No pós-transplante hepático (pós-TxHep), complicações da doença cardiovascular (CV) têm sido cada vez mais prevalentes e aparecem entre as principais causas de morte nessa população. Sabe-se que alterações metabólicas e nutricionais podem estar associadas ao aumento de risco CV. Assim, o objetivo deste trabalho foi avaliar o risco CV e suas associações com o estado nutricional, ingestão alimentar e o perfil metabólico em pacientes pós-TxHep. Este estudo transversal incluiu pacientes adultos pós-TxHep. Pacientes transplantados há menos de 1 ano e com histórico de insuficiência hepática fulminante, perda de enxerto hepático ou insuficiência renal crônica pós-TxHep não foram incluídos. Os pacientes passaram por avaliação clínica, nutricional e laboratorial. A avaliação nutricional compreendeu a ingestão alimentar, através de Registro Alimentar de três dias, antropometria e dinamometria. A medida da espessura da camada íntima-média carotídea (EIMC) foi avaliada por ultrassonografia Doppler e considerada alterada quando maior que 1 milímetro. Foram avaliados 69 pacientes transplantados há 2,8 (1,4 - 6,3) anos, sendo a maioria do sexo masculino (61%). Encontrou-se alta prevalência de desnutrição e sarcopenia, apresentada por 45% dos pacientes com área muscular do braço abaixo do percentil 15, e 71% com força do aperto de mão abaixo do percentil 30. Em contraste, 72% dos pacientes estavam com excesso de peso e 35% apresentaram Índice de Massa Corporal (IMC) maior que 30 kg/m2. Pacientes com EIMC alterada (54%) apresentaram maior LDL colesterol (P = 0,01), maior proporção de proteína-C reativa ultrassensível (PCR-us) maior que 1mg/L (P = 0.02) e maior ingestão de ácidos graxos saturados e trans (P = 0.01). Em conclusão, este estudo mostrou alta prevalência de EIMC alterada em uma amostra de pacientes pós-TxHep com sobrepeso e sarcopenia, associada a níveis mais elevados de LDL colesterol, PCR-us maior que 1mg/L e maior ingestão de ácidos graxos saturados e trans. Este estudo reforça que é necessário fornecer medidas preventivas, incluindo a melhoria da qualidade dietética, para todos os pacientes pós-transplante hepático, a fim de minimizar o risco CV. / In post-liver transplantation (post-LT), complications of cardiovascular (CV) disease have been increasingly prevalent and have become one of the main causes of death in this population. It is known that metabolic and nutritional imbalance may be associated with increased CV risk. Thus, the aim of this study was to evaluate CV risk and its associations with nutritional status, food intake and metabolic profile in post-LT patients. This cross-sectional study included adult post-LT patients, who underwent clinical, nutritional and laboratory evaluation. Patients who have undergone LT for less than 1 year, and with history of fulminant hepatic failure, loss of liver graft or chronic renal failure after LT were not included. The nutritional evaluation included food intake, through a three-day Food Record, anthropometry and dynamometry. The carotid intima-media thickness (CIMT) was assessed by Doppler ultrasonography and considered abnormal when greater than 1 millimeter. A total of 69 patients transplanted 2.8 (1.4 - 6.3) years ago were evaluated, being the majority male (61%). There was a high prevalence of malnutrition and sarcopenia, presented by 45% of patients with arm muscle area below the 15th percentile, and 71% with handgrip strength below the 30th percentile. In contrast, 72% of the patients were overweight and 35% had Body Mass Index greater than 30 kg/m2. Patients with altered CIMT (54%) had higher LDL cholesterol (P = 0.01), higher proportion of high-sensitive C-reactive protein (hs-CRP) greater than 1mg/L (P = 0.02) and higher intake of saturated and trans fatty acids (P = 0.01). In conclusion, this study showed a high prevalence of abnormal CIMT in a sample of post-LT patients with overweight and sarcopenia, associated with higher levels of LDL cholesterol, hs-CRP greater than 1mg/L, and higher intake of saturated and trans fatty acids. This study reinforces that it is necessary to provide preventive measures, including improvement of dietary quality, for all patients after liver transplantation, in order to minimize CV risk.

