In 2018, the United States Preventive Services Task Force (USPSTF) recommended that African American men and those with a family history of prostate cancer should discuss the pros and cons of PSA testing with their physician and engage in shared decision making. Identifying risk factors of prostate cancer, calculating individualized prediction of the risk of prostate cancer, and ensuring that the patients are well informed with knowledge to understand these risks so as to easily make decisions, are extremely important in shared decision making. The overarching goal of this dissertation is to assist in these three steps and facilitate shared decision making in a high-risk population. Aim 1 assessed the association of demographic characteristics, clinical markers and genitourinary symptoms with the diagnosis of prostate cancer (Aim 1a), as well as with the diagnosis of significant prostate cancer (Aim 1b), in a high-risk population. A nested case-control study for Aim 1a and a case-control study for Aim 1b was conducted using the Prostate Risk Assessment Program (PRAP) data, which enrolls African American men and those with a family history of prostate cancer. Multivariate conditional logistic regression was used to assess the association between the risk factors for any prostate cancer, while multivariate logistic regression was used for clinically significant prostate cancer. The risk of any prostate cancer increased with increasing age, presence of family history and increasing PSA levels, while the risk of significant prostate cancer was associated with increasing PSA level. This suggests that PSA level, as a continuum, is extremely important while predicting prostate cancer, especially significant prostate cancer within a high-risk population. Using Aim 2, we compared the performance of two prostate cancer risk calculators, Prostate Cancer Prevention Trial – Risk Calculator 2.0 (PCPT-RC 2.0) and the European Randomized Study of Screening for Prostate Cancer -Risk Calculator 3/5 (ERSPC-RC 3/5) to predict any prostate cancer and clinically significant prostate cancer in a high-risk American population. All men who underwent prostate biopsy with the PRAP data registry since 1996 were included in the study. The probability of being diagnosed with any prostate cancer and significant prostate cancer (Gleason score > 6) was calculated using the online versions of PCPT-RC 2.0 and ERSPC-RC 3/5. The performance of these calculators was compared using calibration (calibration plot and calibration-in-the-large), discrimination (comparing AUC curves using DeLong’s method) and decision curve analysis (to assess clinical utility). The calibration suggested that both risk calculators under-predicted the probability of any prostate cancer while PCPT-RC 2.0 over-predicted the probability of significant prostate cancer. Analysis of the AUC curves suggested that the PCPT-RC 2.0 (AUC: 0.59, 95% CI 0.52 to 0.66) showed a trend towards better discrimination for any prostate cancer as compared to ERSPC-RC 3/5 (AUC: 0.55, 95% CI 0.48-0.63, p= 0.3819). Similarly, PCPT-RC 2.0 (AUC: 0.71, 95% CI 0.61-0.82) showed a trend towards better discrimination for significant prostate cancer as compared to ERSPC-RC 3/5 (AUC: 0.63, 95% CI 0.51 to 0.75, p= 0.2335). PCPT-RC 2.0 proved to be clinically beneficial to predict significant prostate cancer in the range of lower prediction thresholds. These results suggest that the PCPT-RC 2.0 is superior to ERSPC-RC 3/5 in a high-risk American population. Aim 3 utilized a systematic review of the decision aids used to improve prostate cancer knowledge, improve risk perception, reduce confusion, involve in shared decision making or utilize PSA tests in men at high-risk of prostate cancer, defined as those with African descent or those with a family history of prostate cancer. Data was extracted by searching MEDLINE, CINAHL, EMBASE, and PsycINFO via Ovid and EBSCOhost. After screening titles and abstracts, the resulting full-text articles were assessed for inclusion and exclusion criteria. A data extraction table was created, and the methodological quality of the studies was assessed based on three criteria – randomization, double blinding and intention-to-treat analysis. Due to the clinical heterogeneity of the studies, a descriptive analysis of all the studies was conducted and tabulated. A total of 2605 articles were retrieved after literature