse e a periodontite(estudo 2) em 621 indiv?duos. A aplica??o de um question?rio foi realizada para obten??o de informa??es socioecon?mico-demogr?ficas, h?bitos de vida e relativas ? sa?de. O transtorno mental comum foi avaliado a partir do Self Reporting Questionnaire (SRQ-20) e o estresse, pela Escala de Estresse Percebido. O diagn?stico de periodontite foi realizado a partir de exame periodontal completo, empregando: n?vel de inser??o cl?nica, profundidade de sondagem e sangramento ? sondagem. As raz?es de preval?ncia (RP) e respectivos intervalos de confian?a a 95% (IC95%) foram obtidas pela an?lise de regress?o de Poisson. Na segunda etapa, um estudo caso-controle estimou o efeito de n?veis de gravidade da periodontite no infarto agudo do mioc?rdio (estudo 3), com 207 indiv?duos do grupo caso, atendidos na emerg?ncia dos Hospitais Santa Izabel e Ana Nery em Salvador, Bahia, Brasil, diagnosticados com o primeiro evento de infarto agudo do mioc?rdio,e 407 do grupo controle, sem diagn?stico de infarto agudo do mioc?rdio.Dois crit?rios foram empregados para definir os n?veis de gravidade da periodontite. An?lise de regress?o log?stica n?o condicional foi usada para investigar a associa??o entre os n?veis de gravidade da periodontite e o infarto agudo do mioc?rdio: odds ratio (OR) e IC95%. Resultados: Os achados foram apresentados em forma de artigo. Artigo 1 -mostraram que a ocorr?ncia de periodontite entre aqueles expostos ao transtorno mental comum foi, aproximadamente, 50% maior que naqueles sem esta condi??o mental, mesmo ap?s ajuste por: idade, sexo, renda familiar, h?bito de fumar atual, consumo de bebida alco?lica e doen?a cardiovascular (RPajustada = 1,54, IC95%: [1,13 ? 2,10]). Artigo 2 -as medidas demonstraram existir associa??o positiva entre estresse e periodontite, independentemente da defini??o do desfecho: profundidade de sondagem ? 4mm (RPajustada= 1,28, IC95%: [1,04-1,58]), n?vel de inser??o cl?nica ? 5mm (RPajustada= 1,15, IC95%: [1,01-1,31]) e periodontite (RPajustada= 1,36, IC95%: [1,01-1,83]), ap?s ajuste para idade, sexo, n?vel de escolaridade, h?bito de fumar atual, doen?a pulmonar e ?ndice de massa corporal.Artigo 3 -associa??o positiva forte foi verificada entre as periodontites grave e moderada (RPajustada= 2,21 a 3,92; e 1,96 a 2,51, respectivamente) com o infarto agudo do mioc?rdio, com signific?ncia estat?stica (p? 0,05), para ambos os crit?rios de diagn?stico da periodontite. Conclus?es: associa??o positiva entre os fatores psicol?gicos e presen?a de periodontite foi demonstrada, assim como o efeito dose-resposta dos n?veis de gravidade da periodontite sobre o infarto agudo do mioc?rdio.