A exposição precoce a fatores de risco cardiovascular gera estado inflamatório crônico, podendo causar dano da função endotelial, seguido de espessamento da íntima-média carotídea. O objetivo desta pesquisa foi estudar a espessura íntima-média carotídea e seu comportamento em relação aos fatores e biomarcadores de risco cardiovascular em crianças com excesso de peso pré-púberes. Realizou-se estudo transversal com 80 obesos, 18 com sobrepeso e 31 eutróficos do Ambulatório de Pediatria do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro. Avaliou-se, através de comparação de médias, medianas e frequências, o comportamento dos fatores de risco e da espessura íntima-média carotídea entre os sexos; entre obesos, com sobrepeso e eutróficos; entre resistentes e não resistentes à insulina. Avaliou-se, através de análise de regressão logística bivariada e multivariada, associação entre os fatores de risco e espessamento de íntima-média carotídea. Houve diferença estatisticamente significativa das médias e medianas de escore Z de índice de massa corpórea (p-valor=0,02), pressão arterial sistólica (p-valor=0,04) e adiponectina (p-valor=0,02) entre sexos; de circunferência da cintura (p-valor=0,0001), pressão arterial sistólica (p-valor=0,0001), diastólica (p-valor=0,001), homeostaticmodelacessment for insulinresitance (p-valor=0,0001), colesterol total (p-valor=0,02), HDL (p-valor=0,01), LDL (p-valor=0,03), triglicerídeos (p-valor=0,01), proteína C reativa (p-valor=0,0001), interleucina 6 (p-valor=0,02), leptina (p-valor=0,0001), espessura da íntima-média carotídea esquerda (p-valor=0,03) entre obesos, com sobrepeso e eutróficos; de escore Z de índice de massa corpórea (p-valor=0,0009), circunferência da cintura (p-valor=0,0001), pressão arterial sistólica (p-valor=0,0001), diastólica (p-valor=0,0006), colesterol total (p-valor=0,0004), triglicerídeos (p-valor=0,0002), leptina (p-valor=0,004) entre resistentes e não resistentes à insulina. Na regressão logística bivariada, escore Z de índice de massa corpórea, circunferência da cintura e pressão arterial sistólica associaram-se positivamente (p-valor<0,05) com o espessamento das carótidas direita, esquerda e com média dos valores de ambas. Na regressão logística multivariada, escore Z de índice de massa corpórea (p-valor=0,02) e pressão arterial sistólica (p-valor=0,04), associaram-se positivamente com íntima-média carotídea espessada à esquerda; níveis tensionais sistólicos (p-valor=0,01) se associaram com a média dos valores da íntima média carotídea de ambos os lados.Os achados mostram nas crianças pré-púberes com excesso de peso: que os fatores e biomarcadores de risco cardiovascular já se encontram presentes; influência de escore Z de índice de massa corpórea e níveis tensionais sistólicos sobre espessura íntima-média carotídea. A prevenção de aterosclerose deve iniciar precocemente, identificando-se e controlando-se fatores de risco cardiovascular. O pediatra deve procurar promover saúde cardiovascular da criança, prevenindo e/ou controlando obesidade, orientado prática regular de exercícios físicos e hábitos alimentares saudáveis. / Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima media. The goal of this project was to study the carotid intima media thickness and its relationship to factors and biomarkers of cardiovascular risk in prepubertal children with excess weight. Eightyobese, 18 overweightand 31 normal weightchildrenfromthe Ambulatório de Pediatria do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro participated in thestudy. Mean, median and frequencies of cardiovascular risk factors and carotid intima media thickness were compared between genders, obese, overweight and normal weight children and between children with insulin resistance and without insulin resistance. The association between cardiovascular risk factors and carotid intima media thickness was investigated using bivariate (or binary) and multivariate logistic regression. There was a statistically significant difference between the mean and median body mass index Z-score (p= 0.02), arterial blood pressure (p=0.04) e adiponectin (p=0.02) between genders. When comparing obese, overweight and normal weight children there were statistically significant differences in the abdominal circumference (p=0.0001), arterial systolic blood pressure (p=0.0001), diastolic blood pressure (p=0.001), homeostatic model assessment for insulin resistance (p =0.0001), total cholesterol (p=0.02), HDL cholesterol (p=0.01), LDL cholesterol (p=0.03), triglycerides (p=0.01), C reactive protein (p=0.0001), interleukin 6 (p=0.02), leptin (p=0.0001) and carotid intima media thickness. When comparing insulin resistant and non resistant children there were statistically significant differences between body mass index (p =0.0009), abdominal circumference (p =0.0001), systolic arterial blood pressure (p =0.0001), diastolic arterial blood pressure (p =0.0006), total cholesterol (p =0.0004), triglycerides (p=0.0002), and leptin (p =0.004). Using bivariate logistic regression there was a positive association (p<0.05) between body mass index Z score, abdominal circumference and systolic arterial pressure and right, left and mean intima media thickness. Using multivariate logistic regression there was a positive association between left carotid intima media thickness and body mass index Z score (p=0.02) and systolic arterial pressure (p=0.04) and systolic blood pressure and the mean intima media thickness (p=0.01). These results demonstrate that prepubertal children with excess weight already have factors associated with and biomarkers of cardiovascular risk and the influence of the score Z of the body mass index and systolic arterial blood pressure on the carotid intima media thickness. The prevention of arteriosclerosis must start early, with the identification and the control of cardiovascular risk factors. The pediatrician should encourage the cardiovascular health of children, preventing and/or controlling obesity, orienting the need for regular practice of physical exercises and healthy eating habits.