search, of which 8 articles met the inclusion criteria and were included in the qualitative analysis. Of these 8 articles, 6 were targeted at those who were African American or those with an African descent and 2 articles included interventions targeted at those with a family history of prostate cancer. Majority of the studies targeted at African American men demonstrated an improvement in knowledge and reduction in decisional conflict in the intervention group compared to the control group. The two studies that included men with a family history of prostate cancer did not show any change in knowledge or decisional conflict in the intervention group compared to the comparison group. All studies were of low quality, except one which was medium quality. Thus, this review unveiled that tailored decision aids would be helpful in improving knowledge and reducing decisional conflict in African American men while decision aids designed for men with family history of prostate cancer would not significantly change prostate cancer knowledge or decisional conflict compared to the standard decision aid. Thus, one of the tailored decision aids can be used to help African American men improve their knowledge of prostate cancer and reduce decisional conflict, while the standard decision aid can be used in men with a family history of prostate cancer. These conclusions can be assimilated into the USPSTF recommended shared decision-making sessions between the patients and the physicians. / Epidemiology

家族檔案最重要的功能除了提供後世子孫瞭解先人生活的歷史紀錄外，也是追本溯源的重要來源之一。由追溯家族史之風，呈現家族檔案之重要性，以及家族檔案在建構家族歷史時，發揮其最大功效。家族檔案與家族史兩者息息相關，在今日重視臺灣家族史發展的同時，若能具備完整的家族檔案，對於追溯家族歷史必能達到事半功倍之效。完善的家族檔案，不僅能夠真實反映家族的歷史紀錄，並能提供後世子孫瞭解前人過去的生活方式及生命歷程。 本研究採用「個案研究法」與「深度訪談法」進行研究，主要訪談對象包括：中央研究院臺灣史研究所、臺北市文獻委員會、國立中央圖書館臺灣分館、國立臺灣博物館、國史館臺灣文獻館、宜蘭縣史館六所單位，以瞭解家族檔案蒐藏情況。藉由此六個單位蒐藏家族檔案情況，以瞭解目前國內家族檔案管理現況，並分析國內家族檔案相關典藏單位對於家族檔案管理之見解。 根據實際訪談的結果，提出結論如下：一、各蒐藏單位對於「家族檔案」認知及定義不一；二、各蒐藏單位蒐藏內容以古文書及族譜為主；三、各單位蒐藏之古文書及族譜資料多有重複現象；四、各單位蒐藏方式不甚相同；五、家族檔案使用者多為學術研究居多；六、家族檔案蒐藏價值以多面向作為考量。 針對前述研究結果提出七項建議：一、儘速制定家族檔案管理之法源依據；二、釐清家族檔案定義及範圍；三、採行集中或分散式家族檔案管理模式；四、建置全國性家族檔案檢索目錄機制；五、建立全民家族檔案意識；六、建立蒐藏家族檔案特色館；七、積極推動公共圖書館蒐藏地方文獻及服務的功能。 / Family records are not only a historical resource for later generations to understand the lives before them, but also an essential way to trace back their origins. Investigating family histories is becoming more and more common nowadays. Family records, closely related to family histories, are playing a crucial role when structuring family histories. At present, the development of Taiwanese family histories is put emphasis on. Tracing back one’s family histories will be much easier and more efficient if family records are complete. Complete family records include genuinely reflecting a family’s history records and also providing a resource of past lives to pass on to later generations. 　　This research aims at understanding the management of family records. Two methods are adopted, ‘individual research’ and ‘in-depth interview. Six institutes are studied, including, 1. Institute of Taiwan History, AcademiaSinica, 2. Taiwan Historica, 3. Taipei City Archives, 4. National Taiwan Library, 5.National Taiwan Museum, 6. Institute of Yilan County History. By investigating the collection in the six institutes, an idea of how family records are assorted in Taiwan will be obtained. The results also show different viewpoints that each institute holds when managing family records. The conclusion made according to the results of actual interviews is as following: 1. Each institute holds a different view on defining ‘family records’. 2. The collections in the six institutes are mainly old English and family trees. 3. Overlaps frequently occur between institutes. 4. The adopted methods are not the same. 5. Family records are mostly used for the purpose of academic researches. 6. Family records are collected with diverse values. In response to the results of this research, suggestions are stated as follows: 1. Set up regulations to manage family records as soon as possible. 2. Make clear the definition and the scope of family records. 3. Manage family records with the methods of either centralization or decentralization. 4. Create national wide catalogues. 5. Raise people’s awareness of family records. 6. Establish characteristics galleries where store family records. 7. Encourage public libraries to include collections of local cultural document and service.