Made available in DSpace on 2016-01-26T12:51:18Z (GMT). No. of bitstreams: 1 claudiathomebeletti_dissert.pdf: 580160 bytes, checksum: 663a2cdc74524cec05b176a5c247317d (MD5) Previous issue date: 2007-10-30 / Chronic daily headache (CDH) can be studied according to the psychosomatic perspective. Considering that CDH is a heterogeneous group of headaches and that some comorbidity and emotional factors can trigger the pain such as stress, anxiety and depression; a study that takes into account the emotional overload and its impact on the affected people's lives is very important. Objective: This research aims to investigate the presence of emotional overload in patients with CDH, and the possible reasons which may impair the symptoms as well as to know which are the psychological, social and existential aspects developed by these people. Casuistic and Method: The subjects of this study were 40 patients of both genders, over 18 years of age, who attended the headache clinic of Hospital de Base, Medical School of S?o Jos? do Rio Preto. A semi-structured interview as reference to the Psychosomatic Psychoanalytic Investigation was used. Results: The sample comprised 10% of males and 90% of females, the ages ranging from 24 to 64 years old. Since the majority of interviews were made up of open questions, it was decided to divide the answers into categories. The most frequent categories when they knew the meaning of getting sick were: psychical suffering (35.53%); physical suffering (23.68%); damage at work (19.74%) and social damage (10.52%). Regarding the question about factors related with pain, the main categories were: nervousness (23.16%); preoccupation (15.79%) and tension (11.58%). The question on how the pain was developed, the most frequent categories were: the attempt at self-cure (27.36%), different kinds of pain (16.98%) and affected by emotions (13.2%). The question on the consequences of the pain, the majority reported the interruption of their activities. The length-time of the disease varied between 2 and 40 years with headaches. It was also observed, if the patients with CDH had diagnosis hypotheses regarding their pains or a "personal insight" on the disease. Among them, psychical factors could trigger the pain with 48.84%, and 34.88% of them did not have hypothesis regarding their headaches. Conclusions: In conclusion, there is some emotional overload in patients with CDH, and the typical performance of the psychosomatic disorders and the operating mind control is directly related with the patient?s complaints. It was also observed aspects of depression associated with the emotional functioning of these people. / A cefal?ia cr?nica di?ria (CCD) pode ser estudada de acordo com a perspectiva psicossom?tica. Considerando-se que a CCD ? um grupo heterog?neo de cefal?ias e que algumas comorbidades e fatores emocionais est?o associados como precipitantes da dor, tais como o estresse, a ansiedade e a depress?o; um estudo que leve em conta a sobrecarga emocional e qual o impacto na vida das pessoas afetadas reveste-se de import?ncia. Objetivo: A presente pesquisa visa investigar presen?a de sobrecarga emocional de pacientes portadores de CCD, e os poss?veis motivos agravadores de sintomas, bem como conhecer quais os percursos psicol?gicos, sociais e existenciais desenvolvidos por esses indiv?duos. Casu?stica e M?todo: S?o sujeitos deste estudo 40 pacientes de ambos os sexos, maiores de 18 anos, atendidos no ambulat?rio de cefal?ias do Hospital de Base de S?o Jos? do Rio Preto. Foi utilizado um roteiro de entrevista semi-estruturada, tendo como refer?ncia a Investiga??o Psicossom?tica Psicanal?tica. Resultados: A amostra foi composta por 10% dos sujeitos do sexo masculino e 90% do sexo feminino, com idades variando entre 24 e 64 anos. Por se tratar de entrevistas compostas, em sua maioria por quest?es abertas, optou-se por distribuir as respostas em categorias. Ao conhecer o significado de adoecer, as categorias que mais apareceram foram: sofrimento ps?quico (35,53%); sofrimento f?sico (23,68%); preju?zo no trabalho (19,74%) e preju?zo social (10,52%). Quanto ao questionamento com os fatores que relacionavam a dor, as principais categorias foram: o nervosismo (23,16%); preocupa??o (15,79%) e tens?o (11,58%). Na investiga??o de como se desenvolvia a dor, o que mais se verificou foram: tentativas de auto-cura (27,36%); diferentes tipos de dor (16,98%) e provocadas pelas emo??es (13,2%). A quest?o referente ?s conseq??ncias acarretadas pela dor mostrou que a grande maioria descreveu interromper as atividades. O tempo de doen?a variou entre dois e mais de quarenta anos de dores de cabe?a. Foi observado, ainda, se os portadores de CCD t?m hip?teses diagn?sticas a respeito das suas dores ou ?insight? pessoal sobre a doen?a. Entre elas, fatores ps?quicos poderiam desencadear a dor com 48,84% e 34,88% n?o t?m hip?tese a respeito das suas dores de cabe?a. Conclus?es: Pode-se concluir que existe sobrecarga emocional em pacientes portadores de CCD, e que o funcionamento caracter?stico dos transtornos psicossom?ticos e do pensamento operat?rio est? diretamente relacionado com suas queixas. Tamb?m foram observados aspectos de depress?o relacionados ao funcionamento emocional desses indiv?duos.