A exposição precoce a fatores de risco cardiovascular gera estado inflamatório crônico, podendo causar dano da função endotelial, seguido de espessamento da íntima-média carotídea. O objetivo desta pesquisa foi estudar a espessura íntima-média carotídea e seu comportamento em relação aos fatores e biomarcadores de risco cardiovascular em crianças com excesso de peso pré-púberes. Realizou-se estudo transversal com 80 obesos, 18 com sobrepeso e 31 eutróficos do Ambulatório de Pediatria do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro. Avaliou-se, através de comparação de médias, medianas e frequências, o comportamento dos fatores de risco e da espessura íntima-média carotídea entre os sexos; entre obesos, com sobrepeso e eutróficos; entre resistentes e não resistentes à insulina. Avaliou-se, através de análise de regressão logística bivariada e multivariada, associação entre os fatores de risco e espessamento de íntima-média carotídea. Houve diferença estatisticamente significativa das médias e medianas de escore Z de índice de massa corpórea (p-valor=0,02), pressão arterial sistólica (p-valor=0,04) e adiponectina (p-valor=0,02) entre sexos; de circunferência da cintura (p-valor=0,0001), pressão arterial sistólica (p-valor=0,0001), diastólica (p-valor=0,001), homeostaticmodelacessment for insulinresitance (p-valor=0,0001), colesterol total (p-valor=0,02), HDL (p-valor=0,01), LDL (p-valor=0,03), triglicerídeos (p-valor=0,01), proteína C reativa (p-valor=0,0001), interleucina 6 (p-valor=0,02), leptina (p-valor=0,0001), espessura da íntima-média carotídea esquerda (p-valor=0,03) entre obesos, com sobrepeso e eutróficos; de escore Z de índice de massa corpórea (p-valor=0,0009), circunferência da cintura (p-valor=0,0001), pressão arterial sistólica (p-valor=0,0001), diastólica (p-valor=0,0006), colesterol total (p-valor=0,0004), triglicerídeos (p-valor=0,0002), leptina (p-valor=0,004) entre resistentes e não resistentes à insulina. Na regressão logística bivariada, escore Z de índice de massa corpórea, circunferência da cintura e pressão arterial sistólica associaram-se positivamente (p-valor<0,05) com o espessamento das carótidas direita, esquerda e com média dos valores de ambas. Na regressão logística multivariada, escore Z de índice de massa corpórea (p-valor=0,02) e pressão arterial sistólica (p-valor=0,04), associaram-se positivamente com íntima-média carotídea espessada à esquerda; níveis tensionais sistólicos (p-valor=0,01) se associaram com a média dos valores da íntima média carotídea de ambos os lados.Os achados mostram nas crianças pré-púberes com excesso de peso: que os fatores e biomarcadores de risco cardiovascular já se encontram presentes; influência de escore Z de índice de massa corpórea e níveis tensionais sistólicos sobre espessura íntima-média carotídea. A prevenção de aterosclerose deve iniciar precocemente, identificando-se e controlando-se fatores de risco cardiovascular. O pediatra deve procurar promover saúde cardiovascular da criança, prevenindo e/ou controlando obesidade, orientado prática regular de exercícios físicos e hábitos alimentares saudáveis. / Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima media. The goal of this project was to study the carotid intima media thickness and its relationship to factors and biomarkers of cardiovascular risk in prepubertal children with excess weight. Eightyobese, 18 overweightand 31 normal weightchildrenfromthe Ambulatório de Pediatria do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro participated in thestudy. Mean, median and frequencies of cardiovascular risk factors and carotid intima media thickness were compared between genders, obese, overweight and normal weight children and between children with insulin resistance and without insulin resistance. The association between cardiovascular risk factors and carotid intima media thickness was investigated using bivariate (or binary) and multivariate logistic regression. There was a statistically significant difference between the mean and median body mass index Z-score (p= 0.02), arterial blood pressure (p=0.04) e adiponectin (p=0.02) between genders. When comparing obese, overweight and normal weight children there were statistically significant differences in the abdominal circumference (p=0.0001), arterial systolic blood pressure (p=0.0001), diastolic blood pressure (p=0.001), homeostatic model assessment for insulin resistance (p =0.0001), total cholesterol (p=0.02), HDL cholesterol (p=0.01), LDL cholesterol (p=0.03), triglycerides (p=0.01), C reactive protein (p=0.0001), interleukin 6 (p=0.02), leptin (p=0.0001) and carotid intima media thickness. When comparing insulin resistant and non resistant children there were statistically significant differences