Vascular disease is the leading cause of global disease burden, but substantial gaps in our knowledge regarding family history of vascular disease, peripheral arterial disease (PAD) and acute aortic disease persist. Prospective, population-based data in these neglected areas may be useful in diagnosis, risk prediction, prognosis and clinical management of vascular disease. The Oxford Vascular Study (OXVASC) is an ongoing prospective, population-based study of vascular disease in all territories in Oxfordshire, UK, which started in 2002. The study population comprises all 91,106 individuals registered with nine general practices. Multiple overlapping methods of “hot” and “cold” pursuit are used to identify all patients with acute vascular events. I have shown that patients with acute coronary syndromes (ACS) and a history of myocardial infarction (MI) in both parents are 6 times more likely to have siblings with MI than those ACS patients with no parental history of MI, whereas, parental stroke does not predict stroke in siblings among TIA/stroke patients. Maternal history of MI is more common in women than men with ACS. Premature maternal MI is strongly associated with premature MI in females and males. I have also shown that maternal stroke is more common than paternal stroke in female ACS patients, and that family history of stroke is as common in patients with ACS as in patients with TIA/stroke. However, I showed that these associations between family history and MI or stroke cannot be explained by disease localisation or disease severity on coronary angiography. In both primary and secondary prevention settings, PAD indicates a high risk of future events. I have shown that, although acute PAD events account for only 7% of acute vascular events at 1 year, they account for 12% of acute vascular deaths. Acute peripheral arterial events are more aggressive in terms of risk factor profile, mortality and morbidity than other vascular disease. Half of patients with incident PAD had history of vascular disease. Incidence and severity of PAD events generally increases with age, and severity of disease predicts mortality. I have shown that incidence of ruptured abdominal aortic aneurysm (RAAA) and aortic dissection increased steeply with age, and 5-year mortality rates were 74% and 65% for RAAA and aortic dissection respectively. I have also shown that the true population-based incidence of acute aortic dissection is similar to previous estimates of incidence, implying that it is accurately diagnosed and coded, and that retrospective data analysis produces valid estimates of incidence.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2017-04-20T12:44:05Z No. of bitstreams: 1 Bruna Gomes Rangel_.pdf: 929202 bytes, checksum: a9ee1fe68e365fe33311a91fdf8605ee (MD5) / Made available in DSpace on 2017-04-20T12:44:06Z (GMT). No. of bitstreams: 1 Bruna Gomes Rangel_.pdf: 929202 bytes, checksum: a9ee1fe68e365fe33311a91fdf8605ee (MD5) Previous issue date: 2016-12-05 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente dissertação tem por objetivo compreender as práticas de leitura de famílias da elite de Porto Alegre no século XIX, a partir do estudo de caso da família Fernandes Pinheiro. José Feliciano Fernandes Pinheiro, o Visconde de São Leopoldo, foi um intelectual e político brasileiro, considerado o primeiro historiador do Rio Grande do Sul, apesar de ter nascido em Santos (RJ). A biblioteca da família, arrolada no inventário post mortem do Visconde, era composta por 754 livros. A análise baseia-se nas propostas teórico-metodológicas da Nova História Cultural e investiga as práticas de leitura e os significados da acumulação e posse de bibliotecas por parte de segmentos das elites oitocentistas, como demonstrativo de estilo de vida e forma de auto-representação. O objetivo foi compreender os usos desta biblioteca, não só no prazer imediato da leitura, mas como forma de auto-representação de indivíduos de elite. Em uma sociedade ainda fortemente calcada em noções de honra, qual o papel de um acervo bibliográfico deste volume? Desnaturalizamos este acervo bibliográfico, pensando a sua constituição como um investimento familiar não apenas dirigido a formação de um capital financeiro, mas a um capital simbólico, a uma insígnia de gosto de classe vinculado à ilustração e ao refinamento. / This master thesis aims to understand the elite families practices reading in Porto Alegre in the nineteenth century, from the case study of Fernandes Pinheiro Family. José Feliciano Fernandes Pinheiro, the Viscount of São Leopoldo, was a brazilian intelectual and politician, considered the first historian of Rio Grande do Sul, despite being born in Santos (RJ). The family library, listed at inventary post mortem of Viscount, was composed by 754 books. The analysis is based on theorical and methodological proposals of the New Cultural History and investigates the reading practices and meanings of accumulation and possession of libraries by segments of the nineteenth-century elites, as a lifestyle statement and self-representation. The purpose was to understand the uses of this library, not only in the immediate pleasure, but also as form of self-representation of elite individuals. In a society strongly based on notions of honor, what is the role of a collection this volume? We desnaturalized this bibliographic, considering its constitution as a familiy investment not only directed to the formation of a financial capital, but also as a simbolic capital, a insígnia of lifestyle linked to illustration and refinement.

Mestrado em Saúde Pública / Master Degree Course in Public Health / A etiologia da Doença de Parkinson (DP) encontra-se, em parte, por desvendar. Factores ambientais e genéticos poderão interagir e contribuir para o desenvolvimento desta condição neurodegenerativa. Estudos epidemiológicos recentes colocam o enfoque na possibilidade de determinadas exposições a agentes ambientais com acção neurotóxica poderem precipitar o desenvolvimento da DP, uma vez que as formas puramente genéticas da doença são raras. O objectivo deste estudo foi avaliar possíveis factores familiares e ambientais para a DP. Foi realizado um estudo caso-controlo de base hospitalar, tendo como amostra 88 casos de indivíduos com diagnóstico de DP, efectuado por neurologista, e 176 controlos seleccionados segundo a idade, sexo e local de residência, semelhante aos casos. Vários possíveis factores de risco e/ou protectores foram avaliados, relacionados com estilos de vida, história anterior, profissão, local de residência e diferentes exposições a potenciais agentes neurotóxicos. Os resultados do estudo permitiram verificar diferenças estatisticamente significativas entre a história familiar positiva de DP (p=0,002), profissão (p=0,001), habitação em ambiente rural (p=0,037), habitação/trabalho perto de fábrica ou indústria (p=0,017), exposição a pesticidas, herbicidas e insecticidas (p<0,001), consumo de café (p=0,036) e consumo de chá (p=0,001), em casos e controlos. O modelo de regressão logística permitiu identificar como potenciais factores de risco da DP a história familiar positiva de DP (odds ratio [OR]=9,996; intervalo de confiança [IC] 95%=2,191-45,597), as profissões manuais (blue collar) (OR=3,967; IC 95%=1,670 9,426), exposição a pesticidas, insecticidas e herbicidas (OR= 2,619 ; IC 95%=1,170-5,862). Por outro lado, o consumo de chá sugeriu um efeito protector na ocorrência da DP (OR= 0,356 ; IC 95%=0,174-0,727). Os resultados parecem consistentes, com estudos actuais, que apontam um modelo multifactorial para etiologia da DP. / The etiology of Parkinson s disease (PD) remains in a certain part unknown. Both genetic susceptibility an environmental factors are some times considered to be putative contributors to its origin. Recent epidemiologic studies have focused on the possible role of environmental risk factors present during adult life or aging, once pure genetic forms of PD are rare. The purpose of this study was to investigate environmental and familial risk factors for PD. We perfomed a hospital based case-control study using 88 PD patients with neurologist confirmed diagnostic, and 176 sex, age, and residence similiar controls. Several possible risk factors were evaluted related to life style, past history, family history, occupational history and other exposures to potencial neurotoxins agents. Statist differences, using a 95% confidence interval, were observed in positive family history of PD (p=0,002), occupation category (p=0,001), rural living (p=0,037), living/working near a industry (p=0,017), exposure to pesticides, herbicides and insecticides (p<0,001), coffee consumption (p=0,036) and tea consumption (p=0,001). Logistic regression showed as potencial risk factors, a positive family history of PD (odds ratio [OR]=9,996; 95% confidence interval [CI]=2,191-45,597), blue collar occupations (OR=3,967; 95% CI=1,670 9,426), exposure to pesticides, herbicides and insecticides (OR= 2,619 ; 95% CI=1,170-5,862). An inverse relanshionship was found between tea consumption and the risk of PD (OR=0,356 ; 95% CI=0,174-0,727). The results of the study show that both familial and environmental factors may contribute to the development of PD. Like other study s suggest, PD is of unknown, but presumably multifactorial etiology.

Genetic as well as environmental factors are believed to be of importance in the etiology of rheumatoid arthritis (RA). There are a number of previous studies of genetic markers in RA, but so far no genetic linkage and only a few associations have been found. Of the associations only one (with the HLA antigen DR4) appears to be well documented. In most previous association studies the patients have not been divided according to sex and family history of RA. In this investigation the HLA antigens A, B and DR and five serum protein systems (Bf, C3, Pi, Hp and Tf) were studied in patients with erosive rheumatoid arthritis (RA), from northern Sweden. Special attention was paid to variations in the strength of associations accord­ing to sex and family history of polyarthritis. The following results were found:  The frequency of the HLA antigen B27 was significantly increased in the North-Swedish population (16.6%) and among patients with a family history of polyarthritis (42.6%). In agree­ment with previous investigations a significantly increased frequency of the DR4 antigen was found in the RA patients.  In the properdin factor B (Bf) system the S phenotype was found to be significantly in­creased in male patients and in patients with a family history of polyarthritis, more severe form of RA and high titres of rheumatoid factor.  No significant differences with respect to phenotype or gene frequencies were found in the C3 complement system. Thus, the association between RA and C3 found in previous investiga­tions was not confirmed.  A significant increase of rare alpha-1-antitrypsin (Pi) types (MS, MZ, MF and SZ) was found among RA patients. However, the increase concerned mainly Z heterozygotes and was more strongly pronounced among male patients.  In the haptoglobin system a significant increase of the Hp^ gene and the Hp2-2 type was found among patients with a family history of polyarthritis, more pronounced among males.  A significant increase of the transferrin gene and of the 2 type was found among male RA patients, more pronounced among patients with a family history of polyarthritis. In 6 out of 8 gene loci studied significant associations were found, which is in agreement with a multifactorial etiology of RA. The results were largely in agreement with the hypothesis that associations would be expected to be stronger in males and in patients with a family history of polyarthritis. A notable finding was the high frequency of first degree relatives (around 40%) with symmetric peripheral polyarthritis of which more than 70% had a diagnosis of RA verified by hospital records. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1985, härtill 6 uppsatser.</p> / digitalisering@umu