between body mass index (p =0.0009), abdominal circumference (p =0.0001), systolic arterial blood pressure (p =0.0001), diastolic arterial blood pressure (p =0.0006), total cholesterol (p =0.0004), triglycerides (p=0.0002), and leptin (p =0.004). Using bivariate logistic regression there was a positive association (p<0.05) between body mass index Z score, abdominal circumference and systolic arterial pressure and right, left and mean intima media thickness. Using multivariate logistic regression there was a positive association between left carotid intima media thickness and body mass index Z score (p=0.02) and systolic arterial pressure (p=0.04) and systolic blood pressure and the mean intima media thickness (p=0.01). These results demonstrate that prepubertal children with excess weight already have factors associated with and biomarkers of cardiovascular risk and the influence of the score Z of the body mass index and systolic arterial blood pressure on the carotid intima media thickness. The prevention of arteriosclerosis must start early, with the identification and the control of cardiovascular risk factors. The pediatrician should encourage the cardiovascular health of children, preventing and/or controlling obesity, orienting the need for regular practice of physical exercises and healthy eating habits.

No pós-transplante hepático (pós-TxHep), complicações da doença cardiovascular (CV) têm sido cada vez mais prevalentes e aparecem entre as principais causas de morte nessa população. Sabe-se que alterações metabólicas e nutricionais podem estar associadas ao aumento de risco CV. Assim, o objetivo deste trabalho foi avaliar o risco CV e suas associações com o estado nutricional, ingestão alimentar e o perfil metabólico em pacientes pós-TxHep. Este estudo transversal incluiu pacientes adultos pós-TxHep. Pacientes transplantados há menos de 1 ano e com histórico de insuficiência hepática fulminante, perda de enxerto hepático ou insuficiência renal crônica pós-TxHep não foram incluídos. Os pacientes passaram por avaliação clínica, nutricional e laboratorial. A avaliação nutricional compreendeu a ingestão alimentar, através de Registro Alimentar de três dias, antropometria e dinamometria. A medida da espessura da camada íntima-média carotídea (EIMC) foi avaliada por ultrassonografia Doppler e considerada alterada quando maior que 1 milímetro. Foram avaliados 69 pacientes transplantados há 2,8 (1,4 - 6,3) anos, sendo a maioria do sexo masculino (61%). Encontrou-se alta prevalência de desnutrição e sarcopenia, apresentada por 45% dos pacientes com área muscular do braço abaixo do percentil 15, e 71% com força do aperto de mão abaixo do percentil 30. Em contraste, 72% dos pacientes estavam com excesso de peso e 35% apresentaram Índice de Massa Corporal (IMC) maior que 30 kg/m2. Pacientes com EIMC alterada (54%) apresentaram maior LDL colesterol (P = 0,01), maior proporção de proteína-C reativa ultrassensível (PCR-us) maior que 1mg/L (P = 0.02) e maior ingestão de ácidos graxos saturados e trans (P = 0.01). Em conclusão, este estudo mostrou alta prevalência de EIMC alterada em uma amostra de pacientes pós-TxHep com sobrepeso e sarcopenia, associada a níveis mais elevados de LDL colesterol, PCR-us maior que 1mg/L e maior ingestão de ácidos graxos saturados e trans. Este estudo reforça que é necessário fornecer medidas preventivas, incluindo a melhoria da qualidade dietética, para todos os pacientes pós-transplante hepático, a fim de minimizar o risco CV. / In post-liver transplantation (post-LT), complications of cardiovascular (CV) disease have been increasingly prevalent and have become one of the main causes of death in this population. It is known that metabolic and nutritional imbalance may be associated with increased CV risk. Thus, the aim of this study was to evaluate CV risk and its associations with nutritional status, food intake and metabolic profile in post-LT patients. This cross-sectional study included adult post-LT patients, who underwent clinical, nutritional and laboratory evaluation. Patients who have undergone LT for less than 1 year, and with history of fulminant hepatic failure, loss of liver graft or chronic renal failure after LT were not included. The nutritional evaluation included food intake, through a three-day Food Record, anthropometry and dynamometry. The carotid intima-media thickness (CIMT) was assessed by Doppler ultrasonography and considered abnormal when greater than 1 millimeter. A total of 69 patients transplanted 2.8 (1.4 - 6.3) years ago were evaluated, being the majority male (61%). There was a high prevalence of malnutrition and sarcopenia, presented by 45% of patients with arm muscle area below the 15th percentile, and 71% with handgrip strength below