Devido a sua alta incidência, mortalidade e custos elevados, o câncer de mama feminino é considerado um problema de saúde pública no Brasil. Sua etiologia envolve uma interação de diversos fatores denominados de risco os quais podem ser ambientais e genéticos. A história familiar positiva para câncer de mama é um importante fator de risco para o desenvolvimento dessa patologia. Conhecer esses fatores e as medidas de proteção permite que mulheres com risco elevado possam criar estratégias pessoais que venham minimizar os danos causados pela doença. Diante do exposto, o presente estudo tem como objetivos avaliar o nível de conhecimento de mulheres acerca do risco de desenvolverem câncer de mama em decorrência do vínculo familiar com a população portadora desta neoplasia matriculada no Hospital do Câncer III, unidade do Instituto Nacional de Câncer (INCA) especializada no tratamento e controle do câncer de mama, localizada no município do Rio de Janeiro, Brasil; descrever as características sociodemográficas das mulheres familiares de pacientes portadoras de câncer de mama e descrever a história reprodutiva e hormonal, bem como seus hábitos de cuidado com a saúde. Metodologia: trata-se de um estudo exploratório sob a perspectiva quantitativa, transversal e descritiva com 52 mulheres que acompanhavam suas familiares internadas em unidade clínica e cirúrgica do Hospital do Câncer III. A coleta de dados ocorreu no período entre julho e agosto de 2011. A técnica de amostragem adotada foi a não probabilística, intencional Para o cálculo amostral aplicou-se a fórmula de população infinita. Foram selecionadas as seguintes variáveis para compor o estudo: aspectos sociodemográficos, aspectos da vida reprodutiva e hormonal, aspectos de cuidados com a saúde e aspectos de esclarecimento relacionados à patologia/doença. Realizou-se entrevista estruturada com utilização de um formulário composto por 63 questões. A descrição das variáveis foi feita através de frequência simples e porcentagem. Resultados: 61,5% eram filhas, 34,6% eram irmãs e 3,8% eram mães, 40,4% moram no município do Rio de Janeiro, 86,4% encontram-se na faixa etária entre 29 e acima de 51 anos de idade, 32% são pardas, 46,1% apresentavam 2 grau completo, 46,2% são do lar, 15,4% tiveram menarca precoce, 7,7 % tiveram na menopausa tardia, 7,7% fizeram Terapia de Reposição Hormonal, 38,5% nunca engravidaram, 3,8% engravidaram após 30 anos, 3,8% não amamentaram, 42,4% usam anticoncepcional hormonal por mais de 5 anos e 40,4% nunca fizeram descanso ou faz por tempo inferior a 6 meses, 7,7% e 7,6% nunca fizeram e apresenta mais de 24 meses que fizeram exame ginecológico. Quanto ao grau de esclarecimento 34% concordaram com as afirmativas sobre fatores de risco, 65% concordaram com medidas preventivas e os profissionais de saúde foram os que mais transmitiram informação sobre o câncer de mama. Conclusão: ser familiar de primeiro grau associado à falta de esclarecimento sobre a doença torna essas mulheres mais vulneráveis em relação à população geral feminina. Torna-se oportuno para a enfermagem estratégias educativas que visem à promoção da saúde e que contribuam para a modificação do panorama da doença, em razão da detecção mais precoce. / Due to the incidence, mortality and high costs, female breast cancer is considered a Health Care issue in Brazil. Its etiology binds an interaction of various risk factors which can be environmental and genetic ones. A positive family history for breast cancer is an important risk factor for the development of this pathology. Knowing the factors and protection measures allow the women with high risk create personal strategies that minimize the damage caused by the disease. Objectives: evaluate the level of knowledge of the women regarding the risk of breast cancer development related to family history with population which carries this neoplasia assisted by the Hospital do Câncer III, Cancer National Institute (INCA) branch specialized on breast cancer treatment and control, located at the city of Rio de Janeiro, Brazil; describe the social demographical characters of the women whose relatives are breast cancer patients and report their hormonal and reproductive history as well as their health care habits. Methodology: It consists of an exploratory study under a quantitative perspective in a descriptive and transversal way with 52 women that accompanied their hospitalized relatives in a clinic and surgery unity of Hospital do Câncer III. The data collection was performed between July and August 2011. The sampling technique adopted was intentionally the non-probabilistic. The applied sample size calculation was infinite population. The selected variables to compose the study were the following: social demographical aspects, reproductive and hormonal life aspects, health care aspects and awareness concerning the pathology/disease. The structured interview counted with a form of 63 questions. Results: 61,5% were daughters 34,6% were sisters and 3,8% were mothers, 40,4% lived in the city of Rio de Janeiro, 86,4% were between 29 and 51 years old, 32% were yellow, 46,1% finished high school, 46,2% were housewives, 15,4% had premature menarche, 7,7 % had late menopause, 7,7% adopted Hormone Replacement Therapy (HRT), 38,5% never got pregnant 3,8% got pregnant after 30 years old, 3,8% did not breastfeed, 42,4% took hormonal contraceptive for more than 5 years and 40,4% never stopped taking hormone contraceptive or stopped for period under 6 months, 7,7% and 7,6% never stopped taking hormone contraceptive and had more than 24 months from their last gynecological exam. Regarding the degree of awareness 34% agreed with the risk factor affirmatives, 65% agreed with preventive measures and the health professionals were the main source of information about breast cancer. Conclusion: first-degree relative associated with lack of knowledge put the women more vulnerable in relation to general feminine population. Here resides the chance for nursery assistance educational strategies which achieve health promotion and contribute for a disease changing panorama caused by early detection.