the 30th percentile. In contrast, 72% of the patients were overweight and 35% had Body Mass Index greater than 30 kg/m2. Patients with altered CIMT (54%) had higher LDL cholesterol (P = 0.01), higher proportion of high-sensitive C-reactive protein (hs-CRP) greater than 1mg/L (P = 0.02) and higher intake of saturated and trans fatty acids (P = 0.01). In conclusion, this study showed a high prevalence of abnormal CIMT in a sample of post-LT patients with overweight and sarcopenia, associated with higher levels of LDL cholesterol, hs-CRP greater than 1mg/L, and higher intake of saturated and trans fatty acids. This study reinforces that it is necessary to provide preventive measures, including improvement of dietary quality, for all patients after liver transplantation, in order to minimize CV risk.

Bakgrund: Ateroskleros är en känd bakomliggande orsak till hjärt-och kärlsjukdomar. Progressionen av ateroskleros är en långsam process som börjar redan i unga år. En accepterad subklinisk markör för utvecklingen av ateroskleros är carotis intima-media tjockleken. Syfte: Syftet med studien var att undersöka om det föreligger en statistisk signifikant skillnad på carotis intima-media tjockleken mellan unga kvinnor och män utan någon känd kardiovaskulär riskfaktor. Metod: I studien undersöktes 38 friska studiedeltagare med medelåldern 24,5 år. Carotis intima-media tjockleken undersöktes med ultraljud. Resultat: Resultatet påvisade ingen statistisk signifikant skillnad på carotis intima-media tjockleken mellan unga kvinnor och män. Diskussion: Resultatet kan påverkas av liten provstorlek och för att kunna dra mer generella slutsatser bör en större population undersökas. / Background: Atherosclerosis is a known underlying cause of cardiovascular disease. The progression of atherosclerosis is a slow process that begins at an early age. An accepted subclinical marker for the development of atherosclerosis is carotid intima media thickness. Purpose: The purpose of the study was to investigate whether there is a statistically significant difference in intima-media thickness in the carotid artery between young women and men without any known cardiovascular risk factor. Method: The study examined 38 healthy participants with a mean age of 24.5 years. Carotid intima-media thickness was measured by ultrasound. Results: The results showed no statistically significant difference in carotid intima-media thickness between young women and men. Discussion: The result can be affected by the small sample size and in order to be able to draw more general conclusions, a larger population should be examined.

Stroke is the 2nd leading cause of death in the UK and worldwide. 150,000 people have a stroke each year in the UK (ischaemic stroke being the most common) and a significant proportion of NHS resources go towards the treatment of these individuals (~£2.8 billion). Twin and family history studies have shown that having affected relatives makes you between 30 and 76% more likely to suffer a stroke, suggesting that there is a genetic component to the disease. So far, no genes have been convincingly associated with stroke. Intermediate traits may be useful tools for identifying genetic factors in complex disease. For stroke, two commonly used intermediate traits are carotid intima-media thickness (CIMT) and white matter hyperintensities (WMHs), which both show high heritabilities. These traits have both been studied widely for associations with many candidate gene polymorphisms. In this thesis I systematically reviewed the literature for all genetic association studies of these two traits. Where particular associations have been studied in large numbers I meta-analysed the available data, developing novel methods for meta-analysis of genetic association data. I found there was substantial heterogeneity and small study bias in the literature and most polymorphisms have still been studied in too small numbers to make accurate conclusions. Apolipoprotein E (APOE) ε is the only polymorphism which shows a consistent association with CIMT, even when only the largest studies are analysed (MD 8μm (95% CI 6 to 11) between E4 and E3, and E3 and E2). No polymorphism has shown a convincing association with WMHs and interestingly APOE appears unlikely to be associated with this trait. This is consistent with previous work that shows that APOE is associated with large artery but not small artery stroke. Taking this hypothesis I attempted to investigate the association of APOE comparing patients who have had a large artery stroke with those who have had a small artery stroke in the Edinburgh Stroke Study cohort. However, genotyping of this polymorphism failed and I present investigatory analyses of problems from the genotyping laboratory.

[pt] A estrutura produtiva mundial vive uma intensa reestruturação desde o final do século XX, que tem influenciado na produção e reprodução do espaço e nas formas de organização e reprodução do trabalho. Essas transformações, ao longo das últimas décadas, têm repercutido em mudanças na organização das empresas e promovendo, com novas roupagens, antigas formas de trabalho que auxiliam a reprodução do capital, como o trabalho em domicílio, por exemplo. No Brasil, é em setores controlados pelos grandes capitais públicos e privados que as mudanças tecnológicas e organizacionais ocorrem de forma mais intensa. Já no conjunto da estrutura produtiva, as mudanças mais frequentes ficam a cargo da prática da subcontratação, promovendo a manutenção e intensificando da precarização de nosso mercado de trabalho. Nesse sentido, a presente pesquisa tem por objetivo analisar e compreender a influência dessas transformações nos processos construtores do espaço da moda íntima do bairro de Olaria, do município de Nova Friburgo - Estado do Rio de Janeiro, onde se expande principalmente o trabalho feminino precariamente realizado em domicílio. Nova Friburgo, mesmo que de forma mais tardia, participa diretamente dos efeitos das mudanças reestruturantes do capital. O município concentra a maior produção de moda íntima do país, e sua expansão ocorreu a partir da década de 1980, quando grande parte dos operários locais foi dispensada de suas funções devido ao fechamento de diversas indústrias decorrente da crise estrutural que assolava o mundo produtivo desde a década de 1970. Desde então, a produção de moda íntima de Nova Friburgo é formada majoritariamente por trabalhadoras domiciliares. Neste contexto, consideramos a importância da mulher e do seu trabalho em domicílio elementos estruturadores desse espaço produtivo. / [en] The structure of global production is experiencing a severe restructuring since the late twentieth century, which has influenced the production and reproduction of space and forms of organization and development work. These changes, over the past decades have passed on changes in the organization of enterprises and promoting, with new clothes, old ways of working that help the reproduction of capital, such as work at home, for example. In Brazil, in areas controlled by the major public and private capital that the technological and organizational changes occur more intensely. In the whole of the productive structure, the changes are more frequent over the practice of subcontracting, maintaining and promoting the increasing casualization of our labor market. In this sense, this research aims to analyze and understand the influence of these changes in the processes of space builders in the neighborhood of underwear in Olaria, in the city of Nova Friburgo - State of Rio de Janeiro, where it expands mainly female labor performed poorly at home. Nova Friburgo, even if it is later, is directly involved in the effects of changes reestruturantes capital. The city has the largest production of intimate apparel in the country, and its expansion occurred from the 1980s, when much of the local workers were dismissed from their duties due to the closure of many industries due to the structural crisis that plagued the world since production the 1970s. Since then, the production of underwear Nova Friburgo is formed mainly by home workers. In this context, we consider the importance of women and their work at home structuring elements of production space.