Devido a sua alta incidência, mortalidade e custos elevados, o câncer de mama feminino é considerado um problema de saúde pública no Brasil. Sua etiologia envolve uma interação de diversos fatores denominados de risco os quais podem ser ambientais e genéticos. A história familiar positiva para câncer de mama é um importante fator de risco para o desenvolvimento dessa patologia. Conhecer esses fatores e as medidas de proteção permite que mulheres com risco elevado possam criar estratégias pessoais que venham minimizar os danos causados pela doença. Diante do exposto, o presente estudo tem como objetivos avaliar o nível de conhecimento de mulheres acerca do risco de desenvolverem câncer de mama em decorrência do vínculo familiar com a população portadora desta neoplasia matriculada no Hospital do Câncer III, unidade do Instituto Nacional de Câncer (INCA) especializada no tratamento e controle do câncer de mama, localizada no município do Rio de Janeiro, Brasil; descrever as características sociodemográficas das mulheres familiares de pacientes portadoras de câncer de mama e descrever a história reprodutiva e hormonal, bem como seus hábitos de cuidado com a saúde. Metodologia: trata-se de um estudo exploratório sob a perspectiva quantitativa, transversal e descritiva com 52 mulheres que acompanhavam suas familiares internadas em unidade clínica e cirúrgica do Hospital do Câncer III. A coleta de dados ocorreu no período entre julho e agosto de 2011. A técnica de amostragem adotada foi a não probabilística, intencional Para o cálculo amostral aplicou-se a fórmula de população infinita. Foram selecionadas as seguintes variáveis para compor o estudo: aspectos sociodemográficos, aspectos da vida reprodutiva e hormonal, aspectos de cuidados com a saúde e aspectos de esclarecimento relacionados à patologia/doença. Realizou-se entrevista estruturada com utilização de um formulário composto por 63 questões. A descrição das variáveis foi feita através de frequência simples e porcentagem. Resultados: 61,5% eram filhas, 34,6% eram irmãs e 3,8% eram mães, 40,4% moram no município do Rio de Janeiro, 86,4% encontram-se na faixa etária entre 29 e acima de 51 anos de idade, 32% são pardas, 46,1% apresentavam 2 grau completo, 46,2% são do lar, 15,4% tiveram menarca precoce, 7,7 % tiveram na menopausa tardia, 7,7% fizeram Terapia de Reposição Hormonal, 38,5% nunca engravidaram, 3,8% engravidaram após 30 anos, 3,8% não amamentaram, 42,4% usam anticoncepcional hormonal por mais de 5 anos e 40,4% nunca fizeram descanso ou faz por tempo inferior a 6 meses, 7,7% e 7,6% nunca fizeram e apresenta mais de 24 meses que fizeram exame ginecológico. Quanto ao grau de esclarecimento 34% concordaram com as afirmativas sobre fatores de risco, 65% concordaram com medidas preventivas e os profissionais de saúde foram os que mais transmitiram informação sobre o câncer de mama. Conclusão: ser familiar de primeiro grau associado à falta de esclarecimento sobre a doença torna essas mulheres mais vulneráveis em relação à população geral feminina. Torna-se oportuno para a enfermagem estratégias educativas que visem à promoção da saúde e que contribuam para a modificação do panorama da doença, em razão da detecção mais precoce. / Due to the incidence, mortality and high costs, female breast cancer is considered a Health Care issue in Brazil. Its etiology binds an interaction of various risk factors which can be environmental and genetic ones. A positive family history for breast cancer is an important risk factor for the development of this pathology. Knowing the factors and protection measures allow the women with high risk create personal strategies that minimize the damage caused by the disease. Objectives: evaluate the level of knowledge of the women regarding the risk of breast cancer development related to family history with population which carries this neoplasia assisted by the Hospital do Câncer III, Cancer National Institute (INCA) branch specialized on breast cancer treatment and control, located at the city of Rio de Janeiro, Brazil; describe the social demographical characters of the women whose relatives are breast cancer patients and report their hormonal and reproductive history as well as their health care habits. Methodology: It consists of an exploratory study under a quantitative perspective in a descriptive and transversal way with 52 women that accompanied their hospitalized relatives in a clinic and surgery unity of Hospital do Câncer III. The data collection was performed between July and August 2011. The sampling technique adopted was intentionally the non-probabilistic. The applied sample size calculation was infinite population. The selected variables to compose the study were the following: social demographical aspects, reproductive and hormonal life aspects, health care aspects and awareness concerning the pathology/disease. The structured interview counted with a form of 63 questions. Results: 61,5% were daughters 34,6% were sisters and 3,8% were mothers, 40,4% lived in the city of Rio de Janeiro, 86,4% were between 29 and 51 years old, 32% were yellow, 46,1% finished high school, 46,2% were housewives, 15,4% had premature menarche, 7,7 % had late menopause, 7,7% adopted Hormone Replacement Therapy (HRT), 38,5% never got pregnant 3,8% got pregnant after 30 years old, 3,8% did not breastfeed, 42,4% took hormonal contraceptive for more than 5 years and 40,4% never stopped taking hormone contraceptive or stopped for period under 6 months, 7,7% and 7,6% never stopped taking hormone contraceptive and had more than 24 months from their last gynecological exam. Regarding the degree of awareness 34% agreed with the risk factor affirmatives, 65% agreed with preventive measures and the health professionals were the main source of information about breast cancer. Conclusion: first-degree relative associated with lack of knowledge put the women more vulnerable in relation to general feminine population. Here resides the chance for nursery assistance educational strategies which achieve health promotion and contribute for a disease changing panorama caused by early detection.

This study is an exploration of familial bilingualism in which I examined the reported experiences of a small group of bilingual family members who live in the South of England and whose heritage languages are French or Spanish. The study, located in applied linguistics and sociolinguistics, draws upon the main fields of bilingualism, second language acquisition, language ideologies, family language policies, as well as bilingualism and emotions. It offers evidence of the difficulties to transmit heritage languages and implement familial bilingualism because of a mixture of intertwined ideological and practical factors. Having experienced familial bilingualism, I was interested in understanding the meaning that familial bilingualism had for other families and how familial bilingualism subjectively affected family members in their everyday lives and in their interactions at home and in society. To conduct the study, I adopted an interpretative approach in which I tried to derive context-situated interpretations from the narratives of my participants. Thus, my data enabled me to examine the complexity of maintaining and transmitting heritage languages within families. The data highlighted the strong link between familial bilingualism and society as the heritage languages of the participants could be construed as social capital that the parents had to transmit in order to be 'good parents'. The data also highlighted the complex relationships between bilingualism and emotions not only at societal level but also at individual and familial levels. The salient emotions revealed in the data comprise feelings of responsibility about maintaining and transmitting heritage languages as well as feelings of insecurity and isolation generated by migrating and belonging to bilingual families. A greater understanding of familial bilingualism and how families view their languages as lenses through which they negotiate family and societal relations, as well as emotions and education, is not simply an academic exercise but is arguably of importance to all of us, given the world in which we live, with diversity and migration featuring as major political and ideological issues.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-27T11:38:25Z No. of bitstreams: 1 liviavictorinodesouza.pdf: 1494176 bytes, checksum: f585792135ba272a938d24f794c1a178 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-28T13:04:06Z (GMT) No. of bitstreams: 1 liviavictorinodesouza.pdf: 1494176 bytes, checksum: f585792135ba272a938d24f794c1a178 (MD5) / Made available in DSpace on 2016-06-28T13:04:06Z (GMT). No. of bitstreams: 1 liviavictorinodesouza.pdf: 1494176 bytes, checksum: f585792135ba272a938d24f794c1a178 (MD5) Previous issue date: 2012-08-17 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / INTRODUÇÃO: Indivíduos com histórico familiar positivo para doença renal crônica (HF+DRC) apresentam alterações hemodinâmicas que influenciam diretamente no surgimento e desenvolvimento dessa doença. Porém, ainda não está claro se há