Made available in DSpace on 2017-07-10T14:17:05Z (GMT). No. of bitstreams: 1 Jeferson Toregeani.pdf: 4855703 bytes, checksum: 73138fe4322e7ec033e3fe59b166567e (MD5) Previous issue date: 2013-01-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Atherosclerotic disease, one of the leading causes of morbidity and mortality in the world, expresses inflammatory markers that can be evaluated in the laboratory or by Doppler ultrasound, that can detect common carotid artery intima-media thickening (IMT), which is a precursor morphological change of atherosclerotic disease. The atherosclerotic disease risk factors most relevant are diabetes, hypertension, hypercholesterolemia and smoking. Periodontal disease, which has a high prevalence worldwide, has been increasingly correlated to atherosclerotic disease, where the bacterial activity and the inflammatory process in the periodontal tissues seem to aggravate atherosclerosis. The objectives of this research were to evaluate the treatment of periodontal disease and the influence of this treatment on the variation of thickness of the common carotid artery miointimal complex and the variations of laboratory parameters. Forty-four volunteers patients were divided into 2 groups, healthy patients 23 (GI) and 21 patients with moderate to severe periodontitis (GII). All patients underwent clinical and nutritional assessment. Also periodontal clinical parameters were evaluated: plaque index (PI), gingival index (IS), probing depth (PS), clinical attachment level (NI) and bleeding on probing (SS). The patients were submitted to assess carotid intima-media thickness and to laboratory evaluation by collecting of counting blood cells, creatinine, total cholesterol and fractions, triglycerides, fibrinogen, C-reactive protein, homocysteine, erythrocyte sedimentation rate, fasting blood glucose and glycated hemoglobin. All patients received the basic periodontal treatment and only group II were submitted to mechanical control with scaling and root planning and coronary sinus polishing. Data were obtained in the pre-treatment, with 6 months and after 12 months from the beginning of the study. The results showed a significant improvement in periodontal clinical parameters in both groups (p < 0,05), more evident between the first and second evaluations and greater in GII (p < 0,05). There were a decrease of triglycerides and low-density lipoprotein in GI and increase in their levels in GII (p < 0,05), increased Fibrinogen along the GI study (p < 0,05) and decrease in glycated hemoglobin concentration in both groups. The average counts of erythrocytes, hematocrit, hemoglobin and platelets were lower in the last reviews. The variation of the amount of platelets was significantly higher in the first phase of the GI (p < 0,05). There was a decrease IMT in 2 groups in the first phase, and fall of systolic and diastolic velocity, pulsatility and resistivity index in the second phase of both groups (p < 0,05). Thus, based on the results, treatments imposed were effective in improving the periodontal clinical parameters of patients with periodontitis and toothbrushing associated with dental floss and the motivation of oral hygiene was also effective in the improvement of clinical periodontal parameters even in relatively healthy patients. The improvement of periodontal parameters promoted significant effect on reduction of IMT in both groups, in the initial period of 6 months. At the end of the study (360 days), there was no significant effect of changes in periodontal clinical parameters in IMT variations in both groups I and II / A doença aterosclerótica, que é uma das principais causas de morbimortalidade no mundo, expressa marcadores inflamatórios que podem ser avaliados laboratorialmente ou por exames como a ultrassonografia Doppler, o qual pode detectar o espessamento miointimal da artéria carótida comum (IMT), que é uma alteração morfológica precursora da doença aterosclerótica. Os fatores de risco da doença aterosclerótica mais relevantes são o diabetes, a hipertensão arterial, a hipercolesterolemia e o tabagismo. A doença periodontal, que tem elevada prevalência no mundo, vem sendo cada vez mais correlacionada à doença aterosclerótica, onde a atividade bacteriana e o processo inflamatório no periodonto parecem agravar o risco da aterosclerose. Os objetivos desta pesquisa foram avaliar o efeito do tratamento da doença periodontal na variação da espessura do complexo miointimal da artéria carótida comum e dos parâmetros laboratoriais de marcadores inflamatórios. Quarenta e quatro pacientes voluntários foram distribuídos em 2 grupos, sendo 23 pacientes periodontalmente sadios (GI) e 21 pacientes com periodontite moderada a grave (GII). Todos os pacientes foram submetidos à avaliação clínica e nutricional. Também foram avaliados os parâmetros clínicos periodontais de índice de placa, índice de sangramento, profundidade de sondagem, nível de inserção clínica e sangramento à sondagem. Foram submetidos à avaliação da espessura do complexo miointimal e à avaliação laboratorial através da coleta de hemograma, creatinina, colesterol total e frações (HDL, LDL, VLDL), triglicerídeos (TGs), fibrinogênio (FB), proteína C reativa, velocidade de hemossedimentação, homocisteína, hemoglobina glicada (HBGLI) e glicemia de jejum. Todos os pacientes receberam o tratamento periodontal básico e somente os pacientes do grupo GII foram submetidos ao controle mecânico com a raspagem e alisamento radicular e o polimento coronário. Os dados