prejuízo na vasodilatação em indivíduos HF+DRC, durante o exercício físico. OBJETIVOS: Testar a hipótese de que indivíduos saudáveis com HF+DRC apresentam vasodilatação muscular diminuída durante o exercício físico. MÉTODOS: Foram avaliados 9 indivíduos saudáveis com HF+DRC e 17 indivíduos saudáveis sem histórico familiar para doença renal crônica (Grupo HF-DRC), pareados por idade (27±2 vs. 26±1 anos, p=0,67, respectivamente). A pressão arterial (oscilométrico - DIXTAL® 2023), a frequência cardíaca (DIXTAL® 2023) e o fluxo sanguíneo do antebraço (pletismografia de oclusão venosa - Hokanson®) foram aferidos durante 3 minutos basais seguidos de 3 minutos de exercício físico isométrico de preensão de mão a 30% da contração voluntária máxima. A vasodilatação muscular foi calculada pela divisão do fluxo sanguíneo do antebraço pela pressão arterial média, multiplicada por 100. A creatinina sérica foi medida para estimativa da taxa de filtração glomerular. Foi aplicada ANOVA two-way seguida pelo post hoc de Tukey, adotando significativo p<0,05. Os resultados são expressos como média±EP. RESULTADOS: A Creatinina sérica (p=0,74), a taxa de filtração glomerular estimada (p=0,90), a pressão arterial sistólica (p=0,11), diastólica (p=0,82), média (p=0,44) e a frequência cardíaca (p=0,86) foram semelhantes entre os grupos. E, todos os voluntários apresentaram ausência de proteinúria e hematúria. No basal, o fluxo sanguíneo do antebraço foi semelhante entre os grupos HF+DRC e HF-DRC (2,51±0,37 vs. 2,85±0,18 mL/min/100mL, p=0,06), porém aumentou significativamente durante o exercício físico apenas no grupo HF-DRC (p=0,03). No basal, a vasodilatação muscular foi semelhante entre os grupos (2,85±0,37 vs. 3,41±0,21 unidades, respectivamente, p=0,78). Durante o exercício físico o grupo HF+DRC não apresentou mudanças significativas durante o primeiro, segundo e terceiro minutos de exercício físico em relação ao basal (3,19±0,54, 2,91±0,30 e 2,45±0,24 unidades, respectivamente). Porém, foi observado aumento significativo da vasodilatação muscular em relação ao exercício físico no grupo HF-DRC (4,06±0,36, 4,30±0,34 e 4,55±0,48 unidades, respectivamente). CONCLUSÃO: Indivíduos saudáveis com histórico familiar positivo para DRC apresentam disfunção vasodilatadora durante o exercício físico. / INTRODUCTION: Individuals with positive family history of chronic kidney disease (CKD+FH) present hemodynamic changes that directly influence the emergence and development of this disease. However it is unclear whether there is impairment of vasodilatation in CKD+FH individuals during the exercise. OBJECTIVES: To test the hypothesis that healthy subjects with CKD+FH have diminished muscle vasodilatation during exercise. METHODS: We study nine healthy subjects with CKD+FH and 17 healthy individuals without family history of chronic disease (CKD-FH) matched for age (27±2 vs. 26±1 years, p=0,67, respective). Blood pressure (oscilometric - DIXTAL® 2023) heart rate (DIXTAL® 2023) and forearm blood flow (venous occlusion pletysmography - Hokanson®) were measured for 3 minutesbaseline followed by 3 minutes isometric handgrip exercise 30% of maximum voluntary contration. Vasodilatation muscle was calculated by dividing the forearm blood flow by the blood pressure mean multiplied by 100. Serum creatinina was measure to estimate glomerular filtration rate. Was applied ANOVA two-way followed by post hoc Tukey, adopting p<0,05. The results are expressed as mean ± SE. RESULTS: Serum creatinina (p=0,74), the estimate glomerular filtration rate (p=0,90), systolic blood pressure (p=0,11), diastolic blood pressure (p=0,82), mean blood pressure (p=0,44) and heart rate (p=0,86) were similar between groups. And all the volunteers showed no proteinuria and hematuria. At baselina forearm blood flow was similar between the groups CKD+FH and CKD-FH (2,51±0,37 vs. 2,85±0,18 mL/min/100mL, p=0,06), but increased significantly during exercise only in CKD-FH group (p=0,03). At baseline, muscle vasodilatation was similar between groups (2,85±0,37 vs. 3,41±0,21 units, respectively, p=0,78). During exercise the CKD+FH group showed no significant changes during the first, second and third minute of exercise in relation to baseline (3,19±0,54, 2,91±0,30 e 2,45±0,24 units, respectively). However we observed a significant increased in muscle vasodilatation in relation to physical exercise in CKF-FH group (4,06±0,36, 4,30±0,34 e 4,55±0,48 units, respectively). CONCLUSION: In healthy subjects with positive family history of chronic kidney disease have vasodilator dysfunction during exercise.