foram obtidos no pré-tratamento, com 6 meses e após 12 meses do início do estudo. Os resultados demonstraram uma significativa melhora nos parâmetros clínicos periodontais em ambos os grupos (p<0,05), mais evidentes entre a primeira e a segunda avaliações e maiores no GII (p<0,05). Não ocorreu alteração significativa dos marcadores inflamatórios. Houve queda das concentrações de TGs e LDLs no GI e aumento no GII (p<0,05), aumento do FB ao longo do estudo no GI (p<0,05) e diminuição da concentração de HBGLI em ambos os grupos. As médias das quantidades dos eritrócitos, hematócrito, hemoglobina e das plaquetas foram menores nas últimas avaliações. A variação da quantidade de plaquetas foi significativamente maior na primeira fase do GI (p<0,05). Nas avaliações ultrassonográficas, houve diminuição do IMT nos 2 grupos na primeira fase, e queda das velocidades sistólica e diastólica e índices de pulsatilidade e resistividade na segunda fase de ambos os grupos (p<0,05). Com base nos resultados, os tratamentos instituídos foram efetivos na melhoria dos parâmetros clínicos periodontais dos pacientes portadores de periodontite e a escovação associada ao fio dental e a motivação da higiene oral também foi efetiva na melhora dos parâmetros clínicos periodontais mesmo em pacientes sadios. A melhora dos parâmetros periodontais promoveu efeito significativo na diminuição do IMT em ambos os grupos, no período inicial de 6 meses. Ao final do estudo, não houve efeito significativo das variações dos parâmetros clínicos periodontais nas variações do IMT em ambos os grupo I e II

Marital quality is linked to health benefits for men and women. Although women have less risk factors than men for cardiovascular disease prior to menopause, their risk increases substantially after menopause. The purpose of this study was to assess the impact of marital quality and vasomotor symptoms on cardiovascular risk factors including C-reactive protein (CRP) and carotid intima-media thickness (cIMT) in women before, during, and after the menopausal transition. The final sample consisted of 92 married women between the ages of 40 and 60 years. Hypotheses were tested using hierarchical regression and general linear modeling. Results suggest that greater marital quality reduces the negative effect of a lower level of vasomotor symptoms on cIMT but not CRP. Contrary to hypotheses, marital quality did not predict CRP or cIMT and vasomotor symptoms were not correlated with CRP or cIMT. While analyses did not support an interaction between menopausal status and lower marital quality on vasomotor symptoms or CRP, there was limited support for an interaction between menopausal status and lower marital quality on cIMT (p = .057) suggesting that for postmenopausal women higher marital quality is related to lower levels of cIMT. Overall, findings suggest that it is important to consider the impact of psychosocial aspects of a middle aged woman's life (i.e., marital quality) in conjunction with biological stressors when assessing cardiovascular risks in women during the menopausal transition.

Despite advances, stroke remains the largest cause of disability and fourth leading cause of death in the United States. The relationship between changes in human vasculature (atherosclerosis and arteriosclerosis) prior to clinical incident, and other risk factors for stroke remains unclear. This dissertation represents work towards the identification of imaging biomarkers for vascular change, focusing on ultrasound to characterize persons at risk, including differences among race/ethnic groups. This research contained three distinct projects. The first goal was to determine if changes within ultrasonographic measures of carotid vasculature could be found across race/ethnic groups after adjustment for risk factors. The second was to determine if those same measures were related to changes in cerebral white matter known to be associated with ongoing cerebrovascular disease; we compared ultrasound to an MRI marker of subclinical vascular disease, white matter hyperintensity volume (WMHV). Finally, we sought to investigate a known and well-studied ultrasound marker for atherosclerosis, carotid intima-medial thickness, with those same MRI markers of subclinical vascular disease (WMHV). All studies were conducted within an on-going multiethnic cohort that has been followed since 1990, The Northern Manhattan Study. The population is comprised of persons who self-identify as Hispanic (52%), Black (24%), or White (21%), with less than 3% identified as “race/other.” We found race/ethnic differences in carotid arterial stiffness and diameter; carotid diameter increases with age among Hispanics, but not among blacks or whites. A significant correlation was also found between diastolic diameter and subclinical vascular disease, and this relationship was also increased among Hispanics; neither black race nor white race was associated with corresponding increases in both MRI white matter hyperintensity and diastolic diameter. Finally, using a surrogate marker for atherosclerosis, carotid intima-medial thickness (cIMT), we document for the first time, positive associations between cIMT and WMHV. There are important developments still to be made in the field of vascular risk. Use of inexpensive and non-invasive ultrasound technology to approximate ongoing cerebrovascular disease could lead to better understanding of the effect of known risk factors, and could help stroke risk assessment and treatment modification.